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A comprehensive guide

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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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Teaching Strategies for Behavioral Disorders

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Teaching Strategies for Behavioral Disorders

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Behavioral disorders also known as conduct disorders are one of the most common forms of disability among children and young adults and is the most frequently cited reason for referral to mental health services. The appearance of behavioral disorders is increasing dramatically in our K-12 classrooms. As a result, their presence severely constrains the ability of the school systems to educate students effectively. The prevalence of behavioral problems among children and young adults is substantial. Many surveys indicate that behavioral disorders vary among young adults, ranging from 2 and 6 percent among K-12 students. This percentage translates into 1.3 to 3.8 million cases of behavioral disorders among the school and pre-college population.

Behavior disorders have also been referred to in a variety of different terminologies, including but not limited to:

1. Emotional and Behavior Disorders (EBD)

2. Emotional Conflict (EC)

3. Serious Emotional Disturbance (SED)

Behavioral disorders become apparent when the student displays a repetitive and impact persistent pattern of behavior that results in the significant disruption of other students. Such disturbances may cause significant impairments in academic, social, and or occupational functioning. Among the characteristics of a behavioral disorder among children and adolescents are:

General Strategies

Multidisciplinary educational teams, including parents, must design programs to meet the individual behavioral and academic needs of identified SED students. Most students can benefit from supportive treatments provided in general education programs. For others, at least temporary placements in special education classrooms, schools, or institutional programs may be appropriate.

Special education programs usually attempt to provide a structured environment where students experience a high degree of success; rules and routines are predictable; and students are consistently rewarded for appropriate behavior. Behavior management techniques, such as positive reinforcement, token economies, contracting, and time-out, which rely on direct measurement and monitoring of behavioral change, are commonly used in SED programs. The assessment and systematic teaching of social skills through modeling, discussion, and rehearsal are frequently used to help students increase control over their behavior and improve their relations with others. In addition, supportive therapies involving music, art, exercise, and relaxation techniques, as well as affective education, individual, and group counseling are sometimes employed to improve self-understanding, self-esteem, and self-control. The following are strategies that may be effective with students with EBD:

Teacher Presentation

Laboratory

Group Interaction and Discussion

1. Acknowledge the contributions of the student with an emotional disorder.

2. Call for responses and participation commensurate with the student's socialization skills.

3. As the student's comfort level rises and when a safe topic is available, encourage the student to be a group spokesperson.

4. Along with the student, devise a contingency plan in which inappropriate forms of response are replaced by appropriate ones.

5. Gradually increase the challenges in the student's participation in group exercises while providing increased positive reinforcement.

6. Help the student to feel as though he or she has something worthwhile to contribute to the discussion.

7. Some students may experience considerable strain in social adjustment in a group context. It may be necessary to work gradually toward group activities. One can devise a strategy of progressing from spectatorship to one-to-one instruction and eventually to small group discussion.

8. Should monitor carefully to ensure that the nondisabled students do not dominate the discussion or detract in any way from the successful performance of the student with the behavioral disorder.

Reading

1. It is necessary to target specific pro-social behaviors for appropriate instruction and assessment to occur such as:

1. Taking turns, working with partner, following directions.

2. Reading in group or with others.

3. Increasing positive relationships by means of awards when they read appropriately.

4. Demonstrating appropriate reading

2. Instructional strategies involving self-control, self-reinforcement, self-monitoring, self-management, problem solving, cognitive behavior modification, and metacognitive skills should be focused on teaching students reading skills

Research

1. Review and discuss with the student the steps involved in a research activity. Think about which step(s) may be difficult for the specific functional limitations of the student and jointly devise accommodations for that student.

2. Use appropriate laboratory and field strategies.

3. Depending on the site of the research check the previous two sections.

4. Show clear examples of what the students should expect as an outcome of their research.

Field Experiences

1. Use appropriate general strategies.

2. Consider alternate activities/exercises that can be utilized with less difficulty for the student, but has the same or similar learning objectives.

3. In field activities acknowledge the contributions and assistance of the student with an emotional disorder.

4. Help the student to feel as though he or she has something worthwhile to contribute to the field trip.

5. Use a buddy system.

6. Gradually increase the challenges in the student's participation in field exercises while providing increased positive reinforcement.

7. Group participation in field activities is highly desirable because it enhances social contacts.

8. Make the student with the behavioral disorder become one of the field trip leader of an activity which can often reduce their disorder.

9. Special efforts should be made to get students with behavioral disorders to interact with other students.

10. You should encourage students to practice field skills during their free hours.

11. Every effort should be made to arouse the interest of such students in activities, so they will learn to perform the activities with success and pleasure with appropriate behaviors.

Testing

1. Be sensitive to the student's reactions to the various aspects of assessment.

2. For each student, accumulate in his or her portfolio several examples of work (quizzes, assignments, projects) that demonstrate knowledge of the subject matter or the unit of study.

3. Make special arrangements for the student with an emotional disorder according to what their special needs are and that they do not compromise the integrity of the testing situation.

4. Stay on top of student progress through informal assessment, don't wait until it's too late to discover that there is a problem.

5. Provide private room/smaller group setting/alternative test site (with proctor present); alternatively screens to block out distractions.

Organizations

Council for Exceptional Children-Council for Children with Behavior Disorders (CCBD)
The Council for Children with Behavioral Disorders (CCBD) is dedicated to supporting the professional development and enhancing the expertise of those who work on behalf of children with challenging behavior and their families. It is a division of the Council for Exceptional Children (CEC).

CCBD Foundation
The CCBD Foundation was founded in 1997 by the Council for Children with Behavioral Disorders (CCBD), to support its mission of improving the education of children and youth with emotional or behavioral disorders (EBD).

Resources

Council for Exceptional Children (Behavior Disorders/Emotional Disturbance)
The Council for Exceptional Children (CEC) page on EBD. The Council for Exceptional Children (CEC) is the largest international professional organization dedicated to improving the educational success of individuals with disabilities and/or gifts and talents.

BehaviorDisorder.org
The site offers information on behavior disorders, conduct disorders, and other behavior problems.

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Behavioral disorders also known as conduct disorders are one of the most common forms of disability among children and young adults and is the most frequently cited reason for referral to mental health services. The appearance of behavioral disorders is increasing dramatically in our K-12 classrooms. As a result, their presence severely constrains the ability of the school systems to educate students effectively.

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School Mental Health Referral Pathways Toolkit

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School Mental Health Referral Pathways Toolkit

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What's the Difference??

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Basic Description

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.

What It Does

Provides individualized special education and related services to meet a child's unique needs.

Provides services and changes to the learning environment to enable students to learn alongside their peers.

As with an IEP, a 504 plan is provided at no cost to families.

These services are provided at no cost to families.

What Law Applies

The Individuals with Disabilities Education Act (IDEA)

Section 504 of the Rehabilitation Act of 1973

This is a federal civil rights law to stop discrimination against people with disabilities.

This is a federal special education law for children with disabilities.

Who's Eligible

To get an IEP, there are two requirements:

To get a 504 plan, there are two requirements:

1. A child has any disability. Section 504 covers a wide range of different struggles in school.

2. 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.

1. 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.

2. 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.

Independent Educational Evaluation

Families can ask the school district to pay for an independent educational evaluation (IEE) by an outside expert. The district doesn't have to agree.

Doesn't allow families to ask for an IEE. As with an IEP evaluation, families can always pay for an outside evaluation themselves.

Families can always pay for an outside evaluation themselves, but the district may not give it much weight.

Who Creates It

There are strict legal requirements about who participates. An IEP is created by an IEP team that 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

School psychologist or other specialist who can interpret evaluation results

A district representative with authority over special education services

With a few exceptions, the entire team must be present for IEP meetings.

What's in It

The IEP sets learning goals and describes the services the school will provide. It's a written document.

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

Here are some of the most important things the IEP must include:

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

Notice

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.

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.

Families also have "stay put" rights to keep services in place while there's a disagreement about the IEP.

Consent

A parent or caregiver must consent in writing for the school to evaluate a child. They must also consent in writing before the school can provide the services in an IEP.

A parent or caregiver's consent is required for the school district to evaluate a child.

How Often It's Reviewed and Revised

The IEP team must review the IEP at least once a year.

The rules vary by state. Generally, a 504 plan is reviewed each year and a reevaluation is done every three years or when needed.

The child must be reevaluated every three years to determine whether services are still needed.

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

Funding/Costs

Students receive these services at no charge.

Students receive these services at no charge.

States do not receive extra funding for students with 504 plans. But the federal government can take funding away from programs (including schools) that don't meet their legal duty to serve kids with disabilities.

IDEA funds can't be used to serve students with 504 plans.

States receive additional funding for students with IEPs.

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

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Basic Description 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. What It Does Provides individualized special education and related services to meet a child's unique needs.

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Engaging with Schools to Support Your Child With Psychosis

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Engaging with Schools to Support Your Child With Psychosis

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Oppositional Defiant Disorder

No. 72; Reviewed January 2019

All children are oppositional from time to time, particularly when tired, hungry, stressed, or upset. They may argue, talk back, disobey, and defy parents, teachers, and other adults. Oppositional behavior is a normal part of development for two to three year olds and early adolescents. However, openly uncooperative and hostile behavior becomes a serious concern when it is so frequent and consistent that it stands out when compared with other children of the same age and developmental level and when it affects the child's social, family, and academic life.

In children with Oppositional Defiant Disorder (ODD), there is an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the child's day to day functioning.

Symptoms of ODD may include:

Frequent temper tantrums

Excessive arguing with adults

Often questioning rules

Active defiance and refusal to comply with adult requests and rules

Deliberate attempts to annoy or upset people

Blaming others for his or her mistakes or misbehavior

Often being touchy or easily annoyed by others

Frequent anger and resentment

Mean and hateful talking when upset

Spiteful attitude and revenge seeking

The symptoms are usually seen in multiple settings but may be more noticeable at home or at school. One to sixteen percent of all school-age children and adolescents have ODD. The causes of ODD are unknown, but many parents report that their child with ODD was more rigid and demanding than the child's siblings from an early age. Biological, psychological, and social factors may have a role.

A child presenting with ODD symptoms should have a comprehensive evaluation. It is important to look for other disorders which may be present, such as attention-deficit hyperactivity disorder (ADHD), learning disabilities, mood disorders (depression, bipolar disorder), and anxiety disorders. It may be difficult to improve the symptoms of ODD without treating the coexisting disorder. Some children with ODD may go on to develop conduct disorder.

Treatment of ODD may include:

Parent Management Training to help parents and others manage the child's behavior

Individual Psychotherapy to develop more effective anger management

Family Psychotherapy to improve communication and mutual understanding

Cognitive Problem-Solving Skills Training and Therapies to decrease negativity

Social Skills Training to increase flexibility and improve social skills and frustration tolerance with peers

Medications may be helpful in controlling some of the more distressing symptoms of ODD as well as the symptoms related to coexistent conditions such as ADHD, anxiety, and mood disorders.

A child with ODD can be very difficult for parents. These parents need support and understanding. Parents can help their child with ODD in the following ways:

Always build on the positives, give the child praise and positive reinforcement when s/he shows flexibility or cooperation.

Take a time-out or break if you are about to make the conflict with your child worse, not better. This is good modeling for your child. Support your child if s/he decides to take a time-out to prevent overreacting.

Pick your battles. Since the child with ODD has trouble avoiding power struggles, prioritize the things you want your child to do. If you give your child a time-out in his room for misbehavior, don't add time for arguing. Say "your time will start when you go to your room."

Set reasonable, age appropriate limits with consequences that can be enforced consistently.

Maintain interests other than your child with ODD, so that managing your child doesn't take all your time and energy. Try to work with and obtain support from the other adults (teachers, coaches, and spouse) dealing with your child.

Manage your own stress with healthy life choices such as exercise and relaxation. Use respite care and other breaks as needed.

Many children with ODD will respond to the positive parenting techniques. Parents may ask their pediatrician or family physician to refer them to a child and adolescent psychiatrist or other qualified mental health professional who can help diagnose and treat ODD and any coexisting psychiatric condition.

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Oppositional Defiant Disorder No. 72; Reviewed January 2019 All children are oppositional from time to time, particularly when tired, hungry, stressed, or upset. They may argue, talk back, disobey, and defy parents, teachers, and other adults. Oppositional behavior is a normal part of development for two to three year olds and early adolescents.

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Causes, Characteristics, and Treatment Information

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

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

What is bipolar disorder?

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

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

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

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

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

What causes bipolar disorder?

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

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

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

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

What are the symptoms of bipolar disorder?

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

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

Children and teens having a manic episode may:

Show intense happiness or silliness for long periods of time.

Have a very short temper or seem extremely irritable.

Talk fast about a lot of different things.

Have trouble sleeping but not feel tired.

Have trouble staying focused, and experience racing thoughts.

Seem overly interested or involved in pleasurable but risky activities.

Do risky or reckless things that show poor judgment.

Children and teens having a depressive episode may:

Feel frequent and unprovoked sadness.

Show increased irritability, anger, or hostility.

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

Have a noticeable increase in amount of sleep.

Have difficulty concentrating.

Feel hopeless and worthless.

Have difficulty communicating or maintaining relationships.

Eat too much or too little.

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

Think about death, or have thoughts of suicide.

Can children and teens with bipolar disorder have other problems?

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

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

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

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

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

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

How is bipolar disorder diagnosed?

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

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

How is bipolar disorder treated?

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

Treatment options include:

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

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

What can children and teens expect from treatment?

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

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

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

How can I help my child or teen?

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

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

Be patient.

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

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

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

Help your child have fun.

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

Help your child understand that treatment can make life better.

How does bipolar disorder affect caregivers and families?

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

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

Where do I go for help?

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

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

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

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

Do not leave the person alone.

Call 911 or go to the nearest hospital emergency room.

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

What should I know about clinical trials?

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

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

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For More Information

MedlinePlus (National Library of Medicine) ( En español)

ClinicalTrials.gov ( En español)

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

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

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It’s not unusual for young people to experience “the blues” or feel “down in the dumps” occasionally. Adolescence is always an unsettling time, with the many physical, emotional, psychological and social changes that accompany this stage of life. Unrealistic academic, social, or family expectations can create a strong sense of rejection and can lead to deep disappointment. When things go wrong at school or at home, teens often overreact.

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ASCA Professional Standards & Competencies

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ASCA Professional Standards & Competencies

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Information, Strategies for Schools and Educators, and Resources for Eating Disorders

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Suggestions for Eating Disorder Education in Schools

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A group of Canadian researchers offer practical suggestions for preventing eating disorders in schools, and how to identify and work with at-risk students. Issues with current eating disorder educations Researchers suggest that the current eating disorder efforts in schools pay undue attention to the signs and symptoms of eating disorders, whereas more attention is needed to cultivate healthy attitude and behaviors among students.

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The School Counselor's Role in Addressing Eating Disorders

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The School Counselor's Role in Addressing Eating Disorders

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Early Intervention is Key to Helping Students

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The School Counselor's Role in Addressing Eating Disorder

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Think about the last time you helped someone out. Maybe you sent a supportive text to a stressed-out friend or gave directions to a lost stranger.

How did it make you feel?

If you said good, happy, or maybe even "warm and fuzzy," you're not alone. Research shows that helping others offers a number of important psychological and health benefits.

In daily life, people report better mood on days that they assist a stranger or offer an empathetic ear to a friend. Adults who volunteer, spend money on others and support their spouses also experience improved well-being and reduced risk of death.

Helping others is beneficial in part because it promotes social closeness and feelings of personal competence.

As a researcher who studies adolescent development, I decided to investigate how all this might play out in teenagers. I'm interested in studying teens' prosocial behavior - things like helping, comforting and sharing - in the context of their close relationships. Given that adolescence is a time of heightened emotional intensity, do teens reap mood benefits from helping out others in everyday life?

Teens and depression

Looking back on your own high school years, you might recall feeling intensely anxious about looking cool in front of classmates or being liked by your crush. During adolescence, youth become increasingly preoccupied with the opinions of their peers, including their friends and romantic partners. Indeed, adolescence is a time when experiences of social exclusion or rejection can sting particularly badly.

Paul De Los Reyes, CC BY

The teenage years are also a high-risk time for developing depressive symptoms. Almost 1 in every 11 adolescents and young adults in the U.S. experience a major depressive episode. And, even youth with depressive symptoms who don't meet criteria for an official diagnosis of depression are at risk for adjustment problems, such as loneliness and romantic relationship difficulties.

Depressed adolescents, in addition to feeling hopeless and lacking self-esteem, often respond to social stress with intensified negative emotions. For example, adolescents with major depressive disorder take peer rejection harder than do their healthy peers.

If depressed adolescents feel especially bad after negative social encounters, might they feel especially good after positive social encounters? Psychologists know that in general adolescents' concerns about social approval can make positive interpersonal interactions - like offering a peer support or assistance - all the more rewarding. I wanted to see if that held even for teens who were feeling down.

Did you help someone today?

In our 2018 study, my colleagues and I examined teenagers' prosocial behavior in their everyday interactions with friends and romantic partners. Our goal was to understand whether giving help is particularly mood-enhancing for youth with depressive symptoms.

We recruited 99 late adolescents from the community around us in Los Angeles. Most of them were high school students or recent high school graduates. First we assessed their depressive symptoms in the lab so we could find out how they'd been feeling the prior couple weeks.

Then we asked them to complete 10 consecutive days of short surveys at home. Each of the 10 days, participants told us whether they helped out their friends or romantic partners - things like doing them a favor, or making them feel important. They also reported their own mood.

On days that teens helped their friends or dating partners, they experienced increased positive mood. Even if their mood wasn't great the day before or if they themselves didn't receive any social support that day, helping someone else was still related to a boost in their spirits.

But does helping help some teens more than others? The positive effects of day-to-day prosocial behavior on mood that we saw were strongest for teens with higher levels of depressive symptoms. So youth with elevated emotional distress reaped the greatest mood benefits from lending their peers a helping hand.

While we often talk about the importance of receiving social support when we're feeling down, these findings highlight the unique value of providing support to others.

Justin Groep/Unsplash, CC BY

Helping others helps yourself

This study provides a glimpse into the potential benefits of help-giving for teens, particularly those experiencing depressive symptoms. Our finding builds upon previous research demonstrating that prosocial behavior is most rewarding for people experiencing social anxiety, neuroticism and body dissatisfaction.

Although we did not test for underlying mechanisms for why this might be, it's possible that providing help can make individuals feel appreciated by others or promote their sense of purpose and self-esteem. For youth with high levels of social-emotional distress, opportunities to strengthen social connections and feel competent within close relationships might be especially important for improving mood.

Many studies linking prosocial behavior to mood, ours included, are correlational - we cannot conclude that helping friends or romantic others causes more positive mood. Experimental studies that randomly assign some participants to engage in acts of kindness and others to engage in non-helping social activities will help rule out the possibility that it's actually positive mood that drives subsequent prosocial behavior.

It's also important to keep in mind that very few of our participants were clinically depressed. Research still needs to determine whether prosocial behavior is similarly linked to positive mood among adolescents with a diagnosed depressive disorder. An interesting question is whether some depressed youth experience emotional "burnout" from very frequent help-giving.

Although the word "adolescence" may conjure up images of reckless teens experiencing interpersonal conflict and emotional turmoil, the adolescent years are a time of great social opportunity and growth. Understanding when, how and why teens behave prosocially - and for whom help-giving most promotes well-being - can contribute to our understanding of adolescent social development.

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Teens who feel down may benefit from picking others up

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Think about the last time you helped someone out. Maybe you sent a supportive text to a stressed-out friend or gave directions to a lost stranger. How did it make you feel? If you said good, happy, or maybe even "warm and fuzzy," you're not alone.

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Chances are you've seen a significant increase in the number of students who struggle with mental health over the past several years. According to JAMA Pediatrics, even before the pandemic, the rate of child and adolescent anxiety increased 27% between 2016 and 2019. By 2020, more than 5.6 million youths were diagnosed with anxiety. With symptoms such as trouble concentrating, an upset stomach, or sleeplessness, anxiety can be one of the most debilitating challenges students face in classrooms today.

We know anxiety is more than just "worries." It can influence classroom performance just as much as any other learning disability. Kids who are worried and anxious aren't doing it on purpose. The nervous system acts automatically, especially when it comes to worry (which often stems from fight-or-flight reflexes). That's why phrases like "just relax" or "calm down" aren't helpful. But with practice, kids can learn to slow down their anxious brains, and we can learn to help them. Here are a few ways you can help anxious kids in the classroom.

1. Educate yourself about anxiety

The more you understand about anxiety, the more you can arm yourself with strategies to help your students. This article from district superintendent Jon Konen provides a definition of anxiety, its causes, how to recognize it, types of anxiety disorders, and, most importantly, how you can help as a teacher.

2. Create strong bonds

Building strong bonds and connecting to youth can protect their mental health. Schools and parents can create these protective relationships with students and help them grow into healthy adulthood. Try these 12 Ways To Build Strong Classroom Community.

3. Practice those deep breaths

When people slow down their breathing, they slow down their brain. When I notice that one of my kids is struggling with anxiety, I'll often lead the whole class in a breathing exercise. It helps the child who is overwhelmed and usually a few other kids too. Sometimes I'll do it just because the whole class is squirrelly and we need to focus. Slow, deep breaths are the key. This article about belly breathing describes the process I like to use with my kids. It works every single time.

4. Take a break and go outside

Being out in nature can also calm an anxious brain. Sometimes just a change of scenery is what makes the difference. Breathing the cool air or making time to notice chirping birds can also calm an overactive worrier. Asking students to carefully observe their environment can help them turn the focus away from their worries and toward something more tangible: How many different kinds of trees do you see? How many different bird songs do you hear? How many different shades of green are in the grass?

It doesn't hurt for us to take a mental break sometimes too. Check out 20 Terrific Guided Meditation for Teachers.

5. Talk openly about anxiety

Don't set anxiety up as something you want (or should) get rid of. It's part of life, and it's not realistic to think it'll go away completely. You can help students see and understand this in your own actions. Check out this great article of what you should (and shouldn't) do when working with kids dealing with anxiety.

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6. Tackle the topic with a good book

Often, when one of my kids is struggling, the school counselor will come and share a picture book about managing anxiety with the entire class. Some kids may not be receptive to direct, one-on-one intervention, but they will respond beautifully if they know the whole class is receiving the same information. Check out this list of great books for kids with anxiety.

7. Get kids moving

Exercise helps anyone who is feeling anxious. Anxiety can end up looking like anger, so if you see this, try taking a movement break. You probably already have some favorite ways to do this, but if you're looking for some ideas, check out our video above. You can also get the free set of printables for that right here.

8. Try walking and talking

Building on the moving idea, if you have a student that needs some one-on-one attention, try the " On My Walk " activity. I used to have a student who struggled a lot with anxiety, and this worked great with her. After a couple of loops around the playground with me, everything would feel a little better. Our walk served three purposes: 1. It removed her from the situation. 2. It gave her a chance to explain the issue to me. 3. It got her blood pumping, which clears out the anxiety-producing energy and brings in the positive exercise endorphins.

9. Focus on the positive by having students keep a gratitude journal

The brain is incapable of producing anxious thoughts while it is producing positive thoughts stemming from gratitude. If you can trigger a positive train of thought, you can sometimes derail the anxiety. I knew a teacher who had his fifth graders keep gratitude journals, and every day they would record at least one thing they were thankful for. When his students seemed overwhelmed by negativity or mired in anxiety, he'd encourage them to reread their journals.

Check out the video above for another inspiring teacher or these 22 videos to help kids understand gratitude.

10. Validate students' feelings

Before trying to problem-solve with students who are in the midst of racing thoughts or have completely shut down, Phyllis Fagell, a school counselor and therapist based in Maryland and Washington, D.C., recommends validating their feelings. For instance, saying, "If I was afraid I might look dumb, I'd be worried about raising my hand too," may reduce the impact of anxiety and help a student relax, develop trust, and feel understood. Fagell also reminds teachers not to shame anxious students. For more, check out the full article from WGU.

11. Remind kids to eat healthily and stay well

For the most part, teachers don't really have a lot of control over what students eat and how much they sleep, but these things do matter when it comes to managing anxiety. Not surprisingly, a healthy diet and plenty of sleep make a difference in how well a student is able to handle situations that could be overwhelming. It's one of the reasons that snack and rest time are an essential part of the day for preschoolers!

For your younger students, check out 17 tasty books that teach kids about nutrition and healthy eating habits for a list of picture books about healthy eating.

12. Encourage families to make sure their children are getting enough sleep

With all the extracurricular activities available to kids, not to mention the allure of high-stimulus technology, many kids are just not getting the amount of healthy sleep they need. According to the CDC, children ages 6-12 need as much as 9-12 hours of sleep each night. Preschoolers need even more (10-13 hours), and teens need between 8 and 10 hours. A solid night's sleep does wonders for improving mood, concentration, and outlook. Good sleep quality is also essential. Encourage healthy sleep habits in your students with these Tips for Better Sleep.

13. Create a space where kids can express their anxiety

You've probably heard of classroom safe spaces, and this is a great option to offer if you have students dealing with anxiety. A safe space is a comfy zone in the classroom where kids can go to decompress and regroup. Many teachers include glitter jars, headphones, books, or other items to help kids get back on track.

14. Use fidgets

Another helpful idea, which can stand on its own or be part of your safe space, is offering students classroom fidgets. Sometimes this can work wonders in just giving kids an outlet for their amped-up energy. Here are 39 of our favorite classroom fidgets.

15. Try aromatherapy

Aromatherapy is thought to help activate certain receptors in the brain, potentially easing anxiety. Whether in the form of essential oil, incense, or a candle, natural scents like lavender, chamomile, and sandalwood can be very soothing. Check for sensitivities among your students before introducing a scent to the whole class. An alternative could be an unlit candle, dried herbs, or a sachet treated with essential oil kept in the classroom safe space for students to use individually.

16. Teach kids to recognize their warning signs

Everyone experiences anxiety differently. For children, signs may include shortness of breath, stomachaches, or inability to settle down and concentrate, among others. Coaching students to recognize their unique triggers and warning signs can help them know when to take a step back. Integrate social-emotional strategies throughout the day to help students learn to manage their anxiety.

17. Incorporate Zones of Regulation strategies

Students with anxiety need concrete, easy-to-use strategies to help them cope. Rooted in cognitive therapy, Zones of Regulation is a curriculum developed to help kids understand and learn to manage their emotions. This informative article offers 18 helpful strategies.

18. Offer individual accommodations

For older students, accommodations can make all the difference. Many students struggle with performance anxiety, especially when it comes to tests. When a student is feeling anxious, their brain simply can't function as effectively. When we can set up our tests and assignments so anxious kids are less stressed, they'll likely perform better. Extended time and cue sheets could help kids who suffer from test anxiety. For other accommodations for kids who struggle with anxiety, check out this list from Worry Wise Kids.

The good news about anxiety is that it is one of the most manageable mental-health struggles that children face in the classroom. With the right support and strategies, most children are able to develop strategies that help them manage their anxiety.

The Child Mind Institute offers a " Symptom Checker " to help inform you about a student's possible diagnoses and information and articles to help facilitate a conversation.

19. Mind your classroom management

Schools play a critical role in helping students manage anxiety by creating environments where all students feel that they are cared for, supported, and belong. Certain classroom management approaches strengthen school connectedness. From teacher expectations and behavior management to student autonomy and empowerment, these strategies make a difference.

20. Teach inclusivity

Poor mental health is a growing problem for children and adolescents. According to a JAMA Pediatrics meta-analysis of 29 studies including 80, 879 youths, the prevalence of depression and anxiety symptoms has significantly increased, remains high, and therefore warrants attention.

And some groups are affected more than others. In a report by the CDC, feelings of anxiety and depression were found to be more common among lesbian, gay, or bisexual students and female students. Almost half of lesbian, gay, or bisexual students and nearly one-third of students not sure of their sexual identity reported they had seriously considered suicide-far more than heterosexual students. It is essential that schools put serious effort into creating safe, inclusive classrooms and invest in curricula that supports equity. Here are 50 Tips for Facilitating a More Inclusive Classroom and 5 Ways Social-Emotional Learning Can Help Your Class Become a More Inclusive Community.

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20 Ways To Help Students Who Struggle With Anxiety

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If you have students with anxiety in your classroom, words like "relax" don't help. Instead, try these ideas.

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Substance Abuse and Mental Health Services Administration

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Frequently Asked Questions - What is SAMHSA’s National Helpline?

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Stress Management Tips for Kids and Teens

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Stress Management Tips for Kids and Teens

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Stress Management Tips for Kids and Teens!

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Understanding Anxiety in Secondary School Students

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Understanding Anxiety in Secondary School Students

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Most young people will experience times in their lives when they feel anxious; it's a perfectly natural, normal reaction to stress and worry.
In fact, it's the brain's way of signalling that things are becoming too much, and it can help us deal with tense or overwhelming situations.

It's like a built-in panic button that is essentially there to protect us: heart rate can rise and adrenaline increases, enabling us to focus and function on high alert.

This is rather useful when being chased by a dog, for instance, or wanting to do well in an exam, as the desired outcome is to protect oneself and perform well - whether through running fast to escape the dog, or being on form to ace the test.

It's important, therefore, to remember that a certain amount of anxiety is helpful, and feeling anxious is an important, spontaneous response to keep us safe.

However, this built-in protective mechanism becomes more of a hindrance than a help when prolonged or intense emotional stress goes undetected or unchallenged, especially in the context of a school setting.

There may be upsetting or traumatic situations in the past that have been stored away and buried in the subconscious mind that threaten to resurface at times and present as anxiety, which is scary and confusing for the sufferer.

What does it look like?

Anxiety can present in various ways - these are some typical symptoms teachers can look out for, and perhaps ask parents about if concerns are being raised by colleagues regarding a particular student:

becoming irritable or other noticeable mood changes

seeming withdrawn

aggressive behaviour

obsessive behaviour (over such as homework, timings, performing well, hygiene)

constant worrying

anxiety/panic attacks

feeling physically ill (such as headaches, stomach aches, nausea)

poor focus

avoidance

crying

For a young person experiencing feelings of anxiety, it is a very real, very scary and often debilitating time.

Coping is about so much more than simply being able to 'pull oneself together', and the key to helping that young person is to respect and accept how they are feeling, and validate what is going on for them.

How can you help?

Identifying the trigger or cause for why an individual is feeling anxious is key in being able to help and support them. There are many reasons why young people might be experiencing anxiety - these could include:

Family issues: family breakdown, conflict, changes, arguments

Friendships and peers: bullying, pressure, competitiveness

Loss and bereavement: death, family changes, moving house/school

Social issues: drugs, worrying about the news, war, terrorism, social media

School: exam stress, pressure, competitiveness, fitting in.

One size doesn't fit all - we are all different, and everybody will experience anxiety in their own, unique way. And because no experience will be exactly the same, no cure will be the same either.

This can make it tricky to know how to support somebody best. The key is to be led by the young person - ask them what they need and how you can help support them best.

Some people like to talk; some people like to have space to reflect and work through their feelings. Be non-judgemental and where possible, exercise confidentiality to help build trust.

Go at the young person's pace and keep checking in on what they need and how you can best help. And never underestimate the importance of listening; actively listening (giving the person your full attention) is such an effective way of allowing somebody to trust in you and your caring intentions.

Sound strategies

Breathing exercises, physical exercise or hobbies away from technology, managing day-to-day expectations and tapping into home support networks - these are all really useful ways to help eliminate feelings of anxiety.

Letting a young person know that they are not alone, and that they can talk through what is going on for them with you, will absolutely help in reducing those intense feelings.

It is also important for you, as their caregiver or teacher, to take care of your own emotional health. Ensure you have a support system of your own in place, so you are able to debrief regularly and offload any of your own feelings.

Collaborating with the young person's parents and/or caregiver is also vital in helping everybody feel supported. Family and school are the main areas a child can seek support from - it is essential that everybody works together.

Student voice: "You can feel like the world is collapsing around you"

"Did you know that as many as one in six young teens suffer from severe anxiety? This means up to five people just in your classroom may be living with it. And although it may be hard to understand how we are feeling and why we might be acting the way we are, in times of need or difficulty, we need teachers to be there to help us through our troubles and give us an escape from the craziness inside the classroom.

I can tell you from my own personal experiences, when I was in need of help, I felt that my school didn't give this to me very well. Looking back now, I wonder whether this was because teachers like you are not able to understand how a child like me, suffering with anxiety, is feeling. I decided to speak out about it, and let a trusted adult outside of school know how I felt. In this way, I was able to get help and support from my school after trying and procrastinating many times.

Anxiety is indescribable. One minute you may be feeling great and within seconds you can feel like the world is collapsing around you and you go into a state of panic. Sometimes this is hidden inside and nobody is able to tell how you are feeling, which is why I think that teachers should be more aware and understanding about what is happening within the mind of someone suffering with anxiety.

By being more understanding, this allows pathways to open in our minds and we suddenly feel able to connect and talk to you teachers about our feelings. By being more understanding, it makes you as a teacher more approachable to students like us. By being more understanding, it reduces our anxiety and stops us students feeling worried about asking for help."
Maisie Harris, Y9, Honywood School, Essex Anna Williamson is the author of How Not to Lose It: Mental Health Sorted, out now in paperback and ebook (Scholastic). Follow her on Twitter at @awilliamsonTV.

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Understanding anxiety in secondary school students

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Most young people will experience times in their lives when they feel anxious; it's a perfectly natural, normal reaction to stress and worry. In fact, it's the brain's way of signalling that things are becoming too much, and it can help us deal with tense or overwhelming situations.

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Even the 4- and 5-year-olds in Marty Davis' Utah kindergarten classroom get anxious. "We expect so much from them, and they feel the pressure," she said. "They're like 'I can't!' And I'm like [the Little Engine That Could, who says], 'I think I can! I think I can! I think I can!'"

By high school and college, many students have run out of steam. Anxiety-the mental-health tsunami of their generation-has caught up with them. Today's teens and young adults are the most anxious ever, according to mental-health surveys. They admit it themselves: In February, a Pew survey found that 70 percent of teens say anxiety and depression is a "major problem" among their peers, and an additional 26 percent say it's a minor problem.

"Honestly, I've had more students this year hospitalized for anxiety, depression, and other mental-health issues than ever," said Kathy Reamy, school counselor at La Plata High School in southern Maryland and chair of the NEA School Counselor Caucus. "There's just so much going on in this day and age, the pressures to fit in, the pressure to achieve, the pressure of social media. And then you couple that with the fact that kids can't even feel safe in their schools-they worry genuinely about getting shot-and it all makes it so much harder to be a teenager."

In 2016, nearly two-thirds of college students reported "overwhelming anxiety," up from 50 percent just five years earlier, according to the National College Health Assessment. For seven straight years it has been the top complaint among college students seeking mental-health services, notes the Chronicle of Higher Education. Nearly a quarter say their anxiety affects their academic performance. Common symptoms include persistent feelings of dread and jumpiness, frequent panic attacks, as well as headaches, stomach problems, shortness of breath, and fatigue.

Reamy does all that she can to talk to students about deep breathing exercises, the power of positive self-talk, healthy nutrition, yoga, sleep, and more. She hands out stress balls, and encourages therapy. Together, she and her anxious students sit and unravel the things that are making them anxious. They talk about ways to cope in the short term and to resolve the issue in the long term. She points out that their typical tactics-teens "tend to self-medicate with drugs and alcohol"-only make things worse.

But, with more than 325 students in her charge and acres of paperwork to complete each week, Reamy has limited time. Most of her peers have even less time. Even as the mental health issues worsen each year, the national average is 491 students per counselor. Only three states in the nation meet the overall recommended ratio of 250-to-1 for students-to-school-counselor.

Have Smartphones Made Student Anxiety Worse?

Experts point to a number of reasons that anxiety has blossomed among today's students. "I see two major issues," says Rob Benner, a Bridgeport, Conn., school psychologist with nearly 30 years' experience. "One is testing anxiety, and the other is anxiety over social media."

Today's teenagers grew up in classrooms governed by No Child Left Behind, the federal law that introduced high-stakes standardized testing to every public school in America. In kindergarten, instead of making art and new friends, they learned to write full-on sentences in timed tests. Hours spent in art, music, physical education and recess were limited, or eliminated. For fun, these students attended pep rallies to pump them up for state testing.

Honestly, I've had more students this year hospitalized for anxiety, depression, and other mental-health issues than ever. There's just so much going on in this day and age, the pressures to fit in, the pressure to achieve, the pressure of social media." - Kathy Reamy, school counselor

By high school, high-achieving students face overwhelming pressure to succeed -and their parents aren't always helpful. "They have start taking the SATs in eighth grade," says Reamy. "It's so hard for the kids who are already maybe perfectionists, and they're getting the first B in their lives and they're fearful it's going to prevent them going to college, any college, never mind their dream college. And they don't want to disappoint their parents."

In the Pew survey of teens, academic pressure tops their list of stressors: 61 percent say they face a lot of pressure to get good grades. By comparison, 29 percent say they feel pressure to look good; 28 percent to fit in socially; and just 6 percent to drink alcohol.

The other issue is social media. A study published in Clinical Psychological Science points to the development of something very troubling in the lives of U.S. teens between 2010 and 2015. During those five years, the number of teens who felt "useless and joyless" surged 33 percent. The number of 13- to 18-year-olds who committed suicide jumped 31 percent.

"What happened so that so many more teens, in such a short time, would feel depressed, attempt suicide and commit suicide?" wrote one of the study's authors, San Diego State University professor Jean Twenge, in a Washington Post column. "After scouring several large surveys for clues, I found that all of the possibilities traced back to a major change in teens' lives: the sudden ascendance of the smartphone."

Teens who spend five or more hours online a day were 71 percent more likely than those who spent only one hour a day to have at least one suicide risk factor, Twenge's research found.

"I have one student who is completely addicted to social media and her phone," said Reamy. "It was honestly preventing her from doing what she needed to do at school. So, now she leaves her phone in my office. She still comes between classes to check some things, and she's got it for a solid hour at lunchtime. For her, it's like an appendage, like her right arm!"

Students are incredibly mean to each other on social media. They say things to a screen that they would never say face to face, things like "you should kill yourself." And many studies have found that increased social media use actually makes people feel more socially isolated. It also disrupts sleep, which is related to mental health.

Schools can create policies around phone use during school hours, but ultimately "parents need to manage the time that students are on their phone, and I think students need to earn that time," said Brenner.

Solutions are complex, advocates say. Reamy often suggests therapy to students and parents, but many are resistant. School psychologists and counselors need more time to spend with one-on-one with students, but that's difficult to find in these days of austerity. Many school districts, alarmed by rising suicide rates, are hosting community-wide conversations, involving students, parents, and educators, about the academic and social pressures placed on kids.

"Despite the fact I go to high school every day, I often say, 'I would not want to go back to high school,'" said Reamy. "People don't understand how hard it is to be a kid today."

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The Epidemic of Anxiety Among Today's Students | NEA

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Even the 4- and 5-year-olds in Marty Davis' Utah kindergarten classroom get anxious. "We expect so much from them, and they feel the pressure," she said. "They're like 'I can't!' And I'm like [the Little Engine That Could, who says], 'I think I can! I think I can!