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When parents start googling behavior issues, one phrase tends to jump out: oppositional defiant disorder. It's easy to see why. "The words 'oppositional' and 'defiant' show up in parents' vocabulary fairly frequently," says Dr. David Anderson, director of the ADHD and Behavior Disorders Center at the Child Mind Institute. "It's one of the more aptly named diagnoses that exists."

Whether your child has oppositional defiant disorder (or ODD) or not, learning about the disorder can be helpful. That's because the behavior management strategies used in treatment are evidence-based techniques that all parents will benefit from knowing.

What is oppositional defiant disorder?

It is normal for children to be oppositional and defiant at least some of the time. In fact, it's a sign of healthy development. So when does a child have oppositional defiant disorder? The diagnosis should not be given, for example, to a toddler who has just discovered that her new favorite word is "no."

ODD is typically diagnosed around early elementary school ages and stops being diagnosed around adolescence. Kids who have ODD have a well-established pattern of behavior problems. Symptoms include:

Being unusually angry and irritable

Frequently losing their temper

Being easily annoyed

Arguing with authority figures

Refusing to follow rules

Deliberately annoying people

Blaming others for mistakes

Being vindictive

All children can have these symptoms from time to time. What distinguishes ODD from normal oppositional behavior is how severe it is, and how long it has been going on for. A child with ODD will have had extreme behavior issues for at least six months.

Another hallmark of ODD is the toll it takes on family relationships. Regular daily frustrations - ignored commands, arguments, explosive outbursts - build up over time, and these negative interactions damage the parent-child bond and reinforce hostile patterns of behavior.

Parenting under fire

"Kids who have behavioral issues push parents towards the extremes," says Dr. Anderson. "They push parents to become permissive and they push parents to become hyper-coercive in the hope that a larger amount of control will get the kid to listen."

Neither of these extremes make for ideal parenting. It is never a parent's intention to reinforce bad behavior, and we often don't realize when we're doing it. Here are two common scenarios:

1. You tell your child to stop playing a game and get ready for bed. He ignores your first two requests. By the third time you ask, you're so mad that you yell.

2. You tell your child to stop playing a game and get ready for bed. He throws a tantrum because he wants to keep playing. You don't want him to be so worked up before bedtime, so you back down and say he can play for another ten minutes - but then he has to go to bed.

In the first scenario, your child learns that yelling is an acceptable way to get a message across. More subtly, he might also be learning that he can continue ignoring those first few requests - when you escalate the situation is when he knows you're serious.

In the second scenario, your child has learned that throwing a tantrum might give him something that he wants, so he'll be more likely to do it again in the future.

Both of these scenarios can set families up for future conflicts, and the more they are repeated the more they become familiar patterns of behavior that are harder to break out of. Your child doesn't have to have ODD for these scenarios to happen, but repeated negative interactions like these make diagnosing a behavior disorder much more likely.

And just like parents aren't necessarily to blame, neither are the kids, says Dr. Anderson. "Through no conscious effort of the child, he learns through hundreds of trials that this is a way to continue getting what he wants."

This also explains why kids who have ODD might act out more at home. Dr. Anderson notes, "Kids who have ODD are likely to be more oppositional with people they know well, partly because the pathways are so well worn. Whereas in a place like school, where a kid has less control in general over their environment, the types of behaviors that are common to ODD may not pay off as much."

ADHD and other risk factors

There is a very high overlap in kids who have ADHD who are also diagnosed with ODD. Depending on the study, the overlap could be 30 to 50 percent of kids with ADHD also have ODD.

Dr. Anderson explains the connection like this: "Kids with ADHD are biologically loaded to be distractible, to be impulsive, to have difficulty staying in one place for a little while. So kids with ADHD start off doing things that parents perceive as off limits. And then when those kids get negative feedback they start to become even more negatively oriented towards adults." These repeated patterns of negative interactions can lead to developing ODD.

But another pathway into developing ODD has more to do with a child's temperament and might be apparent early on. Children who had a lot of difficulty soothing themselves as toddlers and continue to struggle with an age-appropriate ability to control their emotions in the face of disappointment or frustration can sometimes develop ODD. The adults in their environment might be more inclined to accommodate their demands in order to keep the family functioning as harmoniously as possible.

Kids who have experienced a lot of life stress and trauma are also more likely to develop ODD.

Why treatment is important

It's important to get treatment to improve the parent-child relationship, which is crucial to the health and happiness of the entire household. It is also important for your child's future. Some children will grow out of oppositional defiant disorder, but others will continue to have behavior issues, which could lead to peer rejection and difficulty forming healthy relationships, not to mention continued family discord.

They'll also be less likely to achieve their potential. If something doesn't go their way, they might think it's anyone's fault but theirs. Dr. Anderson says they might also "retreat to the places where they know they can get what they want. That might mean that they try even less, push even more on the people who are closest to them, who they actually care about the most, causing even more frayed relationships."

A small percentage of kids with ODD go on to develop something called conduct disorder, which is a more severe behavior disorder that includes criminal acts like stealing, setting fires and hurting people. Getting treatment sooner rather than later improves a child's trajectory.

What treatment for ODD looks like

Parents play a key role in treatment for oppositional defiant disorder. This might be surprising, since children are the ones given the diagnosis, but in ODD the parent-child relationship needs to be repaired, which means both parties need to make changes to get back on track.

All programs have certain goals in common, like helping parents find the middle ground between being too authoritative and too permissive. A behavioral therapist helps parents learn how to train their child's behavior through setting clear expectations, praising kids when they follow through and using effective consequences when they don't. Parents also learn to use these strategies consistently - one reason why behavior management strategies sometimes don't work is because parents try different, conflicting techniques, or don't stick to one program long enough to see gains. Parents and children will also learn problem solving skills they can rely on when they run into issues.

Parent training programs might include sessions with parents and children working together, or just parents alone. Some different programs include:

Parent-Child Interaction Therapy (PCIT)

Parent Management Training (PMT)

Defiant Teens

Positive Parenting Program (Triple P)

The Incredible Years

Clinicians might also recommend social skills training to help improve your child's peer relationships or cognitive behavioral therapy if she is struggling with anxiety or depression.

There is no FDA-approved medication for ODD, but medications are sometimes used as an adjunct to behavioral therapy. Anti-psychotic medications like Abilify (aripiprazole) and Risperdal (risperidone), which have been shown to reduce aggression and irritability, are frequently used in cases where a child is at risk of being removed from the school or home. Stimulant medication may be used if a child has excessive impulsivity, including those who have an ADHD diagnosis. Antidepressants (SSRIs) may be helpful if a child has underlying depression or anxiety.

Regardless of the treatment plan your therapist recommends, parents will need to provide a lot of encouragement. "Make no mistake, kids do not often just suddenly wake up with the insight that they wish their behavior was better and then ask all the adults in their life how they can change," warns Dr. Anderson. "They'll stick with whatever behavior is working for them, even if it's not working that well."

But once the family dynamic begins to change, and kids (and parents) begin to feel more confident in their ability to get along, everyone will be a lot happier.

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When parents start googling behavior issues, one phrase tends to jump out: oppositional defiant disorder. It's easy to see why. "The words 'oppositional' and 'defiant' show up in parents' vocabulary fairly frequently," says Dr. David Anderson, director of the ADHD and Behavior Disorders Center at the Child Mind Institute.

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Learning that your child has a behavioral health problem is upsetting and worrisome for any parent. Rest assured, however, that here at Boston Children's Hospital, your child and family are in good hands.
How is oppositional defiant disorder treated at Boston Children's?
ODD is typically treated with one or a combination of the following methods:
Parenting guidance and modification
Your involvement as a parent is crucial to the treatment of your child's oppositional defiant disorder. Here at Boston Children's, we've learned that the best approach to ODD is helping parents learn and use effective parenting strategies; anticipate and prepare for problematic behavior; manage and respond to outbursts and tantrums; and implement structure and consistency in the child's life and daily routine.

Parenting modification strategies taught at Boston Children's focus on:

developing a warm, loving relationship between parent and child

providing a predictable, structured household environment

setting clear and simple household rules

consistently praising and rewarding positive behaviors (such as getting ready for school and bed on time)

consistently ignoring annoying behaviors (such as whining or badgering), followed by praise when the annoying behavior ceases

consistently delivering consequences (such as "time-outs" or loss of privileges) for dangerous or destructive behaviors (such as physical aggression or destroying possessions)

Social-emotional skills training
Strengthening the impact of the parenting modification techniques you are learning, therapy for ODD will also focus on providing social-emotional skills training for your child. Through the course of therapy sessions with the clinician, your child will learn:

new skills for identifying and managing feelings

how to get along better with others

strategies for making good decisions that are based on thinking rather than feeling

Psychiatric medication
In addition to therapy, your clinician may recommend medication to treat your child's oppositional defiant disorder. There currently are no drugs prescribed specifically for ODD, but certain symptoms of the disorder, when found in conjunction with another disorder, can respond very well to medication in conjunction with psychotherapy (which is also referred to as "talk therapy").

Drugs that may be prescribed to treat ODD symptoms include:

Stimulants for ADHD

methylphenidate (Ritalin)

dextroamphetamine (Dexedrine)

Antidepressants for depression or anxiety

escitalopram (Lexapro)

fluoxetine (Prozac)

Other medications that may help decrease disruptive behaviors

guanfacine (Tenex)

clonidine (Catapres)

risperidone (Risperdal)

aripiprazole (Abilify)

Boston Children's Department of Psychiatry and Behavioral Sciences has a specialized Psychopharmacology Clinic to help determine whether psychiatric medication might be a useful addition to a child's treatment plan, but we never prescribe medication as a standalone treatment. Medication, when prescribed, is always part of a two-step approach in conjunction with talk therapy.

Learn more about psychiatric medications for children and adolescents.

Coping and support

In addition to the condition-specific information provided here, Boston Children's offers the following resources for support:

Boston Children's Hale Family Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families and health professionals are welcome to use the center's services at no extra cost. The Center for Families is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.

The Boston Children's chaplaincy is a source of spiritual support for parents and family members. Our program includes nearly a dozen clergy members - representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian, and United Church of Christ traditions - who will listen to you, pray with you and help you observe your own faith practices during your child's treatment.

The Experience Journal was designed by Boston Children's psychiatrist-in-chief, David DeMaso, MD, and members of his team. This online collection features reflections from kids, families and health professionals about dealing with physical illnesses like asthma and diabetes, as well as mental health conditions like ADHD and depression.

The Advocating Success for Kids (ASK) Program at Boston Children's provides multidisciplinary evaluation, referral and advocacy services for children under 14 who are experiencing behavioral, emotional, learning or developmental problems, either at home or at school. ASK works with children who receive their primary care either at Boston's Bowdoin Street Community Health Center, Martha Eliot Health Center, Joseph M. Smith Community Health Center, or at Boston Children's Primary Care Center. For more information about ASK, please call 617-355-4690.

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Treatments for Oppositional Defiant Disorder in Children

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Learning that your child has a behavioral health problem is upsetting and worrisome for any parent. Rest assured, however, that here at Boston Children's Hospital, your child and family are in good hands. How is oppositional defiant disorder treated at Boston Children's?

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Early diagnosis and treatment of schizophrenia increase the chance of successful recovery.﻿﻿ Knowing the early warning signs, and how they differ by age group, can be important for identifying the onset of schizophrenia and seeking treatment.

Schizophrenia is a chronic psychiatric disorder that affects how a person thinks, feels, and behaves. It usually develops slowly, with early warning signs developing before the first severe episode, where positive symptoms, such as hallucinations and delusions, are experienced for the first time. These severe episodes are also referred to as psychosis.

The age at which someone develops schizophrenia is thought to have an impact on the symptoms that person will experience.﻿﻿﻿﻿ Even though men and women have roughly similar rates of schizophrenia, they tend to develop the condition at slightly different ages.

Early Warning Signs of Schizophrenia

The period where early warning signs are experienced is called the prodromal stage. The onset of schizophrenia can last from months to several years and the first signs differ depending on what age the disorder develops.

In Young Children

Children who are diagnosed with schizophrenia have more developmental issues than those diagnosed later in life.

Very early developmental warning signs include:﻿﻿﻿﻿

Delayed motor development: Such as not walking until over 18 months old.

Delayed speech and/or language development: Such as not speaking meaningful two- or three- word phrases until aged over 36 months

Impaired social development at an early age: Such as not using gestures to communicate or failing to regulate facial expressions.

It is important to note that these issues are not necessarily indicative of schizophrenia and may instead be related to something completely different.

In Teenagers

Prior to the onset of schizophrenia children often develop changes in behavior. This can lead to children struggling at school, one of the most common issues reported by children diagnosed with schizophrenia.

Early warning signs include:﻿﻿﻿﻿﻿

Difficulty concentrating and paying attention

Unexplained functional decline

Increased introversion

Loneliness

Depression

Aggression

Suicidal ideation

Theft

Bizarre behaviors

It is hard to diagnose schizophrenia in children because many of the features of the condition are common during normal childhood development. For example, a normal part of childhood is having vivid imaginations and fantasies. However, these can be misunderstood to be hallucinations, a symptom of schizophrenia.﻿﻿﻿﻿﻿

Those developing the disorder at a young age are more likely to go on to experience certain symptoms compared to those in other age groups.

It is also thought that children may be less likely to experience paranoid delusions, which is the belief that others are out to harm you, than those who develop schizophrenia at an older age.﻿﻿

In Early Adulthood

Schizophrenia typically develops during this period. Its onset is characterized by changes in behavior and a deterioration in functioning in daily life.

The most common earliest signs are:﻿﻿﻿﻿﻿

Nervousness and/or restlessness

Depression

Difficulty in thinking clearly or concentrating

Worrying

Lack of self-confidence

Lack of energy and/or slowness

A worrying drop in grades or job performance

Social withdrawal and/or or uneasiness around other people

Not everyone will experience these early warning signs over the same period of time. According to some studies, these prodromal symptoms can be present for years.﻿﻿﻿﻿

While the exact cause of the disorder is unknown, schizophrenia has a strong genetic component and is highly heritable. Having a family member with schizophrenia increases your risk of developing the disease.

These risk factors will be taken into account if you are thought to be experiencing these early warning signs of schizophrenia.

Over the Age of 45

The majority of early warning signs for this age group are the same as for those that develop schizophrenia at early adulthood. However, there are some differences.

A study has reported that men who developed schizophrenia over the age of 35 experienced fewer negative symptoms during the early warning stage. Specifically, the study found that they were less likely to experience social isolation and difficulties with concentration.﻿﻿﻿﻿﻿

Some scientists think that those who develop schizophrenia later in life will experience less disorganized thinking and negative symptoms.﻿﻿﻿﻿﻿

When Schizophrenia Symptoms Start

Symptoms usually start to develop between late adolescence and early 30s, also called early adulthood. It typically emerges slightly earlier in men than in women. Symptoms tend to emerge between late adolescence and early 20s in men and between the early 20s and the early 30s in women.﻿﻿﻿﻿

Early-Onset Schizophrenia

If the disease is diagnosed prior to the age of 18 this is called early-onset schizophrenia (EOS). EOS is rare with an estimated prevalence of 0.23%.﻿﻿﻿﻿ Rarer still, the disease can develop in very young children. This is called childhood-onset schizophrenia (COS) when the disease is diagnosed before the age of 13.

According to the National Institute of Mental Health, approximately 1 in 40,000 will have COS.﻿﻿﻿﻿ It is thought to be extremely uncommon that COS develops before the age of 10.

Late-Onset Schizophrenia

Although schizophrenia most commonly presents between late adolescence and the early 30s, it is estimated that up to 20% of patients first develop symptoms after the age of 40 years old.﻿﻿﻿﻿﻿﻿ Some scientists have identified this as a subtype of schizophrenia called late-onset schizophrenia (LOS).

Women are more likely to be in this group than men. Symptoms typically develop during menopause, between 44 and 49 years old. However, this is less common for women than developing schizophrenia in early adulthood.

Complications

In the early stages of schizophrenia it can be confused with other disorders, including depression. This is because the majority of the most common early warning signs for schizophrenia are also the most common initial symptoms for moderate to severe depression.

It is not until positive symptoms (such as hallucinations, delusions, and disorganized thoughts and speech) are experienced that schizophrenia can be more easily distinguished from mood disorders such as depression.﻿﻿﻿﻿﻿﻿﻿﻿

People with schizophrenia may experience suicidal thoughts. The risk of suicide for those with schizophrenia is higher for men and for those that develop the disease at a young age.

Depression has been identified as one of the major risk factors for suicide among those with schizophrenia. Other disorders that are highly prevalent among those with schizophrenia, such as substance abuse disorder, also increase the risk of suicide.﻿﻿﻿﻿﻿

Substance abuse, in general, is linked to poor outcomes in terms of recovery. For those affected, a comprehensive plan that includes treatment for the substance use disorder along with the schizophrenia is important.

When to See a Doctor

As schizophrenia usually develops gradually, it can be difficult to pinpoint when changes in behavior start or know if they are something to worry about. Identifying that you are experiencing a pattern of these changes can be a sign you should consult with a professional.

Symptoms may intensify in the run-up to an acute episode of positive psychosis in schizophrenia. The warning signs include:﻿﻿﻿﻿﻿

A worrying drop in grades or job performance

New difficulty thinking clearly or concentrating

Suspiciousness or uneasiness with others

Withdrawing socially, spending a lot more time alone than usual

Unusual, overly intense new ideas, strange feelings, or having no feelings at all

Decline in self-care or personal hygiene

Difficulty telling reality from fantasy

Confused speech or trouble communicating

While these changes might not be concerning by themselves, if you, or a loved one, are experiencing a number of them then you should contact a mental health professional. It can be difficult for those with schizophrenia to want to get help, especially if they are experiencing symptoms such as paranoia.

A Word From Verywell

Getting help as early as possible increases the chance for successful recovery. You should speak to your doctor, or your loved one's doctor, if you are concerned about any changes in behavior. However, the early warning signs highlighted above do not necessarily point to schizophrenia and might instead be related to something else.

This is especially true for children. As it is very rare for this age group, it is likely that, even if they are experiencing the early warning signs highlighted above, your child doesn't have schizophrenia.

If you, or a loved one, does receive a diagnosis of schizophrenia then know that there are effective treatments available that can help manage symptoms well.

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What Are the Early Signs of Schizophrenia?

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Early diagnosis and treatment of schizophrenia increase the chance of successful recovery.﻿﻿ Knowing the early warning signs, and how they differ by age group, can be important for identifying the onset of schizophrenia and seeking treatment. Schizophrenia is a chronic psychiatric disorder that affects how a person thinks, feels, and behaves.

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Schizophrenia changes how you think, feel, and act. It might affect you differently from someone else. The symptoms can come and go, too. No one has all of them all of the time.

They usually start between ages 16 and 30. Men often get them earlier than women. Oftentimes there is a gradual change in the person before obvious symptoms start. This is sometimes called the prodrome phase.

When the disease is in full swing and symptoms are severe, the person with schizophrenia can't tell when certain ideas and perceptions they have are real or not. This happens less often as they get older.

People with the condition usually aren't aware that they have it until a doctor or counselor tells them. They won't even realize that something is seriously wrong. If they do happen to notice symptoms, like not being able to think straight, they might chalk it up to things like stress or being tired.

If you're concerned that you or someone you know is showing signs of schizophrenia, talk to a doctor or counselor.

Positive Symptoms of Schizophrenia: Things That Might Start Happening

Positive symptoms are highly exaggerated ideas, perceptions, or actions that show the person can't tell what's real from what isn't. Here the word "positive" means the presence (rather than absence) of symptoms. They can include:

Hallucinations. People with schizophrenia might hear, see, smell, or feel things no one else does. The types of hallucinations in schizophrenia include:

Auditory. The person most often hears voices in their head. They might be angry or urgent and demand that they do things. It can sound like one voice or many. They might whisper, murmur, or be angry and demanding.

Visual. Someone might see lights, objects, people, or patterns. Often it's loved ones or friends who are no longer alive. They may also have trouble with depth perception and distance.

Olfactory and gustatory. This can include good and bad smells and tastes. Someone might believe they're being poisoned and refuse to eat.

Tactile. This creates a feeling of things moving on your body, like hands or insects.

Delusions. These are beliefs that seem strange to most people and are easy to prove wrong. The person affected might think someone is trying to control their brain through TVs or that the FBI is out to get them. They might believe they're someone else, like a famous actor or the president, or that they have superpowers. Types of delusions include:

Persecutory delusions. The feeling someone is after you or that you're being stalked, hunted, framed, or tricked.

Referential delusions. When a person believes that public forms of communication, like song lyrics or a gesture from a TV host, are a special message just for them.

Somatic delusions. These center on the body. The person thinks they have a terrible illness or bizarre health problem like worms under the skin or damage from cosmic rays.

Erotomanic delusions. A person might be convinced a celebrity is in love with them or that their partner is cheating. Or they might think people they're not attracted to are pursuing them.

Religious delusions. Someone might think they have a special relationship with a deity or that they're possessed by a demon.

Grandiose delusions. They consider themselves a major figure on the world stage, like an entertainer or a politician.

Confused thoughts and disorganized speech. People with schizophrenia can have a hard time organizing their thoughts. They might not be able to follow along when you talk to them. Instead, it might seem like they're zoning out or distracted. When they talk, their words can come out jumbled and not make sense.

Trouble concentrating. For example, someone might lose track of what's going on in a TV show as they're watching.

Movement disorders. Some people with schizophrenia can seem jumpy. Sometimes they'll make the same movements over and over again. But sometimes they might be perfectly still for hours at a stretch, which experts call being catatonic. Contrary to popular belief, people with the disease usually aren't violent.

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Schizophrenia Symptoms: Positive and Negative Symptoms Explained

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Schizophrenia changes how you think, feel, and act. It might affect you differently from someone else. The symptoms can come and go, too. No one has all of them all of the time. They usually start between ages 16 and 30. Men often get them earlier than women.

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Source

Loewy, Rachel L., et al. (2011). Psychosis risk screening with the Prodromal Questionnaire-Brief Version (PQ-B). Schizophrenia research 12(1) pp. 42-46.

Screenings with missing answers cannot be scored. A positive score on the Prodromal Questionnaire-Brief Version (PQ-B) suggests the need for further evaluation by a qualified health (M.D., R.N.) or mental health (Ph.D., Psy.D., LCSW) professional who is trained in recognizing the early signs of psychosis. The PQ-B is designed to test for Prodrome or Ultra high-risk of Psychosis and is considered the first step in a two-stage screening process.

Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with a physician or healthcare provider. Mental Health America Inc., sponsors, partners, and advertisers disclaim any liability, loss, or risk incurred as a consequence, directly or indirectly, from the use and application of these screens.

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Source Loewy, Rachel L., et al. (2011). Psychosis risk screening with the Prodromal Questionnaire-Brief Version (PQ-B). Schizophrenia research 12(1) pp. 42-46. Screenings with missing answers cannot be scored. A positive score on the Prodromal Questionnaire-Brief Version (PQ-B) suggests the need for further evaluation by a qualified health (M.D., R.N.)

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MedlinePlus links to health information from the National Institutes of Health and other federal government agencies. MedlinePlus also links to health information from non-government Web sites. See our disclaimer about external links and our quality guidelines.

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MedlinePlus links to health information from the National Institutes of Health and other federal government agencies. MedlinePlus also links to health information from non-government Web sites. See our disclaimer about external links and our quality guidelines.

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Use this assessment to learn more about your risk.

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Did you know:

Anxiety disorders affect about 40 million American adults every year

Generalized Anxiety Disorder (GAD) affects 6.8 million adults in the United States, but only 43.2% of those people receive treatment.

Take our Anxiety health risk assessment to learn more about your risk, and to take action to prevent future complications.

Click Here to learn if You Are at Risk Now

*This assessment is not intended to replace the evaluation of a healthcare professional.

Facts provided by the Anxiety and Depression Association of America

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Anxiety disorders affect about 40 million American adults every year Generalized Anxiety Disorder (GAD) affects 6.8 million adults in the United States, but only 43.2% of those people receive treatment. Click Here to learn if You Are at Risk Now *This assessment is not intended to replace the evaluation of a healthcare professional.

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Overview

Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, school work, and relationships.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and various phobia-related disorders.

Signs and Symptoms

Risk Factors

Treatments and Therapies

Join a Study

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Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time.

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We all experience anxiety. For example, speaking in front of a group can make us anxious, but that anxiety also motivates us to prepare and practice. Driving in heavy traffic is another common source of anxiety, but it helps keep us alert and cautious to avoid accidents. However, when feelings of intense fear and distress become overwhelming and prevent us from doing everyday activities, an anxiety disorder may be the cause.

Anxiety disorders are the most common mental health concern in the United States. Over 40 million adults in the U.S. ( 19.1%) have an anxiety disorder. Meanwhile, approximately 7% of children aged 3-17 experience isses with anxiety each year. Most people develop symptoms before age 21.

Symptoms

Anxiety disorders are a group of related conditions, each having unique symptoms. However, all anxiety disorders have one thing in common: persistent, excessive fear or worry in situations that are not threatening. People typically experience one or more of the following symptoms:

Emotional symptoms:

Feelings of apprehension or dread

Feeling tense or jumpy

Restlessness or irritability

Anticipating the worst and being watchful for signs of danger

Physical symptoms:

Pounding or racing heart and shortness of breath

Sweating, tremors and twitches

Headaches, fatigue and insomnia

Upset stomach, frequent urination or diarrhea

Types of Anxiety Disorders

There are many types of anxiety disorders, each with different symptoms. The most common types of anxiety disorders include:

Generalized Anxiety Disorder (GAD)

GAD produces chronic, exaggerated worrying about everyday life. This worrying can consume hours each day, making it hard to concentrate or finish daily tasks. A person with GAD may become exhausted by worry and experience headaches, tension or nausea.

Social Anxiety Disorder

More than shyness, this disorder causes intense fear about social interaction, often driven by irrational worries about humiliation (e.g. saying something stupid or not knowing what to say). Someone with social anxiety disorder may not take part in conversations, contribute to class discussions or offer their ideas, and may become isolated. Panic attacks are a common reaction to anticipated or forced social interaction.

Panic Disorder

This disorder is characterized by panic attacks and sudden feelings of terror sometimes striking repeatedly and without warning. Often mistaken for a heart attack, a panic attack causes powerful physical symptoms including chest pain, heart palpitations, dizziness, shortness of breath and stomach upset. Many people will go to desperate measures to avoid an attack, including social isolation.

Phobias

We all tend to avoid certain things or situations that make us uncomfortable or even fearful. But for someone with a phobia, certain places, events or objects create powerful reactions of strong, irrational fear. Most people with specific phobias have several things that can trigger those reactions; to avoid panic, they will work hard to avoid their triggers. Depending on the type and number of triggers, attempts to control fear can take over a person's life.

Other anxiety disorders include:

Agoraphobia

Selective mutism

Separation anxiety disorder

Substance/medication-induced anxiety disorder, involving intoxication or withdrawal or medication treatment

Causes

Scientists believe that many factors combine to cause anxiety disorders:

Genetics. Studies support the evidence that anxiety disorders "run in families," as some families have a higher-than-average amount of anxiety disorders among relatives.

Environment. A stressful or traumatic event such as abuse, death of a loved one, violence or prolonged illness is often linked to the development of an anxiety disorder.

Diagnosis

Physical symptoms of an anxiety disorder can be easily confused with other medical conditions, like heart disease or hyperthyroidism. Therefore, a doctor will likely perform an evaluation involving a physical examination, an interview and lab tests. After ruling out an underlying physical illness, a doctor may refer a person to a mental health professional for evaluation.

Using the Diagnostic and Statistical Manual of Mental Disorders (DSM) a mental health professional is able to identify the specific type of anxiety disorder causing symptoms as well as any other possible disorders that may be involved. Tackling all disorders through comprehensive treatment is the best recovery strategy.

Treatment

Different anxiety disorders have their own distinct sets of symptoms. This means that each type of anxiety disorder also has its own treatment plan. But there are common types of treatment that are used.

Related Conditions

Anxiety disorders can occur along with other mental health conditions, and they can often make related conditions worse. So, talk with a mental health care professional if you are experiencing anxiety and any of the following:
Reviewed December 2017

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We all experience anxiety. For example, speaking in front of a group can make us anxious, but that anxiety also motivates us to prepare and practice. Driving in heavy traffic is another common source of anxiety, but it helps keep us alert and cautious to avoid accidents.

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References

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2. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a non-clinical sample of children and adolescents in Saudi Arabia.

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3. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study.

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Dariotis J.K.

Mirabal-Beltran R.

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Gould L.F.

Greenberg M.T.

Mendelson T.

A qualitative exploration of implementation factors in a school-based mindfulness and yoga program: Lessons learned from students and teachers.

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5. The benefits of yoga for children in schools.

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6. Are there benefits from teaching yoga at schools? A systematic review of randomized control trials of yoga-based interventions.

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7. Therapeutic effects of yoga for children: A systematic review of the literature.

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8. Lexico. (2020). Definition of anxiety in English. Retrieved from https://www.lexico.com/en/definition/anxiety

9. Yoga research and public health: Is research aligned with the stakeholders' needs.

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10. Young children's embodied experiences: A classroom-based yoga intervention.

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11. A study of the Yoga Ed program at the Accelerated School.

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12. Effect of yoga or physical exercise on physical, cognitive and emotional measures in children: A randomized controlled trial.

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13. Yoga for kids: A 4-H healthy living program.

University of Arkansas System Division of Agriculture, Little Rock, AR 2014

Article Info

Publication History

Footnotes

The authors hereby confirm that this material is original work and that the manuscript has not been published in whole or in part elsewhere. This manuscript is currently not being considered for publication elsewhere. All authors have been personally and actively involved in substantive work leading to the manuscript and will hold themselves jointly and individually responsible for its content. All relevant ethical safeguards have been met in relation to participation protection.

This work was supported by a University of Arkansas Provost Collaborative Grant.

This study was approved by the University of Arkansas Institutional Review Board (Protocol no. 16-11-211).

Conflicts of interest: None to report.

Identification

DOI: https://doi.org/10.1016/j.pedhc.2020.07.008

ScienceDirect
Access this article on ScienceDirect

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Using Yoga to Reduce Anxiety in Children: Exploring School-Based Yoga Among Rural Third- and Fourth-Grade Students

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Yoga as a school-wide positive behavior support. : 109-113 Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in a non-clinical sample of children and adolescents in Saudi Arabia. : 554-562 Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study.

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Task-related motivation and academic achievement in children and adolescents with ADHD

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Academic impairment in individuals with attention-deficit/hyperactivity disorder (ADHD) is in part due to reduced motivation for academic tasks, which is likely to vary as a function of task characteristics. The current study employed a new questionnaire-the Child and Adolescent Motivational Profile (CHAMP)-to examine; (1) which task characteristic participants with ADHD perceive as most motivating relative to typically developing peers (TDP) and (2) whether these differences mediate academic functioning.

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Mindsets and behaviors for student success: K-12 college- and career-readiness standards for every student. 

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Mindsets and behaviors for student success: K-12 college- and career-readiness standards for every student. 

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ASCA Student Standards: Mindsets & Behaviors for Student Success

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The ASCA Student Standards: Mindsets & Behaviors for Student Success describe the knowledge, skills and attitudes students need to achieve academic success, college and career readiness and social/emotional development. The standards are based on a survey of research and best practices in student achievement from a wide array of educational standards and efforts.

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Kids with ADHD rarely keep their backpacks tidy - and that sometimes has serious consequences on overall academic performance. These 20+ organization strategies can help kids build the skills they need to stay neat - or at least neatish!

Organization skills for students with ADHD who need to use color-coded folders and Post-It notes

What Organization Skills Matter Most for Students with ADHD?

Students with good organizational skills have the ability to create and maintain systems to keep track of information or materials. A young child can, with a reminder, put school materials in a designated place. An adolescent can organize and locate sports equipment. Kids with attention deficit hyperactivity disorder ( ADHD or ADD) have problems with these tasks. To be organized requires time, effort, and sustained attention. Of these, your children may have only time - and they'd prefer to be doing something else with it.

How Can Students Learn Organization Skills at School?

Make desk-cleaning a part of the daily routine. A half hour before dismissal, a teacher might say, "OK, let's do a speed cleaning!" to her first-grade class, prompting kids to tidy up their desks and other common spaces. When the classroom is tidy, they can play a short group game before getting ready to go home for the day.

Talk about it. Have a class discussion about what it means to be organized. Ask kids to design a system for cleaning up their cubbies or a common play area. Talk about how to organize classroom routines to make them go more smoothly. Set up a suggestion box kids can use if they think of other ideas.

Instruct the class in how to set up and organize a notebook and binder. Each time you tell students something that should go in the notebook or binder, tell them exactly where it goes and supervise them to make sure it gets there. Work in pairs to ensure each follows the plan.

Use brightly colored paper for project assignments, providing details and due dates. Give each student two copies - one for the notebook and one to be posted at home.

[This School Year, Get It Together (and Keep It There)]

Stay organized yourself. Have classroom systems in place for daily routines - turning in homework assignments, collecting lunch money and permission slips, and so on. Teach students the systems, and appoint student monitors to make sure the routines are followed as much as possible.

Make organization a team effort. Divide the class into two teams, appoint team leaders, and award points for keeping desks clean, cubbies or lockers organized, or notebooks neat. With the class, create a checklist that can be used for inspections. Hold daily or random spot-checks and award points based on the checklist. The team with the most points at the end of the week gets to choose the class reward from a rewards menu.

Provide handouts that are three-hole-punched in advance.

Keep classroom systems simple. Use two color-coded folders - red for incomplete homework assignments, green for completed assignments. Use this for class work as well, and teach the class to move their work from red to green as the morning progresses. Make sure they pack the folders before they go home. First thing in the morning, ask them to get out their green folders with completed homework and place them on top of their desk for review.

Give bonus points, or some other reward, for improved organization skills. Reward disorganized students when they are able to quickly locate a certain book or paper in their desk or notebooks.

[Free Resource: How Teachers Can Manage Common ADHD Behaviors]
How Can Children Learn Organization Skills at Home?

Label where things should go. Affix pictures or text on clear plastic containers to show what goes in each container.

Schedule an after-dinner cleanup. Set aside five minutes after dinner to clean up the common areas in the house (living room, countertops, mudroom). Set a timer, put on some lively music, and have the family pitch in. Make it a daily routine!

Have your child stay put when cleaning up his work area. Instead of taking away the stuff that belongs in other rooms, have him make piles. One for the bedroom, one for the kitchen, one for the playroom. If he walks off to another area, chances are, he will get sidetracked.

Buy your child a corkboard and pins - for hanging up important papers that might get lost on a cluttered desk.

Assemble a homework supply kit. Place in a see-through plastic container, with a lid, everything she will need to complete assignments - from crayons and a glue stick to a calculator and dictionary. With this system, it does not matter where your child chooses to study. The necessary supplies can accompany her anywhere.

Provide plastic sleeves for notebooks - and insert them into your child's notebooks or binders for storing important papers that are not three-hole-punched.

Color-code entries on a calendar - one color for school-related stuff, another for sports, a third for social activities.

Take a photograph of what neatness should look like - whether it's in a backpack or your child's workspace. Have your child compare his work to the photograph and critique himself. Did he do a five-star job (his work looks exactly like the photo), a three-star job (only a couple of things out of place), or a one-star job (he made an effort but seemed to run out of steam)?

Put up a large whiteboard that includes a space for a calendar. Give each family member a different-colored marker to write down tasks and events for the week, so each can easily spot his or her own.

Have your child design a system that works for him. An organizational system that works for you is unlikely to work as well for your child.

Take out the academic component. When helping your child organize his backpack or workspace, don't say anything about his terrible handwriting or a paper his teacher has marked up with comments. Continue organizing. You are working on organization, not academics.

Ask permission before going into his backpack to assist him in organizing it. You wouldn't want him going into your purse or briefcase without asking first.

Make organization a family affair. Sometimes entire families are organizationally challenged. If so, admit your difficulties and ask the family to choose a problem to tackle. Design a system and get a commitment from family members to stick with the program for a few weeks to see if it helps. Hold a meeting after one week to evaluate and fine-tune the system, and decide on a reward if everyone makes it through week two.

Tackle one mess at a time. Parents' biggest downfall is having kids organize their room, backpack, and homework space all at once. Choose one task, get that system up and running, and, after a month or two, move on to another task.
[Free Download: Routines for Morning and Night]
Updated on August 7, 2020

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Kids with ADHD rarely keep their backpacks tidy - and that sometimes has serious consequences on overall academic performance. These 20+ organization strategies can help kids build the skills they need to stay neat - or at least neatish! Students with good organizational skills have the ability to create and maintain systems to keep track of information or materials.

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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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Credit: Julius-Maximilians-Universität Würzburg, JMU

An overactive molecular signal pathway in the brain region of the amygdala can lead to obsessive-compulsive disorder (OCD). A research team from Würzburg has established this connection.

Some people have an extreme fear of dirt or bacteria. As a result, they may develop a habit of compulsive washing and repeatedly cleaning their hands or body. They are trapped in a vicious circle, as the fear of new contamination returns quickly after washing. Sufferers see no way out. They are even incapable of changing their behaviour when the excessive washing has led to skin irritation or damage.

Around two percent of the general population suffer from some kind of obsessive-compulsive disorder (OCD) at least once in their life. The disorder is characterised by persistent intrusive thoughts which the sufferers try to compensate for by repetitive ritualized behaviour.

Like depression, eating disorders and other mental diseases, OCD is treated with antidepressants. However, the drugs are non-specific, that is they are not tailored to the respective disease. Therefore, scientists have been looking for new and better targeted therapies that have fewer side effects.
Missing protein triggers urge to wash
Professor Kai Schuh from the Institute of Physiology at the Julius-Maximilians-Universität (JMU) Würzburg (Germany) and his team explore the underlying causes of obsessive-compulsive disorder in collaboration with the JMU's Departments of Psychiatry and Neurology.

"We were able to show in mouse models that the absence of the protein SPRED2 alone can trigger an excessive grooming behaviour," Schuh says. He believes that this finding is crucial as no clear trigger for this type of disorder has been identified until now. Previous research pointed to multiple factors being responsible for developing OCD.

Occurring in all cells of the body, the protein SPRED2 is found in particularly high concentrations in regions of the brain, namely in the basal ganglia and the amygdala. Normally, the protein inhibits an important signal pathway of the cell, the so-called Ras/ERK-MAP kinase cascade. When it is missing, this signal pathway is more active than usual.
Hyperactive signal cascade in the brain
"It is primarily the brain-specific initiator of the signal pathway, the receptor tyrosine kinase TrkB, that is excessively active and causes the overshooting reaction of the downstream components", biologist Dr. Melanie Ullrich explains.

Administering an inhibitor to attenuate the overactive signal cascade in the animal model improves the obsessive-compulsive symptoms. Moreover, the JMU research team was able to treat the OCD with an antidepressant, similarly to standard therapy in humans. Their detailed results have been published in the journal Molecular Psychiatry.
New targets for therapies pinpointed
"Our study delivers a valuable new model that allows the disease mechanisms to be investigated and new therapy options for obsessive-compulsive disorders to be tested," Professor Schuh says.

The recently discovered link between OCDs and the Ras/ERK-MAP kinase cascade also opens up new targets for therapy. Drugs that inhibit this cascade are already available and some of them are approved for human treatment.

According to Melanie Ullrich, these are cancer drugs, as overactivation of the Ras/ERK-MAP kinase cascade is also a frequent trigger of cancer: "So we are wondering whether such drugs could also be effective in the treatment of obsessive-compulsive disorders and whether they are beneficial in terms of side effects."

More information: M Ullrich et al. OCD-like behavior is caused by dysfunction of thalamo-amygdala circuits and upregulated TrkB/ERK-MAPK signaling as a result of SPRED2 deficiency, Molecular Psychiatry (2017). DOI: 10.1038/mp.2016.232

Provided by Julius-Maximilians-Universität Würzburg

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An overactive molecular signal pathway in the brain region of the amygdala can lead to obsessive-compulsive disorder (OCD). A research team from Würzburg has established this connection. Some people have an extreme fear of dirt or bacteria. As a result, they may develop a habit of compulsive washing and repeatedly cleaning their hands or body.

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Obsessive-compulsive disorder (OCD) is characterized by repetitive, unwanted, intrusive thoughts (obsessions) and irrational, excessive urges to do certain actions (compulsions). Although people with OCD may know that their thoughts and behavior don't make sense, they are often unable to stop them.

Symptoms typically begin during childhood, the teenage years or young adulthood, although males often develop them at a younger age than females. 1.2% of U.S. adults experience OCD each year.

Symptoms

Most people have occasional obsessive thoughts or compulsive behaviors. In an obsessive-compulsive disorder, however, these symptoms generally last more than an hour each day and interfere with daily life.

Obsessions are intrusive, irrational thoughts or impulses that repeatedly occur. People with these disorders know these thoughts are irrational but are afraid that somehow they might be true. These thoughts and impulses are upsetting, and people may try to ignore or suppress them.

Examples of obsessions include:

Thoughts about harming or having harmed someone

Doubts about having done something right, like turning off the stove or locking a door

Unpleasant sexual images

Fears of saying or shouting inappropriate things in public

Compulsions are repetitive acts that temporarily relieve the stress brought on by an obsession. People with these disorders know that these rituals don't make sense but feel they must perform them to relieve the anxiety and, in some cases, to prevent something bad from happening. Like obsessions, people may try not to perform compulsive acts but feel forced to do so to relieve anxiety.

Examples of compulsions include:

Hand washing due to a fear of germs

Counting and recounting money because a person is can't be sure they added correctly

Checking to see if a door is locked or the stove is off

"Mental checking" that goes with intrusive thoughts is also a form of compulsion

Causes

The exact cause of obsessive-compulsive disorder is unknown, but researchers believe that activity in several portions of the brain is responsible. More specifically, these areas of the brain may not respond normally to serotonin, a chemical that some nerve cells use to communicate with each other. Genetics are thought to be very important. If you, your parent or a sibling, have obsessive-compulsive disorder, there's around a 25% chance that another immediate family member will have it.

Diagnosis

A doctor or mental health care professional will make a diagnosis of OCD. A general physical with blood tests is recommended to make sure the symptoms are not caused by illicit drugs, medications, another mental illness, or by a general medical condition. The sudden appearance of symptoms in children or older people merits a thorough medical evaluation to ensure that another illness is not causing of these symptoms.

To be diagnosed with OCD, a person must have must have:

Obsessions, compulsions or both

Obsessions or compulsions that are upsetting and cause difficulty with work, relationships, other parts of life and typically last for at least an hour each day

Treatment

A typical treatment plan will often include both psychotherapy and medications, and combined treatment is usually optimal.

Medication, especially a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), is helpful for many people to reduce the obsessions and compulsions.

Psychotherapy is also helpful in relieving obsessions and compulsions. In particular,cognitive behavior therapy (CBT) and exposure and response therapy (ERT) are effective for many people. Exposure response prevention therapy helps a person tolerate the anxiety associated with obsessive thoughts while not acting out a compulsion to reduce that anxiety. Over time, this leads to less anxiety and more self-mastery.

Though OCD cannot be cured, it can be treated effectively. Read more on our treatment page.

Related Conditions

There are related conditions that share some characteristics with OCD but are considered separate conditions.

Body Dysmorphic Disorder. This disorder is characterized by an obsession with physical appearance. Unlike simple vanity, BDD is characterized by obsessing over one's appearance and body image, often for many hours a day. Any perceived flaws cause significant distress and ultimately impede on the person's ability to function. In some extreme cases, BDD can lead to bodily injury either due to infection because of skin picking, excessive exercise, or from having unnecessary surgical procedures to change one's appearance.

Hoarding Disorder. This disorder is defined by the drive to collect a large amount of useless or valueless items, coupled with extreme distress at the idea of throwing anything away. Over time, this situation can render a space unhealthy or dangerous to be in. Hoarding disorder can negatively impact someone emotionally, physically, socially and financially, and often leads to distress and disability. In addition, many hoarders cannot see that their actions are potentially harmful, and so may resist diagnosis or treatment.

Trichotillomania. Many people develop unhealthy habits such as nail biting or teeth grinding, especially during periods of high stress. Trichotillomania, however, is the compulsive urge to pull out (and possibly eat) your own hair, including eyelashes and eyebrows. Some people may consciously pull out their hair, while others may not even be aware that they are doing it. Trichotillomania can create serious injuries, such as repetitive motion injury in the arm or hand, or, if the hair is repeatedly swallowed, the formation of hairballs in the stomach, which can be life threatening if left untreated. A similar illness is excoriation disorder, which is the compulsive urge to scratch or pick at the skin.

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Obsessive-compulsive disorder (OCD) is characterized by repetitive, unwanted, intrusive thoughts (obsessions) and irrational, excessive urges to do certain actions (compulsions). Although people with OCD may know that their thoughts and behavior don't make sense, they are often unable to stop them.

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What is OCD? | International OCD Foundation

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Obsessive compulsive disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings.…

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understanding Bipolar disorder & depression

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Students with Internalizing Disorders