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Infographic: Eating Disorders & Athletes

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Infographic: Eating Disorders & Athletes

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FAQ, tips, and standards for aiding students with eating disorders. Helpful for teachers, staff, administration, and counselors.

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Mod. 3, Article, EducatorToolkit for Eating Disorders

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Child Mind Institute | Transforming Children’s Lives.

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The Child Mind Institute is an independent nonprofit dedicated to transforming the lives of children struggling with mental health and learning disorders.

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Online resource that provides career information, requirements, and listings. Helpful for individuals who are self-motivated and self-efficient in research. This resource is not specific to people with disabilities.

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Resources and links to disability-related products that aid in increasing quality of life for individuals. This website provides links to outside websites and blogs.

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Jim Lubin's disABILITY Information and Resources Pages. One of the largest collections of resources for all types of disabilities. The pages provided here are meant to serve as a resource to provide useful information and guidance for all people dealing with disabilities.

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Free consultation services for job accommodations or employment issues related to disabilities.

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Article: Supporting Students Experiencing Early Psychosis in Middle School and High School 

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Article: Supporting Students Experiencing Early Psychosis in Middle School and High School 

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Mod. 7, Article, Supporting Students Experiencing Early Psychosis in Middle School and High School 

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Mod. 7, A Toolkit for Educating About Psychosis

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School Staff Can Aid Treatment of Psychotic Children

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School Staff Can Aid Treatment of Psychotic Children

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School staff can play an important role in helping children with psychotic disorders live more normal lives, according to Dr. Jonathan R. Stevens and Dr. Jefferson B. Prince.

"School interventions often involve optimizing the environment to minimize undue stress to the patient, which increases vulnerability to psychotic episodes, and to match the level of stimulation with the patient's level of arousal. Across conditions contributing to psychosis, school staff efforts to identify precipitants surrounding episodes or deterioration can be useful in determining appropriate home and classroom expectations," they wrote in the January issue of Child and Adolescent Psychiatric Clinics of North America.

They noted several early warning signs of psychosis that may present at school: changes in thinking; mood; behavior; physicality; social changes, including withdrawal or isolation from friends and family; changes in functioning; students' perception; and persistent false beliefs (delusions), suspicion, and paranoia.

"Although data on psychosocial treatments in youth psychotic disorders in schools are scant, psychosocial treatment remain a mainstay of the overall treatment plan, and school staff have an essential role in caring for a child with psychosis," wrote Dr. Stevens and Dr. Prince, both of the pediatric inpatient psychiatry unit of MassGeneral for Children at North Shore in Lynn, Mass ( Child Adolesc. Psychiatric Clin. N. Am. 2012;21:187-200 [doi:10.1016/j.chc.2011.09.008]).

In the school setting, the goals of psychosocial interventions are largely to anticipate problems and to develop strategies that better allow the student to cope. Interventions include developing trust and rapport among the student, family, treatment team, and school staff; developing strategies that support and enhance reality testing for the student; developing strategies that support academic, psychological, and social adjustment; developing a monitoring system to reduce the likelihood of relapse and to respond if it occurs; identifying barriers to treatment; and supporting the student's autonomy, relatedness, and competency.

"Parents and other caregivers can help identify the patient's progression toward psychosis, which may provide specific topics for school staff to 'check in' with the patient to monitor the patient's reality testing," the researchers wrote. Strategies should address both positive (delusions, hallucinations) and negative (withdrawal, decreased interactions) symptoms. Treatment for positive symptoms may include anchoring activities with others as part of their daily routine. "When a patient with psychotic symptoms is agitated, distressed, or unsure of what is and is not 'real,' simplifying the environment, decreasing expectations, and diminishing stimulation are often required," they wrote. For negative symptoms, regular social interactions with others and structured familiar activities can help diminish isolation. These interactions need to be carefully configured and supported by staff because these students may be inclined to withdraw or avoid interactions.

Psychosocial treatments for students with psychosis typically involve either multimodal treatment programs or specific psychosocial interventions. Multimodal treatments programs can provide a comprehensive array of service, such as community outreach/early detection efforts; inpatient and outpatient treatment; individual, group, or family therapy; and case management.

Specific psychosocial interventions have been studied, including individual cognitive behavioral therapy, group programming, and family interventions. "Providing youth suffering psychosis with 'cognitively oriented' individual psychotherapy appears to help these youth adjust to their condition, resume usual developmental tasks, as well as improve symptoms of anxiety and depression," wrote Dr. Stevens and Dr. Prince. CBT can help students target specific thoughts and beliefs that intensify their symptoms and compromise their function at school.

In particular, a "safe and private space" can be designated, which allows the student to decompress initially as practice with CBT techniques can then more easily be internalized and generalized. The more specific and frequent the practice sessions are, the more likely they will take hold and be helpful to the student.

Family and school intervention programs can emphasize psychoeducation, the need to identify warning signs, stress management techniques, the importance of attributing maladaptive behavior to the illness rather than to "bad behaviors" or "laziness," communication skills training, and the reduction of high expressed emotion, the researchers noted.

Dr. Stevens and Dr. Prince outlined specific tasks for the school team, teachers and support staff, and administrators. The school team needs to stay connected; stay positive; remember that children dealing with psychosis are children first, and often unable to understand their perceptions or why they are changing so differently from peers; and refer children who show early warning signs to mental health clinicians.

Teachers and support staff should break tasks down into smaller steps, minimize distractions, and have a plan to redirect the student to help him or her return to the task at hand; give short, concise directions; assist with planning and organizational skills; provide modifications and accommodations to the school; and provide support with social problems.

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School Staff Can Aid Treatment of Psychotic Children

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School staff can play an important role in helping children with psychotic disorders live more normal lives, according to Dr. Jonathan R. Stevens and Dr. Jefferson B. Prince. "School interventions often involve optimizing the environment to minimize undue stress to the patient, which increases vulnerability to psychotic episodes, and to match the level of stimulation with the patient's level of arousal.

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A compilation of short tips and strategies for use with emotional disturbance or behavior problems.

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Working to deliver a better special education service

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This is an example of a referral form for use by teachers or staff to refer students to a school counselor.

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2-Page document discussing the prevalent role of a school counselor as presented by the ASCA.

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Article: Counseling Persons with Disabilities

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Article: Counseling Persons with Disabilities

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Mod. 1, Article, Counseling Persons with Disabilities

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Article: Characteristics of Students with Emotional Disturbance Manifesting Internalizing Behaviors: A Latent Class Analysis

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Article: Characteristics of Students with Emotional Disturbance Manifesting Internalizing Behaviors: A Latent Class Analysis

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Mod. 1, Article, Chacteristics of Students with Emotional Disturbance Manifesting Internalizing Behaviors- A Latent Class Analysis

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Article: Out of Sight, Out of Mind: A Case Study of an AlternativeSchool for Students with Emotional Disturbance (ED)

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Article: Out of Sight, Out of Mind: A Case Study of an AlternativeSchool for Students with Emotional Disturbance (ED)

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Mod. 1, Article, Out of Sight, Out of Mind- A Case Study of an Alternative School for Students with Emotional Disturbance (ED)

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Article: Mindfulness for Students Classified with Emotional/Behavioral Disorder

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Article: Mindfulness for Students Classified with Emotional/Behavioral Disorder

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Mod. 1, Article, Mindfulness for Students Classified with Emotional:Behavioral Disorder

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Designed as a parent resource to aid anxious children.

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From Dr. Tamar Chansky Creator of Worrywisekids.org

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How to Help a Child with an Anxiety Disorder

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How to Help a Child with an Anxiety Disorder

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A New York Times article discussing the rise of childhood anxiety and the responsive actions of parents.

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When worrying gets in the way of a child's functioning, parents need to get help rather than arranging the child's life to avoid the occasions of anxiety.

Credit... Getty Images

By

Anxiety disorders, the most common mental health problems in children and adolescents, often go untreated while children suffer, even though there are effective treatments available, according to a new report on anxiety in children and adolescents from the Child Mind Institute in New York. Anxiety may be missed because it doesn't necessarily declare itself with attention-getting disruptive behaviors; in fact, symptoms may keep some children quiet and inhibited, though in other children, alternatively, anxiety may be misunderstood as oppositional behavior.

Adults may also assume that anxiety in a child is just a phase to be outgrown. A certain amount of anxiety is a normal aspect of development for young children - consider separation anxiety, for example - and it can even be protective, since children need to learn to keep themselves safe and anticipate certain kinds of dangers. But when worrying or avoiding possible threats gets in the way of a child's functioning or a child's enjoyment, it should be a signal to parents that help is needed, not just watching and waiting, not arranging the child's life to avoid the occasions of anxiety.

Kathleen Merikangas, the senior investigator and chief of the Genetic Epidemiology Research Branch at the National Institute of Mental Health, said, "To me, anxiety is one of the most underrecognized or under-treated conditions of childhood and adolescence." These children can get missed, she said, because they may seem to be functioning well; many don't have the kinds of developmental problems or attention issues that draw attention in school, though they may be suffering.

Consider the child whose anxiety about speaking in public gets in the way of participating in class. The child may be silent out of a fear of being laughed at or otherwise rejected, Dr. Merikangas said, but to the teacher, it may look like the child is just not interested. Environmental modifications can really help these children thrive in school, she said; for example, working in small groups with children they know.

The new report, released in September, summarizes the evidence that early temperament in children predicts their later behavior patterns around anxiety; toddlers who show what are called "behaviorally inhibited" behaviors, which parents are likely to perceive as extreme shyness, or anxiety around new people, are more likely to develop social anxiety later on. That doesn't mean that shyness is pathological (as with all varieties of temperament, there's a wide range of function), but it does suggest how important it is to help a child with this temperament who develops difficulties.

The tendency toward anxiety - and toward some specific forms of anxiety, like phobias - may persist throughout childhood and adolescence and into adulthood. And anxiety is closely tied to depression, Dr. Merikangas said. Although there have been reports that anxiety rates among American teenagers have soared, she cited evidence that the international rates of the underlying disorders had stayed consistent from 1998 to 2013; there is no global "epidemic" of clinical anxiety disorders, she said.

But with rates of suicide and suicidal ideation on the rise, it's particularly important to provide information to schools and to parents about recognizing anxiety and getting children help.

Dr. Harold Koplewicz, the president of the Child Mind Institute, said that when anxiety disorders in children are left untreated, anxiety can inhibit their lives, making standard daily activities difficult, from attending school to sleeping in their own beds, and lead to many extra visits to the school nurse or the pediatrician.

But beyond that, he said, "people underestimate that this is a gateway disorder." If children don't get help with these disorders, they may be at risk to develop other mental health problems; the child with severe separation anxiety may develop panic disorder, he said; the child with untreated general anxiety may be at greater risk for depression.

Dr. Merikangas was a co-investigator on a national study of mental disorders in adolescents, which has shown both that anxiety disorders were the most common mental health problems in adolescents in the United States, and also the problems that showed up earliest in those children's lives - the mean age of onset for anxiety disorders was 6. But many adolescents had never received treatment. That makes it essential to get the word out, Dr. Merikangas said, that anxiety is "one of the most treatable symptoms and syndromes, we can really change their lives with minimal intervention."

"All these disorders are remarkably treatable," Dr. Koplewicz said. There are highly effective behavioral and psychosocial therapies, including cognitive behavioral therapies, to help children cope with the demands of daily life. For children who don't respond to psychosocial therapies, he said, medications can be added.

But perhaps because anxiety is a normal response, parents often believe that even severe and disabling anxiety symptoms are just a phase, and on average, there is a two-year lag between the time children develop anxiety and the time they get help. "It's bad for these children's brains," he said. "Having your brain's thermostat miss-set is not good for your brain."

"Anxiety can manifest itself along a continuum," said Rachel Busman, the senior director of the anxiety disorders center at the Child Mind Institute. The report shows that there is some overlap with physical illnesses, such as chronic headaches or stomach aches, often coordinated with school. "That could be a kid's way of saying, 'I'm anxious,'" she said.

And when a child who is having a lot of difficulty with separation gets into the classroom, Dr. Busman said, that child may start throwing things, or running and hiding, and that "bad behavior" may represent the fight or flight response of anxiety. "We've also seen kids who have intense social anxiety and their way of managing it is to be class clown," she said.

Treating children with anxiety always means working with their parents. Jerry Bubrick, senior clinical psychologist at the anxiety disorders center of the Child Mind Institute, said that when children are little, it's normal for parents to operate in "fix-it mode," blocking the staircase so a toddler doesn't tumble down, averting problems before they happen.

As children get older, parents normally pull back, helping children find solutions of their own. "But anxious parents of anxious children remain in fix-it mode," he said, helping their children avoid the situations that make them anxious. Therapy involves exposing children to those situations and helping them develop strategies to manage them; with treatment, Dr. Bubrick said, parents can "let the child experience the anxiety and learn to tolerate and overcome it on their own."

"If you see things you're not sure about, talk to the preschool, talk to the pediatrician, be open to the idea that maybe there is anxiety," even in a young child, Dr. Busman said. Separation anxiety can be a problem even in children who are able to go to school, she said. Parents should pay attention if a child can't be left with a babysitter, a child can't sleep alone at home."These are the kids, they go into the bathroom, and they're like, are you still there?" she said. "We do see really young anxious children."

"If your child is suffering distress and dysfunction, reach out to your pediatrician," Dr. Koplewicz said. When you get to a mental health professional, "make sure you ask the right questions," he said, including asking whether that person has specific experience with treating anxiety and how long the treatment is expected to take.

"You want a professional who understands what they're doing and can explain to you what they're doing."

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How to Help a Child With an Anxiety Disorder

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When worrying gets in the way of a child's functioning, parents need to get help rather than arranging the child's life to avoid the occasions of anxiety. By Anxiety disorders, the most common mental health problems in children and adolescents, often go untreated while children suffer, even though there are effective treatments available, according to a new report on anxiety in children and adolescents from the Child Mind Institute in New York.

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Article: Treating Anxiety Disorders in Youth

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Article: Treating Anxiety Disorders in Youth

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Mod. 2, Article, Treating Anxiety Disorders in Youth

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Article: Posttraumatic Stress Disorder in Youth

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Article: Posttraumatic Stress Disorder in Youth

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Mod. 2, Article, Posttraumatic Stress Disorder in Youth

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Article: Addressing Anxiety in School Settings: Information for Counselors

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Article: Addressing Anxiety in School Settings: Information for Counselors

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Mod. 2, Article, Addressing Anxiety in School Settings- Information for Counselors

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Article: Students with Anxiety: The Role of the Professional School Counselor

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Article: Students with Anxiety: The Role of the Professional School Counselor

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Mod. 2, Article, Students with Anxiety- The Role of the Professional School Counselor

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Article: Assessment of the Risk Factors Involved in the Onset of Anxiety Disorder in Children and Adolescents

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Article: Assessment of the Risk Factors Involved in the Onset of Anxiety Disorder in Children and Adolescents

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Mod. 2, Article, ASSESSMENT OF THE RISK FACTORS INVOLVED IN THE ONSET OF ANXIETY DISORDERS IN CHILDREN AND ADOLESCENTS

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Article: Test Anxiety Interventions for Children and Adolescents: A Systematic Review of Treatment Studies 2000-2010

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Article: Test Anxiety Interventions for Children and Adolescents: A Systematic Review of Treatment Studies 2000-2010

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Mod. 2, Article, Test Anxiety Interventions for Children and Adolescents- A Systematic Review of Treatment Studies

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Article: Eating Issues and Body Image in Elementary School: Detection and Prevention Strategies for School Counselors 

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Article: Eating Issues and Body Image in Elementary School: Detection and Prevention Strategies for School Counselors 

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Mod. 3, Article, Eating Issues in Schools

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Article: Eating Issues in Schools: Detection, Management, andConsultation With Allied Professionals

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Article: Eating Issues in Schools: Detection, Management, andConsultation With Allied Professionals

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Mod. 3, Article, Eating Issues in Schools

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Article: Teaching Students with Emotional Disturbances: 8 Tips forTeachers

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Article: Teaching Students with Emotional Disturbances: 8 Tips forTeachers

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Mod. 3, Article, Teaching Students with Emotional Disturbance

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Article: The School Counselor’s Role in Addressing Eating Disorder Symptomatology Among Adolescents 

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Article: The School Counselor’s Role in Addressing Eating Disorder Symptomatology Among Adolescents 

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Most children and parents will have some distress or upset - so how do I know when a child or family needs additional help?

Ask your patients (and their parents) about reactions and coping.

Listen for ongoing or severe traumatic stress symptoms.

Consider a referral for a more thorough evaluation with a mental health professional if:

Traumatic stress reactions are severe or prolonged (more than a month).

Traumatic stress reactions interfere with recovery or with returning to normal activities.

Consider: Is the child participating in daily activities to the extent possible given their medical condition? Are stress reactions interfering with treatment adherence? Are new fears or worries troubling the child or parent?

Steps for making a referral Effective mental health treatment for traumatic stress Online resources - help in finding a mental health professional Distinguishing between types of mental health professionals
Therapist Resource Guide: There are many ongoing stressors that children and families endure after diagnosis of an illness or an injury. This guide focuses specifically on medical traumatic stress and responses that children and families may have.

Steps for making a referral

Mention concerns you have identified.
Say something like: "I'm concerned that (you are / your child is) having these upsetting thoughts and feelings. It might be useful to talk with a specialist who can help your family more."

Involve child and family in making a plan.
Ask for their ideas about what is needed now
Say something like: "What issues or difficulties are impacting you / your family the most right now? What would help make things better?"

Ask for permission to offer advice. Present advice as range of possibilities; be sure to incorporate patient/family ideas

Say something like: "I have some suggestions that have helped other patients in the past in situations similar to yours. May I share them with you?"

Range of possibilities might include: patient education materials / websites; speaking with social worker, local clergy, school counselor; seeking out support group, referral to therapist / community mental health center.

Ask about their readiness to act on this now or in the future.
Say something like: "Is this (suggested plan) something you would be willing to do when you leave today, or if you need it next week...month?"

Ask about barriers to potential plans / referrals, and strategies to overcome barriers.
Say something like: "What kinds of things would interfere with following-up on this plan we just discussed? How can we work through this so you end up getting the help you need.?"

Involve the child and parent in setting the agenda*:*Adapted from Wissow et al. (2008)

Keep the door open.

If your patient or their parents are not quite ready to act on a suggested referral now, arrange to follow up to see how your patient is doing.

You might say: "I'd like to talk with you again in a few weeks to see how things are going."

Promote continuity of care.
If your care for this patient is ending, ask permission to communicate your concerns about traumatic stress reactions or risk factors to the child's primary care provider, or to other providers who will continue to take care of this patient.

Facilitating collaboration between pediatric health care and mental health providers: The American Academy of Pediatrics Task Force on Mental Health has developed tools to facilitate collaboration between pediatric health care providers and mental health professionals, including a Physician Referral and Feedback Form template

Effective mental health treatment for traumatic stress

There are very good and helpful treatments for children who continue to have traumatic stress symptoms.
What treatment approaches are effective?
Evidence-based treatments include cognitive-behavioral treatment approaches, and in particular Trauma-Focused Cognitive Behavior Therapy (TF-CBT).

Click here for a fact sheet about effective treatments for youth trauma from the National Child Traumatic Stress Network.

A recent article includes informative summaries of effective mental health treatments for child traumatic stress symptoms, and guidance for health care professionals:
Cohen, J, Kelleher, K, Mannarino, A.. Identifying, treating, and referring traumatized children: The role of pediatric providers. Archives of Pediatric and Adolescent Medicine 2008;162(5):447-452 How can I help parents find effective treatment for their child?
When helping parents find a counselor or therapist to help their child with traumatic stress symptoms, you might suggest that they ask prospective therapists questions such as:

Do you have experience working with children after trauma?

What is your approach to working with this type of problem?

What is your success rate?

How do you work with parents?

The National Child Traumatic Stress Network offers useful tips and information about finding a mental health professional to help children and their families after trauma.

Online resources - help in finding a mental health professional

The National Child Traumatic Stress Network (NCTSN) has trauma-trained, child mental health professionals and community-based treatment centers in 35 states in the US. For information about or referral to a NCTSN center near you, please go to the NCTSN Organizational Members site.
American Psychological Association - Psychologist Locator National Association of Social Workers - Find a Licensed Social Worker American Academy of Child and Adolescent Psychiatrists - Psychiatrist Finder Anxiety Disorders Association of America - Find a Therapist Sidran Institute Help Desk - Locate Trauma Resources ISTSS Clinician Directory - Find a Clinician, Counselor or Mental Health Professional
Distinguishing between types of mental health professionals

Psychologists are professionals who have earned a doctoral degree (Ph.D. or Psy.D.) after 4-6 years of graduate-level training in human behavior and development, psychological testing and evaluation, and psychotherapy. Psychologists are licensed by the state in which they practice.

Psychiatrists are physicians (M.D. or D.O.) who have completed medical school, plus additional advanced training in the evaluation and treatment of psychiatric disorders and emotional and behavioral problems. Psychiatrists are licensed by the state in which they practice. As medical doctors, psychiatrists can prescribe and monitor medications.

Clinical Social Workers are professionals who have earned a master's degree (M.S.W.) after 2-3 years of graduate training. Clinical Social Workers are licensed by the state in which they practice (LCSW or similar credential - varies by state).

Marriage and Family Therapists are professionals who have completed a master's degree (M.A. or M.S.) after 2-3 years of graduate training. Some Marriage and Family Therapists have completed a required amount of clinical hours and passed a state-administered examination to become licensed marriage and family therapist (LMFT).

Licensed Professional Counselors (LPC) & Licensed Mental Health Counselors (LMHC) are mental health professionals who have earned a master's degree (M.A. or M.S.) after 2-3 years of graduate training and have obtained a required amount of clinical experience and passed a state-administered licensing examination.

For more information on the training and credentialing of mental health professionals, see Mayo Clinic: Mental health providers.

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When and How to Refer for Mental Health Care

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Pediatric providers can follow specific steps to determine if and how to refer a child and familiy for further mental health services after a medically traumatic event. Providers can also become familiar with current evidence-based treatments and online resources for mental health services for traumatic stress.

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Article: School Referral Patterns Among Adolescents with Serious Emotional Disturbance Enrolled in Systems of Care

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Article: School Referral Patterns Among Adolescents with Serious Emotional Disturbance Enrolled in Systems of Care

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Mod. 1, Article, School Referral Patterns Among Adolescents with Serious Emotional Disturbance Enrolled in Systems of Care

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Article: A Closer Examination of Bipolar Disorder in School-Age Children

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Article: A Closer Examination of Bipolar Disorder in School-Age Children

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Mod. 4, Article, A Closer Examination of Bipolar Disorder in School-Age Children

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Article: Counseling Youth Who Have Bipolar Disorders

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Article: Counseling Youth Who Have Bipolar Disorders

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Article: Gender Differences in Depression in Representative National Samples: Meta-Analyses of Diagnoses and Symptoms

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Article: Gender Differences in Depression in Representative National Samples: Meta-Analyses of Diagnoses and Symptoms

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This organization was founded with the intent to help those with ADHD live better lives.

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Home - ADDA - Attention Deficit Disorder Association

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Empowering adults with adhd to live their best lives A Different Brain Requires a Different Approach Whether you're newly diagnosed, wondering if you have ADHD, or simply ready to take charge of your life - we're here to help. Have ...

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Strategies for Working with Students with Conduct Disorder

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Strategies for Working with Students with Conduct Disorder

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ADHD Fact Sheet from the Response Ability Initiative

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ADHD Fact Sheet from the Response Ability Initiative

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Mod. 5, ADHD Fact Sheet from the Rosponse Ability Initiative

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 ADHD Fact Sheet from the National Alliance on Mental Illness

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 ADHD Fact Sheet from the National Alliance on Mental Illness

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Mod. 5, ADHD Fact Sheet from the National Alliance on Mental Illness

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Disruptive and Conduct Disorders Fact Sheet from the Response Ability Initiative

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Disruptive and Conduct Disorders Fact Sheet from the Response Ability Initiative

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Mod. 5, Disruptive and Conduct Disorders Fact Sheet from the Response Ability Initiative

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Conduct Disorder Fact Sheet from Children’s Mental Health Fact Sheet for the Classroom

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Conduct Disorder Fact Sheet from Children’s Mental Health Fact Sheet for the Classroom

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Mod. 5, Conduct Disorder Children’s Mental Health Fact Sheet for the Classroom

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Oppositional Defiant Disorder and Conduct Disorder Fact Sheet

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Oppositional Defiant Disorder and Conduct Disorder Fact Sheet

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Mod. 5, Oppositional Defiant Disorder and Conduct Disorder Fact Sheet

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Conduct Disorder Fact Sheet from the School Mental Health Initiative

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Conduct Disorder Fact Sheet from the School Mental Health Initiative

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Mod. 5, Conduct Disorder Fact Sheet from the School Mental Health Initiative

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

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

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Mod. 5, Article, Early Development of Comorbidity Between Symptoms of Attention-Deficit:Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD)

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Article: Addressing Conduct Disorder in Elementary School Children- An Application of the ASCA National Model

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Article: Addressing Conduct Disorder in Elementary School Children- An Application of the ASCA National Model

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Mod. 5, Article, Early Development of Comorbidity Between Symptoms of Attention-Deficit:Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD)

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Article: Oppositional Defiant Disorder: An Overview and Strategies

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Article: Oppositional Defiant Disorder: An Overview and Strategies

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Mod. 5, Article, ODD- An Overview and Strategies for Educators

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Mod. 5, Article, Counseling Youth With Attention-Deficit:Hyperactivity Disorder (ADHD)

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Children's Books on Disabilities and Dysfunctional Behaviors

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Children's Books on Disabilities and Dysfunctional Behaviors

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Copyright 2023 Vanderbilt University. All rights reserved.

* For refund and privacy policy information visit our Help & Support page.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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Children's Books: Portrayals of People with Disabilities

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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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