# data[].attributes.attachment_link.readable_text
Although the term "eating" is in the name, eating disorders are about more than food. They're complex mental health conditions that often require the intervention of medical and psychological experts to alter their course.

These disorders are described in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) ( 1).

In the United States alone, an estimated 28 million Americans have or have had an eating disorder at some point in their life ( 2).

This article describes six of the most common types of eating disorders and their symptoms.

Eating disorders are a range of psychological conditions that cause unhealthy eating habits to develop. They might start with an obsession with food, body weight, or body shape ( 3).

In severe cases, eating disorders can cause serious health consequences and may even result in death if left untreated. In fact, eating disorders are among the deadliest mental illnesses, second to opioid overdose ( 4).

People with eating disorders can have a variety of symptoms. Common symptoms include severe restriction of food, food binges, and purging behaviors like vomiting or overexercising.

Although eating disorders can affect people of any gender at any life stage, they're increasingly common in men and gender nonconforming people. These populations often seek treatment at lower rates or may not report their eating disorder symptoms at all ( 5, 6).

Different types of eating disorders have different symptoms, but each condition involves an extreme focus on issues related to food and eating, and some involve an extreme focus on weight.

This preoccupation with food and weight may make it hard to focus on other aspects of life ( 3).

Mental and behavioral signs may include ( 7):

dramatic weight loss

concern about eating in public

preoccupation with weight, food, calories, fat grams, or dieting

complaints of constipation, cold intolerance, abdominal pain, lethargy, or excess energy

excuses to avoid mealtime

intense fear of weight gain or being "fat"

dressing in layers to hide weight loss or stay warm

severely limiting and restricting the amount and types of food consumed

refusing to eat certain foods

denying feeling hungry

expressing a need to "burn off" calories

repeatedly weighing oneself

patterns of binge eating and purging

developing rituals around food

excessively exercising

cooking meals for others without eating

missing menstrual periods (in people who would typically menstruate)

Physical signs may include ( 7):

Experts believe that a variety of factors may contribute to eating disorders.

One of these is genetics. People who have a sibling or parent with an eating disorder seem to be at an increased risk of developing one ( 3).

Personality traits are another factor. In particular, neuroticism, perfectionism, and impulsivity are three personality traits often linked to a higher risk of developing an eating disorder, according to a 2015 research review ().

Other potential causes include perceived pressures to be thin, cultural preferences for thinness, and exposure to media promoting these ideals ().

More recently, experts have proposed that differences in brain structure and biology may also play a role in the development of eating disorders. In particular, levels of the brain messaging chemicals serotonin and dopamine may be factors ( 9).

However, more studies are needed before strong conclusions can be made.

Eating disorders are a group of related conditions involving extreme food and weight issues, but each disorder has unique symptoms and diagnosis criteria. Here are six of the most common eating disorders and their symptoms.

Anorexia nervosa is likely the most well-known eating disorder.

It generally develops during adolescence or young adulthood and tends to affect more women than men ().

People with anorexia generally view themselves as overweight, even if they're dangerously underweight. They tend to constantly monitor their weight, avoid eating certain types of foods, and severely restrict their calorie intake.

Common symptoms of anorexia nervosa include ( 1):

very restricted eating patterns

intense fear of gaining weight or persistent behaviors to avoid gaining weight, despite being underweight

a relentless pursuit of thinness and unwillingness to maintain a healthy weight

a heavy influence of body weight or perceived body shape on self-esteem

a distorted body image, including denial of being seriously underweight

However, it's important to note that weight should not be the major focus of diagnosing someone with anorexia.

Using body mass index as a factor in diagnosis is outdated because people who are categorized as "normal" or "overweight" can have the same risks.

In atypical anorexia, for example, a person may meet the criteria for anorexia but not be underweight despite significant weight loss ( 7).

Obsessive-compulsive symptoms are also often present. For instance, many people with anorexia are preoccupied with constant thoughts about food, and some may obsessively collect recipes or hoard food.

They may also have difficulty eating in public and exhibit a strong desire to control their environment, limiting their ability to be spontaneous ( 3).

Anorexia is officially categorized into two subtypes - the restricting type and the binge eating and purging type ( 1).

Individuals with the restricting type lose weight solely through dieting, fasting, or excessive exercise.

Individuals with the binge eating and purging type may binge on large amounts of food or eat very little. In both cases, after they eat, they purge using activities such as vomiting, taking laxatives or diuretics, or exercising excessively.

Anorexia can be very damaging to the body. Over time, individuals living with it may experience thinning of their bones, infertility, and brittle hair and nails.

In severe cases, anorexia can result in heart, brain, or multi-organ failure and death.

Bulimia nervosa is another well-known eating disorder.

Like anorexia, bulimia tends to develop during adolescence and early adulthood and appears to be less common among men than women ().

People with bulimia frequently eat unusually large amounts of food in a specific period of time.

Each binge eating episode usually continues until the person becomes painfully full. During a binge, the person usually feels that they cannot stop eating or control how much they are eating.

Binges can happen with any type of food but most commonly occur with foods the individual would usually avoid.

Individuals with bulimia then attempt to purge to compensate for the calories consumed and to relieve gut discomfort.

Common purging behaviors include forced vomiting, fasting, laxatives, diuretics, enemas, and excessive exercise.

Symptoms may appear very similar to those of the binge eating or purging subtypes of anorexia nervosa. However, individuals with bulimia usually maintain a relatively typical weight rather than losing a large amount of weight.

Common symptoms of bulimia nervosa include ( 1):

recurrent episodes of binge eating with a feeling of lack of control

recurrent episodes of inappropriate purging behaviors to prevent weight gain

self-esteem overly influenced by body shape and weight

a fear of gaining weight, despite having a typical weight

Side effects of bulimia may include an inflamed and sore throat, swollen salivary glands, worn tooth enamel, tooth decay, acid reflux, irritation of the gut, severe dehydration, and hormonal disturbances ().

In severe cases, bulimia can also create an imbalance in levels of electrolytes, such as sodium, potassium, and calcium. This can cause a stroke or heart attack.

Binge eating disorder is the most prevalent form of eating disorder and one of the most common chronic illnesses among adolescents ().

It typically begins during adolescence and early adulthood, although it can develop later on.

Individuals with this disorder have symptoms similar to those of bulimia or the binge eating subtype of anorexia.

For instance, they typically eat unusually large amounts of food in relatively short periods of time and feel a lack of control during binges.

People with binge eating disorder do not restrict calories or use purging behaviors, such as vomiting or excessive exercise, to compensate for their binges ().

Common symptoms of binge eating disorder include ():

eating large amounts of food rapidly, in secret, and until uncomfortably full, despite not feeling hungry

feeling a lack of control during episodes of binge eating

feelings of distress, such as shame, disgust, or guilt, when thinking about the binge eating behavior

no use of purging behaviors, such as calorie restriction, vomiting, excessive exercise, or laxative or diuretic use, to compensate for the binge eating

People with binge eating disorder often consume an excessive amount of food and may not make nutritious food choices. This may increase their risk of medical complications such as heart disease, stroke, and type 2 diabetes ().

Pica is an eating disorder that involves eating things that are not considered food and that do not provide nutritional value ( 14).

Individuals with pica crave non-food substances such as ice, dirt, soil, chalk, soap, paper, hair, cloth, wool, pebbles, laundry detergent, or cornstarch ().

Pica can occur in adults, children, and adolescents.

It is most frequently seen in individuals with conditions that affect daily functioning, including intellectual disabilities, developmental conditions such as autism spectrum disorder, and mental health conditions such as schizophrenia ( 14).

Individuals with pica may be at an increased risk of poisoning, infections, gut injuries, and nutritional deficiencies. Depending on the substances ingested, pica may be fatal.

However, for the condition to be considered pica, the eating of non-food substances must not be a typical part of someone's culture or religion. In addition, it must not be considered a socially acceptable practice by a person's peers.

Rumination disorder is another newly recognized eating disorder.

It describes a condition in which a person regurgitates food they have previously chewed and swallowed, re-chews it, and then either re-swallows it or spits it out ( 15).

This rumination typically occurs within the first 30 minutes after a meal ( 16).

This disorder can develop during infancy, childhood, or adulthood. In infants, it tends to develop between 3 and 12 months of age and often disappears on its own. Children and adults with the condition usually require therapy to resolve it.

If not resolved in infants, rumination disorder can result in weight loss and severe malnutrition that can be fatal.

Adults with this disorder may restrict the amount of food they eat, especially in public. This may lead them to lose weight and become underweight ( 16).

Avoidant/restrictive food intake disorder (ARFID) is a new name for an old disorder.

The term has replaced the term "feeding disorder of infancy and early childhood," a diagnosis previously reserved for children under age 7 ( 17).

Individuals with this disorder experience disturbed eating due to either a lack of interest in eating or a distaste for certain smells, tastes, colors, textures, or temperatures.

Common symptoms of ARFID include ():

avoidance or restriction of food intake that prevents the person from eating enough calories or nutrients

eating habits that interfere with typical social functions, such as eating with others

weight loss or poor development for age and height

nutrient deficiencies or dependence on supplements or tube feeding

It's important to note that ARFID goes beyond common behaviors such as picky eating in toddlers or lower food intake in older adults.

Moreover, it does not include the avoidance or restriction of foods due to lack of availability or religious or cultural practices.

In addition to the six eating disorders above, other less known or less common eating disorders also exist.

These include ( 18):

Purging disorder. Individuals with purging disorder often use purging behaviors, such as vomiting, laxatives, diuretics, or excessive exercising, to control their weight or shape. However, they do not binge.

Night eating syndrome. Individuals with this syndrome frequently eat excessively at night, often after awakening from sleep.

Other specified feeding or eating disorder (OSFED). While it is not found in the DSM-5, this category includes any other conditions that have symptoms similar to those of an eating disorder but don't fit any of the disorders above.

One disorder that may currently fall under OSFED is orthorexia. Although orthorexia is increasingly mentioned in the media and in scientific studies, the DSM does not yet recognize it as a separate eating disorder ( 19).

Individuals with orthorexia tend to have an obsessive focus on healthy eating to an extent that disrupts their daily lives. They may compulsively check ingredient lists and nutritional labels and obsessively follow "healthy lifestyle" accounts on social media.

Someone with this condition may eliminate entire food groups, fearing that they're unhealthy. This can lead to malnutrition, severe weight loss, difficulty eating outside the home, and emotional distress.

Individuals with orthorexia are rarely focused on losing weight. Instead, their self-worth, identity, or satisfaction is dependent on how well they comply with their self-imposed diet rules ( 19).

If you have an eating disorder, identifying the condition and seeking treatment sooner will improve your chances of recovering. Being aware of the warning signs and symptoms can help you decide whether you need to seek help.

Not everyone will have every sign or symptom at once, but certain behaviors may signal a problem, such as ( 20):

behaviors and attitudes that indicate that weight loss, dieting, and control over food are becoming primary concerns

preoccupation with weight, food, calories, fats, grams, and dieting

refusal to eat certain foods

discomfort with eating around others

food rituals (not allowing foods to touch, eating only particular food groups)

skipping meals or eating only small portions

frequent dieting or fad diets

extreme concern with body size, shape, and appearance

frequently checking in the mirror for perceived flaws in appearance

extreme mood swings

If these symptoms resonate with you and you think you may have an eating disorder, it's important to reach out to a medical professional for help.

Making the decision to start eating disorder recovery might feel scary or overwhelming, but seeking help from medical professionals, eating disorder recovery support groups, and your community can make recovery easier.

If you're not sure where to start, you can contact the National Eating Disorders Association helpline for support, resources, and treatment options for yourself or someone you know.

To contact, call: (800) 931-2237

Monday-Thursday 11 a.m.-9 p.m. ET

Friday 11 a.m.-5 p.m. ET

Text: (800) 931-2237

Monday-Thursday 3 p.m.-6 p.m. ET

Friday 1 p.m.-5 p.m. ET

Eating disorder treatment plans are specifically tailored to each person and may include a combination of multiple therapies.

Treatment will usually involve talk therapy, as well as regular health checks with a physician ( 21).

It's important to seek treatment early for eating disorders, as the risk of medical complications and suicide is high ().

Treatment options include:

Individual, group, or family psychotherapy. A type of psychotherapy called cognitive behavioral therapy (CBT) may be recommended to help reduce or eliminate disordered behavior such as binge eating, purging, and restricting. CBT involves learning how to recognize and change distorted or unhelpful thought patterns ().

Medications. A doctor may recommend treatment with medications such as antidepressants, antipsychotics, or mood stabilizers to help treat an eating disorder or other conditions that may occur at the same time, such as depression or anxiety ().

Nutritional counseling. This involves working with a dietitian to learn proper nutrition and eating habits and may also involve restoring or managing a person's weight if they have experienced significant weight changes. Studies suggest that combining nutritional therapy with cognitive therapy may significantly improve treatment outcomes (22).

If you think someone in your life has an eating disorder, your best bet is to support and encourage them to seek help from a healthcare professional.

This can be extremely difficult for someone living with an eating disorder, but supporting them in other ways will help them feel cared for and encouraged in their recovery.

Recovering from an eating disorder can take a long time, and this person may have periods of relapsing into old behaviors, especially during times of stress. If you're close to this person, it's important to be there for them, and be patient, throughout their recovery ( 21).

Ways to support someone with an eating disorder include ( 21):

Listening to them. Taking time to listen to their thoughts can help them feel heard, respected, and supported. Even if you don't agree with what they say, it's important that they know you're there for them and that they have someone to confide in.

Including them in activities. You can reach out and invite them to activities and social events or ask if they want to hang out one-on-one. Even if they do not want to be social, it's important to check in and invite them to help them feel valued and less alone.

Trying to build their self-esteem. Make sure they know that they are valued and appreciated, especially for nonphysical reasons. Remind them why you are their friend and why they are valued.

The categories above are meant to provide a better understanding of the most common eating disorders and dispel myths about them.

Eating disorders are mental health conditions that usually require treatment. They can also be damaging to the body if left untreated.

If you have an eating disorder or know someone who might have one, you can seek help from a healthcare professional who specializes in eating disorders.

You can book an appointment with an eating disorder specialist in your area using our Healthline FindCare tool.
Read this article in Spanish.

# data[].attributes.attachment_link.title
Learn about 6 common types of eating disorders and their symptoms

# data[].attributes.attachment_link.description
Eating disorders are characterized by unusual or disturbed eating habits. Learn more here.

# data[].attributes.attachment_link.description
The identification of a new mental health condition, Disruptive Mood Dysregulation Disorder (DMDD), could affect how bipolar disorder is diagnosed in children. DMDD better describes children who are intensely irritable, have temper tantrums, but do not have classic symptoms of mania.

# data[].attributes.headline
How School Counselors can Support Students with ADHD

# data[].attributes.subject
How School Counselors can Support Students with ADHD

# data[].attributes.attachment_link.readable_text
More than 6 million children between the ages of 4 and 17 had been diagnosed with attention deficit hyperactivity disorder (ADHD) as of 2011, according to the Centers for Disease Control and Prevention. It's a complicated disorder with a long history. In order to cope with the symptoms, children with ADHD need continuous support from parents, teachers, and school counselors. School counselors are especially poised to serve as a key intermediary between parents and teachers and can be essential in helping students with ADHD thrive.

The Difference Between ADD and ADHD

The term "attention deficit disorder" was first coined in 1980 when the Diagnostic and Statistical Manual (DSM) - the industry standard publication for psychiatric diagnoses - published its third edition. Since then, "ADD" and "ADHD" have become relatively ubiquitous in American vocabularies, yet they do not exist simultaneously. In fact, they are mutually exclusive terms.

As research poured in in the 1980s and 1990s, the DSM adjusted the nomenclature to reflect new findings. Specifically, "attention deficit hyperactivity disorder" was introduced in the 1987 edition and appeared again in 1994, this time with three subtypes: predominantly inattentive subtype, predominantly hyperactive/impulsive subtype, and combined subtype. With the DSM 5, these have been re-termed as "presentations" (i.e., predominantly inattentive presentation, predominantly hyperactive/impulsive presentation, and combined presentation) owing to the research suggesting that children can have different presentations over time. The Attention Deficit Disorder Association has a helpful fact sheet with more details on the evolution of ADHD's nomenclature and its subtypes on its website.

Ultimately, while many use the terms "ADD" and "ADHD" interchangeably, the latter is technically the correct, up-to-date term.

Symptoms of ADHD

According to the Mayo Clinic, symptoms of ADHD often appear in early childhood, with diagnoses typically occurring before age 12. Typical symptoms of ADHD include fidgeting, excessive daydreaming, continual forgetfulness or losing things, taking needless risks, talking too much, limited self-control, misreading social cues and struggles with social interactions such as taking turns or getting along with others

Some may think, "Don't most children experience these 'symptoms' at one point or another during childhood?" - and they'd be right. The difference for children with ADHD is that these behaviors never subside and often worsen over time, and must result in impairment in key domains of functioning (e.g., social, familial, and academic), and often co-occur in two or more settings. Ultimately, ADHD is chronic for many affected children, impeding their social and academic lives well beyond their childhood and adolescence. According to the nonprofit Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), "more than 75% of children with ADHD continue to experience significant symptoms in adulthood." As such, school counselors and educators have an opportunity to support children and teens with ADHD to develop effective techniques to manage their symptoms in school, and maintain them into adulthood.

Helping Students with ADHD

Children with ADHD can have a particularly hard time managing their symptoms in school environments. For example, experiencing difficulty sitting still during class, having trouble waiting for a turn during an activity or conversation, or being unable to play quietly and independently are not only disruptive behaviors, they also interfere with a student's social, emotional, and academic development and functioning.

With up to roughly 11 percent of children ages 4 to 17 diagnosed with ADHD, school counselors serve as an important support system for children with ADHD and their families, as well as an essential resource for teachers and other professionals who work with students in and outside of the classroom. Because ADHD manifests itself in many different ways (most children are diagnosed with a combined form of ADHD), counselors should be equipped with several strategies to address the many ways symptoms may occur in students.

Before jumping into strategies and suggestions, it's critical to understand what skills, specifically, students coping with ADHD need help developing. "Children need to learn to develop impulse control and time management skills, as well as the ability to focus or concentrate on an undesired task," said Rebecca Newman, an early childhood mental health consultant for the Child Center of NY. If the development of these skills is ignored, "they may experience continual frustration, fatigue, poor self-esteem, or embarrassment," she said.

A big part of successfully managing ADHD symptoms is providing structure. The National Institute for Mental Health says that keeping the same routine every day and addressing any changes (such as school assemblies or field trips) as far in advance as possible is imperative. Helping students stay organized is another way to provide structure while keeping them on track with demands and expectations from homework, clubs, and sports.

Strategies for School Counselors

Evidence-based interventions (EBIs) are a primary way school counselors can provide support to students coping with ADHD. EBIs are an important part of managing ADHD symptoms, and usually occur outside of where a change in behavior is needed, such as a classroom.

Anil Chacko, a professor for Counseling@NYU's online master's in school counseling program, said there are specific strategies that school counselors can implement when working with students who have ADHD.

"School counselors should utilize methods that support students' time management, planning, and organization," Chacko said, citing the work of Joshua Langberg at VCU and Howard Abikoff at NYU's School of Medicine - both leaders in ADHD research for children and adolescents. "I would also encourage school counselors to work directly with parents to create a school-home note system to support cross-setting changes."

Research as recent as 2016 found that with early intervention for behavioral therapy External link , children who received behavioral therapy first before other interventions (such as medication) received "four fewer rules violations an hour at school than the medication-first group." This is not to say medical treatments should be dismissed, as they have proven benefits for helping children as well, but rather demonstrates the importance of a school counselor's role in encouraging behavior modification. This form of therapy is also cost-effective, as the reports found behavior-first therapy cost roughly $700 less per year compared to medication-first treatment. The CDC agrees both behavioral therapy and medication are important for treatment moving forward.

These intervention techniques can be implemented at any point in a student's academic career; it's equally applicable for elementary students as it is for high schoolers. What's more, social and emotional learning is increasingly appearing in schoolwide curricula, which can further support a student coping with ADHD in a formal classroom setting, as well.

Strategies for Teachers

In addition to EBIs, school counselors can train teachers to support children coping with ADHD in the classroom. It can be as simple as suggesting that teachers implement point- or token-based systems in class to reward good behavior, or as robust as dedicating a day of in-service training to identify symptoms and provide additional intervention strategies.

As for some immediate tips, for students who are easily distracted (predominantly inattentive), the National Resource Center (NRC) on ADHD suggests:

Seating the student near the teacher's desk or away from distractions like windows or the corridor.

Splitting longer assignments into smaller segments, and providing more breaks during class time.

For students who squirm and fidget often (predominantly hyperactive/impulsive), the NRC recommends:

Seating students in an area where there will be the least disruption, such as along the side of the classroom.

Creating opportunities for movement throughout the day, such as completing assignments sitting on the floor or helping with class activities (e.g., handing out activity sheets).

Newman adds that using "first/then" statements - such as "First push your chair in, then come sit for story time" - with children, and directing them to assist during class time will help them both refocus their energy and also feel valuable. A general best practice is for school counselors, teachers, and parents to offer praise and reward when children coping with ADHD exhibit good behavior.

The NRC has additional resources for teachers on supporting students with ADHD for reading, writing, and math accommodations, and general classroom instruction.

Strategies for Parents

ADHD is a relatively well-known mental disorder and is subsequently stigmatized - discussions of ADHD as a "fake" disorder on mainstream news sites don't help, either. As such, ADHD is oversimplified or even appropriated with things like "AD/HD" T-shirts and an endless meme stream across the internet. Beyond the web, stigmas of ADHD are found in television. Season 2 of Netflix's wildly successful Unbreakable Kimmy Schmidt references an ADHD medication, Dyziplen, that transforms rambunctious kids into slow-moving, deadpan pseudo-robots.

A big part of empowering children to manage their ADHD is providing them with interventions, therapies, medications, and lots of support from adults in all aspects of their life. But when it comes to stigma, speaking up in defense of your child is a great way to fight it, just as this parent did in reaction to the Kimmy Schmidt episode last year.

While misconceptions of ADHD are seemingly omnipresent, there are many strategies parents can use for helping their child with ADHD at home:

Provide positive communication and reinforcement; praise and reward good behavior with things as simple as stickers.

Create and maintain as much structure in their day-to-day life as possible, such as providing written to-do lists for chores.

Practice strategies at home that are covered during therapy sessions.

Additionally, Chacko encourages parents to learn more about available behavior parent training programs - arguably the most well-studied and effective "therapy" for children with ADHD and related oppositional problems.

"It's important to remember that many students with ADHD also have a learning disability or learning issues," Chacko said. "School counselors, teachers and parents should appreciate that the challenges these children face may be more than just 'ADHD.' "

As with many misunderstood mental disorders, the best way to change the conversation is through an amplified voice. In terms of supporting parents, school counselors can educate them on support groups, online forums, and through websites like CHADD.
When sharing our graphic and referencing our data, please cite us as "Counseling@NYU, the online masters in school counseling program from NYU Steinhardt."

# data[].attributes.attachment_link.title
Strategies for ADHD: How Counselors Help Today's Students Succeed | Counseling@NYU

# data[].attributes.attachment_link.description
An estimated 11% of school-aged children are diagnosed with attention deficit hyperactivity disorder (ADHD) - but what does that diagnosis really look like, and what strategies are available to students? Here, we spoke with Counseling@NYU's Professor Anil Chacko about how parents, teachers and school counselors can help.

# data[].attributes.headline
Implications for School Counselors who Serve Students with ADHD

# data[].attributes.subject
Implications for School Counselors who Serve Students with ADHD

# data[].attributes.attachment_link.readable_text
What Is OCD?

Obsessive-compulsive disorder (OCD) causes upsetting thoughts called obsessions. It also causes the urge to do behaviors called compulsions (also called rituals). Kids and teens with OCD get stuck in a stressful cycle of these thoughts, anxiety, and rituals.

If you think your child has OCD, start with a visit to your child's doctor or mental health provider. They can check for OCD or for other problems that could be the cause of your child's symptoms.

How Is OCD Treated?

Treatment for OCD is a type of cognitive behavioral therapy (CBT). In therapy, kids learn coping and calming skills for anxiety. They learn how to safely face fears without doing rituals.

Along with therapy, doctors may give medicines for OCD to some kids. For kids who need medicines, doctors give SSRIs (selective serotonin reuptake inhibitors). These include Zoloft®, Prozac®, and Luvox®.

Treatment works best when a parent or caregiver goes to therapy with their child. That way, they can learn how to coach their child through OCD symptoms, help their child practice skills they learn in therapy, and offer daily support.

What Signs Might Parents Notice?

Obsessions

These are stressful thoughts that come to mind over and over. A child with OCD doesn't want to think about these things. But they feel they can't stop.

Parents may notice obsessions as intense fears or worries. Kids with OCD may feel unusually upset about:

germs, dirt, illness, injury, or harm

whether someone could get sick, hurt, or die

things that seem wrong, or out of place

whether bad thoughts might come true

things that are not straight, even, or arranged "just right"

Compulsions (Rituals)

These are behaviors a child will do, trying to feel better. To the child, rituals seem like the way to stop thoughts and relieve fears. They seem like a way to keep bad things from happening.

Parents may notice that kids:

touch, tap, or step in unusual ways

arrange things over and over

repeat words, phrases, or questions

have many doubts, and trouble making choices

wash or clean more than needed

take a long time to do things - like get dressed, shower, eat, do homework

Kids may involve parents in rituals. And at first, parents may not realize that something is a ritual. For example, a child with OCD might ask for reassurance over and over. Or a child may insist a parent say or do something a set number of times, or in a set way.

Kids and teens with OCD can have obsessions, compulsions, or both.

Feelings

OCD symptoms are hard on kids. Rituals may seem to give them some relief at first. But rituals multiply. They start to take more time and energy. Kids have little left for things they enjoy. OCD thoughts, feelings, and rituals become a stressful cycle. This can make it hard to focus in school, have fun with friends, get to sleep, or relax.

Kids may seem:

anxious, worried

frustrated, irritable

sad, tired

upset when they can't do a ritual

to need constant reassurance from a parent that things are OK

Some kids may not let parents know about the thoughts, fears, and behaviors OCD causes. They may feel confused or ashamed about their fear and keep it to themselves. They may try to hide rituals they do. Some kids may have OCD symptoms for a while before their parents realize it.

How Can I Help My Child?

If you think your child may have OCD:

Talk with your child about what you've noticed. Talk in a supportive way, listen, and show love. Say something that works for your child's situation like, "I notice you fixing your socks a lot, trying to get them even. Getting them to feel right causes you a lot of stress."

Say that something called OCD might be causing the worry and the fixing. Tell your child that a checkup with a doctor can find out if this is what's going on. Let your child know that this can get better, and that you want to help.

Make an appointment with a child psychiatrist or psychologist. Your child's doctor can help you find the right person. To diagnose OCD, they will spend time talking with you and your child. They will ask questions about your child's symptoms that help point them to signs of OCD. If they diagnose OCD, they can explain the treatment.

Take part in your child's therapy. Part of treatment is coaching parents on how to respond to their child's OCD symptoms. Learn all you can about ways you can help. Learn how to support your child's progress without giving in to rituals.

Be patient. Overcoming OCD is a process. There will be many therapy visits. Be sure to go to them all. Help your child practice the things the therapist shows you. Praise your child's effort. Show how proud you feel. Remind them that OCD is not their fault.

Get support, and give it. There are lots of resources and support for families dealing with OCD. The International OCD Foundation is a good place to start. Knowing that you're not alone can help you cope. Sharing success stories with other parents can give you hope and confidence.

# data[].attributes.attachment_link.description
OCD causes upsetting thoughts (obsessions) and the urge to do "ritual" behaviors (compulsions). Kids and teens get stuck in a stressful cycle of these thoughts, anxiety, and rituals. OCD can get better with the right attention and care.

# data[].attributes.headline
How Can a School Counselor Support a Student with OCD?

# data[].attributes.subject
How Can a School Counselor Support a Student with OCD?

# data[].attributes.body
(Boystown, 2016)

# data[].attributes.headline
What do School Counselors Need to Know About Students with ODD?

# data[].attributes.subject
What do School Counselors Need to Know About Students with ODD?

# data[].attributes.body
Supporting Students with ODD

# data[].attributes.attachment_link.readable_text
Depression is defined as a mood disorder that causes a persistent feeling of sadness and loss of interest, according to the Mayo Clinic. A 2014 survey from the Abuse and Mental Health Service Administration reported that as many as 2.8 million adolescents in the United States between the ages of 12 and 17 experienced at least one depressive episode during that year alone. With the prevalence of this disorder, knowing how to recognize signs of depression in students can be extremely valuable in understanding and treating the condition.

Signs and Symptoms of Depression in Children and Teens

Depression cannot be attributed to one specific cause. Factors such as life events or even simply genetics can influence a student's likelihood of experiencing depression. Although depression sufferers may share common symptoms, the disorder affects each individual differently, with girls suffering from more than twice as many instances of depression as boys. Oftentimes, depression coincides with other disorders as well. Those that experience anxiety or eating disorders, for example, may also struggle with depression.

As depression manifests, it can negatively impact students' social development and their success in school. Young children experiencing depression may display behaviors such as clinginess, worry, or even a refusal to attend school, whereas teens with depression may resort to behavior such as substance abuse or self-harm.

Withdrawal, another warning sign of depression in children and teens, can have a large impact on the relationships that students have established. A student's battle with depression may not be evident to everyone in their life, and could alienate them from individuals closest to them. This could include friends and even educators, who are often among the first to notice problems because students spend much of their time in the classroom. Educators may initially see changes in behavior as a lack of effort on a student's part, but with knowledge about signs of depression in students, this behavior can be identified and addressed.

Although the most common indicators of depression are behavioral changes such as sadness, difficulty concentrating, and withdrawal, physical changes can also result from depression. Weight loss, upset stomach, and headaches are some of these examples, along with a host of other symptoms, including:

What Types of Depression Affect Children and Teens?

Depression is classified according to symptoms that differ from one form of the disorder to another. Three of the most common types of depression among children and teens are:

Major depressio n - With major depression, a student's feelings of sadness are ongoing. Children and teenagers suffering from this form of depression struggle with everyday tasks such as eating and sleeping, and are unable to feel happiness.

Dysthymia - Students with dysthymia may have low self-esteem and find it difficult to complete day-to-day functions without persistent feelings of hopelessness. This condition differs from major depression in that it is not as severe. Students may experience dysthymia for a year or longer.

Bipolar disorder - This disorder is characterized by intense mood changes, ranging from moments of low-energy depression to high-energy irritability.

Treatment and Management of Depression in Children and Teens

Talk therapy and medication have both been found to be effective forms of treatment for depression.

* Talk therapy: Cognitive behavioral therapy is a form of talk therapy that addresses thoughts, behaviors and feelings among depression sufferers, whereas interpersonal psychotherapy is focused on the relationships that students share with others. Educators, parents, and therapists can all play a role in ensuring that students experiencing depression receive the treatment they need by providing them with opportunities to freely express their thoughts and emotions. Talk therapy can be used alone or in conjunction with antidepressants.

* Medication: Antidepressants relieve the symptoms of depression by regulating neurotransmitters in the brain. If a doctor recognizes signs of depression in students while assessing them, they may prescribe medication accordingly. Because antidepressants can have a range of negative side effects, it is important that students taking the medication are monitored by a healthcare professional.

Whether an educator or a parent, when an individual learns to recognize the signs of depression in children and teens, they can better understand the disorder, show that they care, and extend opportunities for students to open up about coping with depression.

Those looking to aid students in managing their depression can utilize practices that will help improve students' overall health and mental well-being, preventing the frequency with which they experience feelings of sadness. Suggested depression management methods include:

* Exercise

* Sleep

* Relaxation techniques

* Spending time with close family and friends

Working Together to Help Children and Teens with Depression

Knowing how to recognize signs of depression in students is the first step in addressing the problem. By recognizing the disorder and seeking treatment for those experiencing it, educators, parents, and doctors can work together to improve students' overall well-being and prevent life-threatening situations from occurring. Students gain confidence and strengthen their relationships when they are given the correct tools to manage their disorder.
[9] "Symptoms." Mayoclinic.org. Retrieved from http://www.mayoclinic.org/diseases-conditions/depression/basics/symptoms/con-20032977 on June 8, 2016.

# data[].attributes.attachment_link.title
Recognizing Signs of Depression in Students | Pride Surveys

# data[].attributes.attachment_link.description
Depression is defined as a mood disorder that causes a persistent feeling of sadness and loss of interest, according to the Mayo Clinic[1]. A 2014 survey from the Abuse and Mental Health Service Administration reported that as many as 2.8 million adolescents in the United States between the ages of 12 and 17 experienced at ...

# data[].attributes.attachment_link.readable_text
I just found an amazing website that I thought I'd share with you. It's called The Counseling Youth With Depression. It seems like more and more students each year suffer from depression. . .well maybe it's not more each year, but I think as a society we are more aware of those who are depressed and the need to help make life more manageable for them.
Counseling Youth With Depression website is designed with school counselors in mind. The purpose is to provide resources and depression rating scales to counselors. An interesting fact that was posted is:

One of the most vulnerable groups for completed suicide is the 18-24 age group. Adolescent suicide is the second leading cause of death, following accidents, among youth and young adults in the U.S. It is estimated that 500,000 teens attempt suicide every year with 5,000 succeeding. Many of these teens suffer from depression.

One of the great features of the website is the resources that it links you up to. Several depression rating scales with a description of who it is best for and who can administer it, as well as lesson for school counselors to use on the topic of helping students understand depression as well as icebreakers and other get to know you activities. I guess I never knew how many teens attempted suicide every year, even though I have had several students that I have administered the Columbia Suicide Severity Rating Scale to. For more info about this free product and extremely useful tool, see
this post. And in case you missed it, take a look at this post for more information about Kognito, an online program to help teachers determine how to refer kids in crisis to their counselor.
Do you have any tools that you use to determine the severity of depression a student is dealing with? If you do, please share. Leave a comment or join in the conversation through one of the ways below:

# data[].attributes.attachment_link.description
I just found an amazing website that I thought I'd share with you. It's called The Counseling Youth With Depression . It seems like more and more students each year suffer from depression. .

# data[].attributes.headline
A School Counselor's Story about Serving Students with Depression

# data[].attributes.subject
A School Counselor's Story about Serving Students with Depression

# data[].attributes.attachment_link.readable_text
Depression can be an isolating illness. Despite progress in knowledge, stigma reduction, and treatment options, it is not uncommon for someone struggling with depression-or that person's family and friends-to feel alone. The goal of this blog series is to break through that isolation and connect the various people who play a role in any person's depression: the person themselves, a parent or caregiver, a school counselor, a clinician, and individuals who work in policy and advocacy. Though these specific individuals can only share their own journeys, each story is part of a larger narrative that illuminates what the entire worlds of depression and treatment can look like. The ultimate goal of this project is to share individual stories with a larger audience and to allow each stakeholder the chance to give advice to those who occupy different spaces in the journey and struggle of depression. Each interviewee was given the choice to have their story told with their name or to remain anonymous. Those who remain anonymous have chosen to do so in order to protect the confidentiality of their friends and family whose lives intertwine with their struggles. In those cases, the interviewee's name will be replaced with a random initial.
We welcome your thoughts and comments in our comment section! And, of course, thank you so very much to all of the brave individuals who so generously and vulnerably shared their stories with us.

Karen is a school counselor and is one of the staff sponsors for the Erika's Lighthouse Teen Club at Evanston Township High School (ETHS) in Evanston, IL. She first interacted with depression personally. She says that she always struggled with depression, but because people didn't talk about it, it was written off as the moodiness that comes with "being a girl." Karen was in a bad car accident that caused a brain injury which she believes triggered her depression. Without conversations and resources, Karen struggled for a long time and has worked hard to get a place where she can use her experiences to help others. It's a set of experiences she says she would never wish on anyone, but it has made her better at her job and has given her an important level of understanding.

Karen was a Physical Education teacher for quite a while and says that during that time she was moved by the vulnerability she saw in her students. She says she saw them "at their most raw" when they were asked to do things like swim in front of their peers or come together to support each other through tough team building challenges. Karen also led health class and spent time teaching her students about mental health. She feels, she says, like she had always been a counselor. She just needed a degree to back up that expertise and experience, so she went back to get a Master's degree in counseling.

Now, she is immersed in the world of mental health every day when she helps her students and their parents deal with what it means to need therapy, medication, and/or hospitalization. Though she does not always choose to disclose her own struggles, she is open about the fact that she has depression and lets the knowledge she has gained through the years guide and inform the students and parents with whom she works. Her role here varies based on the student and the situation, but she always aims to be open, caring, and easy to talk to. Sometimes, this means riding with a student in an ambulance if they have to be hospitalized; sometimes it is about letting students sit in her office to do school work if a typical classroom setting is too overwhelming; other times, it is about advocating for a student's right to mental health care and explaining the necessity to parents who are reluctant to access help. Karen's support can also just mean listening and empathizing with her students that depression is really, really hard, with both good days and bad days, but that one day at a time, students can get better.

The same way that a good therapist meets her client where they are, it is important to meet parents where they are in their understanding of mental health and working with them to help their children and provide information. However, because there is student confidentiality, it takes a lot of patience and care to navigate that boundary. This also means understanding the cultural norms and concerns of a student and their parents so that Karen can help the student engage in that conversation in a way which is effective for the student and helpful for their parents.

At ETHS, there is a movement towards more coordinated care within the high school which means that there are more resources in place to help students who need help or who are returning from in-patient treatment. There is now a clinician whose job it is to help students re-enter into the high school after being hospitalized; Karen calls this role an unfortunate necessity which is at the forefront of changing the ways in which the school can play an active role in the care of students struggling with mental illness. For students at ETHS who have been hospitalized, there is a full re-entry plan that is created and instituted by the hospital and the school. This means figuring out what information teachers are going to be given and if students want to create a signal for times when they might need to leave the room and access supports within the school. ETHS has a "red pass" procedure in place, where students can use their pass to visit the nurse, counselors, or social workers if they need a break from class.

Though disclosure is always up to the student, Karen feels like the more information teachers and other supportive adults in the building have, the more safeguards can be put in place to keep students happy and safe. By creating a safe school environment, students who need extra support can still access their education. Karen also discussed the process of getting official paperwork in place that formalize accommodations for students. She often has to help parents navigate the forms and figure out what kinds of choices will be best for their children. This coordinated care also means that the mental health professionals can all work together to provide the best possible service, instead of relegating some tasks to the social workers and others to the counselors.

Mental health, Karen says, is a priority of ETHS and of the community at large. Wellness is one of the school's major goals both for students and for faculty and staff. She has found wellness for herself-a process she actively engages in every day-and has been transformative both to ETHS and to the Erika's Lighthouse Teen Club there in breaking down stigma, advocating for students, and showing that a life with depression can still include a lot of compassion and caring.
What Karen wants you to know...
What should a young adult/child know? Recognize that what you are going through is tough and your feelings about your experience are valid; you might have a bad time and good time within five minutes of one another and that's okay. You are not alone: there are people here who want to be there for you and help you.

What would you want a parent to know? You can be a model of strength and empowerment for your children-they can see how to advocate for themselves and how to be there for another person selflessly and without judgment. Trust your child, be willing to hear what they need to tell you, and know that even if your child takes a step back know that you can move forward again.

What would you want another school counselor/social worker to know? We all took this job because we want to make a difference in the lives of the students we work with; sometimes this means thinking out-of-the-box to figure out what one specific student needs. Be open and empowering unconditionally.

What would you want a doctor/therapist/clinician to know? Find ways to push your clients safely. If you've been to a lot of therapists, you know how to be a client and move through therapy without digging too deeply into what is happening internally so you need to know how to help examine those things that need to be talked about but are easy to avoid.

What would you want a policy maker/advocate to know? Try to find ways to understand individual needs as they relate to policy. Also, make mental health care a part of more insurance policies so that people can access the care that they need with a therapist they connect to and can afford.

Story #4 of this blog series will be posted in a few short weeks! For more depression resources for schools, visit the school section of our website.

# data[].attributes.attachment_link.title
5 Perspectives On Teen Depression: A School Counselor's Story - Erika's Lighthouse

# data[].attributes.attachment_link.description
aren is a school counselor and is one of the staff sponsors for the Erika's Lighthouse Teen Club at Evanston Township High School (ETHS) in Evanston, IL. She first interacted with depression personally. She says that she always struggled with depression, but because people didn't talk about it,

# data[].attributes.attachment_link.readable_text
A group of female classmates has been harassing 13-year-old Marie for a month, making fun of her clothing and her weight. She has stopped socializing, other than to check Facebook to ensure no other hurtful things are being said about her. She sleeps fitfully, has stopped eating regularly and her grades have dropped.

Robert, Marie's classmate, didn't make the basketball team, which represented his singular dream. His recently divorced parents and his teachers have noticed he has grown much more irritable, to the point that other students avoid him.

His older brother, Randy, was previously a high school honor student. Now his grades have plummeted.

Kaitlyn, the girl who sits behind Randy in chemistry, smokes marijuana. She is often high in school and nearly always high when she is with her new group of friends. Her younger brother in fourth grade calls his foster mother and goes home sick from school one or two times per week.

Another student, Juan, always seems very sad. For two years, teachers have told his counselor about his mood. In Juan's file, the counselor finds similar reports dating back to middle school.

Under the current criteria, any one of these students might potentially be diagnosed with major depressive disorder, which generally involves a client experiencing six or more of nine common symptoms for a duration of two weeks, or dysthymic disorder, which presents as having a chronic depressed mood with two established symptoms for two years or more.

But based on proposed revisions, when the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5) is published approximately two years from now, new criteria will likely suggest that each of these students is depressed - by degrees.

"[The DSM-5] will introduce the idea of looking at disorders such as depression on a spectrum, with certain severity levels used as cut points to identify maladaptive symptoms and functioning, much like we associate blood pressure of 140 over 90 as higher risk," says Gary Gintner, associate professor of counselor education and program leader at Louisiana State University. "Depression, too, will have a dimensional rating that notes severity."

But no matter the process for diagnosis, experts would say that all of these students have serious symptoms of depression and need attention from counselors to help them feel better and address the problem early when it is easier to make inroads.

Gintner says at any one time, about 2 percent of children younger than age 12 have depressive disorders. That number rises to between 4 and 8 percent for those ages 12 to 18. Once adolescent girls hit puberty, their risk of depression is double that of their male classmates (see sidebar, page 34). The rate of depression among young people has increased every decade since the 1940s, according to Gintner, who trains counselors in the use of the DSM and is an expert in planned revisions for the DSM-5.

Each of the professionals interviewed for this article noted that an early diagnosis of depression can make it easier to treat the issue successfully, often with talk therapy.
The diagnosis
That means it is important for counselors - especially those in schools - to be the first line in identifying students struggling with depression.

According to Dr. Graham Emslie, a psychiatrist at Southwestern Medical Center in Dallas and a specialist in child depression, only about 40 percent of adolescents and children needing treatment get adequate care, often because the problem is not spotted. "It is a quiet problem," he says. "We tend to relieve the symptoms or simply not identify it."

One key indicator of depression among students is a precipitous drop in grades, he says, especially if accompanied by other symptoms of depression: low self-esteem, sleep problems, fatigue, apathy and feelings of worthlessness, changes in appetite, loss of pleasure in life and problems concentrating.

Gintner, a past president of the American Mental Health Counselors Association, a division of the American Counseling Association, notes that uncharacteristic or excessive irritability is a symptom associated with depressed adolescents and children. He adds that children may have temper tantrums, stomachaches or headaches associated with depression, while adolescents may be moody, act out or even injure themselves by cutting or burning their skin.

"Many times, the behavior is interpreted as oppositional, but the young person is actually depressed," Gintner says. "The key thing to look for is if they have one of these other depressive symptoms (see sidebar, page 35). And it is critical to identify these problems early when there is a greater chance of treating them successfully."

Often, experts say, life stressors cause depression. For children and adolescents, those stressors don't necessarily stem from a serious personal failure or a major event such as the death of a loved one but rather from common daily hassles or interpersonal problems, such as changes in relationships with peers.

James Matta, an associate professor of counseling at Geneva College in Pennsylvania and senior research principal at the Western Psychiatric Institute and Clinic in Pittsburgh, says counselors should pay particular attention to feelings of hopelessness among young people. "It hinders an individual's ability to form and maintain close relationships with family, friends and early romantic partners," he warns.

Matta, an ACA member who presented on depression in young people at the 2011 ACA Annual Conference in New Orleans, adds that comorbidity is not adequately studied or identified, even though substance use disorders and depression are often linked. Depressed young people are twice as likely to have a substance abuse problem than other adolescents, he says, and "comorbidity is more often seen than not in adolescents with substance use disorders."

Emslie says it is often difficult to determine whether certain characteristics and circumstances cause depression or whether they are symptoms of it. For instance, being bullied can cause children to become depressed, but depressed children might also be more likely to be targets of bullying because they are less likely to defend themselves and perhaps present themselves in a way that encourages bullies.
The treatment
When school counselors are concerned about a student, Matta says, it is critical that they develop a baseline for the student's mood, demeanor and performance in school, using communications with former teachers and counselors as a guide. Early treatment is key, he says.

"We are determining - and it's very affirming to counselors - that psychotherapy or talk therapy is most useful for those with mild to moderate levels of depression," he says. "Cognitive behavior therapy (CBT) and interpersonal therapy seem to be very effective."

Laura Choate, an associate professor at Louisiana State University and the author of books and papers on depression, particularly as it relates to young women (see sidebar, this page), says considerable research has reached that conclusion about treatment. She says the most effective components of CBT to date are psychoeducation about the nature of depression, the development of problem-solving skills, self-monitoring, building relationship skills, communication training (assertiveness, social interactions, family communication, active listening), cognitive restructuring and behavioral activation - for instance, increasing pleasant activities or setting small, achievable goals.

Choate, a member of ACA, notes that a popular "Coping With Depression-Adolescent" program from Kaiser Permanente's Center for Health Research is "among the most studied CBT programs for adolescents and has the most empirical support." The training manual and student workbook in individual and group formats are available for free at kpchr.org/acwd/acwd.html.

Meanwhile, through interpersonal therapy, young people improve relationships by building support and developing their interpersonal competence, Choate says. "Most counselors are not familiar with interpersonal therapy, but there is a strong line of research supporting its effectiveness with adolescents, particularly with girls of color from impoverished backgrounds," she says, noting that Laura Mufson, a researcher and professor at the Columbia University Medical Center, has developed research and training material surrounding the treatment.

Gintner says counseling should include positive interactions, active listening, restoring hope and doing problem solving for real problems. Emslie adds that family therapy is also useful.

Matta notes the American Psychiatric Association released guidelines for treatment of depression in October that suggested talk therapy is most effective initially for clients with less severe cases of depression. "Four to six weeks into treatment, if they are not showing improvement - or in more severe cases - then you consider an antidepressant," Matta says.

Emslie agrees: "Data would suggest that the persistence of the problem in spite of attempts to improve the situation is the best indicator for medication. Unfortunately, only 40 percent of young people who suffer from depression are treated, and only 20 percent of those treated use medication."

A study that Matta helped conduct found that young people with comorbidity who received both talk therapy and the antidepressant fluoxetine (more commonly known by the brand name Prozac) did not have significantly better results than those receiving only talk therapy, though both groups showed significant within-group improvement.

"It was not the specific intent of this study," Matta says, "but its results support the recent recommendation that psychotherapy intervention should be considered the first-line treatment in comorbid populations, with pharmacotherapy being offered to those who do not respond to psychotherapy intervention alone."

But Gintner cautions that the "old class" of antidepressants such as Elavil isn't helpful with children and youth, while selective serotonin reuptake inhibitors (SSRIs) only seem to work with adolescents. He also notes these drugs are not without risks.

"In 2000," he says, "studies began to find risk of suicide ideation or suicidal behavior increased from 2 percent with a placebo to 4 percent on SSRIs. It's a risk, but not a huge risk, so we have to weigh the risk versus the benefit and, sometimes, the benefit is significant." Research has shown that Paxil seems to have a higher incidence of suicidal ideation and acts, he says, while adding that Prozac is the only SSRI approved for use with youth by the U.S. Food and Drug Administration. The FDA recommends that youth taking SSRIs be seen by a psychiatrist every week for a month and be monitored closely, he points out.

Still, experts say better treatment techniques and the refined use of medication are helping increasing numbers of young people. And Matta notes the weighty issue is not without positive data. "Adolescent recovery rate is 90 percent over one to two years from the onset of depressive disorder with treatment," he says. "So we do know how to treat it."

Jim Paterson is a writer and editor and the head of counseling at Argyle Middle School in Silver Spring, Md. Contact him atjamespaterson7@gmail.com

Letters to the editor: ct@counseling.org

# data[].attributes.attachment_link.description
A group of female classmates has been harassing 13-year-old Marie for a month, making fun of her clothing and her weight. She has stopped socializing, other than to check Facebook to ensure no other hurtful things are being said about her. She sleeps fitfully, has stopped eating regularly and her grades have dropped.

# data[].attributes.headline
When a School Counselor Should Refer a Student to Outside Counseling

# data[].attributes.subject
When a School Counselor Should Refer a Student to Outside Counseling

# data[].attributes.attachment_link.readable_text
One of the questions I see pop up pretty regularly on IG and FB is "How do I set up a school counseling self-referral system?" While having students use google forms on computers in their class is an awesome idea, it's not a great fit for schools with limited technology or with students who don't have the needed computer/typing skills yet. Me? I love an old school paper and "mailbox" version. This post will walk you through how I introduce the system and how I problem solve issues with it.

Early each year, I make sure to cover the self-referral process in a class lesson with all of my grade levels. For some of my classes, especially the younger ones, I do an entire lesson around size of the problem - it's easy for them to think a conflict with a friend is an "emergency" without being explicit taught that it's not! For older grades, I usually just do a quick review of problem size and ask them to give me an example of each. With everyone, I tell them that their teachers and parents are great problem solvers but that if they want me to help them with a rainy, or thunderstorm, or tornado problem, that they can write me a note. Then I show them all the self-referral form and talk them through each of the spots. I also like to ask them why I need all of the information.

Then I show them an example of the self-referral form completed incorrectly - wrong problem size, missing last name, etc. I try to project it and then ask them to find the mistakes and I explain why those mistakes make it harder for me to help everyone.

On the outside of my office door is my " self-referral station ". I have a mini-poster reminding them of the size of problems, blank self-referral forms, my "mailbox", and a note reminding them of what to do. My mailbox is just an accordion folder. It's not closed or secure at all, but in my seven years of using it with 2nd-4th graders, I've never had an issue.

And now - some FAQ and problem solving!

Triage. There's a spot on the right side of my planner that is titled "follow-up" but that I use for "students I need to see this week". Anyone with a rainy or thunderstorm problem gets their name written there. If it's a tornado problem, I add their name in that column and I find the earliest open spot in my planner that I can see them and add their name. Whenever I have open time in my schedule, I look to the list of students on the right and start pulling them. If I'm feeling really proactive, I'll add their names into spots in my planner as well, but the truth is that I don't always get to that step.

Some years I also give some copies of the self-referral form to classroom teachers and related arts teachers. This past year, my teachers were a bit stricter about letting students go to get forms (and my office was a bit of a hike sometimes), so this cut down on hallway time and also helped to remind teachers of one of my roles.

If I feel pretty confident that a student is self-referring to try and get out of classtime, then I'll say "Hey, the only time I'm able to talk to you this week is lunch or recess. Is that ok? Or do you think you want to try and solve the problem on your own?" If they really do need my help, they will be ok with my pulling them whenever. If it becomes an ongoing issue, then I have a pretty frank conversation with the student about my suspicion...and turn it into a counseling conversation about their reasons for class avoidance and how I can help them with that.

We all have those kiddos that have a little bit trickier of a time effectively managing their conflict. Or who really like the validation they get from telling a safe person about someone being rude to them. When this starts to happen, I 1) review conflict resolution strategies, 2) post a visual of conflict resolution strategies on my door, and 3) ask the student write on the back of the self-referral form to tell me what things they've already tried.

1. Go outside to recess a few times. Bring a list of the students that self-referred. Pop a squat on the floor and meet with each of them one at a time. There's a good chance that some of them are only going to take just a few minutes, and that some will turn into mediations where it's great to have the other party(ies) right there to pull in. Ones that you want to use a specific intervention (toy, game, worksheet, etc.) with or that you think is pretty meaty, write their name down on a list to go back to lately.

2. There's an ebb and a flow to self-referrals. It's normal! You're likely to get a zillion right after you first introduce the system. And then right before/after breaks (family stuff), and then again when spring fever hits.

3. This is great informal data! If you're getting lots of self-referrals for the same thing within a specific grade, that's a clue that there's a need for some small groups or class lessons on that topic.

4. Is there anything you can add to classrooms to help students handle their own problems better? Conflict resolution strategy posters? I-Message sentence stems? A peace corner? It's awesome to feel needed; it's an even better feeling when we've taught students how to be successful without us.

Pin for later:

# data[].attributes.attachment_link.title
School Counseling Self-Referral System - The Responsive Counselor

# data[].attributes.attachment_link.description
One of the questions I see pop up pretty regularly on IG and FB is "How do I set up a school counseling self-referral system?" While having students use google forms on computers in their class is an awesome idea, it's not a great fit for schools with limited technology or with students who don't have the needed computer/typing skills yet.

# data[].attributes.attachment_link.readable_text
Part of tiered school counseling services are school counseling referrals from teachers. Getting teachers to make referrals can be a challenge. You can also have teachers who refer way more students than they should. Check out these tips from Laura and Rebecca for how to work with teachers to make necessary referrals.

Work With Them

I often think that teachers who over-refer are really just very excited about the services we have to offer. I usually sit with them and ask them what skills they are hoping to build in a student or a group of students. If a large portion of the class seems to need skill-building, I'll offer to teach extra classes in addition to my normal schedule.

For a small group of students, I work with them to problem solve using the I always want teachers, parents, and administration to feel supported by the school counseling program. At the same time, I really don't have a magic wand. By requesting teachers to work with me, we build a better support network for students without me owning the whole problem.

Educate Them

At the beginning of the year I do a presentation with my staff on counseling services and explain that a counselor has tiered services, similar to academic intervention tiers. After completing a needs assessment, I try and follow up by visiting teacher PLC and plan meetings to discuss needs and services that will help us reach the most students. I share data with them through newsletters and meetings so they get a better understanding of my use of time.

During School Counselor Week, I share with them information on services and the role of the counselor, for example that we provide short term counseling and not long term therapy.

Lastly, I use punch cards made from VistaPrint, for students and teachers to have a reminder of meeting dates, but also to give them a visual for how many times (approximately 5) that I meet with students. I think the punch cards help increase the knowledge that we provide short term solution focused sessions, ideally with an end date or transition to outside services.

I think getting accurate, needed referrals comes down to a teacher's understanding of counseling services and me sticking to a tiered system. I meet with each grade level to assess their needs, develop a plan for students we know will need services immediately, go over how they can make a referral, and when they should.

Also, I have to be firm about what services are needed. I do not need to see each student in small groups or individually. I can provide strategies for a teacher or push-in for classroom support. This helped make sure services weren't spread too thin and helped teachers understand the decision making process.

# data[].attributes.attachment_link.title
Strategies for When Teachers Over Refer Students - Confident Counselors

# data[].attributes.attachment_link.description
Part of tiered school counseling services are school counseling referrals from teachers. Getting teachers to make referrals can be a challenge. You can also have teachers who refer way more students than they should. Check out these tips from Laura and Rebecca for how to work with teachers to make necessary referrals.

# data[].attributes.headline
How the School Counselor Can Support a Student with an Eating Disorder

# data[].attributes.subject
How the School Counselor Can Support a Student with an Eating Disorder

# data[].attributes.attachment_link.title
The School Counselor's Role in Addressing Eating Disorder

# data[].attributes.headline
How School Counselors Can Support Students with Bipolar Disorder

# data[].attributes.subject
How School Counselors Can Support Students with Bipolar Disorder

# data[].attributes.attachment_link.provider_name
National Association of School Psychologists (NASP)

# data[].attributes.attachment_link.readable_text
Editor's Note: This is the second of a two-part article on bipolar disorder in children. Part I appeared in the October 2005 issue and is posted online (www.nasponline.org). Treatment and Intervention Research Medical Management of Bipolar Disorder
Part I of this series focused on identification and diagnosis of bipolar disorder in children. In children, bipolar disorder usually shows a different pattern than the classic adult presentation with rapid cycles of manic, depressed, and mixed periods with indistinguishable episodes eliciting instability in behavior, mood, energy, and sleep (e.g., Kowatch et al., 2005). It is a chronic disability exacerbated by co-existing disorders affecting all areas of a child's functioning. As research continues to define the nature of the disorder in children, school psychologists require current knowledge about treatment in order to develop intervention plans for the child to be successful in the educational setting.

Treatment of bipolar disorder in childhood has followed a downward extension, utilizing protocols similar to those designed for adults with bipolar disorder (Ryan, 2003). Only recently has there been research focusing specifically on children and adolescents diagnosed with bipolar disorder (Frazier et al., 2001; Fristad, Goldberg-Arnold, & Gavazzi, 2003; Kowatch et al., 2000). Part II presents information on medical treatment, psychosocial interventions, and implications for the school psychologist to provide school-based strategies to support the complex needs of children with bipolar disorder.

Treatment of bipolar disorder in children often involves the prescription of psychotropic medications. The most commonly prescribed classes of medication are mood stabilizers and antipsychotics; however SSRIs (selective serotonin reuptake inhibitors) and stimulant medications are often used (Kowatch et al., 2005).

Research regarding the use of these medications in children is limited, and treatment guidelines for children with bipolar disorder are largely based on research studying adults. Nonetheless, the severity of symptoms exhibited by children with bipolar disorder necessitates the use of medication as part of treatment with goals of reducing symptoms, preventing reoccurrence, treating coexisting disorders, and improving the child's ability to function.

Mood stabilizers are used to alleviate symptoms of mania or depression and to control mood cycling (Fristad & Goldberg-Arnold, 2004). Mood stabilizers include Lithium, divalproex, and carbamazepine.

Lithium is the first known mood stabilizer and is the most frequently prescribed medication in adults with bipolar disorder (Kahn, Ross, Printz & Sachs, 2000). Lithium has been shown to stabilize and prevent rapid cycling of moods as well as decrease instances of suicide (Ryan, 2003). Side effects of Lithium include weight gain, sedation, tremors, acne, hypothyroidism, increased urination, and gastro-intestinal symptoms, and it can be lethal in overdose (Kusumakar, Lazier, MacMaster & Santor, 2002). The Food and Drug Administration (FDA) has only approved Lithium for use in children older than 12 years of age (Giedd, 2000). Lack of approval is mostly due to limited availability of controlled research studies, not lack of efficacy or appropriate safety profile.

Divalproex (i.e., valproic acid, depakene, depakote, depakote XR) is an anticonvulsant medication used to treat seizures, prevent migraines, and manage mood cycling. In adults, divalproex has been effective in treating mixed episodes and rapid cycling (Ryan, 2003). Divalproex also has worked well in managing co-existing disorders such as substance abuse and anxiety disorders (Kahn et al., 2000). Common side effects include weight gain, sedation, tremors, and gastro-intestinal complaints. Less common side effects include polycystic ovary syndrome, transient thrombocytopenia (i.e., decrease in blood platelets), blood dyscrasia (i.e., abnormalities in blood or bone marrow's cellular components), and hypersensitivity (Schapiro, 2005).

Carbamazapine (i.e., Tegretol) is an anticonvulsant medication also used to treat bipolar disorder (Ryan, 2003), showing efficacy in adults with both euphoric and mixed manic episodes. Common side effects include weight gain, gastro-intestinal complaints, sedation, and dizziness. Less common side effects include rash, Steven-Johnson syndrome (i.e., severe reaction to medication), blood dyscrasia, cardiac arrhythmias, bone marrow suppression, and liver inflammation (Schapiro, 2005).

Antipsychotics are used to control psychotic symptoms (e.g., delusions and hallucinations), stabilize mood, and decrease agitation (Fristad & Goldberg-Arnold, 2004). Atypical antipsychotics include risperidone (i.e., Risperdal), olanzapine (i.e., Zyprexa), quetiapine (i.e., Seroquel), and clozapine (i.e., Clozaril). A recent review investigating the effects of antipsychotic medication in children with bipolar disorder revealed that the majority of studies are anecdotal and/or short term in nature (Cheng-Shannon, McGough, & Pataki, 2004). However, initial findings suggest that the use of antipsychotics can be effective by decreasing symptoms that occur in a manic state. They also may be used in combination with mood stabilizers to aid in controlling aggression often exhibited by children with bipolar disorder (Pavuluri, Naylor, & Janicak, 2002). Tardive dyskinesia (i.e., abnormal involuntary movements), a potentially irreversible syndrome, has been associated with typical antipsychotics, and less often with atypical antipsychotics (Kahn et al., 2000; Schapiro, 2005). Atypical antipsychotics are relatively new and tend to have a better side effect profile than typical antipsychotics.

Selective serotonin reuptake inhibitors (SSRIs) have been effective in reducing depressive symptoms in bipolar disorder after mood stabilization (Biederman et al., 2000). SSRIs also have been effective in treating anxiety disorders that may coexist with bipolar disorder. Healthcare providers must proceed with caution when using SSRIs as they can cause activation that may be misinterpreted as a mania and/or ADHD (Lansford, 2005). Faedda and colleagues' (2004) retrospective study of 82 children who met the DSM-IV criteria for bipolar disorder indicated that of the 69% of the children who were given a mood-elevating medication, 58% met the criteria for treatment-emergent mania (TEM). The authors found that antidepressants are associated with TEM twice as often as stimulant medication. Thus, meticulous monitoring of children taking SSRI's for activation or worsening of manic symptoms is imperative.
Psychosocial Interventions
Stimulants are the main class of medications utilized to treat ADHD in children and include medications such as Ritalin, Ritalin LA, Adderall, Adderall XR, Concerta, Focalin, Focalin XR, and Methylin. Extensive research has supported their safety and efficacy in treating ADHD. Stimulants are felt to be ineffective in the treatment of bipolar disorder and may actually induce mania in some children (Giedd, 2000; Schapiro, 2005). However, if ADHD coexists with bipolar disorder, the addition of a stimulant as adjunct therapy can be useful after mood stabilization has occurred (Lansford, 2005; Pavuluri et al, 2002). However, mood should be successfully controlled and ADHD symptoms should be negatively impacting the child's ability to function in multiple settings before prescribing stimulants (Kowatch et al., 2005).

Psychopharmacological treatment of bipolar disorder in children can be challenging given the limited amount of research and the complexity surrounding diagnosis. Of those studies that exist, only short-term results have been reported and long-term use in children has not been investigated thoroughly. Before initiating medication, the target symptoms in a child should be delineated to assist in determining the mode of psychopharmacological treatment. Diligent follow-up is imperative when managing medication in children with bipolar disorder due to potential side effects (Cheng-Shannon, McGough, & Pataki, 2004). Blood level monitoring of medications is necessary, especially with lithium and divalproex, to assist the healthcare provider in determining whether the child is getting enough medication, but not more than necessary to prevent adverse side effects. Periodic blood counts (e.g., CBC) and liver/thyroid/kidney function tests also are recommended because of the potential impact these medications may have on those particular body systems (Kahn et al., 2000).

Due to the extreme mood lability that is often present in children with bipolar disorder, psychotropic medications often are used as the first mode of treatment prior to psychosocial intervention efforts. To date, well-established psychosocial treatment has not been substantiated for children with bipolar disorder. Although guidelines exist that outline treatment approaches with individuals, groups, and families (Geller & DelBello, 2003; Mackinaw-Koons & Fristad, 2004), these recommendations are based on clinical experience and have not yet been empirically validated.

Cognitive-behavioral strategies. Initial research has suggested that cognitive-behavioral therapeutic strategies and family psychoeducational approaches may be effective in the treatment of bipolar disorder in children (Kowatch et al., 2005). Danielson and colleagues (2004) proposed a model for cognitive-behavioral treatment of children with bipolar disorder consisting of 12 therapeutic sessions. Potential follow-up treatment, if needed, includes a focus on medication compliance, mood monitoring, anticipation of stressors, problem-solving, identification and modification of unhelpful thinking, sleep regulation, relaxation, and family communication. Preliminary results regarding the efficacy of this treatment are pending.
Implications for School Psychologists
Family-focused strategies. Pavuluri and colleagues (2004) demonstrated promising results for the use of combined cognitive-behavioral and family-focused strategies (e.g., problem-solving techniques for the family and behavioral management techniques to establish routine and consistency), showing overall improvements in global functioning in the child with bipolar disorder based on therapist ratings. The children in this research also concurrently received psychopharmacological treatment. Fristad and colleagues (2003) found increases in positive family ratings, perceptions of parental support by children, and knowledge regarding bipolar disorder among randomized participants receiving family psychoeducation when compared to wait-list controls. Miklowitz and colleagues (2004) published preliminary research suggesting that involving families via psychoeducation in the treatment of bipolar disorder in children decreases both depressive and manic symptoms and improves overall behavior at one year post-treatment.

Although future research is needed to further establish efficacy, utilizing cognitive-behavioral strategies and involving families in treatment is a rising trend in treatment of mood disorders. When paired with psychopharmacologic treatment, these psychosocial interventions seem hopeful in decreasing the severity of some of the symptoms that are prevalent with bipolar disorder in children.

Intervention development in schools. Each child with bipolar disorder has a unique pattern of symptomology often making it difficult to determine the most effective plan of intervention in the school setting. Using a systematic, consultative, and problem-solving approach that incorporates collaboration among the family, educators, medical providers, and community members can guide the school psychologist in developing successful individualized interventions. The Biopsychoeducational Model of Consultation for the assessment, intervention, and evaluation of children with pediatric health issues and chronic disabilities provides this structure (Grier & Bradley-Klug, 2004). The first stage of problem identification distinguishes and prioritizes challenging or problematic behaviors. Stage two of problem analysis results in an understanding of the function of the problem behavior from thorough investigation of potential contributing factors including child issues, family triggers, educational aspects, and medical components. In stage three, a specific intervention plan can be developed and implemented. Finally, and most importantly, the intervention plan requires evaluation to determine effectiveness and/or need for modification. Applying the Biopsychoeducational Model's foundation of problem-solving (a skill in which school psychologists are well versed) to address the child's entire ecology while collaborating with those involved in treatment can prove useful in building interventions for the child with bipolar disorder in the school setting.

School-based interventions. Several avenues of school-based intervention are available for the child with bipolar disorder including differing levels of special education services, specific classroom modifications in general and special education classrooms, and/or direct services provided by the school psychologist. Children diagnosed with bipolar disorder can be served in general education, special education, or a combination of the two services. A formal plan can be developed under Section 504 of the Rehabilitation Act if the disorder substantially limits the child's education. Generally, this type of plan is implemented through accommodations in the general education classroom and/or within the school environment, but it can also include behavior plans and school-based counseling.

Under IDEA, an Individual Education Program (IEP) can be created under the "Emotional Disability" or "Other Health Impaired" programs if the disorder adversely affects the child's learning. The Child and Adolescent Bipolar Foundation has advocated for children with bipolar disorder to be identified as "Other Health Impaired" due to the biological component of the illness. School psychologists should be integrally involved in developing the educational plan for a child diagnosed with bipolar disorder.

School psychologists also may provide direct intervention services including individual counseling, social skills training, class-wide intervention, psychoeducation to teachers/administrators/parents/students, and/or group counseling. Further, the school psychologist could function as a "mentor" or provide a "safe zone" for a child experiencing aggression or rage episodes. School psychologists are equipped with the basic skills necessary to advocate for and directly serve students with challenging behaviors associated with bipolar disorder.

Best practices direct school psychologists to tailor placement options and intervention strategies to the individual needs of the child. A "one size fits all" approach should not be employed. However, some specific interventions might be more relevant for children with bipolar disorder based on their specific pattern of symptoms. Papolos and colleagues (2002) outlined relevant school interventions that correspond to potential symptoms and side effects of medications used to treat bipolar disorder. These modifications may be included in the IEP or 504 plan based on the student's symptom expression. It is recommended that school psychologists and educators become familiar with potential side effects associated with medications commonly used to treat bipolar disorder and recognize when medical consultation is warranted. Any change in school performance, mood, energy level, self-esteem, behavior, interaction with peers, and participation in activities should warrant a medical evaluation. Side effects such as excessive thirst at school can be easily managed by allowing the child to have access to a water bottle during the school day. A child with an increased need for urination may require accommodations such as unrestricted bathroom privileges. Increased hunger also may interfere with school functioning, necessitating a system of scheduled, nutritious, and satisfying snacks for the student.

Like many with chronic illnesses and disabilities, school-age children with bipolar disorder often have difficulties in medication compliance. School psychologists may be able to create, in collaboration with the school nurse, a behavioral intervention plan to increase adherence to the student's medication regimen during the school day.

Specific symptoms of bipolar disorder also warrant changes to educational programming (Papolos et al., 2002). Some children with bipolar disorder may have a disturbed sleep-wake cycle, and thus a school may allow that student to start class later in the morning or to schedule academic classes later in the day so that the student is more alert. A student experiencing great irritability or rage episodes may be assigned a "safe zone" during times of great duress. This student also may be assigned to specific meeting times with a guidance counselor, school-based mental health professional, and/or school psychologist for learning anger management and/or relaxation techniques. For those students exhibiting perfectionistic tendencies with writing, teachers may allow verbal response for tests and/or typing. Those students with attention problems may benefit from similar interventions used for students with ADHD such as preferential seating, provision of frequent breaks, and instruction in organizational strategies. See the resource list for additional sources of intervention.

Consultation.Another defining role of the school psychologist is consultation, which also can be applied to helping the student with bipolar disorder on several levels. In school, the school psychologist can offer information to other educators (e.g., school nurses, administrators, teachers, social workers, guidance counselors, fellow school psychologists, and therapists) about bipolar disorder in children to give them tools to successfully manage the symptoms associated with bipolar disorder in the educational setting. Consultation may involve giving direct support to teachers in terms of mood and behavior management in the classroom; problem solving difficult situations and challenging behaviors with the teacher, parent, and/or IEP Team to develop intervention and crisis plans (e.g., as part of informal assessments of Functional Behavior Assessments); offering suggestions as a contributing member in a multidisciplinary team meeting (e.g., IEP, Student Assistance Team, 504 plan, informal planning); and proposing recommendations for academic and behavioral accommodations to support the student in the general and special education classrooms.

Consultation with family members of children with bipolar disorder may involve serving as a support system for the family and providing information and resources. Fristad and Goldberg-Arnold (2003) suggest using a positive, informative approach when working with families that includes avoiding blame, building on families' strengths, and encouraging families to accept, tolerate, and manage symptoms. As with many chronic illnesses, parents of children with bipolar disorder often feel like they are struggling against treatment providers rather than working with them (Mackinaw-Koons & Fristad, 2004). School psychologists can provide families with support proactively by listening and offering suggestions for references (e.g., internet sources, books, or handouts). See resource list at the end of the article. School psychologists also should be aware of local advocacy and support groups in their areas. A listing of these support groups by state can be found through the Child and Adolescent Bipolar Foundation's website ( www.bpkids.org).
Conclusion
Finally, a school psychologist can provide valuable consultation to medical and mental health professionals who work with the student with bipolar disorder outside the school setting. The educational system has many rules and guidelines for determining services for a child. The school psychologist can communicate and explain the process of determining eligibility and developing school-based strategies to these professionals. This communication also lays the groundwork for a collaborative relationship that will proactively provide appropriate intervention and follow-up based on the child's individual needs across settings.
Resources Websites
Collaboration. Working with parents, other psychologists, educational personnel, community members, and medical professionals to support the needs of a student with bipolar disorder is a necessary and defining part of the school psychology profession. The complexity of the diagnosis and uncertainty of the treatment associated with bipolar disorder underscores the importance of a quality collaborative relationship between all those involved in helping the student with bipolar disorder.

Bipolar disorder exists in children and has the potential to be a severely impairing illness impacting all areas of the child's life. Although our knowledge is evolving, many uncertainties and questions remain. Best practices guides school psychologists to: (1) stay abreast of the evolving research; (2) focus on the problematic or challenging behavior and needs of each individual child to best provide appropriate interventions in the school setting; (3) consult with teachers to support their needs in working with children with bipolar disorder; (4) consult with parents to support their needs in parenting and dealing with educational issues of students with bipolar disorder; (5) collaborate with the child's medical professionals including pediatricians, psychiatrists, psychologists, and/or counselors; and (6) evaluate the effectiveness of intervention efforts. School psychologists who proactively apply these skills will successfully support the needs of this unique population of children with bipolar disorder.
Books for parents
Juvenile Bipolar Research Foundation--www.bpchildresearch.org/
edu_forums/accommodations.html

Child and Adolescent Bipolar Foundation--www.bpkids.org
Books for children
Fristad, M. A., & Goldberg-Arnold, J.S. (2004). Raising a moody child: How to cope with depression and bipolar disorder. New York: Guilford Press.

Papolos, D., & Papolos, J. (2002). The bipolar child: The definitive and reassuring guide to childhood's most misunderstood disorder (revised and expanded edition). New York: Broadway Books.
Handouts
Anglada, T. (2004). Brandon and the bipolar bear: A story for children with bipolar disorder. Victoria, BC: Trafford Publishing.

McGee, C. C., Hall, N.C. (2002). Matt the moody hermit crab. Nashville: Soul Wave Publishers.
References
Lofthouse, N., Mackinaw-Koons, B., & Fristad, M. (2004). Bipolar spectrum disorders: Early onset. InA. S. Canter, L. Z. Paige, M.D. Roth, I. Romero, & S. Carroll (Eds.), Helping children at home and school II: Handouts for families and educators (pp. S5-13-S5-16). Bethesda, MD: National Association of School Psychologists.

NIMH Update: http://www.nimh.nih.gov/
publicat/NIMHbipolarupdate.pdf

Biederman, J., Mick, E., Spencer, T. J., Wilens, T. E., & Faraone, S. V. (2000). Therapeutic dilemmas in the pharmacotherapy of bipolar depression in the young. Journal of Child and Adolescent Psychopharmacology, 10, 185-192.

Cheng-Shannon, J., McGough, J., & Pataki, C. (2004). Second-generation antipsychotic medications in children and adolescents. Journal of Child & Adolescent Psychopharmacology, 14, 372-394.

Danielson, C. K., Feeny, N. C., Findling, R. L., & Youngstrom, E. A. (2004). Psychosocial treatment of bipolar disorder in adolescents: A proposed cognitive-behavioral intervention. Cognitive and Behavioral Practice, 11, 283-297.

Faedda, G. L., Baldessarini, R. J.,& Glovinsky, I. (2004). Treatment emergent mania in pediatric bipolar disorder: A retrospective case review. Journal of Affective Disorders, 82(1), 149-158.

Frazier, J. A., Biederman, J., Tohen, M., Feldman, P., Jacobs, T., Toma, V., et al. (2001). A prospective open-label treatment trial of olanzapine monotherapy in children and adolescents with bipolar disorder. Journal of Child and Adolescent Psychopharmacology, 11, 239-250.

Fristad, M. A., & Goldberg Arnold, J. S. (2003). Family interventions for early-onset bipolar disorder. In B. Geller & M. P. DelBello (Eds.), Bipolar Disorder in Childhood and Early Adolescence (pp. 295-313). New York: Guilford Press.

Fristad, M. A., & Goldberg-Arnold, J.S. (2004). Raising a moody child: How to cope with depression and bipolar disorder. New York: Guilford Press.

Fristad, M. A., Goldberg-Arnold, J. S., & Gavazzi, S. M. (2003). Multi-family psychoeducation groups in the treatment of children with mood disorders. Journal of Marital and Family Therapy, 29, 491-504.

Geller, B., & DelBello, M. P. (2003). Bipolar disorder in childhood and early adolescence. New York: Guilford.

Giedd, J. N. (2000). Bipolar disorder and attention-deficit/hyperactivity disorder in children and adolescents. Journal of Clinical Psychiatry, 61, 31-34.

Grier, J. E. C., & Bradley-Klug, K. (2004, April). A biopsychoeducational model of consultation for students with pediatric health issues. Paper presented at the annual meeting of the National Association of School Psychologists, Dallas, Texas.

Kahn, D., Ross, R., Printz, D., & Sachs, G. (2000). Treatment of bipolar disorder : A guide for patients and families. A Postgraduate Medicine Special Report, 1-8.

Kowatch, R. A., Fristad, M., Birmaher, B., Wagner, K. D., Findling, R. L., & Hellander, M. (2005). Treatment guidelines for children and adolescents with bipolar disorder: Child psychiatric workgroup on bipolar disorder. Journal of American Academy of Children and Adolescent Psychiatry, 4(3), 213-235.

Kowatch, R. A., Suppes, T., Carmody, T., Bucci, J., Hume, J., Kromelis, M., et al. (2000). Effect size of lithium, divalproex sodium and carbamazepine in children and adolescents with bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 713-720.

Kusumakar, V., Lazier, L., MacMaster, F. P., & Santor, D. (2002). Bipolar mood disorder: Diagnosis, etiology and treatment. In S. Kutcher (Ed.), Practical child and adolescent psychopharmacology. Cambridge: Cambridge University Press, 106-133.

Lansford, A. (2005). The importance of recognizing a child with bipolar disorder. Contemporary Pediatrics, 22, 69-78.

Mackinaw-Koons, B. & Fristad, M. A. (2004). Children with bipolar disorder: How to break down barriers and work effectively together. Professional Psychology: Research and Practice, 35, 481-484.

Miklowitz, D. J., George, E. L., Axelson, D. A., Kim, E. Y., Birmaher, B., Schneck, C., Beresford, C., Craighead, W. E., Brent, D. A. (2004). Family-focused treatment for adolescents with bipolar disorder. Journal of Affective Disorders, 82S, S113-128.

Papolos, J., Hatton, M. J., Norelli, S., Garcia, C. E., & Smith, A. M. (2002). Challenging negative remarks that threaten to derail the IEP process. Retrieved February 19, 2005, from http://www.bpchildresearch.org/
edu_forums/accommodations.html.

Pavuluri, M. N., Grayczyk, P., Carbray, J., Heidenreich, J., Henry, D., Miklowitz, D. (2004). Child and family focused cognitive behavior therapy in pediatric bipolar disorder. Journal of American Academy of Child and Adolescent Psychiatry, 43, 528-537.

Pavuluri, M. N., Naylor, M. W., & Janicak, P. G. (2002). Recognition and treatment of pediatric bipolar disorder. Contemporary Psychiatry, 1 (1), 1-9.
© 2005, National Association of School Psychologists. Elizabeth Chesno Grier, PhD, NCSP, is on the faculty of the University of South Carolina School of Medicine; Megan L. Wilkins, MA, is a graduate student in school psychology at the University of South Carolina; Laura Szadek, RN, MSN, CPNP, is a clinical nurse practitioner at the University of South Carolina School of Medicine. The submission and editing of this article was coordinated by Contributing Editor Steven Shaw.
Ryan, N. D. (2003). The pharmacological treatment of child and adolescent bipolar disorder. In B. Geller & M.P. DelBello (Eds.), Bipolar disorder in childhood and early adolescence (pp. 255-271). New York: Guilford.

Schapiro, N. A. (2005). Bipolar disorders in children and adolescents. Journal of Pediatric Health Care, 19, 131-141.

# data[].attributes.attachment_link.title
Bipolar Disorder in Children: Treatment and Intervention, Part II

# data[].attributes.attachment_link.description
Editor's Note: This is the second of a two-part article on bipolar disorder in children. Part I appeared in the October 2005 issue and is posted online ( www.nasponline.org ). Treatment and Intervention Research Medical Management of Bipolar Disorder Part I of this series focused on identification and diagnosis of bipolar disorder in children.

# data[].attributes.headline
Accommodations for Students with Bipolar Disorder

# data[].attributes.subject
Accommodations for Students with Bipolar Disorder

# data[].attributes.attachment_link.readable_text
Error! You must specify a value for the Video ID, Width, Height and Anchor parameters to use this shortcode!

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

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

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

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

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

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

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

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

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

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

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

Shortened assignments.

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

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

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

Preferential seating in the classroom.

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

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

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

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

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

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

Students on some medications may need:

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

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

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

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

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

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

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

# data[].attributes.attachment_link.title
Accommodations for Students with Bipolar Disorder and Related Disabilities - International Bipolar Foundation

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