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What Are Psychotic Disorders?

Psychotic disorders are mental disorders in which a person's personality is severely confused and that person loses touch with reality. When a psychotic episode occurs, a person becomes unsure about what is real and what isn't real and usually experiences hallucinations, delusions, off-the-wall behavior, chaotic speech and incoherency. A person behaving in this manner is often referred to as being schizophrenic.

A hallucination is an internal sensory perception that isn't actually present and can be either visual or auditory. Smelling odors or having a funny taste in the mouth are other hallucinations that may occur. A delusion is defined as a false, inaccurate belief that a person holds on to. A grandiose delusion occurs when a person believes that their life is out of proportion as compared to what is really true. For example, a patient may believe that she is God or Jesus Christ. A persecutory delusion occurs when a person believes that there is a conspiracy amongst others to attack, punish or harass him. Although these hallucinations and delusions appear odd to others, they are very real to the person with the disorder.

What Are the Types of Psychotic Disorders?

Schizophrenia

The most common psychotic disorder is schizophrenia. Patients with this condition experience changes in behavior, delusions and hallucinations that last longer than six months. Those diagnosed with this type of disorder often show a decline in social function, school and work.

Schizoaffective Disorder

Patients with schizoaffective disorder have symptoms of both a mood disorder, such as depression and schizophrenia.

Schizophreniform Disorder

When a patient with schizophrenia has symptoms that last fewer than six months are diagnosed with schizophreniform disorder.

Brief Psychotic Disorder

When a patient has only short, sudden episodes of psychotic behavior, the condition is diagnosed as brief psychotic disorder. These episodes are typically a response to a stressful situation and usually last less than a month.

Delusional Disorder

Patients that have false, fixed beliefs involving real-life situations that could be true, such as having a disease or being conspired against, are diagnosed with delusional disorder. These delusions persist for at least one month.

Substance-Induced Psychotic Disorder

Sometimes, withdrawal from substances like methamphetamines and alcohol cause delusions and hallucinations. This is known as substance-induced psychotic disorder.

Psychotic Disorder Due to a Medical Condition

When psychotic disorder symptoms are a result of illnesses that affect the function of the brain, such as a brain tumor, the patient is diagnosed with psychotic disorder due to a medical condition.

Paraphrenia

Paraphrenia is schizophrenia in elderly patients.

Who Can Get a Psychotic Disorder?

Approximately 1 percent of the population suffers from a psychotic disorder. These conditions are most commonly found in people in their late teens to early thirties and effects men and women equally. Like many other mental disorders, psychotic disorders are often genetic. People who have a family member with this type of disorder are more likely to develop it than those who do not have a family history of it. It is also believed that these disorders are related to the hyper activity of chemicals in the brain that are vital to normal functioning. Additionally, those who experienced brain injury during fetal development or childhood are at a higher risk of developing the condition.

How Are Psychotic Disorders Diagnosed?

If the symptoms of a psychotic disorder appear in an individual, the doctor will conduct a physical exam as well as gather medical history. Once physical reasons for the abnormal behaviors are ruled out, the doctor will then refer the patient to a psychiatrist. Psychiatrists have a specific set of tools to properly diagnose a psychotic disorder.

How are Psychotic Disorders Treated?

The two main forms of treatment for psychotic disorders are medication and psychotherapy. The signature medications to treat psychotic disorders are antipsychotics. These medications aid in managing the symptoms of the disease like the hallucinations and delusions. Some examples of antipsychotics are pimozide, haloperidol, chlorpromazine and amisulpride. Depending on how each individual is affected by the medications, it may be necessary for the doctor to prescribe more than one consecutively until the proper medication is found that meets the required results.

Psychotherapy for psychotic disorders may include individual sessions, family sessions and support groups. While most patients are treated as outpatients, in severe cases, such as when the physical well-being is in danger, hospitalization may be necessary to stabilize the patient's condition.

In addition to medication and psychotherapy, self-help can also aid in successfully managing living with psychotic disorders. It is important that the patient learn how to cope when these episodes occur and learn how to find help on treating someone with psychosis. Studying and learning as much as possible about the specific disorder is vital to managing a healthy, happy, fulfilling life.

What Is the Prognosis for Those with Psychotic Disorders?

Many people who have been diagnosed with a psychotic disorder tend to lead productive lives and function normally with the proper treatment. The prognosis for those with psychotic disorders varies from person to person. For example, women tend to respond better to medication than men. Those with a family history of illness have a lower prognosis than those without. The number of negative symptoms also determines the individual prognosis as well as age; the older the patient, the more promising prognosis. Another important factor in determining prognosis is the individual's support system. Most will never fully recover from or be cured of psychotic disorders and will need to continue treatment for the duration of their lives. To maintain mental and physical stability with the condition, it is important for patients to strictly follow the treatment of psychotic disorders recommended by their healthcare providers.

For more on the topic of Psychotic Disorders, we've included the following expert consensus documents as reference materials:

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What Are Psychotic Disorders? Psychotic disorders are mental disorders in which a person's personality is severely confused and that person loses touch with reality. When a psychotic episode occurs, a person becomes unsure about what is real and what isn't real and usually experiences hallucinations, delusions, off-the-wall behavior, chaotic speech and incoherency.

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Disruptive behavior disorders are among the easiest to identify of all coexisting conditions because they involve behaviors that are readily seen such as temper tantrums, physical aggression such as attacking other children, excessive argumentativeness, stealing, and other forms of defiance or resistance to authority. These disorders, which include ODD and CD, often first attract notice when they interfere with school performance or family and peer relationships, and frequently intensify over time.

Behaviors typical of disruptive behavior disorders can closely resemble ADHD-particularly where impulsivity and hyperactivity are involved-but ADHD, ODD, and CD are considered separate conditions that can occur independently. About one third of all children with ADHD have coexisting ODD, and up to one quarter have coexisting CD. Children with both conditions tend to have more difficult lives than those with ADHD alone because their defiant behavior leads to so many conflicts with adults and others with whom they interact. Early identification and treatment may, however, increase the chances that your child can learn to control these behaviors.

Oppositional Defiant Disorder

Many children with ADHD display oppositional behaviors at times. Oppositional defiant disorder is defined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as including persistent symptoms of "negativistic, defiant, disobedient, and hostile behaviors toward authority figures." A child with ODD may argue frequently with adults; lose his temper easily; refuse to follow rules; blame others for his own mistakes; deliberately annoy others; and otherwise behave in angry, resentful, and vindictive ways. He is likely to encounter frequent social conflicts and disciplinary situations at school. In many cases, particularly without early diagnosis and treatment, these symptoms worsen over time-sometimes becoming severe enough to eventually lead to a diagnosis of conduct disorder.

Conduct disorder is a more extreme condition than ODD. Defined in the as "a repetitive and persistent pattern of behavior in which the basic rights of others or major age appropriate social rules are violated," CD may involve serious aggression toward people or the hurting of animals, deliberate destruction of property (vandalism), stealing, running away from home, skipping school, or otherwise trying to break some of the major rules of society without getting caught. Many children with CD were or could have been diagnosed with ODD at an earlier age-particularly those who were physically aggressive when they were younger. As the CD symptoms become evident, these children usually retain their ODD symptoms (argumentativeness, resistance, etc) as well. This cluster of behaviors, combined with the impulsiveness and hyperactivity of ADHD, sometimes causes these children to be viewed as delinquents, and they are likely to be suspended from school and have more police contact than children with ADHD alone or ADHD with ODD.

Children with ADHD whose CD symptoms started at an early age also tend to fare more poorly in adulthood than those with ADHD alone or ADHD with ODD-particularly in the areas of delinquency, illegal behavior, and substance abuse.

ODD and CD: What to Look For

A child with ADHD and a coexisting disruptive behavior disorder is likely to be similar to children with ADHD alone in terms of intelligence, medical history, and neurological development. He is probably no more impulsive than children with ADHD alone, although if he has conduct disorder, his teachers or other adults may misinterpret his aggressive behavior as ADHD-type impulsiveness. (Attention-deficit/hyperactivity disorder behavior without CD, however, does not typically involve this level of aggression.) A child with ADHD and CD does have a greater chance of experiencing learning disabilities such as reading disorders and verbal impairment. But what distinguishes children with ODD and CD most from children with ADHD alone is their defiant, resistant, even (in the case of CD) aggressive, cruel, or delinquent, behavior. Other indicators to look for include

Relatives with ADHD/ODD, ADHD/CD, depressive disorder or anxiety disorder. A child with family members with ADHD/ODD or ADHD/CD should be watched for ADHD/CD as well. Chances of developing CD are also greater if family members have experienced depressive, anxiety, or learning disorders.

Stress or conflict in the family. Divorce, separation, substance abuse, parental criminal activity, or serious conflicts within the family are quite common among children with ADHD and coexisting ODD or CD.

Poor or no positive response to the behavior therapy techniques at home and at school. If your child defies your instructions, violates time-out procedures, and otherwise refuses to cooperate with your use of appropriate behavior therapy techniques, and his aggressive behavior continues unabated, he should be evaluated for coexisting ODD or CD.

Children with ADHD and disruptive behavior disorders often benefit from special behavioral techniques that can be implemented at home and at school. These approaches typically include methods for training your child to become more aware of his own anger cues, use these cues as signals to initiate various coping strategies ("Take five deep breaths and think about the three best choices for how to respond before lashing out at a teacher."), and provide himself with positive reinforcement (telling himself, "Good job, you caught the signal and used your strategies!") for successful self-control. You and your child's teachers, meanwhile, can learn to better manage ODD or CD-type behavior through negotiating, compromising, problem-solving with your child, anticipating and avoiding potentially explosive situations, and prioritizing goals so that less important problems are ignored until more pressing issues have been successfully addressed. These highly specific techniques can be taught by professional behavior therapists or other mental health professionals recommended by your child's pediatrician or school psychologist, or other professionals involved with your family.

If your child has a diagnosis of coexisting ODD or CD, and well-planned classroom behavioral techniques in his mainstream classroom have been ineffective, this may lead to a decision to place him in a special classroom at school that is set up for more intensive behavior management. However, schools are mandated to educate your child in a mainstream classroom if possible, and to regularly review your child's education plan and reassess the appropriateness of his placement.

There is growing evidence that the same stimulant medications that improve the core ADHD symptoms may also help coexisting ODD and CD. Stimulants have been shown to help decrease verbal and physical aggression, negative peer interactions, stealing, and vandalism. Although stimulant medications do not teach children new skills, such as helping them identify and respond appropriately to others' social signals, they may decrease the aggression that stands in the way of forming relationships with others their age. For this reason, stimulants are usually the first choice in a medication treatment approach for children with ADHD and a coexisting disruptive behavior disorder.

The earlier stimulants are introduced to treat coexisting ODD or CD, the better. A child with a disruptive behavior disorder whose aggressive behavior continues untreated may start to identify with others who experience discipline problems. By adolescence, he may resist treatment that could help him change his behavior and make him less popular among these friends. He will have grown accustomed to his defiant "self" and feel uncomfortable and "unreal" when stimulants help check his reckless, authority-flaunting style. By treating these behaviors in elementary school or even earlier, you may have a better chance of preventing your child from creating a negative self-identity.

If your child has been treated with 2 or more types of stimulants and his aggressive symptoms are the same or worse, his pediatrician may choose to reevaluate the situation and replace the stimulant with other medications. If stimulant medication alone led to some but not enough improvement, his pediatrician may continue to prescribe stimulants in combination with one of these other agents.

ADHD: A Complete and Authoritative Guide (Copyright © 2004 American Academy of Pediatrics)

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Disruptive behavior disorders are among the easiest to identify of all coexisting conditions because they involve behaviors that are readily seen such as temper tantrums, physical aggression such as attacking other children, excessive argumentativeness, stealing, and other forms of defiance or resistance to authority.

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Last updated September 2023

About

Attention Deficit/Hyperactivity Disorder (ADHD) is a condition which includes difficulties with attention, increased activity, and difficulties with impulsivity. Estimates show that up to 10 percent of school-aged children and about 4 percent of adults have ADHD. It is usually first identified when children are school-aged, although it also can be diagnosed in people of all age groups. In an average classroom of 30 children, research suggests that at least one will have ADHD.

No single biological cause for ADHD has been found. But most research points to genes inherited from parents as the leading contributor to ADHD. ADHD often runs in families.

The good news is that there are safe and effective treatments for children and adolescents with ADHD. Treatment is most effective when it begins early and when intervention is individualized to the needs of the child.
Choose a topic: Glossary of Symptoms: ADHD
Frequently Asked Questions

1. What is ADHD?

2. How common is ADHD?

3. What causes ADHD?

4. Common signs and symptoms of ADHD?

5. What are the types of treatment for ADHD?

6. When is it okay to stop taking ADHD medication?

7. What are the consequences of untreated ADHD?

Treatment Resources

Parents' Medication Guide

The American Academy of Child and Adolescent Psychiatry (AACAP) and the American Psychiatric Association (APA) created the Parents' Medication Guide series.

Included in these guides are new research on effective treatments for child and adolescent ADHD. The goal of the guide is to help parents make informed decisions about getting the best care for a child or adolescent with ADHD.

Facts for Families

AACAP's Facts for Families provide concise up-to-date information on issues that affect children, teenagers, and their families. Below are links to Facts for Families with information that may be useful to families of children with ADHD.

Video Clips

ADHD: A Guide for Families
Many children have restless behaviors that are typical of ADHD. When fidgeting, poor concentration, or impulsiveness begins disrupting performance in school, at home, or in relationships with other children, the cause might be ADHD. To be a good advocate for your child, you need to learn as much as you can about ADHD.

The following are chapters from the ADHD: A Guide for Families book:

Clinical Resources

Information about Choices in Psychotherapy Treatment

Treatment for ADHD comes in the form of medication and psychotherapy treatment. Both can be important elements of a comprehensive treatment plan. There are several psychotherapies that are helpful for children with ADHD. We have the most evidence that cognitive-behavioral therapy (CBT) and behavioral management techniques can be helpful for children with ADHD.
Learn more about the types of psychotherapy that are available to help children and adolescents with mental illness here.
Information about Choices in Medication
Learn more about how psychiatric medication is used to treat children and adolescents here Learn more about the types of psychiatric medication that are available to treat children and adolescents with mental health disorder here. .
Vanderbilt Diagnostic Parent Rating Scale
Parents who have a child or adolescent with ADHD, or any mental health condition, are often left facing difficult decisions regarding medication.

View up-to-date information about advances in psychopharmacological treatment for mood disorders here.

ADHD Rating Scales

Two rating scales which can be used by clinicians to help identify ADHD and monitor symptoms are the SWAN rating scale and the SNAP-IV rating scale. These scales are completed separately by a parent and a teacher.

The SWAN Rating Scale has 30 items and includes ADHD symptoms and symptoms of oppositional defiant disorder. Download the SWAN Rating Scale.

The SNAP-IV Rating Scale contains 90 items and includes symptoms of ADHD and also ODD and aggression. Download the SNAP-IV Rating Scale.

Research and Training

AHRQ review of ADHD, Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment in Children and Adolescents

The abstract for the Multimodal Treatment Study of Children with ADHD is an NIMH sponsored research study that examined close to 600 children with ADHD and studied how they responded to different treatments. Click here to find a brief description of results from this study:
Multimodal Treatment Study of Children with ADHD

Learn more about the Multimodal Treatment Study of Children with ADHD and results from this large research study.

Books

AACAP's books: and Your Adolescent offer easy-to-understand and comprehensive information on the emotional development and behavior of children from infancy through the teen years.

A Bird's-Eye View of Life with ADD and ADHD: Advice from Young Survivors
Chris A. Zeigler Dendy and Alex Zeigler

ADHD and Me: Forty Years in a Fog
Ken Patterson

For more bibliotherapy resources, visit Living with Mental Illness: Books, Stories and Memoirs.

Getting Help

Getting help is the most important thing that parents can do for children and adolescents with a mental health concern. Parents should try to find a mental health professional with advanced training and experience evaluating and treating children and adolescents with attention-deficit/hyperactivity disorder. Also, it is important to find a comfortable match between your child, your family, and the mental health professional.

A child and adolescent psychiatrist is a physician who specializes in the diagnosis and treatment of mental health disorders that affect children and adolescents. Child and adolescent psychiatrists have completed four years of medical school, and at least three years of residency training in medicine, neurology, or general psychiatry with adults, and two years of additional training in psychiatric work with children and adolescents.

Find a child and adolescent psychiatrist in your area.
Services In School For Children With Special Needs: What Parents Need To Know
To learn about accessing child and adolescent psychiatrists and other mental health professionals, please read Where To Find Help For Your Child.

Oftentimes, parents are unsure when to seek a referral to a child and adolescent psychiatrist. For more information on when to seek a referral, please read this article.

Learn more about understanding mental health insurance, please read AACAP's Facts For Families on Mental Health Insurance.

Related Websites

This Resource Center was made possible through funding from the Lasdon Foundation.

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Attention Deficit/Hyperactivity Disorder (ADHD) is a condition which includes difficulties with attention, increased activity, and difficulties with impulsivity.

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Introduction

Do you sometimes have sudden attacks of anxiety and overwhelming fear that last for several minutes? Maybe your heart pounds, you sweat, and you feel like you can't breathe or think. Do these attacks occur at unpredictable times with no obvious trigger, causing you to worry about the possibility of having another one at any time?

If so, you may have a type of anxiety disorder called panic disorder. Left untreated, panic disorder can lower your quality of life because it may lead to other fears and mental health disorders, problems at work or school, and social isolation.

What is it like to have panic disorder?
"One day, without any warning or reason, a feeling of terrible anxiety came crashing down on me. I felt like I couldn't get enough air, no matter how hard I breathed. My heart was pounding out of my chest, and I thought I might die. I was sweating and felt dizzy. I felt like I had no control over these feelings and like I was drowning and couldn't think straight."After what seemed like an eternity, my breathing slowed and I eventually let go of the fear and my racing thoughts, but I was totally drained and exhausted. These attacks started to occur every couple of weeks, and I thought I was losing my mind. My friend saw how I was struggling and told me to call my doctor for help."
What is panic disorder?

People with panic disorder have sudden and repeated attacks of fear that last for several minutes or longer. These are called panic attacks. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger. A person may also have a strong physical reaction during a panic attack. It may feel like having a heart attack. Panic attacks can occur at any time, and many people with panic disorder worry about and dread the possibility of having another attack.

A person with panic disorder may become discouraged and feel ashamed because he or she cannot carry out normal routines like going to school or work, going to the grocery store, or driving.

Panic disorder often begins in the late teens or early adulthood. More women than men have panic disorder. But not everyone who experiences panic attacks will develop panic disorder.

What causes panic disorder?

Panic disorder sometimes runs in families, but no one knows for sure why some family members have it while others don't. Researchers have found that several parts of the brain, as well as biological processes, play a key role in fear and anxiety. Some researchers think that people with panic disorder misinterpret harmless bodily sensations as threats. By learning more about how the brain and body functions in people with panic disorder, scientists may be able to create better treatments. Researchers are also looking for ways in which stress and environmental factors may play a role.

What are the signs and symptoms of panic disorder?

People with panic disorder may have:

Sudden and repeated panic attacks of overwhelming anxiety and fear

A feeling of being out of control, or a fear of death or impending doom during a panic attack

Physical symptoms during a panic attack, such as a pounding or racing heart, sweating, chills, trembling, breathing problems, weakness or dizziness, tingly or numb hands, chest pain, stomach pain, and nausea

An intense worry about when the next panic attack will happen

A fear or avoidance of places where panic attacks have occurred in the past

How is panic disorder treated?

First, talk to your doctor about your symptoms. Your doctor should do an exam and ask you about your health history to make sure that an unrelated physical problem is not causing your symptoms. Your doctor may refer to you a mental health specialist, such as a psychiatrist or psychologist.

Panic disorder is generally treated with psychotherapy, medication, or both. Talk with your doctor about the best treatment for you.

Psychotherapy. A type of psychotherapy called cognitive behavioral therapy (CBT) is especially useful as a first-line treatment for panic disorder. CBT teaches you different ways of thinking, behaving, and reacting to the feelings that come on with a panic attack. The attacks can begin to disappear once you learn to react differently to the physical sensations of anxiety and fear that occur during panic attacks.
For more information on psychotherapy, see http://www.nimh.nih.gov/health/topics/psychotherapies.
Medication. Doctors also may prescribe different types of medications to help treat panic disorder:

Selective serotonin reuptake inhibitors (SSRIs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Beta-blockers

Benzodiazepines

SSRIs and SNRIs are commonly used to treat depression, but they are also helpful for the symptoms of panic disorder. They may take several weeks to start working. These medications may also cause side-effects, such as headaches, nausea, or difficulty sleeping. These side effects are usually not severe for most people, especially if the dose starts off low and is increased slowly over time. Talk to your doctor about any side effects that you have.

Another type of medication called beta-blockers can help control some of the physical symptoms of panic disorder, such as rapid heart rate. Although doctors do not commonly prescribe beta-blockers for panic disorder, they may be helpful in certain situations that precede a panic attack.

Benzodiazepines, which are sedative medications, are powerfully effective in rapidly decreasing panic attack symptoms, but they can cause tolerance and dependence if you use them continuously. Therefore, your doctor will only prescribe them for brief periods of time if you need them.

Your doctor will work with you to find the best medication and dose for you.

For more information about these medications, see http://www.nimh.nih.gov/health/topics/mental-health-medications. Also check the Food and Drug Administration's website ( http://www.fda.gov/) for the latest information on warnings, patient medication guides, or newly approved medications.

Don't give up on treatment too quickly. Both psychotherapy and medication can take some time to work. A healthy lifestyle can also help combat panic disorder. Make sure to get enough sleep and exercise, eat a healthy diet, and turn to family and friends who you trust for support.

Finding Help

Mental Health Treatment Program Locator

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides this online resource for locating mental health treatment facilities and programs. The Mental Health Treatment Locator section of the Behavioral Health Treatment Services Locator lists facilities providing mental health services to persons with mental illness. Find a facility in your state at https://findtreatment.samhsa.gov/. For additional resources, visit www.nimh.nih.gov/findhelp.

Questions to Ask Your Doctor

Asking questions and providing information to your doctor or health care provider can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Visit the Agency for Healthcare Research and Quality website for tips at http://www.ahrq.gov/patients-consumers/index.html.

Reprints

This publication is in the public domain and may be reproduced or copied without permission from NIMH. Citation of NIMH as a source is appreciated. We encourage you to reproduce it and use it in your efforts to improve public health. However, using government materials inappropriately can raise legal or ethical concerns, so we ask you to use these guidelines:

NIMH does not endorse or recommend any commercial products, processes, or services, and our publications may not be used for advertising or endorsement purposes.

NIMH does not provide specific medical advice or treatment recommendations or referrals; our materials may not be used in a manner that has the appearance of providing such information.

NIMH requests that non-Federal organizations not alter our publications in ways that will jeopardize the integrity and "brand" when using the publication.

The addition of non-Federal Government logos and website links may not have the appearance of NIMH endorsement of any specific commercial products or services, or medical treatments or services.

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If you have questions regarding these guidelines and use of NIMH publications, please contact the NIMH Information Resource Center at 1-866-615-6464 or e-mail nimhinfo@nih.gov.

For More Information

To learn more information about panic disorder, visit:

Medline Plus (National Library of Medicine) http://medlineplus.gov (En Español: http://medlineplus.gov/spanish)

For information on clinical trials, visit:

ClinicalTrials.gov: http://www.clinicaltrials.gov (En Español: http://salud.nih.gov/investigacion-clinica/)

For more information on conditions that affect mental health, resources, and research, visit the NIMH website ( http://www.nimh.nih.gov).

National Institute of Mental Health
Office of Science Policy, Planning and Communications
Science Writing, Press, and Dissemination Branch
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Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or 1-866-615-NIMH (6464) toll-free
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FAX: 301-443-4279
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Website: www.nimh.nih.gov

U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
National Institutes of Health
National Institute of Mental Health

NIH Publication No. 19-MH-8077
Revised 2016

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Do you sometimes have sudden attacks of anxiety and overwhelming fear that last for several minutes? Maybe your heart pounds, you sweat, and you feel like you can't breathe or think. Do these attacks occur at unpredictable times with no obvious trigger, causing you to worry about the possibility of having another one at any time?

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Overview

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

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

Signs and Symptoms

Risk Factors

Treatments and Therapies

Join a Study

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

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At a glance

Special education refers to a range of services that help kids with disabilities learn.

It's not a "one size fits all" approach - special education is tailored to meet the needs of individual kids.

Kids who qualify for special education have an IEP.

Special education refers to a range of services that can be provided in different ways and in different settings. There's no "one size fits all" approach to special education. It's tailored to meet the needs of students with disabilities.

Special education focuses on helping kids with disabilities learn. But it doesn't mean placing kids in a special classroom all day long. In fact, federal law says that kids who get special education services should learn in the same classrooms as other kids as much as possible. This is known as the least restrictive environment (or LRE).

The services and supports for one student may be very different from those of another student. It's all about the individual child and giving them the resources they need to make progress in school.

For example, some students may spend most of the day in a general education classroom. Others may spend just an hour or two in a resource room working with a specialist. And others might need to attend a different school that specializes in teaching kids with learning disabilities.

Kids who qualify for special education have an Individualized Education Program (IEP). They get individualized teaching and other resources at no cost to their families. Specialists work with kids on strengths as well as challenges. And families are key members of the team that decides what kids need to thrive in school.

Dive deeper

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Special education refers to a range of services to help kids with disabilities learn and make progress in school. Explore this guide to special education basics.

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Section 504 - just what exactly is it? You've probably heard about it, but every school district addresses Section 504 in a different manner. Some districts have even been heard to say, "We don't do that in this district." But in fact, compliance to Section 504, which is a federal statute, is not optional. This article attempts to answer basic questions pertaining to the implementation of Section 504 in public school systems.

What is Section 504?

Section 504 is a part of the Rehabilitation Act of 1973 that prohibits discrimination based upon disability. Section 504 is an anti-discrimination, civil rights statute that requires the needs of students with disabilities to be met as adequately as the needs of the non-disabled are met.

Section 504 states that: "No otherwise qualified individual with a disability in the United States, as defined in section 706(8) of this title, shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance..." [29 U.S.C. §794(a), 34 C.F.R. §104.4(a)].

Who is covered under Section 504?

To be covered under Section 504, a student must be "qualified " (which roughly equates to being between 3 and 22 years of age, depending on the program, as well as state and federal law, and must have a disability) [34 C.F.R. §104.3(k)(2)].

Who is an "individual with a disability"?

As defined by federal law: "An individual with a disability means any person who: (i) has a mental or physical impairment that substantially limits one or more major life activity; (ii) has a record of such an impairment; or (iii) is regarded as having such an impairment" [34 C.F.R. §104.3(j)(1)].

What is an "impairment" as used under the Section 504 definition?

An impairment as used in Section 504 may include any disability, long-term illness, or various disorder that "substantially" reduces or lessens a student's ability to access learning in the educational setting because of a learning-, behavior- or health-related condition. ["It should be emphasized that a physical or mental impairment does not constitute a disability for purposes of Section 504 unless its severity is such that it results in a substantial limitation of one or more major life activities" (Appendix A to Part 104, #3)].

Many students have conditions or disorders that are not readily apparent to others. They may include conditions such as specific learning disabilities, diabetes, epilepsy and allergies. Hidden disabilities such as low vision, poor hearing, heart disease or chronic illness may not be obvious, but if they substantially limit that child's ability to receive an appropriate education as defined by Section 504, they may be considered to have an "impairment" under Section 504 standards. As a result, these students, regardless of their intelligence, will be unable to fully demonstrate their ability or attain educational benefits equal to that of non-disabled students (The Civil Rights of Students with Hidden Disabilities under Section 504 of the Rehabilitation Act of 1973-Pamphlet). The definition does not set forth a list of specific diseases, conditions or disorders that constitute impairments because of the difficulty of ensuring the comprehensiveness of any such list. While the definition of a disabled person also includes specific limitations on what persons are classified as disabled under the regulations, it also specifies that only physical and mental impairments are included, thus "environmental, cultural and economic disadvantage are not in themselves covered" (Appendix A to Part 104, #3).

What are "major life activities"?

Major life activities include, but are not limited to: self-care, manual tasks, walking, seeing, speaking, sitting, thinking, learning, breathing, concentrating, interacting with others and working. As of January 1, 2009 with the reauthorization of the Americans with Disabilities Amendment Act, this list has been expanded to also include the life activities of reading, concentrating, standing, lifting, bending, etc. This may include individuals with AD/HD, dyslexia, cancer, diabetes, severe allergies, chronic asthma, Tourette 's syndrome, digestive disorders, cardiovascular disorders, depression, conduct disorder, oppositional defiant disorder, HIV/AIDS, behavior disorders and temporary disabilities (e.g., broken writing arm, broken leg, etc.). Conditions that are episodic or in remission are also now covered if they create a substantial limitation in one or more major life activity while they are active. Students who are currently using illegal drugs or alcohol are not covered or eligible under Section 504.

What does "substantially limits" mean?

Substantially limits is not defined in the federal regulations. However, in a letter from the Office for Civil Rights (OCR), they state, "this is a determination to be made by each local school district and depends on the nature and severity of the person's disabling condition." New guidance from the Americans with Disabilities Amendment Act states that Section 504 standards must conform with the ADAAA and is "intended to afford a broad scope of protection to eligible persons." In considering substantial limitations, students must be measured against their same age, non-disabled peers in the general population and without benefit of medication or other mitigating measures such as learned behavioral or adaptive neurological modifications, assistive technology or accommodations.

Who can refer a child for consideration for evaluation under Section 504?

Anyone can refer a child for evaluation under Section 504. However, while anyone can make a referral, such as parents or a doctor, OCR has stated in a staff memorandum that "the school district must also have reason to believe that the child is in need of services under Section 504 due to a disability" (OCR Memorandum, April 29, 1993). Therefore, a school district does not have to refer or evaluate a child under Section 504 solely upon parental demand. The key to a referral is whether the school district staff suspects that the child is suffering from a mental or physical impairment that substantially limits a major life activity and is in need of either regular education with supplementary services or special education and related services [letter to Mentink, 19 IDELR 1127 (OCR) 1993]. If a parent requests a referral for evaluation, and the school district refuses, the school district must provide the parent with notice of their procedural rights under Section 504.

Who decides whether a student is qualified and eligible for services under Section 504?

According to the federal regulations: "...placement decisions are to be made by a group of persons who are knowledgeable about the child, the meaning of the evaluation data, placement options, least restrictive environment requirements, and comparable facilities" [34 C.F.R. §104.35(c)(3)].

Unlike Special Education, the federal regulations for Section 504 do not require or even mention that parents are to be a part of the decision-making committee. The decision to include parents in the decision-making committee is a determination that is made by each school district and should be spelled out in the district's procedures for implementing Section 504. Parents should at least be asked and encouraged to contribute any information that they may have (e.g., doctor's reports, outside testing reports, etc.) that would be helpful to the Section 504 committee in making their determination of what the child may need. Schools are expected to make sound educational decisions as to what the child needs in order to receive an appropriate education.

What information is used in doing an evaluation under Section 504?

Under Section 504, no formalized testing is required. The 504 Committee should look at grades over the past several years, teacher's reports, information from parents or other agencies, state assessment scores or other school administered tests, observations, discipline reports, attendance records, health records and adaptive behavior information. Schools must consider a variety of sources. A single source of information (such as a doctor's report) cannot be the only information considered. Schools must be able to assure that all information submitted is documented and considered.

Can my child be placed under Section 504 without my knowledge?

No. Parents must always be given notice before their child is evaluated and/or placed under Section 504 (34 C.F.R. §104.36). Parents must also be given a copy of their child's Section 504 accommodation plan if the committee determines that the child is eligible under Section 504.

What types of accommodations will my child receive if determined eligible under Section 504?

Each child's needs are determined individually. Determination of what is appropriate for each child is based on the nature of the disabling condition and what that child needs in order to have an equal opportunity to compete when compared to the non-disabled. There is no guarantee of A's or B's or even that the student will not fail. Students are still expected to produce. The ultimate goal of education for all students, with or without disabilities, is to give students the knowledge and compensating skills they will need to be able to function in life after graduation.
Accommodations that may be used, but are not limited to, include:

Highlighted textbooks

Extended time on tests or assignments

Peer assistance with note taking

Frequent feedback

Extra set of textbooks for home use

Computer aided instruction

Enlarged print

Positive reinforcements

Behavior intervention plans

Rearranging class schedules

Visual aids

Preferred seating assignments

Taping lectures

Oral tests

Individual contracts

Will my child still be in the regular classroom or will he be in a "special class"?

A Section 504 eligible child will always be in the regular classroom unless (according to federal regulations): "... the student with a disability is so disruptive in a regular classroom that the education of other students is significantly impaired, then the needs of the student with a disability cannot be met in that environment. Therefore, regular placement would not be appropriate to his or her needs and would not be required by §104.34" (34 C.F.R. §104.34, Appendix A, #24).

Can my child still be disciplined under Section 504?

Yes. Children under Section 504 are still expected to follow the district's student code of conduct. However, when disciplining a child under Section 504, schools must consider the relationship between the disability and the misbehavior if the child is going to be removed from the regular setting for longer than 10 days. This does not mean that a student with a disability cannot be sent to a discipline center or that they cannot go to in-school suspension, or be suspended from school for three days. Very strict guidelines exist for schools in discipline issues with students who have a disability under Section 504. Your campus or district 504 coordinator can assist you in this area should you have additional questions concerning the discipline of students with disabilities. Children having disabilities with behavioral components should have individual discipline plans as well as behavior intervention plans.

If I disagree with the school's evaluation, will the school district pay for an outside independent evaluation?

Under Section 504, schools are not required to pay for an outside independent evaluation. If a parent disagrees with the school's evaluation decision, they may request a due process hearing or file a complaint with the Office for Civil Rights. (Ask your district or campus for a copy of Notice of Parent and Student Rights Under Section 504 of the Rehabilitation Act of 1973.)

How often will my child be re-evaluated?

While there are no specific time lines on this issue, students must be re-evaluated at least every three years or whenever there is going to be a "significant change in placement." The campus 504 committee should re-evaluate your child's plan every year to make sure that his or her accommodation plan is appropriate based on their current schedule and individual needs. The accommodation plan may be revised at any time during the school year if needed.

Will my child still be able to participate in nonacademic services?

Yes. Districts must provide equal opportunity in areas such as counseling, physical education and/or athletics, transportation, health services, recreational activities, and special interest groups or clubs. However, the "no pass, no play " standard used for students in most states also applies to students under Section 504 (34 C.F.R. §104.37).

What are my rights as a parent under Section 504?
As a parent or legal guardian, you have the right to:

1. Receive notice regarding the identification, evaluation and/or placement of your child;

2. Examine relevant records pertaining to your child;

3. Request an impartial hearing with respect to the district's actions regarding the identification evaluation, or placement of your child, with an opportunity for the parent/guardian to participate in the hearing, to have representation by an attorney, and have a review procedure;

4. File a complaint with your school District Section 504 Coordinator, who will investigate the allegations regarding Section 504 matters other than your child's identification, evaluation and placement.

5. File a complaint with the appropriate regional Office for Civil Rights. For additional information, contact: U.S. Department of Education, Washington, D.C. 20202-1100
(800) 421-3481
www.ed.gov/ocr
E-mail: ocr@ed.gov

Do I contact the State Education Agency (SEA) if I have a complaint concerning Section 504?

No. The State Education Agency has no direct jurisdiction over Section 504 implementation. Complaints may be addressed to your local District 504 Coordinator or to the Office for Civil Rights.
One note of caution: Please do not substitute this information for independent and individual legal advice. Such advice should be sought from a licensed, qualified attorney in the field of Section 504 disabilities. Every situation is different, and a good assessment of the risks involved in your particular situation can only be determined by consulting with your attorney and providing him or her with all of the relevant factual data. Sometimes just one "minor" detail can make a material difference in the outcome of a case. Understood.org is a comprehensive resource for parents of kids with learning and attention issues. Explore their 504 plan tools, including this Sample 504 Plan for a Child With ADHD.
Updated January 2010

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A parent's guide to Section 504 in public schools

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Section 504 - just what exactly is it? You've probably heard about it, but every school district addresses Section 504 in a different manner. Some districts have even been heard to say, "We don't do that in this district." But in fact, compliance to Section 504, which is a federal statute, is not optional.

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This severe mental disorder can result in hallucinations, delusions, and extremely disordered thinking and behavior that interfere with daily living.

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Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.

Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Historians and psychologists have found evidence of people displaying symptoms of anorexia for hundreds or thousands of years.

Although the disorder most frequently begins during adolescence, an increasing number of children and older adults are also being diagnosed with anorexia. You cannot tell if a person is struggling with anorexia by looking at them. A person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.

DIAGNOSTIC CRITERIA

To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met:

1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.

2. Intense fear of gaining weight or becoming fat, even though underweight.

3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.

WARNING SIGNS & SYMPTOMS OF ANOREXIA NERVOSA
Emotional and behavioral

Dramatic weight loss

Dresses in layers to hide weight loss or stay warm

Is preoccupied with weight, food, calories, fat grams, and dieting

Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)

Makes frequent comments about feeling "fat" or overweight despite weight loss

Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy

Denies feeling hungry

Develops food rituals (e.g., eating foods in certain orders, excessive chewing, rearranging food on a plate)

Cooks meals for others without eating

Consistently makes excuses to avoid mealtimes or situations involving food

Expresses a need to "burn off" calories taken in

Maintains an excessive, rigid exercise regimen - despite weather, fatigue, illness, or injury

Withdraws from usual friends and activities and becomes more isolated, withdrawn, and secretive

Seems concerned about eating in public

Has limited social spontaneity

Resists or is unable to maintain a body weight appropriate for their age, height, and build

Has intense fear of weight gain or being "fat," even though underweight

Has disturbed experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight

Postpuberty female loses menstrual period

Feels ineffective

Has strong need for control

Shows inflexible thinking

Has overly restrained initiative and emotional expression

Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

Difficulties concentrating

Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)

Dizziness

Fainting/syncope

Feeling cold all the time

Sleep problems

Menstrual irregularities-amenorrhea, irregular periods or only having a period while on hormonal contraceptives (this is not considered a "true" period)

Cuts and calluses across the top of finger joints (a result of inducing vomiting)

Dental problems, such as enamel erosion, cavities, and tooth sensitivity

Dry skin

Dry and brittle nails

Swelling around area of salivary glands

Fine hair on body (lanugo)

Thinning of hair on head, dry and brittle hair

Cavities, or discoloration of teeth, from vomiting

Muscle weakness

Yellow skin (in context of eating large amounts of carrots)

Cold, mottled hands and feet or swelling of feet

Poor wound healing

Impaired immune functioning

HEALTH CONSEQUENCES OF ANOREXIA NERVOSA

In anorexia nervosa's cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences.

The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it's incredibly important to understand the many ways that eating disorders affect the body.

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Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat.

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Conduct disorder is a serious behavioral and emotional disorder that can occur in children and teens. A child with this disorder may display a pattern of disruptive and violent behavior and have problems following rules.

It is not uncommon for children and teens to have behavior-related problems at some time during their development. However, the behavior is considered to be a conduct disorder when it is long-lasting and when it violates the rights of others, goes against accepted norms of behavior and disrupts the child's or family's everyday life.

What Are the Symptoms of Conduct Disorder?

Symptoms of conduct disorder vary depending on the age of the child and whether the disorder is mild, moderate, or severe. In general, symptoms of conduct disorder fall into four general categories:

Aggressive behavior: These are behaviors that threaten or cause physical harm and may include fighting, bullying, being cruel to others or animals, using weapons, and forcing another into sexual activity.

Destructive behavior: This involves intentional destruction of property such as arson (deliberate fire-setting) and vandalism (harming another person's property).

Deceitful behavior: This may include repeated lying, shoplifting, or breaking into homes or cars in order to steal.

Violation of rules: This involves going against accepted rules of society or engaging in behavior that is not appropriate for the person's age. These behaviors may include running away, skipping school, playing pranks, or being sexually active at a very young age.

In addition, many children with conduct disorder are irritable, have low self-esteem, and tend to throw frequent temper tantrums. Some may abuse drugs and alcohol. Children with conduct disorder often are unable to appreciate how their behavior can hurt others and generally have little guilt or remorse about hurting others.

Continued

What Causes Conduct Disorder?

The exact cause of conduct disorder is not known, but it is believed that a combination of biological, genetic, environmental, psychological, and social factors play a role.

Biological: Some studies suggest that defects or injuries to certain areas of the brain can lead to behavior disorders. Conduct disorder has been linked to particular brain regions involved in regulating behavior, impulse control, and emotion. Conduct disorder symptoms may occur if nerve cell circuits along these brain regions do not work properly. Further, many children and teens with conduct disorder also have other mental illnesses, such as attention-deficit/hyperactivity disorder (ADHD), learning disorders, depression, substance abuse, or an anxiety disorder, which may contribute to the symptoms of conduct disorder.

Genetics: Many children and teens with conduct disorder have close family members with mental illnesses, including mood disorders, anxiety disorders, substance use disorders and personality disorders. This suggests that a vulnerability to conduct disorder may be at least partially inherited.

Environmental: Factors such as a dysfunctional family life, childhood abuse, traumatic experiences, a family history of substance abuse, and inconsistent discipline by parents may contribute to the development of conduct disorder.

Psychological: Some experts believe that conduct disorders can reflect problems with moral awareness (notably, lack of guilt and remorse) and deficits in cognitive processing.

Social: Low socioeconomic status and not being accepted by their peers appear to be risk factors for the development of conduct disorder.

How Common Is Conduct Disorder?

It is estimated that 2%-16% of children in the U.S. have conduct disorder. It is more common in boys than in girls and most often occurs in late childhood or the early teen years.

How Is Conduct Disorder Diagnosed?

As with adults, mental illnesses in children are diagnosed based on signs and symptoms that suggest a particular problem. If symptoms of conduct disorder are present, the doctor may begin an evaluation by performing complete medical and psychiatric histories. A physical exam and laboratory tests (for example, neuroimaging studies, blood tests) may be appropriate if there is concern that a physical illness might be causing the symptoms. The doctor will also look for signs of other disorders that often occur along with conduct disorder, such as ADHD and depression.

If the doctor cannot find a physical cause for the symptoms, he or she will likely refer the child to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental disorder. The doctor bases his or her diagnosis on reports of the child's symptoms and his or her observation of the child's attitudes and behavior. The doctor will often rely on reports from the child's parents, teachers, and other adults because children may withhold information or otherwise have trouble explaining their problems or understanding their symptoms.

Continued

How Is Conduct Disorder Treated?

Treatment for conduct disorder is based on many factors, including the child's age, the severity of symptoms, as well as the child's ability to participate in and tolerate specific therapies. Treatment usually consists of a combination of the following:

Psychotherapy: Psychotherapy (a type of counseling) is aimed at helping the child learn to express and control anger in more appropriate ways. A type of therapy called cognitive-behavioral therapy aims to reshape the child's thinking (cognition) to improve problem solving skills, anger management, moral reasoning skills, and impulse control. Family therapy may be used to help improve family interactions and communication among family members. A specialized therapy technique called parent management training (PMT) teaches parents ways to positively alter their child's behavior in the home.

Medication: Although there is no medication formally approved to treat conduct disorder, various drugs may be used (off label) to treat some of its distressing symptoms (impulsivity, aggression), as well as any other mental illnesses that may be present, such as ADHD or major depression.

What Is the Outlook for Children With Conduct Disorder?

If your child is displaying symptoms of conduct disorder, it is very important that you seek help from a qualified doctor. A child or teen with conduct disorder is at risk for developing other mental disorders as an adult if left untreated. These include antisocial and other personality disorders, mood or anxiety disorders, and substance use disorders.

Children with conduct disorder are also at risk for school-related problems, such as failing or dropping out, substance abuse, legal problems, injuries to self or others due to violent behavior, sexually transmitted diseases, and suicide. Treatment outcomes can vary greatly, but early intervention may help to reduce the risk for incarcerations, mood disorders, and the development of other comorbidities such as substance abuse.

Can Conduct Disorder Be Prevented?

Although it may not be possible to prevent conduct disorder, recognizing and acting on symptoms when they appear can minimize distress to the child and family, and prevent many of the problems associated with the condition. In addition, providing a nurturing, supportive, and consistent home environment with a balance of love and discipline may help reduce symptoms and prevent episodes of disturbing behavior.

Sources

SOURCES:

American Academy of Child & Adolescent Psychiatry: "Conduct Disorder."

MedlinePlus: "Conduct Disorder."

HealthyChildren.org: "Disruptive Behavior Disorders."

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Conduct disorder is a serious behavioral and emotional disorder that can occur in children and teens. A child with this disorder may display a pattern of disruptive and violent behavior and have problems following rules. It is not uncommon for children and teens to have behavior-related problems at some time during their development.

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Children, teens and college students all face certain challenges at school, and these can be even more difficult if they also have bipolar disorder. Drowsiness from medications and trouble concentrating are only a few of the problems that commonly plague bipolar students.

Laws are in place to help ensure that bipolar children and teens are able to succeed in school. There are also some things that students, parents and teachers can do. With hard work, patience and plenty of communication, it is possible for students to manage their bipolar symptoms and even graduate from college. ¹

Bipolar Disorder and the Classroom

There are two laws that are designed to protect bipolar students in the classroom.

The Individuals with Disabilities Education Act (IDEA) states that all schools must identify any students with special needs. It goes on to require schools to provide educational services from kindergarten to the 12th grade or the student is 22 years of age.

Section 504 of the 1973 Rehabilitation Act requires schools to make the necessary adjustments to accommodate all students, including those with a learning impairment.
How Schools Can Help
The Child and Adolescent Bipolar Foundation stresses that it is also important to remember that every student is different. This means that their needs are unique. While these laws are in place to protect students with bipolar disorder, flexibility and open lines of communication are just as important. ²

Reducing the amount of homework, and extending deadlines and time limits on assignments and tests.

If the bipolar student is having difficulty sleeping at night or fatigue is a problem, allow them to start school an hour or two later.

Provide assistance if the bipolar disorder is making it difficult for the student to focus or sit still in the classroom.

Ensure that there is constant communication between teachers and parents concerning the student's progress and behavior in class.

Have tutoring in place if the student's bipolar disorder symptoms result in extended absences.
If a student is falling behind in class, most educational experts recommend enrolling them in summer school.
Record lectures in class when the student isn't able to concentrate due to their bipolar disorder symptoms.

Allow the student to have full access to the bathroom and water fountain at school. This can be especially helpful in preventing classroom disruptions during a manic episode.

There are several things schools can do to help bipolar children and teens succeed in the classroom. These include,

Schools, parents and students are also finding that participating in art, music and even sports programs can be beneficial. Some students with bipolar disorder find that these "enrichment" programs can relieve some of the stress and challenges associated with school. This often makes it a little easier for them to control their symptoms.

It has also been noted that bipolar disorder students often perform better academically in a smaller size class. Fewer distractions can make it easier for them to concentrate, especially during a manic episode.
Tips on Managing Bipolar Disorder at College
If you think that you might have bipolar disorder it is important to speak with a licensed health care professional immediately. It is the best way to prevent any problems that could interfere with your ability to get an education.

Remember that bipolar disorder is a treatable illness. This means that you have to take charge of your care. If you don't take care of yourself, you won't be able to control your bipolar disorder.

Exercise is an important tool in managing bipolar disorder symptoms. Just walking to class should be able to provide you with at least 20 minutes of exercise each day.

Try to manage your homework so you can stay on a consistent sleep schedule. It might mean that you have to miss a few parties, but it is worth it when you are able to avoid a manic episode.

Eating a healthy diet is also important. It can also be difficult when you are away at college. Most universities have registered dieticians on staff at the campus medical center, and they can help you create a nutritious meal plan that fits your tastes and budget.

One tip to remember is that students with bipolar disorder do not have a learning disability, and in most cases do not need to be placed in a special education class.

Doing so often causes the student additional stress, and can make it even more difficult for them to successfully manage their symptoms.
See here for a list of bipolar disorder support groups.
Bipolar Disorder and College

Unfortunately college isn't any easier for students with bipolar disorder. The stress of being away from home, along with the pressures of college can easily trigger a manic episode.

Bipolar disorder often manifests in teens and adults ages 15 to 24, and some mental health experts tie this to the increase in academic pressure that usually occurs around this time. A greater emphasis is placed on grades and when this is combined with all of the other new experiences college typically brings, many students find it overwhelming.

According to the National Institute for Mental Health, almost half of those diagnosed with bipolar disorder experienced their first onset of symptoms before the age of 25.

You are not alone if this applies to you. There are also steps you can take to manage your bipolar disorder at college.

College for students with bipolar disorder is tough. This doesn't mean that you can't succeed. You might have to make some adjustments to your overall "life plan" and accept that it will take a little longer to graduate, and successfully control your bipolar disorder. There is nothing wrong with taking your time, especially if it helps you stay mentally and physically healthy!

Support for Bipolar Disorder at School
¹ ² https://www.jbrf.org/page-for-families/educational-issues-facing-children-with-bipolar-disorder/ https://www.bphope.com/kids-children-teens/how-your-childs-bipolar-disorder-can-affect-the-school-day/
There are several bipolar disorder support groups for parents and students to take advantage of.

Along with licensed therapists and counselors, family and friends are often the best source of support for bipolar disorder students at any age. Peer counseling groups can become a vital support network, especially for college students dealing with the stress of being away from home for the first time.

Having a strong network of support is essential for the success of any student with bipolar disorder regardless of their age.

Bipolar Disorder and Success at School

Whether you are a student with bipolar disorder or a parent of one, it is possible to have success at school.

It will take the combined efforts of educators, parents and the student, but you can graduate with your friends even if you are dealing with bipolar disorder. Just because it makes school a little harder doesn't mean that you have to give up.

If you believe that a school is discriminating against bipolar disorder it is important that you understand your rights. There are laws in place that are designed to ensure that everyone receives a quality education, regardless of their physical or mental disabilities.

References:

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Children, teens and college students all face certain challenges at school, and these can be even more difficult if they also have bipolar disorder.

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About this booklet

This booklet, prepared by the National Institute of Mental Health (NIMH), provides an overview on depression. NIMH is part of the National Institutes of Health (NIH), the primary Federal agency for conducting and supporting medical research.

This booklet will help you learn the following four things that everyone should know about depression:

Depression is a real illness.

Depression affects people in different ways.

Depression is treatable.

If you have depression, you are not alone.

This booklet contains information on the signs and symptoms of depression, treatment and support options, and a listing of additional resources. It is intended for informational purposes only and should not be considered a guide for making medical decisions. Please review this information and discuss it with your doctor or health care provider. For more information on depression, please visit the NIMH website at www.nimh.nih.gov.

Need help now?

Call the 24-hour, toll-free confidential National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or go to www.suicidepreventionlifeline.org.

Depression is a real illness.

I'm a firefighter and ex-Marine. I should be able to deal with anything. But I was sleeping poorly and always in a bad mood. My work was suffering because I couldn't concentrate. I felt like I was just going through the motions and wondering what the point of it all was. I never considered that I might have an underlying condition. I figured this is just how life is.

Sadness is something we all experience. It is a normal reaction to difficult times in life and usually passes with a little time.

When a person has depression, it interferes with daily life and normal functioning. It can cause pain for both the person with depression and those who care about him or her. Doctors call this condition "depressive disorder," or "clinical depression." It is a real illness. It is not a sign of a person's weakness or a character flaw. You can't "snap out of" clinical depression. Most people who experience depression need treatment to get better.

Signs and Symptoms

Sadness is only a small part of depression. Some people with depression may not feel sadness at all. Depression has many other symptoms, including physical ones. If you have been experiencing any of the following signs and symptoms for at least 2 weeks, you may be suffering from depression:

Persistent sad, anxious, or "empty" mood

Feelings of hopelessness, pessimism

Feelings of guilt, worthlessness, helplessness

Loss of interest or pleasure in hobbies and activities

Decreased energy, fatigue, being "slowed down"

Difficulty concentrating, remembering, making decisions

Difficulty sleeping, early-morning awakening, or oversleeping

Appetite and/or weight changes

Thoughts of death or suicide, suicide attempts

Restlessness, irritability

Persistent physical symptoms

Factors That Play a Role in Depression

Many factors may play a role in depression, including genetics, brain biology and chemistry, and life events such as trauma, loss of a loved one, a difficult relationship, an early childhood experience, or any stressful situation.

Depression can happen at any age, but often begins in the teens or early 20s or 30s. Most chronic mood and anxiety disorders in adults begin as high levels of anxiety in children. In fact, high levels of anxiety as a child could mean a higher risk of depression as an adult.

Depression can co-occur with other serious medical illnesses such as diabetes, cancer, heart disease, and Parkinson's disease. Depression can make these conditions worse and vice versa. Sometimes medications taken for these illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

Research on depression is ongoing, and one day these discoveries may lead to better diagnosis and treatment. To learn more about current research, visit the NIMH website at www.nimh.nih.gov.

Types of Depression

There are several types of depressive disorders.

Major depression: Severe symptoms that interfere with the ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person's lifetime, but more often, a person has several episodes.

Persistent depressive disorder: A depressed mood that lasts for at least 2 years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for 2 years.

Some forms of depression are slightly different, or they may develop under unique circumstances. They include:

Psychotic depression, which occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).

Postpartum depression, which is much more serious than the "baby blues" that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.

Seasonal affective disorder (SAD), which is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.

Bipolar disorder is different from depression. The reason it is included in this list is because someone with bipolar disorder experiences episodes of extreme low moods (depression). But a person with bipolar disorder also experiences extreme high moods (called "mania").

You can learn more about many of these disorders on the NIMH website at www.nimh.nih.gov.

Depression affects people in different ways.

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms. Some people have many. The severity and frequency of symptoms, and how long they last, will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.

Women

My friends keep asking what's wrong with me. I have a great job and a wonderful family. But nothing seems fun anymore. I'm tired all the time. I'm trying to force myself to be interested in my kid's activities, but I'm just not anymore. I feel lonely, sad, and don't have the energy to get things done. I feel like I'm being a bad mom.

Women with depression do not all experience the same symptoms. However, women with depression typically have symptoms of sadness, worthlessness, and guilt.

Depression is more common among women than among men. Biological, lifecycle, hormonal, and psychosocial factors that are unique to women may be linked to their higher depression rate. For example, women are especially vulnerable to developing postpartum depression after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming.

Men

I'd drink and I'd drink just to get numb. I'd get numb to try to numb my head. You're talking many, many beers to get to that state when you can shut your head off. But then you wake up the next day, and it's still there. You have to deal with it. It doesn't just go away.

Men often experience depression differently than women. While women with depression are more likely to have feelings of sadness, worthlessness, and excessive guilt, men are more likely to be very tired, irritable, lose interest in once-pleasurable activities, and have difficulty sleeping.

Men may turn to alcohol or drugs when they are depressed. They also may become frustrated, discouraged, irritable, angry, and sometimes abusive. Some men may throw themselves into their work to avoid talking about their depression with family or friends, or behave recklessly. And although more women attempt suicide, many more men die by suicide in the United States.

Children

My son Timothy used to be an outgoing 9-year-old who loved school. Now he frequently complains of stomachaches and refuses to go to school. He yells at his younger sister a lot. He quit the soccer team and instead has stayed in his room playing video games.

Before puberty, girls and boys are equally likely to develop depression. A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child is just going through a temporary "phase" or is suffering from depression. Sometimes the parents become worried about how the child's behavior has changed, or a teacher mentions that "your child doesn't seem to be himself." In such a case, if a visit to the child's pediatrician rules out physical symptoms, the doctor will probably suggest that the child be evaluated, preferably by a mental health professional who specializes in the treatment of children. Most chronic mood disorders, such as depression, begin as high levels of anxiety in children.

Teens

I was constantly bullied, my heart was in the midst of being broken, and my grades were falling. The pain I suffered day after day, night after night was unbearable. I felt as if I was drowning. I hated myself. My mom was worried and took me to the doctor. My doctor diagnosed me with depression at the end of my junior year in high school. I needed help.

The teen years can be tough. Teens are forming an identity apart from their parents, grappling with gender issues and emerging sexuality, and making independent decisions for the first time in their lives. Occasional bad moods are to be expected, but depression is different.

Older children and teens with depression may sulk, get into trouble at school, be negative and irritable, and feel misunderstood. If you're unsure if an adolescent in your life is depressed or just "being a teenager," consider how long the symptoms have been present, how severe they are, and how different the teen is acting from his or her usual self. Teens with depression may also have other disorders such as anxiety, eating disorders, or substance abuse. They may also be at higher risk for suicide.

Children and teenagers usually rely on parents, teachers, or other caregivers to recognize their suffering and get them the treatment they need. Many teens don't know where to go for mental health treatment or believe that treatment won't help. Others don't get help because they think depression symptoms may be just part of the typical stress of school or being a teen. Some teens worry what other people will think if they seek mental health care.

Depression often persists, recurs, and continues into adulthood, especially if left untreated. If you suspect a child or teenager in your life is suffering from depression, speak up right away.

Quick Tips for Talking to Your Depressed Child or Teen:

Offer emotional support, understanding, patience, and encouragement.

Talk to your child, not necessarily about depression, and listen carefully.

Never discount the feelings your child expresses, but point out realities and offer hope.

Never ignore comments about suicide.

Remind your child that with time and treatment, the depression will lift.

Older People

My mother is 68 years old, and I've noticed some changes...She isn't interested in her favorite foods anymore. She has trouble sleeping at night and snaps at the grandchildren more than usual. She used to be pretty outgoing, but now she keeps to herself a lot.

Having depression for a long period of time is not a normal part of growing older. Most older adults feel satisfied with their lives, despite having more illnesses or physical problems. But depression in older adults may be difficult to recognize because they may show different, less obvious symptoms.

Sometimes older people who are depressed appear to feel tired, have trouble sleeping, or seem grumpy and irritable. Confusion or attention problems caused by depression can sometimes look like Alzheimer's disease or other brain disorders. Older adults also may have more medical conditions such as heart disease, stroke, or cancer, which may cause depressive symptoms. Or they may be taking medications with side effects that contribute to depression.

Some older adults may experience what doctors call vascular depression, also called arteriosclerotic depression or subcortical ischemic depression. Vascular depression may result when blood vessels become less flexible and harden over time, becoming constricted. The hardening of vessels prevents normal blood flow to the body's organs, including the brain. Those with vascular depression may have or be at risk for heart disease or stroke.

Sometimes it can be difficult to distinguish grief from major depression. Grief after loss of a loved one is a normal reaction and generally does not require professional mental health treatment. However, grief that is complicated and lasts for a very long time following a loss may require treatment.

Older adults who had depression when they were younger are more at risk for developing depression in late life than those who did not have the illness earlier in life.

Depression is treatable.

My daily routine was shot. I didn't have the energy to do anything. I got up because the dog had to be walked and my wife needed to go to work. The day would go by, and I didn't know where it went. I wanted to get back to normal. I just wanted to be myself again. A friend noticed that something wasn't right. I talked to him about the time he had been really depressed and had gotten help from his doctor.

Depression, even the most severe cases, can be treated. The earlier treatment begins, the more effective it is. Most adults see an improvement in their symptoms when treated with antidepressant drugs, talk therapy (psychotherapy), or a combination of both.

If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary doctor or a health provider who specializes in diagnosing and treating mental health conditions (psychologist or psychiatrist). Certain medications, and some medical conditions, such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by doing a physical exam, interview, and lab tests. If the doctor can find no medical condition that may be causing the depression, the next step is a psychological evaluation.
Quick Tip: Making an Appointment
If you still need to make an appointment, here are some things you could say during the first call: "I haven't been myself lately, and I'd like to talk to the provider about it," or "I think I might have depression, and I'd like some help."

Talking to Your Doctor

How well you and your doctor talk to each other is one of the most important parts of getting good health care. But talking to your doctor isn't always easy. It takes time and effort on your part as well as your doctor's.

To prepare for your appointment, make a list of:

Any symptoms you've had, including any that may seem unrelated to the reason for your appointment

When did your symptoms start?

How severe are your symptoms?

Have the symptoms occurred before?

If the symptoms have occurred before, how were they treated?

Key personal information, including any major stresses or recent life changes

All medications, vitamins, or other supplements that you're taking, including how much and how often

Questions to ask your health provider

If you don't have a primary doctor or are not at ease with the one you currently see, now may be the time to find a new doctor. Whether you just moved to a new city, changed insurance providers, or had a bad experience with your doctor or medical staff, it is worthwhile to spend time finding a doctor you can trust.

Tests and Diagnosis

Your doctor or health care provider will examine you and talk to you at the appointment. Your doctor may do a physical exam and ask questions about your health and symptoms. There are no lab tests that can specifically diagnose depression, but your doctor may also order some lab tests to rule out other conditions.

Ask questions if the doctor's explanations or instructions are unclear, bring up problems even if the doctor doesn't ask, and let the doctor know if you have concerns about a particular treatment or change in your daily life.

Your doctor may refer you to a mental health professional, such as a psychiatrist, psychologist, social worker, or mental health counselor, who should discuss with you any family history of depression or other mental disorder, and get a complete history of your symptoms. The mental health professional may also ask if you are using alcohol or drugs, and if you are thinking about death or suicide. If your doctor does not refer you to a mental health professional or you feel your concerns were not adequately addressed, call or visit the website for your health insurance provider, Medicare ( www.medicare.gov/), or Medicaid ( http://medicaid.gov/). You can also try searching in the Substance Abuse and Mental Health Services Administration's (SAMHSA) Behavioral Health Treatment Services Locator ( https://findtreatment.samhsa.gov/) or one of the other resources listed at the end of this booklet to find one.

Need Help Now?

Call the 24-hour, toll-free confidential National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or go to www.suicidepreventionlifeline.org.

Treatment

Depression is treated with medicines, talk therapy (where a person talks with a trained professional about his or her thoughts and feelings; sometimes called "psychotherapy"), or a combination of the two. Remember: No two people are affected the same way by depression. There is no "one-size-fits-all" for treatment. It may take some trial and error to find the treatment that works best for you.

I called my doctor and talked about how I was feeling. She had me come in for a checkup and gave me the name of a specialist who is an expert in treating depression.

Medications
Quick Tip: Medications
Because information about medications is always changing, the following section may not list all the types of medications available to treat depression. Check the Food and Drug Administration (FDA) website ( www.fda.gov) for the latest news and information on warnings, patient medication guides, or newly approved medications.

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress.

There are several types of antidepressants:

Selective serotonin reuptake inhibitors (SSRI)

Serotonin and norepinephrine reuptake inhibitors (SNRI)

Tricyclic antidepressants (TCA)

Monoamine oxidase inhibitors (MAOI)

There are other antidepressants that don't fall into any of these categories and are considered unique, such as Mirtazapine and Bupropion.

Although all antidepressants can cause side effects, some are more likely to cause certain side effects than others. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has side effects that you can manage.

Most antidepressants are generally safe, but the U.S. Food and Drug Administration (FDA) requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers, and young adults under age 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. The warning also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

Common side effects listed by the FDA for antidepressants are:

Nausea and vomiting

Weight gain

Diarrhea

Sleepiness

Sexual problems

Other more serious but much less common side effects listed by the FDA for antidepressant medicines can include seizures, heart problems, and an imbalance of salt in your blood, liver damage, suicidal thoughts, or serotonin syndrome (a life-threatening reaction where your body makes too much serotonin). Serotonin syndrome can cause shivering, diarrhea, fever, seizures, and stiff or rigid muscles.

Your doctor may have you see a talk therapist in addition to taking medicine. Ask your doctor about the benefits and risks of adding talk therapy to your treatment. Sometimes talk therapy alone may be the best treatment for you.
If you are having suicidal thoughts or other serious side effects like seizures or heart problems while taking antidepressant medicines, contact your doctor immediately.
The National Suicide Prevention Lifeline is available at 1-800-273-TALK (8255), or you can visit www.suicidepreventionlifeline.org.

How Should Antidepressants Be Taken?

People taking antidepressants need to follow their doctor's directions. The medication should be taken in the right dose for the right amount of time. It can take 3 or 4 weeks until the medicine takes effect. Some people take the medications for a short time, and some people take them for much longer periods. People with long-term or severe depression may need to take medication for a long time.

Once a person is taking antidepressants, it is important not to stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and stop taking the medication too soon, and the depression may return. When it is time to stop the medication, the doctor will help the person slowly and safely decrease the dose. It's important to give the body time to adjust to the change. People don't get addicted, or "hooked," on the medications, but stopping them abruptly can cause withdrawal symptoms. If a medication does not work, it may be helpful to be open to trying another one.
FDA Warning on Antidepressants
Antidepressants are generally considered safe, but some studies have suggested that they may have unintentional effects, especially in young people. The FDA adopted a "black box" warning label-the most serious type of warning-on all antidepressant medications. The warning says there is an increased risk of suicidal thinking or suicide attempts in children, adolescents, and young adults up through age 24.

The warning also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. Families and caregivers should report any changes to the doctor.

Finally, the FDA has warned that combining the newer SSRI or SNRI antidepressants with one of the commonly used "triptan" medications used to treat migraine headaches could cause a life-threatening illness called "serotonin syndrome." A person with serotonin syndrome may be agitated, have hallucinations (see or hear things that are not real), have a high temperature, or have unusual blood pressure changes. Serotonin syndrome is usually associated with the older antidepressants called MAOIs, but it can happen with the newer antidepressants as well, if they are mixed with the wrong medications.

The benefits of antidepressant medications may outweigh their risks to children and adolescents with depression. To find the latest information, talk to your doctor and visit www.fda.gov.

Are Herbal Medicines Used to Treat Depression?

You may have heard about an herbal medicine called St. John's wort. St. John's wort is an herb. Its flowers and leaves are used to make medicine. It is one of the top-selling botanical products in the United States. But St. John's wort is not a proven therapy for depression. The FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety and effectiveness.

Taking St. John's wort can weaken many prescription medicines, such as:

Antidepressants

Birth control pills

Cyclosporine, which prevents the body from rejecting transplanted organs

Digoxin, a heart medication

Some HIV drugs

Some cancer medications

Medications used to thin the blood

Quick Tip: If You Are Considering St. John's Wort for Depression

Do not use St. John's wort to replace conventional care or to postpone seeing a health care provider. If not adequately treated, depression can become severe.

Keep in mind that dietary supplements can cause medical problems if not used correctly or if used in large amounts, and some may interact with medications you take. Your health care provider can advise you.

Many dietary supplements have not been tested in pregnant women, nursing mothers, or children. Little safety information on St. John's wort for pregnant women or children is available, so it is especially important to talk with health experts if you are pregnant or nursing or are considering giving a dietary supplement to a child.

Tell all your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health.

For more information, please visit the website for the National Center for Complementary and Integrative Health at https://nccih.nih.gov/.

For more information on medications for depression, please visit the FDA website at www.fda.gov. You can also find information on drugs, supplements, and herbal information on the National Library of Medicine's Medline Plus website ( www.nlm.nih.gov/medlineplus/druginformation.html).

Talk Therapy ("Psychotherapy")

Several types of psychotherapy-or "talk therapy"-can help people with depression. There are several types of psychotherapies that may be effective in treating depression. Examples include cognitive-behavioral therapy, interpersonal therapy, and problem-solving therapy.

Now I'm seeing the specialist on a regular basis for "talk therapy," which helps me learn ways to deal with this illness in my everyday life, and I'm taking medicine for depression. I'm starting to feel more like myself again. Without treatment, I felt like everything was dark-as if I was looking at life through tinted glasses. Treatment is helping it clear.

Cognitive-Behavioral Therapy (CBT)

CBT can help an individual with depression change negative thinking. It can help you interpret your environment and interactions in a positive, realistic way. It may also help you recognize things that may be contributing to the depression and help you change behaviors that may be making the depression worse.

Interpersonal Therapy (IPT)

IPT is designed to help an individual understand and work through troubled relationships that may cause the depression or make it worse. When a behavior is causing problems, IPT may help you change the behavior. In IPT, you explore major issues that may add to your depression, such as grief, or times of upheaval or transition.

Problem-Solving Therapy (PST)

PST can improve an individual's ability to cope with stressful life experiences. It is an effective treatment option, particularly for older adults with depression. Using a step-by-step process, you identify problems and come up with realistic solutions. It is a short-term therapy and may be conducted in an individual or group format.

For mild to moderate depression, psychotherapy may be the best option. However, for severe depression or for certain people, psychotherapy may not be enough. For teens, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the chances of it coming back. Another study looking at depression treatment among older adults found that people who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least 2 years.

More information on psychotherapy is available on the NIMH website at www.nimh.nih.gov/health/topics/psychotherapies/index.shtml.

Computer and/or Internet-Based Therapies

Meredith made a cup of coffee and settled into the living room sofa, then she clicked on an icon on her laptop. Hundreds of miles away, her face popped up on her therapist's computer monitor; he smiled back on her computer screen.

Your therapist could be only a mouse click or email away. There are many therapy programs available online or on the computer (e.g., DVDs, CDs), and some research shows that Internet-based therapies may be just as helpful as face-to-face. But results can vary from program to program, and each program is different.

Many of these therapies are based on the two main types of psychotherapies-CBT and IPT. But they may be in different formats.

For example, you might learn from materials online and get support from your therapist by email. It could be a video conferencing session that progresses much like a face-to-face session. Or you may use a computer program with video, quizzes, and other features with very little contact with a therapist. Sometimes these therapies are used along with face-to-face sessions. Sometimes they are not.

There are pros to receiving therapy on the Internet or on the computer. These options could provide more access to care if you live in a rural area where providers aren't available or if you have trouble fitting sessions into your schedule. Also, tech-savvy teens who feel uncomfortable with office visits may be more open to talking to a therapist through a computer screen.

There are also cons. For example, your health insurance may only cover therapy that is face-to-face. And although these various formats may work for a range of patients, they also may not be right for certain patients depending on a variety of factors.

If you are interested in exploring Internet or computer-based therapy, talk to your doctor or mental health provider. You may also be able to find an online mental health care provider on your own. But remember that there are many online "therapists" who may lack the proper training or who may try to take advantage of you. Speak with your provider first to see if he or she can provide a recommendation or trusted source for more information. You can also check the online provider's credentials and ask about his or her treatment approach. Sometimes you may need to have a conversation with more than one provider to find the right one for you. If cost is an issue, be sure to also contact your health insurance provider to see what's covered and what's not.

Depression: Is There an App for That?

If you have a smartphone, tablet, or "phablet" (phone tablets), you may have noticed that there are many mobile applications, or apps, marketed as support for people with depression. Some of these apps aim to provide treatment and education. Other apps offer tools to help you assess yourself, manage your symptoms, and explore resources.

With a few taps on the screen, you could have information and tools to help your depression in the palm of your hand. But, just like with online health information, it is important to find an app that you can trust.

Here are a few things that are important to remember about mobile apps for depression:

Some apps provide reliable, science-based health information and tools. Some do not.

Some app developers consult doctors, researchers, and other experts to develop their app. Others do not.

A mobile app should not replace seeing your doctor or other health care provider.

Talk to your doctor before making any changes recommended by any online or mobile source.

Quick Tip: Questions to Ask Before Using a Mobile Health App:

Who developed the app? Is that information easy to find?

Who wrote and/or reviews the information?

Is your privacy protected? Does the app clearly state a privacy policy?

Does the website offer quick and easy solutions to your health problems? Are miracle cures promised?

Does the FDA Regulate Mobile Apps?

Many mobile apps for depression provide information or general patient educational tools. Because these are not considered medical devices, the FDA does not regulate them.

Some mobile apps carry minimal risks to consumers or patients, but others can carry significant risks if they do not operate correctly. The FDA is focusing its oversight on mobile medical apps that:

Are intended to be used as an accessory to a regulated medical device-for example, an app that allows a health care professional to make a specific diagnosis by viewing a medical image from a picture archiving and communication system on a smartphone or a mobile tablet.

Transform a mobile platform into a regulated medical device-for example, an app that turns a smartphone into an electrocardiograph (ECG) machine to detect abnormal heart rhythms or determine if a patient is experiencing a heart attack.

Does NIMH Have an App for Depression?

NIMH does not currently offer any mobile apps, but NIMH's website, www.nimh.nih.gov, is mobile-friendly. This means you can access the NIMH website anywhere, anytime, and on any device-from desktop computers to tablets and mobile phones.

If you see an app that claims to be created or reviewed by NIMH, please call the NIMH Information Resource Center to verify that it was developed or reviewed by us.

NIMH Information Resource Center
Telephone:

1-866-615-6464 (toll-free)

1-301-443-8431 (TTY)

1-866-415-8051 (TTY toll-free)

Available in English and Spanish

Monday through Friday
8:30 a.m. to 5:00 p.m. Eastern Time

Electroconvulsive Therapy And Other Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. There are a lot of outdated beliefs about ECT, but here are the facts:

ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.

ECT can be an effective treatment for depression.

ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short term, but sometimes they can linger. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment.

Some people believe that ECT is painful or that you can feel the electrical impulses. This is not true. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. He or she sleeps through the treatment and does not consciously feel the electrical impulses.

Within 1 hour after the treatment session, which takes only a few minutes, the patient is awake and alert.

Other more recently introduced types of brain stimulation therapies used to treat severe depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). In 2008, the FDA approved rTMS as a treatment for major depression for patients who have not responded to at least one antidepressant medication. In 2005, the FDA approved VNS for use in treating depression in certain circumstances-if the illness has lasted 2 years or more, if it is severe or recurrent, and if the depression has not eased after trying at least four other treatments. VNS is less commonly used, and more research is needed to test its effectiveness.
Quick Tip: Get the Latest Information
This information may have changed since the publication of this booklet, so please visit the NIMH website at www.nimh.nih.gov to explore the latest research and the FDA website at www.fda.gov for the most recently approved treatment options.

Beyond Treatment: Things You Can Do

If you have depression, you may feel exhausted, helpless, and hopeless. It may be extremely difficult to take any action to help yourself. But as you begin to recognize your depression and begin treatment, you will start to feel better. Here are other tips that may help you or a loved one during treatment:

Try to be active and exercise. Go to a movie, a ballgame, or another event or activity that you once enjoyed.

Set realistic goals for yourself.

Break up large tasks into small ones, set some priorities, and do what you can as you can.

Try to spend time with other people and confide in a trusted friend or relative. Try not to isolate yourself and let others help you.

Expect your mood to improve gradually, not immediately. Do not expect to suddenly "snap out of" your depression. Often during treatment for depression, sleep and appetite will begin to improve before your depressed mood lifts.

Postpone important decisions, such as getting married or divorced or changing jobs, until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.

Remember that positive thinking will replace negative thoughts as your depression responds to treatment.

Continue to educate yourself about depression.

You are not alone.

Major depressive disorder is one of the most common mental disorders in the United States. You are not alone.

Sometimes living with depression can seem overwhelming, so build a support system for yourself. Your family and friends are a great place to start. Talk to trusted family members or friends to help them understand how you are feeling and that you are following your doctor's recommendations to treat your depression.

In addition to your treatment, you could also join a support group. These are not psychotherapy groups, but some may find the added support helpful. At the meetings, people share experiences, feelings, information, and coping strategies for living with depression.
Remember: Always check with your doctor before taking any medical advice that you hear in your group.
You can find a support group through many professional, consumer, advocacy, and service-related organizations. On the NIMH website ( www.nimh.nih.gov/outreach/partnership-program/index.shtml), there is a list of NIMH Outreach Partners. Some of these partners sponsor support groups for different mental disorders including depression. You can also find online support groups, but you need to be careful about which groups you join. Check and make sure the group is affiliated with a reputable health organization, moderated professionally, and maintains your anonymity.

If unsure where to start, talk to someone you trust who has experience in mental health-for example, a doctor, nurse, social worker, or religious counselor. Some health insurance providers may also have listings of hospitals offering support groups for depression.

Remember: Joining a support group does not replace your doctor or your treatment prescribed by your doctor. If a support group member makes a suggestion that you are interested in trying, talk to your doctor first. Do not assume what worked for the other person will work for you.

If You Think a Loved One May Have Depression

If you know someone who is depressed, it affects you too. The most important thing you can do is to help your friend or relative get a diagnosis and treatment. You may need to make an appointment and go with him or her to see the doctor. Encourage your loved one to stay in treatment or to seek different treatment options if no improvement occurs after 6 to 8 weeks.

To help your friend or relative:

Offer emotional support, understanding, patience, and encouragement.

Talk to him or her, and listen carefully.

Never dismiss feelings, but point out realities and offer hope.

Never ignore comments about suicide and report them to your loved one's therapist or doctor.

Invite your loved one out for walks, outings, and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon.

Provide assistance in getting to doctors' appointments.

Remind your loved one that with time and treatment, the depression will lift.

Caring for someone with depression is not easy. Someone with depression may need constant support for a long period of time. Make sure you leave time for yourself and your own needs. If you feel you need additional support, there are support groups for caregivers too.

Helpful resources

NIMH has a variety of publications on depression available at www.nimh.nih.gov/health/publications/depression-listing.shtml. If you need additional information and support, you may find the following resources to be helpful.

Centers for Medicare and Medicaid Services (CMS)

CMS is the Federal agency responsible for administering the Medicare, Medicaid, State Children's Health Insurance (SCHIP), and several other programs that help people pay for health care. Visit www.cms.gov for more information.

Clinical Trials and You

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. To learn more about participating in a clinical trial, please visit www.nih.gov/health/clinicaltrials/index.htm.

Depression (PDQ®)

PDQ ® (Physician Data Query) is the National Cancer Institute's comprehensive cancer database. The PDQ cancer information summaries are peer-reviewed, evidence-based summaries on topics including adult and pediatric cancer treatment, supportive and palliative care, screening, prevention, genetics, and complementary and alternative medicine. Visit www.cancer.gov (Search: Depression).

Locate Affordable Health Care in Your Area

Within the Federal Government, a bureau of the Health Resources and Services Administration provides a Health Center Database for a nationwide directory of clinics to obtain low or no-cost health care. Start your search at http://findahealthcenter.hrsa.gov/Search_HCC.aspx.

Mental Health Treatment Program Locator

The Substance Abuse and Mental Health Services Administration is pleased to provide this online resource for locating mental health treatment facilities and programs. The Mental Health Treatment Locator section of the Behavioral Health Treatment Services Locator lists facilities providing mental health services to persons with mental illness. Find a facility in your state at https://findtreatment.samhsa.gov/.

National Alliance on Mental Illness (NAMI)

NAMI is the Nation's largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. There are nearly 1,000 NAMI state organizations and NAMI affiliates across the country. Many NAMI affiliates offer an array of free support and education programs. Find your local NAMI at www.nami.org/Find-Your-Local-NAMI.

NIDA for Teens: Depression

NIDA for Teens website is a project of the National Institute on Drug Abuse (NIDA), National Institutes of Health. Created for middle and high school students and their teachers, this website provides accurate and timely information for use in and out of the classroom. Find information and discussions on depression at http://teens.drugabuse.gov/ (Search: Depression).

NIHSeniorHealth: Depression

NIHSeniorHealth ( www.NIHSeniorHealth.gov) has added depression to its list of health topics of interest to older adults. This senior-friendly medical website is a joint effort of the National Institute on Aging and the National Library of Medicine, which are part of the National Institutes of Health (NIH). It is available at http://nihseniorhealth.gov/depression/.

St. John's Wort and Depression

This fact sheet has information about St. John's wort, a popular herb being used by the public today to treat mild depression. This publication includes information on the FDA's role to monitor the use of this herb, how St. John's wort works, how it is used to treat depression, and a drug interaction advisory. Read it at https://nccih.nih.gov/health/stjohnswort/sjw-and-depression.htm.

Questions to Ask Your Doctor

Asking questions and providing information to your doctor and other care providers can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Visit the Agency for Healthcare Research and Quality website for tips at www.ahrq.gov/patients-consumers/index.html.

Reprints

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NIMH does not endorse or recommend any commercial products, processes, or services, and our publications may not be used for advertising or endorsement purposes.

NIMH does not provide specific medical advice or treatment recommendations or referrals; our materials may not be used in a manner that has the appearance of such information.

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If you have questions regarding these guidelines and use of NIMH publications, please contact the NIMH Information Resource Center at 1-866-615-6464 or e-mail at nimhinfo@nih.gov.

Citing This Publication

U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health. (2015). Depression (NIH Publication No. 15-3561). Bethesda, MD: U.S. Government Printing Office.

National Institute of Mental Health
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U.S. Department of Health and Human Services
National Institutes of Health
NIH Publication No. 15-3561

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This booklet contains information on depression (depressive disorder or clinical depression), including signs and symptoms, treatment and support options, and a listing of additional resources.

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Comprehensive Counseling Program Resources for Counselors

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Comprehensive Counseling Program Resources for Counselors

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Information on labor market needs to be shared with high school students by November 1

The vision of the School Counseling Staff is to work with schools to help ensure that each school has a fully implemented comprehensive school counseling program that supports the academic, career, and social/emotional development of all students through the delivery of counseling curriculum, individual student planning, and responsive services. The program is managed and evaluated through system support activities that also support the on-going mission of the school.

Effective comprehensive school counseling programs are vital to the school climate and a critical element in the development of success ready students. Comprehensive school counseling programs have a positive impact on students, parents, schools and communities.

Missouri Connections is a comprehensive, online, career development and planning program that is provided free of charge to all Missouri citizens. The platform promotes lifelong learning and includes assessment, career and college planning and financial aid resources. It is appropriate for middle schools, high schools, post-secondary institutions, as well as for agencies serving adult populations, such as employment offices, vocational rehabilitation programs and correctional facilities.

Funded by the Missouri Department of Elementary and Secondary Education, this program supports the career development efforts of schools, community organizations, and adult job seeker programs. Missouri Connections helps individuals learn about their talents, skills, and interests and makes the connection between planning for continued education and the work world.

Per House Bill 1606:

Access to assessments and interest inventories that provide insight into the types of careers that would be suitable for students

Resources that describe the types of skills and occupations most in demand in the current job market and those skills and occupations likely to be in high demand in future years

Resources that describe the typical salaries for occupations and salary trends

Information on how to obtain financial assistance for postsecondary education

Information on how to choose a college, school, or apprenticeship that aligns with the student's career goals and values

Information on self-employment

Resources related to creating a resume, interviewing, networking, and finding job opportunities

Information on the skills and traits necessary to succeed in various careers.

Awards

Gysbers Missouri Comprehensive School Counseling Program Award

The Gysbers Missouri Comprehensive School Counseling Program Award recognizes Missouri school buildings that have demonstrated the commitment to be fully implemented. This prestigious award is a five year distinction. Buildings may reapply after five years.

Due Date: Last Friday in June.

Applications will be scored by a panel of five trained reviewers comprised of a counselor educator, MSCA representative, elementary counselor, middle school counselor, and high school counselor. A K-12 counselor can be chosen to serve as one of the school counseling positions. An application must receive a score of 54 (90% or higher) to achieve the designation. Successful applicants will be notified no later than the last Friday in September. Applications should be sent to DESE.GysbersAwardProposal@dese.mo.gov.

For more information contact Cierra Griffin, at 573-751-3368 or cierra.griffin@dese.mo.gov

Gysbers Missouri Comprehensive School Counseling Program Award Application

Gysbers Templates:

The Word Document format can be uploaded to a shared platform in order for multiple building counselors to see and use. Only one copy of the form will be submitted for the award.

History of Gysbers (House Bill 1606) Award Winning Schools

1. Festus High School - Festus, MO (2019-2023)

2. Festus Elementary - Festus, MO (2020-2024)

3. Festus Intermediate - Festus, MO (2020-2024)

4. Festus Middle School - Festus, MO (2020-2024)

5. Hillsboro High School - Hillsboro, MO (2021-2025)

History of Missouri RAMP Schools

1. Green Pines Elementary - Wildwood, MO (2010)

2. Lasalle Springs Middle School - Glencoe, MO (2007)

3. Morgan Selvidge Middle School - Ballwin, MO (2008, 2012)

4. Stanton Elementary School - Fenton, MO (2009)

History of Dr. Norman C. Gysbers Nationally Recognized Missouri Program Award (NRM)

NRM information can be viewed here.

1. Park Hill South High School, Park Hill School District (2019)

2. Indian Trails Elementary, Fort Osage School District (2019)

3. Mesiner Primary School, Affton School District (2020)

4. Mason Elementary School, Lee's Summit School District (2020)

Career Advisors

The regional Career Advisors work with school districts, area career centers, military, and post-secondary institutions to ensure that Missouri students will have the knowledge, skills and experiences to make successful transitions to post-secondary options based on their educational and career goals.

Work collaboratively with school districts to develop and enhance career pathways programs/processes

Assist school counselors in the development and implementation of a rigorous and relevant Individual Career and Academic Plan

Support schools with the implementation and integration of Missouri Connections

Coordinate regional Missouri Connections training and support

Collaborate on regular basis with DESE School Counseling section staff and DESE CTE program staff, to ensure regional and state programs are aligned and complementary (coordinated through the DESE School Counseling Director and Missouri Career Pathways Manager)

Collaborate with the Missouri Pathways Regional Consultants

Provide assistance to comprehensive high schools, area career centers and community/technical colleges regarding strategies to improve nontraditional participation and completion in career and technical education programs

Assist with career planning opportunities such as a statewide Nontraditional event(s) featuring Nontraditional Careers.

Meet your Regional Career Advisor

Certification

List of approved programs Career Certification Information

Evaluation

Evaluation: Program + Personnel = Results

This page is designed to provide you with information and resources to more effectively evaluate a comprehensive school counseling program. PowerPoint presentations videos, sample templates, and summaries of action based projects conducted by practicing school counselors are available to assist you in developing your own evaluation plan as required by MSIP.

This presentation provides you with an overview of the evaluation process for comprehensive school counseling programs--a process that includes program evaluation, personnel evaluation and results evaluation.

Evidence of Impact (narrated Powerpoint)

Program Evaluation: Determining the Level of Implementation

The first aspect of evaluation asks the question, "To what extent is the school counseling program fully implemented?" MSIP5 Standard 6.9 begins to address this question by outlining the necessary and essential components of a school counseling program that is integral to the total educational process.

School counselors and administrators should first determine if the components are in place.

Once it is determined that the program components are in place, it is important to determine the degree of implementation. For example, there may be a school counseling curriculum in place, but to what extent is it being delivered to students? The "Internal Improvement Review (IIR)" allows you to take an open and honest look at the degree to which your comprehensive school counseling program is being implemented. The links below provide access to the IIR and to a presentation that guides you through the IIR process. The end result is an action plan for you to follow that will lead you toward a more fully implemented comprehensive school counseling program.

The Time on Task Analysis is a survey of the school counselors' time spent on performing the tasks that have been assigned in the program as it currently exists. The results of this initial analysis will provide baseline data for comparing the time and tasks involved in the current program to the time on tasks chosen for the desired district's comprehensive school counseling program. A district may conduct the Time on Task Analysis using 15 or 30 minute time intervals.

Student Learning Objectives (SLO)

Personnel Evaluation Documents

The following materials for the School Counselor Evaluation Process are aligned with the Missouri Educator Evaluation System. As with all school counseling materials, districts are free to use and/or customize. School Counselors should be provided support and evaluated using tools designed for school counselors.

New Counselor Evaluation Documents

New Counselor

Mentoring

DESE and MSCA collaborated on a statewide two year mentoring program for school counselors who are new to the profession. To upgrade from an Initial Student Services (ISS) certification to a Career Student Services (CSS) certification a school counselor must participate in a two year mentoring program (in addition to other criteria). After completion of this two year program, mentees will be issued a DESE certificate that can be used in the upgrade process. The DESE mentor program is specifically designed for participants who register into the DESE mentoring program the first year. Registration is now open and will close September 15th. This deadline will not be extended.

* All participants who register will begin the first year of the two-year mentoring program.

For more information contact: Cierra.griffin@dese.mo.gov or 573-751-3368.

* Registration is now open!

* Required to attend regional training.

* Complete two-year obligation of school counseling "experiences" with mentor to earn DESE monitoring completion certificate.

* Contact logs will contain reflections about topics by both mentor and mentee. Must be submitted to obtain certificate of completion.

* Registration is now open!

* Required to attend regional training.

* Complete two-year obligation as a mentor helping to provide feedback on essential experiences and skills a beginning counselor needs.

* Contact logs will contain reflections and feedback from mentor. Must be submitted to receive stipend.

NSCI

New School Counselor Institute (NSCI)

NSCI 2022

July 18-20, 2022

Holiday-Inn Executive Center
Columbia, Missouri

We are excited to announce the New School Counselor Institute will be in person this year.

NSCI is designed for those entering school counseling positions with:

Recent graduation from a school counseling Master's program and no counseling experience

An Alternative Certification with no or one year of school counseling experience

Certification and experience but changing positions

Space is limited so apply as soon as possible. Priorities for acceptance will be based on the bulleted list above and date registration is received. Local administrator approval is required. Registration must be received by June 27, 2022. No purchase orders accepted. Contact Cierra Griffin at 573-751-3368.

ICAP

The Individual Career & Academic Plan (ICAP), is a plan of study to guide students through the coursework and activities for achieving personal career goals, post-secondary planning and providing individual pathway options. An ICAP is a multi-year process, beginning no later than the eighth grade, that intentionally guides students and families in the exploration of career, academic and multiple post-secondary opportunities to include *direct access to the workforce *military *tech school/area career center *vocational training (apprenticeship), *2 year college and *4 year college. An ICAP is a "roadmap" to help students develop the awareness, knowledge, attitudes, and skills to create their own meaningful pathways to be success ready graduates.

ICAP (Personal Plan of Study) legislative requirements begin on Section 167.903 of Senate Bill 638 (page 45)

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The vision of the School Counseling Staff is to work with schools to help ensure that each school has a fully implemented comprehensive school counseling program that supports the academic, career, and social/emotional development of all students through the delivery of counseling curriculum, individual student planning, and responsive services.

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What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) is a mental disorder in which you have thoughts (obsessions) and rituals (compulsions) over and over. They interfere with your life, but you cannot control or stop them.

What causes obsessive-compulsive disorder (OCD)?

The cause of obsessive-compulsive disorder (OCD) is unknown. Factors such as genetics, brain biology and chemistry, and your environment may play a role.

Who is at risk for obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) usually begins when you are a teen or young adult. Boys often develop OCD at a younger age than girls.

Risk factors for OCD include:

Family history. People with a first-degree relative (such as a parent, sibling, or child) who has OCD are at higher risk. This is especially true if the relative developed OCD as a child or teen.

Brain structure and functioning. Imaging studies have shown that people with OCD have differences in certain parts of the brain. Researchers need to do more studies to understand the connection between the brain differences and OCD.

Childhood trauma, such as child abuse. Some studies have found a link between trauma in childhood and OCD. More research is needed to understand this relationship better.

In some cases, children may develop OCD or OCD symptoms following a streptococcal infection. This is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).

What are the symptoms of obsessive-compulsive disorder (OCD)?

People with OCD may have symptoms of obsessions, compulsions, or both:

Obsessions are repeated thoughts, urges, or mental images that cause anxiety. They may involve things such as

Fear of germs or contamination

Fear of losing or misplacing something

Worries about harm coming towards yourself or others

Unwanted forbidden thoughts involving sex or religion

Aggressive thoughts towards yourself or others

Needing things lined up exactly or arranged in a particular, precise way

Compulsions are behaviors that you feel like you need to do over and over to try to reduce your anxiety or stop the obsessive thoughts. Some common compulsions include

Excessive cleaning and/or handwashing

Repeatedly checking on things, such as whether the door is locked or the oven is off

Compulsive counting

Ordering and arranging things in a particular, precise way

Some people with OCD also have Tourette syndrome or another tic disorder. Tics are sudden twitches, movements, or sounds that people do over and over. People who have tics cannot stop their body from doing these things.

How is obsessive-compulsive disorder (OCD) diagnosed?

The first step is to talk with your health care provider about your symptoms. It's important to check whether a physical problem is causing your symptoms. So your provider will do a physical exam and will ask you about your medical history. If your symptoms do not seem to be caused by a physical problem, your provider may do an OCD test or may refer you to a mental health specialist for further evaluation or treatment.

Obsessive-compulsive disorder (OCD) can sometimes be hard to diagnose. Its symptoms are like those of other mental disorders, such as anxiety disorders. It is also possible to have both OCD and another mental disorder.

Not everyone who has obsessions or compulsions has OCD. Your symptoms would usually be considered OCD when you:

Can't control your thoughts or behaviors, even when you know that they are excessive

Spend at least 1 hour a day on these thoughts or behaviors

Don't get pleasure when performing the behaviors. But doing them may briefly give you relief from the anxiety.

Have significant problems in your daily life because of these thoughts or behaviors

What are the treatments for obsessive-compulsive disorder (OCD)?

The main treatments for obsessive-compulsive disorder (OCD) are cognitive behavioral therapy, medicines, or both:

Cognitive behavioral therapy (CBT) is a type of psychotherapy. It teaches you different ways of thinking, behaving, and reacting to your obsessions and compulsions.
Exposure and Response Prevention (ERP) s a specific type of CBT. ERP involves gradually exposing you to your fears or obsessions. You learn healthy ways to deal with the anxiety they cause.

Medicines for OCD include certain types of antidepressants. If those don't work for you, your provider may suggest taking some other type of psychiatric medicine.

If you have severe OCD that does not get better with these treatments, your provider may suggest a treatment called repetitive transcranial magnetic stimulation (rTMS). It is a brain stimulation procedure that uses magnetic waves. It can target specific brain areas associated with OCD.

NIH: National Institute of Mental Health

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People with obsessive-compulsive disorder (OCD) suffer from frequent, upsetting thoughts called obsessions. Read about the treatments available.

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School Counseling Standards

Four sets of school counseling standards define the school counseling profession. These standards help school counselors develop, implement and assess their school counseling program to improve student outcomes.

Ethical Standards
The ASCA Ethical Standards for School Counselors serve as a guide for the ethical practices of all school counselors, supervisors/directors of school counseling programs and school counselor educators regardless of level, area, population served or membership in this professional association. ASCA also has Ethical Standards for School Counselor Education Faculty.

School Counselor Professional Standards & Competencies
The ASCA School Counselor Professional Standards & Competencies outline the mindsets and behaviors school counselors need to meet the rigorous demands of the school counseling profession and the needs of pre-K-12 students.

Mindsets & Behaviors for Student Success
The " ASCA Mindsets & Behaviors for Student Success: K-12 College- and Career-Readiness Standards for Every Student" describe the knowledge, skills and attitudes students need to achieve academic success, college and career readiness and social/emotional development. Each standard has corresponding grade-level competencies that are specific, measurable expectations that students attain as they make progress toward the standards. Use the ASCA Mindsets & Behaviors database to search for grade-level competencies that support the standards.

ASCA School Counselor Preparation Program Standards
The ASCA School Counselor Preparation Program Standards are a unified set of principles guiding school counselor preparation programs in training effective future school counselors in areas of professional practice and ethical behavior. The standards are intended to define the training of school counselors and ensure school counselors are prepared to implement school counseling programs and advocate on behalf of the profession.

Standards in Practice
Election Conversations: The School Counselor's Role (11/20)
School Reentry: The School Counselor's Role (8/20)
Eliminating Racism and Bias in Schools: The School Counselor's Role (8/20)

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Standards | American School Counselor Association (ASCA)

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School Counseling Standards Four sets of school counseling standards define the school counseling profession. These standards help school counselors develop, implement and assess their school counseling program to improve student outcomes.