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Parent center for children with disabilities

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Parent center for children with disabilities

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https://www.parentcenterhub.org/

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https://childmind.org/

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Fact sheet for parents with children with mental health challenges

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Fact sheet for parents with children with mental health challenges

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https://www.pacarepartnership.org/uploads/MH_fact_sheet_minn07.pdf

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How to help a child with an anxiety disorder

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How to help a child with an anxiety disorder

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https://www.nytimes.com/2018/10/01/well/family/how-to-help-a-child-with-an-anxiety-disorder.html

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https://fod-infobase-com.easydb.angelo.edu/p_ViewVideo.aspx?xtid=160471

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Pink Wellness Workbook - Ebook Lead Magnet  (2) (1)

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addressing mental health in school crisis prevention and response_1_

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Individuals with Disabilities Education Act

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Individuals with Disabilities Education Act (IDEA)

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The U.S. Department of Education’s Individuals with Disabilities Education Act website brings together department and grantee IDEA information and resources. The IDEA makes available a free appropriate public education to and ensures special education and related services to eligible children with disabilities.

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Effective Classroom Strategies for Students with ADHD

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Effective Classroom Strategies for Students with ADHD

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Strategies for Learning and Teaching Website

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Strategies for Learning and Teaching Website

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Working to deliver a better special education service

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The mission of the International OCD Foundation is to help those affected by obsessive compulsive disorder (OCD) and related disorders to live full and productive lives. Our aim is to increase access to effective treatment through research and training, foster a hopeful and supportive community for those affected by OCD and the professionals who treat them, and fight stigma surrounding mental health issues.

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A Teacher's Guide to OCD in the Classroom

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A Teacher's Guide to OCD in the Classroom

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares.

Children who have obsessive-compulsive disorder (OCD) are plagued with unwanted thoughts, images or impulses that are difficult to suppress, causing them great stress and worry. These are called obsessions. To alleviate the anxiety caused by their obsessive thoughts, they perform repetitive, ritualized actions called compulsions. A child with OCD might need to line things up, touch things in a certain order when leaving the room or wash his hands repeatedly.

Obsessions Common in Kids With OCD

Contamination: Kids with this obsession are sometimes called "germaphobes." In schools, this plays out with kids worrying about other kids sneezing and coughing, touching things that might be dirty or getting sick in many different ways. This is the most common obsession seen in children.

Magical thinking: This is a kind of superstition, like "step on a crack, break your mother's back," taken to extremes. For example, kids might worry that their thoughts can cause someone to get hurt, or get sick. A child might think, "Unless my things are lined up in a certain way, mom will get in a car accident."

Catastrophizing: Some kids easily jump to the conclusion that something terrible has happened. For example, if her parents are five minutes late picking her up, a girl who is catastrophizing might tell herself that they've decided to abandon her.

Scrupulosity: This is when kids have obsessive worries about offending God or being blasphemous in some way.

What ifs: Kids may be plagued by a lot of different kinds of thoughts about bad things they could do. "What if I hurt someone? What if I stab someone? What if I kill someone?"

The "just right feeling": When OCD first develops, from about 6 to 9 years of age, kids may not know why they are doing something, but just that they need to do it until they get what we call the "just right feeling." So: "I'll line these things up until it just kind of feels right, and then I'll stop." And then over time - in the 9- to 12-year-old range - it evolves into magical thinking and becomes more superstitious in nature.

Behaviors You Might See in Students With OCD

Frequent requests to go to the bathroom: This could be to wash hands, if someone near the child was coughing or sneezing, or if she touched something that she perceives as contaminated. She could be washing items-pens, pencils, backpacks, books. It could also be an excuse to get out the classroom and just be away from everyone, and have some respite.

Constant reassurance-seeking: This takes the form of repetitive questions. "Are you sure that's the answer? Could you tell me again? Did you hear what I said?" Checking doors, windows, lockers, desks. Over and over and over again.

Getting stuck on tasks: Sometimes kids with OCD will need to finish something to completion, or understand it to completion, before they're able to move on. So if a child is working out what he did wrong on a math test, and the teacher says, "Now let's open the textbook and start a new chapter," he's not going to be able to shift gears.

Retracing: If a child leaves the classroom and worries that she left a pencil behind, she'll go back into the classroom and go to her desk and check. If she had a bad thought as she went through the doorway, she might have to "fix it" by going back through the doorway again saying a good word. If she had a bad thought when she went down a flight of stairs on the way to class, she might need to go back up that same stairway at the end of the period, even if it means being late to her next class.

Obsessive erasing: A child could be erasing a lot because the letters have to look perfect. Or he could have used a word that disturbs him. For example, if he has a fear of vomiting and he's written the word vomit, he might not be able to stand seeing that word, so he erases it. Kids start having erasers worn down to the metal. Teachers start to see holes in the paper. Words will be drawn over on the back of the page. A lot of different areas of writing become problematic.

Behaviors Often Confused With Another Disorder

Some behaviors associated with OCD are easy to confuse with ADHD, learning problems or being oppositional.

Distraction: If a child is busy thinking that if she doesn't turn the pen cap and count to four the right way then her mom is going to get sick, she's not going to be paying attention in class. And if her teacher calls on her to answer a question, her distraction might look like ADHD, but it isn't.

Slowness on exams, papers and tasks: Sometimes when kids take a long time, they're struggling with the perfectionism of needing to do things the right way. This could look like learning problems, or inattention, but it isn't.

Avoidance: Teachers might see a child who doesn't want to sit on the floor, or pick things up that touched the floor, or get his hands dirty in art class. He may avoid a lot of playground activities - kids with germ fears will view the playground the way some adults view the subway: it's gross. Why touch anything there?

Tapping and touching symmetrically: If a child sits down at her desk and she accidentally kicks the chair of the kid next to her with her right foot, she's going to have to then kick it with her left foot. That might look like somebody who's being oppositional, or somebody who's got too much energy, but actually it's OCD.

Complaints of anxiety and fatigue: There's one interesting theory that kids with OCD are smarter than other kids. And if you consider how much thinking they're doing, they're really using their brain more frequently than a lot of other kids are. But when that's coupled with a lot of anxiety, you can have a lot of fatigue. So it's common for kids with OCD to want to come home and take a nap after school.

How to Help Students With OCD

For children struggling with OCD, functioning in school can be complicated and very difficult. Here are some things you can do to help them, and the class as a whole, focus on learning:

Seating arrangement: If the school has noisy hallways, you might not want to have a child with OCD sit by the door. You might have her sit in the front, where she's less able to hear the noise and can stay more focused on her work. On the other hand, a child who has very observable symptoms, and doesn't want other kids to see her fidgeting with her hands, rocking or getting up a lot, might be better off closer to the door, toward the back of the room.

Extended time for tests and papers: If writing is a problem for a child who needs to find the perfect way to say something, he's going to need more time to finish those essay questions or papers.

Laptops for writing: If writing and rewriting/erasing is really problematic for a child, consider letting her use a laptop for taking notes, and having all assignments be typed instead of handwritten.

Private testing rooms: Research is quite clear that kids with OCD do better, are less overwhelmed and are more in control of their thoughts and their reactions if they're in a quiet place away from the other kids.

Skip reading out loud: Kids who feel they need to read perfectly may have to go back and reread sentences or whole paragraphs over and over to make sure they've got them right. So reading becomes a very laborious task, and reading in front of the class can become a nightmare. So if we know doing this is a problem for children, we can spare them.

Books on tape: If kids get so hung up reading that it takes forever, listening to the books can be a solution.

Break homework into chunks: If looking at a whole page of math makes kids feel overwhelmed and anxious - think of the potential for mistakes! - the problems can be broken up over four pages. It helps kids stay focused on doing the problems instead of worrying.

How to Minimize Behavioral Problems

Plan an escape route: Try working out a communication system so that if the student feels symptoms coming on, she can signal to you and leave the classroom, or go to a protected place in the classroom, without interrupting the class. It can prevent an embarrassing and disruptive blowup of symptoms in the classroom, and the other kids picking on or bullying her about it.

Be aware of triggering events: It's very important for teachers to know what kind of things might trigger the symptoms. Fatigue is a huge piece of OCD, and it can be exacerbated by medication. So it's important to know that if a child is drowsy in class, and maybe he's putting his head down, it's not because he's being oppositional or disrespectful, but because he's overwhelmed with fatigue.

Advance notice: Irritability and frustration are two of the longer-lasting things that kids with OCD are feeling on a daily basis. Changes in schedule can be very disruptive for a child with OCD, so it can be helpful for teachers to give advance notice of things. Kids who know what to expect are less likely to be thrown by the change.

Children with OCD are often teased and bullied because of their symptoms. Kids feel very uncomfortable about their rituals, knowing that they're being watched. It can be helpful to educate the whole class about what's going on, especially if a child is going to be in the same school for a number of years, and it can inspire a surprising amount of support from other children.

Peer understanding program: A peer understanding program includes a presentation in the classroom that explains (with the child participating) what OCD is. The child might say, "Listen, I have OCD. It's an anxiety disorder. It makes me think that my hands are dirty and I have to wash my hands a lot, so if you see me getting up and going to the sink to wash my hands, that's why." Psychologists can role-play with the teacher and child ahead of time, to anticipate questions his classmates might ask, and how to answer them.

A buddy system: A buddy is like a peer coach who sits next to the child and prompts him to keep up with note taking and staying on task. It can be great for the buddy, to foster a sense of confidence and pride and to be able to help someone in need, and great for fostering friendship.

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares. Children who have obsessive-compulsive disorder (OCD) are plagued with unwanted thoughts, images or impulses that are difficult to suppress, causing them great stress and worry.

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The School Counselor's Role in Addressing Eating Disorders

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The School Counselor's Role in Addressing Eating Disorders

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The Role of the School Counselor in Supporting Mental Health

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The Role of the School Counselor in Supporting Mental Health

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strategies

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Hadfield, K., & Pecroino, S. (2019). Helping kids with fellings of anxiety and worry. The pathway 2 success. Retrieved July 18, 2021, from https://www.thepathway2success.com/helping-kids-with-feelings-of-anxiety-worry/

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Gatuso, D. (2019). How college students and binge eating disorder are related. The Digestible. Retrieved July 18, 2021, from, https://www.thedigestible.com/blog/how-college-students-and-binge-eating-disorder-are-related-by-dominique-gattuso

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Basic Description

A blueprint or plan for a child's special education experience at school.

A blueprint or plan for how the school will provide support and remove barriers for a student with a disability.

What It Does

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

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

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

These services are provided at no cost to families.

What Law Applies

The Individuals with Disabilities Education Act (IDEA)

Section 504 of the Rehabilitation Act of 1973

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

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

Who's Eligible

To get an IEP, there are two requirements:

To get a 504 plan, there are two requirements:

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

2. The disability must interfere with the child's ability to learn in a general education classroom.

Section 504 has a broader definition of a disability than IDEA. (It says a disability must substantially limit one or more basic life activities. This can include learning, reading, communicating, and thinking.) That's why a child who doesn't qualify for an IEP might still be able to get a 504 plan.

1. A child has one or more of the 13 disabilities listed in IDEA. The law lists specific challenges, like learning disabilities, ADHD, autism, and others.

2. The disability must affect the child's educational performance and/or ability to learn and benefit from the general education curriculum. The child must need specialized instruction to make progress in school.

Independent Educational Evaluation

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

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

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

Who Creates It

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

The rules about who's on the 504 team are less specific than they are for an IEP.

A 504 plan is created by a team of people who are familiar with the child and who understand the evaluation data and special services options. This might include:

The child's parent or caregiver

General and special education teachers

The school principal

The child's parent or caregiver

At least one of the child's general education teachers

At least one special education teacher

School psychologist or other specialist who can interpret evaluation results

A district representative with authority over special education services

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

What's in It

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

There is no standard 504 plan. Unlike an IEP, a 504 plan doesn't have to be a written document.

A 504 plan generally includes the following:

Specific accommodations, supports, or services for the child

Names of who will provide each service

Name of the person responsible for ensuring the plan is implemented

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

The child's present levels of academic and functional performance-how the child is currently doing in school

Annual education goals for the child and how the school will track progress

The services the child will get-this may include special education, related, supplementary, and extended school year services

The timing of services-when they start, how often they occur, and how long they last

Any accommodations-changes to the child's learning environment

Any modifications-changes to what the child is expected to learn or know

How the child will participate in standardized tests

How the child will be included in general education classes and school activities

Notice

When the school wants to change a child's services or placement, it has to tell families in writing before the change. This is called prior written notice. Notice is also required for any IEP meetings and evaluations.

The school must notify families about an evaluation or a "significant change" in placement. Notice doesn't have to be in writing, but most schools do so anyway.

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

Consent

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

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

How Often It's Reviewed and Revised

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

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

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

How to Resolve Disputes

IDEA gives families several ways to resolve disputes (usually in this order):

Section 504 gives families several options for resolving disagreements with the school:

Mediation

Alternative dispute resolution

Impartial hearing

Complaint to the Office for Civil Rights (OCR)

Lawsuit

Funding/Costs

Students receive these services at no charge.

Students receive these services at no charge.

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

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

States receive additional funding for students with IEPs.

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

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Basic Description A blueprint or plan for a child's special education experience at school. A blueprint or plan for how the school will provide support and remove barriers for a student with a disability. What It Does Provides individualized special education and related services to meet a child's unique needs.

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Addressing eating disorders in middle school and high school

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Addressing eating disorders in middle school and high school

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There's nothing shameful about having attention deficit disorder (ADHD or ADD) - or at least there shouldn't be. But in our society, people who have the disorder are somehow seen as "defective," which is clearly untrue.

Can this stigma be avoided? How can children and adults with ADHD avoid being the victims of ridicule, contempt, or discrimination? ADDitude's Carl Sherman, Ph.D., posed these and other questions to Stephen Hinshaw, Ph.D., the author of The Mark of Shame: Stigma of Mental Illness and an Agenda for Change (#CommissionsEarned) (Oxford). Dr. Hinshaw, who chairs the psychology department at the University of California, Berkeley, has done pioneering research on ADHD and the ways it affects children and adolescents.

Why does ADHD carry a stigma?

Despite evidence to the contrary, many people still don't believe that ADHD is a bona fide medical condition. They see it as an excuse for sloppiness or laziness. The fact that ADHD symptoms appear to come and go, depending on the situation, only feeds the doubters' contempt. They say, or think, things like, "Why can't you pull it together? You're fine with certain friends - how come you can't sit down and do your homework?"

Another factor is the widespread negative feeling about the use of psychiatric drugs. In recent years, there's been a surge in the number of people taking ADHD medication. Some wonder if this increase is justified.

Finally, the fact that ADHD can undermine academic performance worsens the stigma. Our society seems to think, "If your grades are poor, you're not worth much." This is especially true if the cause of poor performance is hidden, as it is with ADHD.
[Click to Download: Your Free Guide to Debunking Annoying ADHD Myths]
What harm does ADHD stigmatization cause?

There are obvious things, like social problems and workplace discrimination. But the greatest harm often comes from self-stigmatization - that is, when people with ADHD internalize negative stereotypes.

In the course of my research, I've gotten to know hundreds of children who have ADHD, and I've heard many say things like, "I just can't make it," or "I'm just not cut out for school." The stigma has so corrupted their motivation that they've given up even trying to be successful.

The flip side of self-stigmatization is denial. You consider the stereotypes of ADHD and think, "That's not me." You want nothing to do with such a shameful identity.

People with ADHD tend to have trouble seeing themselves realistically, and the desire to avoid discrimination makes it even harder. For example, if you believe that needing medication proves there's something wrong with you, then not taking your medication "proves" there is nothing wrong with you.
[Free Webinar Replay: From Shame and Stigma to Pride and Truth: It's Time to Celebrate ADHD Differences]
Who is affected most by stigmatization?

Stigmatization can be difficult for anyone who has ADHD, but the burden falls more heavily on girls and young women. People continue to think of ADHD as an exclusively male problem. According to this stereotype, if a girl exhibits common ADHD traits, there must really be something wrong with her.

Something similar may be operating with adults. Since ADHD is commonly thought of as a childhood disorder, adults who have it, or claim to have it, come under suspicion. The thinking seems to be, "Either you made it up to compensate for the failures in your life, or there's something very wrong with you."

What should you do if you hear a hurtful comment about ADHD?

A firm, but gentle, discussion with the person making the remark goes a long way toward raising awareness.

"I have ADHD," you might say, "and it's just as real as other medical conditions." Or you might say, "I work hard, and I bet that you have no idea how demoralizing it is to hear a comment like that."

What else can people with ADHD do to counteract the effects of stereotyping?

The more aware you are of stereotyping, the easier it is to recognize when it is affecting you.

Of course, it's also important to recognize that negative feedback about oneself is occasionally valid - and valuable. If you believe that all criticism leveled at you is the result of stereotyping, you'll be less motivated to seek appropriate treatment.

Taking positive action is another way to avoid the negative effects of stereotyping. Joining others in the struggle to do away with discrimination is empowering. So, when you encounter biased, belittling portrayals of people with ADHD in the media, write a letter to the people responsible for those portrayals.

If you're not already involved with advocacy groups, like CHADD and ADDA, consider getting involved. Or contact your elected representatives to ask them to consider needed policy changes, such as parity. This means putting insurance coverage for mental health problems, like ADHD, on an equal footing with coverage for physical illnesses.

What can parents do to help protect their children with ADHD?

If you're the parent of a child with ADHD, make sure that he or she understands what that means. ADHD should never be used as an excuse, but it probably explains why your child has trouble doing certain things, and why she or he might have to work a little harder than other kids to get the same results.

Make sure your child's school understands that ADHD is a legitimate disorder - and that it may be legally obligated to provide accommodations.

How or when should you reveal a diagnosis of ADHD?

It's a dilemma. If you conceal the fact that you have ADHD, you avoid the ADHD label and the discrimination that can lead to. However, you risk a kind of indirect discrimination. People who notice you being disorganized, impulsive, or forgetful might assume that you are simply rude or lazy.

When is the right time to talk to your boss about your ADHD? When to tell a new friend? It's a judgment call, and timing is crucial. If your employer has a reputation of being good about providing accommodations, for example, you might broach the subject. Otherwise, it might be better to keep it quiet, at least until you get established in your job. Advice from a therapist or consultant can be helpful.

There's no need to tell everyone that you or a loved one has ADHD. But if you feel you shouldn't tell anyone, you're wasting energy - and reducing the likelihood that you will get treatment.

Secrecy fuels feelings of shame. Better to seek out people and places that make secrecy unnecessary, and open up.
[Read This Next: Life Is Too Short for Shame]
#CommissionsEarned
As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

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Tired of battling other people's opinions about ADHD? Learn how adults with the condition and parents of children with ADHD can ignore the stigma, and also discover the best time to tell people about your diagnosis.

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NCMH (National Centre for Mental Health)

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Obsessive-Compulsive Disorder: Information for Parents and Educators By Leslie Z. Paige, EdS, NCSP
Fort Hays State University
Obsessive-Compulsive Disorder (OCD) is a type of anxiety disorder that causes unwanted, obsessive thoughts and compulsive, repeated behaviors. The ritualistic behaviors associated with OCD are an attempt to cope with the intrusive obsessive thoughts. For example, a child with obsessive thoughts regarding disease or contamination might frequently wash his or her hands. OCD symptoms range from mild to severe, and can interfere with school or social functioning.
Background
Approximately 2-3 % of adults and children have OCD. Rates of OCD in children are approximately 1.9%. Because individuals with OCD may try to hide the symptoms, this number may be an underestimate. Symptoms in females usually begin in young adulthood, and symptoms in males usually begin between the ages of 6 and 15. OCD occurs equally in both genders, and is present in all ethnic groups. The earlier OCD is diagnosed and treated, the better the outcome.

The cause of OCD is unknown, but research suggests it may be due to a problem with the way information is processed in the brain. OCD appears to result from a biochemical imbalance that causes the brain to send false messages of danger and prevents screening. There is also research suggesting that OCD may be a learned response to reduce anxiety through compulsive behaviors, sometimes triggered by a stressful event. Diagnosis of OCD is usually made by a mental health provider or physician and is based upon the symptoms.
Characteristics of OCD
Individuals with OCD exhibit obsessive thinking and compulsive behaviors. They typically report that they feel unable to control their thoughts and feel compelled to perform the behaviors. Symptoms may worsen when the child is stressed, ill, or sleep deprived.
Symptoms and Patterns of OCD
Obsessions. These are involuntary, recurring, unwanted thoughts that cause feelings of anxiety or dread. Obsessions are irrational and interfere with normal thinking. Common obsessions include fears of contamination, disease, or causing harm, sexual images, doubting (checking locks), thinking something must be done a certain number of times or keeping items in certain positions to avoid harm, hoarding, and fears associated with religion.

Compulsions. These are behaviors that are repeated to try to control the obsessions. These behaviors reduce anxiety temporarily, but the urge to perform the compulsive behavior becomes stronger over time. Other compulsive behaviors may be added when the original compulsive behaviors become less effective in reducing anxiety. The vicious cycle of OCD is that more elaborate rituals are needed to provide relief from the unwanted thoughts. Sometimes it is possible to see the connection between the obsession and the compulsion, such as fear of contamination and washing hands. However, sometimes there is no logical link, such as needing to wear certain clothes to prevent a burglary. Some children can delay performing the compulsive behavior, but this is very difficult and they will nearly always engage in the compulsive behavior later. Common compulsions include:

Excessive washing and cleaning

Checking (checking and rechecking locks, appliances)

Counting

Redoing (opening and closing, erasing and rewriting)

Hoarding (cannot throw things away)

Praying (continuous and excessive)

Symmetry (movements need to match, things have to look the same)

Some compulsions cannot be observed (such as counting rituals), but others can be easily seen (such as hand washing).
Impact of OCD Symptoms
Key questions to ask when diagnosing OCD include:

How time consuming are the behaviors?

What is the degree of distress?

How much do the obsessions or compulsions interfere with daily functioning?

Although many people may feel anxious and check to see if they left the iron on, once they determine that it is off they can go about their daily lives. Individuals with OCD need to check, recheck, and check again, and this can involve an hour or more. Cleaning household items with disinfectant as part of housekeeping or during flu season is a good habit, but cleaning schoolbooks daily with disinfectant and washing hands until they bleed may indicate a problem.

As a result of the compulsions and obsessions, OCD can be very disruptive. Depression, agitation, difficulty paying attention, feelings of shame, stress, slow performance (owing to time-consuming rituals), and other problems may be associated with poor academic performance and difficulties with family and social relationships.
Treating OCD
Early diagnosis is important. There is no cure, but a combination of medication and cognitive-behavior therapy is considered to be the most effective treatment.

Medication. There are medications that are effective for treating OCD. Medication helps to decrease the feelings of anxiety and the intensity of the symptoms, and allows the child to ignore or turn down the volume of the obsessive thoughts.

Cognitive-behavior therapy. Children with OCD benefit from learning to cope with the obsessive thoughts and reduce the compulsive behaviors. Many individuals with OCD believe that they are going crazy and knowing what the disorder is and the brain's role in tricking individuals into thinking that there is danger or a threat can help to alleviate this fear. Therapy helps to decrease the symptoms, provides explanations for the behaviors, and teaches children strategies to deal with OCD.

Treatment strategies vary, depending upon the age of the child and the severity of the symptoms. Sometimes the behavior is limited by setting a time limit. For example the child is allowed to pray for 10 minutes instead of 2 hours. Sometimes the child will be asked to perform rituals in reverse order, or to engage in a different activity. The mental health practitioner can help children find ways to keep OCD from controlling their lives.
Support From Families
Living with a child with OCD can be very challenging. OCD can disrupt families. Simply telling the child to stop the behavior will be ineffective. Some families may accidentally encourage the rituals; for example, by helping the child turn lights on and off in a set pattern. These reactions do not reduce the child's feeling of anxiety or danger. Many parents report feeling fear, frustration, or anger when their child engages in these disruptive rituals.

It is important for parents to participate in therapy sessions to learn about OCD and how to help their child. Parents can help by learning how to help their child follow their treatment plan and to take the medication. Support groups may also be beneficial for parents.
Support From School Personnel
Identifying OCD. Children with OCD typically try hard to hide their disorder, which makes diagnosis difficult. Teachers can help by becoming educated about OCD. If they notice that there is a child who seems to engage in time-consuming strange behaviors that are repetitive and interfere with social or academic functioning, they should consult with their school psychologist or school counselor. Some children with OCD exhibit behaviors commonly associated with Attention Deficit Hyperactivity Disorder. For example, children with OCD may appear inattentive because they are focused on their obsessive thoughts. A lesson in math or spelling is less compelling than the fear that the house may burn down or the belief that he or she is contaminated with cancer or AIDS. They may become agitated because they want to engage in a ritualistic behavior but want to comply with classroom rules to stay seated.

Interventions. Good communication between home and school is very important. Teachers can help work with the child and the family to help alleviate symptoms by following through on treatment plans that involve the school day. Plans for dealing with certain behaviors that work at home may be helpful at school.

Information from the outside mental health provider and/or school psychologist will be helpful in understanding and helping the child in managing the OCD. The school nurse may need to administer medication during the school day. The school psychologist will be able to assist with educational and behavioral strategies to decrease anxiety, reassure the child, and reinforce coping skills.

A well-structured classroom with clear expectations, smooth transitions, and a calm climate is helpful for most students, but particularly for the child with OCD. Be aware of any teasing or problems with social relationships. Punishing or embarrassing the child are ineffective and should be avoided because they may make the behaviors worse. The symptoms will tend to worsen if the child is feeling stressed.

Teachers may need to know how the obsessive thoughts or compulsive behaviors are interfering with academic or social behaviors. For example, some children may need extra time to take a test because they need to check and recheck their answers. Children with contamination fears may be unable to tolerate being touched.

Some children with OCD may qualify for special education services if the disorder interferes with learning or behavior to a significant degree.
Summary
The symptoms of Obsessive-Compulsive Disorder can be extremely disruptive and distressing. Children with OCD can be helped with a combination of medication and cognitive-behavior therapy designed to reduce the intensity of the obsessions and decrease the compulsive behaviors. It is important that caregivers and educators learn about OCD and how to work together with the child to manage the behaviors and implement the treatment plans.
Resources
Chansky, T.E. (2000). Freeing your child from obsessive-compulsive disorder. New York: Three Rivers Press. ISBN: 0812931173.
Websites
National Institute of Mental Health-www.nimh.nih.gov/publicat/ocd.cfm##ocd2

OCD Foundation-www.ocfoundation.org/ocf1010a.htm

Leslie Z. Paige, EdS, NCSP, is the Grants Facilitator for the Docking Institute of Public Affairs and the Graduate School at Ft. Hays State University in Hays, KS. Previously she was a school psychologist for the Hays West Central Kansas Education Cooperative and directed several federally funded mental health projects, including RURAL: Safe Schools/Healthy Students Initiative and the Hays Middle School Drug Prevention and School Safety Coordinator Grant. She is currently the project director for the Hays Emergency Action Response Team Crisis Preparedness Grant for the Hays Unified School District. This handout will be published by NASP in spring 2004, in Helping Children at Home and School II: Handouts for Families and Educators.

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Obsessive-Compulsive Disorder: Information for Parents and Educators

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Obsessive-Compulsive Disorder: Information for Parents and Educators By Leslie Z. Paige, EdS, NCSP Fort Hays State University Obsessive-Compulsive Disorder (OCD) is a type of anxiety disorder that causes unwanted, obsessive thoughts and compulsive, repeated behaviors. The ritualistic behaviors associated with OCD are an attempt to cope with the intrusive obsessive thoughts.

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Substance Abuse and Mental Health Services Administration

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

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Information for parents

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Understanding teen depression

The teen years can be extremely tough and depression affects teenagers far more often than many of us realize. In fact, it's estimated that one in five adolescents from all walks of life will suffer from depression at some point during their teen years. However, while depression is highly treatable, most depressed teens never receive help.

Teen depression goes beyond moodiness. It's a serious health problem that impacts every aspect of a teen's life. Fortunately, it's treatable and parents can help. Your love, guidance, and support can go a long way toward helping your teen overcome depression and get their life back on track.

If you're a teen feeling depressed...

Is my teen depressed?

While occasional bad moods or acting out is to be expected during the teenage years, depression is something different. The negative effects of teenage depression go far beyond a melancholy mood. Depression can destroy the essence of your teen's personality, causing an overwhelming sense of sadness, despair, or anger.

Many rebellious and unhealthy behaviors or attitudes in teenagers can be indications of depression. The following are some the ways in which teens "act out" in an attempt to cope with their emotional pain:

Persistent negative mood. Frequent crying due to an overwhelming sense of hopelessness is a common sign of depression. However, teens with depression may not necessarily appear sad. Instead, irritability, anger, and agitation may be the most prominent symptoms.

Problems at school. Depression can cause low energy and concentration difficulties. At school, this may lead to poor attendance, a drop in grades, or frustration with schoolwork in a formerly good student.

Loss of interest in activities. Outside of school, you might notice that your teen shows less enthusiasm for their favorite hobbies. They may quit a sports team or hobby, for example, or withdraw from family and friends.

Running away. Many depressed teens run away from home or talk about running away. Such attempts are usually a cry for help.

Drug and alcohol abuse. Teens may use alcohol or drugs in an attempt to self-medicate their depression. Unfortunately, substance abuse only makes things worse.

Low self-esteem. Depression can trigger and intensify feelings of ugliness, shame, failure, and unworthiness.

Smartphone addiction. Teens may go online to escape their problems, but excessive smartphone and Internet use only increases their isolation, making them more depressed.

Reckless behavior. Depressed teens may engage in dangerous or high-risk behaviors, such as reckless driving, binge drinking, and unsafe sex.
[Read: Help for Parents of Troubled Teens]
Violence. Some depressed teens-usually boys who are the victims of bullying -can become aggressive and violent.

Sudden changes in sleep and diet. Depressed teens may spend more time sleeping in bed than usual, or conversely, experience insomnia. You may also notice that your teen is eating more or less than normal.

While depression can cause tremendous pain for your teen-and disrupt everyday family life-there are plenty of things you can do to help your child start to feel better. The first step is to learn what teen depression looks like and what to do if you spot the warning signs.

Depression in teens vs. adults

Depression in teens can look very different from depression in adults. The following signs and symptoms are more common in teenagers than in their adult counterparts:

Irritable or angry mood. As noted, irritability, rather than sadness, is often the predominant mood in depressed teens. A depressed teenager may be grumpy, hostile, easily frustrated, or prone to angry outbursts.

Unexplained aches and pains. Depressed teens frequently complain about physical ailments such as headaches or stomachaches. If a thorough physical exam does not reveal a medical cause, these aches and pains may indicate depression.

Extreme sensitivity to criticism. Depressed teens are plagued by feelings of worthlessness, making them extremely vulnerable to criticism, rejection, and failure. This is a particular problem for "over-achievers."

Withdrawing from some, but not all people. While adults tend to isolate themselves when depressed, teenagers usually keep up at least some friendships. However, teens with depression may socialize less than before, pull away from their parents, or start hanging out with a different crowd.

Is it depression or teenage "growing pains"?

If you're unsure if your teen is depressed or just "being a teenager," consider how long the symptoms have been going on, how severe they are, and how different your teen is acting from their usual self. Hormones and stress can explain the occasional bout of teenage angst-but not continuous and unrelenting unhappiness, lethargy, or irritability.

Suicide warning signs in depressed teens

Seriously depressed teens, especially those who also abuse alcohol or drugs, often think about, speak of, or make attempts at suicide-and an alarming and increasing number are successful. So it's vital that you take any suicidal thoughts or behaviors very seriously. They're a cry for help from your teen.

Suicide warning signs to watch for

Talking or joking about committing suicide

Saying things like, "I'd be better off dead," "I wish I could disappear forever," or "There's no way out"

Speaking positively about death or romanticizing dying ("If I died, people might love me more")

Writing stories and poems about death, dying, or suicide

Engaging in reckless behavior or having a lot of accidents resulting in injury

Giving away prized possessions

Saying goodbye to friends and family as if for the last time

Seeking out weapons, pills, or other ways to kill themselves

Get help for a suicidal teen

Causes of teen depression

Biological factors, such as genes, can increase a teen's risk of developing depression. However, environmental and social conditions also have a role to play. The following factors may trigger or exacerbate symptoms of depression in your teen:

Bullying. Being bullied by peers can add stress to a teen's life and affect their self-esteem. This can, in turn, trigger feelings of intense helplessness and hopelessness.

Other mental and physical health conditions. Teen depression is associated with a number of other mental health problems, including eating disorders, self-injury, anxiety, ADHD, or a learning disorder. The struggles that accompany these conditions may lead a teen to feel unconfident and frustrated when it comes to academics and socializing. Similarly, physical disabilities or chronic illness can also play a role.

Past and present stressful experiences. Past trauma from violent or abusive situations can put teens at risk of depression as well as post-traumatic stress disorder (PTSD). Recent events, such as the loss of a loved one, can also trigger a depressed mood.

Lack of social support. Teens who feel unsupported by family or peers are at risk of depression. For example, a teen may be struggling with their sexual identity in a hostile or unaccepting environment.

Other causes of teen depression can include alcohol and drug abuse, family problems, and academic struggles. Depression can cause or worsen these issues as well, creating a cycle that needs to be broken.

Depression and social media use

Some studies draw a connection between teen depression and social media use. Teens that spend more time on social media tend to report higher rates of depression than their peers. Several explanations may explain this connection:

Online interactions may be emotionally unsatisfying or increase fear of missing out (FOMO). For example, your teen may see images of their peers enjoying time together and feel excluded.

Teens on social media may spend lots of time comparing their looks and their lives with those of their peers. This can damage self-esteem.

Spending time on social media may decrease the amount of time your teen spends being physically active or developing skills. Some studies show that a sedentary lifestyle can have a negative effect on mental health.

Too much time on social media may interfere with your teen's sleep routine, indirectly affecting their mood.

How to help a depressed teenager

Depression is very damaging when left untreated, so don't wait and hope that worrisome symptoms will go away. If you suspect that your teen is depressed, bring up your concerns in a loving, non-judgmental way. Even if you're unsure that depression is the issue, the troublesome behaviors and emotions you're seeing are signs of a problem that should be addressed.

Open up a dialogue by letting your teen know what specific depression symptoms you've noticed and why they worry you. Then ask your child to share what they're going through-and be ready and willing to truly listen. Hold back from asking a lot of questions (most teenagers don't like to feel patronized or crowded), but make it clear that you're ready and willing to provide whatever support they need.

How to communicate with a depressed teen

Focus on listening, not lecturing. Resist any urge to criticize or pass judgment once your teenager begins to talk. The important thing is that your child is communicating. You'll do the most good by simply letting your teen know that you're there for them, fully and unconditionally.

Be gentle but persistent. Don't give up if they shut you out at first. Talking about depression can be very tough for teens. Even if they want to, they may have a hard time expressing what they're feeling. Be respectful of your child's comfort level while still emphasizing your concern and willingness to listen.

Acknowledge their feelings. Don't try to talk your teen out of depression, even if their feelings or concerns appear silly or irrational to you. Well-meaning attempts to explain why "things aren't that bad" will just come across as if you don't take their emotions seriously. Simply acknowledging the pain and sadness they are experiencing can go a long way in making them feel understood and supported.

Trust your gut. If your teen claims nothing is wrong but has no explanation for what is causing the depressed behavior, you should trust your instincts. If your teen won't open up to you, consider turning to a trusted third party: a school counselor, favorite teacher, or a mental health professional. The important thing is to get them talking to someone.

Helping a depressed teen tip 1: Encourage social connection

Depressed teens tend to withdraw from their friends and the activities they used to enjoy. But isolation only makes depression worse, so do what you can to help your teen reconnect.

Make face time a priority. Set aside time each day to talk-time when you're focused totally on your teen, without distractions or trying to multi-task. The simple act of connecting face to face can play a big role in reducing your teen's depression. And remember: talking about depression or your teen's feelings will not make the situation worse, but your support can make all the difference in their recovery.

Combat social isolation. Do what you can to keep your teen connected to others. Encourage them to go out with friends or invite friends over. Participate in activities that involve other families and give your child an opportunity to meet and connect with other kids.

Try to reduce their social media use. Remind your teen that social media isn't an ideal substitute for face-to-face interactions. Encourage them to turn off their phone-or at least disable notifications-when socializing in person, focusing on work, or preparing for bed.

Get your teen involved. Suggest activities-such as sports, after-school clubs, or an art, dance, or music class-that take advantage of your teen's interests and talents. While your teen may lack motivation and interest at first, as they reengage with the world, they should start to feel better and regain their enthusiasm.

Promote volunteerism. Doing things for others is a powerful antidepressant and self-esteem booster. Help your teen find a cause they're interested in and that gives them a sense of purpose. If you volunteer with them, it can also be a good bonding experience.

Tip 2: Make physical health a priority

Physical and mental health are inextricably connected. Depression is exacerbated by inactivity, inadequate sleep, and poor nutrition. Unfortunately, teens are known for their unhealthy habits: staying up late, eating junk food, and spending hours on their phones and devices. But as a parent, you can combat these behaviors by establishing a healthy, supportive home environment.

Get your teen moving! Exercise is absolutely essential to mental health, so get your teen active-whatever it takes. Ideally, teens should be getting at least an hour of physical activity a day, but it needn't be boring or miserable. Think outside the box: walking the dog, dancing, shooting hoops, going for a hike, riding bikes, skateboarding-as long as they're moving, it's beneficial.

Set limits on screen time. Teens often go online to escape their problems, but when screen time goes up, physical activity and face time with friends goes down. Both are a recipe for worsening symptoms. Gently encourage your teen to take an occasional vacation from their devices or engage in family activities that don't involve screen time. You can also set an example by reducing your own time spent online.

Provide nutritious, balanced meals. Make sure your teen is getting the nutrition they need for optimum brain health and mood support: things like healthy fats, quality protein, and fresh produce. Eating a lot of sugary, starchy foods -the quick "pick me up" of many depressed teens-will only have a negative effect on their mood and energy.

Encourage plenty of sleep. Teens need more sleep than adults to function optimally-up to 9-10 hours per night. Make sure your teen isn't staying up until all hours at the expense of much-needed, mood-supporting rest.

Tip 3: Know when to seek professional help

Support and healthy lifestyle changes can make a world of difference for depressed teens, but it's not always enough. When depression is severe, don't hesitate to seek professional help from a mental health professional with advanced training and a strong background treating teens.

Involve your child in treatment choices

When choosing a specialist or pursuing treatment options, always get your teen's input. If you want your teen to be motivated and engaged in their treatment, don't ignore their preferences or make unilateral decisions. No one therapist is a miracle worker, and no one treatment works for everyone. If your child feels uncomfortable or is just not 'connecting' with the psychologist or psychiatrist, seek out a better fit.

Explore your options

Expect a discussion with the specialist you've chosen about depression treatment options for your teen. Talk therapy is often a good initial treatment for mild to moderate cases of depression. Over the course of therapy, your teen's depression may resolve. If it doesn't, medication may be warranted.
[Read: Finding a Therapist Who Can Help You Heal]
Unfortunately, some parents feel pushed into choosing antidepressant medication over other treatments that may be cost-prohibitive or time-intensive. However, unless your child is acting out dangerously or at risk for suicide (in which case medication and/or constant observation may be necessary), you have time to carefully weigh your options. In all cases, antidepressants are most effective when part of a broader treatment plan.

Medication comes with risks

Antidepressants were designed and tested on adults, so their impact on young, developing brains is not yet fully understood. Some researchers are concerned that exposure to drugs such as Prozac may interfere with normal brain development-particularly the way the brain manages stress and regulates emotion.

Antidepressants also come with risks and side effects of their own, including a number of safety concerns specific to children and young adults. They are also known to increase the risk of suicidal thinking and behavior in some teenagers and young adults. Teens with bipolar disorder, a family history of bipolar disorder, or a history of previous suicide attempts are particularly vulnerable.

The risk of suicide is highest during the first two months of antidepressant treatment. Teenagers on antidepressants should be closely monitored for any sign that the depression is getting worse.

Teens on antidepressants: Red flags to watch out for

Tip 4: Support your teen through depression treatment

As your depressed teenager goes through treatment, the most important thing you can do is to let them know that you're there to listen and offer support. Now more than ever, your teenager needs to know that they're valued, accepted, and cared for.

Be understanding. Living with a depressed teenager can be difficult and draining. At times, you may experience exhaustion, rejection, despair, aggravation, or any other number of negative emotions. During this trying time, it's important to remember that your child is not being difficult on purpose. Your teen is suffering, so do your best to be patient and understanding.

Stay involved in treatment. Make sure your teenager is following all treatment instructions, whether it's attending therapy or correctly taking any prescribed medication. Track changes in your teen's condition, and call the doctor if depression symptoms seem to be getting worse.
[Read: Depression Treatment]
Be patient. The road to your depressed teenager's recovery may be bumpy, so be patient. Rejoice in small victories and prepare for the occasional setback. Most importantly, don't judge yourself or compare your family to others. As long as you're doing your best to get your teen the necessary help, you're doing your job.

Tip 5: Take care of yourself (and the rest of the family)

As a parent, you may find yourself focusing all your energy and attention on your depressed teen and neglecting your own needs and the needs of other family members. However, it's extremely important that you continue to take care of yourself during this difficult time.

Above all, this means reaching out for much needed support. You can't do everything on your own so enlist the help of family and friends. Having your own support system in place will help you stay healthy and positive as you work to help your teen.
[Read: Helping Someone with Depression]
Don't bottle up your emotions. It's okay to feel overwhelmed, frustrated, helpless, or angry. Reach out to friends, join a support group, or see a therapist of your own. Talking about how you're feeling will help defuse the intensity.

Look after your health. The stress of your teen's depression can affect your own moods and emotions, so support your health and well-being by eating right, getting enough sleep, and making time for things you enjoy.

Be open with the family. Don't tiptoe around the issue of teen depression in an attempt to "protect" the other children. Kids know when something is wrong. When left in the dark, their imaginations will often jump to far worse conclusions. Be open about what is going on and invite your children to ask questions and share their feelings.

Remember the siblings. Depression in one child can cause stress or anxiety in other family members, so make sure "healthy" children are not ignored. Siblings may need special individual attention or professional help of their own to handle their feelings about the situation.

Avoid the blame game. It can be easy to blame yourself or another family member for your teen's depression, but it only adds to an already stressful situation. Furthermore, depression is normally caused by a number of factors, so it's unlikely-except in the case of abuse or neglect-that any loved one is "responsible."

Depression support, suicide prevention help

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Parent's Guide to Teen Depression - HelpGuide.org

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Learn what teen depression looks like in teens and what you can do to help your child.

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Evidence-Based Case Review

Understand the importance of diagnosing and treating depression in adolescents

Identify the symptoms of depression in adolescents and the difference between depression and normal adolescent moods

Identify suicidal risk in a depressed adolescent

Understand when a specialty consultation is needed

Understand what effective treatments are available

By age 18, about 20% of our nation's youth will have had depressive episodes,, with girls at substantially higher risk. Major depressive episodes in adolescence last an average of 6 to 9 months,, 6% to 10% of depressed adolescents have protracted episodes, and the probability of recurrence within 5 years is about 70%. Given that depressed people are as likely to seek help in primary care settings as in mental health establishments, primary care physicians may be the first to be aware of this problem in their adolescent patients.

Case history

Wanda S, aged 16 years, comes for her checkup accompanied by her mother. She is in good health and has had no notable illnesses in the past year. However, Wanda complains of difficulty sleeping in the past few months and of frequently being tired. Her mother asks for a few minutes alone to discuss her concerns about her daughter. She states that "Wanda has been much more irritable than her usual self" and that "her teachers have been complaining that she doesn't seem to attend to her work lately and her grades are slipping." Wanda's mother remembers being an unhappy adolescent herself and asks your advice on how to help her daughter.

When directly questioned, Wanda admits to "feeling pretty bad for the last few months, since school began." She concedes that she feels sad and blue most days of the week and believes that she is "a loser." She's been spending more time alone and, despite complaining of chronic boredom, has little energy or desire to engage in recreational activities.

METHODS

Our conclusions are based on literature searches using both MEDLINE and PsychLIT databases, and most are derived from empiric findings and clinical trials. Because of the relatively modest literature, particularly on treatment, some suggestions are based on published opinions of experts. We have noted when expert opinion is our source.

What does depression look like in adolescents?

According to the Diagnostic and statistical manual of mental disorders, fourth edition, an adolescent must have five out of nine characteristic symptoms most of the time for at least 2 weeks for a diagnosis of major depressive disorder. At least one of these symptoms must be either depressed or irritable mood or a pervasive loss of pleasure or interest in events that were once enjoyed. Many seriously depressed adolescents experience both. For example, a depressed adolescent may feel sad most of the day, act crabby, stop hanging out with friends, and seem to lose her love of soccer.
Summary points
Although all adolescents occasionally become sad, and adolescent angst may be normal and common, symptoms of major depression are more severe in intensity, interfere with social, academic, and recreational activities, and last for months at a time, instead of fluctuating like more typical adolescent ups and downs. Depression occurs as a cluster of signs and symptoms, including emotional, physical, and mental changes that usually signify an alteration from the adolescent's normal personality.

Some adolescents present with depressive symptoms but do not meet the full criteria for having major depression. Dysthymic disorder is characterized by milder but more persistent symptoms than major depression. In dysthymic disorder, symptoms are present much of the time for at least one year in adolescents (2 years in adults).

What contributes to adolescent depression?

The vulnerability-stress model is useful for understanding depression. According to this model, adolescent depression results from a predisposition for depression, which is then triggered or complicated by environmental stress. The exact nature of the predisposition may include biologic and cognitive factors. This interplay between life's stresses and cognitive and biologic vulnerabilities is important in conceptualizing depression in an adolescent.

An accumulation of adverse life circumstances and events can trigger depression. Family adversity, academic difficulties, chronic medical conditions, and loss in the adolescent's life may increase risk. As Wanda's history illustrates, losses such as her breakup with a boyfriend and failure to make the track team may serve as triggers. Illnesses such as asthma, sickle cell anemia, irritable bowel syndrome, recurrent abdominal pain, and diabetes mellitus may put an adolescent at particular risk.

Cognitive models of depression suggest that it is not stressful events and circumstances but rather the tendency toward negative interpretations about these situations that initiates and maintains depression., When an adverse event occurs, the depressed adolescent often understands the cause of the event as something stable, internal, and global. For example, Wanda fails to make the track team and attributes this failure to being a "loser." This cause is stable (unlikely to change), internal (her own fault), and global (affecting everything she does).

Vulnerability to depression may result from biologic or genetic factors and lead to numerous biologic changes. First, studies of family history show that offspring of depressed parents are at high risk for depression and that depressed adolescents have high rates of depression among their family members. Wanda's mother may have been depressed during adolescence. Second, as depressions become more severe, biologic changes may occur, including dysregulation of growth hormone and changes in sleep architecture.

How do you assess adolescent depression?

The diagnosis of depression is made clinically. Physicians need to ask about changes in an adolescent's moods, feelings, and thoughts; behaviors; daily functioning; and any impairment in that functioning, as well as physical symptoms. Furthermore, a medical explanation (for example, thyroid disease or adrenal dysfunction) or substance misuse needs to be ruled out as possible causes. The best methods of assessment supplement the adolescent's selfreport with reports from parents or guardians and other outside sources. Whereas youths tend to be better reporters of their internal experiences, such as their mood and thoughts, parents tend to be better reporters of overt behaviors, such as disruptive behavior in the classroom and defiance. As in all primary care evaluations, ethnic and cultural factors must also be considered. For example, in some cultures, making eye contact with an authority figure may not be considered proper etiquette, and the failure to do so may not reflect a depressed mood. In recent years, several screening tools for depression have been adapted for use in primary care settings., The use of these screening techniques can improve the quality of assessments of depression while reducing the time needed for questioning during routine examinations.

How do you assess and intervene when an adolescent is suicidal?

Depression is associated with a markedly increased risk of suicide and attempted suicide.,, About 41% of depressed youths have suicidal ideation, and 21% report a past attempt at suicide. Although many people are concerned that asking directly about suicide may suggest the idea, most depressed youths have suicidal thoughts and are relieved at the opportunity to share them. Unfortunately, adolescents may not volunteer this information unless directly questioned. Often depressed youths have thoughts of death, a desire to die, or a more overt suicidal intention. Asking straightforward, unambiguous questions to assess the risk of suicide is the best strategy. Questions may include "Have you thought that life was not worth living?" "Have you wished you were dead?" "Have you thought about killing yourself?" "What have you thought about doing?" "Have you ever tried to hurt yourself?" or "Have you ever actually tried to kill yourself?" If there is evidence of suicidal thoughts or attempts, it is then critical to establish if the adolescent has the intent, plan, and means to attempt suicide. Questions to ask may include "Are you going to try?" "How would you do it?" and "Do you have a gun (knife, pills)?"

When is a specialty consultation needed?

Depression in adolescents is frequently complicated by other mental health and life problems. Because these additional problems affect management strategies, it is important to screen for comorbid disorders and problems with psychosocial functioning and life stress. If at any point the primary care physician feels uncertain about the diagnosis and/or management strategy, specialty mental health consultation is recommended. Primary care physicians should obtain a consultation with a specialist if any of the following are present: current or past mania, two previous episodes of depression, chronic depression, substance dependence or abuse, eating disorder, a history of being admitted to a hospital for psychiatric problems, or a history of suicide attempts or concerns regarding the risk for suicide.

TREATMENTS EFFECTIVE FOR ADOLESCENT DEPRESSION

Although research on the treatment of adolescent depression is limited, recent clinical trials have identified promising interventions, both pharmacologic and psychotherapeutic. The physician also needs to help the family to understand the adolescent's symptoms.

Although research has clearly documented the use of antidepressant medication for adults with depression, far fewer studies have examined the use of these agents in adolescents. Selective serotonin reuptake inhibitors are the first choice in medication for depressed adolescents because of their relatively benign side effects, their safety in overdose, and because they only need to be taken once daily. Both tricyclic antidepressants and monoamine oxidase inhibitors are less efficacious in adolescents, are more lethal in overdose, and are not recommended at this time.

Cognitive behavior therapies are effective in treating adolescent depression., They assume that developing more adaptive ways of thinking, understanding events, and interacting with the environment will reduce depressive symptoms and improve a youth's ability to function. The cognitive component of the treatment focuses on helping adolescents identify and interrupt negative or pessimistic thoughts, assumptions, beliefs, and interpretations of events and to develop new, more positive or optimistic ways of thinking. The behavioral component focuses on increasing constructive interactions with others to improve the likelihood of receiving positive feedback.

Interpersonal therapy emphasizes improving relationships. The therapy is brief and focuses on the problems that precipitated the current depressive episode. It helps the adolescent to reduce and cope with stress. Two studies, have shown its effectiveness in reducing depression.

No definitive guidelines have been published for deciding when to begin with medication, psychotherapy, or a combination of medication plus psychotherapy. We have, however, suggested several considerations based on common sense to help clinicians make this decision.,, For example, medication should be considered if an adolescent does not seem interested in thinking about problems, has limited cognitive abilities, is severely depressed with vegetative symptoms, has had two or more episodes of depression, has not responded to 8 to 12 weeks of psychotherapy, or cannot regularly get to therapy sessions. Conversely, psychotherapy should be considered as the first alternative for adolescents who fear medication or do not like taking pills, prefer talking about problems, have complex life stressors that need sorting out, have contraindications to medication (such as pregnancy or breast-feeding), or have not responded to an adequate trial of medication. For some adolescents who have combinations of severe depression, limited cognitive skills, and complex life stressors, it may be best to begin with both medication and psychotherapy.

Parents may have little understanding of the adolescent's symptoms and sometimes interpret falling grades and lack of interest as willful behavior. By giving parents information about the symptoms, causes, and treatments of depression, the physician can help them to help their child to recover, to monitor symptoms, and to facilitate ongoing care. Families differ in their willingness to consider the possibility that their child may have a psychological or psychiatric problem. For personal and/or cultural reasons, some families may be more receptive to a medical model, which identifies the depressive symptoms as part of an illness, and so they are more comfortable with a pharmacologic intervention. Other families may find a cognitive explanation more acceptable and see psychotherapy as a more palatable option. Further, primary care physicians may note that on finding out about their adolescent's depression, parents may feel guilty or feel they are being blamed and thus be resistant to suggestions for interventions. Appropriate education about depression and possible causes may help allay these concerns.
Symptoms of major depressive disorder in adolescents

Depressed or irritable mood

Loss of pleasure or interest in activities that were once enjoyed

Significant weight loss or gain when not dieting, or an increase or decrease in appetite

Insomnia or hypersomnia

Observable slowing of movements and speech or increased agitation

Feelings of worthlessness or excessive and/or inappropriate guilt

Difficulty concentrating and/or making decisions

Recurrent thoughts of death or suicide or a suicide attempt

For a diagnosis, an adolescent must have at least 5 symptoms, which must include at least one of either of the first 2 symptoms, for at least 2 weeks.

When assessing adolescents for depression who already have chronic illnesses, it is important to look at the symptoms that are less likely to overlap with the physical illness, such as feelings of guilt, worthlessness, and hopelessness. It may be difficult to decipher whether changes in sleep patterns, appetite, and increased fatigue are due to the illness or to depression.
Symptoms of dysthymic disorder in adolescents
Depressed or irritable mood must be present for most of the day, more days than not, for at least 1 year. In addition, 2 of the following 6 symptoms must be present:

During this time, the adolescent has never been without the depressive symptoms for more than 2 months at a time but does not meet criteria for a major depressive episode.

Having assessed thoughts of death, the intention to die, plans for an attempt, the means to commit suicide, and the availability of support, the physician must estimate the degree of risk and make choices for managing the patient's risk of suicide. First, although thoughts of death or thinking of suicide in vague terms suggests a low risk, such symptoms indicate a need for both immediate intervention and close monitoring (because suicidal risk can increase). Second, when the adolescent acknowledges having a plan or means but no intent, emergency care may not be needed if safety can be ensured through involving parents and other support systems. Parents need to be in close proximity and to remove potential means such as firearms, and the adolescent needs to be referred for psychotherapy. However, if the adolescent does not have a supportive family, has access to lethal means, or has other risk factors (for example, a past suicide attempt, family history of suicide, recent exposure to suicide, substance abuse, bipolar illness, mixed state, or severe stress), more intensive interventions are needed, and the adolescent needs to see a mental health specialist. Finally, when the adolescent has intent, plan, and means, the risk for suicide is high. Such adolescents need help immediately, and psychiatric emergency care may be needed. Regardless of risk, follow-up care is essential to tackle the concerns that contributed to the adolescent's suicidal feelings.
Empirically supported treatment options
Selective serotonin reuptake inhibitors Alters dysfunctional neurotransmitter systems

Cognitive behavioral therapy Monitors and changes dysfunctional ways of thinking

Interpersonal therapy Improves interpersonal skills and problem-solving abilities

​

Notes

Funding: National Institutes of Health, Agency for Health Care Policy and Research

References

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Evidence-Based Case Review: Identifying and treating adolescent depression

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Evidence-Based Case Review Understand the importance of diagnosing and treating depression in adolescents Identify the symptoms of depression in adolescents and the difference between depression and normal adolescent moods Identify suicidal risk in a depressed adolescent Understand when a specialty consultation is needed Understand what effective treatments are available By age 18, about 20% of our nation's youth will have had depressive episodes,, with girls at substantially higher risk.

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Today, I would recognize the signs: the 11 year old girl in the sixth grade class spending her entire recess and lunch-break running in the schoolyard and doing circuits in the gym; every day, exercising more; the same girl continuing to get top marks with her school work, always punctual, eager to please, but becoming withdrawn; her bubbly personality disappearing; she is not eating her lunch - she offers it to her playmates. She keeps only the apple and eats this very, very slowly, one nibble at a time. Today I would recognize these signs as symptoms of anorexia nervosa, for this child was me.

Teachers are in a prime position to be among the first people to notice a child is developing an eating disorder. I certainly wish my teacher had recognized the symptoms and intervened. But that was 50 years ago. Today, I like to think that all teachers are aware of the signs of anorexia nervosa, and that they know how to respond. Sometimes, friends of the child will notice the symptoms, and confide in the teacher. Or perhaps the coach or dance instructor may notice behavioral changes.

Teachers often want to help when they suspect a child is suffering symptoms of anorexia nervosa, but don't know when to say something, what to say or how to say it. They might even decide that it is better to say nothing than say the wrong thing. This just goes to show how important it is for school staff to be educated and informed about eating disorders - so that they feel confident and more able to help. A teacher's attitude and response can greatly influence whether the illness is 'nipped in the bud' and stopped in its tracks or gathers pace and becomes entrenched.

School staff are well placed to spot the early signs of anorexia nervosa, enabling early diagnosis, early intervention and a far better prognosis. A child may feel more comfortable talking about food difficulties with a teacher rather than someone in their immediate family. The school can provide a bridge between the child, their family and other care providers to ensure the best possible outcome.

How the teacher responds - how they offer support - can greatly influence what happens next. The clues below on what to say, and when to say it, are drawn from my latest book with Professor Janet Treasure: Anorexia Nervosa: A Recovery Guide for Sufferers, Families and Friends. This updated version includes information for teachers and others whose daily work involves the care of children.

School-specific warning signs
Some anorexia nervosa warning signs are more easily noticed at school. Observing me at age 11, the teacher would have ticked a box in each of the following:

Weight loss (not because I did not want to eat, but was afraid to eat)

Avoidance of PE or swimming (because it involved undressing)

Excessive exercise (I felt driven to do more each day)

Busy during lunch breaks (to avoid questions like 'why aren't you eating?')

Wearing extra clothing (to keep warm and hide the body)

Perfectionism (important to get everything right to avoid anxiety)

Inability to focus in class (when the brain is starved, concentration is more difficult)

Loss of friends (because food thoughts increasingly dominate thinking time)

When a child is causing concern
When a teacher suspects a child may be suffering from anorexia nervosa, they should tell the person responsible for pastoral care within the school. They may already be aware of the problem, or they may enlist your help.

Creating opportunities for confiding
A child feels more comfortable when they 'make the first move' with regards to talking about their eating disorder as this helps them to feel in control of the situation. To facilitate this, a teacher can create situations for one on one time such as suggesting they stay after class to discuss their homework. Often, a child with an eating disorder feels scared and alone, and during the early stages may welcome the chance to offload to someone.

Remain calm and don't judge. Encourage the child to share their fears with questions such as: 'You don't seem quite yourself lately, how can I help you?' Avoid talking about food or weight directly as this is likely to frighten the child. Take this first meeting gently and accept that you are unlikely to get to the crux of the issue immediately. Focus on listening to the child. Work on building a trusting relationship and ensure that they know when and where they can talk to you further about what's on their mind.

* For more information, see Anorexia Nervosa: A Recovery Guide for Sufferers, Families and Friends. Pooky Knightsmith writes the chapter 'Guidelines for School Staff'.

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A Lesson for Teachers in Addressing the Eating Disorder Bully

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Today, I would recognize the signs: the 11 year old girl in the sixth grade class spending her entire recess and lunch-break running in the schoolyard and doing circuits in the gym; every day, exercising more; the same girl continuing to get top marks with her school work, always punctual, eager to please, but becoming withdrawn; her bubbly personality disappearing; she is not eating her lunch - she offers it to her playmates.

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Overview

Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which causes significant distress for the individual, their family members, and friends. If left untreated, the symptoms of schizophrenia can be persistent and disabling. However, effective treatments are available. When delivered in a timely, coordinated, and sustained manner, treatment can help affected individuals to engage in school or work, achieve independence, and enjoy personal relationships.

Onset and Symptoms

Risk Factors

Treatments and Therapies

Finding Help

Join a Study

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Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which causes significant distress for the individual, their family members, and friends. If left untreated, the symptoms of schizophrenia can be persistent and disabling.

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These self-help tips can help you manage bipolar disorder, cope with symptoms, and prevent relapse.

How to cope with bipolar disorder

No matter how down or out of control you feel, it's important to remember that you're not powerless when it comes to bipolar disorder. Beyond the treatment you get from your doctor or therapist, there are many things you can do for yourself to reduce your symptoms and stay on track.

Living well with bipolar disorder requires certain adjustments. Like diabetics who take insulin or recovering alcoholics who avoid drinking, if you have bipolar disorder, it's important to make healthy choices for yourself. Making these healthy choices will help you keep your symptoms under control, minimize mood episodes, and take control of your life.

Managing bipolar disorder starts with proper treatment, including medication and therapy. But there is so much more you can do to help yourself on a day-to-day basis. These tips can help you influence the course of your illness, enabling you to take greater control over your symptoms, to stay well longer, and to quickly rebound from any mood episode or relapse.

Living with bipolar disorder tip 1: Get involved in your treatment

Be a full and active participant in your own treatment. Learn everything you can about bipolar disorder. Become an expert on the illness. Study up on the symptoms, so you can recognize them in yourself, and research all your available treatment options. The more informed you are, the better prepared you'll be to deal with symptoms and make good choices for yourself.

Using what you've learned about bipolar disorder, collaborate with your doctor or therapist in the treatment planning process. Don't be afraid to voice your opinions or questions. The most beneficial relationships between patient and healthcare provider work as a partnership. You may find it helpful to draw up a treatment contract outlining the goals you and your provider have agreed upon.

Improve your treatment by:

Being patient. Don't expect an immediate and total cure. Have patience with the treatment process. It can take time to find the right program that works for you.

Communicating with your treatment provider. Your treatment program will change over time, so keep in close contact with your doctor or therapist. Talk to your provider if your condition or needs change and be honest about your symptoms and any medication side effects.

Taking your medication as instructed. If you're taking medication, follow all instructions and take it faithfully. Don't skip or change your dose without first talking with your doctor.

Getting therapy. While medication may be able to manage some of the symptoms of bipolar disorder, therapy teaches you skills you can use in all areas of your life. Therapy can help you learn how to deal with your disorder, cope with problems, regulate your mood, change the way you think, and improve your relationships.

Tip 2: Monitor your symptoms and moods

In order to stay well, it's important to be closely attuned to the way you feel. By the time obvious symptoms of mania or depression appear, it is often too late to intercept the mood swing, so keep a close watch for subtle changes in your mood, sleeping patterns, energy level, and thoughts. If you catch the problem early and act swiftly, you may be able to prevent a minor mood change from turning into a full-blown episode of mania or depression.

Know your triggers and early warning signs

It's important to recognize the warning signs of an oncoming manic or depressive episode. Make a list of early symptoms that preceded your previous mood episodes. Also try to identify the triggers, or outside influences, that have led to mania or depression in the past. Common triggers include:

stress

financial difficulties

arguments with your loved ones

problems at school or work

seasonal changes

lack of sleep

Common red flags for relapse

Warning signs of depression

You've stopped cooking your own meals.

You've stopped mixing with friends.

People bother you.

You crave sugary food such as chocolate.

You're getting frequent headaches.

You don't care about others.

You need more sleep and take naps during the day.

Warning signs of mania or hypomania

You can't concentrate.

You find myself reading lots of books at once.

You're talking faster than normal.

You feel irritable.

You're hungry all the time.

Friends have commented on your irritable mood.

You have more energy than usual so need to be moving.

Knowing your early warning signs and triggers won't do you much good if you aren't keeping close tabs on how you're feeling. By checking in with yourself through regular mood monitoring, you can be sure that red flags don't get lost in the shuffle of your busy, daily life.

Keeping a mood chart is one way to monitor your symptoms and moods. A mood chart is a daily log of your emotional state and other symptoms you're having. It can also include information such as how many hours of sleep you're getting, your weight, medications you're taking, and any alcohol or drug use. You can use your mood chart to spot patterns and indicators of trouble ahead.

Develop a wellness toolbox

If you spot any warning signs of mania or depression, it's important to act swiftly. In such times, it's helpful to have a wellness toolbox to draw from. A wellness toolbox consists of coping skills and activities you can do to maintain a stable mood or to get better when you're feeling "off."

The coping techniques that work best will be unique to your situation, symptoms, and preferences. It takes experimentation and time to find a winning strategy. However, many people with bipolar disorder have found the following tools to be helpful in reducing symptoms and maintaining wellness:

Talk to a supportive person

Get a full eight hours of sleep

Cut back on your activities

Attend a support group

Call your doctor or therapist

Do something fun or creative, or write in your journal

Take time for yourself to relax and unwind

Increase your exposure to light

Exercise

Ask for extra help from loved ones

Cut back on sugar, alcohol, and caffeine

Increase or decrease the stimulation in your environment

Create an emergency action plan

Despite your best efforts, there may be times when you experience a relapse into full-blown mania or severe depression. In crisis situations where your safety is at stake, your loved ones or doctor may have to take charge of your care. Such times can leave you feeling helpless and out of control, but having a crisis plan in place allows you to maintain some degree of responsibility for your own treatment.

A plan of action typically includes:

A list of emergency contacts - your doctor, therapist, close family members

A list of all medications you are taking, including dosage information

Symptoms that indicate you need others to take responsibility for your care, and information about any other health problems you have

Treatment preferences - who you want to care for you, what treatments and medications do and do not work, who is authorized to make decisions on your behalf

Tip 3: Reach out for face-to-face connection

Having a strong support system is essential to staying happy and healthy. Often, simply having someone to talk to face-to-face can be an enormous help in relieving bipolar depression and boosting your outlook and motivation. The people you turn to don't have to be able to "fix" you; they just have to be good listeners. The more people that you can turn to who will be available and good listeners, the more likely you are to manage your moods.

Don't isolate! - Support for bipolar disorder starts close to home. It's important to have people you can count on to help you through rough times. Isolation and loneliness can cause depression, so regular contact with supportive friends and family members is therapeutic in itself. Reaching out to others is not a sign of weakness and it won't make you a burden. Support for bipolar disorder starts close to home. Your loved ones care about you and want to help. In order to manage bipolar disorder, it's essential that you have people you can count on to help you through rough times.

Join a bipolar disorder support group - Spending time with people who know what you're going through and can honestly say they've "been there" can be very therapeutic. You can also benefit from the shared experiences and advice of the group members.

Build new relationships - Isolation and loneliness make bipolar disorder worse. If you don't have a support network you can count on, take steps to develop new relationships. Try taking a class, joining a church or a civic group, volunteering, or attending events in your community.

1. Talk to one person about your feelings.

2. Help someone else by volunteering.

3. Have lunch or coffee with a friend.

4. Ask a loved one to check in with you regularly.

5. Accompany someone to the movies, a concert, or a small get-together.

6. Call or email an old friend.

7. Go for a walk with a workout buddy.

8. Schedule a weekly dinner date

9. Meet new people by taking a class or joining a club.

10. Confide in a counselor, therapist, or clergy member.

10 tips for reaching out and building relationships

Tip 4: Develop an active daily routine

Your lifestyle choices, including your sleeping, eating, and exercise patterns, have a significant impact on your moods. There are many things you can do in your daily life to get your symptoms under control and to keep depression and mania at bay.

Build structure into your life. Developing and sticking to a daily schedule can help stabilize the mood swings of bipolar disorder. Include set times for sleeping, eating, socializing, exercising, working, and relaxing. Try to maintain a regular pattern of activity even through emotional ups and downs.

Exercise frequently and avoid sitting for long periods of time. Exercise has a beneficial impact on mood and may reduce the number of bipolar episodes you experience. Aerobic exercise such as running, swimming dancing, climbing or drumming - all activities that keep both arms and legs active are especially effective at treating depression. Try to incorporate at least 30 minutes of activity into your daily routine. Ten minutes here and there is just as effective as exercising for longer periods of time. Walking is a good choice for people of all fitness levels.

Keep a strict sleep schedule. Getting too little sleep can trigger mania, so it's important to get plenty of rest. For some people, losing even a few hours can cause problems. However, too much sleep can also worsen your mood. The best advice is to maintain a consistent sleep schedule.

Go to bed and wake up at the same time each day.

Avoid or minimize napping, especially if it interferes with your sleep at night.

Instead of viewing screens or other stimulating activities before bed, try taking a bath, reading a book, or listening to relaxing music.

Limit caffeine after lunch and alcohol at night as both interfere with sleep.

Healthy sleep habits for managing bipolar disorder

Tip 5: Keep stress to a minimum

Stress can trigger episodes of mania and depression in people with bipolar disorder, so keeping it under control is extremely important. Know your limits, both at home and at work or school. Don't take on more than you can handle and take time to yourself if you're feeling overwhelmed.

Learn how to relax. Relaxation techniques such as deep breathing, meditation, yoga, and guided imagery can be very effective at reducing stress and keeping you on an even keel. A daily relaxation practice can improve your mood and keep depression at bay.

Make leisure time a priority. Do things for no other reason than that it feels good to do them. Go to a funny movie, take a walk on the beach, listen to music, read a good book, or talk to a friend. Doing things just because they are fun is no indulgence. Play is an emotional and mental health necessity.

Appeal to your senses. Stay calm and energized by appealing to your senses: sight, sound, touch, smell, and taste. Listen to music that lifts your mood, place flowers where you will see and smell them, massage your hands and feet, or sip a warm drink.

Tip 6: Watch what you put in your body

From the food you eat to the vitamins and drugs you take, the substances you put in your body have an impact on the symptoms of bipolar disorder-for better or worse.

Eat a healthy diet. There is an undeniable link between food and mood. For optimal mood, eat plenty of fresh fruits, vegetables, and whole grains and limit your fat and sugar intake. Space your meals out through the day, so your blood sugar never dips too low. High-carbohydrate diets can cause mood crashes, so they should also be avoided. Other mood-damaging foods include chocolate, caffeine, and processed foods.

Get your omega-3s. Omega-3 fatty acids may decrease mood swings in bipolar disorder. You can increase your intake of omega-3 by eating cold-water fish such as salmon, halibut, and sardines, soybeans, flaxseeds, canola oil, pumpkin seeds, and walnuts. Omega-3 is also available as a nutritional supplement.

Avoid alcohol and drugs. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression. Even moderate social drinking can upset your emotional balance. Substance use also interferes with sleep and may cause dangerous interactions with your medications. Attempts to self-medicate or numb your symptoms with drugs and alcohol only create more problems.

Be cautious when taking any medication. Certain prescription and over-the-counter medications can be problematic for people with bipolar disorder. Be especially careful with antidepressant drugs, which can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.

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No matter how down or out of control you feel, it's important to remember that you're not powerless when it comes to bipolar disorder. Beyond the treatment you get from your doctor or therapist, there are many things you can do for yourself to reduce your symptoms and stay on track.

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strategies for teachers, counselors and parents

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strategies for teachers, counselors and parents

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As an elementary school counselor, you will create a nurturing environment in which children develop the knowledge, habits, and emotional skills to succeed in middle school, high school, and beyond.

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NYU Steinhardt's Online Master's in School Counseling prepares aspiring school counselors to pursue certification and employment in public and private schools.

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ADHD: Implications for school counselors

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ADHD: Implications for school counselors