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NEDA

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By Valerie K. Hardy

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Links updated, November 2021
This information in Spanish

The mental health of our children is a natural and important concern for us all. The fact is, many mental disorders have their beginnings in childhood or adolescence, yet may go undiagnosed and untreated for years. ( 1)

We refer to mental disorders using different "umbrella" terms such as emotional disturbance, behavioral disorders, or mental illness. Beneath these umbrella terms, there is actually a wide range of specific conditions that differ from one another in their characteristics and treatment. These include (but are not limited to):

anxiety disorders;

bipolar disorder (sometimes called manic-depression);

conduct disorders;

eating disorders;

obsessive-compulsive disorder (OCD); and

psychotic disorders.

You may be reading this fact sheet with one of these specific disorders in mind, or you may be looking for information about emotional disturbances in general. In either case, keep reading to find out what different emotional distubances have in common, how they are defined in federal law, and where to find more detailed information on specific disorders.
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Definition
IDEA defines emotional disturbance as follows:
We've chosen to use the term "emotional disturbance" in this fact sheet because that is the term used in the nation's special education law, the Individuals with Disabilities Education Act (IDEA).

"...a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance:

(A) An inability to learn that cannot be explained by intellectual, sensory, or health factors.

(B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

(C) Inappropriate types of behavior or feelings under normal circumstances.

(D) A general pervasive mood of unhappiness or depression.

(E) A tendency to develop physical symptoms or fears associated with personal or school problems." ( 2)

As defined by IDEA, emotional disturbance includes schizophrenia but does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance. ( 3)

Characteristics

As is evident in IDEA's definition, emotional disturbances can affect an individual in areas beyond the emotional. Depending on the specific mental disorder involved, a person's physical, social, or cognitive skills may also be affected. The National Alliance on Mental Illness of Southern Arizona puts this very well:

Mental illnesses are medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. ( 4)

Some of the characteristics and behaviors seen in children who have an emotional disturbance include:

Hyperactivity (short attention span, impulsiveness);

Aggression or self-injurious behavior (acting out, fighting);

Withdrawal (not interacting socially with others, excessive fear or anxiety);

Immaturity (inappropriate crying, temper tantrums, poor coping skills); and

Learning difficulties (academically performing below grade level).

Children with the most serious emotional disturbances may exhibit distorted thinking, excessive anxiety, bizarre motor acts, and abnormal mood swings.

Many children who do not have emotional disturbance may display some of these same behaviors at various times during their development. However, when children have an emotional disturbance, these behaviors continue over long periods of time. Their behavior signals that they are not coping with their environment or peers.

Causes

No one knows the actual cause or causes of emotional disturbance, although several factors-heredity, brain disorder, diet, stress, and family functioning-have been suggested and vigorously researched. A great deal of research goes on every day, but to date, researchers have not found that any of these factors are the direct cause of behavioral or emotional problems.

According to NAMI, mental illnesses can affect persons of any age, race, religion, or income. Further:

Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan. ( 5)

Frequency

Of the 74.5 million children in the United States, an estimated 17.1 million have or have had a psychiatric disorder. ( 6) Half of all psychiatric illness occurs before the age of 14, and 75% by the age of 24. The most common psychiatric disorders in childhood are anxiety disorders, AD/HD and disruptive behavior, depression and bipolar disorders, and eating disorders. ( 7)

Help for School-Aged Children

IDEA requires that special education and related services be made available free of charge to every eligible child with a disability, including preschoolers (ages 3-21). These services are specially designed to address the child's individual needs associated with the disability-in this case, emotional disturbance, as defined by IDEA (and further specified by states). In the 2016 school year, more than 349,000 children and youth with emotional disturbance received these services to address their individual needs related to emotional disturbance. ( 8)

Determining a child's eligibility for special education and related services begins with a full and individual evaluation of the child. Under IDEA, this evaluation is provided free of charge in public schools.
10 Basic Steps in Special Education Questions Often Asked by Parents about Special Education Services Evaluating Children for Disability Developing Your Child's IEP
There is a lot to know about the special education process, much of which you can learn here on the CPIR site. We invite you to read the wide range of publications we offer on the topic, especially:

A Look at Specific Emotional Disturbances

As we mentioned, emotional disturbance is a commonly used umbrella term for a number of different mental disorders. Let's take a brief look at some of the most common of these.

We all experience anxiety from time to time, but for many people, including children, anxiety can be excessive, persistent, seemingly uncontrollable, and overwhelming. An irrational fear of everyday situations may be involved. This high level of anxiety is a definite warning sign that a person may have an anxiety disorder.

The term "anxiety disorder" is a broad term covering several different disabilities that share the core symptom of irrational fear. These include such different disorders as generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder (also called social phobia), and specific phobias. ( 9)

According to the Anxiety Disorders Association of America, anxiety disorders are the most common psychiatric illnesses affecting children and adults. ( 10) They are also highly treatable. Unfortunately, only about 36.9% of those affected receive treatment. ( 11)

Also known as manic-depressive illness, bipolar disorder is a serious medical condition that causes dramatic mood swings from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. ( 12)

For most people with bipolar disorder, these mood swings and related symptoms can be stabilized over time using an approach that combines medication and psychosocial treatment. ( 13)

Conduct Disorder

Conduct disorder refers to a group of behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. ( 14) This may include some of the following behaviors:

aggression to people and animals;

destruction of property;

deceitfulness, lying, or stealing; or

truancy or other serious violations of rules. (15)

Treatment will depend on the child's symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may include:

helping the child learn how to better solve problems, communicate, and handle stress, as well as how to control impulses and anger (what's known as cognitive-behavioral therapy);

family therapy;

peer group therapy (to help better social and interpersonal skills); and

medications (although these are not typically used to treat conduct disorder). (16)

Eating disorders are characterized by extremes in eating behavior-either too much or too little-or feelings of extreme distress or concern about body weight or shape. Females are much more likely than males to develop an eating disorder. ( 17)

Anorexia nervosa and bulimia nervosa are the two most common types of eating disorders. Anorexia nervosa is characterized by self-starvation and dramatic loss of weight. Bulimia nervosa involves a cycle of binge eating, then self-induced vomiting or purging. Both of these disorders are potentially life-threatening. ( 18)

Binge eating is also considered an eating disorder. It's characterized by eating excessive amounts of food, while feeling unable to control how much or what is eaten. Unlike with bulimia, people who binge eat usually do not purge afterward by vomiting or using laxatives. ( 19)

According to the National Eating Disorders Association:

Treating an eating disorder generally involves a combination of psychological and nutritional counseling, along with medical and psychiatric monitoring. Treatment must address the eating disorder symptoms and medical consequences, as well as psychological, biological, interpersonal, and cultural forces that contribute to or maintain the eating disorder... Many people utilize a treatment team to treat the multi-faceted aspects of an eating disorder. ( 20)

Obsessive-Compulsive Disorder

Often referred to as OCD, obsessive-compulsive disorder is actually considered an anxiety disorder (which was discussed earlier in this fact sheet). OCD is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors (handwashing, counting, checking, or cleaning) are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety. ( 21)

A large body of scientific evidence suggests that OCD results from a chemical imbalance in the brain. ( 22) Treatment for most people with OCD should include one or more of the following:

therapist trained in behavior therapy;

Cognitive Behavior Therapy (CBT);

medication (usually an antidepressant). (23)

"Psychotic disorders" is another umbrella term used to refer to severe mental disorders that cause abnormal thinking and perceptions. Two of the main symptoms are delusions and hallucinations. Delusions are false beliefs, such as thinking that someone is plotting against you. Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there. Schizophrenia is one type of psychotic disorder. ( 24) There are others as well.

Treatment for psychotic disorders will differ from person to person, depending on the specific disorder involved. Most are treated with a combination of medications and psychotherapy (a type of counseling). ( 25)

More about School

As mentioned, emotional disturbance is one of the categories of disability specified in IDEA. This means that a child with an emotional disturbance may be eligible for special education and related services in public school. These services can be of tremendous help to students who have an emotional disturbance.

Typically, educational programs for children with an emotional disturbance need to include attention to providing emotional and behavioral support as well as helping them to master academics, develop social skills, and increase self-awareness, self-control, and self-esteem. A large body of research exists regarding methods of providing students with positive behavioral support (PBS) in the school environment, so that problem behaviors are minimized and positive, appropriate behaviors are fostered. (See the resource section at the end of this fact sheet for more information on PBS.) It is also important to know that, within the school setting:

For a child whose behavior impedes learning (including the learning of others), the team developing the child's Individualized Education Program (IEP) needs to consider, if appropriate, strategies to address that behavior, including positive behavioral interventions, strategies, and supports.

Students eligible for special education services under the category of emotional disturbance may have IEPs that include psychological or counseling services. These are important related services available under IDEA and are to be provided by a qualified social worker, psychologist, guidance counselor, or other qualified personnel.

Recognizing and Addressing the Impact of COVID-19 | As young people return to in-person schooling in the 2021-2022 school year, they may bring with them the impact of the pandemic's trauma. This makes it essential that schools consider the possibility that many students will need to be re-evaluated to determine if they need additional services, especially behavioral support and mental health services, than they needed prior to COVID-19. Two resources of great relevance to reopening schools and returning students are the following:

Other Considerations

Children and adolescents with an emotional disturbance should receive services based on their individual needs, and everyone involved in their education or care needs to be well-informed about the care that they are receiving. It's important to coordinate services between home, school, and community, keeping the communication channels open between all parties involved.

The Importance of Support

Families often need help in understanding their child's disability and how to address the needs that arise from the disability. Help is available from psychiatrists, psychologists, and other mental health professionals that work in the public or private sector. There is also a network of mental health support operating in every state as well as locally.

To locate systems of support in your community or state, visit the organizations we've listed below. They can connect you with local resources, including support groups that provide connection and understanding, information, referral, and advocacy for those living with emotional disturbance.

There are also support groups available from organizations that address specific mental disorders under the umbrella term of emotional disturbance. See the resources at the end of this fact sheet to identify some of these groups.

Resources of More Information

AACAP | American Academy of Child and Adolescent Psychiatry | AACAP offers Facts for Families, a series in English, Spanish, and several other languages that includes many briefs on specific mental disorders, including the ones mentioned in this publication.

AACAP also operates different Resource Centers, which offer consumer-friendly definitions, answers to frequently asked questions, clinical resources, expert videos, Facts for Families, and much more. Visit the Resource Center home page if you are concerned with one of the following:

Anxiety Disorders

Autism

Bipolar Disorder

Conduct Disorder

Depression

Oppositional Defiant Disorder

NIMH | National Institute of Mental Health | NIMH is clearly a source of authoritative information on specific mental disorders. Phone: 1.866.615.6464. TTY: 1.866.415.8051

NAMI | National Alliance on Mental Illness | NAMI is an excellent source of information and connection on mental illness, including the individual disorders mentioned in this fact sheet. NAMI's website and toll-free helpline are available in English and Spanish.

SAMHSA is the Substance Abuse & Mental Health Services Administration. It offers many resources to consumers, including:.

Detailed information on specific emotional disturbances, or related issues such as positive behavior supports, is also available from these sources:

Anxiety Disorders Association of America | https://adaa.org/

Center on Positive Behavioral Interventions and Supports | The PBIS Center provides research-based information on how to provide behavioral supports to children who need them. | https://www.pbis.org

Conduct Disorders | A soft place to land for battle-weary parents
https://www.conductdisorders.com/community/

Encyclopedia of Mental Disorders | http://www.minddisorders.com/index.html

National Eating Disorders Association
1.800.931.2237 | www.nationaleatingdisorders.org

Something Fishy | (eating disorders)
https://www.something-fishy.org

**Highly Rated Resource! This resource was reviewed by 3-member panels of Parent Center staff working independently from one another to rate the quality, relevance, and usefulness of CPIR resources. This resource was found to be of "High Quality, High Relevance, High Usefulness" to Parent Centers.
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References

2 | Code of Federal Regulations, Title 34, §300.8(c)(4)(i)

3 | Code of Federal Regulations, Title 34, §300.8(c)(4)(ii)

5 | Ibid.

7 | Ibid.

11 | Ibid.

13 | Ibid.

14 | American Academy of Adolescent and Child Psychiatry. (2013, August). Conduct disorder: Facts for families. Washington, DC: Author. Available online at:
http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Conduct_Disorder_33.aspx

15 | Ibid.

16 | Johns Hopkins Medicine Health Library. (n.d.). Conduct disorder in children. Baltimore, MD: Author. Online at:
https://www.hopkinsmedicine.org/healthlibrary/conditions/mental_health_disorders/conduct_disorder_90,P02560

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Links updated, November 2021 This information in Spanish The mental health of our children is a natural and important concern for us all. The fact is, many mental disorders have their beginnings in childhood or adolescence, yet may go undiagnosed and untreated for years.

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National Institute of Mental Health

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Overview

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

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

Signs and Symptoms

Risk Factors

Treatments and Therapies

Join a Study

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

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Addressing Anxiety in School Settings: Information for Counselors

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Addressing Anxiety in School Settings: Information for Counselors

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-Ways to help students cope with anxiety.

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"My heart is pounding. I feel like I can't breathe. My stomachs hurts. I don't want to be here at school. I know I shouldn't be worried about it, but I

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National Institute of Mental Health

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NIMH " Eating Disorders: About More Than Food

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This brochure provides information about different types of eating disorders, including anorexia nervosa, bulimia nervosa, and binge-eating disorder. It also addresses how eating disorders are treated and what research is being done to better understand these disorders.

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Anorexia, bulimia and binge-eating disorder affect physical and mental health. Learn about symptoms, causes, risk factors, diagnosis and treatment options.

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Bulimia Nervosa Signs, Symptoms, and Treatment Guide

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Bulimia nervosa is a complex eating disorder with medical and psychological aspects. Bulimia nervosa is serious and can even be life threatening. Bulimia recovery requires not only a multidisciplinary healthcare team for treatment, but appropriate education, understanding, and support from friends, family, and others, like teachers and coaches, who interact with the affected person day to day.

Bulimia nervosa can be scary and overwhelming for all concerned. Knowing how best to help and not hinder recovery is important to achieve the best outcome. The information here is intended to provide bulimia recovery help to family, friends, coaches, and teachers of someone struggling with bulimia nervosa. You'll find straightforward information on bulimia symptoms, bulimia diagnosis, bulimia statistics, bulimia facts, bulimia treatment, and bulimia recovery.

If you are family, friend, teacher, or coach to
someone you believe has bulimia nervosa,
the information here is intended
to help you learn how to be supportive.

If you have a diagnosis of bulimia nervosa
and are seeking recovery, this resource
is intended to provide information that
can help you along the way.

Supporting Recovery

If you are family, friend, teacher, or coach to
someone you believe has bulimia nervosa,
the information here is intended
to help you learn how to be supportive.

Seeking Recovery

If you have a diagnosis of bulimia nervosa
and are seeking recovery, this resource is intended to provide information that can help you along the way.

Knowing how to be supportive of someone close to you who has or may have bulimia nervosa is hard. You don't want to say or do anything that is off-putting, disrespectful, or makes wrong assumptions. The information here is intended to help you understand the disorder, available treatment options for bulimia nervosa, how well they work, how to find quality treatment providers, how to navigate the health insurance maze, and ways to be supportive.

Knowing how to be supportive of someone close to you who has or may have bulimia nervosa is hard. You don't want to say or do anything that is off-putting, disrespectful, or makes wrong assumptions. The information here is intended to help you understand the disorder, available treatment options, how well they work, how to find quality treatment providers, how to navigate the health insurance maze, and ways to be supportive.

Students often spend more waking time in school and sports activities than they do their families. Behaviors at school or in sports activities can differ from behaviors family members see at home. Educators, including teachers and guidance counselors, as well as sports coaches, may be the first to witness behaviors suggestive of bulimia nervosa. The information here is intended to help educators and coaches learn about the disorder and the resources that are available to help educate and support students affected by bulimia nervosa.

Students often spend more waking time in school and sports activities than they do their families. Behaviors at school or in sports activities can differ from behaviors family members see at home. Educators, including teachers and guidance counselors, as well as sports coaches, may be the first to witness behaviors suggestive of bulimia nervosa. The information here is intended to help educators and coaches learn about the disorder and the resources that are available to help educate and support students affected by bulimia nervosa.

ECRI Institute research analysts who are experts in evidence-based medicine analyzed a large body of published clinical studies on the different types of treatments and combinations of treatments for bulimia nervosa. This work resulted in a 400-page scientific report on how well the various treatments and combinations of treatments work. This analysis also identified areas where more research is needed to learn what works best for treating bulimia. This is a short consumer-oriented summary of the findings of the full scientific report.

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Bulimia Nervosa Signs, Symptoms, and Treatment Guide

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Bulimia nervosa is a complex eating disorder with medical and psychological aspects. Bulimia nervosa is serious and can even be life threatening. Bulimia recovery requires not only a multidisciplinary healthcare team for treatment, but appropriate education, understanding, and support from friends, family, and others, like teachers and coaches, who interact with the affected person day to day.

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What Is a 504 Plan?

A 504 plan is a way for schools to provide support for students with a disability so that they can learn in a regular classroom.

The name 504 plan comes from Section 504 of the Rehabilitation Act. This law prohibits discrimination against people with disabilities in programs or activities that receive federal funding (such as public schools or publicly funded private schools). This ensures that students with disabilities can get a free education that works for them.

Who Can Get a 504 Plan?

Students are eligible for 504 plans if they have a disability that limits daily life activities such as self-care, walking, seeing, breathing, hearing, speaking, or learning.

Students who need a 504 plan can include those with:

A student returning to school after a serious illness or injury also might get a 504 plan.

How Is a 504 Plan Made?

First, a parent, teacher or other school staff member, health care provider, or therapist asks the school to evaluate the student for a 504 plan. Every school handles 504 plans a little differently, but most have a 504 team that may include the principal, teachers, school nurse, guidance counselor, and psychologist. The team looks at a child's grades, test scores, medical records, and what teachers report about the student to decide if the student is eligible for a 504 plan.

If the 504 team decides that a student is eligible, they work with the parents to decide what kind of supports (called accommodations) the student needs to succeed. These are listed in the 504 plan.

What Does a 504 Plan Include?

The 504 plan is based on each student's needs and strengths. Accommodations can include:

sitting in a certain place or with a certain desk or chair in the classroom

extra time on tests and assignments

use of speech-to-text (dictation) for writing

modified textbooks (such as one that can be read aloud to the student)

adjusted class schedules

verbal (out loud) testing

allowing visits to the nurse's office

occupational therapy or physical therapy

Many other accommodations are available. If a parent asks for one that the school can't provide, the school might offer another one that would help. Most accommodations in 504 plans don't change what the student learns - rather, they remove barriers to learning.

The 504 plan should be reviewed at least yearly to make sure the accommodations are up to date and work for the student's needs.

How Do 504 Plans and Individualized Education Programs (IEPs) Differ?

The main difference is that:

A 504 plan provides accommodations so a student can learn in a regular classroom.

An IEP is a plan for specialized learning (for example, for dyslexia) or special education. 504 plans don't usually change what the child learns but IEPs can.

There are other differences too, such as who is eligible, who creates the plan, and how changes are made to the plan.

Some students have both a 504 plan and an IEP. For example, a student with autism spectrum disorder may have an IEP for learning supports and a 504 plan for occupational therapy.

What Happens if Parents Don't Agree With the School About the 504 Plan?

Sometimes parents and the school disagree on whether a child should have a 504 plan and/or what should be in it. If this happens to you, start by setting up a meeting to talk to the school 504 team. Schools want their students to succeed and will work with parents.

If you still have concerns, you can ask for a mediation session with a mediator. A mediator is professionally trained to help with the discussion without taking either side. If the issue is not resolved in the mediation session, you can request a due process hearing. You may need to get a lawyer for the hearing. You can also make a written appeal to the school district or the U.S. Office for Civil Rights saying that the school violated 504 rights.

How Can Parents Help?

You are your child's most important teacher and advocate. Help your child by building a strong relationship with the 504 team. This way, you show that you value education and that you want to work together respectfully to help your child succeed at school.

It also helps to:

Understand the 504 plan. Know what the accommodations are and how they will be used.

Talk to the school about how your child is doing. Let them know if you think the accommodations are working.

If you think you need to add or change accommodations, talk to the 504 team about your concerns.

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Kids who have special needs in the classroom may be eligible for a government-supported learning plan.

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What Is ADHD?

ADHD stands for attention deficit hyperactivity disorder. It is a medical condition. A person with ADHD has differences in brain development and brain activity that affect attention, the ability to sit still, and self-control. ADHD can affect a child at school, at home, and in friendships.

What Are the Signs of ADHD?

All kids struggle at times to pay attention, listen and follow directions, sit still, or wait their turn. But for kids with ADHD, the struggles are harder and happen more often.

Kids with ADHD can show signs in any or all these areas:

Inattentive. Kids who are inattentive (easily distracted) have trouble focusing their attention, concentrating, and staying on task. They may not listen well to directions, may miss important details, and may not finish what they start. They may daydream or dawdle too much. They may seem absent-minded or forgetful, and lose track of their things.

Hyperactive. Kids who are hyperactive are fidgety, restless, and easily bored. They may have trouble sitting still, or staying quiet when needed. They may rush through things and make careless mistakes. They may climb, jump, or roughhouse when they shouldn't. Without meaning to, they may act in ways that disrupt others.

Impulsive. Kids who are impulsive act too quickly before thinking. They often interrupt, might push or grab, and find it hard to wait. They may do things without asking for permission, take things that aren't theirs, or act in ways that are risky. They may have emotional reactions that seem too intense for the situation.

Sometimes parents and teachers notice signs of ADHD when a child is very young. But it's normal for little kids to be distracted, restless, impatient, or impulsive - these things don't always mean that a child has ADHD.

Attention, activity, and self-control develop little by little, as children grow. Kids learn these skills with help from parents and teachers. But some kids don't get much better at paying attention, settling down, listening, or waiting. When these things continue and begin to cause problems at school, home, and with friends, it may be ADHD.

What Causes ADHD?

It's not clear what causes the brain differences of ADHD. There's strong evidence that ADHD is mostly inherited. Many kids who have ADHD have a parent or relative with it. Kids also can be more at risk for it if they were born early, are exposed to environmental toxins, or their mothers used drugs during pregnancy.

ADHD is not caused by too much screen time, poor parenting, or eating too much sugar.

How Is ADHD Diagnosed?

If you think your child has ADHD, make an appointment with your child's doctor. They will do a checkup, including a vision and hearing check, to be sure something else isn't causing the symptoms.

To diagnose ADHD, doctors start by asking about a child's health, behavior, and activity. They talk with parents and kids about the things they have noticed. Your doctor might ask you to complete checklists about your child's behavior, and might ask you to give your child's teacher a checklist too.

After gettng this information, doctors diagnose ADHD if it's clear that:

A child's trouble with paying attention, hyperactivity, or impulsivity go beyond what's usual for their age.

The behaviors have been going on since the child was young.

The behaviors affect the child at school and at home.

A health check shows that another health or learning issue isn't causing the problems.

Many kids with ADHD also have learning problems, oppositional and defiant behaviors, or mood and anxiety problems. Doctors usually treat these along with the ADHD.

The doctor can refer you to a child psychologist or psychiatrist, if needed.

How Is ADHD Treated?

Treatment for ADHD usually includes:

Medicine. This activates the brain's ability to pay attention, slow down, and use more self-control.

Behavior therapy. Therapists can help kids develop the social, emotional, and planning skills that are lagging with ADHD.

Parent coaching. Through coaching, parents learn the best ways to respond to behavior problems that are part of ADHD.

School support. Teachers can help kids with ADHD do well and enjoy school more.

The right treatment helps ADHD improve. Parents and teachers can teach younger kids to get better at managing their attention, behavior, and emotions. As they grow older, kids should learn to improve their own attention and self-control.

When ADHD is not treated, it can be hard for kids to succeed. This may lead to low self-esteem, depression, oppositional behavior, school failure, risk-taking behavior, or family conflict.

How Can Parents Help?

If your child is diagnosed with ADHD:

Be involved. Learn all you can about ADHD. Follow the treatment your child's health care provider recommends. Go to all recommended therapy visits.

Give medicines safely. If your child is taking ADHD medicine, always give it at the recommended time and dose. Keep medicines in a safe place.

Work with your child's school. Ask teachers if your child should have an IEP or 504 plan. Meet often with teachers to find out how your child is doing. Work together to help your child do well

Parent with purpose and warmth. Learn what parenting approaches are best for a child with ADHD - and which can make ADHD worse. Talk openly and supportively about ADHD with your child. Focus on your child's strengths and positive qualities.

Connect with others for support and awareness. Join a support group like CHADD for ADHD to get updates on treatment and other information.

ADHD can improve when kids get treatment, eat healthy food, get enough sleep and exercise, and have supportive parents who know how to respond to ADHD.

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ADHD is a common medical condition that can affect kids at school, at home, and in friendships. Learn more about ADHD and how to help kids get the best diagnosis and care.

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by Colleen Reilly

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for teachers & schools

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What Teachers Should Know

Bipolar disorder affects how the brain functions, causing shifts in a person's moods and energy levels. It's also called manic depression, manic-depressive disorder, manic-depressive illness, bipolar mood disorder, and bipolar affective disorder.

People with bipolar disorder go through episodes of low-energy depression and high-energy mania.

Depression episodes may include:

sadness or feelings of worthlessness or guilt

loss of interest in usual activities

sleeping too much or inability to sleep

inability to concentrate and a drop in academic performance

inability to experience pleasure

overeating or loss of appetite

thoughts of death or suicide

Mania episodes may include:

increased physical and mental activity

racing speech and thoughts

elevated mood and exaggerated optimism

inflated sense of self-importance

decreased need for sleep

difficulty concentrating

reckless or aggressive behavior

anger, excessive irritability, or impatience

poor judgment and making rash decisions

In adults, mania or depression episodes can last weeks or months. In kids and teens, episodes can be much briefer, going back and forth between mania and depression throughout a day.

Without treatment, bipolar disorder can worsen as children get older. But following a medication treatment plan and making a few lifestyle changes - like eating a nutritious diet, getting enough sleep, exercising regularly, and managing stress - can help kids and teens with bipolar disorder control the symptoms and lead normal lives.

Students with bipolar disorder may:

need seating near the front of the room to help avoid distractions

show drops in grades and changes in class participation

need additional time for tests and assignments or require modified schedules

miss class time due to appointments with health care professionals

need to visit the school nurse for medication

need to carry a water bottle and have unlimited access to restrooms (especially students taking lithium)

need to talk with a school counselor or psychologist periodically

be at a higher risk for suicide

What Teachers Can Do

Treatment for bipolar disorder usually involves the use of medications, such as mood stabilizers, and counseling or psychotherapy. Teachers need to watch for extreme behavioral changes or any signs of suicidal thoughts. Educators should take these signs seriously. The student's parents or guardians, psychologist, or other health care professionals can talk to school staff about how to respond to such situations.

Encourage your students with bipolar disorder to participate in all school-based activities as best they can, when they can.

Plan and agree on a "safe place" with your student - a place to go if he or she feels overwhelmed or just needs to relax. You also can agree on a "safe person" (possibly you) your student can talk to. When your student needs to go to the safe place or talk with the safe person, allow for a discreet exit without drawing his or her classmates' attention.

If the student does not have an individualized education plan (IEP) or a 504 education plan, consult with a school counselor, psychologist, or social worker to see if developing a plan with parents or guardians would help. If the student does have an IEP or 504, make sure to follow the plan's requirements.

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bipolar mood disorder and bipolar affective disorder

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Bipolar Disorder Factsheet (for Schools)

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Bipolar disorder affects how the brain functions, causing shifts in a person's moods and energy levels. It's also called manic depression, manic-depressive disorder, manic-depressive illness, bipolar mood disorder, and bipolar affective disorder. People with bipolar disorder go through episodes of low-energy depression and high-energy mania.

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ASCA

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By Lori Townsend and Monika Yount

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The role of a school counselor in the 504 process may vary from state to state, district to district and even building to building. The school counselor's primary role is to be an advocate for students in this process. We may be the first person to notice attendance issues; grade trends; frequent tardiness or a frequent presence in the behavior room, counselor's office or nurse's office. These are all reasons to start getting curious about what is going on with the student. We may discover or suspect a mental health issue, a health concern or a physical or mental impairment. This is the first indication that it is time to act and alert the 504 team. Any student with a physical or mental impairment that substantially limits a major life activity is eligible for a 504 plan. Even when we suspect that a student has a mental or physical impairment, we should activate the 504 process.

In Campbell County School District, the 504 process usually, but not always, starts with a visit to our Building Intervention Team. Some physical and mental impairments may require specialized instruction; this would activate a special education evaluation. However, sometimes a student has a physical impairment, such as an anaphylactic allergy, that is not impacting their education: they have good grades, no attendance issues and no behavior concerns. In these cases, we sometimes bypass the BIT team and go straight toward evaluating for a 504 plan.

The 504 team consists of the nurse, the school counselor, the classroom teacher and any others who may have pertinent information about the student. The 504 team then collects any relevant data: medical diagnosis if available, nurse's information, teacher reports, grades, behavior log, attendance for three years and assessment scores. We then look for trends or patterns. We also look to see if a student has received special education services in the past. This would indicate an educational diagnosis as a mental impairment. Even if a student has been exited from special education, a disability may require accommodations even if it does not require specialized instruction.

The school counselor plays a vital role in advocating for the needs of students with physical impairments, mental health issues or cognitive impairments. A student may be referred for 504 consideration/evaluation by a teacher, staff member, medical professional or a parent. The school counselor's job is to start the 504 evaluation process once a referral is received. Accommodations may help this student access their education and prevent exclusion or discrimination based on an impairment. Student accommodations are designed to level the playing field for students with disabilities and assure equal access to learning. Accommodations are never designed to enable a student with a disability.

Lori Townsend is the 504 coordinator for Campbell County School District #1 in Gillette, Wyo., and Monika Yount is a school counselor at Prairie Wind Elementary in Gillette and the WySCA conference chair.

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504s - The School Counselor's Role | American School Counselor Association (ASCA)

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The role of a school counselor in the 504 process may vary from state to state, district to district and even building to building. The school counselor's primary role is to be an advocate for students in this process.

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Oppositional Defiant Disorder Counseling Tools

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Oppositional Defiant Disorder Counseling Tools

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Katie McKinney Pinterest Board

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GREAT RESOURCE FOR ALL MODULES, PARENTS & TEACHERS!

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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.

Transforming Children's Mental Health

The Child Mind Institute is dedicated to transforming the lives of children and families struggling with mental health and learning disorders by giving them the help they need to thrive.

We're the leading independent nonprofit in children's mental health, operating three Mission Areas that work together for greater impact: Care, Education and Science.

Care at the Child Mind Institute

Our clinicians provide gold-standard, evidence-based treatment to thousands of kids annually through our clinical centers and in-school programs:

Education at the Child Mind Institute

We deliver free resources to millions of families and training to hundreds of educators each year, so more kids get the help they need:

Science at the Child Mind Institute

Our researchers and engineers are uncovering the causes of mental health and learning disorders to develop tomorrow's breakthrough treatments:

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Child Mind Institute | Transforming Children's Lives.

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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. Transforming Children's Mental Health The Child Mind Institute is dedicated to transforming the lives of children and families struggling with mental health and learning disorders by giving them the help they need to thrive.

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Information & Resources

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Without intervention, children tend to grow into their fears, not grow out of them. But once children have learned how to challenge worry's authority and outsmart the tricks the brain can play, they are no longer at the whim of their fearful imaginations.

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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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An article in The New York Times

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

Credit... Getty Images

By

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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How to Help a Child With an Anxiety Disorder

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

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definitions, characteristics, and  information specific to IDEA and emotional disturbances.

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Council for Children with Behavioral Disorders

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

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

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

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

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

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

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

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

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

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

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

Shortened assignments.

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

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

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

Preferential seating in the classroom.

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

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

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

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

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

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

Students on some medications may need:

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

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

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

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

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

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

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

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Accommodations for Students with Bipolar Disorder and Related Disabilities - International Bipolar Foundation

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

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Both Individualized Education Programs (IEPs) and 504 plans can offer formal help for K-12 students who are struggling in school. They're similar in some ways but very different in others. This chart compares them side by side to help you understand the differences.

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.

To get an IEP, there are two requirements: 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. And 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.

To get a 504 plan, there are two requirements: A child has any disability. Section 504 covers a wide range of different struggles in school. And 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.

There are strict legal requirements about who participates. With a few exceptions, the entire IEP team must be present for IEP meetings. The team 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

* A school psychologist or other specialist who can interpret evaluation results

* A district representative with authority over special education services

The IEP sets learning goals and describes the services the school will provide. It's a written document. Here are some of the most important things the IEP must include:

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

* 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

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

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.

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

* Mediation

* Due process complaint

* Resolution session

* Civil lawsuit

* State complaint

* Lawsuit

And if you need help navigating special education law in your state, consider reaching out to your local Parent Training and Information Center. The people there can answer questions and give practical advice on issues specific to your area.

Do you want to learn more about how IEPs and 504 plans compare? Watch as an expert explains the differences between them.

About the author

About the author

The Understood Team is made up of passionate writers and editors. Many of them have kids who learn and think differently.

Reviewed by

Reviewed by

Andrew M.I. Lee, JD is an editor and attorney who strives to help people understand complex legal, education, and parenting issues.

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

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Individualized Education Programs (IEPs) and 504 plans are similar but different. See how they compare in what they provide and the processes and laws involved.

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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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At a glance

The Individuals with Disabilities Education Act (IDEA) requires public schools to provide special education services to eligible students.

IDEA covers 13 disability categories.

Not every student who struggles in school qualifies.

The Individuals with Disabilities Education Act (IDEA) requires public schools to provide special education and related services to eligible students. But not every child who struggles in school qualifies. To be covered, a child's school performance must be "adversely affected" by a disability in one of the 13 categories below.

1. Specific learning disability (SLD)

The "specific learning disability" (SLD) category covers a specific group of learning challenges. These conditions affect a child's ability to read, write, listen, speak, reason, or do math. Here are some examples of what could fall into this category:

SLD is the most common category under IDEA. In the 2018-19 school year, around 33 percent of students who qualified did so under this category.

2. Other health impairment

The "other health impairment" category covers conditions that limit a child's strength, energy, or alertness. One example is ADHD, which impacts attention and executive function.

3. Autism spectrum disorder (ASD)

ASD is a developmental disability. It involves a wide range of symptoms, but it mainly affects a child's social and communication skills. It can also impact behavior.

Various mental health issues can fall under the "emotional disturbance" category. They may include anxiety disorder, schizophrenia, bipolar disorder, obsessive-compulsive disorder, and depression. (Some of these may also be covered under "other health impairment.")

5. Speech or language impairment

This category covers difficulties with speech or language. A common example is stuttering. Other examples are trouble pronouncing words or making sounds with the voice. It also covers language problems that make it hard for kids to understand words or express themselves.

6. Visual impairment, including blindness

A child who has eyesight problems is considered to have a visual impairment. This category includes both partial sight and blindness. If eyewear can correct a vision problem, then it doesn't qualify.

Kids with a diagnosis of deafness fall under this category. These are kids who can't hear most or all sounds, even with a hearing aid.

The term "hearing impairment" refers to a hearing loss not covered by the definition of deafness. This type of loss can change over time. Being hard of hearing is not the same thing as having trouble with auditory or language processing.

Kids with a diagnosis of deaf-blindness have both severe hearing and vision loss. Their communication and other needs are so unique that programs for just the deaf or blind can't meet them.

10. Orthopedic impairment

An orthopedic impairment is when kids lack function or ability in their bodies. An example is cerebral palsy.

11. Intellectual disability

Kids with this type of disability have below-average intellectual ability. They may also have poor communication, self-care, and social skills. Down syndrome is one example of a condition that involves an intellectual disability.

12. Traumatic brain injury

This is a brain injury caused by an accident or some kind of physical force.

13. Multiple disabilities

A child with multiple disabilities has more than one condition covered by IDEA. Having multiple issues creates educational needs that can't be met in a program designed for any one disability.

Having a disability is not enough to qualify for special education. The disability has to have an "adverse effect" on a child's education.

Key takeaways

Each of the 13 disability categories in IDEA can cover a range of difficulties.

Dyslexia, dyscalculia, and written expression disorder fall under the "specific learning disability" category.

"Other health impairment" can cover ADHD.

About the author

About the author

Andrew M.I. Lee, JD is an editor and attorney who strives to help people understand complex legal, education, and parenting issues.

Reviewed by

Reviewed by

Rayma Griffin, MA, MEd has spent 40 years working with children with learning and thinking differences in the classroom and as an administrator.

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See a list of the 13 IDEA disability categories. Find out which disabilities can qualify kids for special education.

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The Learning Disabilities Association of Texas
https://ldatx.org

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Is it a modification or is it an accommodation

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Working to deliver a better special education service

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ADDA - Attention Deficit Disorder Association

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You've only had a taste of what ADDA's about.

You may not realize it yet, but we know that you're right where you belong.

We get you.

Take a minute, sign up to receive our FREE Starter Kit.

Trust us...do it now

Otherwise, you know it's true, you may forget.

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Home | ADDA - Attention Deficit Disorder Association

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You may not realize it yet, but we know that you're right where you belong. We get you. Take a minute, sign up to receive our FREE Starter Kit. Trust us...do it now Otherwise, you know it's true, you may forget.

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from National Alliance on Mental Illness

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Attention deficit hyperactivity disorder (ADHD) is a condition in which characterized by inattention, hyperactivity and impulsivity. ADHD is most commonly diagnosed in young people. An estimated 17 have ADHD. While ADHD is usually diagnosed in childhood, it does not only affect children. An estimated 8.8% of children aged 4- 4.4% of adults aged 18-44 have ADHD.

With treatment, people with ADHD can be successful in school, work and lead productive lives. Researchers are using new tools such as brain imaging to better understand the condition and to find more effective ways to treat and prevent ADHD.

Symptoms

While some behaviors associated with ADHD are "normal" and not a cause for concern to most people, someone with ADHD will have trouble controlling these behaviors and will show them much more frequently and for longer than 6 months.

Signs of inattention include:

Becoming easily distracted, and jumping from activity to activity.

Becoming bored with a task quickly.

Difficulty focusing attention or completing a single task or activity.

Trouble completing or turning in homework assignments.

Losing things such as school supplies or toys.

Not listening or paying attention when spoken to.

Daydreaming or wandering with lack of motivation.

Difficulty processing information quickly.

Struggling to follow directions.

Signs of hyperactivity include:

Fidgeting and squirming, having trouble sitting still.

Non-stop talking.

Touching or playing with everything.

Difficulty doing quiet tasks or activities.

Signs of impulsivity include:

Impatience.

Acting without regard for consequences, blurting things out.

Difficulty taking turns, waiting or sharing.

Interrupting others.

Causes

There are several factors believed to contribute to ADHD:

Genetics. Research shows that genes may be a large contributor to ADHD. ADHD often runs in families and some trends in specific brain areas that contribute to attention.

Environmental factors. Studies show a link between cigarette smoking and alcohol use during pregnancy and children who have ADHD. Exposure to lead as a child has also been shown to increase the likelihood of ADHD in children.

Diagnosis

ADHD occurs in both children and adults, but is most often and diagnosed in childhood. Getting a diagnosis for ADHD can sometimes be difficult because the symptoms of ADHD are similar to typical behavior in most young children. Teachers are often the first to notice ADHD symptoms because they see children in a learning environment with peers every day.

There is no one single test that can diagnose a child with ADHD, so meet with a doctor or mental health professional to gather all the necessary information to make a diagnosis. The goal is to rule out any outside causes for symptoms, such as environmental changes, difficulty in school, medical problems and ensure that a child is otherwise healthy.

Treatment

ADHD is managed and treated in several ways:

including stimulants, nonstimulants and antidepressants

Behavioral therapy

Self-management, education programs and assistance through schools or work or alternative treatment approaches

Related Conditions

Around two-thirds of children with ADHD also have another condition. Many adults are also impacted by the symptoms of another condition. Common conditions associated with ADHD include the following.

Symptoms from other conditions make treating ADHD more difficult. Talking to a skilled professional to help establish an accurate diagnosis can help increase the effectiveness of treatment.

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Attention deficit hyperactivity disorder (ADHD) is a condition in which characterized by inattention, hyperactivity and impulsivity. ADHD is most commonly diagnosed in young people. An estimated 17 have ADHD. While ADHD is usually diagnosed in childhood, it does not only affect children. An estimated 8.8% of children aged 4- 4.4% of adults aged 18-44 have ADHD.

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from National Alliance on Mental Illness

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Anxiety Disorders | NAMI: National Alliance on Mental Illness

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Discover the symptoms, causes, diagnosis advice, treatment options and related conditions of anxiety disorders.

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from National Alliance on Mental Illness

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When you become so preoccupied with food and weight issues that you find it harder and harder to focus on other aspects of your life, it may be an early sign of an eating disorder. Without treatment, eating disorders can take over a person's life and lead to serious, potentially fatal medical complications. Eating disorders can affect people of any age or gender, but rates are higher among women. Symptoms commonly appear in adolescence and young adulthood.

Symptoms

Eating disorders are a group of related conditions that cause serious emotional and physical problems. Each condition involves extreme food and weight issues; however, each has unique symptoms that separate it from the others.

Anorexia Nervosa. People with anorexia will deny themselves food to the point of self-starvation as they obsesses about weight loss. With anorexia, a person will deny hunger and refuse to eat, practice binge eating and purging behaviors or exercise to the point of exhaustion as they attempt to limit, eliminate or "burn" calories.

The emotional symptoms of anorexia include irritability, social withdrawal, lack of mood or emotion, not able to understand the seriousness of the situation, fear of eating in public and obsessions with food and exercise. Often food rituals are developed or whole categories of food are eliminated from the person's diet, out of fear of being "fat".

Anorexia can take a heavy physical toll. Very low food intake and inadequate nutrition causes a person to become very thin. The body is forced to slow down to conserve energy causing irregularities or loss of menstruation, constipation and abdominal pain, irregular heart rhythms, low blood pressure, dehydration and trouble sleeping. Some people with anorexia might also use binge eating and purge behaviors, while others only restrict eating.

Bulimia Nervosa. People living with bulimia will feel out of control when binging on very large amounts of food during short periods of time, and then desperately try to rid themselves of the extra calories using forced vomiting, abusing laxatives or excessive exercise. This becomes a repeating cycle that controls many aspects of the person's life and has a very negative effect both emotionally and physically. People living with bulimia are usually normal weight or even a bit overweight.

The emotional symptoms of bulimia include low self-esteem overly linked to body image, feelings of being out of control, feeling guilty or shameful about eating and withdrawal from friends and family.

Like anorexia, bulimia will inflict physical damage. The binging and purging can severely harm the parts of the body involved in eating and digesting food, teeth are damaged by frequent vomiting, and acid reflux is common. Excessive purging can cause dehydration that effect the body's electrolytes and leads to cardiac arrhythmias, heart failure and even death.

Binge Eating Disorder (BED). A person with BED losses control over their eating and eats a very large amount of food in a short period of time. They may also eat large amounts of food even when he isn't hungry or after he is uncomfortably full. This causes them to feel embarrassed, disgusted, depressed or guilty about their behavior. A person with BED, after an episode of binge eating, does not attempt to purge or exercise excessively like someone living with anorexia or bulimia would. A person with binge eating disorder may be normal weight, overweight or obese.

Causes

Eating disorders are very complex conditions, and scientists are still learning about the causes. Although eating disorders all have food and weight issues in common, most experts now believe that eating disorders are caused by people attempting to cope with overwhelming feelings and painful emotions by controlling food. Unfortunately, this will eventually damage a person's physical and emotional health, self-esteem and sense of control.

Factors that may be involved in developing an eating disorder include:

Genetics. People with first degree relatives, siblings or parents, with an eating disorder appear to be more at risk of developing an eating disorder, too. This suggests a genetic link. Evidence that the brain chemical, serotonin, is involved also points a contributing genetic and biological factors.

Environment. Cultural pressures that idealize a particular body type place undue pressure on people to achieve unrealistic standards. Popular culture and media images often tie thinness (for women) or muscularity (for men) to popularity, success, beauty and happiness.

Peer Pressure. With young people, this can be a very powerful force. Pressure can appear in the form of teasing, bullying or ridicule because of size or weight. A history of physical or sexual abuse can also contribute to some people developing an eating disorder.

Emotional Health. Perfectionism, impulsive behavior and difficult relationships can all contribute to lowering a person's self-esteem and make them vulnerable to developing eating disorders.

Eating disorders affect all types of people. However there are certain risk factors that put some people at greater risk for developing an eating disorder.

Age. Eating disorders are much more common during teens and early 20s.

Gender. Women and girls are more likely to have a diagnosed eating disorder. However, it is important to recognize that men and boys may be under-diagnosed due to differences in seeking treatment.

Family history. Having a parent or sibling with an eating disorder increases the risk.

Dieting. Dieting taken too far can become an eating disorder.

Changes. Times of change like going to college, starting a new job, or getting divorced may be a stressor towards developing an eating disorder.

Vocations and activities. Eating disorders are especially common among gymnasts, runners, wrestlers and dancers.

Diagnosis

A person with an eating disorder will have the best recovery outcome if they receive an early diagnosis. If an eating disorder is believed to an issue, a doctor will usually perform a physical examination, conduct an interview and order lab tests. These will help form the diagnosis and check for related medical issues and complications.

In addition, a mental health professional will conduct a psychological evaluation. They may ask questions about eating habits, behaviors and beliefs. There may be questions about a patient's history of dieting, exercise, bingeing and purging.

Symptoms must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in order to warrant a diagnosis. Each eating disorder has its own diagnostic criteria that a mental health professional will use to determine which disorder is involved. It is not necessary to have all the criteria for a disorder to benefit from working with a mental health professional on food and eating issues.

Often a person with an eating disorder will have symptoms of another mental health condition that requires treatment. Whenever possible, it is best to identified and address all conditions at the same time. This gives a person comprehensive treatment support that helps ensure a lasting recovery.

Treatment

Eating disorders are managed using a variety of techniques. Treatments will vary depending on the type of disorder, but will generally include the following.

Psychotherapy, such as talk therapy or behavioral therapy.

Medicine, such as antidepressants and anti-anxiety drugs. Many people living with an eating disorder often have a co-occurring illness like depression or anxiety, and while there is no medication available to treat eating disorders themselves, many patients find that these medicines help with underlying issues.

Nutritional counseling and weight restoration monitoring are also crucial. Family-based treatment is especially important for families with children and adolescents because it enlists the families' help to better ensure healthy eating patterns, and increases awareness and support.

Related Conditions

People with eating disorders often have additional illnesses:

Treating these illnesses can help make treating an eating disorder easier. Some of the symptoms of eating disorders may be caused by another ilnesss.

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Discover the symptoms, causes, diagnosis advice, treatment options and related conditions of eating disorders.

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from National Alliance on Mental Illness

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Bipolar disorder | NAMI: National Alliance on Mental Illness

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Discover the symptoms, causes, diagnosis advice, treatment options and related conditions of Bipolar disorder.

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In this 2-part podcast series, NAMI Chief Medical Officer Dr. Ken Duckworth guides discussions on major depressive disorder that offer insights from individuals, family members and mental health professionals. Read the transcript.
Note: Content includes discussions on topics such as suicide attempts and may be triggering.

Depressive disorder, frequently referred to simply as depression, is more than just feeling sad or going through a rough patch. It's a serious mental health condition that requires understanding and medical care. Left untreated, depression can be devastating for those who have it and their families. Fortunately, with early detection, diagnosis and a treatment plan consisting of medication, psychotherapy and healthy lifestyle choices, many people can and do get better.

Some will only experience one depressive episode in a lifetime, but for most, depressive disorder recurs. Without treatment, episodes may last a few months to several years.

About 21 million U.S. adults- 8.4% of the population-had at least one major depressive episode in 2020. People of all ages and all racial, ethnic and socioeconomic backgrounds experience depression, but it does affect some groups more than others.

Symptoms

Depression can present different symptoms, depending on the person. But for most people, depressive disorder changes how they function day-to-day, and typically for more than two weeks. Common symptoms include:

Changes in sleep

Changes in appetite

Lack of concentration

Loss of energy

Lack of interest in activities

Hopelessness or guilty thoughts

Changes in movement (less activity or agitation)

Physical aches and pains

Suicidal thoughts

Causes

Depression does not have a single cause. It can be triggered by a life crisis, physical illness or something else-but it can also occur spontaneously. Scientists believe several factors can contribute to depression:

Trauma. When people experience trauma at an early age, it can cause long-term changes in how their brains respond to fear and stress. These changes may lead to depression.

Genetics. Mood disorders, such as depression, tend to run in families.

Life circumstances. Marital status, relationship changes, financial standing and where a person lives influence whether a person develops depression.

Brain changes. Imaging studies have shown that the frontal lobe of the brain becomes less active when a person is depressed. Depression is also associated with changes in how the pituitary gland and hypothalamus respond to hormone stimulation.

Other medical conditions. People who have a history of sleep disturbances, medical illness, chronic pain, anxiety and attention-deficit hyperactivity disorder (ADHD) are more likely to develop depression. Some medical syndromes (like hypothyroidism) can mimic depressive disorder. Some medications can also cause symptoms of depression.

Drug and alcohol misuse. Adults with a substance use disorder are at significantly higher risk for experiencing a major depressive episode. Co-occurring disorders require coordinated treatment for both conditions, as alcohol can worsen depressive symptoms.

Diagnosis

To be diagnosed with depressive disorder, a person must have experienced a depressive episode lasting longer than two weeks. The symptoms of a depressive episode include:

Loss of interest or loss of pleasure in all activities

Change in appetite or weight

Sleep disturbances

Feeling agitated or feeling slowed down

Fatigue

Feelings of low self-worth, guilt or shortcomings

Difficulty concentrating or making decisions

Suicidal thoughts or intentions

Treatments

Although depressive disorder can be a devastating illness, it often responds to treatment. The key is to get a specific evaluation and treatment plan. Safety planning is important for individuals who have suicidal thoughts. After an assessment rules out medical and other possible causes, a patient-centered treatment plans can include any or a combination of the following:

Psychotherapy including cognitive behavioral therapy, family-focused therapy and interpersonal therapy.

Medications including antidepressants, mood stabilizers and antipsychotic medications.

Exercise can help with prevention and mild-to-moderate symptoms.

Brain stimulation therapies can be tried if psychotherapy and/or medication are not effective. These include electroconvulsive therapy (ECT) for depressive disorder with psychosis or repetitive transcranial magnetic stimulation (rTMS) for severe depression.

Light therapy, which uses a light box to expose a person to full spectrum light in an effort to regulate the hormone melatonin.

Alternative approaches including acupuncture, meditation, faith and nutrition can be part of a comprehensive treatment plan.

Reviewed August 2017

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In this 2-part podcast series, NAMI Chief Medical Officer Dr. Ken Duckworth guides discussions on major depressive disorder that offer insights from individuals, family members and mental health professionals. Read the transcript. Note: Content includes discussions on topics such as suicide attempts and may be triggering.

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

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

Symptoms

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

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

Examples of obsessions include:

Thoughts about harming or having harmed someone

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

Unpleasant sexual images

Fears of saying or shouting inappropriate things in public

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

Examples of compulsions include:

Hand washing due to a fear of germs

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

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

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

Causes

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

Diagnosis

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

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

Obsessions, compulsions or both

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

Treatment

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

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

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

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

Related Conditions

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

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

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

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

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

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Credit: Julius-Maximilians-Universität Würzburg, JMU

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

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

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

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

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

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

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

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

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

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

Provided by Julius-Maximilians-Universität Würzburg

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

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Supporting Students Experiencing Early Psychosis

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Supporting Students Experiencing Early Psychosis

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Special needs educators do not just take a course in teaching students with severe behavior problems, receive a certificate and then look forward to smooth sailing from there on in. 15 to 30 percent of special needs students struggle to learn due to psychosocial problems which affect attention to task and retention of material . For these classmates and their peers, positive behavior intervention and support (PBIS) is crucial to their success.

According to the Individuals with Disabilities Act (IDEA), the term " Emotional and Behavioral Disorder " is an umbrella term which includes several distinct diagnoses (such as Anxiety Disorder, Manic-Depressive Disorder, Oppositional-Defiant Disorder and more). All of these disorders are often referred to under many labels, i.e., "emotional disturbance", "emotionally challenged" or "behavior disordered"
According to IDEA, these children exhibit one or more of these five characteristics:

1. An inability to learn that cannot be explained by intellectual, sensory, or health factors.

2. An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

3. Inappropriate types of behavior or feelings under normal circumstances.

4. A general pervasive mood of unhappiness or depression.

5. A tendency to develop physical symptoms or fears associated with personal or school problems.

Under the umbrella term of Emotional and Behavioral Disorders, there can be found two major categories: Psychiatric Disorders and Behavioral Disabilities.

Psychiatric Disorders

This category encompasses a wide range of conditions. Psychiatric disorders are defined as mental, behavioral, or perceptual patterns or anomalies which impair daily functioning and cause distress. Some of the most common examples of these diagnoses include:

Anxiety Disorder

Bipolar Disorder (aka Manic-Depressive Disorder)

Eating Disorder (such as anorexia, bulimia, and binge-eating disorder)

Obsessive-Compulsive Disorder

Psychotic Disorder

Schools are not hospitals. Teachers are not doctors. They cannot be expected to "treat" these disorders. Students who struggle with these sorts of challenges are often undergoing treatment by medical professionals and may be receiving medication. Medication can affect people in unexpected ways and, because medical information is confidential under the HIPPA regulations, teachers may be unaware of why students are acting the way they are. This makes it difficult to respond appropriately to certain behaviors. Additionally, students suffering from these conditions may be just unable to meet academic and behavioral expectations. In such cases, students need to receive special education interventions of some sort and may need to be moved into a special education classroom or separate school program.

Behavioral Disabilities

The key word is safety, for all children. Children with behavioral disabilities engage in conduct which is disruptive to classroom functioning and/or harmful to themselves and others. To be diagnosed as a behavioral disability, the behaviors must not be attributable to one of the aforementioned psychiatric disorders.

There are two categories of behavioral disabilities: oppositional defiant disorder and conduct disorder.

An oppositional defiant disorder is characterized by extreme non-compliance, negativity, and an unwillingness to cooperate or follow directions. Children with this condition are typically not violent or aggressive; they just refuse to cooperate with adults or peers.

is much more severe. This disorder is characterized by aggression, violence, and harm inflicted on self and/or others. Students with conduct disorder typically need to be taught in special education classrooms, or separate schools, until their behavior has improved enough to allow inclusion with the general education population.

What are some strategies for teaching students with emotional and behavioral disorders?

A positive, structured environment, which supports growth, fosters self-esteem and rewards desirable behavior is essential. Let's start with rules and routines:

Rules and Routines

Here are the rules when it comes to rules:

They must be established at the beginning of the school year.

They must be written in simple and understandable terms.

The wording should be positive.

Consequences for breaking the rules should be introduced at the same time:

They must be applied consistently and firmly.

They must be understood clearly, and remain constant and predictable.

Feedback should be administered clearly when consequences are administered.

Students that struggle with transitions and unexpected change thrive on routines. Use of visual cues to go over a daily schedule of the day's activities can be very helpful for these types of students.

Supporting Positive Behavior

These are time-tested strategies for guiding and supporting growth toward more positive, adaptive behaviors:

Token Economy - A reward system is standard when addressing the behavior of special needs children. With points or tokens, students are given constant reinforcement for correct behavior and following the rules. Students earn points, or tokens, for instances of positive behavior on a set schedule. These tokens can then be used to purchase rewards at the token store or "prize box". In order for a token economy to be effective, positive behavior must be rewarded consistently, and items in the token store must be genuinely motivating for the student. This takes a fair amount of preparation and organization, and collaboration with the family, but has proven to be quite effective with many students.

Classroom Behavior Chart - This may appeal to any competitive nature in the students. Students who are behaving progressively will see themselves rising up the charts and surpassing others. Progress is monitored and rewarded. The only downside is that students who perpetually see themselves at the bottom may begin to see that as their identity.

Lottery System - This one is simple. Students who show positive behavior place a ticket with their name on it in a jar. Once or twice a week, the teacher will draw out a winner and award a prize

Positive Peer Review - Has anyone ever thought of reversing "tattle-telling"? This builds teamwork and social support in the classroom. Encourage students to watch their peers and identify positive behavior. Reward both the reporters and their peers.

Fostering and rewarding positive behavior is now the rule of teaching children with emotional and behavioral disorders. The last thing you need is a power struggle, which punishment strategies and negative consequences often lead to. Don't give up, and remember that your influence could mean a world of difference to these students who are struggling with an incredibly difficult condition.

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Students with emotional and behavioral disorders - How to manage

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Psychiatric disorders and behavioral disorders can adversely affect a students progress in addition to their safety and ability to cope in school.

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

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

Listen for ongoing or severe traumatic stress symptoms.

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

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

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

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

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

Steps for making a referral

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

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

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

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

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

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

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

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

Keep the door open.

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

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

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

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

Effective mental health treatment for traumatic stress

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

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

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

Do you have experience working with children after trauma?

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

What is your success rate?

How do you work with parents?

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

Online resources - help in finding a mental health professional

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

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

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

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

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

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

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

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When and How to Refer for Mental Health Care

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

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Emotional & Behavioral Disorders in the Classroom

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Emotional & Behavioral Disorders in the Classroom

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by Becton Loveless

"Emotional and Behavioral Disorder" is an umbrella term under which several distinct diagnoses (such as Anxiety Disorder, Manic-Depressive Disorder, Oppositional-Defiant Disorder, and more) fall. These disorders are also termed "emotional disturbance" and "emotionally challenged." According to the Individuals with Disabilities Education Act (IDEA), children with emotional and behavioral disorders exhibit one or more of these five characteristics:

1. An inability to learn that cannot be explained by intellectual, sensory, or health factors.

2. An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

3. Inappropriate types of behavior or feelings under normal circumstances.

4. A general pervasive mood of unhappiness or depression.

5. A tendency to develop physical symptoms or fears associated with personal or school problems.

IDEA guarantees students access to a Free and Appropriate Public Education (FAPE) in the Least Restrictive Environment (LRE) possible. As such, students diagnosed with emotional disorders (ED) are often included in general education classrooms. However, severe cases often require students to be taught in special education "cluster units," self-contained programs, or even separate schools.

Under the umbrella term of Emotional and Behavioral Disorders, there are two categories: Psychiatric Disorders and Behavioral Disabilities.

Psychiatric Disorders

This category encompasses a wide range of conditions. Psychiatric disorders are defined as mental, behavioral, or perceptual patterns or anomalies which impair daily functioning and cause distress. Some of the most common examples of these diagnoses include:

Anxiety Disorder

Bipolar Disorder (aka Manic-Depressive Disorder)

Eating Disorder (such as anorexia, bulimia, and binge-eating disorder)

Obsessive-Compulsive Disorder

Psychotic Disorder

From a teacher's perspective, psychiatric disorders present a profound challenge for a number of reasons. For one, schools are not hospitals, and teachers can not be expected to "treat" these disorders. Students who struggle with these sorts of challenges are often undergoing treatment and may be receiving medication. Medication can affect people in unexpected ways and, because medical information is confidential, teachers may be unaware why students are acting the way they are. This makes it difficult to respond appropriately to certain behaviors. Additionally, students suffering from these conditions may be simply unable to meet academic and behavioral expectations. In such cases, students need to receive special education interventions of some sort, and may need to be moved into a special education classroom.

Behavioral Disabilities

Children with behavioral disabilities engage in conduct which is disruptive to classroom functioning and/or harmful to themselves and others. To be diagnosed as a behavioral disability, the behaviors must not be attributable to one of the aforementioned psychiatric disorders.

There are two categories of behavioral disabilities: oppositional defiant disorder and conduct disorder.

Oppositional defiant disorder is characterized by extreme non-compliance, negativity, and an unwillingness to cooperate or follow directions. Children with this condition are not violent or aggressive, they simply refuse to cooperate with adults or peers.

Conduct disorder is much more severe. This disorder is characterized by aggression, violence, and harm inflicted on self and others. Students with conduct disorder typically need to be taught in special education classrooms until their behavior has improved enough to allow contact with the general education population.

Strategies for Teaching Students with Emotional and Behavioral Disorders

As with other conditions, students with emotional and behavioral disorders need a positive, structured environment which supports growth, fosters self-esteem, and rewards desirable behavior.

Rules and Routines

Rules need to be established at the beginning of the school year, and must be written in such a way as to be simple and understandable. The wording of rules should be positive: "Respect yourself and others" is a better rule than "Don't hurt anyone." Keep it simple: 6 rules or less.

Consequences for breaking rules should also be established at the beginning of the school year, and applied consistently and firmly whenever the rules are broken. The consequences must be consistent and predictable. When administering consequences, provide feedback to the student in a calm, clear manner. That way, the student understands why the consequence is necessary. Try to avoid becoming emotionally reactive when rules are broken. Emotional reactivity gives the student negative attention, which many children find very rewarding. Remain calm and detached, be firm yet kind. It's a difficult balance to achieve, but crucially important for positive results.

Routines are very important for classroom management. Students with emotional and behavioral disorders tend to struggle with transitions and unexpected change. Going over a visual schedule of the day's activities is an effective way to start the day, and helps the students feel grounded.

Techniques for Supporting Positive Behavior

Students with emotional and behavioral disorders often need to receive instruction in a special education setting because their behavior is too maladaptive for a general education classroom. Here are a few ideas to guide and support growth towards more positive, adaptive behavior:

Token Economy - Students earn points, or tokens, for every instance of positive behavior. These tokens can then be used to purchase rewards at the token store. In order for a token economy to be effective, positive behavior must be rewarded consistently, and items in the token store must be genuinely motivating for the student. This takes a fair amount of preparation and organization, but has proven to be quite effective.

Classroom Behavior Chart - A chart which visually plots the level of behavior of every student in the classroom. Students who are behaving positively progress upwards on the chart; those who are behaving negatively fall downwards. This makes every student accountable, and helps you monitor and reward progress. This won't work if difficult students perpetually stay on the bottom of the chart. Focus on the positive to the fullest degree possible, and keep them motivated.

Lottery System - Similar to the token economy, students who behave in positive ways are given a ticket with their name on it. These tickets are placed in a jar, and once or twice a week you draw one out. The winner of the lottery is rewarded with a prize.

Positive Peer Review - Students are asked to watch their peers, and identify positive behavior. Both the student who is behaving positively and the student who does the identifying are rewarded. This is the exact opposite of "tattle-telling," and fosters a sense of teamwork and social support in the classroom.

Teaching children with emotional and behavioral disorders can be extremely challenging. Remember: fostering and rewarding positive behavior has proven to be vastly more effective than attempting to eliminate negative behavior. Punishment and negative consequences tend to lead to power struggles, which only make the problem behaviors worse. It is not easy to remain positive in the face of such emotionally trying behaviors, but don't give up. Your influence could mean a world of difference to these students who are struggling with an incredibly difficult condition.

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Emotional and Behavioral Disorders in the Classroom

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Explore the characteristics of children with emotional and behavioral disorders, as well as strategies for teaching these student.

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New research finds that after a child experiences inadequate sleep, changes are seen in the way they experience, regulate and express their emotions. Credit: University of Houston

In a new study published in the Journal of Child Psychology and Psychiatry, Candice Alfano, University of Houston professor of psychology and director of the Sleep and Anxiety Center of Houston, reports the results from an innovative, experimental study showing inadequate nighttime sleep alters several aspects of children's emotional health.

Although plenty of correlational research links inadequate sleep with poor emotional health, experimental studies in children are rare. Alfano and her team studied 53 children ages 7-11 over more than a week. The children completed an in-lab emotional assessment twice, once after a night of healthy sleep and again after two nights where their sleep was restricted by several hours.

"After sleep restriction, we observed changes in the way children experience, regulate and express their emotions," reports Alfano. "But, somewhat to our surprise, the most significant alterations were found in response to positive rather than negative emotional stimuli."

The multi-method assessment had children view a range of pictures and movie clips eliciting both positive and negative emotions while the researchers recorded how children responded on multiple levels. In addition to subjective ratings of emotion, researchers collected respiratory sinus arrhythmias (a non-invasive index of cardiac-linked emotion regulation) and objective facial expressions. Alfano points out the novelty of these data. "Studies based on subjective reports of emotion are critically important, but they don't tell us much about the specific mechanisms through which insufficient sleep elevates children's psychiatric risk."

Alfano highlights the implications of her findings for understanding how poor sleep might 'spill over' into children's everyday social and emotional lives. "The experience and expression of positive emotions are essential for children's friendships, healthy social interactions and effective coping. Our findings might explain why children who sleep less on average have more peer-related problems," she said.

Another important finding from the study is that the impact of sleep loss on emotion was not uniform across all children. Specifically, children with greater pre-existing anxiety symptoms showed the most dramatic alterations in emotional responding after sleep restriction.

According to Alfano, these results emphasize a potential need to assess and prioritize healthy sleep habits in emotionally vulnerable children.

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Insufficient sleep harms children's mental health

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In a new study published in the Journal of Child Psychology and Psychiatry, Candice Alfano, University of Houston professor of psychology and director of the Sleep and Anxiety Center of Houston, reports the results from an innovative, experimental study showing inadequate nighttime sleep alters several aspects of children's emotional health.