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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.
________________________________________

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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It's a normal part of life to experience occasional anxiety.

But you may experience anxiety that is persistent, seemingly uncontrollable, and overwhelming. If it's an excessive, irrational dread of everyday situations, it can be disabling. When anxiety interferes with daily activities, you may have an anxiety disorder.

Anxiety disorders are real, serious medical conditions - just as real and serious as physical disorders such as heart disease or diabetes. Anxiety disorders are the most common and pervasive mental disorders in the United States.

The term "anxiety disorder" refers to specific psychiatric disorders that involve extreme fear or worry, and includes generalized anxiety disorder (GAD), panic disorder and panic attacks, agoraphobia, social anxiety disorder, selective mutism, separation anxiety, and specific phobias.

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are closely related to anxiety disorders, which some may experience at the same time as depression.

Irritable Bowel Syndrome, also called IBS, is characterized by abdominal pain, cramping, bloating, gas, constipation, and diarrhea. Click here to learn more about IBS and its connection to stress and anxiety.

What is Anxiety? (from ADAA's partner organization Anxiety.org) is an in-depth analysis and explanation of key anxiety disorders written by ADAA member experts.

Depression is a condition in which a person feels discouraged, sad, hopeless, unmotivated, or disinterested in life in general for more than two weeks and when the feelings interfere with daily activities. Major depression is a treatable illness that affects the way a person thinks, feels, behaves, and functions. At any point in time, 3 to 5 percent of people suffer from major depression; the lifetime risk is about 17 percent.

Facts and Statistics

Anxiety disorders are the most common psychiatric illnesses affecting children and adults. An estimated 44 million American adults suffer from anxiety disorders. Only about one-third of those suffering from an anxiety disorder receive treatment, even though the disorders are highly treatable.
Find more facts about anxiety disorders.
Read this important and helpful article " What is Anxiety?" from our partner Anxiety.org.

Videos

See what people with anxiety disorders are saying about how they manage.

Watch or download videos on how to manage and overcome stress and anxiety, including how to reduce stress, the differences between normal everyday anxiety and an anxiety disorder, how to recognize symptoms, and what to do if you have generalized anxiety disorder (GAD) or OCD.

Everyday anxiety or an anxiety disorder?

Researchers are learning that anxiety disorders run in families, and that they have a biological basis, much like allergies or diabetes and other disorders. Anxiety disorders may develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.

Other resources

Continue to learn more about anxiety in all its forms on the free BetterHelp resource.

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It's a normal part of life to experience occasional anxiety. But you may experience anxiety that is persistent, seemingly uncontrollable, and overwhelming. If it's an excessive, irrational dread of everyday situations, it can be disabling. When anxiety interferes with daily activities, you may have an anxiety disorder.

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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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Home - American School Counselor Association (ASCA)

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Resource Guide for Bipolar Disorder, Depression, and Schizophrenia. Referral Process, IDEA, and 504

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Resource Guide for Bipolar Disorder, Depression, and Schizophrenia. Referral Process, IDEA, and 504

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Obsessive-compulsive disorder (OCD) manifests in many ways and is caused by many triggers. One of those triggers is stress. The best way to improve your OCD self-help skills is to learn and regularly practice relaxation techniques. Here are three easy techniques you can practice on your own.

Deep diaphragmatic breathing, or "belly breathing," sends a very strong relaxation signal to the brain that effectively turns down physiological arousal, and in turn, stress levels. During belly breathing, we experience a reduced heart rate, lowered blood pressure and more efficient breathing, each of which promotes a state of calm and relaxation.

The first step in belly breathing is to sit or lie in a quiet room in a comfortable position with one hand on your chest and the other on your stomach. Some people feel more comfortable closing their eyes, but this is not essential. Begin by breathing in through your nose. When you breathe in, you should only feel your stomach expand. You will know that you are doing this correctly if the hand on your chest is almost motionless while the hand on your stomach moves outward.

Once you have taken a deep breath in, blow the air out slowly through pursed lips-similar to the face you would make blowing up a balloon-and feel your stomach fall back towards your spine. Again, only the hand on your stomach should be moving. Exhaling should take two to three times as long as inhalation. The relaxation that comes with deep breathing will kick in after a minute or two, but keep going for 5, 10 or even 20 minutes for maximum benefits.

Mindfulness meditation seems to be all the rage these days and there's a reason for it. Multiple reasons, actually. Once you have mastered the deep breathing technique outlined above, you may want to try mindfulness meditation. Mindfulness meditation is the practice of noticing thoughts without judging them or pushing them away.

By practicing mindfulness meditation we become more aware of the thoughts we are having and become better at detaching ourselves from these thoughts and being more "arm's length" to them. By practicing this technique we are less likely to be affected by troubling thoughts, including the obsessions that are part of OCD. In fact, mindfulness is a key component of acceptance and commitment therapy.

To practice mindfulness meditation, begin with the deep breathing exercise described above. As you are breathing, try to pay attention to the thoughts, sensations, fears, anxiety, and worries that are passing through your mind. Simply notice these thoughts without trying to push them away. Notice what happens to these thoughts when you simply leave them alone and let them pass. Use deep breathing as your anchor throughout this exercise.

It is not uncommon for people to experience greater levels of anxiety when starting to learn mindfulness meditation as it puts us in touch with troubling thoughts, fear, worries, etc. However, over time you will grow more comfortable simply sitting with these thoughts without taking action.

Progressive muscle relaxation (PMR) can also be used with the deep breathing described above. Progressive muscle relaxation can be very helpful in identifying hidden tension throughout the body.

To practice PMR, lie or sit in a comfortable position in a quiet room and begin the breathing exercise above. As in your inhale, clench all of the muscles in your face. Hold this for 10 to 20 seconds and then release the tension while slowly exhaling. Repeat this a couple of times and then gradually move down your body-shoulders, arms, stomach, buttock, legs, calves-repeating this pattern of inhalation/tensing and exhalation/relaxing.

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How to Improve Your OCD Self-Help Strategy With Relaxation Techniques

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Obsessive-compulsive disorder (OCD) manifests in many ways and is caused by many triggers. One of those triggers is stress. The best way to improve your OCD self-help skills is to learn and regularly practice relaxation techniques. Here are three easy techniques you can practice on your own.

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The first step in treatment is helping children understand how OCD works. It often helps to put OCD in a context that children can understand. For example, a clinician might explain that OCD functions like a bully. If a bully asks for your lunch money and you give in because you're afraid, then the bully will be happy and go away. But the next day the bully will come back for more, because he knows you are afraid. The more you give in to a bully the more he will ask for. OCD functions the same way. The goal of treatment is to help a child learn how to stand up to his bully.

The gold-standard treatment for OCD is a kind of cognitive behavioral therapy called exposure and response prevention, or ERP. ERP works by helping children face the things that trigger their anxiety in structured, incremental steps, and in a safe environment. This allows children to experience anxiety and distress without resorting to compulsions, with the support of the therapist. Through facing their triggers children learn to tolerate their anxiety and, over time, they discover that their anxiety has actually decreased.

For example, a child with fears about germs and contamination would create a "fear hierarchy" with his therapist. They would work together to identify all of the contamination situations he fears, rate them on a scale of 0-10, and then tackle them one at a time until his fear subsides. The child would start with a low-level trigger, such as touching clean towels, and build to more difficult triggers, such as holding something from the trash.

Because children often have symptoms that are specific to settings outside the clinical office, at home or in restaurants, for instance, it is important for treatment to move outside the office as needed. Your clinician should provide ERP in real world locations where your child experiences anxiety, and make sure that caregivers know how to reinforce ERP skills outside of treatment, too.

For most cases of mild to moderate OCD, treatment once a week for 12-15 weeks is usually enough to get strong results.

Working with parents

Parents spend the most time with their children, so it is essential for family to be involved in treatment. You should expect your child's clinician to work closely with you, explaining how treatment works and giving you and your child homework to practice the skills your child is learning in therapy.

Because children often come to parents looking for reassurance or to help with an obsession or compulsion, it is also important for parents to learn the best way to respond to their child without reinforcing her OCD. When a parent gives reassurance, it makes the child feel better in the moment, but that relief is fleeting and can actually reinforce the child's anxiety in the long run. It also doesn't help her learn any coping skills to help herself - only that asking mom or dad will help.

Similarly, if your child has an aversion to a certain word, your family might have learned to avoid saying that word and apologize if someone accidentally uses it. However inadvertent, this also reinforces the OCD because it doesn't give the child a chance to overcome her anxiety. Your child's clinician should work with you on finding ways to respond to requests for reassurance that are supportive without reinforcing OCD symptoms.

Intensive CBT and hospitalization

For children with severe symptoms, weekly or even twice-weekly therapy sessions might not be effective enough. If your child's symptoms are seriously interfering with school performance, family life and friendships, and if typical treatment isn't helping, you may want to consider a treatment program that is more intensive.

Some institutions that specialize in OCD, like the Child Mind Institute, offer intensive treatment programs that allow children to be seen several times a week, compressing treatment and helping children make more gains faster. These programs can have a transformative effect on children struggling with severe OCD, and can many times prevent hospitalization.

An inpatient hospitalization program is another option for children with severe OCD who are not getting the help they need from traditional outpatient treatment. After an inpatient OCD hospitalization, a child may be recommended to participate in an intensive outpatient program to help ease his transition away from being in a clinical environment and to help him maintain the gains he has made.

Medication treatment for OCD

While the primary treatment for OCD is cognitive behavioral therapy, children with more severe cases are often treated with a combination of CBT and medication. A class of antidepressant medication called SSRIs, or selective serotonin reuptake inhibitors, can be used to help reduce a child's anxiety, which in turn allows the child to be more responsive to therapy. Medication can be decreased or discontinued as the child learns skills to help her overcome her anxiety on her own.

Sometimes other types of medicines can be prescribed to control excessive irritability or anger that may be complicating treatment.

Related:
Kids and OCD: The Parents' Role in Treatment Intensive Treatment for OCD and Anxiety

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What Is the Best Treatment for OCD? | Child Mind Institute

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The first step in treatment is helping children understand how OCD works. It often helps to put OCD in a context that children can understand. For example, a clinician might explain that OCD functions like a bully. If a bully asks for your lunch money and you give in because you're afraid, then the bully will be happy and go away.

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National Institute of Mental Health (NIMH)

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Overview

Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms:

Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.

Hyperactivity means a person may seem to move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks. In adults, hyperactivity may mean extreme restlessness or talking too much.

Impulsivity means a person may act without thinking or have difficulty with self-control. Impulsivity could also include a desire for immediate rewards or the inability to delay gratification. An impulsive person may interrupt others or make important decisions without considering long-term consequences.

Signs and Symptoms

Risk Factors

Treatment and Therapies

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Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms: Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.

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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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familydoctor.org editorial staff and jswords

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What Is Pica? - Pica Eating Disorder | familydoctor.org

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Pica is a compulsive eating disorder in which people eat nonfood items, such as dirt, clay, or flaking paint. Learn more about symptoms and treatment here.

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What is rumination syndrome?

Rumination syndrome (also known as rumination disorder or merycism) is a feeding and eating disorder in which undigested food comes back up from a person's stomach into his or her mouth (regurgitation). Once the food is back in the mouth, the person may chew it and swallow it again, or spit it out. This behavior usually occurs after every meal, and may appear effortless. Rumination may follow a sensation of burping/belching and typically does not involve nausea or retching. In rumination, the regurgitated food does not tend to taste sour or bitter because it has not had time to fully mix with stomach acid and be digested.

This act of regurgitation is a reflex action that can be a learned and intentional act or can be unintentional. People who have rumination syndrome are not regurgitating food because of a stomach illness or because they feel sick.

Who gets rumination syndrome?

Rumination syndrome has been long known to occur in babies and in people with developmental disabilities, but can occur in people of all ages. Children and adults with high levels of stress or anxiety may be at higher risk for rumination syndrome.

What are the signs and symptoms of rumination syndrome?

The signs and symptoms of rumination syndrome include:

Regurgitating and re-chewing food on a regular basis

Digestive problems, such as indigestion and stomach aches

Dental problems, such as bad breath and tooth decay

Weight loss

Chapped lips

Babies who have rumination syndrome may strain or arch their backs (which could also be a sign of gastroesophageal reflux) or make sucking noises with their mouths.

What causes rumination syndrome?

The exact causes of rumination syndrome are not known. Some people may develop this syndrome if they have emotional problems or if they are undergoing stressful events.

Mechanically, one explanation is that food expands the stomach, which is followed by an increase in abdominal pressure and a relaxation of the lower esophageal sphincter (the juncture where the esophagus [food tube from mouth] meets the stomach). The sequence of events allows stomach contents to be regurgitated.

Last reviewed by a Cleveland Clinic medical professional on 08/09/2019.

References

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Rumination Syndrome: Causes, Signs & Symptoms, Treatment

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Rumination syndrome (also known as rumination disorder or merycism) is a feeding and eating disorder in which undigested food comes back up from a person's stomach into his or her mouth (regurgitation). Once the food is back in the mouth, the person may chew it and swallow it again, or spit it out.

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Avoidant/Restrictive Food Intake Disorder (ARFID), oftentimes characterized as "extreme picky eating," is an eating disorder impacting thousands of individuals, particularly children. The meaning of "fear food" in clients with ARFID differs from clients with anorexia nervosa and bulimia. For individuals with ARFID the fear may stem from knowing they must eat, when they have no interest in eating, fearing the temperature might not be what they like, fear of choking or becoming sick or fear of eating a new food.

Types of ARFID

1. Lack of interest: clients with this type of ARFID have a genuine lack of interest in eating and food. They also get full quickly.

2. Sensory Avoidance: clients with sensory avoidance have issues with food tastes, textures, temperature and smells.

3. Fear of Aversive Consequences; fear of illness, choking, nausea and allergies

Symptoms & Warning Signs

Do you think about food, dieting and weight all the time?

Are you constantly trying a new diet?

Do you think you are overweight when you look in the mirror?

Do other people constantly tell you that you are thin?

Do you have an intense fear of gaining weight?

Do you measure or weigh your food?

Do you avoid certain food types out of fear of weight gain?

Are you envious of other people because they are thinner than you?

Risks & Complications

Malnutrition

Weight Loss

Developmental delays

Co-occurring anxiety disorders

Failure to gain weight (children)

Gastrointestinal complications

Causes

ARFID does not have one root cause; instead, researchers and clinicians have explored a variety of potential contributing factors, such as biological, psychosocial, and environmental influences.

A child who is already predisposed to ARFID due to biological or genetic makeup may be triggered by environmental or psychosocial situations, such as a traumatic event.

Since there can be disrupted eating patterns among other mental illnesses, co-occurring diagnoses - such as anxiety disorders, developmental disabilities, and autism may exacerbate - may also be present.

In autism and other developmental disabilities, an individual's relationship to their body and senses are already very heightened.

Treatment for ARFID

The good news is that recovery is possible! Treating Avoidant/Restrictive Food Intake Disorder requires highly specialized care with an expert treatment team that is specifically-trained in this illness, as well as any co-occurring illnesses.

Seek Help

If you or a loved one is struggling, please reach out to us. Center for Discovery's Treatment Centers specialize in treatment for eating disorders, mental health and dual diagnosis treatment with unique treatment programs for every individual to get them on their way to eating disorder recovery.

For more information, resources, or to consult with one of our specialists, call 866.482.3876.

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What is ARFID: Symptoms, Causes, and Complications

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Avoidant/Restrictive Food Intake Disorder (ARFID), oftentimes characterized as "extreme picky eating," is an eating disorder impacting thousands of individuals, particularly children. The meaning of "fear food" in clients with ARFID differs from clients with anorexia nervosa and bulimia.

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

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

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

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

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

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

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

Avoidance of PE or swimming (because it involved undressing)

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

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

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

Perfectionism (important to get everything right to avoid anxiety)

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

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

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

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

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

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

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A Lesson for Teachers in Addressing the Eating Disorder Bully

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

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Annenberg CPB - The World of Abnormal Psychology part (3/13) The Anxiety Disorders (1992)

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Cognitive‐behavioural outreach for an adolescent experiencing social anxiety, panic and agoraphobia: A single‐case experimental design. 

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Cognitive‐behavioural outreach for an adolescent experiencing social anxiety, panic and agoraphobia: A single‐case experimental design. 

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Chung, C. (2020). What is schizophrenia? Verywell Mind. Retrieved from https://www.verywellmind.com/schizophrenia-what-you-need-to-know-4156588

National Dissemination Center for Children with Disabilities. (2010, June). Emotional disturbances: NICHCY disability fact sheet #5. Retrieved from https://blackboard.angelo.edu/bbcswebdav/courses/11451.202110/emotional%20disturbance%20fact%20sheet%282%29.pdf

Turning, J. (2018). Autism and anxiety…. finding the root cause for symptoms. Retrieved from https://www.baconandjuiceboxes.com/?p=791

Waldron, S. M., Maddern, L., & Wynn, A. (2018). Cognitive‐behavioural outreach for an adolescent experiencing social anxiety, panic and agoraphobia: A single‐case experimental design. Journal of Child and Adolescent Psychiatric Nursing, 31(4), 120–126. https://doi-org.easydb.angelo.edu/10.1111/jcap.12216