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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.

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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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How Educators can Help in Preventing Eating Disorders

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How Educators can Help in Preventing Eating Disorders

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Take it Seriously

Eating disorders are illnesses that have biological and psychological components. The symptoms can be life threatening. Every organ system of the body can be damaged, including: brain, heart, kidney, cardiovascular, gastrointestinal, endocrine, skin and bones.

Create a Safe Environment

Create an environment where students feel safe to discuss matters privately and confidentially. Remember the saying, "We have two ears and one mouth, so we should listen twice as much as we talk." Listening without judgment helps students feel safe enough to tell you what they're thinking, feeling, and doing.

People with eating disorders are 18 times more likely to die early compared with people of similar age in the general population.

Eating disorders have the highest mortality rate of any psychiatric disorder.

Eating disorders are the third most common chronic illness among adolescents.

Prevention is the First Line of Defense

Coaches, teachers, and other school personnel are role models for young people. It's important to be a resource for them. The environment you create will help students and athletes form healthy attitudes about weight, body image, nutrition, strength and even success.

Focus on Healthy Habits Rather Than on Body Weight or Fat

The factors listed below can enhance performance by improving both physical and psychological health. Emphasizing healthy behaviors in this way does not put students at risk for eating disorders.

Nutrition and Exercise - Young people need information about healthy meal planning and regular exercise, especially if they're athletes. Educate your students by providing nutritional information through the school curriculum and as part of their athletic training. Having knowledge about healthy habits will help them avoid overeating or under-eating. Some examples are:

Eat Breakfast! Grandmother was right. Breakfast is the most important meal of the day. People who eat breakfast, eat healthier the rest of the day, have more energy, and do better in school.

Meals and snacks should be nutritional and well balanced.

Plan for a regular mealtime schedule rather than eating on the run or skipping meals. Students with unusual or no meal schedule are at risk for eating disorders.

Sleep and Rest - Young adults and teens require between 8 to 9 hours of sleep a night. Many student-athletes sleep less than 6 hours a day. Encourage students to form regular sleep habits. The teen lifestyle of staying up late and getting up early is difficult to change but getting enough sleep is essential to health and wellbeing, which in turn helps to maximize both physical and mental performance. Lack of sleep can also lead to:

Body aches and pains

Irritability

Difficulty concentrating

Increased appetite

Decreased resilience and performance

Substance Use and Abuse - Provide your students with information about the consequences of drug and alcohol use, and teach them interpersonal and behavior skills. Include information about:

Alcohol and prescription or illegal drugs

Nicotine

Performance enhancing drinks or supplements

Dietary or "stacker" supplements

Peer pressure

Psychological Factors - Both thinking and emotional factors can affect performance. Educate young people to resist visual and social messages that imply they should achieve unrealistic body types such as extreme thinness. Mixed messages fill the media. Ultra-thin models happily eat fast food, while the nightly news reports an increasing number of Americans are obese. Replacing these messages with an emphasis on healthy eating habits can help the student make informed decisions and good choices for their own health and wellbeing.

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What Can I Do - Educators & Coaches - Eating Disorder Program - Adolescent Medicine - Golisano Children's Hospital - University of Rochester Medical Center

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Eating disorders are illnesses that have biological and psychological components. The symptoms can be life threatening. Every organ system of the body can be damaged, including: brain, heart, kidney, cardiovascular, gastrointestinal, endocrine, skin and bones. Create an environment where students feel safe to discuss matters privately and confidentially.

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Resource Guide for Bipolar & Depressive Disorders, Services, and Referral

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Resource Guide for Bipolar & Depressive Disorders, Services, and Referral

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F. L. Moffett Primary School Resource Guide.docx

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Parents: Is your child's teacher doing everything possible to support learning? Teachers often dictate the success or failure of a child's education - particularly if that child has attention deficit hyperactivity disorder (ADHD or ADD).

Next to parents, teachers are the most influential people in a student's life. The best teacher will develop ADHD strategies to show students that they are capable and worthwhile.

Here are some strategies for teaching children with ADHD that work to establish a supportive, structured classroom that will encourage learning, enforce discipline, and boost self-esteem.

Strategies for Students with ADHD

Assign work that suits the student's skill level. Students with ADHD will avoid classwork that is too difficult or too long.

Offer choices. Children with ADHD who are given choices for completing an activity produce more work, are more compliant, and act less negative. Establish, for instance, a list of 15 activity choices for practicing spelling words like writing words on flash cards, using them in a sentence, or air-writing words.
[Get This Download: How to Teach Children with ADHD - Classroom Challenges & Solutions]

Provide visual reminders. Students with ADHD respond well to visual cues and examples. For instance, demonstrate a skill like essay writing on an overhead projector or on the board. When children get to their independent work, leave key points about a topic visible on the board. Post important concepts the children will use again and again on brightly colored poster board around the room.

Increase active class participation. Group strategies include asking students to write their answers on dry-erase white boards and showing them to the teacher, asking students to answer questions in unison (choral response), having students give a thumbs up or down if the answer to the question is yes or no - a level palm, if they don't know the answer. Paired learning is also effective. Have students work through a problem in a group and discuss for maximized understanding.

Encourage hands-on learning. Create learning opportunities where children experience things first-hand. Have students write and act out a play, record an assignment on videotape or take apart and put together a model of a miniature eyeball when studying the human body.

Establish Rules & Routines for ADHD Students

Post classroom rules for student with and without ADHD. With input from students, establish short, simple classroom rules. State them in positive terms that convey what you want students to do.
For example, instead of saying: "No loud talking when you come into class," say, "When you come into class, check the assignment on the board and start working quietly." Or, "Sit down first and then you may talk quietly with your neighbor until I start teaching."

[Click to Download: 10 Teaching Strategies that Help Students with ADHD]

Establish classroom routines. This will help students with ADHD stay on task. Routines for all students can include: homework always being written on the board, "row captains" checking to see that assignments are written and that completed work is picked up, etc. Students with ADHD can check in with the classroom aide at the end of the day to make sure they understand the homework assignment and what's required of them.

Give appropriate supervision to ADHD students. Children with ADHD require more supervision than their peers because of their delayed maturity, forgetfulness, distractibility, and disorganization. Help these students by pairing them with classmates who can remind them of homework and classwork, using student partners to team up on a project, and involving classroom aides as much as you can during and after class.

Offer Accommodations for ADHD in the Classroom

Some students with ADHD may need school accommodations to address academic challenges. Make sure they get them. Some accommodations can be as easy as monitoring the student's work and developing a plan to help him not fall behind and even accepting the occasional late assignment - this can give the student confidence and get her back on track.

Other common ADHD accommodations include:

Extended time on tests

Shortened assignments

Instruction in note-taking or designating a class notetaker

Segmented assignments for long-term projects (with separate due dates and grades).

The Attention Deficit Disorder Association ( ADDA) makes the following recommendations for accommodations:

Reduce potential distractions. Always seat students who have problems with focus near the source of instruction and/or stand near student when giving instructions in order to help the student by reducing barriers and distractions between him and the lesson. Always seat this student in a low-distraction work area in the classroom.

Use positive peer models. Encourage the student to sit near positive role models to ease the distractions from other students with challenging or diverting behaviors.

Prepare for transitions. Remind the student about what is coming next (next class, recess, time for a different book, etc.). For special events like field trips or other activities, be sure to give plenty of advance notice and reminders. Help the student in preparing for the end of the day and going home, supervise the student's book bag for necessary items needed for homework.

Allow for movement. Allow the student to move around or fidget, preferably by creating reasons for the movement. Provide opportunities for physical action - do an errand, wash the blackboard, get a drink of water, go to the bathroom, etc. If this is not practical, then permit the student to play with small objects kept in their desks that can be manipulated quietly, such as a soft squeeze ball, if it isn't too distracting.

Let the children play. Recess can actually promote focus in children with ADHD so don't use it as a time to make-up missed schoolwork or as punishment as you might for other students.

Focus on the Positive

Establish a positive relationship with students who have ADHD. Greet them by name as they enter the classroom or when calling on them in class. Create a class bulletin board for posting students' academic and extracurricular interests, photographs, artwork, and/or accomplishments.

Provide frequent, positive feedback. Students with ADHD respond best to feedback that is immediate. Use positive praise, such as "You're doing a great job" or "Now you've got it." If a student's answer is incorrect, say, "Let's talk this through" or "Does that sound right to you?"

Ask questions rather than reprimand. If the student misbehaves, in class, ask, "Is that a good choice or a bad choice?" The student will get the message that his behavior is inappropriate.

Partner with Parents

For best results, teachers must partner with the parents to ensure that their child is ready to learn in the classroom. Here are some guidelines to share with the parents of your students with ADHD:

Communicate regularly with the teacher about problems.

See that your child's ADHD medication is working effectively at school and during homework sessions.

Help your child organize papers for evening homework and prepare for the next school day.

Watch your child put completed homework in the proper folder.

Monitor completion of work in the classes that he is in danger of failing.

Save all completed homework until the semester is over.

Talk with the teacher about using a daily or weekly report, if needed.

[Your Free Download: The Teacher's Guide to Better Assignments for Students with ADHD]

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Teaching Strategies for Students with ADHD: Ideas to Help Every Child Shine

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Your child's teacher is your partner in a fair and equitable education, but does she have the ADHD tools she needs? The following ADHD teaching strategies will help all students - but especially those with ADD - learn to the best of their ability in any classroom.

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What comes to mind when you hear OCD? Do you picture TV detective Adrian Monk refusing to touch door handles because of germs? Or maybe super-nerd Sheldon Cooper, who absolutely has to use the bathroom at the same time each day? These characters often get played for laughs, but living with Obsessive-Compulsive Disorder, often called OCD, is no joke. The obsessions these people experience, and the compulsions they develop to deal with them, can keep them from leading satisfying lives. Students with OCD often struggle academically and socially. Here's how teachers can help.

What is OCD?

According to Child Mind, OCD is an anxiety condition that plagues a person with unwanted thoughts, images, or impulses called obsessions. The International OCD Foundation estimates that as many as 1 in 200 children have OCD. In an average elementary school, there are at least four or five kids with OCD and as many as 20 in a high school.

People with OCD have unreasonable fears that disrupt their daily lives. They might worry about contamination or fear that they'll suddenly become violent and hurt themselves or others. To cope with these anxieties, they develop repetitive and ritualized actions. These could include counting, locking and re-locking doors, lining up objects, hand-washing, or skin-picking. Those with OCD can get so involved in those behaviors that they're unable to focus on other tasks or function normally.

Children as young as five can develop OCD. It's most commonly diagnosed between the ages of 10 and 12 or between the late teens and early adulthood. To be diagnosed, someone must experience both obsessions and compulsions so strong that they disrupt normal life.

What does OCD look like in students?

For students with OCD, school can be a challenging and stressful place. They may appear to be daydreaming, distracted, uninterested, or lazy. In reality, they're hyper-focused on nagging urges and obsessive thoughts. Here's what that might look like specifically in your classroom. ( See a complete list here.)

Repetitive behaviors

This is one of the classic OCD behaviors. Those with OCD believe their behaviors are absolutely essential to their safety or the safety of others. They might believe that if they don't line up their pencils from smallest to largest, something terrible will happen to all their friends. They develop rituals like checking locks multiple times or reading a paragraph three times out loud before going on to the next one.

If a student with OCD has a bad thought when going through a door, for example, they may want to go back and "fix it." They will retrace steps and attempt to right the wrong of a bad thought or an item left in a room. Attempting to disrupt or deny these behaviors can lead to complete meltdowns.

Frequent bathroom breaks

The bathroom is a safe space for lots of students. Those with OCD may go there to be alone with their anxieties. If they have fears of contamination, they might be washing their hands or even school supplies obsessively. They might also retreat there to perform repetitive behaviors like skin-picking.

Focus on perfection

There's a difference between wanting to do your best and never feeling something is good enough. Students with OCD often focus on perfection. This leads them to spend an excessive amount of time on assignments and especially tests. They may also resist leaving a task unfinished and moving on to something else.

Compulsive erasing

Given that need for perfection, students with OCD especially struggle with writing. They may write and re-write something over and over, erasing it until there are holes in the page. Or, a minor error may cause them to scribble all over the page, trying to make the problem disappear.

Lack of focus

There are many reasons students can appear distracted. But those with OCD are usually dealing with intrusive and obsessive thoughts. For instance, they may be counting the number of red objects in the room, and fear if they miss one, a family member could die. Not surprisingly, those sorts of thoughts make it very hard to concentrate on schoolwork.

Fear of contamination

Many people with OCD have a severe fear of germs and dirt. This leads to compulsive hand-washing (sometimes to the point that their hands bleed). It also means kids might avoid doing things like sitting on the floor, touching books in the library, or even joining in on a messy art project.

Difficulty with transitions

For many kids, moving from one subject or class to the next is as easy as scooping up their stuff and moving on. For kids with OCD, it's not that simple. Their items may need to be arranged just so. They might not want to leave unfinished work behind. And when they start the next subject or class, everything has to be arranged exactly right all over again.

Need for constant reassurance

To quell their anxieties, students with OCD seek constant assurance that everything is okay. They might ask the same question about how to complete an assignment over and over again, interrupting the teacher when everyone else has moved on. They'll straighten their books, check their backpack again and again to make sure everything is there, or apologize profusely for breaking a very small rule.

How can teachers support students with OCD?

Understanding OCD and its behaviors is a good first step. Students who are diagnosed with OCD often undergo cognitive behavioral therapy (CBT). An IEP/504 plan developed with their therapist may outline specific actions for schools and teachers to take.

Tip: Remember, accommodations aren't treatment. Sometimes you may be asked to do something that seems to be allowing behavior that you feel ought to be stopped. But that's up to a student and their doctor or therapist. As a teacher, you want to focus on how they can succeed in your classroom. Some of these actions might help. ( See more ideas here.)

Choose their place in the classroom carefully

Finding the right place for a student with OCD can be tricky. They might need to sit facing away from an object that causes obsessive thoughts. Eliminating distractions like noise or movement might help. Many students need a safe space to fidget, rock, or perform another calming behavior (unless they're actively working to overcome that action).

Make assignments manageable

Students with OCD see any assignment as a chance to make endless mistakes, and longer assignments are even worse. Help younger students by breaking assignments into shorter tasks (read just one paragraph or page at a time, or give them just one math problem rather than a whole worksheet). Teach older students to do the same for themselves.

Reduce test-taking anxiety

Tests are enough to raise anxiety in any kid, but they're a disaster for those seeking perfection. Ensure the test focuses on what you need to assess, and eliminate unnecessary distractions. If a student takes too long to write, let them type their answers. Some students with OCD have trouble with bubble sheets, feeling the need to fill in each circle perfectly. Is there another way to take the test? Can an aide fill in the sheet for them, allowing them to focus on the questions themselves?

Provide separate supplies

For students with fears about germs and contamination, shared supplies are a nightmare. Even when schools make special efforts to keep things clean, a person with OCD may not trust or believe. Give them their own set of supplies when possible. Hand them their worksheet first, so they know other students haven't touched it, and make sure they have books marked for their own particular use.

Give alternatives to writing

When writing isn't the focus, don't make it necessary for success. Let them provide information orally or use a computer to type their answers. Whenever possible, don't grade work on neatness or nitpick about items that don't apply to the learning at hand. (For instance, don't correct spelling on a science paper if it really doesn't make much of a difference.)

Consider audiobooks

When reading proficiency isn't the goal, audiobooks can be an excellent tool for students with OCD. Reading often takes them longer, as they obsessively go back over a paragraph again and again, so they don't miss anything. Audiobooks continue on their own, providing information at a more regular pace.

Set limits

Compulsive behaviors can continue on and on. Let a student know that you'll be limiting what's acceptable. Do they often disappear to the bathroom to perform a repetitive behavior? Limit their visits to a certain number per day, with a set number of allowed minutes. (Of course, you can make exceptions for illness, etc.) For students who ask questions repeatedly, give them a maximum number of times (say, 3) that you'll answer. When a student feels the need to check their supplies obsessively or wash their hands again and again, try limiting that to certain times of day. Communicate these limits clearly, and stick to them.

Acknowledge their fears

You might feel the need to attempt to reassure students their fears aren't really a problem. After all, you know perfectly well that the student won't get into a car accident on the way home if they accidentally step on a line in the tile floor. But that doesn't really help students with OCD. It's okay to acknowledge and validate their feelings, without agreeing that their fears are true. Knowing that you understand and accept them can make a big difference.

Don't use "OCD" lightly

It's become common for us to joke about being "so OCD" about something, like wanting desks to be lined up straight or grading with your favorite pen. But OCD is no joke to the people who have it. Consider your words carefully when you speak.

How can I connect with students with OCD?

Kids with OCD want to succeed and can get very frustrated that their own behavior is getting in the way. According to Denise Egan Stack, a behavioral therapist from the International OCD Foundation, building a relationship is the key to a successful learning experience. Some students with OCD seek teachers out for approval and reassurance. Others, though, may hide because they feel ashamed or don't want to cause trouble. In that case, a teacher may need to be the one to reach out.

Egan Stack notes that these students do well with set check-ins. Set aside time to meet and talk about how things are going. This can help students cross the barrier when they're tempted to hide and avoid dealing with their OCD. Instead, you can work together to make plans.

Build a team to support the student and make them a part of regular meetings as well. This team could include parents, school counselors, the student's therapist, and, of course, the student themselves.

OCD Resources for Teachers

The more you understand about OCD, the more you can help and support your students affected by it. Try these resources for more information.

Online

Books

How do you support students with OCD in your classroom? Come share your thoughts and ask for advice on the WeAreTeachers HELPLINE group on Facebook.

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How To Support Students With OCD (Obsessive-Compulsive Disorder)

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What comes to mind when you hear OCD? Do you picture TV detective Adrian Monk refusing to touch door handles because of germs? Or maybe super-nerd Sheldon Cooper, who absolutely has to use the bathroom at the same time each day? These characters often get played for laughs, but living with Obsessive-Compulsive Disorder, often called OCD, is no joke.

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

Obsessions Common in Kids With OCD

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

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

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

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

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

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

Behaviors You Might See in Students With OCD

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

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

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

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

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

Behaviors Often Confused With Another Disorder

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

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

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

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

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

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

How to Help Students With OCD

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

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

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

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

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

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

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

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

How to Minimize Behavioral Problems

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

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

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

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

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

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

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

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How Educators can Help Students Experiencing Psychosis

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How Educators can Help Students Experiencing Psychosis

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In the mental health world, I am best known as a parent advocate for children with mental illness. But in my professional life as an instructor at an open-access community college, I've had multiple opportunities to connect students in mental health crisis with the right resources. In this article, I'll share some things I've learned about managing psychosis in the classroom and explain why it's so important for educators to know the signs and be ready to help. In fact, teachers at all levels are on the front lines of mental health care. Education, empathy and advocacy are critical to ensuring that your students are able to succeed in the classroom and beyond.

Education

Students with serious mental illness face special challenges in the academic environment. Not only can the illness impede their cognitive function, but they may also face the fear and stigma that too often accompany diagnoses like schizophrenia and bipolar disorder. While these illnesses are rare - schizophrenia occurs in just 1 percent of the population - the first serious symptoms often occur right at the age when students are leaving home for the first time and attending college. This is why it's so important for educators to learn about psychosis and how it can manifest in the classroom.

My school has instituted mental health awareness training for all faculty members, but not everyone is so fortunate. I recommend that all educators take a Mental Health First Aid Course. You'll learn how to recognize the signs of mental illness and explore effective strategies for connecting students with appropriate resources.

Some signs that educators can watch for include:

Social withdrawal and isolation.

Sudden decline in school performance.

Expression of extreme fear (perhaps refusing to attend class or other school functions).

Odd behaviors or statements.

Sudden preoccupation with a narrow topic.

Clear changes in personal hygiene.

Difficulty in attending class and completing assignments (Back to School, p. 9).

You may also want to participate in some form of psychosis simulation. If you have not experienced psychosis, it can be hard to imagine how frightening and disorienting this condition can be for a young person who is experiencing it for the first time. The Mental Health First Aid course includes a simulation exercise, and I have linked to some in the Resources section below.

Empathy

If you see one or more warning signs, don't be afraid to approach the student. Ask open-ended questions, and be willing to listen. When I notice that a student is behaving in an uncharacteristic way, I try to take the student aside and ask a few questions using a communication model developed by Dr. Xavier Amador, who has dedicated his professional life to helping caregivers to communicate with people in psychosis. His LEAP model is a good guideline for educators: Listen-Empathize-Agree-Partner.

Educators who can recognize symptoms and connect students with mental healthcare have a unique opportunity to promote better outcomes for their students. The RAISE project in the United States has focused on getting help to patients after the first episode of psychosis. Early intervention can be critical to long-term positive outcomes, and in fact, many people can and do live in recovery.

Some educators may wonder about the potential risks of working with students who experience psychosis. While it seems like our social media feeds are filled with stories of violence and mental illness, most people experiencing psychosis, especially in the early stages, are not violent toward others. The risk of self-harm, however, is much greater. I keep my office stocked with National Suicide Prevention Hotline cards, and I am never afraid to ask a student, "Are you thinking about hurting yourself?" and "Do you have a plan?"

Advocacy

Advocating for your students is critical to their - and your - success.

A few years ago, I worked at a small college where my duties included managing paperwork for students with documented disabilities. I have to confess that as a mother of a child (now in college) who lives with bipolar disorder, I was often frustrated by the reactions of a few instructors who felt that students were getting "special treatment."

Accommodations are not "special treatment." They are designed to level the field so that students with special needs can succeed along with their peers. A SAMHSA toolkit on inclusion for students experiencing psychosis notes the following: "As is true for many other disabilities, psychosis can lead to multiple additional challenges and obstacles for students, but with the right resources and supports these can almost always be addressed" ( Back to School, p. 13).

Over my teaching career, I have seen students successfully complete my courses while managing conditions that range from schizophrenia to bipolar disorder to major depressive disorder. However, it's also important to realize that as with any illness, health should always come first. Sometimes, I have worked with students to connect them with mental healthcare and encouraged them to return to class when they are better able to manage their illness along with the inevitable stressors of an academic environment. In all cases, I advocate for what the student and I think will best serve their educational and health needs.

I also try to design both my on-ground and online courses with universal design principles in mind. This encompasses everything from closed captioning for hearing-impaired students to make-up work policies and classroom management and attendance policies that benefit all students but can be especially helpful for people who have mental illness.

Resources

If you're ready to make a difference in the lives of your students, you may be wondering where to start. Here are a few resources for educators that I have collected over the years:

I always keep a stack of contact cards from the National Suicide Prevention Lifeline in my office; their phone number is 1-800-273-8255. As many as 10 percent of people with psychosis attempt suicide within the first year of treatment. Don't be afraid to ask students if they are having thoughts about harming themselves. It's the first step to connecting them with help.

For more information about Mental Health First Aid and to find trainings in your area, visit https://www.mentalhealthfirstaid.org/.

For an overview of schizophrenia written with educators in mind, see this article from the National Association of Special Education Teachers.

This SAMHSA publication about including students who are showing signs of early psychosis includes a practical toolkit with accommodations examples and inclusive best practices for higher education.

Dr. Xavier Amador has dedicated his professional career to promoting positive and effective communication with people in psychosis. You can watch his TEDx Talk here, and learn more about his LEAP communication model at the LEAP Institute website.

Watch journalist Anderson Cooper as he attempts to work while experiencing a schizophrenia simulation to learn more about how psychosis can affect cognitive function.

Watch a schizophrenia simulation produced by Jannsen Pharmaceuticals (warning: the experience can be intense).

Open Mind of British Columbia, Canada, has collected a variety of resources for educators about mental illness in the classroom.

Schizophrenia and Related Disorders Alliance of America ( https://sardaa.org/ SARDAA) is a wonderful resource for anyone who wants to learn more about these illnesses.

The International Bipolar Foundation offers a variety of supports and resources, including webinars and local education events (full disclosure: I'm a board member).

The Child Mind Institute is involved in cutting-edge research and provides a variety of educational articles like this one about signs of psychosis in teens.

Find more information on Universal Design and inclusive learning in college courses here.

For more information on RAISE (Recovery After an Initial Schizophrenic Episode), see the National Institute of Mental Health's website.

One of my favorite books about managing mental illness in college students is Perfect Chaos: A Daughter's Journey to Survive Bipolar, A Mother's Struggle to Save Her by Cinda and Linea Johnson. Cinda is a special education professor, but her experience with her daughter's illness took her knowledge and empathy to a new level. The book is both personal and practical, and it provides a valuable glimpse at the struggles college students and teachers face.

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How Educators Can Help Students Experiencing Psychosis | Clarity CGC

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In the mental health world, I am best known as a parent advocate for children with mental illness. But in my professional life as an instructor at an open-access community college, I've had multiple opportunities to connect students in mental health crisis with the right resources.

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The adjective "schizophrenic" needs to be removed from counselors' vocabulary, says Elizabeth Prosek, a counselor and assistant professor at the University of North Texas (UNT).

Schizophrenia has a great deal of stigma and negative connotations associated with it, and referring to clients in the first person can lessen these, she says.

"I encourage counselors to advocate for what clients with schizophrenia can do rather than [focusing on] the limitations of experiencing psychosis," says Prosek, who has counseled clients with severe mental health disorders and served on a support team for individuals with schizophrenia living independently. "I once heard someone discuss the 'aggressive nature' of those diagnosed with schizophrenia. I could not help but wonder where that perception evolved. In my experience, clients did not demonstrate aggressive behavior or language."

Counselors, as part of a multidisciplinary treatment team of helping professionals, can play a critical role in the lives of people diagnosed with schizophrenia, say Prosek and Kara Hurt, a licensed professional counselor who works with clients with schizophrenia at an inpatient psychiatric hospital.

Prosek and Hurt, who is also a doctoral student at UNT, recently collaborated to write a practice brief on schizophrenia for the American Counseling Association's Center for Counseling Practice, Policy and Research (see sidebar below).

In the brief, the duo describes schizophrenia as a lifelong illness characterized by negative symptoms, including "delusions, hallucinations (most commonly auditory), disorganized thinking or speech and disorganized or abnormal motor behavior." The estimated prevalence rate for schizophrenia is 1 percent of the population in Western, developed countries.

For counselors, empathy should play a big part in therapy - from knowing the many side effects of schizophrenia medications to fully understanding what it is like to live with hallucinations and psychosis, say Prosek and Hurt. Special training and workshops can help counselors understand the nuances of the disorder, as can materials from mental health agencies (see "for more information" below).

Prosek once attended a seminar at which participants sat through the experience - virtually - of living with hallucinations, experiencing paranoia and hearing voices intertwined with the dialogue of another person.

Prosek and Hurt led a course this past year in which they showed videos of clients with schizophrenia explaining their own experiences.

"When the students in the class debriefed after the video, many confirmed that hearing firsthand from a client decreased their misperceptions about the disorder," says Prosek. "Watching a video of a client with schizophrenia who was articulate and successful in a career reduced stigma of the disorder. Also, I noticed that when person-first language is used when discussing clients with schizophrenia [as opposed to using the term "schizophrenic"], negative connotations are immediately lessened."
What do counselors need to know about schizophrenia?
Elizabeth Prosek: Living with psychosis can be scary and challenging. When working with those diagnosed with schizophrenia, demonstrating empathic concern is essential to build a therapeutic relationship. In my experience, clients appreciated my willingness to embrace their perspective of psychosis. I think all of the clients I worked with experienced their psychosis uniquely, and it was imperative that I understood their lived experience.

Kara Hurt: Schizophrenia affects the client's support system, not just the client. In my experience, it is just as important to provide counseling and support to family members and loved ones of people diagnosed with schizophrenia as it is to provide support and counseling to clients with schizophrenia. All of us counselors can help provide services in some way that help clients diagnosed with schizophrenia and those that love them.

EP: Counselors may provide family members and friends with psychoeducation on the symptoms and treatment options for schizophrenia. Furthermore, counselors may assist family members and friends to build empathy for the experiences of those diagnosed with schizophrenia. There are support groups for family members through the National Alliance on Mental Illness (NAMI). Find a local NAMI support group through nami.org.

For those clients who do not have a familial support system, encouraging the development of a community support network may be essential for the social and emotional well-being of clients diagnosed with schizophrenia. Regardless of diagnosis, humans in general seek "belongingness" in their community, and those diagnosed with schizophrenia are no different.
What advice would you give about working with clients diagnosed with schizophrenia?
EP: Recognizing strengths can be a great first step to creating an appropriate treatment plan. Several of the clients I counseled had creative interests, such as art and music, and we developed interventions to promote participation in those activities.

Also, I recommend communication with all professionals working with the client. In my experience, collaborating with the client's psychiatrist and case manager allowed for a holistic approach when addressing current therapeutic needs. Having a multidisciplinary team also allows for clients to more easily transition in and out of inpatient psychiatric hospitalization when necessary. With the appropriate releases of information, all professionals involved can be aware of how the client's psychosis presented, any medication changes and any changes in treatment recommendations after an inpatient hospitalization stay.

It did not take long after beginning my work with clients diagnosed with schizophrenia for me to recognize the need for socialization. Several of my clients lived in isolation but longed for social relationships. In collaboration with case managers, I organized social outings for clients, which allowed for a more genuine community-living experience. There are several community resources for clients diagnosed with serious mental health disorders, such as supported-work programs. Having knowledge of such programs in the community will serve as great referral sources for clients diagnosed with schizophrenia.
With what other types of issues can clients diagnosed with schizophrenia present?
KH: One of the presenting issues that I had not expected when I started working with clients diagnosed with schizophrenia was substance abuse. One client in particular stands out in my mind because of the extent of his illicit drug use, which worsened his paranoia and other delusions. When working with clients with schizophrenia, you may need to reconsider your assumptions to appreciate that these clients have many of the same kinds of problems as other clients.

EP: I agree. Substance misuse was prevalent among the clients diagnosed with schizophrenia that I worked with as well. I also observed many secondary diagnoses, including anxiety and depression. I connect the anxiety and depressive symptoms back to the potential isolation clients experienced. Furthermore, it seems to me hearing voices and feeling out of touch from reality would lead to feelings of anxiety. Helping my clients accurately explain symptoms to their psychiatrists allowed for more precise medication prescriptions.
What are some common misperceptions about schizophrenia?
EP: One of the common misperceptions I hear frequently when describing a client with schizophrenia is the term "medication noncompliance." I advocate for this phrase to be removed from counselor language. From my observations, when clients did not take medications regularly or as prescribed, it was not with intentional noncompliance, but rather there was confusion when medication regimens became complex or changed with frequency. Moreover, several antipsychotic medications have uncomfortable side effects. On a bad day, when a client is not feeling well, he or she might not feel inclined to perpetuate the experience by taking medications that may worsen physical symptoms. In counseling sessions, taking time to hear clients' concerns or complaints about side effects may help clients feel validated in their experience.

What challenges do counselors face in this area?

EP: I think there may be a perception that clients with schizophrenia only need a case manager and psychiatrist. From my perspective, counselors can play a vital role in the treatment team. Never underestimate the power of a space in which a client's experience is heard and valued.

KH: I think it is absolutely critical to have good supervision when working with a client diagnosed with schizophrenia. I have felt frustrated with my perceptions of clients' lack of progress or insight, but with supportive supervision, I have been able to be more flexible with my therapeutic expectations and shift my perspective to be a better counselor for my clients. I cannot underestimate the value of good supervision. It can help you gain awareness of potential burnout and the need for regular self-care.

EP: Supervision is helpful. I often felt frustrated with the mental health care system and how clients with schizophrenia became victims of gaps in continuity of care. I agree with Kara that there is a greater potential for burnout when working with clients in and out of crisis.

Another challenge for counselors might be understanding the differences in antipsychotic medications most commonly prescribed for clients with schizophrenia. Actually, Kara introduced me to an app (named Epocrates) that provides names, descriptions and side effects for medications. I remember when I first started working with this population, I had a hard time differentiating the medications the clients were prescribed. There are several research studies published outlining effectiveness and common side effects of antipsychotic medications which may be helpful to read.

Going back to one of Kara's original statements about the importance of family supports, it may be challenging to help family understand the experience of schizophrenia. Counselors can serve as a good source of information to help educate and support family members. Consequently, family members can better support the client diagnosed with schizophrenia.
**** For more information **** ACA Center for Counseling Practice, Policy and Research practice briefs
Prosek and Hurt's information sheet on schizophrenia is one of 30 practice briefs available to American Counseling Association members through the Center for Counseling Practice, Policy and Research.

The briefs, which range from working with victims of domestic violence to animal-assisted therapy to posttraumatic stress disorder, are written by ACA members who are experts on that particular topic. New practice briefs are being added regularly.

The practice briefs are designed to be practical, evidence-based resources for ACA members, says Victoria Kress, executive editor of the ACA center's practice briefs project and a professor at Youngstown State University in Ohio.

Counselors can use the practice briefs as a refresher on topics they may not encounter very often, such as schizophrenia, or as a jumping-off point for further research. Each brief contains links to in-depth sources and data on a topic, as well as therapy models and other tools.

Kress says each practice brief is written and edited to be practical and succinct, with focused bursts of information on topics that counselors in all works settings may encounter, from divorce and autism to perfectionism and suicide prevention.

The plan is to post 15 to 20 new briefs each year, Kress says, including on each of the new disorders added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

Kress began soliciting practice briefs from ACA members, then editing and posting the briefs on the ACA website, close to two years ago. The idea grew out of ACA past president Bradley Erford's focus on counselor use of evidence-based practices, Kress says.

"Counselors don't always have access to, or the time to read, journal articles," she says. "We wanted to provide an outlet for ACA members to sit down and get a quick overview. ... It was really born out of this idea that counselors should be using evidence-based practices. We know that counselors are busy and have competing demands. ... The ultimate idea is that it will improve their practice. It's better for their clients and the profession."

****

Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday

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What counselors need to know about schizophrenia - Counseling Today

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The adjective "schizophrenic" needs to be removed from counselors' vocabulary, says Elizabeth Prosek, a counselor and assistant professor at the University of North Texas (UNT). Schizophrenia has a great deal of stigma and negative connotations associated with it, and referring to clients in the first person can lessen these, she says.

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Clipart Library
http://clipart-library.com/clipart/978885.htm

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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.
Quick-Jump Menu
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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How School Counselor's Guide Students with Mental Health Issues

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How School Counselor's Guide Students with Mental Health Issues

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The School Counselor and Student Mental Health

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Students' unmet mental health needs can be a significant obstacle to student academic, career and social/emotional development and even compromise school safety. Even so, most students in need do not receive adequate mental health supports (Centers for Disease Control and Prevention [CDC], 2013).

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U.S. Department of Health and Human Services. (2007). Minnesota Association for Children’s Mental Health. www.macmh.org