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Anxious feelings, worries, or fears are common among children and adolescents. Many children experience a normal amount of apprehension in certain situations, whether it is about an upcoming test at school or a thunderstorm.

Some children, however, experience these types of situations with an overwhelming sense of fear and dread. Others can't seem to stop thinking about these situations and their accompanying fears. No amount of reassurance seems to help. These children may tend to get "stuck" on their worried thoughts and have a hard time doing normal daily functions like going to school, playing, falling asleep, or trying new things. Getting "stuck," when it begins to interfere with daily functioning, is the key. This is what separates normal, fluctuating worries of childhood from an anxiety disorder that requires professional intervention.

All anxiety-related problems share 4 common features:

The anxiety is often an inexplicable fear or preoccupation that interferes with the child's or adolescent's ability to enjoy life or to complete daily routines or to do the things they are expected to do.

The anxiety is often as puzzling to the child as it is to his or her parents.

The anxiety does not respond to or diminish after logical explanations, since anxiety symptoms often defy logic.

The anxiety problem can be helped.

What are anxiety disorders?

There are many different types of anxiety disorders, including generalized anxiety, social anxiety, separation anxiety, obsessive-compulsive symptoms, phobias, and panic. All of these disorders cause significant distress and a reduced level of functioning and competency for children and adolescents. Some common symptoms of anxiety include:

Feeling nervous or "on edge."

Unfounded or unrealistic fears.

Trouble separating from parents.

Sleep disturbance.

Obsessive thoughts and/or compulsive behaviors.

Trembling, sweating, shortness of breath, stomachaches, headaches, and/or muscle tension or other physical symptoms.

Often, the child or adolescent feels these symptoms are beyond his/her control, which only adds to their concerns.

Types of Anxiety Disorders

Generalized anxiety disorder is an excessive worry and/or apprehension about a number of events or activities. These feelings occur almost all the time and are not triggered by any one specific issue. Rather, the worry seems to float in a more generalized way, from one topic to the next. Some examples include: fear of failure or poor performance, worries about the child's and/or family's safety, worries about thunderstorms or wars, worries about what others will think of them, and apprehension about new situations or meeting new people.

Phobias are highly specific and exclusive fears. The child or adolescent functions normally until confronted by the dreaded object, event, or situation. Some examples include fears of bugs, fears of heights, or fear of flying in an airplane.

Separation anxiety disorder is the child or adolescent's excessive worry and apprehension about being away from their parents. Children with separation anxiety disorder often fear that their parents will be harmed in some way or will not return to them as promised. Separation anxiety disorder is often seen in preschoolers, but it is also seen in older children and adolescents in response to stressful life events.

Obsessive-compulsive disorder is a condition involving obsessions and compulsions. Obsessions are recurrent thoughts, impulses, or images that are difficult to control and cause significant distress. Compulsions are behaviors that the child engages in (such as handwashing, checking, redoing, etc.) to make the distress feel better. Some examples of obsessive-compulsive disorder may include excessive concerns about germs or lucky/unlucky numbers.

Panic disorder is characterized by discrete and intense periods of anxiety that occur unexpectedly, without warning, and are not always linked to a specific place or situation. With panic disorder, there is often no warning, and therefore it is harder to predict when it may occur. Children with panic symptoms may experience high anxiety, have difficulty breathing, feel as if everything around them is closing in and may experience feelings of impending doom.

Post-traumatic stress disorder is an intense re-experiencing of a traumatic event by distressing recollections, dreams, and/or associations (such as things or situations that remind the child or adolescent of the traumatic event). Some examples include witnessing or experiencing a natural disaster, being in a serious automobile accident, or witnessing a violent crime.

What are the risks if I don't seek help for my child?

Not obtaining treatment can have serious negative consequences on your child's development and self-esteem. Untreated anxiety disorders can strain family relationships, impact school performance and social functioning, and lead to more serious mental and physical health problems for the child down the road

What causes anxiety disorders?

Anxiety disorders are caused by a combination of life events, heredity, temperament, and biochemical factors.

In some ways, anxiety disorders are like allergies: We can identify the problem easily enough, but only through a careful evaluation can the causes and circumstances that cause anxiety disorders be identified and effectively treated as well as the underlying thinking and behaviors that are fueling the anxiety.

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Anxiety Disorders in Children & Adolescents | Cleveland Clinic

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Anxious feelings, worries, or fears are common among children and adolescents. Many children experience a normal amount of apprehension in certain situations, whether it is about an upcoming test at school or a thunderstorm. Some children, however, experience these types of situations with an overwhelming sense of fear and dread.

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Does your child go through extreme changes in mood and behavior? Does your child get much more excited or much more irritable than other kids? Do you notice that your child goes through cycles of extreme highs and lows more often than other children? Do these mood changes affect how your child acts at school or at home?

Some children and teens with these symptoms may have bipolar disorder, a brain disorder that causes unusual shifts in mood, energy, activity levels, and day-to-day functioning. With treatment, children and teens with bipolar disorder can get better over time.

What is bipolar disorder?

Bipolar disorder is a mental disorder that causes people to experience noticeable, sometimes extreme, changes in mood and behavior. Sometimes children with bipolar disorder feel very happy or "up" and are much more energetic and active than usual. This is called a manic episode. Sometimes children with bipolar disorder feel very sad or "down" and are much less active than usual. This is called a depressive episode.

Bipolar disorder, which used to be called manic-depressive illness or manic depression, is not the same as the normal ups and downs every child goes through. The mood changes in bipolar disorder are more extreme, often unprovoked, and accompanied by changes in sleep, energy level, and the ability to think clearly. Bipolar symptoms can make it hard for young people to perform well in school or to get along with friends and family members. Some children and teens with bipolar disorder may try to hurt themselves or attempt suicide.

Most people are diagnosed with bipolar disorder in adolescence or adulthood, but the symptoms can appear earlier in childhood. Bipolar disorder is often episodic, but it usually lasts a lifetime.

Signs and symptoms of bipolar disorder may overlap with symptoms of other disorders that are common in young people, such as attention-deficit/hyperactivity disorder (ADHD), conduct problems, major depression, and anxiety disorders. Diagnosing bipolar disorder can be complicated and requires a careful and thorough evaluation by a trained, experienced mental health professional.

With treatment, children and teens with bipolar disorder can manage their symptoms and lead successful lives.

What causes bipolar disorder?

The exact causes of bipolar disorder are unknown, but several factors may contribute to the illness.

For example, researchers are beginning to uncover genetic mechanisms that are linked to bipolar disorder and other mental disorders. Research shows that people's chance of having bipolar disorder is higher if they have a close family member with the illness, which may be because they have the same genetic variations. However, just because one family member has bipolar disorder, it does not mean that other members of the family will have it. Many genes are involved in the disorder, and no single gene causes it.

Research also suggests that adversity, trauma, and stressful life events may increase the chances of developing bipolar disorder in people with a genetic risk of having the illness.

Some research studies have found differences in brain structure and function between people who have bipolar disorder and those who do not. Researchers are studying the disorder to learn more about its causes and effective treatments.

What are the symptoms of bipolar disorder?

Mood episodes in bipolar disorder include intense emotions along with significant changes in sleep habits, activity levels, thoughts, or behaviors. A person with bipolar disorder may have manic episodes, depressive episodes, or "mixed" episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that often last for several days or weeks. During an episode, the symptoms last every day for most of the day.

These mood and activity changes are very different from the child's usual behavior and from the behavior of healthy children and teens.

Children and teens having a manic episode may:

Show intense happiness or silliness for long periods of time.

Have a very short temper or seem extremely irritable.

Talk fast about a lot of different things.

Have trouble sleeping but not feel tired.

Have trouble staying focused, and experience racing thoughts.

Seem overly interested or involved in pleasurable but risky activities.

Do risky or reckless things that show poor judgment.

Children and teens having a depressive episode may:

Feel frequent and unprovoked sadness.

Show increased irritability, anger, or hostility.

Complain a lot about pain, such as stomachaches and headaches.

Have a noticeable increase in amount of sleep.

Have difficulty concentrating.

Feel hopeless and worthless.

Have difficulty communicating or maintaining relationships.

Eat too much or too little.

Have little energy and no interest in activities they usually enjoy.

Think about death, or have thoughts of suicide.

Can children and teens with bipolar disorder have other problems?

Young people with bipolar disorder can have several problems at the same time. These include:

Misuse of alcohol and drugs. Young people with bipolar disorder are at risk of misusing alcohol or drugs.

Attention-deficit/hyperactivity disorder (ADHD). Children and teens who have both bipolar disorder and ADHD may have trouble staying focused.

Anxiety disorders. Children and teens with bipolar disorder also may have an anxiety disorder.

Sometimes extreme behaviors go along with mood episodes. During manic episodes, young people with bipolar disorder may take extreme risks that they wouldn't usually take or that could cause them harm or injury. During depressive episodes, some young people with bipolar disorder may think about running away from home or have thoughts of suicide.

If your child shows signs of suicidal thinking, take these signs seriously and call your child's health care provider.
If you think your child is in crisis and needs immediate help, call 911. You also can call the National Suicide Prevention Lifeline (Lifeline) at 1‑800‑273‑TALK (8255), or text the Crisis Text Line (text HELLO to 741741). The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. These services are confidential, free, and available 24/7.

How is bipolar disorder diagnosed?

A health care provider will ask questions about your child's mood, sleeping patterns, energy levels, and behavior. There are no blood tests or brain scans that can diagnose bipolar disorder. However, the health care provider may use tests to see if something other than bipolar disorder is causing your child's symptoms. Sometimes health care providers need to know about medical conditions in the family, such as depression or substance use.

Other disorders have symptoms like those of bipolar disorder, including ADHD, disruptive mood regulation disorder, oppositional defiant disorder, conduct disorder, and anxiety disorders. It also can be challenging to distinguish bipolar disorder from depression that occurs without mania, which is referred to as "major depression." A health care provider who specializes in working with children and teens can make a careful and complete evaluation of your child's symptoms to provide the right diagnosis.

How is bipolar disorder treated?

Children and teens can work with their health care provider to develop a treatment plan that will help them manage their symptoms and improve their quality of life. It is important to follow the treatment plan, even when your child is not currently experiencing a mood episode. Steady, dependable treatment works better than treatment that starts and stops.

Treatment options include:

Medication. Several types of medication can help treat symptoms of bipolar disorder. Children respond to medications in different ways, so the right type of medication depends on the child. This means children may need to try different types of medication to see which one works best for them. Some children may need more than one type of medication because their symptoms are complex. Children should take the fewest number of medications and the smallest doses possible to help their symptoms. A good way to remember this is "start low, go slow." Medications can cause side effects. Always tell your child's health care provider about any problems with side effects. Do not stop giving your child medication without speaking to a health care provider. Stopping medication suddenly can be dangerous and can make bipolar symptoms worse.

Psychosocial Therapy. Different kinds of psychosocial therapy can help children and their families manage the symptoms of bipolar disorder. Therapies that are based on scientific research-including cognitive behavioral approaches and family-focused therapy-can provide support, education, and guidance to youth and their families. These therapies teach skills that can help people manage bipolar disorder, including skills for maintaining routines, enhancing emotion regulation, and improving social interactions.

What can children and teens expect from treatment?

With treatment, children and teens with bipolar disorder can get better over time. Treatment is more effective when health care providers, parents, and young people work together.

Sometimes a child's symptoms may change, or disappear and then come back. When this happens, your child's health care provider may recommend changes to the treatment plan. Treatment can take time, but sticking with the treatment plan can help young people manage their symptoms and reduce the likelihood of future episodes.

Your child's health care provider may recommend keeping a daily life chart or mood chart to track your child's moods, behaviors, and sleep patterns. This may make it easier to track the illness and see whether treatment is working.

How can I help my child or teen?

Help begins with the right diagnosis and treatment. Talk to your family health care provider about any symptoms you notice.

If your child has bipolar disorder, here are some basic things you can do:

Be patient.

Encourage your child to talk, and listen to your child carefully.

Pay attention to your child's moods, and be alert to any major changes.

Understand triggers, and learn strategies for managing intense emotions and irritability.

Help your child have fun.

Remember that treatment takes time: sticking with the treatment plan can help your child get better and stay better.

Help your child understand that treatment can make life better.

How does bipolar disorder affect caregivers and families?

Caring for a child or teenager with bipolar disorder can be stressful for parents and families. Coping with a child's mood episodes and other problems-such as short tempers and risky behaviors-can challenge any caregiver.

It is important that caregivers take care of themselves, too. Find someone you can talk to or consult your health care provider about support groups. Finding support and strategies for managing stress can help you and your child.

Where do I go for help?

If you're not sure where to get help, your doctor, pediatrician, or other family health care provider is a good place to start. A health care provider can refer you to a qualified mental health professional, such as a psychiatrist or psychologist, who has experience treating bipolar disorder and can evaluate your child's symptoms.

You can learn more about getting help and finding a health care provider on the National Institute of Mental Health website. Hospital health care providers can help in an emergency. The Substance Abuse and Mental Health Services Administration (SAMHSA) has an online tool to help you find mental health services in your area.

I know someone who is in crisis. What do I do?

If you know someone who might be thinking about hurting themselves or someone else, get help quickly.

Do not leave the person alone.

Call 911 or go to the nearest hospital emergency room.

Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the toll-free TTY number at 1-800-799-4TTY (4889). You also can text the Crisis Text Line (text HELLO to 741741) or go to the National Suicide Prevention Lifeline website.

What should I know about clinical trials?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information, visit the NIMH Clinical Trials webpage.

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For More Information

MedlinePlus (National Library of Medicine) ( En español)

ClinicalTrials.gov ( En español)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 20-MH-8081
Revised 2020

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Understanding teen depression

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

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

If you're a teen feeling depressed...

Is my teen depressed?

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

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

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

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

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

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

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

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

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

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

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

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

Depression in teens vs. adults

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

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

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

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

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

Is it depression or teenage "growing pains"?

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

Suicide warning signs in depressed teens

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

Suicide warning signs to watch for

Talking or joking about committing suicide

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

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

Writing stories and poems about death, dying, or suicide

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

Giving away prized possessions

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

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

Get help for a suicidal teen

Causes of teen depression

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

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

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

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

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

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

Depression and social media use

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

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

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

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

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

How to help a depressed teenager

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

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

How to communicate with a depressed teen

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

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

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

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

Helping a depressed teen tip 1: Encourage social connection

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

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

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

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

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

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

Tip 2: Make physical health a priority

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

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

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

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

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

Tip 3: Know when to seek professional help

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

Involve your child in treatment choices

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

Explore your options

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

Medication comes with risks

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

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

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

Teens on antidepressants: Red flags to watch out for

Tip 4: Support your teen through depression treatment

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

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

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

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

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

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

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

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

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

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

Depression support, suicide prevention help

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Parent's Guide to Teen Depression - HelpGuide.org

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

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Angelo State University - Library Online Resources

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Unauthorized use is prohibited; Usage may be subject to security testing and monitoring; Misuse is subject to criminal prosecution; No expectation of privacy except as otherwise provided by applicable privacy laws.

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Comparing Federal Law Disability Regulations for Students

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Read how the differences and similarities between Section 504 of the 1973 Rehabilitation Act and IDEA can affect your child’s public school education.

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National Institute of Mental Health (NIMH)

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Learn about obsessive-compulsive disorder, including signs and symptoms, risk factors, treatments and therapies, and links to other resources to learn more.

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It may be hard to recognize that OCD is causing learning difficulties, interpersonal problems, or great distress and anxiety. When students are barraged by obsessive fears, doubts, and urges, they may perform rituals or compulsions to neutralize or undo these thoughts or feelings to try to feel better. But sometimes it's not clear that a student's behavior is connected to OCD. Students who have OCD may not perform these actions repeatedly in the classroom, or they may be completing rituals mentally or covertly. Some may be afraid of contaminating others or of hurting themselves or others, or because they have aggressive thoughts.

While school personnel may not know or understand the cause of the behavior, they can detect new patterns of behavior that aren't typical of a student. Understanding warning signs is the first step to helping a student get support.

Some Hidden Indicators of OCD in School

Most OCD behavior doesn't make sense when observed, and it often doesn't make sense to the student who does it either. But students with OCD act the way they do because they feel compelled to do so.

Very rough, red, dry, or cracked skin on hands, arms, or face that may result from repeated washing. The student may be spending lunchtime, breaks, or bathroom visits continually washing hands. This behavior may be going on at home, too. Repeatedly asking to go to the bathroom or spending extended periods of time there to engage in washing or cleaning rituals.

Avoiding certain public places, such as the cafeteria or gym because they may trigger OCD symptoms. Students may ask to be excused from sports activities or have unexcused absences from gym class.

Dropping out of or unexplained absences from sports, clubs, team activities after active participation or enjoyment. Some aspect of the activity is triggering OCD symptoms.

Misbehaving in a group activity or class project. Some people with OCD become upset when others are standing or sitting too close, or touching them or their materials, or even for no apparent reason Extreme difficulty moving to a new project or task. Some students may delay turning in work, labor over a single task, or seem to get stuck on a single question or problem and are unable to skip it and go to the next one.

Staying home from school to work on an assignment that should not take a lot of time to complete.

Not turning in homework or consistently turning them in late because the students said it needed more work or wasn't done well enough to turn in on time.

Being drowsy or falling asleep in class, which is common if a student stays up late at night studying or working on homework, laboring over it, reading it repeatedly or checking it multiple times. Research indicates that many young people with OCD experience sleep-related difficulties. Being late for school frequently, often accompanied by fatigue.

Repeatedly asking the same question or asking the teacher to repeat a question many times for more clarification.

Seeking reassurance that they understood the question or that their answer is correct, or that their assignments are correctly done. Students may exhibit great anxiety over whether they get a high test score or are praised for good work.

Inability to make a decision or choose an answer.

If interrupted when reading, writing, or reciting, having to start over at the beginning. Frustration or mounting anxiety at being unable to complete a ritual may lead to an outburst or tantrum.

Fidgeting with clothing or shoes, complaining of skin irritation or bothersome clothing labels, or taking off a piece of clothing doesn't feel right.

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The Not-So-Obvious Symptoms of OCD in School

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It may be hard to recognize that OCD is causing learning difficulties, interpersonal problems, or great distress and anxiety. When students are barraged by obsessive fears, doubts, and urges, they may perform rituals or compulsions to neutralize or undo these thoughts or feelings to try to feel better.

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Having ADHD along with a coexisting disruptive behavior disorder (ODD/CD) can complicate diagnosis and treatment and also worsen the prognosis. Even though many children with ADHD ultimately adjust, some (especially those with an associated conduct or oppositional defiant disorder) are more likely to drop out of school, have fewer years of overall education, have less job satisfaction and fare less well as adults. Early diagnosis and treatment of these conditions is by far the best defense against these poorer outcomes.

What are the types of disruptive behavior disorders?

Disruptive behavior disorders include two similar disorders: oppositional defiant disorder (ODD) and conduct disorder (CD). Common symptoms occurring in children with these disorders include: defiance of authority figures, angry outbursts, and other antisocial behaviors such as lying and stealing. It is felt that the difference between oppositional defiant disorder and conduct disorder is in the severity of symptoms and that they may lie on a continuum often with a developmental progression from ODD to CD with increasing age.

Oppositional defiant disorder (ODD) refers to a recurrent pattern of negative, defiant, disobedient and hostile behavior toward authority figures lasting at least six months. To be diagnosed with ODD four (or more) of the following symptoms must be present:

often loses temper

often argues with adults

often actively defies or refuses to comply with adults' requests or rules

often deliberately annoys people

often blames others for his or her mistakes or misbehavior

is often touchy or easily annoyed by others

is often angry and resentful

is often spiteful or vindictive.

These behaviors must be exhibited more frequently than in other children of the same age and must cause significant impairment in social, academic or occupational functioning to warrant the diagnosis.

Conduct disorder (CD) involves more serious behaviors including aggression toward people or animals, destruction of property, lying, stealing and skipping school. The behaviors associated with CD are often described as delinquency. Children exhibiting these behaviors should receive a comprehensive evaluation.

Children and adolescents with ADHD and CD often have more difficult lives and poorer outcomes than children with ADHD alone.
Incidence of ADHD and ODD or CD
Approximately one-third to one-half of all children with ADHD may have coexisting oppositional defiant disorder (ODD). These children are often disobedient and have outbursts of temper. The rate of children meeting full diagnostic criteria for ODD is similar across all ages. Males have a greater incidence of ADHD and ODD, as do children of divorced parents and mothers with low socioeconomic status. Children with the ADHD combined subtype seem to be more likely to have ODD.

In some cases, children with ADHD may eventually develop conduct disorder (CD), a more serious pattern of antisocial behaviors. Conduct disorder may occur in 25 percent of children and 45 percent of adolescents with ADHD. CD is more commonly seen in boys than girls, and increases in prevalence with age. Children with ADHD who also meet diagnostic criteria for CD are twice as likely to have difficulty reading, and are at greater risk for social and emotional problems. Non-aggressive conduct problems increase with age, while aggressive symptoms become less common.

Given the high co-occurrence of ADHD with disruptive behavior disorders, all children with ADHD symptoms and disruptive behaviors need to be assessed for the possibility that ODD or CD may be present in addition to ADHD.
Risks of having ADHD and a disruptive behavior disorder
Children with ADHD and CD are often at higher risk for contact with the police and the court system than children with ADHD alone. These children frequently lie or steal and tend to disregard the welfare of others. In addition, they risk getting into serious trouble at school or with the police. The risk for legal troubles may be mostly attributable to the symptoms of CD rather than ADHD.

Disruptive behavior disorders and untreated ADHD have been found to lead to an increased risk of substance use disorders. In addition, adolescents with disruptive behaviors disorders and ADHD are more likely to be aggressive and hostile in their interactions with others, and to be arrested. It has also been suggested that the greater impulsivity associated with the ADHD may cause greater antisocial behavior and its consequences. Thus, early recognition and treatment of both the ADHD and disruptive behaviors in children is essential.
Treatment of ADHD and Disruptive Behavior Disorders
All children with symptoms of ADHD and ODD/CD need to be assessed so that both types of problem behaviors can be treated. These children are difficult to live with and parents need to understand that they do not need to deal with their ADHD and ODD/CD child alone. Interventions such as parent training at home and behavioral support in the school can make a difference and parents should not hesitate to ask for assistance.

Home Interventions

Parent Training (PT): Parent training has been shown to be effective for treating oppositional and defiant behaviors. Standardized parent training programs are short-term interventions that teach parents specialized strategies including positive attending, ignoring, the effective use of rewards and punishments, token economies, and time out to address clinically significant behavior problems. Such training programs may include periodic booster sessions.

Severe cases of CD may require multisystemic therapy, an intensive family- and community-based treatment that addresses the multiple causes of serious antisocial behavior in youth. This approach is very comprehensive and demanding. The therapist using such an approach must possess access to developmental and clinical expertise. These intervention services are delivered in a variety of settings, such as home, school and peer groups. Academic and school-based problems are included and some therapists work directly with an entire peer group to influence change.

Parent-child interaction therapy is a treatment that teaches parents to strengthen the relationship with their child and to learn behavior management techniques. It has been found to be effective in the long term for young children with ODD and ADHD. Three to six years after treatment, the mothers of children with these disorders reported that the changes in their children's behavior and their own feelings of control had lasted. Mothers' reports of disruptive behavior decreased with time after treatment.

Collaborative Problem Solving (CPS): Another technique that seems to be promising for children with ADHD and ODD is collaborative problem-solving (CPS). CPS is a treatment that teaches difficult children and adolescents how to handle frustration and learn to be more flexible and adaptable. Parents and children learn to brainstorm for possible solutions, negotiate, make decisions, and implement solutions that are acceptable to both. They learn to resolve disagreements with less conflict.

Family Therapy: Often a child's behavior can have an effect on the whole family. Parents of children with ADHD often report marital difficulties. Mothers may be more depressed and siblings may also develop behavior problems. Family therapy is critical to helping a family address these issues and cope with the realities of having a child with ADHD and disruptive behaviors. Seeking out a counselor or family therapist in your neighborhood can help the entire family address these issues.

School Interventions

School-wide Positive Behavioral Supports: In addition to the environment at home, the school can have a significant impact on a child's behavior patterns. Many school systems now have programs in place to provide school-wide positive behavioral supports. The aim of these programs is to foster both successful social behavior and academic gains for all students. These programs consist of: (1) clear, consistent consequences for inappropriate behaviors; (2) positive contingencies for appropriate behaviors; and (3) team-based services for those students with the more extreme behavioral needs.

Tutoring: Children's ADHD symptoms, as well as oppositional symptoms, have been found to be significantly lower in one-on-one tutoring sessions than in the classroom.

Classroom Management: Providing appropriate instructional supports in the classroom can also lessen disruptive behavior. These include: creating an accepting and supportive classroom climate, promoting social and emotional skills, establishing clear rules and procedures, monitoring child behavior, utilizing rewards effectively, responding to mild problem behaviors consistently and effectively managing anger or aggressive behavior.
Medication
Overall results from several clinical studies indicate that medications used for the treatment of ADHD (stimulants as well as non-stimulants) remain an important component in the treatment of ADHD and coexisting ODD/CD. Children with these disorders treated with these medications were not only more attentive, but less antisocial and aggressive. ADHD medications are often effective treatments for aggressive or antisocial behavior in patients with ADHD and certainly play a role in any treatment program. See Managing Medication for Children with ADHD for more information.

In addition to using stimulant medications alone, medication combinations to reduce behavioral and conduct symptoms associated with attention-deficit/hyperactivity disorder appear to be very effective. In several studies, this treatment combination was reported to be well tolerated and unwanted effects were transient.

What can a parent do?

To increase the chance for a successful future and to discourage delinquent behaviors in children with ADHD, diagnosis and intervention is extremely important. It is essential for parents to provide structure and reinforce appropriate behavior. In addition, a positive behavior management plan to lessen anti-social behavior is important. Parents should discuss their child's behavioral symptoms with the pediatrician or family practitioner and seek a referral to a mental health professional who can suggest effective parenting strategies.

In addition, parents should contact their child's school counselor or school psychologist to discuss possible interventions to improve behaviors at school. Having the counselor or psychologist support the teacher in handling classroom behaviors often results in significant behavioral changes and decreases the incidence of expulsion. Consistent behavior management at home, school and elsewhere needs to be enforced.
For more information and further reading
Barkley, Russell. (1998). Your defiant child: 8 steps to better behavior . New York, NY: Guilford Press. This book is divided into two parts, "Getting to Know Your Defiant Child" and "Getting Along with Your Defiant Child." Part two contains an eight-step parenting program built on consistency.

Clark, Lynn. (1996) SOS! Help for parents . Berkeley, CA: Parents Press. This book helps parents learn methods for helping children to improve their behavior and techniques for aiding a variety of child personalities, from the stubborn and willful child to time-out basics. It focuses on the basic skills of time-out and how parents can use these techniques to further a child's behavior modification.

Forgatch, Marion S. and Gerald R. Patterson. (2005) Parents and adolescents living together: Family problem solving. Champaign, IL: Research Press. This book shows parents how to improve their communication and problem-solving skills, hold family meetings and get the whole family involved in solving problems. It explains how parents can teach their teenaged children to be responsible about schoolwork, sexual behavior and drugs and alcohol.

Goldstein, Sam; Robert Brooks and Sharon K. Weiss. (2004) Angry children, worried parents: Seven steps to help families manage anger . Plantation, FL: Specialty Press. This book helps parents cope with anger in their children. It presents the following seven steps to help children learn to manage anger: (1) understand why children become angry; (2) determine when your child needs help; (3) help the child become an active participant in the process; (4) use strategies to manage and express anger; (5) develop and implement a daily management plan; (6) assess and solve problems; and (7) instill a resilient mindset in the child.

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ADHD and Disruptive Behavior Disorders - CHADD

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Having ADHD along with a coexisting disruptive behavior disorder (ODD/CD) can complicate diagnosis and treatment and also worsen the prognosis. Even though many children with ADHD ultimately adjust, some (especially those with an associated conduct or oppositional defiant disorder) are more likely to drop out of school, have fewer years of overall education, have less...

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Causes Getting Help Support Disordered Eating & Eating Disorders An eating disorder is a disturbance in eating behaviour that can put a persons physical and psychological health at risk Female Caucasians aged 12-24 are at most risk Emotional Parents Physical Signs for Concern