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A legacy resource from NICHCY
Disability Fact Sheet 5 (FS5)
Links updated, March 2015

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.
A Look at Specific Emotional Disturbances
Definition

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).
IDEA defines emotional disturbance as follows:
"...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 (NAMI) 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

According to the CDC (Centers for Disease Control and Prevention), approximately 8.3 million children (14.5%) aged 4-17 years have parents who've talked with a health care provider or school staff about the child's emotional or behavioral difficulties. ( 6) Nearly 2.9 million children have been prescribed medication for these difficulties. ( 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 2003-2004 school year, more than 484,000 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.

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:
10 Basic Steps in Special Education Questions Often Asked by Parents about Special Education Services Evaluating Children for Disability Developing Your Child's IEP
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.

As with the term emotional disturbance, "anxiety disorder" is an umbrella term that actually refers to several distinct disabilities that share the core characteristic of irrational fear: generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, posttraumatic 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 1/3 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 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)

Although conduct disorder is one of the most difficult behavior disorders to treat, young people often benefit from a range of services that include:

training for parents on how to handle child or adolescent behavior;

family therapy;

training in problem solving skills for children or adolescents; and

community-based services that focus on the young person within the context of family and community influences. (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:

The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counseling, coupled with careful attention to medical and nutritional needs. Some medications have been shown to be helpful. Ideally, whatever treatment is offered should be tailored to the individual, and this will vary according to both the severity of the disorder and the patient's individual problems, needs, and strengths. ( 20)

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.
For Science Teachers and Their Students in Grades 6-8:
The Science of Mental Illness
This inquiry-based curriculum from the National Institutes of Health is designed to help students in grades 6-8 gain a better understanding of the biological basis of mental illnesses and what mental illnesses are-and what they are not.

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.

Mental Health America | 1.800.969.6642
http://www.mentalhealthamerica.net/find-affiliate

NAMI | National Alliance on Mental Illness | 1.800.950.NAMI
http://www.nami.org/template.cfm?section=Your_Local_Nami

National Mental Health Consumers' Self-Help Clearinghouse
1.800.553.4539 | http://www.cdsdirectory.org/

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.

Fact sheets in English:
http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Keyword.aspx

Fact sheets in Spanish:
http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Spanish.aspx

Fact sheets in other languages | Including Chinese, Malaysian, Polish, Icelandic, Arabic, Urdu and Hebrew.
http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Home.aspx

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

American Psychological Association | The APA is also a fountain of information and support on specific emotional disturbances.

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 | http://www.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. | www.pbis.org

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

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)
1.866.690.7239 | http://www.something-fishy.org

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.

8 | U.S. Department of Education. (2007). 27th annual report to Congress on the implementation of the Individuals with Disabilities Education Act, 2005 (Vol. 2). Washington, DC: Author.

11 | Ibid.

13 | Ibid.

14 | American Academy of Adolescent and Child Psychiatry. (2004, July). Conduct disorder: Facts for families.

15 | Ibid.

16 | National Mental Health Information Center. (2003). Children's mental health facts: Children and adolescents with conduct disorder.

23 | International OCD Foundation. (n.d.). Treatment of OCD. Available online at:
http://kids.iocdf.org/ocdinkids/parents/treatment.aspx

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A legacy resource from NICHCY Disability Fact Sheet 5 (FS5) Links updated, March 2015 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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Differences with IDEA and Section 504 for special education.

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Differences with IDEA and Section 504 for special education.

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IDEA Checklist for Emotional Disturbances. 

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IDEA Checklist for Emotional Disturbances. 

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Classroom Accommodations for Students with Emotional disturbances. 

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Classroom Accommodations for Students with Emotional disturbances. 

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An introduction to emotional disturbance and some strategies to use in the classroom with these students.

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Intervention and Resources for Conduct Disorders. 

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Intervention and Resources for Conduct Disorders. 

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To the Bone is a 2017 American drama film, written and directed by Marti Noxon. The film stars Lily Collins, Keanu Reeves, Carrie Preston, Lili Taylor, Alex Sharp, Liana Liberato, Brooke Smith, and Ciara Bravo. The film follows a girl (Ellen) as she battles anorexia.

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National Institute of Mental Health (NIMH)

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Learn about anxiety disorders, including signs and symptoms, types, risk factors, and potential treatments and therapies.

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Signs and Symptoms of Attention-Deficit/Hyperactivity Disorders (ADHD). 

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Signs and Symptoms of Attention-Deficit/Hyperactivity Disorders (ADHD). 

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Overview

Do you find it hard to pay attention? Do you feel the need to move constantly during times when you shouldn't? Do you find yourself constantly interrupting others? If these issues are ongoing and you feel that they are negatively impacting your daily life, it could be a sign of attention-deficit/hyperactivity disorder (ADHD).

ADHD is a disorder that makes it difficult for a person to pay attention and control impulsive behaviors. He or she may also be restless and almost constantly active.

ADHD is not just a childhood disorder. Although the symptoms of ADHD begin in childhood, ADHD can continue through adolescence and adulthood. Even though hyperactivity tends to improve as a child becomes a teen, problems with inattention, disorganization, and poor impulse control often continue through the teen years and into adulthood.

What causes ADHD?

Researchers at the National Institute of Mental Health (NIMH), National Institutes of Health (NIH), and across the country are studying the causes of ADHD. Current research suggests ADHD may be caused by interactions between genes and environmental or non-genetic factors. Like many other illnesses, a number of factors may contribute to ADHD such as:

Genes

Cigarette smoking, alcohol use, or drug use during pregnancy

Exposure to environmental toxins, such as high levels of lead, at a young age

Low birth weight

Brain injuries

Warning Signs

People with ADHD show an ongoing pattern of three different types of symptoms:

Difficulty paying attention (inattention)

Being overactive (hyperactivity)

Acting without thinking (impulsivity)

These symptoms get in the way of functioning or development. People who have ADHD have combinations of these symptoms:

Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities

Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading

Seem to not listen when spoken to directly

Fail to not follow through on instructions, fail to finish schoolwork, chores, or duties in the workplace, or start tasks but quickly lose focus and get easily sidetracked

Have problems organizing tasks and activities, such as doing tasks in sequence, keeping materials and belongings in order, keeping work organized, managing time, and meeting deadlines

Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms, or reviewing lengthy papers

Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones

Become easily distracted by unrelated thoughts or stimuli

Forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments

Signs of hyperactivity and impulsivity may include:

Fidgeting and squirming while seated

Getting up and moving around in situations when staying seated is expected, such as in the classroom or in the office

Running or dashing around or climbing in situations where it is inappropriate, or, in teens and adults, often feeling restless

Being unable to play or engage in hobbies quietly

Being constantly in motion or "on the go," or acting as if "driven by a motor"

Talking nonstop

Blurting out an answer before a question has been completed, finishing other people's sentences, or speaking without waiting for a turn in conversation

Having trouble waiting his or her turn

Interrupting or intruding on others, for example in conversations, games, or activities

Showing these signs and symptoms does not necessarily mean a person has ADHD. Many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms. If you are concerned about whether you or your child might have ADHD, the first step is to talk with a health care professional to find out if the symptoms fit the diagnosis. The diagnosis can be made by a mental health professional, like a psychiatrist or clinical psychologist, primary care provider, or pediatrician.

Treating ADHD

Although there is no cure for ADHD, currently available treatments may help reduce symptoms and improve functioning. ADHD is commonly treated with medication, education or training, therapy, or a combination of treatments.

Medication

For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. The first line of treatment for ADHD is stimulants.

Stimulants: Although it may seem unusual to treat ADHD with a medication that is considered a stimulant, it is effective. Many researchers think that stimulants are effective because the medication increases the brain chemical dopamine, which plays essential roles in thinking and attention.

Non-Stimulants: These medications take longer to start working than stimulants, but can also improve focus, attention, and impulsivity in a person with ADHD. Doctors may prescribe a non-stimulant if a person had bothersome side effects from stimulants, if a stimulant was not effective, or in combination with a stimulant to increase effectiveness. Two examples of non-stimulant medications include atomoxetine and guanfacine.

Antidepressants: Although antidepressants are not approved by the U.S. Food and Drug Administration (FDA) specifically for the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD. Older antidepressants, called tricyclics, sometimes are used because they, like stimulants, affect the brain chemicals norepinephrine and dopamine.

There are many different types and brands of these medications-all with potential benefits and side effects. Sometimes several different medications or dosages must be tried before finding the one that works for a particular person. Anyone taking medications must be monitored closely and carefully by their prescribing doctor.

Call your doctor right away if you have any problems with your medicine or if you are worried that it might be doing more harm than good. Your doctor may be able to adjust the dose or change your prescription to a different one that may work better for you.

Therapy

There are different kinds of therapy that have been tried for ADHD, but research shows that therapy may not be effective in treating ADHD symptoms. However, adding therapy to an ADHD treatment plan may help patients and families better cope with daily challenges.

For Children and Teens: Parents and teachers can help children and teens with ADHD stay organized and follow directions with tools such as keeping a routine and a schedule, organizing everyday items, using homework and notebook organizers, and giving praise or rewards when rules are followed.

For Adults: A licensed mental health provider or therapist can help an adult with ADHD learn how to organize his or her life with tools such as keeping routines and breaking down large tasks into more manageable, smaller tasks.

Education and Training

Children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed. Mental health professionals can educate the parents of a child with ADHD about the condition and how it affects a family. They can also help the child and his or her parents develop new skills, attitudes, and ways of relating to each other. Examples include:

Parenting skills training teaches parents the skills they need to encourage and reward positive behaviors in their children.

Stress management techniques can benefit parents of children with ADHD by increasing their ability to deal with frustration so that they can respond calmly to their child's behavior.

Support groups can help parents and families connect with others who have similar problems and concerns.

Adding behavioral therapy, counseling, and practical support can help people with ADHD and their families to better cope with everyday problems.

School-based Programs

Some schools offer special education services to children with ADHD who qualify. Educational specialists help the child, parents, and teachers make changes to classroom and homework assignments to help the child succeed. Public schools are required to offer these services for qualified children, which may be free for families living within the school district. Learn more about the Individuals with Disabilities Education Act (IDEA), visit http://idea.ed.gov/.

Finding Help

The National Resource Center on ADHD, a program of Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD ®) supported by the Centers for Disease Control and Prevention (CDC), has information and many resources. You can reach this center online at https://chadd.org/nrc or by phone at 1-866-200-8098. You can also visit the NIMH's Help for Mental Illness page at www.nimh.nih.gov/findhelp.

Participate in a Clinical Trial

It's your involvement that helps researchers to ultimately uncover better ways to treat, prevent, diagnose, and understand human disease. You can get involved by participating in a clinical research trial. The goal of clinical trials is to determine if a new test or treatment works and is safe. Clinical trials can also look at other aspects of care, such as improving the quality of life for people with chronic illnesses.

Researchers at the NIMH and other NIH institutes, such as the National Human Genome Research Institute, conduct research in many areas including cognition, genetics, epidemiology, brain imaging, and treatment development. The studies take place at the NIH Clinical Center in Bethesda, Maryland. If you think you might be interested in participating in a clinical trial, you should talk to your doctor about whether to apply and identify which ones are right for you. To learn about studies on ADHD that are currently recruiting at NIMH, visit http://www.nimh.nih.gov/joinastudy.

To find a clinical trial near you, visit ClinicalTrials.gov. This is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations, and phone numbers for more details. This information should be used in conjunction with advice from your health care provider.

Learn more about ADHD

To learn more about ADHD, visit:

National Institute of Mental Health www.nimh.nih.gov

Centers for Disease Control and Prevention
https://www.cdc.gov/ncbddd/adhd/

MedlinePlus (National Library of Medicine)
https://www.nlm.nih.gov/medlineplus/attentiondeficithyperactivitydisorder.html

Reprints

This publication is in the public domain and may be reproduced or copied without permission from NIMH. Citation of NIMH as a source is appreciated. We encourage you to reproduce it and use it in your efforts to improve public health. However, using government materials inappropriately can raise legal or ethical concerns, so we ask you to use these guidelines:

NIMH does not endorse or recommend any commercial products, processes, or services, and our publications may not be used for advertising or endorsement purposes.

NIMH does not provide specific medical advice or treatment recommendations or referrals; our materials may not be used in a manner that has the appearance of providing such information.

NIMH requests that non-Federal organizations not alter our publications in ways that will jeopardize the integrity and "brand" when using the publication.

The addition of non-Federal Government logos and website links may not have the appearance of NIMH endorsement of any specific commercial products or services, or medical treatments or services.

Images used in publications are of models and are used for illustrative purposes only. Use of some images is restricted.

If you have questions regarding these guidelines and use of NIMH publications, please contact the NIMH Information Resource Center at 1-866-615-6464 or e-mail nimhinfo@nih.gov.

For More Information

For more information on conditions that affect mental health, resources, and research, go to mentalhealth.gov at http://www.mentalhealth.gov, or the NIMH website at http://www.nimh.nih.gov. In addition, the National Library of Medicine's MedlinePlus service has information on a wide variety of health topics, including conditions that affect mental health.

National Institute of Mental Health
Office of Science Policy, Planning, and Communications
Science Writing, Press, and Dissemination Branch
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513 or 1-866-615-NIMH (6464) toll-free
TTY: 301-443-8431 or 1-866-415-8051 toll-free
Fax: 301-443-4279
Email: nimhinfo@nih.gov
Website: http://www.nimh.nih.gov

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
National Institute of Mental Health
NIH Publication No. QF 16-3572
Revised 2016

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Do you find it hard to pay attention? Do you feel the need to move constantly during times when you shouldn't? Do you find yourself constantly interrupting others? If these issues are ongoing and you feel that they are negatively impacting your daily life, it could be a sign of attention-deficit/hyperactivity disorder (ADHD).

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Psychotic disorders are a group of serious illnesses that affect the mind. They make it hard for someone to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately.

When symptoms are severe, people with psychotic disorders have trouble staying in touch with reality and often are unable to handle daily life. But even severe psychotic disorders usually can be treated.

Types

There are different types of psychotic disorders, including:

Schizophrenia: People with this illness have changes in behavior and other symptoms -- such as delusions and hallucinations -- that last longer than 6 months. It usually affects them at work or school, as well as their relationships.

Schizoaffective disorder: People have symptoms of both schizophrenia and a mood disorder, such as depression or bipolar disorder.

Schizophreniform disorder: This includes symptoms of schizophrenia, but the symptoms last for a shorter time: between 1 and 6 months.

Brief psychotic disorder: People with this illness have a sudden, short period of psychotic behavior, often in response to a very stressful event, such as a death in the family. Recovery is often quick -- usually less than a month.

Delusional disorder: The key symptom is having a delusion (a false, fixed belief) involving a real-life situation that could be true but isn't, such as being followed, being plotted against, or having a disease. The delusion lasts for at least 1 month.

Shared psychotic disorder (also called folie à deux): This illness happens when one person in a relationship has a delusion and the other person in the relationship adopts it, too.

Substance-induced psychotic disorder: This condition is caused by the use of or withdrawal from drugs, such as hallucinogens and crack cocaine, that cause hallucinations, delusions, or confused speech.

Psychotic disorder due to another medical condition: Hallucinations, delusions, or other symptoms may happen because of another illness that affects brain function, such as a head injury or brain tumor.

Paraphrenia: This condition has symptoms similar to schizophrenia. It starts late in life, when people are elderly.

Symptoms

The main ones are hallucinations, delusions, and disordered forms of thinking.

Continued

Hallucinations means seeing, hearing, or feeling things that don't exist. For instance, someone might see things that aren't there, hear voices, smell odors, have a "funny" taste in their mouth, or feel sensations on their skin even though nothing is touching their body.

Delusions are false beliefs that don't go away after even after they've been shown to be false. For example, a person who is certain his or her food is poisoned, even if someone has shown them that the food is fine, has a delusion.

Other possible symptoms of psychotic illnesses include:

Disorganized or incoherent speech

Confused thinking

Strange, possibly dangerous behavior

Slowed or unusual movements

Loss of interest in personal hygiene

Loss of interest in activities

Problems at school or work and with relationships

Cold, detached manner with the inability to express emotion

Mood swings or other mood symptoms, such as depression or mania

People don't always have the same symptoms, and they can change over time in the same person.

Causes

Doctors don't know the exact cause of psychotic disorders. Researchers believe that many things play a role. Some psychotic disorders tend to run in families, which means that the disorder may be partly inherited. Other things may also influence their development, including stress, drug abuse, and major life changes.

People with certain psychotic disorders, such as schizophrenia, may also have problems in parts of the brain that control thinking, perception, and motivation.

In schizophrenia, experts believe that nerve cell receptors that work with a brain chemical called glutamate may not work properly in specific brain regions. That glitch may contribute to problems with thinking and perception.

These conditions usually first appear when a person is in his or her late teens, 20s, or 30s. They tend to affect men and women about equally.

Diagnosis

To diagnose a psychotic disorder, doctors will talk to the person, give them a checkup, and consider whether something else might be to blame for the symptoms. The person may get blood tests and brain imaging (such as MRI scans) to rule out physical illness or drug use like cocaine or LSD.

If the doctor finds no physical reason for the symptoms, he or she may refer the person to a psychiatrist or psychologist. These mental health professionals will use specially designed interview and assessment tools to decide whether the person has a psychotic disorder.

Continued

Treatment

Most psychotic disorders are treated with a combination of medications and psychotherapy, which is a type of counseling.

Medication: The main type of drug that doctors prescribe to treat psychotic disorders are "antipsychotics." Although these medicines aren't a cure, they are effective in managing the most troubling symptoms of psychotic disorders, such as delusions, hallucinations, and thinking problems.

Older antipsychotics include:

Newer "atypical antipsychotics" include:

Doctors usually first prescribe the newer ones because they have fewer and more tolerable side effects than older antipsychotics. Some of the medications are available by injection and only need to be taken once or twice a month. This can be easier to manage than remembering to take a daily pill.

Psychotherapy: There are different types of counseling -- including individual, group, and family therapy - that can help someone who has a psychotic disorder.

Most people with psychotic disorders are treated as outpatients, meaning they don't live in institutions. But sometimes people need to be hospitalized, such as if they have severe symptoms, are in danger of hurting themselves or others, or can't care for themselves because of their illness.

Recovery

Each person being treated for a psychotic disorder may respond to therapy differently. Some will show improvement quickly. For others, it may take weeks or months to get symptom relief.

Some people may need to continue treatment for an extended period of time. Some, such as those who have had several severe episodes, may need to take medication indefinitely. In these cases, the medication usually is given in as low a dose as possible to minimize side effects.

What Is the Outlook for People With Psychotic Disorders?

The depends on the type of psychotic disorder and the person who has it. But these disorders are treatable, and most people will have a good recovery with treatment and close follow-up care.

Continued

Can Psychotic Disorders Be Prevented?

No. But the sooner treatment starts, the better. It helps to prevent symptoms. Seeking help as soon as possible can help the person's life, family, and relationships.

For people who are at high risk for psychotic disorders, such as those who have a family history of schizophrenia, avoiding drugs such as marijuana and alcohol may help to prevent or delay these conditions.

Sources

SOURCES:

UpToDate: "Overview of Psychosis."

MedLinePlus: "Psychotic Disorders."

National Alliance of Mental Illness: "About the First Episodes of Psychosis."

Janssen Pharmaceuticals Inc.

Next Article
Brief Psychotic Disorder

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Psychotic disorders are a group of serious illnesses that affect the mind. They make it hard for someone to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately. When symptoms are severe, people with psychotic disorders have trouble staying in touch with reality and often are unable to handle daily life.

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Teen Depression in the U.S. Is on the Rise

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Researchers identify a spike in major depression among teens since 2005-but there hasn't a corresponding increase in treatment.

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Signs and Symptoms of DISRUPTIVE and CONDUCT disorders  

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Signs and Symptoms of DISRUPTIVE and CONDUCT disorders  

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Disruptive behavior disorders (DBD) are a group of behavioral disorders in which there are patterns of ongoing uncooperative, defiant, and hostile behaviors toward authority figures that seriously impacts a child's daily functioning. When a child's family experiences their child disrupting activities, ignoring the rules, erupting in defiance, or goading others, every member feels the impact. A parent may feel helpless to control their child's anger, unsure how to appropriately respond, or how to restore a sense of peace and harmony to the home. The most common types of disruptive behavior disorders include oppositional defiant disorder (ODD) and conduct disorder. The main difference between these two disorders is the severity of the symptoms; conduct disorder is often considered the more serious of the two disorders.

Oppositional defiant disorder (ODD) is characterized by a recurrent pattern of negative, defiant, hostile, and disobedient behaviors toward authority figures for six months or longer. Children with ODD often lose their temper, argue with adults over rules or requests. They may become easily annoyed by other people and blame others for their mistakes or misbehavior. Children with ODD often become angry, resentful, spiteful, and vindictive to others. While all children - and people - are capable of displaying these behaviors, children who have ODD display these behaviors more often than others their age. These behaviors severely impact the social, occupational, or academic functioning of the child.

Conduct disorder (CD) is often called "delinquency" is the more serious of the disruptive behavior disorders as it involves a higher amount of cruelty. Children and teens who have CD may show aggression toward other people and animals, willfully destroy property, stealing, lying, and truancy. It's thought that disruptive behavior disorders exist along a spectrum and oppositional defiant disorder may progress into CD.

Children who are thought to have ODD or CD or another disruptive behavior disorder should seek medical treatment for proper diagnosis and care. With therapies and occasionally medication, children who have DBDs can learn more positive behaviors and begin to react to life situations in an appropriate fashion. The sooner therapy is begun, the more bright the outlook.

Statistics

Both ODD and CD occur frequently in children and represent a large part of the children who seek mental health services. It's estimated that ODD occurs in between 2 and 16% of the youth, depending upon the population. Conduct disorder is more common in younger boys ranging from 6 to 9% of the child population in the United States.

Co-Occurring Disorders

Disruptive behavior disorders may exist with other types of disorders. The most common co-occurring disorders include:

Attention-deficit hyperactivity disorder (ADHD)

Conduct disorder

Oppositional defiant disorder

Anxiety disorders

Depressive disorder

Substance abuse

Causes for Disruptive Behavior Disorders

The causes for disruptive behavior disorders are thought to be a mixture of different factors working together. Some of the common risk factors include:

Physical: Children who were born of low birth weight or those who suffered neurological damage are at a greater risk for developing disruptive behavior disorders.

Environmental: Children who were rejected by their mothers as infants, separated from their parents, or obtained poor foster care are at an increased risk for DBDs. Additionally, children who were physically, emotionally, or sexually abused or neglected are at higher risk for developing these disorders later in childhood. Children who lived in poverty or witnessed domestic violence or substance abuse are also at a greater risk for developing the disorder.

Psychological: Children who have attention-deficit hyperactivity disorder are at a higher risk for developing disruptive behavior disorders.

Symptoms of Disruptive Behavior Disorders

The symptoms of disruptive behavior disorders will vary based upon the type of disruptive behavioral disorder a child has - oppositional defiant disorder or conduct disorder - as well as individual temperament, social skills, and coping mechanisms. The most common symptoms of disruptive behavior disorders include:

Behavioral Symptoms:

Antisocial behaviors

Sociopathic tendencies that cause serious harm to others

Often loses temper with others

Argues with adults

Actively defies or refuses to comply with requests or rules

Blames others for his or her mistakes

Deliberately annoys other people

Aggressive and cruel toward people and animals

Deliberately intimidates other people

Makes deliberate attempts to annoy others

Bullying

Revenge-seeking behaviors

Lying

Stealing

Conniving

Willful destruction of property

Cognitive Symptoms:

Lack of problem-solving skills
Physical Symptoms:
Psychosocial Symptom s:

Child frightens and alienates friends, family, and peers

Intensely rigid and touchy

Lack of remorse

Easily annoyed

Loneliness

Anger

Spiteful and vindictive

Resentfulness

Feelings as though they have nothing to lose by engaging in illegal or dangerous behaviors

Effects of Disruptive Behavioral Disorders

Without proper care and treatment, children and teens who have conduct disorder or oppositional defiant disorder will face long-term consequences. The effects of untreated and undiagnosed disruptive behavioral disorders includes:

Antisocial personality disorder

Incarceration

Legal problems

Substance use and abuse

Alcoholism

Failure to achieve gainful employment

Homelessness

Poverty

Domestic abuse

Child abuse

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Effects, Signs & Symptoms of Disruptive Behavior Disorder

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Disruptive behavior disorders (DBD) are a group of behavioral disorders in which there are patterns of ongoing uncooperative, defiant, and hostile behaviors toward authority figures that seriously impacts a child's daily functioning. When a child's family experiences their child disrupting activities, ignoring the rules, erupting in defiance, or goading others, every member feels the impact.

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Scholarly source about Binge Eating Disorders. 

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Scholarly source about Binge Eating Disorders. 

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Book about Obsessive-Compulsive Disorder (OCD). 

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Book about Obsessive-Compulsive Disorder (OCD). 

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Kevin can't get to sleep at night until he does many things. He straightens his chair and the books on his desk. He asks his mother questions he already knows the answers to. He checks under his bed for a light he knows isn't there, and then, a minute later, he checks again. Kevin knows these actions don't make sense; he wants to stop, but the worry thoughts keep coming. When his parents realize that Kevin has too many worries, they take him to talk to a therapist. She tells Kevin and his parents that Kevin has a condition called obsessive-compulsive disorder (OCD) and that, more importantly, he can be helped.

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Kevin can't get to sleep at night until he does many things. He checks under his bed for a light he knows isn't there, and then, a minute later, he checks again. Kevin wants to stop, but the worry thoughts keep coming.

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Is the Problem Really ADHD?

Written by Harold Robert Meyer, MBA, BCC, SCAC and Susan Karyn Lasky, M.S., BCC, SCAC

There are many reasons why a child is disruptive or inattentive in class.Â However, many children who exhibit these behaviors have a form of Attention-Deficit/Hyperactivity Disorder. (ADD/ADHD).

ADHD is difficult to diagnose definitively. It is a highly hereditary neurobiological problem characterized by behavioral difficulties that may vary in intensity.Â Environment, attitude and internal motivation can influence behaviors.

Testing (a combination of neurological, psychological and educational testing, along with a detailed family history) is used to pinpoint ADHD as the probable issue.Â Testing should rule out other causes for ADHD-type behaviors. These include medical problems (thyroid, lead, intoxication, Lyme disease, diabetes/hypoglycemia, allergies, asthma, anemia, etc.), as well as visualÂ or auditory problems and emotional/physical issues such as stress, abuse or neglect.Â A knowledgeable practitioner will makeÂ a differential diagnosis, determining whether the symptoms are due to ADHD, to one of the many behavior, mood or cognitive disorders that exhibit similar symptoms, or to a combination.

Few children have pure ADHD; high percentages have comorbid (co-existing) learning and/or communications disabilities.Â Children, particularly those who are not diagnosed until

they are older, may also exhibit affective and regulatory disorders (anxiety, depression, bipolar disorder) and/or disruptive behaviors (oppositional defiant disorder, conduct disorder, etc.).Â They may have developed drug dependency, often as an attempt to self-medicate.

Diagnostic Criteria for ADHD in Children

There are three predominant characteristics associated with ADHD:Â Hyperactivity, Impulsity and Inattention.Â Â However, a child may have ADHD, yet present as non-hyperactive.

There are three primary types of ADHD, each with a different set of diagnostic symptoms:

All of these share the following criteria:

Child must have at least six symptoms in a category, persisting for at least six months, to a degree that is maladaptiveÂ and inconsistent with developmental level.

Some of the symptoms must be present before age seven.

Some impairment from the symptoms must be present in two or more settings (home, school, play).

There must be clear evidence of clinically significant impairment in social, academic or occupational functioning.

Symptoms are not better accounted for by another mental disorder.

Another type is Otherwise Specified ADHD, where the prominent symptoms of ADHD are exhibited,Â but not enough to meet the diagnostic criteria.

Predominantly Hyperactive/Impulsive Type:

Fidgets with hands or feet, or squirms in seat

Leaves seat in situations in which remaining seated is expected

Moves excessively, or feels restless during situations in which such behavior is inappropriate

Has difficulty engaging in leisure activities quietly

Is â€œon the goâ€ or acts as if â€œdriven by a motor

Talks excessively

Blurts out answers before questions have been completed

Has difficulty awaiting turns

Interrupts or intrudes on others

Predominantly Inattentive Type:

Fails to pay close attention to details or makes careless mistakes

Has difficulty sustaining attention to tasks or leisure activities

Does not seem to listen when spoken to directly

Does not follow through on instructions, and fails to finish work

Has difficulty organizing tasks and activities

Avoids, dislikes or are reluctant to engage in tasks that require sustained mental effort

Loses things necessary for tasks or activities

Easily distracted by extraneous stimulus

Forgetful in daily activities

Combined Type:

Meets criteria for both Impulsive-Hyperactive and Inattentive types of AD/HD.

Treatment

Treatment for a child with ADHD can be very effective, especially when the diagnosis is made at an early age. Multi-modal treatment is recommended. This is a combination of individual and family therapy, behavior modification and, when appropriate, medication.Â Additional services are often helpful, such as socialization skills training, occupational therapy, organization, time management and study skills training.Â If there is a question as to whether a child has ADHD, it is important that they are tested, in order to receive appropriate services as soon as possible.

Children with ADHD are generally bright, although they may not show it.Â They are frustrated by their challenges and inconsistent behaviors. Older children may have learned to cover this up, often by manifesting negative attitudes and behaviors.

"If I can't help it, I'll join it,"Â â€œIâ€™d rather be bad than appear stupid.â€

However, they are not "bad" kids and want very much to be liked and appreciated.Â Many older children, upon being diagnosed, are thrilled to find that there is a reason for their lack of control and inability to focus â€" that the things they've always felt are wrong with them have a cause.

Motivating the child with ADHD is critical to his or her success. When motivated, challenged and interested, there is actually a change in their brain chemistry.

Parents of kids with ADHD are generally very frustrated. There is a pervasive attitude that, since the children misbehave, the parents are doing a terrible job of parenting.Â They are often criticized for not exerting enough discipline.Â Meanwhile, they may have relatives or spouses who criticize them for being too strict.Â There is often contention between spouses on how to handle the child.Â People often believe (especially fathers) that the child â€œJust needs to shape up.â€ What is often overlooked at home, as well as at school, is that the child CANNOT "just" shape up. These children have a very real neurological problem and need help to succeed.

The Teacherâ€™s Role

Anything a teacher does to help their students with ADHD will benefit ALL students in the class.Â However, to successfully teach a child with ADHD, teachers must understand their â€œhiddenâ€ disability, along with its behaviors and challenges.Â They need to reach the student on a meaningful level, focus on the childâ€™s strengths, inspire and motivate. This requires commitment and a great deal of energy.

There are many strategies, tips and techniques that are helpful to the classroom teacher.Â Here are a number of tips for effective classroom management:

105 Tips for Successful Teaching

1. Set up an informal support group you can lean on.Â Having ADHD kids in the classroom can be exhausting.Â Â Ask for help from specialists (learning, psychological, medical).Â Involve the parentsâ€"how do they handle certain situations at home; what can they do at home to make your job easier.Â Involve other teachers in finding solutions to particular issuesâ€"t's not a sign of weakness to reach out.

2. Knowâ€"and acceptâ€"your limits. If you accept that it's okay to get angry, tired, frustrated or even a little crazy, it's easier to keep your overall sanity than if you think you have to be perfect.

3. Avoid unfair expectations. Most kids with ADHD are smart, and because their behavior and performance is inconsistent, teachers often think the child's problems are due to non-compliance or laziness, with the standard refrain being , "we know if you just tried harder you could do it."Â But that's not always so... sometimes the child who scored a 98 one day can't perform better than a 65 on another day.Â "Can't" NOT "won't." The same child who answers difficult questions may stumble on the easy ones.Â And they're as frustrated about it as you are!

4. Make sure you have his attention. Unless the child is paying attention, he can't learn.Â So before beginning a lesson or assignment, establish eye contact with the child so you know he's focused.Â ADHD kids frequently have difficulty distinguishing the key element (the teacher) from the background (other kids in the class, noise in the hall). Use frequent eye contact and an occasional touch on the shoulder to maintain or redirect the child's attention.

5. Seat the child near your desk and away from doors, windows, heater and air conditioning.

6. Keep the classroom door closed, especially during tests.

7. Minimize distractions in the classroom itself.

8. Sit the child near a good role model, both for behavioral and organizational skills.

9. Help the child to keep an uncluttered desk. Check that all necessary items (sharpened pencil, paper, etc.) are available.Â If the lesson begins and the child is still looking for her book, she won't be able to catch up with the rest of the class.

10. Set the child up for success, not failure.Â Break instructions into small steps and assign one task at a time.Â Pick one goal at a time.

11. Spell it outâ€"be precise in your directions. Don't say, "get ready," but break it down into severalÂ steps, such as "now sit in the chair with your feet on the floor...face the front of the room...have your work book and pen on the desk."Â Pause between each instruction to give the child time to follow the step.

12. Repeat directions. Write them down.Â Say them.Â Repeat them.Â Then have the child repeat the instructions back to you, while maintaining eye contact.

13. Keep the child on task and redirect attention when necessary, which means supervising with greater frequency than normal.

14. Disruptive/inattentive children need structure. They need their environment to structure for them externally what they can't structure internally.Â ADHD children function best in a highly structured classroom with clearly established patterns and rules.

15. Make lists and post the rules. It must be clear to the child what is expected. By providing rituals in the classroom, the kids then feel more comfortable taking risks from a secure base.

16. Have as predictable a schedule as possible. Post it and refer to it often.Â If you are going to vary it, as most interesting teachers do, give lots of warning.Â Transitions and unannounced changes are hard for these kids.

17. Have the children make their own schedules for afterschool, both to assist with learning the concept of time management and to avoid one of the hallmarks of ADHDâ€"procrastination.

18. Set limits and boundaries. There must be a defined system of acceptable and unacceptable behaviors, along with rewards and consequences (incentives, reinforcements).Â This is containing and soothing, NOT punitive.Â Be consistent and predictable.Â (Reward systems are discussed in more detail later on.)

19. Take charge. Follow through with consequences (positive or negative) immediately.Â Avoid lawyer-like discussions of fairness.Â ADHD kids are notorious negotiators.

20. Your goal is to help SHAPE behavior.Â You can't be responsible for changing it.Â The child who hits won't just stop hitting, because that is an impulsive, reactive act.Â Look for a gradual effect.

21. Discipline means to teach â€"NOT to punish.Â ADHD children are impulsive, which means they'll often do things which get them into trouble, even when they're trying to behave well.Â They need your support.

22. Never blame the childâ€"criticize the behavior! ADHD kids, though they usually do not express or show it, feel badly enough about their behavior and lack of control.Â They frequently do things they didn't plan or want to, due to impulsiveness. They know something is wrong and they cover up with false bravado.Â Â At a young age they begin to think they're no good.Â By high school they've frequently "grown in" to the role they've been assigned as troublemaker.Â They need your support.

23. Reprimand in private as much as possible.

24. Give child a choice of behaving in the correct manner or, if continuing to misbehave, facing predetermined consequences - not punishment, but consequences logically related to behavior and made clear to the child in advance.

For example: If chair is continually tipped, it will be removed.

"It's your choice if you prefer to stand through the lesson"...

If a favored toy is abused, the toy will immediately be given time outÂ (put on a shelf)â€"

"Obviously you've decided not to play with this toy today, or you'd be gentle with it, so it's your choice to put it away."

25. When you have a kid who is obstinate or has trouble making up his mind, give two choices, either of which which would be acceptable to you â€""Do you want to put away the blocks first or would you prefer to put away the puzzles first?"Â The child gets to feel pride in being the one to make a decision, rather than being told what to do and you have made it clear what needs to be done.

26. Provide the consequence of a choice so final behavior is the child's decisionâ€""YourÂ pushing is upsetting both me and the other children.Â Â You can either play gently or go for time out â€"YOU DECIDE" This avoids having the teacher always being the taskmaster and disciplinarian and places the responsibility for acceptable behavior on the child.

27. Present alternatives in a positive way. Instead of "If you don't quiet down you'll have to go to the principle's office," try "If you quiet down now we'll have time for xxx."

28. Act quickly when giving a consequence, especially with younger children, so it's clear punishment tied in to specific activity

29. Try to be specific in defining behaviorâ€" NOT "Stop misbehaving, but "Stop pushing," "Stop banging the book," etc.

30. Relate the criticism to the actionâ€"NOT the child. Instead ofÂ "You're reallyÂ creating disruptions in the class," try "Your behavior (being specific if possible) is causing the other kids to get upset and making it difficult for me to teach."Â It's a subtle difference, but with one you're condemning the child; with the other, the activity.Â This leaves the child free to improve, whereas the other makes him feel worthless.

31. Never call the child good or bad,Â but address the behavior (not acceptable). Avoid accusations which make the child feel he or she is not good as a person,Â and put up their defenses:Â "You're not trying" vs. "I feel upset when you don't start to work on the questions."

32. Focus on actions, not motivations. Say, "It's time to get started on your work."Â NOT "Stop being so lazy."

33. Don't praise with one hand and criticize with the other. It's not positive to tell a child "You haven't done anything wrong today," even if you mean well by it.Â Say, "I'm really happy with the way you raised your hand, rather than interrupting the class."

34. Take advantage of a cooling down period. When you see the child has lost control, don't confront the issue, but quietly go over and tell him to take some quiet time, then when ready, rejoin the group.Â You need to monitor the child, to help prevent negative behaviors by early intervention, to make the rules clear and to see the child experiences predetermined and clearly defined consequences.

35. Choose the issues. Avoid confrontation on every wrong move.Â Ignore minor non-disruptive behavior and reinforce other children's efforts for not attending to the ADHD child's misbehavior (which to the child is reinforcement, albeit negative).

36. Never confront the child or demand response when she's out of control or her body language says NO.Â Give 10 minutes of quiet time and you'll see PHYSICAL changes.Â Then you can discuss what happened from the perspective of being concerned and wanting to work with the child to avoid recurrence.Â Make the child feel good about herself, that you know she can do it, but you also understand how very hard it is for her, and what an accomplishment it will be.

37. When a child is really disruptive, time-out doesn't work and the child's behavior is affecting the entire class, it may be advisable to bring in an authority figure.Â NEVER leave the child alone, but it may be necessary to remove them from class.Â Instead of having the child sit and do nothing, you or an administrator can offer them paper and pencil and give them a chance to work out what they're feeling.Â (This way they aren't sitting bored, and yet it isn't a reward.)Â Â Â For younger children, just having an administrator write their name in an official-looking book may worry them enough to stop the behavior.

38. Styles differ, but when kids are excited or distressed, calmness and predictability from the teacher is needed â€"a structure the child can depend on when they're out of control, a model they can try to emulate.

39. Children will test your limits. Try to be consistent, avoid anger or rejection (anger can be seen as negative reinforcement for unacceptable behavior).

40. Be appreciative of the child's struggles. It's twice as difficult for a child with ADHD. Show that you respect his efforts and appreciate them. NEVER ridicule.

41. Treat children as individuals, not as a typical this or that. Become a detective. Discover what the child responds to and what works for her, vs. what's upsetting.

42. Have high expectations, but express them in a gentle way, so kids feel elevated, not pushed.

43. Make sure the child understands your expectations. DON'T ASSUME. Ask the child to repeat back to you. Ask them again tomorrow and again next week.

44. Make sure the child knows how to meet your expectations. DON'T ASSUME that a student who continually makes noise when he stands up is doing it to annoy you or attract attention. They just might not know how to stand without scraping the chair against the floor. Demonstrate, have the child practice, then praise.

45. Help the child get started on a task. The child may be trying, but doesn't know how to get going. It's not a case of noncompliance. Instead of criticizing for falling behind, try to establish support and involvement - "What can we do to make it easier to get started? Shall I review the assignment?

46. Focus on learning, not rules. Allow more time for these children to complete projects. Allow aids, if needed, such as tape recorders or laptop computers.

47. Build on strengths, rather than contribute to a child's frustrations by focusing on his or her weaknesses. Example: If a child has difficulty in writing, you might ask him to answer a question verbally, but not write the answer on the blackboard.

48. Reinforce that the child is competing only against herself, NOT others.

49. Eliminate or reduce the frequency of timed tests. Teach test-taking skills.

50. Go for quality, rather than quantity of homework.

51. Separate out creativity and neatness into different activities. Have the student write a story for creative development; have her rewrite it neatly afterwards. Let the child dictate an essay into a cassette, then type it afterwards.

52. Use computer software to help the child with organization, outlining and visualization of written projects.

53. Break down large tasks into small tasks. This helps avoid tantrums due to frustration, real or anticipated. It also helps the child absorb what you're trying to teach. An example is to give several target times, each 3-15 minutes, within an assignment (ie, do 4 math problems, break, 4 more, break or 1 essay, break then another). This helps those with trouble starting and those who tend to fizzle in the middle and have difficulty with completion.

54. Target realistically for completion of work. Following through with consequences, give specifics as to when work must be completed if not done in class (recess, after school). Set appropriate goals that the child can (not "should") meet. Start easy. Success is the best motivator, for both you and the child. Acknowledge each success. Encourage.

55. Set time limits. This is helpful for drifters, but also for impulsive students who then must take needed extra time to look over their initial work which may be sloppily done, rather than just rushing though it to get it out of the way. If an ADHD child is the first one done with a test (often the case), give it back to him and ask him to review his answers.

56. Try to give appropriate projects for the time of day. A good time for projects requiring concentration is in the morning when kids are fresh... and for those kids on medication, the medicine is working. Around lunchtime, play or low-key, calming activities work best. Be aware that, depending upon the type of medicine and dosage, medicine does "wear off" and during this period of the day the child may experience the most difficulty. Don't make demands when the kids are going to be weaker. Work from strength.

57. Allow the child time to be alone or away from classroom activities. Sometimes an ADHD child needs quiet space to pull herself back together when the distractions become to much. If other children want to know why she can do things they can't, explain that "everyone in class is special, and this is something she needs that's different from what you might need."

58. Allow the child to move. Let him leave the classroom for a 5 minutes, or walk around the room in between assignments or parts of a project.

59. Allow time to exercise (everyone could benefit from a few neck or shoulder rolls, not just the ADHD children).

60. Watch out for fatigue. ADHD children are often tired in the classroom. Not from lack of sleep, but from the effort it takes just to focus in and concentrate. Physical activity is often needed for the child to stay mentally alert. Otherwise, the longer the time slot, the increased inefficiency and disorganization. You'll see the child yawn and stretch. It's not rest time. It's time to move!

61. Memory is often a problem with these kids. Teach them little tricks, like mnemonics.

62. Use outlines. Teach outlining. Teach underlining.

63. Find little strategies to help the child feel successful.

64. Encourage reading aloud at home. Read aloud in class as much as possible. Use story-telling. Help the child build the skill of staying on one topic.

65. Repeat, repeat, repeat.

66. Teach, don't lecture.

67. Use non-verbal communication. Sometimes it's necessary to show the child what you want physically, as verbal commands, and especially verbal reprimands, are frequently ineffective.

68. Help the children to listen better. Encourage them to write notes to themselves when they have questions, so they can listen without the distraction of having a question on their mind.

69. Frequently compliment the student for on-task behavior. (And remember to call parents about good things too). Positive reinforcement is essential to helping the child develop self-esteem. These kids live with so much failure, they need all the positive handling they can get.

70. Give the child frequent feedback on his or her work. Be honest but positive in approach: "You did a great job writing clearly... Next time, let's work on staying within the margins" Monitor progress frequently; point out even small improvements, like in the frequency or duration of eye contact. THESE KIDS WANT TO DO WELL, BUT DON'T THINK THEY CAN Feedback should help the child develop self-observing behavior and be able to critique that behavior.

71. Consider a daily progress report Have a brief exchange at the end of class in private.

72. Give responsibility back to the child, when possible (ie, watering plants in the classroom, getting changed in gym on time).

73. Involve the child. She needs to feel connected to you, her work, her classmates. Kids are often very intuitive and can tell you how they learn best, if you ask them. They are often too embarrassed to volunteer this information. And they certainly won't volunteer when other kids are around.

74. Involve the child in self-motivating behavior. Consider a point system, with rewards (predetermined) for desirable behavior. Motivational programs, using materials of high interest to the child, are very successful. They help the child stay focused on a goal, filtering that goal (acceptable behavior) out from others. Younger children might benefit from a posted award, such as stars or checkmarks on a corner of the blackboard for good behavior, being a good friend, etc.

75. Encourage and reward responsible behavior with simple things, like letting the child be first on line, sending home a Responsible Behavior Certificate (or maybe a graded GOOD WORK to WOW, TERRIFIC), giving the child performing responsibility, like passing out papers or cleaning the blackboard. Note: You may want to include all children in this process, perhaps giving slips of paper to any child who does well (so as not to ignore the generally well behaved child either) and have a drawing at the end of the week for a "prize."

76. When offering a reward for certain behavior, set the reward in advance, so the child can strive towards it. Make it something age appropriate and desirable. It can be an object (a colorful pen for younger children, a low-cost CD or book for older kids. If it's an object, you may want to have it on display. Smaller rewards along the way may be more successful in motivating a student than promising a big reward for completing a very big job. (One goal at a time...)

77. When determining penalties for misbehavior, be careful. One school I know of would send the child home. One kid loved this and that was positive enforcement for misbehavior!

78. Avoid giving rewards solely for academic performance â€"keep this non-competitive or the ADHD child will give up in frustration. Many ADHD children are perfectionists, and knowing they can't be best, they'd rather not try at all. You can reward for getting homework done on time, reading the book, etc., so long as the reward is for effort, not expertise.

79. In certain cases consider school to home charts, or even a combination homework/notebook (ADHD kids are notorious for losing things, including homework assignments). Charts should track behavior and school performance and be tied to predetermined and mutually agreed upon (by student, teacher and parent) behavior and consequence. The consequence, good or bad, should be administered at school, as that is immediate and related. Examples are a chance to be the class leader, messenger or whatever would give the child a sense of accomplishment and pride (motivation). If the child doesn't do well, consequences may result in a loss of recess time, a particular play item (for younger children), etc.

Note: An older child may feel embarrassed showing pride in an accomplishment or reward. Don't let that stop you!

80. Keep the child stimulated by using challenging and interesting learning materials on level with the child's learning ability, and switch approach when they begin to lose interest.

81. Modulate your voice. Change tone, speedâ€"even whisper. This captures the child's attention, preventing your voice from being just more background noise.

82. Make a game out of things. Motivation improves ADHD. Excitement about a subject changes the chemistry of the brain. That's one reason a child who can't seem to concentrate in class for more than five minutes can spend an hour constructing with Legosïƒ' or building a model airplane.

83. Be playful and have fun yourself! Kids hate being bored. Especially when so much of their "treatment" involves structure, schedules and predictability. They truly enjoy a bit of "silliness."

84. Early warning signs appear before the behavior goes. A child who is about to lose it will clue you in, if you're a careful observer. It's so much easier to stop unwanted behavior before it becomes full-blown. Have the child take a break to recharge. Separate him from the other kids for a little while by giving him a special task. Bring her back into the group dynamics by capturing her attention. Establish a private signal from the teacher to the child, to be used when the child is "tuning out" or acting impulsively. Perhaps it's a hand signal, or a hand on the shoulder (acceptable physical contact sometimes calms the child, especially the younger child).

85. Announce what you are going to say before you say it. Say it. Then repeat what you have said. After that, have the child repeat back what you've said.

86. Simplify!!!

87. Don't give the child too many choices. You're the authority.

88. Plan ahead. Anticipate problems (times when the medication wears off, unstructured activities, those times when you have no patience left, etc.) Have special resources available to see you through.

89. Keep unfocused transition periods short, and monitor the ADHD child. Always explain the next activity in advance.

90. Prepare for unstructured time. Warn them, help them think about what to do with the time and plan ahead.

91. Encourage group participation. Separate clusters that feed on the negative aspects (ie, impulsivity).

92. Work with the child to turn bossiness into leadership.

93. Help them to understand social clues.

94. Encourage a "study buddy" in each subject, with phone number.

95. Meet with parents often. Avoid the pattern of just meeting around problems or crises. View the parent as a partner in educating the child. Try not to scare or depress parents; they've been through a lot. Stress the positive and what can be accomplished. Do not whitewash negative issues that should be brought to their attention.

96. Cooperate with the child's doctors, especially necessary in determining medicine dosage when that's an issue. NEVER discuss the child's medicine in front of the other children.

97. Be on the lookout for sparkling moments. Highlight those times when the talents and gifts surface. Too often they're blocked. This children are far more talented and gifted than they often seem.

98. KEEP IT POSITIVE. Praise, stroke, approve, encourage, nourish. Focus on what you want the child to do, not just on what you want the child to STOP.

99. Keep it honest. Kids know when we're not being honest; praise with respect to actual accomplishment (however minor).

100. Stick to itâ€"your commitment will inspire the child.

101. Remember, the kids are good kids. Children with ADHD don't want to be disruptive or disliked by the other children. They need you to like them and understand they don't mean to always behave the way they do. Help them to feel wonderful about attending and being part of the group, so they'll want to do more. Motivation and respect work beautifully.

Add your own ideas here, and share them with a colleague:

103.

104.

105.

Harold Meyer and Susan Lasky are both Board Certified and Senior Certified ADHD Coaches.

To contact the authors:Â haroldmeyer@addrc.org

ADD and ADHD are used interchangeably for Attention-Deficit/Hyperactivity Disorder.

Any information or suggestions in this article are solely the opinion of the author(s) and should not replace the advice of appropriate medical, legal, therapeutic, financial or other professionals. We do not test or endorse any product, link, author, individual or service listed within.

Â© 2006 â€" 2017, by The ADD Resource Center. All Rights Reserved.

To viewÂ HUNDREDS Â of articles and videos onÂ ADD/ADHD, go toÂ addrc.org

support@addrc.org Â 646/205.8080

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Harold Robert Meyer MBA SCAC and Susan Karyn Lasky MA SCAC

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School-Based Management of Children with Attention-Deficit/Hyperactivity Disorder: 105 Tips for Teachers

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Written by Harold Robert Meyer, MBA, BCC, SCAC and Susan Karyn Lasky, M.S., BCC, SCAC There are many reasons why a child is disruptive or inattentive in class.Â However, many children who exhibit these behaviors have a form of Attention-Deficit/Hyperactivity Disorder. (ADD/ADHD). ADHD is difficult to diagnose definitively.

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Resource for Oppositional Defiant Disorders. 

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Resource for Oppositional Defiant Disorders. 

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Teacher Guidance for Obsession-Compulsive Disorder (OCD). 

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Teacher Guidance for Obsession-Compulsive Disorder (OCD). 

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Teacher's Guide to Depression Students. 

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Teacher's Guide to Depression Students. 

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October 2010 | Volume 68 | Number 2
Interventions That Work Pages 46-51

R. Marc A. Crundwell and Kim Killu

Rita's story illustrates the essential features of clinical depression in children and adolescents: a persistent sad or irritable mood, loss of energy, decreased interest in daily activities or previously enjoyed activities, persistent feelings of worthlessness or guilt, withdrawal, and, possibly, recurrent thoughts of suicide. Children and adolescents with depression may also show appetite changes resulting in weight gain or loss, disturbed sleep patterns, increased defiance or oppositional behavior, and impaired concentration.

Recognizing Rita

Although depression is classified as an adult disorder-and depression in very young children is rare-middle to late adolescence is the most common age when symptoms first appear or a first major depressive episode happens (Burke, Burke, Regier, & Rae, 1990). Lewinsohn, Hops, Roberts, Seeley, and Andrews (1993) randomly sampled adolescents within a U.S. community and discovered that the average age of onset of major depression was 14. Sadly, the earlier the onset of depression in children and adolescents, the more protracted and severe the course of the disorder usually is (Kovacs, Feinberg, Crouse-Novak, Paulauskas, & Finkelstein, 1984).

As Figure 1 (p. 48) illustrates, research and clinical experience show that depression manifests itself differently in children than in adolescents in terms of what teachers see in the classroom (Kashani, Rosenberg, & Reid, 1989).

Figure 1. Characteristics of Depression in Children and Adolescents

When depression is recognized early and when professionals provide treatment, young people can experience improved mood and function better in school and life. Thus, the stakes are high. School personnel play a pivotal role in identifying depression-and intervening. Teachers, administrators, and other school staff must also be knowledgeable about depression because the disorder can seriously impair academic and interpersonal behavior at school (Hammen & Rudolph, 2003).

Depression is significantly correlated with poor academic grades, and students with higher ratings of depression are less likely to graduate from high school (Forehand, Brody, Long, & Fauber, 1988). Cognitive issues may include low tolerance for frustration and negative patterns of thinking. Depressed students often give up more quickly on tasks they perceive as daunting, refuse to attempt academic work they find too difficult, and quickly doubt their ability to independently complete academic tasks or solve problems. Memory, speech, physical and motor activity, and the ability to plan may also be affected. Many depressed children and adolescents are lethargic, speak laboriously, and have difficulty completely expressing thoughts and ideas.

Rita's case illustrates three other issues with regard to recognizing depression. First, the essential features of depression are as recognizable in youth as they are in adults, and the same diagnostic criteria are used for both age groups (Mitchell, McCauley, Burke, & Moss, 1988). Second, irritability is more common in depressed youth than in depressed adults. Third, teachers often overlook children with depression because symptoms like a sad mood or fatigue are more internal and subjective than the kinds of disruptive behavior shown by kids with more externalizing disorders, such as attention deficit disorder. Depressed young people often don't ask for help at school because of negative thinking patterns: No one cares about my feelings, nothing can be done to help me, and so on (Cash, 2003). Younger students often lack the necessary language skills and self-awareness to report-or recognize-their own depressed state.

Helping Students with Depression

Because depression can have broad negative effects on students' academic work and comfort in school, schools need to provide a variety of accommodations and instructional strategies to increase these students' success. Figure 2 (p. 50) shows strategies that can benefit children and adolescents battling depression.

Figure 2. Strategies to Help Students with Depression

Give frequent feedback on academic, social, and behavioral performance.

Teach the student how to set goals and self-monitor.

Teach problem-solving skills.

Coach the student in ways to organize, plan, and execute tasks demanded daily or weekly in school.

Develop modifications and accommodations to respond to the student's fluctuations in mood, ability to concentrate, or side effects of medication. Assign one individual to serve as a primary contact and coordinate interventions.

Give the student opportunities to engage in social interactions.

Frequently monitor whether the student has suicidal thoughts.

Develop a home-school communication system to share information on the student's academic, social, and emotional behavior and any developments concerning medication or side effects.

The best approach is often individualized. Here we describe an approach school personnel might use to help Rita.

As Rita's teacher Mrs. Shannon became worried about her, she shared her concerns with Rita's parents. They were relieved that the school had contacted them and were encouraged by the school's willingness to collaborate with them to address Rita's downward spiral and make decisions about ways to help her. With their cooperation, Mrs. Shannon and the school's guidance counselor brought together a team to provide interventions for Rita. This team brought in the school psychologist, who first strongly recommended that Rita's family physician evaluate her to determine whether further referral to a child psychiatrist was appropriate.

The school's intervention team, the school psychologist, and Rita's parents together developed an individualized plan of accommodations and instructional strategies to help Rita cope. After determining some appropriate interventions, the team met with Rita to discuss these possibilities and get her feedback; they knew this would increase the chance she would buy in. All the players involved agreed to meet monthly to review Rita's response to the interventions, ensure that their actions were helping her, and make any modifications needed.

Establish a Touchstone Teacher

Rita and a teacher from the resource room in her school, Ms. Hunt, began meeting weekly to help Rita develop specific goals for how she could manage better academically, socially, and in terms of behavior. Ms. Hunt was chosen because, as a resource teacher, she had flexibility to meet with Rita and could coordinate services with all of Rita's teachers. They met each Monday morning to review any work that Rita completed over the weekend and to set goals, targeting four areas in which depression typically affects students most strongly: work completion, work submission, social interactions, and physical activity.

The team considered it important that Rita take an active role in setting and achieving goals. This would help her learn self-management skills, which would later serve her in managing her depressive symptoms, accomplishing difficult tasks, and achieving personal goals (Cooper, Heron, & Heward, 2007). On Fridays, Rita again met with Ms. Hunt to review the week's progress toward her goals and discuss any assignments for the weekend. She also informally checked in with Ms. Hunt before lunch and at the end of most days.

Ms. Hunt became a nonthreatening liaison between Rita and her other teachers. Rita's teachers met weekly with this resource teacher to communicate clear guidelines and expectations for Rita's coursework. Thus, Ms. Hunt could help Rita coordinate her work across subjects and follow through on a self-management checklist of in-class assignments. Getting kids to use such self-monitoring tools has been found to improve on-task behavior in the classroom (Wood, Murdock, Cronin, Dawson, & Kirby, 1998); homework completion (Trammel, Schloss, & Alper, 1994); and academic performance (Wolfe, Heron, & Goddard, 2000).

As a result of their fluctuating moods, depressed students often have difficulties organizing work and persisting. Proactive strategies like monitoring progress and providing frequent feedback on whether students are meeting teachers' expectations are essential.

Teach Study Strategies

Rita's classroom teachers monitored her mood and energy level closely, periodically giving her a short break when her energy appeared to flag or her frustration peaked. They developed a system for Rita to initiate a break on her own. She moved to a quiet area of the classroom or left class to sit in the school counselor's office for 10 minutes; after this break, Rita returned to the task at hand.

The school considered the impact of side effects from Rita's antidepressant medications. Rita was allowed to keep water or juice on her desk to combat "dry mouth." She was seated close to the door in each class and given permission to leave the room quietly as needed to use the restroom.

Instructors also broke Rita's schoolwork into discrete tasks and helped her develop and manage a time line for when to complete each task based on her mood and energy levels. This enabled Rita's teachers to shorten or modify work. Teaching students with depression to recognize their typical mood and energy fluctuations throughout the day and take a break before returning to the task at hand increases their self-management.

Students with depression often find studying for tests a struggle because their disorder hampers independent study and concentration. Rita was given access to recorded class lectures that she could review outside class to assist her with taking notes and organizing class material to focus on relevant information. Teachers coached Rita in learning and study strategies to increase her independence in the classroom, including making outlines, doing conceptual mapping, and using mnemonic devices (memory skills can be dulled by depression [Brigham & Brigham, 2001]). Depressed students benefit from teacher-developed study guides for tests that enable them to focus on the most important material.

Within the general education classroom, Rita's teachers integrated specific interventions into the classroom routine. Typically, after the class started doing individual work, the classroom teacher would review with Rita the assignment and expectations. Throughout class, the teacher would frequently check on Rita's progress and give feedback on her performance. At the end of class, she would review Rita's work and provide her with any necessary materials or help she needed to complete the task.

Promote Social Interaction

Students suffering from depression often experience social difficulties and problems maintaining friendships as a result of mood fluctuations and their tendency to perceive relationships and interactions negatively. To foster an accepting, social environment for Rita, her teachers included cooperative group activities in the classroom and carefully selected whom to place in Rita's groups to increase the likelihood she would enjoy some positive interactions. Group work also let her share cognitive responsibilities, alleviating the stress depressed learners often feel about engaging in and completing learning demands independently (Perkins, 1993). Rita's teachers monitored her peer interactions and contribution to the group to ensure that she was participating.

Because students with depression often stop attending group activities they previously found engaging and view interactions with others negatively, it's important to intervene and schedule activities for these youth. Rita's parents and school staff collaborated to enroll her in an after-school program that focused on teaching social skills, and they arranged for individual counseling with the school psychologist. They worked to ensure that Rita took part in physical activity for a short period every day.

Communicate with the Student's Family

Brentwood School developed a home-school communication and tracking system that facilitated better communication between the school and Rita's family. Such communication systems increase depressed learners' participation in school activities by drawing on their personal experiences, letting parents know about classroom events and deadlines, offering a venue for problem solving, and reporting on progress (Davern, 2004).

Ms. Hunt noted Rita's daily progress toward goals and provided feedback on her mood and interactions through a home-school communication notebook. This notebook also enabled the family to keep Brentwood up-to-date on events at home, Rita's treatment, and other helpful information.

Confront the Issue of Suicide

Because Rita had mentioned suicide, it was imperative that school personnel monitor her suicidal thoughts or intentions. For many students, it's important to develop a "no-suicide contract"-an agreement between student and school in which a student promises that if he or she experiences suicidal impulses, the student will inform a health care professional, family member, or teacher rather than engage in self-injurious behavior. In Rita's case, Rita, her parents, and Ms. Hunt signed a contract that indicated the key people Rita should go to if she experienced such thoughts and the procedures and process that would be followed. If Rita told school personnel she was having suicidal thoughts, they would immediately contact Rita's parents, and her parents would take her to an emergency room for a psychiatric evaluation.

Replicating This Approach

Rita's case study reflects an ideal approach in a school where high levels of collaboration exist. Although many schools have worked hard to become more collaborative in their approach to working with students like Rita, in many places teachers will not find this level of support and collaboration. Teachers who find themselves in a school with less support and collaboration may not be able to implement as complete an approach as that discussed here, but they could implement many of the strategies noted.

For example, any teacher could initiate Monday morning meetings with a student struggling with a mood disorder to discuss the coming week, develop goals, and talk over how the student might keep up social interactions. A classroom teacher could support a student like Rita by providing a list of daily in-class assignments, coaching the student in organizing and initiating these tasks, and setting up a schedule to monitor progress and provide frequent feedback. Any teacher who sees one of her students facing mood fluctuations like Rita's could make task-by-task accommodations or modifications to meet that learner halfway, supply the kind of study supports discussed, and flexibly provide intermittent breaks throughout the day.

Depression in children and adolescents has significant implications for students' academic, behavioral, social, and physical well-being. School personnel must educate themselves on the characteristics and effects of depression, so they can provide the most effective interventions. Educators are responsible for not only meeting the academic needs of depressed students, but also ensuring their safety and welfare.

References

Brigham, R., & Brigham, M. (2001). Current practice alerts: Mnemonic instruction. Reston, VA: Council for Exceptional Children.

Burke, K. C., Burke, J. D., Regier, D. A., & Rae, D. S. (1990). Age at onset of selected mental disorders in five community populations. Archives of General Psychiatry, 47, 511-518.

Cash, R. E. (2003). When it hurts to be a teenager. Principal Leadership, 4(2), 11-15.

Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied Behavior Analysis (2nd ed.). Upper Saddle River, NJ: Pearson Education.

Davern, L. (2004). School-to-home notebooks: What parents have to say. Teaching Exceptional Children, 36(56), 22-27.

Forehand, R., Brody, G. H., Long, N., & Fauber, R. (1988). The interactive influence of adolescent and maternal depression on adolescent social and cognitive functioning. Cognitive Therapy and Research, 12, 341-350.

Hammen, C., & Rudolph, K. D. (2003). Childhood depression. In E. Mash & R. Barkley (Eds.), Childhood psychopathology (pp. 153-195). New York: Guilford Press.

Kashani, J., Rosenberg, T., & Reid, J. (1989). Developmental perspectives in child and adolescent depressive symptoms in a community sample. American Journal of Psychiatry, 146, 871-875.

Kovacs, M., Feinberg, T. L., Crouse-Novak, M. A., Paulauskas, S. L., & Finkelstein, R. (1984). Depressive disorders in childhood: I. A longitudinal prospective study of characteristics and recovery. Archives of General Psychiatry, 41, 229-237.

Lewinsohn, P. M., Hops, H., Roberts, R. E., Seeley, J. R., & Andrews, J. A. (1993). Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnormal Psychology, 102, 133-144.

Mitchell, J., McCauley, E., Burke, P. M., & Moss, S. J. (1988). Phenomenology of depression in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 12-20.

Perkins, D. N. (1993). Person plus: A distributed view of thinking and learning. In G. Salmon (Ed.), Distributed cognition: Psychological and educational considerations (pp. 88-110). Cambridge, England: Cambridge University Press.

Trammel, D. L., Schloss, P. J., & Alper, S. (1994). Using self-recording, evaluation, and graphing to increase completion of homework assignments. Journal of Learning Disabilities, 27, 75-81.

Wolfe, L. H., Heron, T. E., & Goddard, Y. I. (2000). Effects of self-monitoring on the on-task behavior and written language performance of elementary students with learning disabilities. Journal of Behavioral Education, 10, 49-73.

Wood, S. J., Murdock, J. Y., Cronin, M. E., Dawson, N. M., & Kirby, P. C. (1998). Effects of self-monitoring on on-task behaviors of at-risk middle school students. Journal of Behavioral Education, 9, 263-279.

Author's note: All names are pseudonyms.

R. Marc A. Crundwell is a school psychologist with Greater Essex County District School Board, Windsor, Ontario, Canada; marc.crundwell@gecsb.on.ca. Kim Killu is associate professor of special education, School of Education, University of Michigan-Dearborn; kimkillu@umd.umich.edu.

# data[].attributes.attachment_link.description
October 2010 | Volume 68 | Number 2 Interventions That Work Pages 46-51 R. Marc A. Crundwell and Kim Killu Rita's story illustrates the essential features of clinical depression in children and adolescents: a persistent sad or irritable mood, loss of energy, decreased interest in daily activities or previously enjoyed activities, persistent feelings of worthlessness or guilt, withdrawal, and, possibly, recurrent thoughts of suicide.

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YouTube about Depressive and Bipolar Disorders.

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YouTube about Depressive and Bipolar Disorders.

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Depressive and Bipolar Disorders: Crash Course Psychology #30

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Individual Education Plan for a student with dysfunctional behavior. 

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Individual Education Plan for a student with dysfunctional behavior. 

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effective treatments for bipolar disorder

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MoodNetwork, a project of Massachusetts General Hospital, is a nationwide effort to find the best treatments for depression and bipolar disorder. For the first time, patients, families, doctors, and researchers are working together as equal partners to change the direction of mood disorder research.

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Movie about Obsessive-Compulsive Disorder (OCD). 

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Movie about Obsessive-Compulsive Disorder (OCD). 

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As Good as It Gets is a 1997 American romantic comedy film directed by James L. Brooks. It stars Jack Nicholson as a misanthropic and obsessive-compulsive novelist, Helen Hunt as a single mother with a chronically ill son, and Greg Kinnear as a gay artist. The screenplay was written by Mark Andrus and Brooks.

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Help your child eat with trust, not logic: the bungee jump (Anorexia & other Eating Disorders)

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Teaching/Learning Guidance for emotional disturbed students. 

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Teaching/Learning Guidance for emotional disturbed students. 

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picture exchange communication system cards

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Do2Learn: Educational Resources for Special Needs

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picture communication cards, songs, games and learning activities for autism, aspergers, fetal alcohol syndrome and disabilities

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The purpose of the project is to provide and maintain an updated web-based platform to assist stakeholders such as local educational agencies (LEAs), advocates, and parents in learning about state and federal laws and regulations by providing rich resources regarding obligations and rights for the provision of a free and appropriate public education in the least restrictive environment to students with disabilities.

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Referral process for student with dysfunctional behavior.

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Referral process for student with dysfunctional behavior.

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Animated film about Attention-Deficit/Hyperactivity Disorders (ADHD). 

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Animated film about Attention-Deficit/Hyperactivity Disorders (ADHD). 

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The sketched animation, created to raise awareness, begins with a small boy's confusion as the letters slowly fall off the page of his school work.

Creatively he decides to use the blank page to fashion a paper boat.

The teacher is not impressed.

The silence is isolating as viewers watch the little boy's imagination run wild, because he cannot focus. He even misses the bus because he got distracted by a flower.

The NHS estimates that up to five percent of school-aged children have ADHD.

Childhood ADHD is more common in boys than girls.

According the charity ADDISS, symptoms include hyperactivity, impulsive behaviour, inattention, social clumsiness, poor coordination, disorganisation and mood swings.

Children diagnosed with ADHD often feel alienated and excluded as the video shows.

Last year, British parents were left distressed after one school asked them to keep their child home on Ofsted report days.

The video, shared on YouTube has touched many who have experienced the disorder first hand.

YouTube user sdcon1 commented: "I haven't cried about my son's childhood in a long time. This is a beautiful, important piece of work.

"I would like for every teacher to watch it and maybe, hopefully, find some compassion."

Beige Panda wrote: "I relate to this on way too many levels. Thanks so much for making this, I now understand how to describe how I've felt every single day at school."

Erik's previous animation the Looking Glass, was nominated for a Golden Palm for best short film at the Cannes film festival in 2007.

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Animated film gives TEARFUL insight into what it is like to live with ADHD as a child

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The sketched animation, created to raise awareness, begins with a small boy's confusion as the letters slowly fall off the page of his school work. Creatively he decides to use the blank page to fashion a paper boat. The teacher is not impressed.