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https://www.apa.org/topics/anxiety

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Anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.

People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness, or a rapid heartbeat.

Anxiety is not the same as fear, but they are often used interchangeably. Anxiety is considered a future-oriented, long-acting response broadly focused on a diffuse threat, whereas fear is an appropriate, present-oriented, and short-lived response to a clearly identifiable and specific threat.

Adapted from the Encyclopedia of Psychology and APA Dictionary of Psychology

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Anxiety is characterized by feelings of tension, worried thoughts and physical changes. Anxiety disorders such as panic disorder and obsessive compulsive disorder (OCD) cause recurring intrusive thoughts or concerns and physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat.

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Article: School-Based Anxiety Treatments for Children and Adolescents

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Article: School-Based Anxiety Treatments for Children and Adolescents

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399129/

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Child Adolesc Psychiatr Clin N Am. Author manuscript; available in PMC 2013 Jul 1.

Published in final edited form as:

Kathleen Herzig-Anderson, PhD, a Daniela Colognori, PsyD, a Jeremy K. Fox, PhD, Catherine E. Stewart, BA, a and Carrie Masia Warner, PhD a, b,*

SUMMARY

School-based empirically supported treatments for anxiety disorders are a promising avenue for providing necessary intervention to distressed youth who would otherwise never receive treatment. Sustaining such programs in school settings should be viewed as a multiple-stage process, from integration of the program into the institution and maintenance of the intervention to responding to institutional change and ownership of the program by the school.51 Given the scarce resources available to schools, additional research on embedding programs into the school culture and maximizing existing resources is essential to enhancing the sustainability of school-based interventions for anxiety disorders and reaching youth in need.

Keywords: Anxiety, School-based treatment, Children, Adolescents, Dissemination

Anxiety disorders are common among children and adolescents; however, anxious youth are rarely identified.1 Unlike disruptive behavior disorders, anxiety disorders often go unnoticed by teachers and parents because clinically anxious youth are generally compliant, follow rules, and do not draw attention. Therefore, it is not surprising that anxious youth are the least likely among youth with psychiatric disorders to receive treatment.2 Furthermore, even when youth access services, it is unclear what type of treatment they receive. Although several empirically supported treatments for anxious youth exist,3-5 more than 80% of community-based treatment for anxious youth is not supported by scientific evidence.6,7 There are also many barriers to treatment in traditional settings (eg, community clinics and independent clinicians), including stigma, long waitlists, and high costs.8 Taken together, these factors underscore the importance of exploring alternative venues and methods for identifying and treating youth with anxiety disorders.

ADVANTAGES OF SCHOOL-BASED TREATMENT

Schools are viewed as a promising avenue for providing mental health services to children and adolescents. Schools are already the main point-of-entry into the mental health service system for youth,9-12 with one study showing that more than 70% of mental health treatment for youth is provided by schools.10 In addition, because schools offer relatively convenient and inexpensive services, barriers to accessing specialty care, such as financial and transportation difficulties, can be eliminated.13,14 For example, school-based mental health clinics have been found to increase service utilization for both low-income adolescents15 as well as adolescents enrolled in a health maintenance organization.16 In light of common stigmas associated with mental health care, school-based treatment may also promote more positive attitudes toward mental health services among youth,17,18 especially when offered among a variety of other routine educational and counseling services. Access to treatment in schools may normalize mental health care and may therefore increase the likelihood of students in need receiving treatment.

For these reasons, school-based treatments are receiving increasing attention as a venue to address the unmet mental health needs of youth, particularly those with anxiety disorders.19 School-based treatments are particularly appropriate for anxiety disorders as schools provide unique opportunities for identification of anxious youth, treatment, and generalization of skills. For example, youth may display significant anxiety in academic and social settings at school that is not apparent or easily triggered in a more comfortable home environment with family support.20 Schools are also optimal for the treatment of anxiety disorders, as there are ample opportunities to help students confront the many anxiety-provoking situations present at school. Specifically, exposure exercises at school could focus on exams and tests for youth with generalized anxiety disorder and achievement-oriented worries. Socially anxious youth may be helped to face negative evaluation fears associated with public speaking, performance in gym and music classes, and approaching unfamiliar peers and authority figures. Additionally, peers and teachers may be enlisted to assist in exposures to feared situations. In sum, these factors indicate that schools are advantageous settings for the treatment of anxiety disorders in children and adolescents.

Although schools are ideal venues for anxiety disorder treatment in youth, only in recent years has the transportability of efficacious cognitive-behavioral treatments for anxiety disorders to schools been evaluated. This article will review four school-based treatments for anxiety disorders that have shown promise in controlled trials (see Table 1 for an overview and Table 2 for links to treatment manuals). This will be followed by a discussion of issues and challenges related to delivering anxiety treatments in a school environment and important areas for future research.

Table 1

Treatment

Number and
Length of
Sessions

Format

Treatment Components

Parent/Teacher
Components

Overview of
Effectiveness in
Schools

Implementation
Strengths and
Limitations

Cool Kids21

Eight 1-hour
sessions

Group

Psychoeducation, cognitive
restructuring, graduated
exposure, coping with
bullying, social skills,
assertiveness

Two parent
information
sessions on
parenting
strategies and
ways for parents
to manage their
own anxiety

Significantly greater
decreases in self-
and teacher-
reported anxiety
when compared
to waitlist control

Strengths:
* Group format
* Includes dealing with
bullying, social skills,
and assertiveness
components.
Limitations:
* Unknown if superior
to attention control
or other treatments.
* Use of community
mental health
workers is
unsustainable.

Baltimore Child
Anxiety Treatment
Study in the
Schools
(BCATSS)24-26

Ten 45-
minute
sessions24
or twelve
35-minute
sessions25

Group24 and
individual25,26

Psychoeducation, cognitive
restructuring, graduated
exposure, self-reward,
contingency
management, relaxation
skills, problem solving,
relapse prevention

Up to three sessions
include parents to
provide parenting
strategies and
psychoeducation.

Significantly greater
decreases in self-
and clinician-rated
anxiety compared
to attention-
support control in
one small study.
Another small
study found no
difference
compared to usual
care.

Strengths:
* Includes self-reward,
contingency
management, and
problem solving.
* Shown to be effective
with urban African
American youth.
Limitations:
* No teacher
components
* Individual format25,26

Cognitive-Behavioral
Intervention for
Trauma in Schools
(CBITS)28

Ten 1-hour
sessions

Group

Psychoeducation, cognitive
restructuring, graduated
exposure, processing of
traumatic memories,
relaxation skills, social
problem-solving skills,
adaptive coping skills

Two parent
education
meetings, one
teacher education
meeting

Two studies found
significantly
greater reductions
in PTSD symptoms
compared to
waitlist control.
One study found
significantly
greater reductions
in depressive
symptoms
compared to
waitlist control.

Strengths:
* Includes social
problem-solving
skills, processing
traumatic memories,
and adaptive coping
skills.
* Shown to be effective
with minor
adaptations for
urban multicultural
populations.
Limitations:
* Unknown whether it
is more effective
than attention
control.
* Use of school-based
psychiatric social
workers is not a
model most schools
have the resources to
replicate.

Support for Students
Exposed to Trauma
(SSET33;an
adaptation of
CBITS)

Ten 45-
minute
sessions
(one class
period)

Group

Psychoeducation, cognitive
restructuring, graduated
exposure, processing
traumatic memories,
relaxation skills, adaptive
coping, problem solving

Parent phone calls.
Can be
implemented by
teachers.

Small improvements
found in PTSD and
depressive
symptoms at 3-
month follow-up
in one study.

Strengths:
* Designed to be
implemented by
teachers and school
counselors.
Limitations:
* Only one study
without enough
power to determine
if modest results are
significant
* No significant parent
component

Skills for Academic
and Social Success
(SASS)35

Twelve 40-
minute
sessions

Group

Psychoeducation, cognitive
restructuring, graduated
exposure, social skills,
peer generalization
(through social events)

Two parent
meetings
including
psychoeducation
and parenting
strategies, two
teacher meetings

Significantly greater
number of
students were
classified as
responders to
treatment
compared to
waitlist and
attention control.

Strengths:
* Inclusion of social
skills and peer
generalization social
events
Limitations:
* To date, shown to be
effective only when
implemented by
clinical psychologists,
although study
examining SASS in
school counselors is
underway.

COOL KIDS

Treatment Description

The Cool Kids Program: School Version21 is an eight-session cognitive-behavioral intervention for anxiety symptoms in children, which was adapted for the school environment from previous group treatments for anxiety disorders.22 Sessions focus on core cognitive-behavioral treatment (CBT) components, such as psychoeducation, cognitive restructuring, and graduated exposure to anxiety-provoking situations. Additionally, Cool Kids includes sessions on assertiveness, coping with bullying, and social skills. Treatment sessions last about 1 hour each and are conducted during the school day in groups of eight to ten children. Two parent information sessions address parenting strategies as well as concepts taught to the children, which parents are encouraged to use to manage their own anxiety.

Evidence for Cool Kids

Mifsud and Rapee21 evaluated Cool Kids in a sample of 91 children (ages 9-10) by randomizing nine schools in low-income communities in Australia to either Cool Kids or a waitlist control.21 Students scoring in the clinical range of the Revised Manifest Anxiety Scale,23 a self-report measure of anxiety, were selected to participate. Groups were co-led by a school counselor and an experienced community mental health worker. Compared to the control, children in the Cool Kids condition showed significantly greater decreases in self- and teacher-reported anxiety both at post-treatment and 4-month follow-up. This study suggests that Cool Kids is a promising school-based intervention; however, since delivery by experienced community mental health workers is not a sustainable model, further research is needed to evaluate its effectiveness when delivered only by school-based providers.

BALTIMORE CHILD ANXIETY TREATMENT STUDY IN THE SCHOOLS

Treatment Description

Baltimore Child Anxiety Treatment Study in the Schools (BCATSS) 24-26 is designed to provide mental health treatment for inner-city adolescents with anxiety disorders as an integrated part of established school-based mental health clinics. The treatment was adapted from a previously supported group CBT program.5,27 The BCATSS program was tailored for the school environment and an urban, lower socioeconomic status, predominantly African American population (eg, examples were changed to be culturally relevant). Based on feedback from school mental health professionals, BCATSS was implemented individually during 12 weekly sessions (35 minutes each).25 This CBT program is comprised of psychoeducation, relaxation skills, problem solving, cognitive restructuring, relapse prevention and graduated in-vivo exposures to feared situations reinforced by self-reward and contingency contracts. The BCATSS intervention has a modular approach, allowing the clinician flexibility in choosing which core CBT skills ("modules") to deliver in a particular session based on the needs of the student.25 Optional parent sessions (one to three) were also added to increase involvement.26

Evidence for BCATSS

The BCATSS treatment has been evaluated in two small randomized controlled trials. Preliminary support for Ginsburg and Drake's24 adaptation of group CBT for a predominantly inner-city African American population was demonstrated in a small randomized controlled study ( N = 12) comparing BCATSS to an attention-support control in 14- to 17-year-old adolescents diagnosed with generalized anxiety disorder, social phobia, specific phobia, and/or agoraphobia. Two advanced psychology graduate students with training in CBT implemented the program. Results showed that self- and clinician-rated anxiety symptoms were significantly lower after treatment in the CBT group compared to the control group. In addition, 80% of the control group continued to meet criteria for an anxiety disorder after treatment, versus only 25% of the CBT group.

The second randomized controlled trial25,26 compared the BCATSS CBT program to usual care (UC) in a small study of 7- to 17-year-old ( M = 10.28) inner-city African American youth with anxiety disorders ( N = 32). Therapists were school-based master's and doctoral level clinicians, trained primarily in social work, counseling, or psychology. Because there was only one clinician per school, the same clinician implemented both conditions.25 Clinicians were explicitly instructed to exclude CBT techniques in the usual care condition and instead implement nonspecific strategies, such as art and supportive therapy.26 Results showed no differences across conditions at post-treatment, with 50% of CBT participants and 46% of UC participants no longer meeting criteria for an anxiety disorder. Similar results were found at 1-month follow-up: 42% of participants in the CBT group and 57% in the UC group no longer met criteria for an anxiety disorder. A central methodologic limitation was that CBT-trained clinicians also delivered usual care, resulting in poor treatment differentiation across conditions. Per review of 25% of UC therapy sessions, 56% contained CBT techniques, despite ongoing coaching to exclude these components. In addition, although the authors rated how much of the module content (eg, psychoeducation, exposure) was delivered (adherence), they did not report how skillfully these specific techniques were conducted (competence). Therefore, it is possible that the implementation quality impacted treatment outcome. Another possibility is that novice therapists may be more effective with structured rather than flexible treatments, as the latter may require more expertise to determine the appropriate module to deliver. Clearly, several questions remain unanswered, and thus additional research examining the value of modular treatments may be necessary.

COGNITIVE-BEHAVIORAL INTERVENTION FOR TRAUMA IN SCHOOLS

Treatment Description

Cognitive-Behavioral Intervention for Trauma in Schools (CBITS)28 is a school-based group treatment developed for youth ages 10 to 15 with clinically significant symptoms of posttraumatic stress disorder (PTSD) and depression secondary to trauma exposure (excluding sexual abuse). CBITS was designed to be implemented by mental health clinicians in an urban multicultural environment. CBITS is generally comprised of ten one-hour weekly group treatment sessions (five to eight students per group), one to three individual sessions, two optional parent education meetings, and one teacher education meeting.28,29 The treatment elements of CBITS include psychoeducation, relaxation, adaptive coping skills, cognitive restructuring techniques, graduated imaginal exposure to traumatic memories, processing of traumatic memories, and social problem solving skills. Imaginal exposure through writing and drawing is initially conducted in individual sessions and subsequently in the group. CBITS sessions present skills using a combination of didactic presentation, developmentally appropriate examples, worksheets, and games. The focus of treatment is the generalization of concepts learned in treatment sessions to real-life situations by applying them to a given child's specific difficulties.28

Evidence for CBITS

Two randomized controlled trials have shown support for CBITS compared to a waitlist control in youth with clinically significant PTSD symptoms secondary to exposure to community violence.28,30 In both studies, CBITS was implemented by psychiatric social workers based in the school districts' mental health clinic. The first study ( N = 199) found that third through eighth graders (mean age = 11.4 years; SD = 1.7) with clinically elevated PTSD symptoms participating in CBITS had significantly lower PTSD symptoms post-treatment compared to waitlist control.30 Small adaptations for this study included reducing group sessions from ten to eight and increasing parent sessions from two to four, which focused on themes of loss and separation common to immigration. Similarly, Stein and colleagues28 found that sixth graders ( N = 126) participating in CBITS reported significantly greater reductions in PTSD and depressive symptoms compared to those in the waitlist control group three months and six months post-treatment. These two studies provide evidence for the effectiveness of CBITS for PTSD symptoms when implemented in urban multicultural schools.

The feasibility of school-based group CBITS compared to clinic-based individual Trauma Focused-Cognitive-Behavioral Therapy (TF-CBT) was supported by an investigation of fourth to eighth graders ( N = 118) with elevated PTSD symptoms 15-months post-Hurricane Katrina in New Orleans.31 Three components of CBITS were not delivered in this study due to resource and time limitations: the individual session prior to the start of group, teacher informational meetings and in two of the three schools, parent meetings. The CBITS treatment was implemented by school-based mental health professionals, while TF-CBT was conducted by social workers and psychologists employed at a community mental health center.32 Although youth in both treatment groups showed clinically significant improvements in PTSD symptoms at 10-month follow-up, CBITS was far more accessible to participants as 98% of youth randomized to CBITS were enrolled in treatment compared to only 23% of youth assigned to TF-CBT. This highlights the greater ability of school-based treatments to reach and retain distressed youth compared to treatments delivered in traditional community mental health settings.

Support for Students Exposed to Trauma

Support for Students Exposed to Trauma (SSET),33 an adaptation of CBITS, was designed to be implemented by school counselors and teachers to increase accessibility. SSET delivers the components of CBITS in 10 weekly group sessions utilizing a lesson plan format and omits the individual and parent meetings included in CBITS. SSET showed superiority to a waitlist control in 76 sixth to eighth graders scoring at least 11 on the Child PTSD Symptom Scale 34 (ie, moderate to high PTSD symptoms) subsequent to exposure to violence within the last year. Students in the SSET group showed small improvements in PTSD and depressive symptoms at 3-month follow-up. While these decreases appeared to be more substantial than those of the waitlist control, the small sample size limited the statistical power to detect effects. Although additional studies are needed, these preliminary findings suggest that SSET is a feasible intervention for PTSD symptoms that can be delivered by school personnel.

SKILLS FOR ACADEMIC AND SOCIAL SUCCESS

Treatment Description

Skills for Academic and Social Success (SASS)35 is a school-based group CBT program for adolescents with social anxiety disorder adapted from Social Effectiveness Therapy for Children (SET-C), an efficacious group treatment for children with social anxiety disorder.3,36 Like SET-C, SASS focuses on gradual exposure, social skills, and peer generalization. However, SASS includes adaptations for adolescents (eg, addition of realistic thinking) and the school environment (eg, shorter sessions, involvement of teachers). SASS consists of 12 weekly 40-minute (ie, one class period) group sessions, two individual meetings, two parent meetings, two teacher meetings, four social events with outgoing peers, and two booster sessions. Social skills training includes initiating and maintaining conversations, nonverbal behaviors (eg, maintaining good eye contact), and assertiveness. Graduated in vivo exposures to feared social situations are often integrated into the school environment, for example, volunteering to answer a question in class, talking with a teacher, or giving an oral presentation. Individual meetings focus on setting goals and problem solving any obstacles to treatment. To increase generalization of skills and exposure to real-world settings, the four social events are conducted with group members and outgoing peers together in settings adolescents often spend time in, such as bowling or laser tag. Parent meetings include psychoeducation, parenting strategies including preventing their child's avoidance, and rewarding nonanxious behavior. Teacher meetings focus on the goals of SASS, education regarding social anxiety, and enlisting teachers' help with classroom exposures.

Evidence for SASS

Support for SASS has been provided by two randomized controlled trials. The first investigation compared SASS to a waitlist control in urban parochial high school students with social anxiety disorder ( N = 35).37 Groups were co-led by a clinical psychologist and a psychology graduate student. Results found that 94% of SASS participants were classified as responders based on their improved functioning at post-treatment, versus only 12% of the control group. In addition, 67% of SASS participants, compared to only 6% of controls, no longer met criteria for social anxiety disorder post-treatment. Lower clinician-rated diagnostic severity and self-reported social anxiety and social avoidance were found for the SASS group at post-treatment and 9-month follow-up.

The second trial examined the specific efficacy of SASS compared to a credible attention control in adolescents aged 14 to 16 ( N = 36) with a primary diagnosis of social anxiety disorder.1 The attention control group, equal in time and adult attention, included relaxation training and four social events without outgoing peers. Results demonstrated superiority of SASS, with more than 82% of SASS participants classified as responders, compared to 7% of those in the attention control. Importantly, only 41% of SASS participants continued to meet criteria for social anxiety disorder post-treatment, while all control participants still qualified for the disorder. Students receiving SASS also exhibited greater overall improvement and lower clinician-rated social anxiety severity at post-treatment and 6-month follow-up.

Currently, Masia Warner and colleagues are conducting a large, federally funded, randomized controlled trial of SASS implemented by school guidance counselors to investigate its transportability to school settings.38 This study will examine whether school personnel without specialized training in CBT can effectively deliver a cognitive-behavioral intervention. Positive findings would highlight the potential effectiveness of a more sustainable model of evidence-based care delivered by school personnel to reach underserved youth with social anxiety disorder.

Summary of School-Based Anxiety Treatments

Studies of school-based treatment programs for anxiety disorders in youth suggest promise for effectively delivering these evidence-based programs in schools. However, several gaps in our current knowledge exist. One shortcoming has been the reliance on specialized mental health clinicians to deliver interventions, which is costly and resource intensive. Researchers have called for training school-based personnel (eg, school counselors and teachers) to deliver these evidence-based interventions, but it remains unknown whether they can do so effectively. In addition, surprisingly few investigations of school-based anxiety treatments have investigated the impact of intervention on academic and other school-related variables upon which schools are evaluated (eg, grades, standardized test scores, attendance). Overall, many questions remain regarding methods to facilitate successful implementation and sustainability of school-based mental health programs. The following section focuses on several areas requiring additional exploration, such as the integration of treatments into school culture, improving identification of anxious youth, and the utilization of school-based personnel as treatment providers.

IMPLICATIONS FOR RESEARCH AND PRACTICE

School Culture and Context

Efforts to increase the accessibility of evidence-based treatments to youth with anxiety disorders may be bolstered by a better understanding of factors affecting the ability of schools to adopt and sustain mental health programs. Consideration of school context, such as school climate, resources, and the impact of educational accountability, will likely influence whether schools will accept and prioritize these treatments.39 Because schools' main focus is education, future studies providing evidence that school-based treatments positively affect academics and other variables aligning with school values are essential to increasing uptake and sustainability of school-based treatments. Further research on methods to better integrate mental health programs into the school culture may also improve the acceptability of programs to important stakeholders, such as school administrators. For example, incorporating treatment components into the general classroom curriculum has been found to increase program sustainability for universal intervention programs.40 Applying this concept to targeted students with anxiety disorders, such as evaluating integration of school-based programs into existing student services (eg, guidance counseling) or extracurricular activities (eg, club format), may also increase feasibility. Finally, future research should examine optimal methods to maximize schools' existing resources to manage students' mental health needs. For instance, Ringeisen and colleagues39 suggest replacing the current individualized case management approach to school-based mental health care with a model combining classroom-based intervention and as-needed group treatment or consultation from specialized clinicians. This innovative model, along with other methods to improve integration of mental health services into the existing school culture, is critical to increasing long-term sustainability of school-based mental health programs.

Identification of Clinically Anxious Students

Another essential area for future study will be testing methods for enhancing recognition or detection of youth with anxiety disorders. Research on the ability of school personnel to identify youth with internalizing disorders has focused mostly on teachers rather than more specialized personnel such as counselors, and findings have been inconclusive. Not surprisingly, teachers are generally more likely to recognize externalizing behaviors than internalizing problems such as anxiety and depression.41,42 There is some evidence to suggest that youth are more likely to access services when school personnel (eg, teachers, school counselors) are made aware of their anxiety rather than parents or other adults.43 This indicates that research on educating and training school personnel in the identification of anxiety, through observation or school-wide screenings, is critical to increasing early detection and treatment.44,45 Studies examining the accuracy and sensitivity of self-report measures in predicting anxiety disorders would clarify the effectiveness and efficiency of utilizing these measures in school-wide screenings to identify anxious youth. Of course, a challenge of improving methods for identifying anxious youth is the resulting increase in referrals for mental health care, which schools may not be equipped to handle. This highlights the importance of increasing the availability of mental health care providers through school-based treatments.

School-Based Treatment Providers

To date, the majority of investigations of school-based interventions have been implemented by mental health clinicians employed by research teams. Because the costs and feasibility of hiring mental health clinicians are prohibitive for most schools, there is a significant need to establish the effectiveness of school-based interventions for anxiety disorders when delivered by school personnel. With specialized training, supervision, and support, school guidance counselors may be ideal candidates to be trained in the implementation of mental health interventions. School counselors are present in all high schools, typically comprise a large team, and enter their profession to assist and guide youth.46 Furthermore, a recent national survey revealed that 90% of guidance counselors wanted reductions in administrative tasks and caseloads to increase time for assisting students and receiving training.47 This indicates that guidance counselors may be open to opportunities to receive training in school-based treatments, especially because guidance counselors are routinely asked to manage their students' emotional needs.

However, the literature has shown that efficacious treatments delivered in research settings often show reduced effectiveness in clinical settings.48 It has been theorized that treatment fidelity, defined as adequate adherence to a treatment manual and competence in delivery,49 is related to treatment outcome.50 Further research is needed to document this relationship and to identify what levels of fidelity are sufficient for treatment response, which has the potential to inform training approaches and supervision. The ongoing study by Masia Warner and colleagues examining whether school counselors can effectively implement a group CBT program for adolescents with social anxiety disorder will contribute to this gap in the literature.

​

School-based empirically supported treatments for anxiety disorders are a promising avenue for providing necessary intervention to distressed youth who would otherwise never receive treatment.

Sustaining such programs in school settings should be viewed as a multiple-stage process, from integration of the program into the institution and maintenance of the intervention to responding to institutional change and ownership of the program by the school.

Given the scarce resources available to schools, additional research on embedding programs into the school culture and maximizing existing resources is essential to enhancing the sustainability of school-based interventions for anxiety disorders and reaching youth in need.

Acknowledgments

This work was supported by NIMH Grant No. R01MH081881 awarded to Carrie Masia Warner, PhD.

Footnotes

The authors have nothing to disclose.

REFERENCES

13. Catron T, Harris VS, Weiss B. Posttreatment results after 2 years of services in the Vanderbilt school-based counseling project. In: Epstein MH, Kutash K, Duchnowski A, editors. Outcomes for children and youth with emotional and behavioral disorders and their families: programs and evaluation best practices. PRO-ED; Austin (TX): 1998. pp. 633-40. [ Google Scholar]

27. Ginsburg G, Silverman W, Kurtines W. Cognitive-behavioral group therapy. In: Eisen A, Kearney C, Schaefer C, editors. Clinical handbook of anxiety disorders in children and adolescents. Jason Aronson; Northvale (NJ): 1995. pp. 521-49. [ Google Scholar]

29. Jaycox LH, Morse LK, Tanielian T, et al. [Accessed May 16, 2012];How schools can help students recover from traumatic experiences: a tool kit for supporting long-term recovery 2006. Available at:http://www.rand.org/pubs/technical_reports/TR413.html.

35. Masia C, Beidel DC, Fisher PH, et al. Skills for academic and social success. New York University School of Medicine; New York: 1999. [ Google Scholar]

38. Masia Warner C, Ryan J, Colognori D, et al. Adapting treatment of social anxiety disorder for delivery in schools: training school counselors to deliver a cognitive-behavioral intervention. In: Gallagher R, editor. How to keep from getting schooled: dissemination and implementation of empirically-based programs for children and adolescents in educational settings; Symposium presented at the 45th annual meeting of the Association for Behavioral and Cognitive Therapies; Toronto, ON. November 2011; Chair. [ Google Scholar]

41. Burnett-Zeigler I, Lyons JS. Youth characteristics associated with intensity of service use in a school-based mental health intervention. J Child Fam Stud. 2011 DOI: 10.1007/s10826-011-9555-z. [ Google Scholar]

43. Colognori D, Ryan JL, Fox JK, et al. Mental health service utilization in a community sample of socially anxious adolescents. In: Masia Warner C, Ryan J, editors. Mental health service utilization in youth: deficiencies of availability, awareness, and use of evidence-based treatments; Symposium presented at the 45th annual meeting of the Association for Behavioral and Cognitive Therapies; Toronto, ON. November 2011; Co-Chairs. [ Google Scholar]

47. Bridgeland J, Bruce M. [Accessed December 27, 2011];National survey of school counselors: counseling at a crossroads 2011. Available at: http://media.collegeboard.com/digitalServices/pdf/nosca/11b_4230_NarReport_BOOKLET_WEB_111104.pdf.

# data[].attributes.attachment_link.title
School-Based Anxiety Treatments for Children and Adolescents

# data[].attributes.attachment_link.description
Child Adolesc Psychiatr Clin N Am. Author manuscript; available in PMC 2013 Jul 1. Published in final edited form as: Kathleen Herzig-Anderson, PhD, a Daniela Colognori, PsyD, a Jeremy K. Fox, PhD, Catherine E.

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Article: Treating Anxiety Disorders in Youth

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Article: Treating Anxiety Disorders in Youth

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http://www.worrywisekids.org/

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From Dr. Tamar Chansky Creator of Worrywisekids.org

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Article: Addressing Anxiety in School Settings: Information for Counselors

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Article: Addressing Anxiety in School Settings: Information for Counselors

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https://www.insidehighered.com/news/2017/03/29/anxiety-and-depression-are-primary-concerns-students-seeking-counseling-services

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Inside Higher Ed | Higher Education News, Events and Jobs

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More than half of the college students who visited their campus counseling centers during the 2015-16 academic year reported symptoms of anxiety, according to a survey by the Association for University and College Counseling Center Directors.

This marks the seventh year in a row that anxiety has been the top complaint among students seeking mental health services. This year, 51 percent of students who visited a counseling center reported having anxiety, followed by depression (41 percent), relationship concerns (34 percent) and suicidal ideation (20.5 percent). Many students reported experiencing multiple conditions at once.

Since 2009, when anxiety overtook depression as the No. 1 concern among college students, the number of students experiencing anxiety has steadily increased.

This survey was conducted between September 2015 and August 2016. In total, 529 counseling center directors representing that many institutions responded to the survey, with an even split between public and private institutions. The majority of respondents came from four-year colleges, but community colleges, professional schools and art schools were also included.

In an effort to reflect the makeup of their student bodies, counseling centers have diversified their clinical staff members. Of new hires, 62.2 percent are white, 15.3 percent black, 7.5 percent Latino and 10 percent Asian. This compares to current clinical staff, who are 70.9 percent white, 10.1 percent black, 7.3 percent Latino and 7.9 percent Asian.

"Student populations have become more diverse," said Micky Sharma, president of the AUCCCD and director of counseling and consultation services at Ohio State University. "Counseling services work to create a staff that represents their student bodies."

At Ohio State, for example, the counseling center now offers clinical services in nine different languages to meet the needs of their international students, who make up about 12 percent of the student body, Sharma said.

Regardless of race, ethnicity, gender or sexual orientation, "anyone could show up with anxiety or depression or a relationship issue," Sharma said. "A university counseling center is charged with providing help for everybody."

Another key finding in the survey is that 41.6 percent of counseling centers hired additional staff members in the last academic year, compared to about 26 percent in 2011 and 36 percent in 2016.

College counseling centers continue to grow to match the demands of their students, according to David Reetz, the lead researcher and coordinator for the 2016 survey and director of counseling and psychological services at the Rochester Institute of Technology.

"More students are seeking services because we continue to be more and more aware that a student's health and well-being have a lot to do with their success in their academic programs and the quality of their student life experience," Reetz said.

In fact, of the students surveyed, about 72 percent who used counseling services said it helped their academic performance in some way.

As more students continue to seek out mental health services and campus counseling centers try to keep up with new hires, the question of student wait times becomes key.

For the first time, this year's survey asked counseling center directors about average wait times for students based on the number of business days between when the appointment was scheduled and when it occurred.

The survey team found that, on average, students waited between six and eight business days for counseling services. However, as might be expected, institutions with a lower ratio of professional staff to students saw shorter wait times.

Reetz noted that the wait-time average is a "tricky number," given that some students opt to schedule their first appointment farther out to accommodate their own schedules.

"Students don't necessarily want to be seen right away," Reetz said, adding that, generally, "the more staff a center has, the shorter that wait time is between initial contact and first appointment."

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Anxiety and depression are the primary concerns for students seeking counseling services

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Survey of campus counseling centers finds increased demand for services, as well as additional positions and more diversity in hiring.

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American Psychological Association. (2022). Anxiety. Encyclopedia of
Psychology APA. https://www.apa.org/topics/anxiety

Herzig-Anderson, K., Colognori, D., . . . Warner, C. (2012). School-based
anxiety treatments for children and adolescents. National Center for
Biotechnology Information (NCBI).
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Paylo, M., Dari, T., & Kress, V. (2015). Treating anxiety disorders in youth.
American Counseling Association. www.counseling.org/practice_briefs

WorryWiseKids.org. (2022). Anxiety types. The Children's and Adult
Center for OCD and Anxiety. http://www.worrywisekids.org/node/47

Ybanez-Llorente, K. (2014). Addressing anxiety in school settings:
Information for counselors. American Counseling Association. 62. 1-
15. counseling.org/knowledge-center/vistas

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The Texas Model for Comprehensive School Counseling Programs

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The Texas Model for Comprehensive School Counseling Programs

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https://tea.texas.gov/sites/default/files/Pub_2018_Texas-Model_5th-Edition.pdf

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https://add.org/adhd-facts/

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ADDA - Attention Deficit Disorder Association

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Written by Michelle Frank, Psy.D., as adapted and updated from Peter Jaska's article, "ADHD Facts" originally posted on the ADDA website in 1998

REFERENCES:

Auerbach, J.G., Atzaba-Poria, N., Berger, A., Landau, R., Arbelle, S., Raz, Y., & Ebstein, R. (2010). Dopamine risk and paternal ADHD symptomatology associated with ADHD symptoms in four and a half-year-old boys. Psychiatric Genetics, 20(4), 160-165. doi: 10.1097/YPG.0b013e32833a1f27.

Barkley, R., Murphy, K.R., & Fischer, M. (2008). ADHD in adults: What the science says. The Guildford Press: New York, NY.

Castellanos, X. (2002). Anatomic magnetic resonance imaging studies of Attention Deficit Hyperactivity Disorder.Dialogues in Clinical Neuroscience, 4(4), 444-448.

Castellanos, X., Lee, P., Sharp, W., Jeffries, N., Greenstein, D. Clasen, L., Blumenthall, J., . . . Rapoport, J. (2002). Developmental trajectories of brain volume abnormalities in children and adolescents with Attention Deficit/Hyperactivity Disorder. JAMA, 288(14), 1740-1748. doi:10.1001/jama.288.14.1740.

Cho, S., Son, J., Kim, B., Kim, J., Yoo, H., Hwang, J., Cho, D., Chung, U., & Park, T. (2012). Serotonin 2A receptor gene polymorphism in Korean children with Attention-Deficit/Hyperactivity Disorder. Psychiatry Investigations, 9(3), 269-277. doi:10.4306/pi.2012.9.3.269

Kessler, R., Adler, L., Barkley, R., Biederman, J., Conners, C., Demier, O., Faraone, S., . . . Zaslavsky, A. (2006). The prevalence and correclates of adult ADHD in the United States: results from the National Comorbidity Survey replication. The American Journal of Pyschiatry, 163(4), 716-723.

Faraone, S. (2007). What is the prevalence of adult ADHD? Results of a population screen of 966 adults. Journal of Attention Disorders, 9(2), 384-391. doi: 10.1177/1087054705281478

Gizer, I.R., Waldman, I.D., Abramowitz, A., Barr, C.L., Feng, Y., Wigg, K.G., Misener, V.L., & Rowe, D.C. (2008). Relations between multi-informant assessments of ADHD symptoms, DAT1, and DRD4. Abnormal Psychology, 117(4), 869-880. doi: 10.1037/a0013297.

Henrigquez, B.H., Henriquez, H.M., Carrasco, C.X, Rothhammer, A.P., Llop, R.E., Aboitiz, F., & Rothhammer, E.F. (2008) Combination of DRD4 and DAT1 genotypes is an important risk factor for attention deficit disorder with hyperactivity families living in Santiago, Chile. Revista Medica de Chile, 136(6), 719-724. doi: /S0034-98872008000600005.

Lee, S.S., Humphreys, K.L., Flory, K., Liu, R., & Glass, K. (2011). Prospective association of childhood Attention Defict/Hyperactivity Disorder (ADHD) and substance use and abuse/dependence: A meta-analytic review. Clinical Psychology Review, 31(3), 328-341. Doi: 10.1016/j.cpr.2011.01.006

McCarthy, H., Skokauskas, N., Mulligan, A., Donohoe, G., Mullins, D., Kelly, J., Johnson, K., . . . Frodi, T. (2013). Attention network hypoconnectivity with default and affective network hyperconnectivity in adults diagnosed with attention-deficit/hyperactivity disorder in childhood. JAMA Psychiatry, 70(12), 1320-1337. doi: 10.1001/jamapsychiatry.2013.2174.

Metin, B., Krebs, R.M., Wiersema, J.R., Verguts, T., Gasthuys, R., van der Meere, J.J., Achten.E., . . . Sonuga-Barke, E. (2014). Dysfunctional Modulation of Default Mode Network Activity in Attention-Deficit/Hyperactivity Disorder. Journal of Abnormal Psychology, 2014 (Oct 13) [Epub ahead of print].

Minde, K., Eakin, L., Hechtman, L., Ochs, E., Bouffard, R., Greenfield, B., & Looper, K. (2003). The psychosocial functioning of children and spouses of adults with ADHD. Jounral of Child Psychology and Psychiatry, 44(4), 627-646. doi: 10.1111/1469-7610.00150

Polanczyk, G., Silva de Lima, M., Horta, B.L. Biederman, J., & Rohde, L.A. (2007). The worldwide prevalence of ADHD: A systematic review and meta-regression analysis. The American Journal of Psychiatry, 164(6), 942-948.

Spencer, T.J., Biederman, J., & Michk, E. (2007). Attention-Deficit/Hyperactivity Disorder: Diagnosis, lifespan, comorbidities, and neurobiology. Pediatric Psychology, 32(6), 631-642. Doi: 10.1093/jpepsy/jsm005

Tomasi,D., &Vokow, N.D. (2014). Functional connectivity of substantia nigra and ventral tegmental area: maturation during adolescence and effects of ADHD. Cerebral Cortex, 24(4), 935-944. doi: 10.1093/cercor/bhs382.

Uddin, L.W., Kelly, A.M., Biswal, B.B., Margulies, D.S., Shehzad, Z., Shaw, D. Ghaffari, M., . . . Milham, M.P. (2008). Network homogeneity reveals decreased integrity of default-mode network in ADHD. Journal of Neuroscience Methods, 169(1), 249-254.

Volkow, N., Wang, G.J., Kollins, S., Wigal, T., Newcorn, J. Telang, F., Fowler, J., . . . Swanson, J. (2009). Evaluating dopamine reward pathway in ADHD: Clinical implications. JAMA, 302(10), 1084-1091. doi:10.1001/jama.2009.1308.

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Written by Michelle Frank, Psy.D., as adapted and updated from Peter Jaska's article, "ADHD Facts" originally posted on the ADDA website in 1998 REFERENCES: Auerbach, J.G., Atzaba-Poria, N., Berger, A., Landau, R., Arbelle, S., Raz, Y., & Ebstein, R. (2010). Dopamine risk and paternal ADHD symptomatology associated with ADHD symptoms in four and a half-year-old boys.

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Cognitive Behavioral Therapy for ADHD in Schools

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Cognitive Behavioral Therapy for ADHD in Schools

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https://beckinstitute.org/blog/cbt-for-adhd-youth-back-to-school-strategies/

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By Betsy Feinberg, PsyD

Beck Institute Adjunct Faculty

With back-to-school season in full swing, caregivers, teachers, and children alike are facing a familiar crossroads. Amid the difficult choices currently at play regarding COVID-19 and vaccinations, many must also return to the more typical issues that arise at school each year. For children and youth with ADHD, the start of the school year presents additional challenges.

CBT for ADHD involves evidence-based, practical applications, tips, and tools that have been shown to be effective in clinical practice. It is important to take a multi-modal approach that engages both the child as well as their caregiver(s) and teachers. For caregivers and teachers, the approach involves not only administering behavioral interventions, but also using CBT to help restructure their own thoughts about the child and reframe expectations. In many cases, effectively collaborating with the teacher is a missing piece that can help change both the child with ADHD's mental framework and the teacher's way of viewing their struggles.

For the therapist:

Evidence shows the most lasting and effective behavioral changes occur when we are rewarding behaviors we want to see, as opposed to punishing those we do not. Therapists often struggle with how to maintain the focus of youth with ADHD within the context of the therapy session. There are a number of strategies that can be employed, including the "mystery timer," which is based on the concept of variable reinforcement. The therapist sets a timer for a mystery amount of time, and for every time the timer buzzes, the child gets a point for positive behaviors (e.g., being seated in their chair, focusing on the conversation, etc.). The therapist and child collaborate beforehand, discussing which behaviors are favorable, deciding on how many points earn a reward, and defining what the reward will be (this can be pre-arranged with the caregiver). Strategies like these tend to help change the dynamic in session from frustration to excitement.

For the teacher:

A practical strategy that can be used to bridge the gap between home and school is creating a home and school report card. This is a way to give kids consistent, systematic, ongoing feedback, as well as an opportunity for praise and recognition of behaviors that the teacher wants to encourage and develop, which strengthens the positive behaviors. This also allows for more seamless communication with caregivers on a regular basis regarding the functioning of the child. Like the mystery timer, the behaviors being observed should be defined well in advance, and caregivers are encouraged follow through on positive feedback with some kind of incentive or reward. In general, patients are more successful when there is regular communication between home and school and when there's a focus on praise.

For the caregiver:

One of the most important pieces of the ADHD puzzle involves cognitive reframing on the caregivers' part. In short, kids are not giving their caregivers a hard time - these kids are having a hard time themselves. It is easy for the caregiver to get stuck labeling children as disobedient or frustrating, which can trigger negative emotions, leading to unhelpful behaviors and interactions. When caregivers reframe the view that the child is not intentionally trying to engage in negative behaviors, their emotions tend to change to empathy. Empathetic actions impact the child, making them more motivated to work toward positive behaviors. With ADHD, the onus is on the caregiver to take some degree of leadership for behavioral interventions. When employing CBT strategies for youth with ADHD, there is an expectation to keep up with interventions in order to maintain progress. It is essential, then, for caregivers to be involved in sessions to some degree.

Since youth with ADHD are often scolded, yelled at, or misunderstood, it is likely that they will develop distortions in the way they see themselves. Over time, they may internalize these messages and start to believe they there is something inherently wrong with them that cannot be fixed. Through the course of CBT treatment, there is an opportunity to provide solid psychoeducation as to what ADHD is, to normalize the child's experience, and to explore it together. This can help kids feel more hopeful about themselves and their future, increasing positive feelings and decreasing self-blame and self-criticism.

A final, more fun activity to do with youth struggling with ADHD is to take time to look up people with ADHD who are famous or admired by the child. This helps them see that just because they have this diagnosis, it does not mean they will not be able to have success, realize their goals, and live in accordance with their values.

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CBT for ADHD in Youth: Back-to-School Strategies for Therapists, Teachers, and Caregivers - Beck Institute

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By Betsy Feinberg, PsyD Beck Institute Adjunct Faculty With back-to-school season in full swing, caregivers, teachers, and children alike are facing a familiar crossroads. Amid the difficult choices currently at play regarding COVID-19 and vaccinations, many must also return to the more typical issues that arise at school each year.

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https://psychcentral.com/adhd/cbt-for-adhd

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Cognitive behavioral therapy (CBT) is an increasingly popular option for managing ADHD, either as a supplement to ADHD medication or as a replacement.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects the way you regulate focus and behavior. The characteristics of ADHD fall into three categories:

Education, medication, and therapy are all approaches that can help manage your ADHD symptoms. Cognitive behavioral therapy (CBT) is a type of therapy that examines how thought affects behavior and emotions.

CBT can help teach you to recognize which thoughts cause unwelcome actions and feelings, and how to replace them with better-serving ones.

CBT for ADHD can be an effective treatment option for children. It can teach them coping strategies and skills to more successfully self-regulate.

For instance, a CBT therapist may suggest a child with ADHD use a planner to write down important tasks as a way to promote better organization. Older children might find a cellphone app more convenient and use other useful tools like timers, alarms, and calendars on their phones.

CBT can also help young people manage emotions. Living with ADHD may feel stressful at times, particularly for those who hear regular criticism from adults and peers. In fact, it's estimated that around of children with ADHD also have anxiety, reports a 2019 study.

CBT strategies for ADHD can help ease the impact of anxiety by reducing the power of demoralizing thoughts, including:

assuming other people think poorly of them

paying more attention to mistakes than successes

blaming themselves for occurrences out of their control

seeing only the negative

feeling inferior when focusing on another person's strengths

believing that a single mistake cancels all the good they've done

using "always" or "never" to describe negative occurrences, like "I always forget my lunch"

Imagine a child with ADHD at recess feeling like they're to blame when a second child is sullen and doesn't want to play.

CBT helps this child remember it might not be their fault: The second child might have another reason for their mood, like fatigue, hunger, or disappointment from an unknown cause.

CBT can also help make task completion easier for children with ADHD. Cleaning their room might feel overwhelming and make them feel like it will "take forever!" CBT can teach them how to break large jobs into smaller tasks. For example, picking up clothes first when cleaning their room.

Therapy combined with medication is often the most successful approach in treating ADHD. This is because medication works quickly to reduce the impact of symptoms. Meanwhile, therapy takes longer to work but teaches skills children can use throughout life.

A 2015 research review clarifies that stimulant medication can be very effective, but only while taken. Therapy, on the other hand, results in long-term improvements in decision making, problem-solving, planning, organizational skills, and more.

Evidence suggests that CBT for ADHD may help manage common ADHD symptoms in adults.

A 2019 study involving 124 participants addressed whether CBT works better alone or with medication to manage ADHD.

Researchers concluded that while CBT helps both with and without medication, it tends to be most effective when paired with medication for supporting time management, organizational skills, and other self-regulating skills.

People with ADHD may experience challenges with organization and time management. CBT may be able to help with this.

How CBT can help manage ADHD

Imagine you have an event planned for a week away. You think to yourself, "I'll prepare the day before."

That day arrives, and you find yourself short on time and scrambling to get ready. The event doesn't run as smoothly as you'd hoped, and you feel stressed and anxious as a result.

It's the "now/not now" thinking common with ADHD that has interfered with your planning efforts. This means you may have a tendency to view time as either now (the tasks immediately requiring completion) or not now (everything else), no matter how useful it may be to prepare further in advance.

CBT may help you identify and adjust this way of thinking.

Instead, you might think, "I'll make a list right now of everything I need to do to prepare for the event." From that list you could create a schedule for the week that gives you enough preparation time. The event runs smoothly, helping reduce your stress and anxiety.

CBT may not cover all areas needed for treating ADHD. For example, CBT may not be able to increase your attention span in the same way medication is able to. However, it may be able to help you direct your focus in more productive ways.

While medication may make it easier to pay attention, CBT can be useful in helping you choose what to pay attention to. CBT treatment may be able to help identify how to best prioritize tasks and for developing better organizational skills.

Are you often late leaving the house? It may be because you need a better system for remembering when you placed your car keys. Identifying the issue helps you solve it, such as by designating a spot for your keys.

CBT isn't the only type of therapy available for ADHD. Some other options include:

Parent training. The American Academy of Pediatrics recommends parent training in behavior management for preschool aged children with ADHD symptoms. They also suggest providing this training to both parents and teachers for students with ADHD in high school.

Family therapy. Because ADHD is a condition that can affect all household members, family therapy may help family members work together to reduce the impact of ADHD symptoms for everyone involved.

Social skills training. The impulsivity symptoms often associated with ADHD may interfere with how children relate to their peers. Social skills training can teach children important social abilities like sharing, turn-taking, and responding appropriately to teasing.

Psychodynamic therapy. A psychodynamic therapist can help children examine how their childhood experiences affect present-day functioning, as well as how to improve their self-awareness and self-esteem. Children may also learn how to express their feelings more effectively.

Dialectical behavior therapy. Dialectical behavior therapy is a type of CBT that works to regulate emotions and teach behavior regulation skills.

CBT can be an effective option for managing ADHD for both children and adults. It may help to improve important life skills, including organization, time management, problem-solving, and more. Studies have also indicated that CBT can help reduce the anxiety that often accompanies ADHD.

Although CBT does not offer as fast an effect as medication, this form of treatment can teach skills that last long after therapy is complete. Medication, in contrast, works only while taken. For this reason, many doctors recommend using medication and CBT together.

In addition to CBT, behavior management training and family therapy are a couple of examples of therapy that may also help manage ADHD symptoms.

Since everyone is unique, consider speaking with a doctor to find out what course of action is best for you (or your child) for managing ADHD.

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Cognitive Behavioral Therapy for ADHD: How can it help?

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Cognitive behavioral therapy (CBT) is an increasingly popular option for managing ADHD, either as a supplement to ADHD medication or as a replacement. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects the way you regulate focus and behavior.

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https://beyou.edu.au/

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Be You provides educators with knowledge, tools and resources to create positive, inclusive and responsive learning communities where every child, young person, educator and family is empowered to achieve their best possible mental health.

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https://adhdcoachdiane.com/does-a-student-with-adhd-really-need-to-use-a-planner/

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In a word, yes. When I meet with students to coach them through their ADHD or executive function challenges, one of the first questions I ask is, "Do you use any type of planner?" In almost every instance, the student says, "No".

Their reasons for not using a planner make complete sense. Many schools, both K-12 and colleges, have some sort of online "blackboard" that lists all of the homework assignments. The student has easy access to the assignments, so why spend valuable time on rewriting their homework assignments into a planner?

Here's why. Homework time is valuable. For many students with ADHD and executive function challenges, homework can take much longer to complete than for a neurotypical student. There are many reasons for this. Perhaps the student has organization challenges, and they cannot find the materials they need to complete the assignment. Or they may have an essay to write, but they can't get started with a topic. They might have slower processing skills, so the math assignment may take longer.

The time spent looking up the assignments and deciding what to do when is valuable time wasted. If the student were to use a planner, they could have their entire week planned out in advance. At a glance, they would know what assignments to work on as soon as they open their planner. They would have already decided if the assignment needed to be broken down in chunks - this is called scaffolding, and it is a valuable tool for students with ADHD and executive function challenges.

I am sure you are thinking, "but they still have to spend all of that time planning this out and writing it in a planner. Isn't that a waste of valuable time?" Absolutely not. The correct way to use a planner is NOT to just rewrite the assignments that are listed in the online blackboard. Instead, the student should plan out their week, and list the actual work they are going to do each day.

As an example, let's say today is Monday. The student's blackboard says there will be a History test on Thursday. In the planner, the student is going to record what they will do each night.
The student is also going to record in the planner the order in which they will do their homework. Let's say the student's least favorite subject is Math. Rather than waiting to do math as the last bit of homework - when it is likely not to get done because the student is dreading it, perhaps they will list it as the second assignment to be completed. The first assignment gets the momentum going.

In order to save time, there is no need to fully write out the assignment in the planner. Instead, the student can create their own "shortcuts" for the planner. History - read Ch. 24, p. 1-36 can become H-24-1to36. If the assignment is an English essay, the student can still rely on the blackboard to look up the topic, whereas the planner might record English: first draft.

Of course, as the week goes on, more work will likely get assigned. The student now has a place to add it to their weekly action plan. Of, in a class where homework is assigned every day, such as math, the student can start the week by adding Math in the planner, just so they remember that they will have an assignment.

By using a planner as a supportive tool, the student can open up the planner (by the way, the planner can be online or an assignment book, it doesn't matter!) each day and see at a glance what needs to get done. No spending time just figuring out the assignments and how long each will take. Eventually the student will start to understand how long each assignment takes, and this will help with any ongoing time management struggles.

If your student needs help in developing an active planner or if they are challenged with ADHD or executive function challenges, contact me to hear more about coaching.

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Does a Student With ADHD Really Need To Use a Planner?

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In a word, yes. When I meet with students to coach them through their ADHD or executive function challenges, one of the first questions I ask is, "Do you use any type of planner?" In almost every instance, the student says, "No". Their reasons for not using a planner make complete sense.

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Impulse and Conduct Disorders References

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Impulse and Conduct Disorders References

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Attention Deficit Disorder Association. (2022). Adhd: The facts. ADDA. https://add.org/adhd-facts/

Brain Balance. (2022). Improve goal setting for kids with ADHD. Brain Balance Achievement Centers. https://www.brainbalancecenters.com/blog/improve-goal-setting-kids-adhd#:~:text=A%20great%20way%20to%20help,attainable%2C%20realistic%2C%20and%20timely.

Feinberg, B. (2021). Cbt for adhd in youth: Back-to-school strategies for therapists, teachers, and caregivers. Beck Institute. https://beckinstitute.org/blog/cbt-for-adhd-youth-back-to-school-strategies/

Lovering, N. (2022). Can cognitive behavioral therapy help treat adhd?. PsychCentral. https://psychcentral.com/adhd/cbt-for-adhd

Mayo Clinic. (2022). Adult attention-deficit/hyperactivity disorder (ADHD). Mayo Foundation for Medical Education and Research (MFMER). https://www.mayoclinic.org/diseases-conditions/adult-adhd/symptoms-causes/syc-20350878

Response Ability. (2015). Attention deficit hyperactivity disorder. Commonwealth of Australia. https://beyou.edu.au/

Sinfield, J. (2020). The link between dyslexia and ADHD. Dotdash Media. https://www.verywellmind.com/dyslexia-and-its-relation-to-adhd-4119917

Sottile, D. (2020). Does a student with adhd really need to use a planner?. ADHD Coach Diane.
https://adhdcoachdiane.com/does-a-student-with-adhd-really-need-to-use-a-planner/

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https://adaa.org/eating-disorders/types-of-eating-disorders

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Please note that eating disorders are complex and some eating issues will not meet diagnostic criteria. All eating concerns must be taken seriously.

Anorexia Nervosa

Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image. People with anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.

Common Signs & Symptoms:

Dramatic weight loss

Dresses in layers to hide weight loss or stay warm

Preoccupation with weight, food, calories, fat grams, and dieting. Makes frequent comments about feeling "fat.'

Resists or is unable to maintain a body weight appropriate for their age, height, and build

Maintains an excessive, rigid exercise regime - despite weather, fatigue, illness, or injury

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Common Signs & Symptoms:

Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food

Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

Drinks excessive amounts of water or non-caloric beverages, and/or uses excessive amounts of mouthwash, mints, and gum

Has calluses on the back of the hands and knuckles from self- induced vomiting

Dental problems, such as enamel erosion, cavities, discoloration of teeth from vomiting, and tooth sensitivity

Binge Eating Disorder (BED)

Binge eating disorder (BED) is a severe, life-threatening, and treatable eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. It is the most common eating disorder in the United States.
BED is one of the newest eating disorders formally recognized in the DSM-5. Before the most recent revision in 2013, BED was listed as a subtype of EDNOS (now referred to as OSFED). The change is important because some insurance companies will not cover eating disorder treatment without a DSM diagnosis.

Common Signs & Symptoms:

Secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating

Feelings of disgust, depression, or guilt after overeating, and/or feelings of low self-esteem

Steals or hoards food in strange places

Creates lifestyle schedules or rituals to make time for binge sessions

Evidence of binge eating, including the disappearance of large amounts of food in a short time period or a lot of empty wrappers and containers indicating consumption of large amounts of food.

Other Specified Feeding and Eating Disorders (OSFED)

Other Specified Feeding and Eating Disorders (OSFED) was previously known as Eating Disorder Not Otherwise Specified (EDNOS) in past editions of the Diagnostic and Statistical Manual. Despite being considered a 'catch-all' classification that was sometimes denied insurance coverage for treatment as it was seen as less serious, OSFED/EDNOS is a serious, life-threatening, and treatable eating disorder. The category was developed to encompass those individuals who did not meet strict diagnostic criteria for anorexia nervosa or bulimia nervosa but still had a significant eating disorder. In community clinics, the majority of individuals were historically diagnosed with EDNOS.

Common Signs & Symptoms:

Because OSFED encompasses a wide variety of eating disordered behaviors, any or all of the following symptoms may be present in people with OSFED.

Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting

Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food

Self-esteem overly related to body image

Dieting behavior (reducing the amount or types of foods consumed)

Expresses a need to "burn off" calories taken in

Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis in the DSM-5, and was previously referred to as "Selective Eating Disorder." ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of fatness.

Although many children go through phases of picky or selective eating, a person with ARFID does not consume enough calories to grow and develop properly and, in adults, to maintain basic body function. In children, this results in stalled weight gain and vertical growth; in adults, this results in weight loss. ARFID can also result in problems at school or work, due to difficulties eating with others and extended times needed to eat.

Common Signs & Symptoms:

Dramatic weight loss

Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens)

Fears of choking or vomiting

No body image disturbance or fear of weight gain

Pica is an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and paint chips.

Common Signs & Symptoms:

The persistent eating, over a period of at least one month, of substances that are not food and do not provide nutritional value

Typical substances ingested tend to vary with age and availability. They may include paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal, ash, clay, starch, or ice.

Rumination Disorder

Rumination disorder involves the regular regurgitation of food that occurs for at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out. Typically, when someone regurgitates their food, they do not appear to be making an effort, nor do they appear to be stressed, upset, or disgusted.

Unspecified Feeding or Eating Disorder (UFED)

Unspecified feeding or eating disorder (UFED) applies to presentations in which symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functions predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class.

The unspecified feeding and eating disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific feeding and eating disorder, and includes presentation in which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).

Thank you to our partner organization, National Eating Disorder Association.

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Please note that eating disorders are complex and some eating issues will not meet diagnostic criteria. All eating concerns must be taken seriously. Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many individuals, distorted body image.

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https://www.healthline.com/health/bulimia-nervosa

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Bulimia nervosa, also known as bulimia, is an eating disorder. It's generally characterized by eating large amounts of food in a short period of time, followed by purging.

Purging can occur through forced vomiting, excessive exercise, or by taking laxatives or diuretics.

Bulimia is a serious condition that can be life threatening.

People living with bulimia may purge or display purge behaviors, as well as follow a binge-and-purge cycle. Purge behaviors can also include other strict methods to maintain weight like fasting, exercise, or extreme dieting.

Bulimia nervosa may also cause an obsession with achieving an unrealistic body size or shape. A person living with this eating disorder might be obsessed with their weight and can often be self-critical.

Read on to learn more about bulimia, as well as the ways you may help yourself or a loved one with this eating disorder.

The symptoms of bulimia include eating large amounts of food at once and purging, along with a lack of control over these behaviors. A person living with bulimia may also experience feelings of self-disgust after eating.

While the precise list of symptoms may vary between individuals, bulimia may include the following symptoms:

fear of gaining weight

making comments about being "fat"

a preoccupation with weight and body

a strongly negative self-image

binge eating, usually within a 2-hour period

self-induced vomiting

misuse of laxatives or diuretics

use of supplements or herbs for weight loss

excessive and compulsive exercise

stained teeth (from stomach acid)

acid reflux

calluses on the back of your hands

going to the bathroom immediately after meals

not eating in front of others

constipation

withdrawal from typical social activities

Complications from bulimia can include:

Bulimia can affect anyone at any age or body weight.

Research indicates that roughly 1.5 percent of women and 0.5 percent of men in the United States will experience bulimia at some point during their life. It's more common in women, and the median age of onset is estimated to be around 12 years old.

Risk factors may include:

social factors

biological makeup

genetics

psychological well-being

Additionally, some people living with bulimia may also have a history of anorexia nervosa or another eating disorder.

If you suspect your loved one needs help, it's important to let them know that you're there for them without any judgment. They may need you to just listen, or they might need your help finding and going to appointments.

Any progress should also be addressed with further encouragement.

Bulimia has no single known cause. However, it's thought that a combination of certain factors can influence its development. These can include:

genes

family history

a past traumatic event

social or cultural influences

A 2019 review, as well as some older research, also suggests that bulimia may also be associated with serotonin deficiencies in the brain. This important neurotransmitter helps regulate mood, appetite, and sleep.

A doctor typically uses a variety of tests to diagnose bulimia. First, they may conduct a physical examination. They may also order blood or urine tests.

A psychological evaluation will help them understand your relationship with food and body image.

The doctor will also use criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 is a diagnostic tool that uses standard language and criteria to diagnose mental disorders.

The criteria used to diagnose bulimia include:

recurrent binge eating

regular purging through vomiting, excessive exercise, misuse of laxatives, or fasting

deriving self-worth from weight and body shape

binge eating and purging that happens, on average, at least once a week for 3 months

not having anorexia nervosa

The also categorizes bulimia from mild to extreme:

Mild: 1 to 3 episodes per week

Moderate: 4 to 7 episodes per week

Severe: 8 to 13 episodes per week

Extreme: 14 or more episodes per week

You may need further tests if you've had bulimia for a long period of time. These tests can check for complications that could include problems with your heart or other organs.

Treatment focuses on food and nutrition education as well as mental health treatment. It requires development of a healthy view of yourself and a healthy relationship with food.

Treatment options can include:

Antidepressants. Currently, fluoxetine (Prozac) is the only antidepressant approved by the Food and Drug Administration (FDA) to treat bulimia. This selective serotonin reuptake inhibitor may also help with depression and anxiety. Fluoxetine is only approved for treating bulimia in adults.

Psychotherapy. Also called talk therapy, this type of counseling can include cognitive behavioral therapy, family-based therapy, and interpersonal psychotherapy. The goal is to help you work through potentially harmful thoughts and behaviors that contribute to your condition. Group talk therapy may also be helpful.

Dietitian support and nutrition education. These can help you learn healthy eating habits and form nutritious meal plans. You may also learn to shift your attitudes toward food.

Treatment for complications. This may include hospitalization, especially for cases of severe dehydration, electrolyte imbalances, and organ damage.

Successful treatment usually involves a combination of the above treatments, along with a collaborative approach between your doctor, mental health professional, and family and friends.

Some eating disorder treatment facilities offer live-in or day treatment programs. Some live-in programs provide around-the-clock support and care.

If you don't already have a therapist, you can browse doctors in your area through the Healthline FindCare tool.

Bulimia can be life threatening if it's left untreated or if the treatment fails. Bulimia is both a physical and psychological condition, and it may be a lifelong challenge to manage it.

However, there are several treatment options available that can help. Often, the earlier bulimia is detected, the more effective treatment may be.

Effective treatments focus on:

These treatments can help you maintain healthy behaviors in the long term.

Bulimia is a type of eating disorder defined by eating large amounts of food in a short amount of time, followed by purging behaviors. While there are some known risk factors, there's no single cause of bulimia.

It's also important to know that this eating disorder can affect anyone.

If you suspect you or a loved one may be living with bulimia, it's important to seek help from both a medical doctor and mental health professional.

Seeking prompt treatment may not only improve your quality of life, but it may also help prevent potentially life threatening complications.

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Bulimia Nervosa: Signs, Causes, and Treatment

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Bulimia nervosa, also known as bulimia, is an eating disorder. It's generally characterized by eating large amounts of food in a short period of time, followed by purging. Purging can occur through forced vomiting, excessive exercise, or by taking laxatives or diuretics. Bulimia is a serious condition that can be life threatening.

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https://www.mayoclinic.org/diseases-conditions/bulimia/symptoms-causes/syc-20353615

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With bulimia, a serious eating disorder, you eat large amounts of food and then purge to get rid of extra calories. Learn about symptoms and treatment.

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https://www.nimh.nih.gov/health/topics/eating-disorders

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National Institute of Mental Health (NIMH)

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Overview

There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people's eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Signs and symptoms

Risk factors

Treatments and therapies

Join a study

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Learn about eating disorders, including types (e.g., anorexia nervosa, bulimia nervosa), signs and symptoms, risk factors, and treatments and therapies.

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School Counselors Dealing with Eating Disorders

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School Counselors Dealing with Eating Disorders

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Anxiety & Depression Association of America. (2022). Types of eating disorders. ADAA. https://adaa.org/eating-disorders/types-of-eating-disorders

Buser, J. (2012). The school counselor’s role in addressing eating disorder symptomatology among adolescents. American Counseling Association. 97. 1-17. http://www.counseling.org/library/

Gabbey, A. (2022). Bulimia nervosa: What it is, symptoms, causes, and more. Healthline Media. https://www.healthline.com/health/bulimia-nervosa

Karl, S. (2014). Anorexia nervosa. American Counseling Association. 1-7. www.counseling.org/practice_briefs

Mayo Clinic. (2022). Bulimia nervosa. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/bulimia/symptoms-causes/syc-20353615

National Institute of Mental Health. (2022). Eating disorders. U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/topics/eating-disorders

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https://www.brainbalancecenters.com/blog/improve-goal-setting-kids-adhd#:~:text=A%20great%20way%20to%20help,attainable%2C%20realistic%2C%20and%20timely

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How to Help Children with ADHD Set and Achieve Goals

One characteristic of kids with ADHD that every parent is familiar with is the slow development of " executive function ." Setting clear goals and working towards them is both the toughest and the most necessary skill that many of these children must acquire in order to be successful. The following are some research-supported tips for helping your child master the crucial skills of goal-setting.

Focus on Personal Best Goals

Helping ADHD kids set goals based on reaching their own "personal best" results in outstanding outcomes, according to conducted at the University of Sydney. Personal best goals were associated with greater engagement in school activities as well as homework completion, planning and perseverance. Even more encouraging is the fact that ADHD children benefited to a greater extent than other children from the approach of setting goals based purely on the child's own track record.

Use a Token System to Track Goals

A numerical method for holding children accountable is very useful for keeping everyone's expectations clear. Kara Tamanini, MS, LMHC, writing in Psych Central, suggests creating a "home token economy." A few goals are mutually agreed upon by parent and child, and each goal is assigned a token value. More difficult goals earn more tokens, which can later be exchanged for privileges or rewards. Negative behaviors result in tokens being subtracted. It is important to keep the token system simple, covering only a few goals at a time, and to involve the child in creating the token system.

Put Goals to the "SMART" Test

A great way to help your ADHD child set goals with the greatest chance for success is to make sure the goals pass the "SMART" test created by ADHD And You . Goals should be specific, measurable, attainable, realistic, and timely. This research-based approach is actually quite simple, resulting in clearly spelled-out goals such as "Complete homework with X or fewer reminders," where X is an agreed-upon number.

Demonstrate Goal Setting

To convey solidarity with your child and let him or her know that everyone faces similar challenges, it's helpful to demonstrate your own goal-setting process. suggests confiding in your child something specific that you are personally trying to achieve today, and asking the child to help you notice whether you succeed.

The wonderful thing about helping your child set small achievable goals is that he or she will experience many individual instances of success. Discovering that goal-setting results in good feelings will motivate the child to increasingly want to repeat the process. This chain of successes sets up a positive feedback loop, so that the child can move forward and recognize new strengths and capabilities.

If you suspect your child has ADHD or has already been diagnosed with ADHD, contact us online or find a center near you to learn more about how the Brain Balance Program can help.
Enjoy These Related Articles
Common ADHD Social Issues and How Parents Can Help
Common ADHD Sleep Issues
A Homework System That Works for Students with ADHD
Motivating Your ADHD Child

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One characteristic of kids with ADHD that every parent is familiar with is the slow development of " executive function ." Setting clear goals and working towards them is both the toughest and the most necessary skill that many of these children must acquire in order to be successful.

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https://www.mayoclinic.org/diseases-conditions/adult-adhd/symptoms-causes/syc-20350878

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Overview

Adult attention-deficit/hyperactivity disorder (ADHD) is a mental health disorder that includes a combination of persistent problems, such as difficulty paying attention, hyperactivity and impulsive behavior. Adult ADHD can lead to unstable relationships, poor work or school performance, low self-esteem, and other problems.

Though it's called adult ADHD, symptoms start in early childhood and continue into adulthood. In some cases, ADHD is not recognized or diagnosed until the person is an adult. Adult ADHD symptoms may not be as clear as ADHD symptoms in children. In adults, hyperactivity may decrease, but struggles with impulsiveness, restlessness and difficulty paying attention may continue.

Treatment for adult ADHD is similar to treatment for childhood ADHD. Adult ADHD treatment includes medications, psychological counseling (psychotherapy) and treatment for any mental health conditions that occur along with ADHD.

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Symptoms

Some people with ADHD have fewer symptoms as they age, but some adults continue to have major symptoms that interfere with daily functioning. In adults, the main features of ADHD may include difficulty paying attention, impulsiveness and restlessness. Symptoms can range from mild to severe.

Many adults with ADHD aren't aware they have it - they just know that everyday tasks can be a challenge. Adults with ADHD may find it difficult to focus and prioritize, leading to missed deadlines and forgotten meetings or social plans. The inability to control impulses can range from impatience waiting in line or driving in traffic to mood swings and outbursts of anger.

Adult ADHD symptoms may include:

Impulsiveness

Disorganization and problems prioritizing

Poor time management skills

Problems focusing on a task

Trouble multitasking

Excessive activity or restlessness

Poor planning

Low frustration tolerance

Frequent mood swings

Problems following through and completing tasks

Hot temper

Trouble coping with stress

What's typical behavior and what's ADHD?

Almost everyone has some symptoms similar to ADHD at some point in their lives. If your difficulties are recent or occurred only occasionally in the past, you probably don't have ADHD. ADHD is diagnosed only when symptoms are severe enough to cause ongoing problems in more than one area of your life. These persistent and disruptive symptoms can be traced back to early childhood.

Diagnosis of ADHD in adults can be difficult because certain ADHD symptoms are similar to those caused by other conditions, such as anxiety or mood disorders. And many adults with ADHD also have at least one other mental health condition, such as depression or anxiety.

When to see a doctor

If any of the symptoms listed above continually disrupt your life, talk to your doctor about whether you might have ADHD.

Different types of health care professionals may diagnose and supervise treatment for ADHD. Seek a provider who has training and experience in caring for adults with ADHD.

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Causes

While the exact cause of ADHD is not clear, research efforts continue. Factors that may be involved in the development of ADHD include:

Genetics. ADHD can run in families, and studies indicate that genes may play a role.

Environment. Certain environmental factors also may increase risk, such as lead exposure as a child.

Problems during development. Problems with the central nervous system at key moments in development may play a role.

Risk factors

Risk of ADHD may increase if:

You have blood relatives, such as a parent or sibling, with ADHD or another mental health disorder

Your mother smoked, drank alcohol or used drugs during pregnancy

As a child, you were exposed to environmental toxins - such as lead, found mainly in paint and pipes in older buildings

You were born prematurely

Complications

ADHD can make life difficult for you. ADHD has been linked to:

Poor school or work performance

Unemployment

Financial problems

Trouble with the law

Alcohol or other substance misuse

Frequent car accidents or other accidents

Unstable relationships

Poor physical and mental health

Poor self-image

Suicide attempts

Coexisting conditions

Although ADHD doesn't cause other psychological or developmental problems, other disorders often occur along with ADHD and make treatment more challenging. These include:

Mood disorders. Many adults with ADHD also have depression, bipolar disorder or another mood disorder. While mood problems aren't necessarily due directly to ADHD, a repeated pattern of failures and frustrations due to ADHD can worsen depression.

Anxiety disorders. Anxiety disorders occur fairly often in adults with ADHD. Anxiety disorders may cause overwhelming worry, nervousness and other symptoms. Anxiety can be made worse by the challenges and setbacks caused by ADHD.

Other psychiatric disorders. Adults with ADHD are at increased risk of other psychiatric disorders, such as personality disorders, intermittent explosive disorder and substance use disorders.

Learning disabilities. Adults with ADHD may score lower on academic testing than would be expected for their age, intelligence and education. Learning disabilities can include problems with understanding and communicating.

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Adult attention-deficit/hyperactivity disorder (ADHD) - Symptoms and causes

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This mental health disorder includes a combination of persistent problems, such as difficulty paying attention, hyperactivity and impulsive behavior.

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https://www.verywellmind.com/dyslexia-and-its-relation-to-adhd-4119917

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Dyslexia is a brain-based specific learning disability (LD). It affects a person's language ability, making it difficult to learn to read, spell, decode, and recognize words. As a result, reading comprehension, vocabulary, and general knowledge is reduced compared to other children the same age who do not have dyslexia. Remember, dyslexia is not a reflection of intelligence. Most people with dyslexia have normal or above-average intelligence.﻿﻿

ADHD and dyslexia are known to frequently co-exist together. Dr. Russell Barkley explains in his book, Taking Charge of ADHD: The Complete Authoritative Guide for Parents, that children with ADHD are more likely to have a learning disability than children who do not have ADHD.﻿﻿ The National Center for Learning Disabilities states that dyslexia is the most prevalent LD.

Telling the Difference Between Conditions

It can seem difficult to know which challenges are related to ADHD or to dyslexia, since both are neurobehavioral disorders.﻿﻿ Since ADHD involves attention and dyslexia affects reading, the conditions can appear similar. Here are three examples.

Distraction

Both children with ADHD and dyslexia can appear distracted; however, the reason behind the distraction is different. A child with ADHD might appear distracted because it is difficult for them to pay attention, while a child with dyslexia might seem distracted because reading requires a great deal of effort and their energy has dwindled.﻿﻿﻿

Fluent readers are able to read with accuracy, relative speed and, if reading aloud, add expression to the words. In order to comprehend what they have read, a child needs to be able to read fluently.

A child with ADHD might not be a fluent reader because they lose their place or skip endings because their fast brain has raced on to the next part.﻿﻿﻿ Someone with dyslexia might not be a fluent reader because they spend a long time sounding out each word or reading words incorrectly.

Writing and penmanship can also be problematic. Someone with ADHD might have problems with organization and proofreading,﻿﻿ while a child with dyslexia has problems with spelling, grammar, organizing ideas, proofreading, and handwriting.

A good way to distinguish the two conditions is to remember that dyslexia problems occur mostly during reading and writing activities, whereas ADHD symptoms appear in many settings and are more behavioral in nature.﻿﻿

Co-Existing Conditions

In the past, ADHD and dyslexia were viewed as being independent of each other. However, as Dr. Thomas E. Brown explains in his book, A New Understanding of ADHD in Children and Adults, that recent research has shown that the executive function impairments related to ADHD are also associated with dyslexia.﻿﻿﻿

The two conditions are diagnosed differently and often by different professionals. ADHD is considered a mental disorder and diagnosed by a psychiatrist, psychologist, neurologist, and some family doctors.

Dyslexia is a condition that is often identified by educators and who may then refer the individual to a doctor or psychologist for diagnosis and further assessment.﻿﻿﻿ Typically, dyslexia is diagnosed by a clinical psychologist, school psychologist, educational psychologist, or neuropsychologist.

The severity of dyslexia varies from mild to severe, which is also true of people with ADHD.﻿﻿﻿ This means no two people will have symptoms that are exactly the same.

There are various specialized dyslexia reading programs. They are often based on or include elements of the Orton-Gillingham approach. Samuel Orton and Anna Gillingham were reading and language mastery pioneers.﻿﻿﻿

According to its website, in the 1930s, Ms. Gillingham published detailed instruction materials to help with reading, writing, and spelling. Its research-based method is widely regarded as an effective form of treatment for dyslexia.﻿﻿﻿

Your child's school may have specially trained teachers that can provide the help they need. However, not all schools do, in which case you could find a special tutor to work with your child after school.﻿﻿﻿ Accommodations in school for ADHD and dyslexia are very helpful for your child to be able to achieve their academic potential.

Dyslexia and Developmental Dyslexia

Dyslexia and developmental dyslexia are the same conditions. Usually, when someone says dyslexia they are referring to developmental dyslexia, a condition that is inherited. The other type of dyslexia is acquired dyslexia, which means a person became dyslexic due to a brain lesion such as after experiencing a traumatic brain injury or having a stroke.﻿﻿

This can happen with ADHD too. Most people inherit ADHD from a family member, yet a small portion of the population might acquire ADHD symptoms, either prenatally or during development, due to a variety of causes that may damage the brain.﻿﻿

How to Increase Confidence

One of the biggest challenges for children with ADHD and dyslexia is being able to feel good about themselves. Often, their confidence and self-esteem are low as they struggle with tasks that their peers may find easy.﻿﻿﻿﻿ Here are three things you can do to help:

Identify: When children know they have a condition with a name, like ADHD and dyslexia, it helps them. They understand why they are the way they are, and it stops them looking for explanations for themselves, which are often terms like 'I am stupid' and 'I am dumb."

Effort, not results:Give your child positive feedback on the effort they put into a task rather than their results or grades. A child with dyslexia and ADHD has to work harder than other students, yet that effort is not always reflected in their grades. Knowing that their effort is recognized by you makes a big difference to a child's self-esteem.

Activity outside of school: When your child shows an interest in an activity outside of school, encourage it. Being good at something-whether it is a martial art, a sport, arts or crafts-builds confidence. It has a positive ripple effect on other areas of life, ​including school-related activities.

As with any learning disability, ADHD and dyslexia cannot be cured.﻿﻿﻿﻿ However, they can both be treated and managed so your child can lead a successful life.

Children often get a great deal of hope and validation when they hear of famous people who face the same challenges as they do. For example, Steven Spielberg has dyslexia, Justin Timberlake has ADHD, and Richard Branson says he has both ADHD and dyslexia.

Seeking Help

When you are learning about dyslexia, a common message is 'early intervention is key.' Early detection of any condition is of course helpful. However, if you realize your child has dyslexia while they are older, do not feel guilty. It is never too late to get tested and seek the appropriate treatment.﻿﻿﻿

If you are reading this as an adult and think you might have dyslexia, you can still get a dyslexia evaluation. Even if you are no longer in school or university, understanding the root of your challenges is helpful for your confidence, self-esteem, and career.﻿﻿﻿

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Why It Can Be Difficult to Tell the Difference Between Dyslexia and ADHD

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Dyslexia is a brain-based specific learning disability (LD). It affects a person's language ability, making it difficult to learn to read, spell, decode, and recognize words. As a result, reading comprehension, vocabulary, and general knowledge is reduced compared to other children the same age who do not have dyslexia.

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Article: Counseling Youth Who Have Bipolar Disorders

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Article: Counseling Youth Who Have Bipolar Disorders

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Making Learning Accessible for All Students

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Making Learning Accessible for All Students

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https://blog.tcea.org/make-learning-accessible-students/?utm_source=TCEA+Emails&utm_campaign=8b48eac50a-tn-oct5-21&utm_medium=email&utm_term=0_f3a5bb651e-8b48eac50a-40971819&ct=t(tn-oct5-21)

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School is underway and you are probably busy once again! You juggle a hectic school schedule along with family activities while trying to maintain some semblance of sanity. To assist you, we have some clarification and ideas to help with your teaching. In this post, we'll be identifying several critical terms that all educators should know. We will also share a few ideas and strategies to help you with them. Additionally, just to make the reading more fun, we have a quiz for you down below to check how well you know the difference between accommodations, modifications, and interventions. You may also have some ideas that we didn't include, so please scroll down to the comment section and share them with our audience!

Accommodation

An accommodation is a change in the environment, curriculum format, or equipment. Students use accommodation to gain access to the content and to complete the work or meet expectations. Though the format of the curriculum might be altered, the curriculum or content itself is not. As a result, the work expectation and skill acquisition of the student with the accommodation is the same as other students who do not have accommodation. In essence, the adaptation lies in how the information is presented, how the student demonstrates mastery, the learning environment, expectations regarding time, scheduling, or utilizing strategies to assist with organization.

Here are a few examples of common accommodations:

Respond orally instead of writing the response on paper (response accommodation)

Use large-text print version of text (presentation accommodation)

Have instructions read aloud (presentation accommodation)

Allow the student to sit where he/she feels they learn best (setting accommodation)

Extended time for task or testing (time accommodation)

Take a test over several shorter periods and possibly over several days (scheduling accommodation)

Use a timer to help with time management (organization accommodation)

Take the test in a small group setting (setting accommodation)

Use a calculator, dictionary, or word processor (response accommodation)

Get an outline of a lesson (presentation accommodation)

Modification

On the other hand, modifications do not address how the student learns, but what the student learns. In this case, modifications to the curriculum or assignments are in place so that the student is not expected to learn the same material. For example, students who are not able to understand all of the content or concepts being taught should have modifications. As a result, assessments may cover less material or have fewer questions. The student is still expected to learn and demonstrate mastery, but the content is changed according to the plan designed for that particular child. In addition, the child can have curriculum modifications, assignment modifications, or both.

Here are a few examples of common modifications:

Different questions on a text are given to a student (assignment modification).

Different/alternative projects are assigned (assignment modification).

A different grading scale is used to assess the student (curriculum modification).

The student learns different content than other students, possibly from another grade level (curriculum modification).

Accommodations are for ALL students. Modifications are only for those with an Individualized Education Program.

Intervention

An intervention is a strategy that is implemented for a student to learn a new skill or concept that he may be struggling with. The purpose of the intervention is for the student to master the expected skill or concept taught to the class. As a result, interventions help students make progress towards the expectations or standards. They utilize assessment, planning, and monitoring of student progress.

Some interventions may include:

A student is provided time/access to a state-approved reading fluency program to improve decoding skills.

One student attends an afterschool (or Saturday) session to learn helpful math strategies for solving division problems.

A student participates in a small group for 30 minutes, twice a week, to improve reading comprehension skills

Particular students receive instruction in study skills so they can better learn the content and master academic goals.

Scenarios and a Quiz

Below are several scenarios. After reading each one, decide if it is detailing an accommodation, modification, or intervention. Last but not least, check your answer! If you're on a laptop or desktop, hover your mouse over the top left corner of the "?" icon to the left of each scenario to see the answer.

Mrs. Miller is a fourth grade reading teacher. They are starting to read "Wonder"by R. J. Palacio. To help one particular student, Jackson, Mrs. Miller has allowed him to listen to the book on tape instead of reading the book like his peers.

Mr. Moore seems to be the favorite teacher of all his tenth grade students. He enjoys teaching chemistry and makes learning fun. He has three students in fifth period that get a shortened version of the test for each chapter. Instead of 25 questions like all the other students recieve, these few students have only ten questions.

Ms. Williams teaches eighth grade science. They are about to do a unit on light and sound waves and how they interact with different materials. Each year, her students say this is their favorite unit. She anticipates that even Irene, who has a different grading scale than her peers, will enjoy this unit.

Professor Jones teaches at the community college. He also teaches a dual credit class for the local high school. Fortunately, he is a master at teaching accounting to both college and high school students. Last week, he noticed that some of his students struggled when applying auditing concepts to evaluate the conformity of financial statements. He was able to pull those students aside and review Auditing Standard No. 15 with them. This was a standard they should have learned about in a prerequisite course.

Dr. Taylor is the principal at Crockett Junior High. As she was doing a walkthrough, she noticed that one of the students wasn't able to finish an assignment within the class period. Dr. Taylor noted that the student had the same assignment as the other students. She suggested that the teacher provide extra time for the student to finish the assignment.

Suggest Helpful Accommodations, Modifications, and Interventions

What are some accommodations, modifications, and interventions that you have found helpful with your students? We would love for you to share with us, but be sure to use a fake name for your student(s). Also, if you have a great website to share that lists strategies and ways to accommodate, modify, and intervene, our readers would appreciate you sharing it. Just jump to the comment section below and pay it forward.

Find other TechNotes posts on accommodation, modification, and intervention here.
Header image attribution: People photo created by lookstudio - www.freepik.com

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Make Learning Accessible for All Students: Accommodation, Modification, and Intervention

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School is underway and you are probably busy once again! You juggle a hectic school schedule along with family activities while trying to maintain some semblance of sanity. To assist you, we have some clarification and ideas to help with your teaching. In this post, we'll be identifying several critical terms that all educators should know.

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Learning Disabilities Association of Texas 

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Learning Disabilities Association of Texas 

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https://ldatx.org/

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https://childmind.org/

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Child Mind Institute | Transforming Children’s Lives.

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The Child Mind Institute is an independent nonprofit dedicated to transforming the lives of children struggling with mental health and learning disorders.

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Gavin, M. (2020). Bipolar disorder factsheet (for schools). Nemours Kids Health. https://kidshealth.org/en/parents/bipolar-factsheet.html

Kress, V., Sedall, S., & Paylo, M. (2016). Counseling youth who have bipolar disorders. American Counseling Association Practice Briefs. 1-7. www.counseling.org/practice_briefs

Kress, V., Dari, T., & Paylo, M. (2015). Depressive disorders in youth. American Counseling Association Practice Briefs. 1-5. www.counseling.org/practice_briefs

Lochrie, A. (2022). Depression factsheet (for schools). Nemours Kids Health. https://kidshealth.org/en/parents/depression-factsheet.html

Mayo Clinic. (2022). Depression (major depressive disorder). Mayo Foundation for Medical Education and Research (MFMER). https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007

National Institute of Mental Health. (2022). Bipolar disorder in children and teens. National Institutes of Health. https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens

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Center for Parent Information & Resources

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Center for Parent Information & Resources

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https://www.parentcenterhub.org/

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Finding the motivation to make positive lifestyle changes can be hard for anyone. For teenagers, it can be especially difficult when parents are the ones telling them to do it. But if they've fallen into unhealthy habits like vaping or alcohol abuse, change can be beneficial. Motivational interviewing is a form of therapy that creates a safe, non-judgmental environment for teens to establish their own goals and values and see how changing unhealthy behaviors can benefit them in the long run.

This series of articles comes from the Child Mind Institute, with most available in English and Spanish. Why might teens be resistant to therapy and how can parents and others to help them get the treatment they need? The articles explain how motivational interviewing can help teens gain the self-confidence to make important behavioral changes. To read more about motivational interviewing, and to connect with the articles in both English and Spanish, please visit CPIR's abstract.

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Center for Parent Information and Resources | Your Central Hub for Parent Centers Serving Families of Children With Disabilities

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Finding the motivation to make positive lifestyle changes can be hard for anyone. For teenagers, it can be especially difficult when parents are the ones telling them to do it. But if they've fallen into unhealthy habits like vaping or alcohol abuse, change can be beneficial.

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https://kidshealth.org/en/parents/bipolar-factsheet.html

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What Teachers Should Know

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

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

Depression episodes may include:

sadness or feelings of worthlessness or guilt

loss of interest in usual activities

sleeping too much or inability to sleep

inability to concentrate and a drop in academic performance

inability to experience pleasure

overeating or loss of appetite

thoughts of death or suicide

Mania episodes may include:

increased physical and mental activity

racing speech and thoughts

elevated mood and exaggerated optimism

inflated sense of self-importance

decreased need for sleep

difficulty concentrating

reckless or aggressive behavior

anger, excessive irritability, or impatience

poor judgment and making rash decisions

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

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

Students with bipolar disorder may:

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

show drops in grades and changes in class participation

need additional time for tests and assignments or require modified schedules

miss class time due to appointments with health care professionals

need to visit the school nurse for medication

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

need to talk with a school counselor or psychologist periodically

be at a higher risk for suicide

What Teachers Can Do

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

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

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

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

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bipolar mood disorder and bipolar affective disorder

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Bipolar Disorder Factsheet (for Schools)

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

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https://www.samhsa.gov/find-help/national-helpline

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Substance Abuse and Mental Health Services Administration

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Frequently Asked Questions - What is SAMHSA’s National Helpline?

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https://kidshealth.org/en/parents/depression-factsheet.html

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What Teachers Should Know

It's normal for students to feel sad, angry, or moody at times. But when a sad or bad mood lasts for weeks, months, or even longer - and when it affects a student's ability to do well in school and with peers - it might be depression.

Depression is not uncommon among students. But it can go unrecognized or undiagnosed. Many students with depression don't receive the care they need.

Depression can get better with the right treatment and support. Mental health professionals treat depression with therapy, medication, or both. Effective early treatment can reduce the risk of future episodes of depression.

Teachers can help by knowing the signs of depression, taking steps to guide students toward the help they need, and by being a source of support and encouragement.

Teachers should know the signs that could mean a student is depressed. Students with depression may:

seem sad or irritable more often than not

seem tired, lack energy, give up easily

put little effort into schoolwork

have trouble concentrating in class

fail to turn in work, get lower grades

seem not to enjoy things

withdraw from friends or activities

miss school days, or be frequently late

Some students with depression may:

have experienced trauma or adverse life events

have other mental health issues, such as anxiety

engage in risky or self-harming behaviors (for example, be reckless or turn to alcohol, drugs, or self-injury)

talk about death or suicide

Teachers should know student behaviors that can be warning signs for suicide, including:

talking about suicide or death

hinting that they might not be around anymore

writing songs, poems, or letters about death

giving away treasured possessions

losing interest in school, classmates, sports, or other activities

engaging in risky behaviors

Teachers should be aware of suicide prevention methods, and follow their school's protocol for how to:

notify parents if a student appears suicidal

get help for a student at risk of suicide

supervise an at-risk student

work with the school's crisis team to set up a support system at school and at home

Students with depression may need:

treatment from mental health professionals

emotional support from a school counselor or school psychologist

a 504 plan for accommodations at school

short breaks throughout the day to avoid feeling overwhelmed

extra time or extra help to complete assignments

to take medication

treatment for other mental health issues or healing for trauma they've faced

What Teachers Can Do

Offer support and encouragement. Help students with depression feel welcome and included. Let them know you're available to help. Encourage their strengths and their interests. Look for opportunities for them to succeed in the classroom. Let them know you see their efforts - even the small steps.

Give extra time to complete assignments. Offer extra help. Consider having students work with a supportive peer to work on assignments or to study for tests.

Make physical activities a part of your daily classroom routine. This can help ease mild depression symptoms. It can energize all of your other students, too.

Make brief mindfulness practices a part of everyday instruction. At random or scheduled times, invite your class, "Let's all pause and take a few slow, calm breaths." This helps students learn and practice this simple but effective self-calming skill.

Use trauma-informed education approaches. Create and maintain an environment where every student can feel a sense of safety and inclusion. This helps every student thrive.

Date reviewed: April 2022

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What teachers should know about depression and how to help a student who is depressed.

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Mayo Clinic: Depression Signs and Symptoms

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Mayo Clinic: Depression Signs and Symptoms

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https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007

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Overview

What is depression? A Mayo Clinic expert explains.

Learn more about depression from Craig Sawchuk, Ph.D., L.P., clinical psychologist at Mayo Clinic.

Hi, I'm Dr. Craig Sawchuk, a clinical psychologist at Mayo Clinic. And I'm here to talk with you about depression. Whether you're looking for answers for yourself, a friend, or loved one, understanding the basics of depression can help you take the next step.

What is depression?

Depression is a mood disorder that causes feelings of sadness that won't go away. Unfortunately, there's a lot of stigma around depression. Depression isn't a weakness or a character flaw. It's not about being in a bad mood, and people who experience depression can't just snap out of it. Depression is a common, serious, and treatable condition. If you're experiencing depression, you're not alone. It honestly affects people of all ages and races and biological sexes, income levels and educational backgrounds. Approximately one in six people will experience a major depressive episode at some point in their lifetime, while up to 16 million adults each year suffer from clinical depression. There are many types of symptoms that make up depression. Emotionally, you may feel sad or down or irritable or even apathetic. Physically, the body really slows down. You feel tired. Your sleep is often disrupted. It's really hard to get yourself motivated. Your thinking also changes. It can just be hard to concentrate. Your thoughts tend to be much more negative. You can be really hard on yourself, feel hopeless and helpless about things. And even in some cases, have thoughts of not wanting to live. Behaviorally, you just want to pull back and withdraw from others, activities, and day-to-day responsibilities. These symptoms all work together to keep you trapped in a cycle of depression. Symptoms of depression are different for everyone. Some symptoms may be a sign of another disorder or medical condition. That's why it's important to get an accurate diagnosis.

What causes depression?

While there's no single cause of depression, most experts believe there's a combination of biological, social, and psychological factors that contribute to depression risk. Biologically, we think about genetics or a family history of depression, health conditions such as diabetes, heart disease or thyroid disorders, and even hormonal changes that happen over the lifespan, such as pregnancy and menopause. Changes in brain chemistry, especially disruptions in neurotransmitters like serotonin, that play an important role in regulating many bodily functions, including mood, sleep, and appetite, are thought to play a particularly important role in depression. Socially stressful and traumatic life events, limited access to resources such as food, housing, and health care, and a lack of social support all contribute to depression risk. Psychologically, we think of how negative thoughts and problematic coping behaviors, such as avoidance and substance use, increase our vulnerability to depression.

The good news is that treatment helps. Effective treatments for depression exist and you do have options to see what works best for you. Lifestyle changes that improve sleep habits, exercise, and address underlying health conditions can be an important first step. Medications such as antidepressants can be helpful in alleviating depressive symptoms. Therapy, especially cognitive behavioral therapy, teaches skills to better manage negative thoughts and improve coping behaviors to help break you out of cycles of depression. Whatever the cause, remember that depression is not your fault and it can be treated.

To help diagnose depression, your health care provider may use a physical exam, lab tests, or a mental health evaluation. These results will help identify various treatment options that best fit your situation.

Help is available. You don't have to deal with depression by yourself. Take the next step and reach out. If you're hesitant to talk to a health care provider, talk to a friend or loved one about how to get help. Living with depression isn't easy and you're not alone in your struggles. Always remember that effective treatments and supports are available to help you start feeling better. Want to learn more about depression? Visit mayoclinic.org. Do take care.

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.
Depression care at Mayo Clinic
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Symptoms

Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

Feelings of sadness, tearfulness, emptiness or hopelessness

Angry outbursts, irritability or frustration, even over small matters

Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports

Sleep disturbances, including insomnia or sleeping too much

Tiredness and lack of energy, so even small tasks take extra effort

Reduced appetite and weight loss or increased cravings for food and weight gain

Anxiety, agitation or restlessness

Slowed thinking, speaking or body movements

Feelings of worthlessness or guilt, fixating on past failures or self-blame

Trouble thinking, concentrating, making decisions and remembering things

Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide

Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Depression symptoms in children and teens

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.

In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

Depression symptoms in older adults

Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

Memory difficulties or personality changes

Physical aches or pain

Fatigue, loss of appetite, sleep problems or loss of interest in sex - not caused by a medical condition or medication

Often wanting to stay at home, rather than going out to socialize or doing new things

Suicidal thinking or feelings, especially in older men

When to see a doctor

If you feel depressed, make an appointment to see your doctor or mental health professional as soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, any health care professional, a faith leader, or someone else you trust.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 in the U.S. or your local emergency number immediately.

Also consider these options if you're having suicidal thoughts:

Call your doctor or mental health professional.

Contact a suicide hotline.

In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

U.S. veterans or service members who are in crisis can call 988 and then press "1" for the Veterans Crisis Line. Or text 838255. Or chat online.

The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).

Reach out to a close friend or loved one.

Contact a minister, spiritual leader or someone else in your faith community.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

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Causes

It's not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.

Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.

Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.

Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.

Risk factors

Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women than men are diagnosed with depression, but this may be due in part because women are more likely to seek treatment.

Factors that seem to increase the risk of developing or triggering depression include:

Certain personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic

Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems

Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide

Being lesbian, gay, bisexual or transgender, or having variations in the development of genital organs that aren't clearly male or female (intersex) in an unsupportive situation

History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder

Abuse of alcohol or recreational drugs

Serious or chronic illness, including cancer, stroke, chronic pain or heart disease

Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)

Complications

Depression is a serious disorder that can take a terrible toll on you and your family. Depression often gets worse if it isn't treated, resulting in emotional, behavioral and health problems that affect every area of your life.

Examples of complications associated with depression include:

Excess weight or obesity, which can lead to heart disease and diabetes

Pain or physical illness

Alcohol or drug misuse

Anxiety, panic disorder or social phobia

Family conflicts, relationship difficulties, and work or school problems

Social isolation

Suicidal feelings, suicide attempts or suicide

Self-mutilation, such as cutting

Premature death from medical conditions

Prevention

There's no sure way to prevent depression. However, these strategies may help.

Take steps to control stress, to increase your resilience and boost your self-esteem.

Reach out to family and friends, especially in times of crisis, to help you weather rough spells.

Get treatment at the earliest sign of a problem to help prevent depression from worsening.

Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.

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Depression (major depressive disorder) - Symptoms and causes

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Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest and can interfere with your daily functioning.

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https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens

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National Institute of Mental Health (NIMH)

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

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

What is bipolar disorder?

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes people to experience noticeable, sometimes extreme, changes in mood and behavior. It is a common misperception that children cannot have bipolar disorder. Although most people are diagnosed with bipolar disorder in adolescence or adulthood, the symptoms can appear earlier in childhood.

Bipolar disorder is not the same as the typical ups and downs every child goes through. The mood changes in bipolar disorder are more extreme, often unprovoked, and accompanied by changes in sleep, energy level, and the ability to think clearly.

Children with bipolar disorder sometimes feel very happy or "up" and are much more energetic and active than usual. This is called a manic episode. Children with bipolar disorder sometimes feel very sad or "down" and are much less active than usual. This is called a depressive episode. Bipolar disorder is often episodic, but it usually lasts a lifetime.

Bipolar disorder symptoms can make it hard to perform well in school or get along with friends and family members. Some children and teens with bipolar disorder may try to hurt themselves or attempt suicide. Early diagnosis and treatment can lead to better functioning and well-being over the long term.

Signs and symptoms of bipolar disorder may overlap with symptoms of other disorders that are common in young people, such as attention-deficit/hyperactivity disorder (ADHD), conduct problems, major depression, and anxiety disorders.

Diagnosing bipolar disorder can be complicated and requires a careful and thorough evaluation by a trained, experienced mental health professional.

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

What causes bipolar disorder?

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

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

Research also suggests that people with a genetic risk of having bipolar disorder may be more likely to develop the disorder after experiencing trauma or other stressful life events.

Some research studies have found differences in brain structure and function between people with bipolar disorder and people without it. Researchers are examining these differences to learn more about possible causes and effective treatments.

What are the symptoms of bipolar disorder?

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

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

Children and teens having a manic episode may:

Show intense happiness or silliness for long periods of time.

Have a very short temper or seem extremely irritable.

Talk fast about a lot of different things.

Have trouble sleeping but do not feel tired.

Have trouble staying focused and experience racing thoughts.

Seem overly interested or involved in pleasurable but risky activities.

Do risky or reckless things that show poor judgment.

Have an inflated sense of ability, knowledge, and power.

Children and teens having a depressive episode may:

Feel frequent and unprovoked sadness.

Show increased irritability, anger, or hostility.

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

Start sleeping a lot more.

Have difficulty concentrating.

Feel hopeless and worthless.

Have difficulty communicating or maintaining relationships.

Eat too much or too little.

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

Think about death or have thoughts of suicide.

Can children and teens with bipolar disorder have other problems?

Young people with bipolar disorder can have several problems at the same time. For example, they may also be at risk of misusing alcohol or drugs. Sometimes extreme behaviors go along with mood episodes. During manic episodes, young people with bipolar disorder may take extreme risks that they wouldn't usually take or that could cause them harm or injury. During depressive episodes, some young people with bipolar disorder may think about running away from home or have thoughts of suicide.

If your child shows signs of suicidal thinking, take these signs seriously and call your child's health care provider.
If your child is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org . This service is confidential, free, and available 24 hours a day, 7 days a week.

How is bipolar disorder diagnosed?

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

Other disorders-such as ADHD, disruptive mood dysregulation disorder, oppositional defiant disorder, conduct disorder, and anxiety disorders-have symptoms like those of bipolar disorder. It can be challenging to distinguish bipolar disorder from depression that occurs without mania, referred to as "major depression." A health care provider who specializes in working with children and teens can carefully evaluate your child's symptoms to provide an accurate diagnosis.

How is bipolar disorder treated?

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

Several types of medication can help treat symptoms of bipolar disorder. Children respond to medications in different ways. They may need to try different types of medication to find the one that works best for them. Some children may need more than one type of medication because their symptoms are complex. Health care providers usually try to prescribe the fewest number of medications and the smallest doses possible to help treat a child's symptoms. Always tell your child's health care provider about any medication side effects. Do not stop giving your child a prescribed medication without speaking to a health care provider. Stopping medication suddenly can be dangerous and can make symptoms worse.

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

What can children and teens expect from treatment?

With treatment, daily functioning and well-being can improve over time. Treatment is more effective when health care providers, caregivers, and young people work together.

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

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

How can I help my child or teen?

Help begins with an accurate diagnosis and treatment. Talk to your child's health care provider about any symptoms you notice.

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

Be patient.

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

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

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

Help your child have fun.

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

Help your child understand that treatment can make life better.

How does bipolar disorder affect caregivers and families?

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

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

Where do I go for help?

If you're unsure of where to get help, your doctor, pediatrician, or other family health care provider is a good place to start. A health care provider can refer you to a qualified mental health professional, such as a psychiatrist or psychologist, who has experience treating bipolar disorder and can evaluate your child's symptoms.

Learn more about getting help on the NIMH website. The Substance Abuse and Mental Health Services Administration has an online treatment locator to help you find mental health services in your area.

What should I know about clinical trials?

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

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to a health care provider about clinical trials, their benefits and risks, and whether one is right for you. Learn more about  participating in clinical trials.

Reprints

The information in this publication is in the public domain and may be reused or copied without permission. However, you may not reuse or copy images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

For More Information

MedlinePlus (National Library of Medicine) ( En español )

ClinicalTrials.gov ( En español )

NIH Publication No. 23-MH-8081
Revised 2023

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Information about bipolar disorder in children and teens including causes, signs and symptoms, diagnosis, treatment options, and how to help a child or teen who has bipolar disorder.

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School Mental Health Referral Pathways Toolkit

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School Mental Health Referral Pathways Toolkit

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https://www.schoolcounselor.org/getmedia/44f30280-ffe8-4b41-9ad8-f15909c3d164/EthicalStandards.pdf

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Anxiety & Depression Association of America. (2022). OCD at school. ADAA. https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder/ocd-at-school

Centers for Disease Control and Prevention. (2022). Obsessive-compulsive disorder in children. U.S. Department of Health & Human Services. https://www.cdc.gov/childrensmentalhealth/ocd.html

Lyness, D. (2021). Obsessive-compulsive disorder. Nemours Kids Health. https://kidshealth.org/en/parents/ocd.html

Pertuit, T., Trusty, J., & Ballard, M. (2014). Suffering in silence: Examining obsessive compulsive behaviors in the school setting. American Counseling Association. https://www.counseling.org/docs/default-source/vistas/article_17.pdf?sfvrsn=12

Wurzburg, J.M.U. (2017). Causes of obsessive-compulsive disorder discovered. Medical Xpress. https://medicalxpress.com/news/2017-03-obsessive-compulsive-disorder.html

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https://medicalxpress.com/news/2017-03-obsessive-compulsive-disorder.html

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Credit: Julius-Maximilians-Universität Würzburg, JMU

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

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

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

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

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

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

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

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

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

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

Provided by Julius-Maximilians-Universität Würzburg

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

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https://iris.peabody.vanderbilt.edu/

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"We initially chose IRIS because of the past experiences and their credible research-based, high-quality modules that align with specific areas of growth and need to support a state-directed corrective action plan in our region."

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"We initially chose IRIS because of the past experiences and their credible research-based, high-quality modules that align with specific areas of growth and need to support a state-directed corrective action plan in our region."

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Article: Suffering in Silence: Examining Obsessive Compulsive Behaviors in the School Setting

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Article: Suffering in Silence: Examining Obsessive Compulsive Behaviors in the School Setting

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https://www.counseling.org/docs/default-source/vistas/article_17.pdf?sfvrsn=12

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https://www.cdc.gov/childrensmentalhealth/ocd.html

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Centers for Disease Control and Prevention

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Many children occasionally have thoughts that bother them, and they might feel like they have to do something about those thoughts, even if their actions don't actually make sense. For example, they might worry about having bad luck if they don't wear a favorite piece of clothing. For some children, the thoughts and the urges to perform certain actions persist, even if they try to ignore them or make them go away. Children may have an obsessive-compulsive disorder (OCD) when unwanted thoughts, and the behaviors they feel they must do because of the thoughts, happen frequently, take up a lot of time (more than an hour a day), interfere with their activities, or make them very upset. The thoughts are called obsessions. The behaviors are called compulsions.

Symptoms

Having OCD means having obsessions, compulsions, or both.

Examples of obsessive or compulsive behaviors include:

Having unwanted thoughts, impulses, or images that occur over and over and which cause anxiety or distress.

Having to think about or say something over and over (for example, counting, or repeating words over and over silently or out loud)

Having to do something over and over (for example, handwashing, placing things in a specific order, or checking the same things over and over, like whether a door is locked)

Having to do something over and over according to certain rules that must be followed exactly in order to make an obsession go away.

Children do these behaviors because they have the feeling that the behaviors will prevent bad things from happening or will make them feel better. However, the behavior is not typically connected to actual danger of something bad happening, or the behavior is extreme, such as washing hands multiple times per hour.

A common myth is that OCD means being really neat and orderly. Sometimes, OCD behaviors may involve cleaning, but many times someone with OCD is too focused on one thing that must be done over and over, rather than on being organized. Obsessions and compulsions can also change over time.
Learn more about OCD
Treatment for OCD

The first step to treatment is to talk with a healthcare provider to arrange an evaluation. A comprehensive evaluation by a mental health professional will determine if the anxiety or distress involves memories of a traumatic event that actually happened, or if the fears are based on other thoughts or beliefs. The mental health professional should also determine whether someone with OCD has a current or past tic disorder. Anxiety or depression and disruptive behaviors may also occur with OCD.

Treatments can include behavior therapy and medication. Behavior therapy, specifically cognitive-behavioral therapy, helps the child change negative thoughts into more positive, effective ways of thinking, leading to more effective behavior. Behavior therapy for OCD can involve gradually exposing children to their fears in a safe setting; this helps them learn that bad things do not really occur when they don't do the behavior, which eventually decreases their anxiety. Behavior therapy alone can be effective, but some children are treated with a combination of behavior therapy and medication. Families and schools can help children manage stress by being part of the therapy process and learning how to respond supportively without accidentally making obsessions or compulsions more likely to happen again.

Get help finding treatment

Here are tools to find a healthcare provider familiar with treatment options:

Prevention of OCD

It is not known exactly why some children develop OCD. There is likely to be a biological and neurological component, and some children with OCD also have Tourette syndrome or other tic disorders. There are some studies that suggest that health problems during pregnancy and birth may make OCD more likely, which is one of many important reasons to support the health of women during pregnancy.
Learn about preventing problems during pregnancy

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Obsessive-Compulsive Disorder in Children | CDC

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Many children occasionally have thoughts that bother them, and they might feel like they have to do something about those thoughts, even if their actions don't actually make sense. Learn about Obsessive-Compulsive Disorder (OCD) in children.

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https://kidshealth.org/en/parents/ocd.html

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What Is OCD?

Obsessive-compulsive disorder (OCD) causes upsetting thoughts called obsessions. It also causes the urge to do behaviors called compulsions (also called rituals). Kids and teens with OCD get stuck in a stressful cycle of these thoughts, anxiety, and rituals.

If you think your child has OCD, start with a visit to your child's doctor or mental health provider. They can check for OCD or for other problems that could be the cause of your child's symptoms.

How Is OCD Treated?

Treatment for OCD is a type of cognitive behavioral therapy (CBT). In therapy, kids learn coping and calming skills for anxiety. They learn how to safely face fears without doing rituals.

Along with therapy, doctors may give medicines for OCD to some kids. For kids who need medicines, doctors give SSRIs (selective serotonin reuptake inhibitors). These include Zoloft®, Prozac®, and Luvox®.

Treatment works best when a parent or caregiver goes to therapy with their child. That way, they can learn how to coach their child through OCD symptoms, help their child practice skills they learn in therapy, and offer daily support.

What Signs Might Parents Notice?

Obsessions

These are stressful thoughts that come to mind over and over. A child with OCD doesn't want to think about these things. But they feel they can't stop.

Parents may notice obsessions as intense fears or worries. Kids with OCD may feel unusually upset about:

germs, dirt, illness, injury, or harm

whether someone could get sick, hurt, or die

things that seem wrong, or out of place

whether bad thoughts might come true

things that are not straight, even, or arranged "just right"

Compulsions (Rituals)

These are behaviors a child will do, trying to feel better. To the child, rituals seem like the way to stop thoughts and relieve fears. They seem like a way to keep bad things from happening.

Parents may notice that kids:

touch, tap, or step in unusual ways

arrange things over and over

repeat words, phrases, or questions

have many doubts, and trouble making choices

wash or clean more than needed

take a long time to do things - like get dressed, shower, eat, do homework

Kids may involve parents in rituals. And at first, parents may not realize that something is a ritual. For example, a child with OCD might ask for reassurance over and over. Or a child may insist a parent say or do something a set number of times, or in a set way.

Kids and teens with OCD can have obsessions, compulsions, or both.

Feelings

OCD symptoms are hard on kids. Rituals may seem to give them some relief at first. But rituals multiply. They start to take more time and energy. Kids have little left for things they enjoy. OCD thoughts, feelings, and rituals become a stressful cycle. This can make it hard to focus in school, have fun with friends, get to sleep, or relax.

Kids may seem:

anxious, worried

frustrated, irritable

sad, tired

upset when they can't do a ritual

to need constant reassurance from a parent that things are OK

Some kids may not let parents know about the thoughts, fears, and behaviors OCD causes. They may feel confused or ashamed about their fear and keep it to themselves. They may try to hide rituals they do. Some kids may have OCD symptoms for a while before their parents realize it.

How Can I Help My Child?

If you think your child may have OCD:

Talk with your child about what you've noticed. Talk in a supportive way, listen, and show love. Say something that works for your child's situation like, "I notice you fixing your socks a lot, trying to get them even. Getting them to feel right causes you a lot of stress."

Say that something called OCD might be causing the worry and the fixing. Tell your child that a checkup with a doctor can find out if this is what's going on. Let your child know that this can get better, and that you want to help.

Make an appointment with a child psychiatrist or psychologist. Your child's doctor can help you find the right person. To diagnose OCD, they will spend time talking with you and your child. They will ask questions about your child's symptoms that help point them to signs of OCD. If they diagnose OCD, they can explain the treatment.

Take part in your child's therapy. Part of treatment is coaching parents on how to respond to their child's OCD symptoms. Learn all you can about ways you can help. Learn how to support your child's progress without giving in to rituals.

Be patient. Overcoming OCD is a process. There will be many therapy visits. Be sure to go to them all. Help your child practice the things the therapist shows you. Praise your child's effort. Show how proud you feel. Remind them that OCD is not their fault.

Get support, and give it. There are lots of resources and support for families dealing with OCD. The International OCD Foundation is a good place to start. Knowing that you're not alone can help you cope. Sharing success stories with other parents can give you hope and confidence.

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OCD causes upsetting thoughts (obsessions) and the urge to do "ritual" behaviors (compulsions). Kids and teens get stuck in a stressful cycle of these thoughts, anxiety, and rituals. OCD can get better with the right attention and care.

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https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder/ocd-at-school

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OCD is like an unwelcome guest with bad manners. It moves into a mind - and it doesn't want to leave.
Students with OCD may appear to be daydreaming, distracted, disinterested, or even lazy. They may seem unfocused and unable to concentrate. But they are really very busy focusing on their nagging urges or confusing, stressful, and sometimes terrifying OCD thoughts and images. They may also be focused on completing rituals, either overtly or covertly, to relieve their distress.

While frustrating to educators, OCD may be torture for the students who have it. This disorder may be difficult to identify because its observable symptoms are similar to other conditions and mental disorders, and mental rituals cannot be observed. Symptoms in children and adolescents can change over time, and they tend to wax and wane for no apparent reason. School personnel who have a good understanding of the variety of behaviors that may signal OCD are better equipped to initiate a plan to assist the student.

The Effect of OCD on Academic Performance

Even very bright and motivated students can struggle with OCD. Although students with OCD typically have average to above-average intelligence levels, they may be unable to learn the same way others do because their focus is frequently on their obsessions or compulsions. Depending on the severity of the symptoms, some students find it difficult to learn and, for some, it's almost impossible to concentrate on and complete schoolwork.

Although they want to pay attention, participate in discussions or presentations, study, and complete homework, they feel compelled to respond to their obsessions or urges.

Students who have untreated OCD re likely to have a very difficult time concentrating in the classroom and completing homework assignments. They may experience overwhelming anxiety or strong urges, possibly describing the feeling of mounting anxiety or intensifying urges as if they were a rising volcano or a tea kettle about to boil - and relief comes when the pressure is released. Unfortunately, the release is usually a compulsive behavior that may be disruptive to learning and possibly to the classroom.

It may not be long before the student who has OCD falls behind and sees a drop in grades. In some cases, academic performance deteriorates abruptly and dramatically. And it may be nearly impossible to catch up unless a student can learn to manage the symptoms. For these reasons, it's important that school personnel take OCD seriously and work with the student and the family to provide support.

What Does OCD Look Like at School?

A student may enter a classroom at the beginning of the school year with a diagnosis of OCD, or the disorder may develop later. Whenever a student begins to falter - academically, socially, or emotionally - educators need to intervene. A proactive approach can make an impressive difference in a student's coping ability, academic performance, and interpersonal capabilities.

The first step is being aware of the behaviors that can signal OCD. The disorder includes a wide variety of symptoms in children and adolescents, which are not always obvious. It is important to keep in mind that OCD symptoms can look like other disorders, so it is critical that a mental health specialist trained in OCD and related disorders conduct a diagnostic assessment OCD can be confused for symptoms of ADHD and anxiety disorders, as well as acting out" or misbehavior not associated with a neurobiological disorder. Also, OCD changes in nature or scope from one set of obsessions and compulsions to another, with differing behaviors, and symptoms can worsen and or seem to disappear, often for no obvious reason.

Common Symptoms of OCD at School

Below are common OCD symptoms of children and adolescents in school.

Obsession: Fears of germs or contamination
Compulsions
* Repeatedly washing hands, using antibacterial wipes or hand-sanitizer
* Protecting what is perceived as clean space -- personal desk, locker, or other property
* Avoiding touching surfaces that others may have touched, such as doorknobs, desks, shared supplies, lab tables or equipment, computer keyboards, paints, paste, soap, cafeteria trays, etc.
* Avoiding contact play or sports either because of a fear of catching a disease or fear of contaminating another student
* Avoiding the use of bathrooms
* Seeking reassurance that they or others are not sick or dirty
* Refusing to share items or supplies with others
* Refusing to eat in the cafeteria
* Avoiding certain products because they may contain poison, such as substances used in chemistry

Obsession: Fears that harm, illness, or death, will befall oneself or others; fear of causing harm to oneself or others, including violent or aggressive obsessions (Note: People with OCD who have violent or aggressive thoughts do not have a history of violence or act upon these urges or ideas.)
Compulsions
* Checking behavior, such as making sure doors or windows are locked or turning light switches on and off repeatedly
* Reading a paragraph over and over again to prevent harm from coming to a loved one, another person, or a pet.
* Asking the teacher for reassurance that the student is safe
* Avoiding leaving a perceived safe zone (classroom); avoiding going into unsafe zones (lunch or recess areas) or open spaces such as a gymnasium
* Unreasonable avoidance of peers, teachers, for fear of causing them harm

Obsession: Fears that harm, illness, or death, will befall oneself or others; fear of causing harm to oneself or others, including violent or aggressive obsessions ( Note: People with OCD who have violent or aggressive thoughts do not act upon these urges or ideas OR have a history of violence.)
Compulsions
* Checking behavior, such as making sure doors or windows are locked or turning light switches on and off repeatedly
* Reading a paragraph over and over again to prevent harm from coming to a loved one, another person, or a pet.
* Asking the teacher for reassurance that the student is "safe"
* Avoiding leaving a perceived "safe" zone (classroom); avoiding going into "unsafe" zones (lunch or recess areas) or open spaces such as a gymnasium
* Unreasonable avoidance of peers, teachers, for fear of causing them harm

Obsession: Fears, feelings, or urges related to numbers
Compulsions
* Counting, touching, or saying words a certain number of times due to believing in a magical significance to certain numbers or using those numbers to keep harm away; counting the number of steps between locations and having to start over if interrupted
* Touching objects a certain number of times; not being able to move on unless this touching has been accomplished
* Reading words or pages a certain number of times
* Going back and forth through doorways a certain number of times before it's OK to enter the room
* Avoiding using certain numbers that are perceived as unlucky or not safe; only using numbers that are perceived as safe or lucky. (math problems may be answered improperly, pages may not be read or pages may be numbered out of sequence )

Obsession: Fears, feelings, or urges related to discarding items because something bad will happen; feelings of incompleteness if something is discarded or the need document and preserve all life experiences; fears of contamination; need to buy items in multiples of a particular number; not discarding objects to avoid repetitive rituals such as washing or checking. (Note: This form of hoarding is related to the obsessions and compulsions of OCD and is distinct from hoarding disorder.)
Compulsions
* Saving scraps of paper, candy wrappers, bottle caps, broken items, or other useless items; inability to part with unneeded things
* Keeping books, toys, food, school papers, clothing, or other items for fear that they might be needed sometime in the future
* Buying every item in a store that one has touched (and therefore contaminated) to prevent others from being contaminated
* Accumulating items or objects in a particular area (desk drawer) because they are contaminated and cannot be touched
* Buying multiples of the same item (buying three of everything because it's a magic number)

Obsession: Scrupulosity, or the excessive fear of violating religious or moral rules
Compulsions
* Apologizing or confessing that something is wrong, such as breaking religious, classroom, or school rules
* Constantly seeking reassurance that a task has been completed right or perfectly; seeking affirmation that a mistake was not made
* Saying prayers a certain number of times; excessive praying to atone for being bad; repeatedly confessing perceived sins or bad behavior
* Repetitive praying, confessing to neutralize or undo bad thoughts, intrusive sexual thoughts, or visions of cursing or blaspheming in school or church
* Avoiding answering questions for fear of telling a lie

Obsession: Fears, feelings, or urges related to symmetry or order
Compulsions
* Constantly evening up books or other items on a shelf or desk; aligning edges to be even
* Rearranging items to be in a certain order, such as by color or alphabetical order
* Avoiding a room with square tiles because seeing the tiles would require tracing each of the edges visually
* Fears, feelings, or urges related to sexual content
* Seeking reassurance that one is not gay or lesbian, despite being heterosexual
* Excessive praying to atone for having inappropriate sexual thoughts or images
* Avoiding magazines, books, DVDs, websites, or other media for fear of seeing sexual content

Obsession: Excessive doubting or dread of uncertainty
Compulsions
* Constantly rechecking to see that everything is in a backpack or book bag
* Asking to leave the classroom to recheck a locker or its contents
* Avoiding a school locker to prevent checking the lock over and over again

Obsession: Fears, feelings, or urges related to having something just right or perfect
Compulsions
* Getting up and sitting down repeatedly at a desk, until feeling just right
* Repeatedly revising the way letters, words, or numbers are written to make them look just right; getting stuck rewriting the same letter or word
* Repeatedly filling in circles on answer sheets; getting stuck on one or two questions because too much time is spent carefully filling in the circles, erasing, refilling until it looks perfect
* Erasing and rewriting words over and over
* Extreme slowness with activities or school work until everything is just right
* Repeating various actions for no apparent reason
* Avoiding a hallway until walking in it until it feels just right

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OCD is like an unwelcome guest with bad manners. It moves into a mind - and it doesn't want to leave. Students with OCD may appear to be daydreaming, distracted, disinterested, or even lazy. They may seem unfocused and unable to concentrate.

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Schizophrenia and Other Psychiatric Disorders References

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Schizophrenia and Other Psychiatric Disorders References

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American Academy of Child & Adolescent Psychiatry. (2018). Schizophrenia in children. AACAP. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Schizophrenia-In-Children-049.aspx

Mayo Clinic. (2022). Schizophrenia. Mayo Foundation for Medical Education and Research (MFMER). https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443#:~:text=Schizophrenia%20is%20a%20serious%20mental,with%20schizophrenia%20require%20lifelong%20treatment

Jundong, J., Kuja-Halkola, R.,...Lichetenstein, P. (2013). Poor school performance in offspring of patients with schizophrenia: What are the mechanisms?. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658106/

Torres, F. (2020). What is schizophrenia. American Psychiatric Association. https://psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia

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https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443#:~:text=Schizophrenia%20is%20a%20serious%20mental,with%20schizophrenia%20require%20lifelong%20treatment.

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Overview

Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling.

People with schizophrenia require lifelong treatment. Early treatment may help get symptoms under control before serious complications develop and may help improve the long-term outlook.

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Symptoms

Schizophrenia involves a range of problems with thinking (cognition), behavior and emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function. Symptoms may include:

Delusions. These are false beliefs that are not based in reality. For example, you think that you're being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you; or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.

Hallucinations. These usually involve seeing or hearing things that don't exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.

Disorganized thinking (speech). Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.

Extremely disorganized or abnormal motor behavior. This may show in a number of ways, from childlike silliness to unpredictable agitation. Behavior isn't focused on a goal, so it's hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.

Negative symptoms. This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (doesn't make eye contact, doesn't change facial expressions or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience pleasure.

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present.

In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It's uncommon for children to be diagnosed with schizophrenia and rare for those older than age 45.

Symptoms in teenagers

Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize. This may be in part because some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:

Withdrawal from friends and family

A drop in performance at school

Trouble sleeping

Irritability or depressed mood

Lack of motivation

Also, recreational substance use, such as marijuana, methamphetamines or LSD, can sometimes cause similar signs and symptoms.

Compared with schizophrenia symptoms in adults, teens may be:

Less likely to have delusions

More likely to have visual hallucinations

When to see a doctor

People with schizophrenia often lack awareness that their difficulties stem from a mental disorder that requires medical attention. So it often falls to family or friends to get them help.

Helping someone who may have schizophrenia

If you think someone you know may have symptoms of schizophrenia, talk to him or her about your concerns. Although you can't force someone to seek professional help, you can offer encouragement and support and help your loved one find a qualified doctor or mental health professional.

If your loved one poses a danger to self or others or can't provide his or her own food, clothing, or shelter, you may need to call 911 or other emergency responders for help so that your loved one can be evaluated by a mental health professional.

In some cases, emergency hospitalization may be needed. Laws on involuntary commitment for mental health treatment vary by state. You can contact community mental health agencies or police departments in your area for details.

Suicidal thoughts and behavior

Suicidal thoughts and behavior are common among people with schizophrenia. If you have a loved one who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

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Causes

It's not known what causes schizophrenia, but researchers believe that a combination of genetics, brain chemistry and environment contributes to development of the disorder.

Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they indicate that schizophrenia is a brain disease.

Risk factors

Although the precise cause of schizophrenia isn't known, certain factors seem to increase the risk of developing or triggering schizophrenia, including:

Having a family history of schizophrenia

Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development

Taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood

Complications

Left untreated, schizophrenia can result in severe problems that affect every area of life. Complications that schizophrenia may cause or be associated with include:

Suicide, suicide attempts and thoughts of suicide

Anxiety disorders and obsessive-compulsive disorder (OCD)

Depression

Abuse of alcohol or other drugs, including nicotine

Inability to work or attend school

Financial problems and homelessness

Social isolation

Health and medical problems

Being victimized

Aggressive behavior, although it's uncommon

Prevention

There's no sure way to prevent schizophrenia, but sticking with the treatment plan can help prevent relapses or worsening of symptoms. In addition, researchers hope that learning more about risk factors for schizophrenia may lead to earlier diagnosis and treatment.

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Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling. People with schizophrenia require lifelong treatment.

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https://psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia

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https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Schizophrenia-In-Children-049.aspx

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Schizophrenia In Children

No. 49; Reviewed October 2018

Schizophrenia is a serious psychiatric illness that causes changes in thinking, feelings, and unusual or strange behavior. It is uncommon in children and hard to recognize in its early phases. Symptoms that are more prominent may be noted in adolescents and young adults. The cause of schizophrenia is not known. Current research suggests a combination of brain changes, biochemical causes, genetic and environmental factors. Early diagnosis and medical treatment are important. Schizophrenia is a life-long disease that can be controlled but not cured.

The symptoms and behavior of children and adolescents with schizophrenia may be different from those of adults with this illness. The following symptoms and behaviors can occur in children or adolescents with schizophrenia:

seeing things and hearing voices which are not real (hallucinations)

odd and eccentric behavior and/or speech

unusual or bizarre thoughts and ideas

confusing television and dreams from reality

confused thinking

new academic problems

extreme moodiness

personality changes

ideas that people are out to get them or talking about them (paranoia)

severe anxiety and fearfulness

difficulty relating to peers and/or keeping friends

withdrawal and increased isolation

worsening personal grooming

The behavior of children with schizophrenia may change slowly over time. For example, children who used to enjoy relationships with others may start to become more shy or withdrawn and seem to be in their own world. Sometimes youngsters will begin talking about strange fears and ideas. They may start to say things that do not make sense. These early symptoms and problems may first be noticed by the child's teachers. Children with these symptoms must have a complete evaluation. Parents should ask their family physician or pediatrician to refer them to a child and adolescent psychiatrist, who is specifically trained and skilled at evaluating, diagnosing, and treating children with schizophrenia. Treating children with schizophrenia can involve a combination of medication, individual therapy, and family therapy, and specialized programs (school, activities, etc.) are often necessary. Psychiatric medication can be helpful for many of the symptoms of the illness. These medications require careful monitoring by a psychiatrist (preferably a child and adolescent psychiatrist).

An experienced child and adolescent psychiatrist should be able to differentiate changes in thinking, feelings, and unusual behavior that could be due to a person's or their families' cultural belief system versus changes caused by a mental illness. Families should feel comfortable discussing these beliefs with their mental health providers; for example, some cultures believe they can communicate with deceased individuals, and so on. Please let your doctor know if these or other beliefs are part of your family's belief and cultural structure.

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Schizophrenia In Children No. 49; Reviewed October 2018 Schizophrenia is a serious psychiatric illness that causes changes in thinking, feelings, and unusual or strange behavior. It is uncommon in children and hard to recognize in its early phases. Symptoms that are more prominent may be noted in adolescents and young adults.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658106/

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Poor school performance in offspring of patients with schizophrenia: What are the mechanisms?

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Offspring to patients with schizophrenia exhibit poorer school performance compared to offspring of non-schizophrenic parents. We aimed to elucidate the mechanisms behind this association.We linked longitudinal national population registers in Sweden ...

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https://www.nimh.nih.gov/health/find-help

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National Institute of Mental Health (NIMH)

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If you or someone you know has a mental illness, there are ways to get help. Use these resources to find help for yourself, a friend, or a family member.

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https://www.hhs.texas.gov/services/mental-health-substance-use/mental-health-substance-use-resources

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COVID-19 IDD and Behavioral Health Resources

Texans experiencing anxiety, stress or emotional changes due to the pandemic can seek help from these resources.

The COVID-19 Mental Health Support Line (PDF) offers COVID-19-related mental health support for all Texans. Call 1-833-986-1919 to reach a mental health professional. Individuals who identify themselves as frontline workers may call the support line for referral to Virtual Support Groups for Frontline Workers in Texas (PDF) where they will have the opportunity to speak with their peers about the mental health effects of helping others during the pandemic.

2-1-1 connects people with the resources they need across Texas. Search easy-to-find information from state and local health and human services programs. You may also find the Local Mental Health Authority in your area by entering "Mental Health Crisis," along with your Zip code, in the search engine.

Crisis Text Line is free, 24/7 support for those in crisis. Text TX to 741741 from anywhere in the U.S. to text with a trained crisis counselor.

Outreach, Screening, Assessment, and Referral (OSAR) Centers may be the first point of contact for people seeking substance use disorder treatment services. Texans seeking services and information may qualify for services based on need.

The National Alliance on Mental Illness (NAMI) offers a helpful COVID-19 Resource and Information Guide (PDF) for individuals with questions or concerns related to COVID-19.

National Association of State Directors of Developmental Disabilities Services (NASDDDS) represents the nation's agencies in 50 states and the District of Columbia, providing services to children and adults with intellectual and developmental disabilities and their families.

The Arc is greatly concerned about the threat of COVID-19 to people with disabilities, their families, and the workforce that supports them. The Arc offers a list of resources to help people with intellectual and/or developmental disabilities (I/DD), their families and service providers to understand this global pandemic.

The Administration for Community Living (ACL) works to improve the lives of older adults and individuals with disabilities through services, research and education. ACL offers COVID-19 resources specifically for individuals with disabilities.

For plain language information on COVID-19, visit Self Advocacy Info, which provides a COVID-19 booklet (PDF) written by and for people with disabilities.

Learn how to reduce stress in yourself and others (PDF)

Other Resources

Texas Health and Human Services offers a variety of resources for families and persons experiencing mental health or substance use issues.

Children, Youth and Families

Crisis Services

Crisis Text Line is free, 24/7 support for those in crisis. Text TX to 741741 from anywhere in the U.S. to reach a trained crisis counselor.

Crisis Services Search - Find the crisis hotline for the local mental health or behavioral health authority in your county.

Law Enforcement Crisis Intervention in Texas - Specially trained police officers who know how to intervene with people who are experiencing a mental health crisis.

Individuals and Family Members

Community Resource Coordination Groups - Local partners and community members who help people with complex, multi-agency needs get benefits and services.

Family Based Support Programs - Helps families maintain a stable and safe home to reduce the risk of future abuse through family counseling, crisis intervention, parenting classes, substance abuse treatment, domestic violence intervention, and day care.

Family Violence Program - Shelters, counseling and legal advocacy for people escaping family violence or domestic abuse.

Mental Health

People with Disabilities

Substance Use

Dose of Reality: Prevent Prescription Painkiller Misuse in Texas - This website is aimed at prevention through education by providing information on opioids, risk factors, and how to safely store and dispose of unwanted prescription painkillers. It also provides vital information for those seeking help for themselves.

Substance Use Disorder Treatment Services Search - Find substance use treatment services in your area through the Outreach, Screening, Assessment and Referral Centers. Texans seeking services and information may qualify for services based on need.

Suicide Prevention

Veterans

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Mental Health & Substance Use Resources | Texas Health and Human Services

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HHS offers a variety of resources for families and persons experiencing mental health or substance use issues.

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Texas Health and Human Services. (2022). Mental Health & Substance Use Resources. Texas Health and Human Services Commission. https://www.hhs.texas.gov/services/mental-health-substance-use/mental-health-substance-use-resources

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