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School Counselors role with Eating Disorders

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School Counselors role with Eating Disorders

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VISTAS Online is an innovative publication produced for ACA by Dr. Garry R. Walz and Dr. Jeanne C. Bleuer of Counseling Outfitters, LLC. Its purpose is to provide a means of capturing the ideas, information and experiences generated by the annual ACA Conference and selected ACA Division Conferences. Papers on a program or practice that has been validated through research or experience may also be submitted. This digital collection of peer-reviewed articles is authored by counselors, for counselors. VISTAS Online contains the full text of over 900 proprietary counseling articles published from 2004 to 2017.

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The School Counselor's Role in Addressing Eating Disorder

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VISTAS Online is an innovative publication produced for ACA by Dr. Garry R. Walz and Dr. Jeanne C. Bleuer of Counseling Outfitters, LLC. Its purpose is to provide a means of capturing the ideas, information and experiences generated by the annual ACA Conference and selected ACA Division Conferences.

# data[].attributes.attachment_link.readable_text
VISTAS Online is an innovative publication produced for ACA by Dr. Garry R. Walz and Dr. Jeanne C. Bleuer of Counseling Outfitters, LLC. Its purpose is to provide a means of capturing the ideas, information and experiences generated by the annual ACA Conference and selected ACA Division Conferences. Papers on a program or practice that has been validated through research or experience may also be submitted. This digital collection of peer-reviewed articles is authored by counselors, for counselors. VISTAS Online contains the full text of over 900 proprietary counseling articles published from 2004 to 2017.

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Addressing Anxiety in School Settings: Information for Counselors

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VISTAS Online is an innovative publication produced for ACA by Dr. Garry R. Walz and Dr. Jeanne C. Bleuer of Counseling Outfitters, LLC. Its purpose is to provide a means of capturing the ideas, information and experiences generated by the annual ACA Conference and selected ACA Division Conferences.

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Suffering in Silence : Examining Obsessive Compulsive Behaviors in the School Setting | Semantic Scholar

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Building a comprehensive school counseling program requires an awareness of the myriad of personal and social issues facing students today (American School Counseling Association [ASCA], 2012). One such issue is obsessive compulsive disorder (OCD) and its accompanying behaviors, which are now considered much more common in children and adolescents than previously reported (National Alliance on Mental Illness [NAMI], 2010).

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Links updated, November 2021
This information in Spanish

The mental health of our children is a natural and important concern for us all. The fact is, many mental disorders have their beginnings in childhood or adolescence, yet may go undiagnosed and untreated for years. ( 1)

We refer to mental disorders using different "umbrella" terms such as emotional disturbance, behavioral disorders, or mental illness. Beneath these umbrella terms, there is actually a wide range of specific conditions that differ from one another in their characteristics and treatment. These include (but are not limited to):

anxiety disorders;

bipolar disorder (sometimes called manic-depression);

conduct disorders;

eating disorders;

obsessive-compulsive disorder (OCD); and

psychotic disorders.

You may be reading this fact sheet with one of these specific disorders in mind, or you may be looking for information about emotional disturbances in general. In either case, keep reading to find out what different emotional distubances have in common, how they are defined in federal law, and where to find more detailed information on specific disorders.
Quick-Jump Menu
Definition
IDEA defines emotional disturbance as follows:
We've chosen to use the term "emotional disturbance" in this fact sheet because that is the term used in the nation's special education law, the Individuals with Disabilities Education Act (IDEA).

"...a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance:

(A) An inability to learn that cannot be explained by intellectual, sensory, or health factors.

(B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

(C) Inappropriate types of behavior or feelings under normal circumstances.

(D) A general pervasive mood of unhappiness or depression.

(E) A tendency to develop physical symptoms or fears associated with personal or school problems." ( 2)

As defined by IDEA, emotional disturbance includes schizophrenia but does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance. ( 3)

Characteristics

As is evident in IDEA's definition, emotional disturbances can affect an individual in areas beyond the emotional. Depending on the specific mental disorder involved, a person's physical, social, or cognitive skills may also be affected. The National Alliance on Mental Illness of Southern Arizona puts this very well:

Mental illnesses are medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. ( 4)

Some of the characteristics and behaviors seen in children who have an emotional disturbance include:

Hyperactivity (short attention span, impulsiveness);

Aggression or self-injurious behavior (acting out, fighting);

Withdrawal (not interacting socially with others, excessive fear or anxiety);

Immaturity (inappropriate crying, temper tantrums, poor coping skills); and

Learning difficulties (academically performing below grade level).

Children with the most serious emotional disturbances may exhibit distorted thinking, excessive anxiety, bizarre motor acts, and abnormal mood swings.

Many children who do not have emotional disturbance may display some of these same behaviors at various times during their development. However, when children have an emotional disturbance, these behaviors continue over long periods of time. Their behavior signals that they are not coping with their environment or peers.

Causes

No one knows the actual cause or causes of emotional disturbance, although several factors-heredity, brain disorder, diet, stress, and family functioning-have been suggested and vigorously researched. A great deal of research goes on every day, but to date, researchers have not found that any of these factors are the direct cause of behavioral or emotional problems.

According to NAMI, mental illnesses can affect persons of any age, race, religion, or income. Further:

Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan. ( 5)

Frequency

Of the 74.5 million children in the United States, an estimated 17.1 million have or have had a psychiatric disorder. ( 6) Half of all psychiatric illness occurs before the age of 14, and 75% by the age of 24. The most common psychiatric disorders in childhood are anxiety disorders, AD/HD and disruptive behavior, depression and bipolar disorders, and eating disorders. ( 7)

Help for School-Aged Children

IDEA requires that special education and related services be made available free of charge to every eligible child with a disability, including preschoolers (ages 3-21). These services are specially designed to address the child's individual needs associated with the disability-in this case, emotional disturbance, as defined by IDEA (and further specified by states). In the 2016 school year, more than 349,000 children and youth with emotional disturbance received these services to address their individual needs related to emotional disturbance. ( 8)

Determining a child's eligibility for special education and related services begins with a full and individual evaluation of the child. Under IDEA, this evaluation is provided free of charge in public schools.
10 Basic Steps in Special Education Questions Often Asked by Parents about Special Education Services Evaluating Children for Disability Developing Your Child's IEP
There is a lot to know about the special education process, much of which you can learn here on the CPIR site. We invite you to read the wide range of publications we offer on the topic, especially:

A Look at Specific Emotional Disturbances

As we mentioned, emotional disturbance is a commonly used umbrella term for a number of different mental disorders. Let's take a brief look at some of the most common of these.

We all experience anxiety from time to time, but for many people, including children, anxiety can be excessive, persistent, seemingly uncontrollable, and overwhelming. An irrational fear of everyday situations may be involved. This high level of anxiety is a definite warning sign that a person may have an anxiety disorder.

The term "anxiety disorder" is a broad term covering several different disabilities that share the core symptom of irrational fear. These include such different disorders as generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder (also called social phobia), and specific phobias. ( 9)

According to the Anxiety Disorders Association of America, anxiety disorders are the most common psychiatric illnesses affecting children and adults. ( 10) They are also highly treatable. Unfortunately, only about 36.9% of those affected receive treatment. ( 11)

Also known as manic-depressive illness, bipolar disorder is a serious medical condition that causes dramatic mood swings from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. ( 12)

For most people with bipolar disorder, these mood swings and related symptoms can be stabilized over time using an approach that combines medication and psychosocial treatment. ( 13)

Conduct Disorder

Conduct disorder refers to a group of behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. ( 14) This may include some of the following behaviors:

aggression to people and animals;

destruction of property;

deceitfulness, lying, or stealing; or

truancy or other serious violations of rules. (15)

Treatment will depend on the child's symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may include:

helping the child learn how to better solve problems, communicate, and handle stress, as well as how to control impulses and anger (what's known as cognitive-behavioral therapy);

family therapy;

peer group therapy (to help better social and interpersonal skills); and

medications (although these are not typically used to treat conduct disorder). (16)

Eating disorders are characterized by extremes in eating behavior-either too much or too little-or feelings of extreme distress or concern about body weight or shape. Females are much more likely than males to develop an eating disorder. ( 17)

Anorexia nervosa and bulimia nervosa are the two most common types of eating disorders. Anorexia nervosa is characterized by self-starvation and dramatic loss of weight. Bulimia nervosa involves a cycle of binge eating, then self-induced vomiting or purging. Both of these disorders are potentially life-threatening. ( 18)

Binge eating is also considered an eating disorder. It's characterized by eating excessive amounts of food, while feeling unable to control how much or what is eaten. Unlike with bulimia, people who binge eat usually do not purge afterward by vomiting or using laxatives. ( 19)

According to the National Eating Disorders Association:

Treating an eating disorder generally involves a combination of psychological and nutritional counseling, along with medical and psychiatric monitoring. Treatment must address the eating disorder symptoms and medical consequences, as well as psychological, biological, interpersonal, and cultural forces that contribute to or maintain the eating disorder... Many people utilize a treatment team to treat the multi-faceted aspects of an eating disorder. ( 20)

Obsessive-Compulsive Disorder

Often referred to as OCD, obsessive-compulsive disorder is actually considered an anxiety disorder (which was discussed earlier in this fact sheet). OCD is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors (handwashing, counting, checking, or cleaning) are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety. ( 21)

A large body of scientific evidence suggests that OCD results from a chemical imbalance in the brain. ( 22) Treatment for most people with OCD should include one or more of the following:

therapist trained in behavior therapy;

Cognitive Behavior Therapy (CBT);

medication (usually an antidepressant). (23)

"Psychotic disorders" is another umbrella term used to refer to severe mental disorders that cause abnormal thinking and perceptions. Two of the main symptoms are delusions and hallucinations. Delusions are false beliefs, such as thinking that someone is plotting against you. Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there. Schizophrenia is one type of psychotic disorder. ( 24) There are others as well.

Treatment for psychotic disorders will differ from person to person, depending on the specific disorder involved. Most are treated with a combination of medications and psychotherapy (a type of counseling). ( 25)

More about School

As mentioned, emotional disturbance is one of the categories of disability specified in IDEA. This means that a child with an emotional disturbance may be eligible for special education and related services in public school. These services can be of tremendous help to students who have an emotional disturbance.

Typically, educational programs for children with an emotional disturbance need to include attention to providing emotional and behavioral support as well as helping them to master academics, develop social skills, and increase self-awareness, self-control, and self-esteem. A large body of research exists regarding methods of providing students with positive behavioral support (PBS) in the school environment, so that problem behaviors are minimized and positive, appropriate behaviors are fostered. (See the resource section at the end of this fact sheet for more information on PBS.) It is also important to know that, within the school setting:

For a child whose behavior impedes learning (including the learning of others), the team developing the child's Individualized Education Program (IEP) needs to consider, if appropriate, strategies to address that behavior, including positive behavioral interventions, strategies, and supports.

Students eligible for special education services under the category of emotional disturbance may have IEPs that include psychological or counseling services. These are important related services available under IDEA and are to be provided by a qualified social worker, psychologist, guidance counselor, or other qualified personnel.

Recognizing and Addressing the Impact of COVID-19 | As young people return to in-person schooling in the 2021-2022 school year, they may bring with them the impact of the pandemic's trauma. This makes it essential that schools consider the possibility that many students will need to be re-evaluated to determine if they need additional services, especially behavioral support and mental health services, than they needed prior to COVID-19. Two resources of great relevance to reopening schools and returning students are the following:

Other Considerations

Children and adolescents with an emotional disturbance should receive services based on their individual needs, and everyone involved in their education or care needs to be well-informed about the care that they are receiving. It's important to coordinate services between home, school, and community, keeping the communication channels open between all parties involved.

The Importance of Support

Families often need help in understanding their child's disability and how to address the needs that arise from the disability. Help is available from psychiatrists, psychologists, and other mental health professionals that work in the public or private sector. There is also a network of mental health support operating in every state as well as locally.

To locate systems of support in your community or state, visit the organizations we've listed below. They can connect you with local resources, including support groups that provide connection and understanding, information, referral, and advocacy for those living with emotional disturbance.

There are also support groups available from organizations that address specific mental disorders under the umbrella term of emotional disturbance. See the resources at the end of this fact sheet to identify some of these groups.

Resources of More Information

AACAP | American Academy of Child and Adolescent Psychiatry | AACAP offers Facts for Families, a series in English, Spanish, and several other languages that includes many briefs on specific mental disorders, including the ones mentioned in this publication.

AACAP also operates different Resource Centers, which offer consumer-friendly definitions, answers to frequently asked questions, clinical resources, expert videos, Facts for Families, and much more. Visit the Resource Center home page if you are concerned with one of the following:

Anxiety Disorders

Autism

Bipolar Disorder

Conduct Disorder

Depression

Oppositional Defiant Disorder

NIMH | National Institute of Mental Health | NIMH is clearly a source of authoritative information on specific mental disorders. Phone: 1.866.615.6464. TTY: 1.866.415.8051

NAMI | National Alliance on Mental Illness | NAMI is an excellent source of information and connection on mental illness, including the individual disorders mentioned in this fact sheet. NAMI's website and toll-free helpline are available in English and Spanish.

SAMHSA is the Substance Abuse & Mental Health Services Administration. It offers many resources to consumers, including:.

Detailed information on specific emotional disturbances, or related issues such as positive behavior supports, is also available from these sources:

Anxiety Disorders Association of America | https://adaa.org/

Center on Positive Behavioral Interventions and Supports | The PBIS Center provides research-based information on how to provide behavioral supports to children who need them. | https://www.pbis.org

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

Encyclopedia of Mental Disorders | http://www.minddisorders.com/index.html

National Eating Disorders Association
1.800.931.2237 | www.nationaleatingdisorders.org

Something Fishy | (eating disorders)
https://www.something-fishy.org

**Highly Rated Resource! This resource was reviewed by 3-member panels of Parent Center staff working independently from one another to rate the quality, relevance, and usefulness of CPIR resources. This resource was found to be of "High Quality, High Relevance, High Usefulness" to Parent Centers.
________________________________________

References

2 | Code of Federal Regulations, Title 34, §300.8(c)(4)(i)

3 | Code of Federal Regulations, Title 34, §300.8(c)(4)(ii)

5 | Ibid.

7 | Ibid.

11 | Ibid.

13 | Ibid.

14 | American Academy of Adolescent and Child Psychiatry. (2013, August). Conduct disorder: Facts for families. Washington, DC: Author. Available online at:
http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Conduct_Disorder_33.aspx

15 | Ibid.

16 | Johns Hopkins Medicine Health Library. (n.d.). Conduct disorder in children. Baltimore, MD: Author. Online at:
https://www.hopkinsmedicine.org/healthlibrary/conditions/mental_health_disorders/conduct_disorder_90,P02560

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Links updated, November 2021 This information in Spanish The mental health of our children is a natural and important concern for us all. The fact is, many mental disorders have their beginnings in childhood or adolescence, yet may go undiagnosed and untreated for years.

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Building Resiliency

The encouraging news is that young people have the innate capacity to bounce back from adversity. You can create an environment that feels safe and connected by helping students understand how negative emotions hijack our learning. I am currently teaching young adolescents, many with significant emotional and behavioral challenges. To facilitate a predictable and consistent environment, we create class guidelines, procedures, and engagement systems so each student knows the class expectations and routines. Here are four strategies that have really worked with my students.

1. Brain-Based Learning Centers

In my classroom, students can go to one corner to recharge and calm down from negative emotion. This corner is called the "amygdala first aid station" as the amygdala is the fight/flight/freeze center in the brain. Students needing a quiet area with tables to study or to complete work can go to the "hippocampus area," named after the part of the brain that memorizes and connects new information to what we already know. Finally, the "prefrontal cortex area"-named after the problem-solving center of the brain-includes tables and collaborative spaces for students who are ready to discuss projects or ideas, watch documentaries, and collaborate. When we teach students about their brain functions and connect them to specific activities, they become more self-aware and fluent in their own cognitive processes. Check out my post " Brain Labs: A Place to Enliven Learning " for a helpful resource as you think about how to design predictable and safe spaces to learn, socialize, and recharge.

2. Personalized Check-In Notes

If students are in a negative brain state, we must regulate behaviors before any learning will occur. The best way I have found is to first attend to their emotional temperature, to let them know I am present and available no matter the negative behaviors. To connect with and create consistency for a diverse array of students with different needs, I use waiter and prescription pads as a way of personalizing communication throughout the day. These are particularly effective for reaching those students who don't respond to spoken communication. Share notes, small goals, affirmations, and requests to maintain individualized consistent connections. Once the task or goal has been ordered and received, you can create fun ways to make a payment or incentivize.

3. Structured Emotional Support

The "2x10 Strategy" developed by psychologist Raymond Wlodkowski is an excellent brain-aligned strategy to implement with our most challenging students. For two minutes each day, 10 days in a row, teachers have a personal conversation-either written or in-person-with a student about anything the student is interested in, as long as the conversation is G-rated. Wlodkowski found an 85 percent improvement in that one student's behavior. In addition, he found that the behavior of all the other students in the class improved.

4. Locked Journal for Safe Self-Expression

When we write out our thoughts and feelings, we clear space in the frontal lobes for positive emotion and higher cognitive processes. A locked journal can give students a safe place to release anxiety while maintaining control over their own privacy. If a student chooses to write or draw their feelings and thoughts through this format, we discuss how this journal can become a trusted friend, and how they might be able to use it to prototype creative forms of expression to be shared under the appropriate circumstances.

Delivery Matters

In working with students, your method of delivery will make a big difference. Students who are emotionally shut down and unresponsive to words may respond better with written notes. You can create note cards for directions, choices, or explanations, and give students the opportunity to write their responses rather than speak. All behavior is communication. Although I might not get a verbal response from a student, I always keep trying with the option of sharing notes and letters.

What I am learning every day-even as a seasoned educator-is that I must regulate behaviors before any learning will occur, and the strategies above have helped immeasurably. Students who struggle with emotional disturbances are some of our most vulnerable, but when we can create predictable and consistent supports for them, their inner resilience can shine.

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Reaching Students With Emotional Disturbances

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A seasoned educator shares four ideas for supporting students who have suffered emotional trauma.

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School Counselors Serving Conduct Disorder

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School Counselors Serving Conduct Disorder

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Conduct Disorder

"Conduct disorder" refers to a group of repetitive and persistent behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules, respecting the rights of others, showing empathy, and behaving in a socially acceptable way. They are often viewed by other children, adults and social agencies as "bad" or delinquent, rather than mentally ill. Many factors may lead to a child developing conduct disorder, including brain damage, child abuse or neglect, genetic vulnerability, school failure, and traumatic life experiences.

Children or adolescents with conduct disorder may exhibit some of the following behaviors:

Aggression to people and animals

bullies, threatens or intimidates others

delights in being cruel and mean to others

starts physical fights

has used a weapon that could cause serious physical harm to others (e.g. a bat, brick, broken bottle, knife or gun)

is physically cruel to people or animals

steals from a victim while hurting them

forces someone into sexual activity

shows no genuine remorse after an aggressive episode

Destruction of Property

Deceitfulness, lying, or stealing

has broken into someone else's building, house, or car

lies to obtain goods, or favors or to avoid obligations

steals items without confronting a victim (e.g. shoplifting, but without breaking and entering)

Serious violations of rules

often stays out at night despite parental objections

runs away from home

often stays away from

Children who exhibit these behaviors should receive a comprehensive evaluation by an experience mental health professional. Many children with a conduct disorder may have coexisting conditions such as mood disorders, anxiety, PTSD, substance abuse, ADHD, learning problems, or thought disorders which can also be treated. Research shows that youngsters with conduct disorder are likely to have ongoing problems if they and their families do not receive early and comprehensive treatment. Without treatment, many youngsters with conduct disorder are unable to adapt to the demands of adulthood and continue to have problems with relationships and holding a job.

Treatment of children with conduct disorder can be complex and challenging. Treatment can be provided in a variety of different settings depending on the severity of the behaviors. Adding to the challenge of treatment are the child's uncooperative attitude, fear and distrust of adults. In developing a comprehensive treatment plan, a child and adolescent psychiatrist may use information from the child, family, teachers, community (including the legal system) and other medical specialties to understand the causes of the disorder.

Behavior therapy and psychotherapy are usually necessary to help the child appropriately express and control anger. Special education may be needed for youngsters with learning disabilities. Parents often need expert help to develop and carry out special management and educational programs in the home and at school. Home-based treatment programs such as Multisystemic Therapy (MST) are effective for helping both the child and family.

Treatment may also include medication in some youngsters who may have difficulty paying attention, impulse problems, or depression.

Treatment is rarely brief since establishing new attitudes and behavior patterns takes time. However, early treatment offers a child a better chance for considerable improvement and hope for a more successful future.

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Conduct Disorder "Conduct disorder" refers to a group of repetitive and persistent behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules, respecting the rights of others, showing empathy, and behaving in a socially acceptable way.

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Bipolar Disorder in School Aged Children

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Bipolar Disorder in School Aged Children

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[PDF] A Closer Examination of Bipolar Disorder in School Age Children | Semantic Scholar

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Children who present with severe behavioral concerns may be diagnosed as having other commonly diagnosed childhood disorders, such as attention deficit hyperactivity disorder, oppositional defiant disorder, and/or conduct disorder, among others, when they may be suffering from early-onset bipolar disorder.

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For both kids and adults, these symptoms create problems at school, work, and in relationships. Though ADHD can make daily life difficult, it's effectively treated with medication and psychotherapy. If you think you or a loved one has ADHD, see a mental health professional for a comprehensive evaluation.

What Are the Risk Factors and Causes of ADHD?

Like other psychological disorders, ADHD is caused by a multitude of factors, including the following.

Genetics: Studies show that ADHD runs in families with greater frequency than in the general population. Twin studies have attributed about 80 percent of ADHD to genes (see Faraone, 2004), though estimates vary. Researchers also have explored the contribution of specific genes. A recent large-scale study demonstrated that many genes are involved in ADHD (see genetic determinants of ADHD). Since many symptoms make up the disorder, that would seem to make sense.

Environment: The maternal environment might increase the risk for ADHD, including smoking during pregnancy (in an already genetically susceptible child), low birth weight and mom's mental health. Some research has found that preschool children exposed to high levels of lead might be vulnerable to ADHD (Braun, Kahn, Froehlich, Auinger & Lanphea, 2006). Also, ADHD seems to be associated with traumatic events, such as emotional or physical abuse (see Banerjee, Middleton & Faraone, 2007).

Food additives: The hypothesis that food additives increase ADHD risk has been a controversial one. A recent study found that drinking beverages with food additives increased hyperactivity in children without ADHD (see here and here).

Brain injury: Head trauma can cause ADHD-like symptoms, though only a small percentage of children with ADHD have experienced brain injury, according to the National Institute of Mental Health (NIMH). Also, a recent study disputes this hypothesis.

Symptoms of ADHD
Inattention

Misses details and makes careless mistakes

Is unable to organize tasks and activities

Has difficulty following through on instructions and completing assignments

Gets bored with a task after only several minutes

Doesn't seem to listen when spoken to

Is easily distracted

Often loses toys, school supplies, or anything necessary for a particular task

Is often forgetful

Avoids, dislikes, or hesitates to participate in activities that require continuous mental effort (e.g., homework)

Hyperactivity

Fidgets or squirms in seat

Leaves his or her seat when it isn't appropriate

Runs or climbs when it isn't appropriate (in adults, this might be restlessness)

Frequently has difficulty playing or participating in activities quietly

Often acts like he or she is "on the go" or "driven by a motor"

Talks excessively

Impulsivity

Blurts out answers before questions are completed

Has a tough time awaiting his or her turn

Interrupts others (e.g., disrupts a conversation or game)

Issues with Adult Diagnosis

The criteria for diagnosing children with ADHD are reliable. However, since they were originally created with children in mind, they may be inappropriate for diagnosing adults.

Many symptoms adults commonly experience, including procrastination, poor motivation, and time management problems, are excluded from the criteria (see Davidson, 2008). Also, it can be difficult to distinguish ADHD from other psychological disorders, including depression, bipolar disorder, and generalized anxiety.

What Are the Different Types of ADHD?

Predominantly Inattentive Type: A prevalent diagnosis among adults, this type shows six or more symptoms from the inattention category and fewer than six symptoms from the hyperactive-impulsive (but individuals can exhibit some of these symptoms).

Predominantly Hyperactive-Impulsive Type: These individuals show six or more symptoms from the hyperactive-impulsive category and fewer than six symptoms from the inattention type (but some of these symptoms can be present).

Combined Type: Common in children, this type exhibits six or more symptoms of the inattentive type along with six or more symptoms from the hyperactive-impulsive type.

How Is ADHD Diagnosed?

A trained mental health professional, such as a psychologist, psychiatrist, or therapist, can accurately diagnose ADHD. This is done with a face-to-face clinical interview. The practitioner will take a comprehensive history, including current and past symptoms, medical conditions, co-existing psychological disorders and family history. When diagnosing ADHD in children, the practitioner will gather information from parents and teachers.

What Treatments Exist for ADHD?

Both children and adults with ADHD are treated with psychotherapy, medication, or both.

What Kinds of Medications Are Used for ADHD?

Both stimulants and nonstimulants are prescribed to treat ADHD, helping to improve academic, occupational and social functioning. Medication is available in either a short-acting dose (which lasts for about four hours) or a long-acting dose (which lasts about 12 hours).

Contrary to their name, stimulants actually calm patients and are used as the first line of treatment. They help control hyperactivity, impulsivity, and inattention, improving an individual's ability to concentrate, learn, follow instructions, and interact with others.

There are two primary types of stimulants-methylphenidate-based (Ritalin, Concerta, Metadate) and amphetamine-based (Adderall, Dexedrine).

Studies have shown that these medications are safe. Side effects may include trouble sleeping, loss of appetite and anxiety. Because of this, stimulants might not be appropriate for someone who already has anxiety.

There are several concerns with prescribing stimulants for children:

1. Stunted growth. Though there might be subtle effects, it seems stimulants don't affect one's ultimate height and weight, according to a recent review (Faraone, Biederman, Morley & Spencer, 2008). The authors did note that doctors should still monitor children's height.

2. Addiction and future drug abuse. Many parents also worry their kids will become addicted to stimulants and develop drug abuse problems. However, a great deal of research has found that taking stimulants does not increase an individual's risk for substance abuse (see Biederman, Monuteaux, Spencer, Wilens, MacPherson & Faraone, 2008). Interestingly, some research has even shown protective effects-children who respond well to stimulants are at lower risk for alcohol and substance-related problems. (This might not be true for adults).

3. Heart problems. Rare, but fatal cardiac complications may occur in children with underlying heart disease. For this reason, the American Heart Association has recommended that all children with ADHD have cardiovascular screenings before they're prescribed stimulants.

4. Nonstimulants. Atomoxetine (Strattera) was the first and so far only nonstimulant medication to receive approval to treat childhood ADHD. It also was the first ADHD medication approved for adults. Strattera lasts 24 hours as opposed to the four- or 12-hour effects of other stimulants. Its side effects also include insomnia and loss of appetite, though this is more common with stimulants.The FDA has required that Strattera be sold with a black box warning about suicidal risk; it might increase children's and teens' suicidal thinking and behavior.

5. Medication concerns for adults. All of the above medications also are prescribed to adults with ADHD. However, because of the high risk for abuse, there is controversy over prescribing stimulants to adults with a history of substance abuse - prevalent among adults with ADHD, reports ADDitude.

Psychotherapy

Psychotherapy is a significant component of ADHD treatment, because it teaches both children and adults the skills they need to succeed. In addition to therapy, many adults with ADHD work with a coach who helps them get organized and develop and achieve their goals and can provide valuable feedback and support. For more details on ADD coaches see here and here.

Behavior therapy is just as it sounds: It helps promote appropriate behavior (e.g., doing one's homework) and decrease problem behavior (e.g., acting out in class). The therapist, parents, and teachers establish rewards and consequences to promote positive behaviors.

Cognitive-behavioral therapy helps adults identify negative thoughts and behaviors and change them. In addition, individuals learn how to overcome everyday struggles, including problems with organization and time management.

Social skills training teaches both adults and children how to interact appropriately with others and build healthy relationships. Individuals with ADHD tend to have difficulty understanding social cues (e.g., facial expressions; body language) and might come off as inattentive or offensive.

What Do I Do Next?

If you think you have or a loved one has ADHD, you've already accomplished your first step: educating yourself about the disorder. For more detailed information, check out our ADHD guide and complete an ADHD questionnaire. Sometimes it helps to know that you're not alone, and that many famous people also live with ADD.

To receive a comprehensive clinical assessment, see a mental health professional or check with your primary care physician or community mental health clinic. Remember that ADHD can be successfully managed, so it's essential to get evaluated as soon as possible.

Further Reading

Attention Deficit Disorder Association
ADDvance
National Institute of Mental Health
National Resource Center of ADHD
ADDitude
Helpguide, Rotary Club of Santa Monica

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Attention Deficit Hyperactivity Disorder Fact Sheet | Psych Central

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For both kids and adults, these symptoms create problems at school, work, and in relationships. Though ADHD can make daily life difficult, it's effectively treated with medication and psychotherapy. If you think you or a loved one has ADHD, see a mental health professional for a comprehensive evaluation.

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GEM: Get Experience in Mindfulness - An Awareness and Acceptance Stress Management Program For Ages 10 & Up

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GEM: Get Experience in Mindfulness is an Awareness and Acceptance Stress Management Program for ages 10 and up - adults too! This program places an emphasis on stress management taught through practical and interactive mindfulness-based activities to facilitate experiential learning. The program is a research based an

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Mindful Me: A 4-H Primary Mindfulness Curriculum

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Mindful Me: A 4-H Primary Mindfulness Curriculum, introduces cloverbud youth members to basic concepts in mindfulness practices. The program promotes mindful practices that lead to improvements in managing one's own goals, developing a sense of self, time management, stress management, emotional regulation, and mindful

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https://www.clayton.k12.ga.us/departments/support_services_and_federal_programs/counseling__enrollment___post-secondary_readiness

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Accommodations for Students with OCD

Adapted with permission from "Tips for Accommodating Students with Obsessive-Compulsive Disorder,"
by Leslie E. Packer, PhD (www.schoolbehavior.com/Files/tips_ocd.pdf)

May , 2008

Type of Accommodation

For

Explanation

Students with various types of rituals

Students with compulsive writing rituals

Minimizing peer problems

Students with various types of rituals

Be alert to teasing or harassment associated with compulsive rituals. If the student is being ridiculed, you might conduct a peer education program on OCD. Two films to consider using are "The Touching Tree" ( www.ocdawareness.com/pages.cfm?ID=39 ) and "In the Shoes of Christopher" ( ). www.ocdawareness.com/pages.cfm?ID=38

For more on OCD, see these articles from the May 2008 issue of 2e:Twice-Exceptional Newsletter:

The Challenges of Parenting and Educating a Gifted Child with OCD

U nderstanding OCD in Children

Resources for Dealing with OCD

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Adapted with permission from "Tips for Accommodating Students with Obsessive-Compulsive Disorder," by Leslie E. Packer, PhD (www.schoolbehavior.com/Files/tips_ocd.pdf) Type of Accommodation For Explanation Students with various types of rituals Students with compulsive writing rituals Minimizing peer problems Students with various types of rituals Be alert to teasing or harassment associated with compulsive rituals.

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares.

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

Obsessions Common in Kids With OCD

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

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

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

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

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

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

Behaviors You Might See in Students With OCD

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

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

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

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

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

Behaviors Often Confused With Another Disorder

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

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

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

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

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

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

How to Help Students With OCD

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

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

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

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

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

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

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

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

How to Minimize Behavioral Problems

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

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

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

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

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

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

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

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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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Strategies for working with students with ODD

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Strategies for working with students with ODD

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As discussed in the "characteristics" section the ability levels and severity of symptoms demonstrated by students with ODD vary greatly. For this reason, the strategies for working effectively with these students also may vary from student to student. The most important thing teachers and school staff members can do when working with a student with ODD is to get to know the student and build rapport with him or her. In this way, the teachers and staff demonstrate care and commitment to the student and can also make informed decisions when choosing strategies, accommodations, and interventions (Wright, 2013). Below are some suggestions for working effectively with students with ODD. Many of these strategies were compiled by the Minnesota Association for Children's Mental Health.

Social/Emotional Strategies

Provide direct instruction in anger management, conflict-resolution, and appropriate assertiveness, individually or in small support groups.

Allow students to take self-appointed time-outs in specified locations for specified times. Time outs should be viewed as a positive opportunity, not a negative consequence.

Use token economies or positive reinforcement systems to encourage appropriate behavior and responses.

Choose your battles and avoid confrontations with the student.

If a confrontation does occur, follow these guidelines:

Remain calm

Don't argue

Stick with the topic or issue at hand

Allow the student to "save face"

Listen actively

Acknowledge the student's feelings

Ask open-ended questions

Debrief with the student when he or she has had a chance to calm down.

Teach students alternative behaviors to replace negative or unwanted behaviors.

Praise students and emphasize the positives.

Teach self-monitoring and self-management strategies.

Display clear rules and consequences. Reinforce them calmly and consistently.

Minimize "down times" and transition times.

Pace and stagger non-preferred activities with preferred activities.

Break down large academic tasks into smaller pieces.

Use coaching, prompting, and visual cues.

Provide many opportunities for students to respond to teacher questions.

Teach through direct instruction.

Differentiate instruction and activities to be at an appropriate level for students so they do not become either bored or frustrated.

Provide highly stimulating, academic activities throughout the day.

Provide structured activities and opportunities for students to interact with peers.

Monitor student progress and participation closely and intervene when necessary.

Allow students choice when possible.

Have students work with peer tutors.

Functional/Organizational Strategies

Post a daily schedule for students to follow.

Use both verbal and written directions and cues throughout the day.

Help students to color-code supplies (green notebook for science, red for math, etc.)

Provide extra supplies for students to borrow when needed.

Provide students with shortened assignments or more time to complete them.

Provide students with "fill-in-the-blank" note sheets during lectures/direct instruction.

Have students keep an assignment notebook that is checked by both teacher and guardian daily.

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Strategies for Working with Students with ODD - Oppositional Defiant Disorder 514

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As discussed in the "characteristics" section the ability levels and severity of symptoms demonstrated by students with ODD vary greatly. For this reason, the strategies for working effectively with these students also may vary from student to student.

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What school counselors need to know about ODD

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What school counselors need to know about ODD

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Third grade teacher Ms. Kim is really struggling with her student Aiden. Every day, he argues over simple things, seemingly just for the sake of causing trouble. He refuses to take responsibility for his behavior, even when caught in the act. And today, Aiden tore up a fellow student's art project after that student wouldn't let him use their red marker. His parents say he's the same at home. A school counselor finally suggests that many of these behaviors line up with the symptoms of ODD in kids-oppositional defiant disorder.

What is ODD?

Image: TES Resources

Oppositional defiant disorder, commonly known as ODD, is a behavioral disorder in which children are-as the name suggests-defiant to the degree that it interferes with their daily lives. The DSM-5, published by the American Psychiatric Association, defines it as a pattern of angry, vindictive, argumentative, and defiant behavior that lasts at least six months.

In an article on Headteacher Update, Dr. Nicola Davies sums it up this way: "The goal of a student with oppositional defiant disorder (ODD) is to gain and maintain control by testing authority to the limit, breaking rules, and provoking and prolonging arguments. In the classroom, this can be distracting for both the teacher and other students."

Between 2% and 16% of the population may have ODD, and we're not entirely sure of the causes. Scientists believe it could be genetic, environmental, biological, or a mix of all three. It's diagnosed more often in younger boys than girls, though by their teen years, both seem to be equally affected. It co-occurs in many kids with ADHD, with some studies indicating up to 50% of students with ADHD also have ODD.

What does ODD in kids look like?

Image: ACOAS

We all know that kids of a certain age, especially toddlers and teenagers, are pretty much always arguing and defying. In fact, those can be appropriate behaviors at those ages, as kids test the world around them and learn how it works.

However, ODD is a whole lot more than that, to the point where students with ODD disrupt their own lives and often the lives of everyone around them. Kids with ODD push the limits of defiance far beyond reason. Their problem behavior is much more extreme than that of their peers, and it happens much more often.

Defiance and arguing

Most kids go through a phase where "no" is their favorite word, but for students with ODD, that phase never ends. They question everything, all the time, and consistently refuse to comply with rules and requests. Their need for argument may lead them to deliberately annoy others in an attempt to create conflict. However, they usually refuse to take responsibility for their mistakes or behaviors, blaming others for everything.

Anger and irritability

These are the kids who seem angry all the time and fly off the handle at the slightest provocation. Their overreactions may devolve into temper tantrums, not just occasionally but frequently. Therefore, every conversation you have with them seems to be a struggle.

Vindictiveness

The ongoing anger of kids with ODD can lead to vindictiveness and a need for revenge. They are spiteful and retaliatory, holding grudges and demanding punishment for others.

Not surprisingly, these behaviors cause students with ODD to struggle both at home and in school. It's hard for them to make friends, and their schoolwork often suffers too. They may become depressed or anxious, or develop conduct or substance abuse disorders as they grow older. Early identification and treatment are vital to helping these kids.

How can teachers help kids with ODD?

It's vital that teachers and parents work together to help students with ODD. The experienced teachers in the WeAreTeachers Helpline group on Facebook suggest trying these methods at school and at home. Find more ideas at Pathway 2 Success.

Be consistent

"Instead of arguing, repeat your words and consequences," says Brandy T. "I use trigger words that I often repeat so the student knows I mean business. If a student tries to argue, I simply say either 'not now,' 'later,' or 'fix the issue!' The student then knows they can go to their chill-out space if they need to calm down."

Give them space to reset

Kids with ODD can learn to recognize when they're feeling overwhelmed and getting ready to challenge or defy. Giving them a safe space to calm down and rethink their choices can be beneficial. Calm-down corners have become popular in classrooms for this very reason. "Put out books, coloring, LEGO bricks, etc., in a place where they can go on their own when they feel like they need a break," says Tobey G. "Often immediately after activities with a lot of stimulation, these kids need a safe space to calm down. Let them decide if and when they need to excuse themselves."

Give them choices

Kids with ODD are looking for control. Rather than letting them drive the situation, you can give them a feeling of control while maintaining control yourself. "Always give choices," advises Holli A. "State your choices-then walk away. Give the student time to process and decide which choice to make. If they don't like the choices, don't engage. When they try to argue, repeat the choices, and walk away again. If the student still will not choose, they do not get to participate in their preferred activity."

As in other situations, it pays to stay consistent in your classroom rules and discipline. "After I give choices, I always reinforce the classroom rules and procedures and follow up with an appropriate consequence," says Kristel R. "You cannot falter; stick to your rules and follow through."

Offer positive reinforcement and appropriate rewards

Kids with ODD often respond to positive behavior reinforcement. It's helpful to offer them a chance to earn certain privileges, rather than taking those privileges away as punishment. For instance, give them the ability to earn screen time when they promptly do as they're asked, instead of threatening to take away screens when they defy.

When using a reward system, make sure that it is appropriate and isn't perceived as manipulation. Leslie L. uses a behavior tracking system and a reward system where students can turn in points for an incentive (iPad time, lunch with a teacher, etc.). "I also build breaks right into their schedule," adds Leslie. "And I try to be as patient and understanding as I possibly can."

Teacher Erica M. also uses a point system checklist with options A and B. If they do each one, they earn "points" for an incentive, which often is iPad time during the last 15 minutes of class. "Find an interest and use that to your advantage!" Erica says.

Avoid power struggles

Most teachers agreed: Stay out of those winless power struggles. As Kris W. said, "Pick your battles. A student of mine corrects me all the time, whether I am wrong or not. I answer back, 'OK, let's double-check that.' If I made a mistake, I correct it, and we move on; if he's wrong, I silently let him figure it out."

Make personal connections

Often kids with ODD are looking for a relationship with a teacher who can help them deal with problems on their own instead of making them stand out in a negative way. Building a connection with them will help get to the root of the behavior.

"Almost all of my students have ODD, and I have a great relationship with most of them," says Kendra J. "Find out what they are interested in and have conversations on their level during breaks." Allow them to set goals and decide together what the consequences will be if they don't meet the goal.

Carol H. says, "Find something at the student's interest level. I once had a middle school girl who hated all of her teachers and was out of control. She would curse at adults and peers, scratch, bite, and refuse to complete work. I found out she played soccer for a travel team. So did my son. A few weeks into the school year, she had a game adjacent to my son's, and I was able to watch her play. It changed everything. She is a freshman in college now, and we still keep in touch."

Find ODD Resources

This is just an overview of what students with ODD are facing. Educate yourself about the condition to find more ways to understand and help these kids in your classroom.

Online

Books

(Just a heads up, WeAreTeachers may collect a share of sales from the book links on this page. We only recommend items our team loves!)

Have more questions about kids with ODD? Come share your thoughts and ask for advice in the WeAreTeachers Helpline Facebook group.

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What Teachers Need To Know About Students With ODD

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What is ODD in kids, and how can teachers help their students with ODD? Learn what oppositional defiant disorder looks like in the classroom.

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What Teachers Should Know

Even the best-behaved students occasionally can be difficult. But kids and teens who display a continual pattern of tantrums, arguing, and angry or disruptive behavior toward teachers, parents, or other authority figures may have oppositional defiant disorder (ODD).

Students with ODD can be so uncooperative and combative that their behavior affects their ability to learn and get along with classmates and teachers. It can lead to poor school performance, anti-social behaviors, and poor impulse control.

ODD is more common in boys than girls. Signs of ODD generally develop during preschool years, and are almost always present before early teens.

Symptoms of ODD can be hard to distinguish from other mental health disorders. Children and teens with ODD may also have:

Behaviors associated with ODD can be mild, moderate, or severe and include:

negativity

being argumentative and defiant

disobedience

hostility toward authority figures

temper outbursts

angry and irritable mood

Students with ODD might need:

seating closer to the teacher to avoid disrupting other students

breaks from classroom activities when they feel overwhelmed

more time to complete assignments

to consult with a school counselor or psychologist

to visit the school nurse to take medication for coexisting conditions, such as ADHD

an individualized education program (IEP) if a learning disability is associated with their ODD

ODD treatment involves therapy, training to help build positive interactions, and sometimes medications to treat related mental health conditions.

What Teachers Can Do

It can be difficult to recognize the differences between a strong-willed or emotional student and one with ODD.

Post classroom rules and review them regularly. Have a plan in place to handle serious behavior problems. Students with ODD often are isolated and lack friends. They may be the targets of bullies or be seen as bullies.

Be sensitive to self-esteem issues. Provide feedback to your student with ODD in private, and avoid asking the student to perform difficult tasks in front of classmates. It can be helpful to praise positive behaviors, such as staying seated, not calling out, taking turns, and being respectful.

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Oppositional Defiant Disorder Factsheet (for Schools)

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Even the best-behaved students occasionally can be difficult. But kids and teens who display a continual pattern of tantrums, arguing, and angry or disruptive behavior toward teachers, parents, or other authority figures may have oppositional defiant disorder (ODD). Students with ODD can be so uncooperative and combative that their behavior affects their ability to learn and get along with classmates and teachers.

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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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Overview

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.

Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).
Bipolar disorder care at Mayo Clinic
Symptoms

There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life.

Bipolar I disorder. You've had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).

Bipolar II disorder. You've had at least one major depressive episode and at least one hypomanic episode, but you've never had a manic episode.

Cyclothymic disorder. You've had at least two years - or one year in children and teenagers - of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).

Other types. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke.

Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

Although bipolar disorder can occur at any age, typically it's diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time.

Mania and hypomania

Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.

Both a manic and a hypomanic episode include three or more of these symptoms:

Abnormally upbeat, jumpy or wired

Increased activity, energy or agitation

Exaggerated sense of well-being and self-confidence (euphoria)

Decreased need for sleep

Unusual talkativeness

Racing thoughts

Distractibility

Poor decision-making - for example, going on buying sprees, taking sexual risks or making foolish investments

Major depressive episode

A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:

Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)

Marked loss of interest or feeling no pleasure in all - or almost all - activities

Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)

Either insomnia or sleeping too much

Either restlessness or slowed behavior

Fatigue or loss of energy

Feelings of worthlessness or excessive or inappropriate guilt

Decreased ability to think or concentrate, or indecisiveness

Thinking about, planning or attempting suicide

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.

Symptoms in children and teens

Symptoms of bipolar disorder can be difficult to identify in children and teens. It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.

Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes.

The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.

When to see a doctor

Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones and don't get the treatment they need.

And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out - and perhaps in financial, legal or relationship trouble.

If you have any symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control.

When to get emergency help

Suicidal thoughts and behavior are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or 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.

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.

Causes

The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:

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

Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.

Risk factors

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

Having a first-degree relative, such as a parent or sibling, with bipolar disorder

Periods of high stress, such as the death of a loved one or other traumatic event

Drug or alcohol abuse

Complications

Left untreated, bipolar disorder can result in serious problems that affect every area of your life, such as:

Problems related to drug and alcohol use

Suicide or suicide attempts

Legal or financial problems

Damaged relationships

Poor work or school performance

Co-occurring conditions

If you have bipolar disorder, you may also have another health condition that needs to be treated along with bipolar disorder. Some conditions can worsen bipolar disorder symptoms or make treatment less successful. Examples include:

Anxiety disorders

Eating disorders

Attention-deficit/hyperactivity disorder (ADHD)

Alcohol or drug problems

Physical health problems, such as heart disease, thyroid problems, headaches or obesity

Prevention

There's no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.

If you've been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression:

Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. You may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you're falling into an episode of depression or mania. Involve family members or friends in watching for warning signs.

Avoid drugs and alcohol. Using alcohol or recreational drugs can worsen your symptoms and make them more likely to come back.

Take your medications exactly as directed. You may be tempted to stop treatment - but don't. Stopping your medication or reducing your dose on your own may cause withdrawal effects or your symptoms may worsen or return.

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Bipolar disorder causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

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Inconsistent Academic Results Can be a Sign of Mental Health Issues

These disorders can also lead to inconsistent academic results. For example, a student may produce incredible work one day and barely be able to complete a single task the next. This unpredictable behavior is a prevalent sign that anxiety or depression might be present. The inconsistency of these disorders can leave students feeling frustrated and teachers confused and unsure how to approach the situation.

When students are depressed or are dealing with anxiety, they are more likely to disengage in the classroom.

This can cause them to participate in behaviors that will allow them to avoid certain events and situations. For example, missing class or going to the nurse during a quiz or presentation are a few ways students may demonstrate an anxiety disorder.

Teachers have to be prepared and know which signs to look for so that they can determine what is really going on with the student and how they can best help them.

Missing Class Can be a Sign of Anxiety

These disorders can also lead to school refusal, or school phobia. This is when a student's anxiety or depression is so severe that they begin avoiding going to school at all. This can begin with missing class, going home early and staying home, but eventually can lead to school drop out. The Centre for Emotional Health at Macquarie University states that 49% of adults with anxiety reported leaving school early and 24% claimed that anxiety was the primary reason for them leaving.

The negative impact anxiety and depression have on students' academic performance doesn't just hurt them and their families, but it has consequences for the economy and society as a whole because they are not receiving a proper education.

Risks That Can't be Ignored

When anxiety and depression are not identified and properly addressed there are long-term risks for students.

A student dealing with one of these disorders can experience negative effects on their attention, interpretation, concentration, memory, social interaction and physical health.

All of these factors play a key role in each student's academic success and achievement. A child who has anxiety is more likely to focus their attention on things that they perceive to be a possible threat rather than focusing on what is important, like learning in the classroom. Individuals will also interpret everyday situations as dangerous or threatening and will often assume the worst case scenario.

When someone is experiencing anxiety or depression the majority of their mental capacity is used to create and process worrisome thoughts. This can make it extremely difficult to focus on positive thoughts and can be very exhausting for the student, which detracts from their learning abilities.

Not only do these disorders impact memory, which makes it hard for students to recall information, but they can also have negative effects on how students engage in social situations. Often, students with anxiety or depression will avoid interactions with their peers and will perceive neutral situations as threats. This, in turn, makes others uncomfortable and results in the student feeling lonely, outcast and increases anxiety and depression.

Physical symptoms like headache, fatigue, nausea and unexplained illness are also risks of untreated anxiety and depression. Children with these disorders have a higher resting heart rate, higher blood pressure, higher cortisol levels and they carry more tension in the body. These physical effects often lead to missed school days causing the child to fall behind.

Dealing with undiagnosed depression or anxiety can result in students feeling like they are constantly missing out on opportunities and this can lead to substance abuse, conduct problems, further mental health problems and even suicide.

Currently, suicide is the second leading cause of death among college students. Heather Morgan, a crisis line manager for Didi Hirsch Mental Health Services Suicide Prevention Center says, "We receive calls from college students daily. Since people go through different traumatic events in life; calls, texts and chats can range from relationship issues, LGBTQI questions or concerns, financial, and family issues or concerns - to name a few."

The negative impact of anxiety and depression on student's academic progress and overall well-being is very clear. Early anxiety disorders typically predict adult anxiety disorders making it crucial to address them early on. 85% of depressed adolescents have a history of having anxiety as a child. If these issues can be identified early on while the child is in school there is a better chance for treatment and preventative care so that the above consequences can be avoided.
Teachers and Schools Need to be Prepared
Under the Individuals with Disabilities Education Act (IDEA), parents have the right to request appropriate accommodations related to their child's diagnosis. Teachers and school staff need to be able to respond effectively and know which accommodations to provide for each student.
Mental health training is crucial in schools, especially for teachers, who are interacting with students on a daily basis and have many opportunities to observe behavior and reach out.
A mental health training program will prepare teachers and staff to look for discreet signs that may indicate disorders like anxiety. These signs include increased inflexibility, over-reactivity, emotional intensity, impulsivity, acting out or escaping to avoid a situation. Very often a student may go to the nurse during a quiz or get kicked out of class on purpose. Teachers may interpret the child as simply being a troublemaker or slacking off, when in reality, they are feeling intense anxiety and are trying to protect themselves.

There's a reason anxiety and depression are referred to as invisible diseases. It can be very difficult to identify these disorders in students unless teachers have a deep understanding of them and know exactly what to look for. Training is necessary because the best way to improve these conditions are to address them as soon as possible.

Isabel, a school superintendent in California says, "In most schools mental health certification is reserved for a social worker or guidance counselor. Yet 99.9% of student contact time everyday is with a teacher, bus driver or coach. Our number one priority should be to train and equip our front line staff to deal with this crisis."

Teachers and classroom staff are on the front lines of helping students seek proper treatment and receive an education in a safe, comfortable environment. When school staff and teachers are properly trained they are able to effectively address anxiety and depression among their students and create a better learning environment that will produce higher academic outcomes.
Student Mental Health Training and Certification
IBCCES and their board of experts , including international leaders in the educational field, Tier 1 University researchers, master educators, and clinical professionals, have designed a Student Mental Health Specialist (SMHS) training and Student Mental Health Certificate (SMHC) certification . 81% of teens with anxiety responded positively to teacher intervention and 71% of students with depression had higher test results after teacher engagement.

The purpose of the SMHS and SMHC training and certification is to prepare teachers and other school staff to provide support for students in the classroom while monitoring changes in student behavior and understanding common disorders or mental health concerns. The IBCCES program is unique because it combines training with independently verifiable certification, providing schools with the resources they need to support students and parents to enhance learning opportunities and the overall school atmosphere.

Benefits of the SMHS and SMHC program include:

Access to relevant strategies that can be implemented immediately

Best practices and latest research in anxiety and mental health disorders

Confidence to handle stressful situations and approach students with useful tools

Ability to improve learning for students and produce better academic results

Credibility and recognition for the staff and school

Ability to create a sense of security in the classroom.

Take the First Step
The SMHS and SMHC program consists of a convenient six step process that can be completed online.

There is no reason why teachers and school staff have to continue feeling unprepared and student anxiety and depression has to continue going unnoticed and unaddressed.

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Impact of Anxiety and Depression on Student Academic Progress

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These disorders can also lead to inconsistent academic results. For example, a student may produce incredible work one day and barely be able to complete a single task the next. This unpredictable behavior is a prevalent sign that anxiety or depression might be present.

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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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Most children and parents will have some distress or upset - so how do I know when a child or family needs additional help?

Ask your patients (and their parents) about reactions and coping.

Listen for ongoing or severe traumatic stress symptoms.

Consider a referral for a more thorough evaluation with a mental health professional if:

Traumatic stress reactions are severe or prolonged (more than a month).

Traumatic stress reactions interfere with recovery or with returning to normal activities.

Consider: Is the child participating in daily activities to the extent possible given their medical condition? Are stress reactions interfering with treatment adherence? Are new fears or worries troubling the child or parent?

Steps for making a referral Effective mental health treatment for traumatic stress Online resources - help in finding a mental health professional Distinguishing between types of mental health professionals
Therapist Resource Guide: There are many ongoing stressors that children and families endure after diagnosis of an illness or an injury. This guide focuses specifically on medical traumatic stress and responses that children and families may have.

Steps for making a referral

Mention concerns you have identified.
Say something like: "I'm concerned that (you are / your child is) having these upsetting thoughts and feelings. It might be useful to talk with a specialist who can help your family more."

Involve child and family in making a plan.
Ask for their ideas about what is needed now
Say something like: "What issues or difficulties are impacting you / your family the most right now? What would help make things better?"

Ask for permission to offer advice. Present advice as range of possibilities; be sure to incorporate patient/family ideas

Say something like: "I have some suggestions that have helped other patients in the past in situations similar to yours. May I share them with you?"

Range of possibilities might include: patient education materials / websites; speaking with social worker, local clergy, school counselor; seeking out support group, referral to therapist / community mental health center.

Ask about their readiness to act on this now or in the future.
Say something like: "Is this (suggested plan) something you would be willing to do when you leave today, or if you need it next week...month?"

Ask about barriers to potential plans / referrals, and strategies to overcome barriers.
Say something like: "What kinds of things would interfere with following-up on this plan we just discussed? How can we work through this so you end up getting the help you need.?"

Involve the child and parent in setting the agenda*:*Adapted from Wissow et al. (2008)

Keep the door open.

If your patient or their parents are not quite ready to act on a suggested referral now, arrange to follow up to see how your patient is doing.

You might say: "I'd like to talk with you again in a few weeks to see how things are going."

Promote continuity of care.
If your care for this patient is ending, ask permission to communicate your concerns about traumatic stress reactions or risk factors to the child's primary care provider, or to other providers who will continue to take care of this patient.

Facilitating collaboration between pediatric health care and mental health providers: The American Academy of Pediatrics Task Force on Mental Health has developed tools to facilitate collaboration between pediatric health care providers and mental health professionals, including a Physician Referral and Feedback Form template

Effective mental health treatment for traumatic stress

There are very good and helpful treatments for children who continue to have traumatic stress symptoms.
What treatment approaches are effective?
Evidence-based treatments include cognitive-behavioral treatment approaches, and in particular Trauma-Focused Cognitive Behavior Therapy (TF-CBT).

Click here for a fact sheet about effective treatments for youth trauma from the National Child Traumatic Stress Network.

A recent article includes informative summaries of effective mental health treatments for child traumatic stress symptoms, and guidance for health care professionals:
Cohen, J, Kelleher, K, Mannarino, A.. Identifying, treating, and referring traumatized children: The role of pediatric providers. Archives of Pediatric and Adolescent Medicine 2008;162(5):447-452 How can I help parents find effective treatment for their child?
When helping parents find a counselor or therapist to help their child with traumatic stress symptoms, you might suggest that they ask prospective therapists questions such as:

Do you have experience working with children after trauma?

What is your approach to working with this type of problem?

What is your success rate?

How do you work with parents?

The National Child Traumatic Stress Network offers useful tips and information about finding a mental health professional to help children and their families after trauma.

Online resources - help in finding a mental health professional

The National Child Traumatic Stress Network (NCTSN) has trauma-trained, child mental health professionals and community-based treatment centers in 35 states in the US. For information about or referral to a NCTSN center near you, please go to the NCTSN Organizational Members site.
American Psychological Association - Psychologist Locator National Association of Social Workers - Find a Licensed Social Worker American Academy of Child and Adolescent Psychiatrists - Psychiatrist Finder Anxiety Disorders Association of America - Find a Therapist Sidran Institute Help Desk - Locate Trauma Resources ISTSS Clinician Directory - Find a Clinician, Counselor or Mental Health Professional
Distinguishing between types of mental health professionals

Psychologists are professionals who have earned a doctoral degree (Ph.D. or Psy.D.) after 4-6 years of graduate-level training in human behavior and development, psychological testing and evaluation, and psychotherapy. Psychologists are licensed by the state in which they practice.

Psychiatrists are physicians (M.D. or D.O.) who have completed medical school, plus additional advanced training in the evaluation and treatment of psychiatric disorders and emotional and behavioral problems. Psychiatrists are licensed by the state in which they practice. As medical doctors, psychiatrists can prescribe and monitor medications.

Clinical Social Workers are professionals who have earned a master's degree (M.S.W.) after 2-3 years of graduate training. Clinical Social Workers are licensed by the state in which they practice (LCSW or similar credential - varies by state).

Marriage and Family Therapists are professionals who have completed a master's degree (M.A. or M.S.) after 2-3 years of graduate training. Some Marriage and Family Therapists have completed a required amount of clinical hours and passed a state-administered examination to become licensed marriage and family therapist (LMFT).

Licensed Professional Counselors (LPC) & Licensed Mental Health Counselors (LMHC) are mental health professionals who have earned a master's degree (M.A. or M.S.) after 2-3 years of graduate training and have obtained a required amount of clinical experience and passed a state-administered licensing examination.

For more information on the training and credentialing of mental health professionals, see Mayo Clinic: Mental health providers.

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When and How to Refer for Mental Health Care

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Pediatric providers can follow specific steps to determine if and how to refer a child and familiy for further mental health services after a medically traumatic event. Providers can also become familiar with current evidence-based treatments and online resources for mental health services for traumatic stress.

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Understanding the Process of IDEA and 504

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Understanding the Process of IDEA and 504

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Understanding the Special Education Process

The chart below offers an overview of the special education process. It is not designed to show all steps or the specific details. It shows what happens from the time a child is referred for evaluation and is identified as having a disability, through the development of an individualized education program (IEP).

The process begins when someone (school staff, parents, etc.) makes a referral for an initial evaluation.

Early Intervention Services in Minnesota

Children ages birth to age 3 who are eligible for special education are served under an Individualized Family Service Plan (IFSP). The IFSP plan and process focuses on identifying the needs of the child and family and determining how to best meet the needs. The law recognizes the importance of the family in the lives of young children and emphasizes that the IFSP plan and process be family centered and directed. The IFSP process is to be comprehensive, coordinated, multidisciplinary, and, when appropriate, interagency.

2010 edition - 14 page pdf

Structure of special education in Minnesota

In Minnesota, special education programs for students with disabilities are provided primarily by school districts (public schools) that sometimes combine with other local school districts to form special education cooperatives.

Sometimes a single school district--usually in highly populated areas-- provides services to all children within its boundaries, including the entire range of programs and services for students with disabilities.

Sometimes a special education cooperative of two or more districts-- usually adjoining or within the same county or region--may join to provide special education services to students with disabilities within their combined boundaries. A cooperative may have a single administrative office with teaching personnel hired by that office.

Charter schools also are required to provide special education services to eligible children. Minnesota also has three intermediate school districts which operate similar to cooperatives.

Regardless how the special education programs of a school district are organized, in most cases, one person called the special education director is in charge of coordinating all special education services.

Resources

A book that help parents understand both the principles of special education and the procedures for writing the educational program for a child with a disability is available free of charge from PACER Center to Minnesota parents:

Parents Can Be the Key
As a parent, you know your child in a way no one else can. You are an expert on your child and a vital member of the team that plans your child's education. You, as a parent, can be the key to an appropriate education for your child. You have important information to share about your child's educational planning, and you can take action to make changes when they are needed. To be an effective advocate, you must know your rights and those of your child. Exercising these rights and fulfilling your responsibilities are important steps in supporting your child on his or her educational journey. This book offers an overview of special education in Minnesota. (2011 edition - 40 pages)

Call to Order
Communication in the special education process

IEP meetings and other school meetings are crucial parts of a child's educational program. A parent's responsibility extends beyond giving consent and accepting explanations. Asking questions, bringing up issues to discuss, gathering information, and clarifying points are all part of the parent's role.

Effective communication is two-way, generating understanding and support the professionals and the parents need to make effective decisions about the child's educational program.

The key to effective communication is preparation and willingness to be actively involved in planning the child's educational program. To foster meaningful communication, the parent can:

Make sure the focus stays on the child.

Be prepared by knowing in advance the important points to discuss and questions to ask. Then write down the points and questions and check them off as they are addressed.

Listen. Listening helps gather information about the child and understanding of other viewpoints.

State issues clearly. It is important to communicate in a honest and clear manner.

Ask questions. Asking questions can be an effective way of clarifying a point and keeping the line of communication open.

Direct comments and questions to the person who can best address or answer them.

Restate concerns if not heard the first time.

Be confident. A parent never has to feel guilty or embarrassed asking questions or assertively pursuing the appropriate services for the child. That is their role and their right.

Work together. Neither the parent nor the professionals have all the answers. Working together as a team encourages finding solutions. Everyone at the meeting has the same goal - to provide an appropriate educational program for the child.

Resources

High Expectations
This book helps parents who have just learned their child has a disability to maintain high expectations for the child's future while challenging the low expectations of others. Call to order.

Working Together: A Parent's Guide to Parent and Professional Partnership and Communication Within Special Education
This book helps parents effectively communicate with special education professionals as they develop their child's educational program. Call to order.

Resolving differences with the school

Most participants want IEP meetings to result in mutual agreement about an appropriate educational program for the child. However, this doesn't always happen. The parent can:

Discuss concerns with the child's IEP case manager

Request another IEP meeting to discuss specific issues and concerns

Explore other school programs or placements if necessary

Consider requesting a conciliation conference, mediation, or an alternate form of dispute resolution

If the above methods don't work and the situation is appropriate, consider initiating due process procedures

It if appears that the school is not complying with special education laws, consider filing a complaint with the state's Division of Compliance and Assistance.

For information about the dispute resolution methods mentioned above visit our Dispute Resolution Section or contact PACER Center.

Tips on resolving conflicts:

Put requests in writing and ask for a written response

Keep written records of communication with the school

Clarify issues and priorities related to points of agreement and disagreement

Define possible solutions

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Understanding the Special Education Process

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An overview of the special education process. It is not designed to show all steps or the specific details. It shows what happens from the time a child is referred for evaluation and is identified as having a disability, through the development of an individualized education program (IEP).

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Each child is an individual with different social, emotional, and academic strengths and weaknesses. Therefore, their educational needs may vary from one season or school year to the next.

In the first section of our chapter, "School: A Child's World Beyond Home" we cover the legal evolution of the Individual with Disabilities Educational Act (IDEA 2004) and advise a parent how to initiate an Individual Education Plan (IEP), prepare for the IEP meeting (including rehearsal strategies), and locate educational consultants and attorneys.

But the more we talked to people in preparation for this chapter, the more we came to understand that both parents and educators were confused about the construction of an IEP for a student struggling with a bipolar disorder. A model IEP-one that specifically addresses the seasonal variations in mood, energy, attention, motivation, and behavior, as well as one that addresses the frequently co-occurring executive function deficits, needed to be developed.

Therefore, we asked special education advocate, Anne Marie Smith, M. Ed., from Agawam, Massachusetts, to construct an IEP that might provide guidelines for educating a middle school student throughout the school year.

With the hope that the following information is helpful to parents and educators alike, we excerpt the following from The Bipolar Child (pages 305-311.) Also see pages 295-303 in the book for a highly focused and very comprehensive list of accommodations, modifications, and special services that can be incorporated into an IEP.
From The Bipolar Child by Demitri Papolos, M.D. and Janice Papolos (Broadway Books, 2006). All rights reserved.

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Bipolar Children Individual Education Plan (IEP) Model

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Each child is an individual with different social, emotional, and academic strengths and weaknesses. Therefore, their educational needs may vary from one season or school year to the next.

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When worrying gets in the way of a child's functioning, parents need to get help rather than arranging the child's life to avoid the occasions of anxiety.

Credit... Getty Images

By

Anxiety disorders, the most common mental health problems in children and adolescents, often go untreated while children suffer, even though there are effective treatments available, according to a new report on anxiety in children and adolescents from the Child Mind Institute in New York. Anxiety may be missed because it doesn't necessarily declare itself with attention-getting disruptive behaviors; in fact, symptoms may keep some children quiet and inhibited, though in other children, alternatively, anxiety may be misunderstood as oppositional behavior.

Adults may also assume that anxiety in a child is just a phase to be outgrown. A certain amount of anxiety is a normal aspect of development for young children - consider separation anxiety, for example - and it can even be protective, since children need to learn to keep themselves safe and anticipate certain kinds of dangers. But when worrying or avoiding possible threats gets in the way of a child's functioning or a child's enjoyment, it should be a signal to parents that help is needed, not just watching and waiting, not arranging the child's life to avoid the occasions of anxiety.

Kathleen Merikangas, the senior investigator and chief of the Genetic Epidemiology Research Branch at the National Institute of Mental Health, said, "To me, anxiety is one of the most underrecognized or under-treated conditions of childhood and adolescence." These children can get missed, she said, because they may seem to be functioning well; many don't have the kinds of developmental problems or attention issues that draw attention in school, though they may be suffering.

Consider the child whose anxiety about speaking in public gets in the way of participating in class. The child may be silent out of a fear of being laughed at or otherwise rejected, Dr. Merikangas said, but to the teacher, it may look like the child is just not interested. Environmental modifications can really help these children thrive in school, she said; for example, working in small groups with children they know.

The new report, released in September, summarizes the evidence that early temperament in children predicts their later behavior patterns around anxiety; toddlers who show what are called "behaviorally inhibited" behaviors, which parents are likely to perceive as extreme shyness, or anxiety around new people, are more likely to develop social anxiety later on. That doesn't mean that shyness is pathological (as with all varieties of temperament, there's a wide range of function), but it does suggest how important it is to help a child with this temperament who develops difficulties.

The tendency toward anxiety - and toward some specific forms of anxiety, like phobias - may persist throughout childhood and adolescence and into adulthood. And anxiety is closely tied to depression, Dr. Merikangas said. Although there have been reports that anxiety rates among American teenagers have soared, she cited evidence that the international rates of the underlying disorders had stayed consistent from 1998 to 2013; there is no global "epidemic" of clinical anxiety disorders, she said.

But with rates of suicide and suicidal ideation on the rise, it's particularly important to provide information to schools and to parents about recognizing anxiety and getting children help.

Dr. Harold Koplewicz, the president of the Child Mind Institute, said that when anxiety disorders in children are left untreated, anxiety can inhibit their lives, making standard daily activities difficult, from attending school to sleeping in their own beds, and lead to many extra visits to the school nurse or the pediatrician.

But beyond that, he said, "people underestimate that this is a gateway disorder." If children don't get help with these disorders, they may be at risk to develop other mental health problems; the child with severe separation anxiety may develop panic disorder, he said; the child with untreated general anxiety may be at greater risk for depression.

Dr. Merikangas was a co-investigator on a national study of mental disorders in adolescents, which has shown both that anxiety disorders were the most common mental health problems in adolescents in the United States, and also the problems that showed up earliest in those children's lives - the mean age of onset for anxiety disorders was 6. But many adolescents had never received treatment. That makes it essential to get the word out, Dr. Merikangas said, that anxiety is "one of the most treatable symptoms and syndromes, we can really change their lives with minimal intervention."

"All these disorders are remarkably treatable," Dr. Koplewicz said. There are highly effective behavioral and psychosocial therapies, including cognitive behavioral therapies, to help children cope with the demands of daily life. For children who don't respond to psychosocial therapies, he said, medications can be added.

But perhaps because anxiety is a normal response, parents often believe that even severe and disabling anxiety symptoms are just a phase, and on average, there is a two-year lag between the time children develop anxiety and the time they get help. "It's bad for these children's brains," he said. "Having your brain's thermostat miss-set is not good for your brain."

"Anxiety can manifest itself along a continuum," said Rachel Busman, the senior director of the anxiety disorders center at the Child Mind Institute. The report shows that there is some overlap with physical illnesses, such as chronic headaches or stomach aches, often coordinated with school. "That could be a kid's way of saying, 'I'm anxious,'" she said.

And when a child who is having a lot of difficulty with separation gets into the classroom, Dr. Busman said, that child may start throwing things, or running and hiding, and that "bad behavior" may represent the fight or flight response of anxiety. "We've also seen kids who have intense social anxiety and their way of managing it is to be class clown," she said.

Treating children with anxiety always means working with their parents. Jerry Bubrick, senior clinical psychologist at the anxiety disorders center of the Child Mind Institute, said that when children are little, it's normal for parents to operate in "fix-it mode," blocking the staircase so a toddler doesn't tumble down, averting problems before they happen.

As children get older, parents normally pull back, helping children find solutions of their own. "But anxious parents of anxious children remain in fix-it mode," he said, helping their children avoid the situations that make them anxious. Therapy involves exposing children to those situations and helping them develop strategies to manage them; with treatment, Dr. Bubrick said, parents can "let the child experience the anxiety and learn to tolerate and overcome it on their own."

"If you see things you're not sure about, talk to the preschool, talk to the pediatrician, be open to the idea that maybe there is anxiety," even in a young child, Dr. Busman said. Separation anxiety can be a problem even in children who are able to go to school, she said. Parents should pay attention if a child can't be left with a babysitter, a child can't sleep alone at home."These are the kids, they go into the bathroom, and they're like, are you still there?" she said. "We do see really young anxious children."

"If your child is suffering distress and dysfunction, reach out to your pediatrician," Dr. Koplewicz said. When you get to a mental health professional, "make sure you ask the right questions," he said, including asking whether that person has specific experience with treating anxiety and how long the treatment is expected to take.

"You want a professional who understands what they're doing and can explain to you what they're doing."

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How to Help a Child With an Anxiety Disorder

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When worrying gets in the way of a child's functioning, parents need to get help rather than arranging the child's life to avoid the occasions of anxiety. By Anxiety disorders, the most common mental health problems in children and adolescents, often go untreated while children suffer, even though there are effective treatments available, according to a new report on anxiety in children and adolescents from the Child Mind Institute in New York.

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From Dr. Tamar Chansky Creator of Worrywisekids.org

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https://medium.com/the-coffeelicious/charlie-browns-existential-crisis-saved-my-life-a9053a90d732

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Your access to the NCBI website at www.ncbi.nlm.nih.gov has been temporarily blocked due to a possible misuse/abuse situation involving your site. This is not an indication of a security issue such as a virus or attack. It could be something as simple as a run away script or learning how to better use E-utilities, http://www.ncbi.nlm.nih.gov/books/NBK25497/, for more efficient work such that your work does not impact the ability of other researchers to also use our site. To restore access and understand how to better interact with our site to avoid this in the future, please have your system administrator contact info@ncbi.nlm.nih.gov.

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Your access to the NCBI website at www.ncbi.nlm.nih.gov has been temporarily blocked due to a possible misuse/abuse situation involving your site. This is not an indication of a security issue such as a virus or attack.

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Be Mindful of children with ed in school

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Be Mindful of children with ed in school

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Enhancing cognitive and social-emotional development through a simple-to-administer mindfulness-based school program for elementary school children: a randomized controlled trial.

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[PDF] Mindfulness for Students Classified with Emotional/Behavioral Disorder. | Semantic Scholar

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A six-week investigation utilizing a standard mindfulness for adolescents curriculum and norm-based standardized resiliency scale was implemented in a self-contained school for students with Emotional/Behavioral Disorders (E/BD). Informal integration of mindfulness activities into a classroom setting was examined for ecological appropriateness and improvement of student resiliency as conceptualized by pre and post-tests using a standardized measure.

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The effect of ADHD on the life of an individual, their family, and community from preschool to adult life

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Attention deficit/hyperactivity disorder (ADHD) may affect all aspects of a child's life. Indeed, it impacts not only on the child, but also on parents and siblings, causing disturbances to family and marital functioning. The adverse effects of ADHD upon children and their families changes from the preschool years to primary school and adolescence, with varying aspects of the disorder being more prominent at different stages.

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School Counseling Standards

Four sets of school counseling standards define the school counseling profession. These standards help school counselors develop, implement and assess their school counseling program to improve student outcomes.

Ethical Standards
The ASCA Ethical Standards for School Counselors serve as a guide for the ethical practices of all school counselors, supervisors/directors of school counseling programs and school counselor educators regardless of level, area, population served or membership in this professional association. ASCA also has Ethical Standards for School Counselor Education Faculty.

School Counselor Professional Standards & Competencies
The ASCA School Counselor Professional Standards & Competencies outline the mindsets and behaviors school counselors need to meet the rigorous demands of the school counseling profession and the needs of pre-K-12 students.

Mindsets & Behaviors for Student Success
The " ASCA Mindsets & Behaviors for Student Success: K-12 College- and Career-Readiness Standards for Every Student" describe the knowledge, skills and attitudes students need to achieve academic success, college and career readiness and social/emotional development. Each standard has corresponding grade-level competencies that are specific, measurable expectations that students attain as they make progress toward the standards. Use the ASCA Mindsets & Behaviors database to search for grade-level competencies that support the standards.

ASCA School Counselor Preparation Program Standards
The ASCA School Counselor Preparation Program Standards are a unified set of principles guiding school counselor preparation programs in training effective future school counselors in areas of professional practice and ethical behavior. The standards are intended to define the training of school counselors and ensure school counselors are prepared to implement school counseling programs and advocate on behalf of the profession.

Standards in Practice
Election Conversations: The School Counselor's Role (11/20)
School Reentry: The School Counselor's Role (8/20)
Eliminating Racism and Bias in Schools: The School Counselor's Role (8/20)

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Standards | American School Counselor Association (ASCA)

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School Counseling Standards Four sets of school counseling standards define the school counseling profession. These standards help school counselors develop, implement and assess their school counseling program to improve student outcomes.

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A meta-analysis of 175 research studies worldwide on ADHD prevalence in children aged 18 and under found an overall pooled estimate of 7.2% (Thomas et al. 2015). The US Census Bureau estimates 1,795,734,009 people were aged 5-19 worldwide in 2013. Thus, 7.2% of this total population is 129 million-a rough estimate of the number of children worldwide who have ADHD.

Based on DSM-IV screening of 11,422 adults for ADHD in 10 countries in the Americas, Europe and the Middle East, the estimates of worldwide adult ADHD prevalence averaged 3.4% (Fayyad et al. 2007)
UNITED STATES Children & Adolescents
According to analysis of data collected by the National Health Interview Survey (NHIS), the prevalence rates of diagnosed ADHD among children and adolescents aged 4 to 17 in the past twenty years are as follows (Xu et al, 2018):

Overall prevalence and by age group (percent)

Prevalence by gender (percent)

Prevalence by race/ethnicity (percent)

The 2016 National Survey of Children's Health (NSCH) interviewed parents and reports the following ADHD prevalence data among children ages 2-17 (Danielson et al. 2018):

6.1 million children (9.4 percent) have ever been diagnosed with ADHD. This includes:

About 388,000 young children ages 2-5 (or 2.4 percent in this age group)

2.4 million school-age children ages 6-11 (or 9.6 percent in this age group)

3.3 million adolescents ages 12-17 (or 13.6 percent in this age group)

5.4 million children (8.4 percent) have a current diagnosis of ADHD. This includes:

About 335,000 young children ages 2-5 (or 2.1 percent in this age group)

2.2 million school-age children ages 6-11 (or 8.9 percent in this age group)

2.9 million adolescents ages 12-17 (or 11.9 percent in this age group)

Treatment used by children ages 2-7 with a current diagnosis of ADHD:

Two out three were taking medication (62 percent).

Less than half received behavioral treatment in the past year (46.7 percent).

Nearly one out of three received a combination of medication and behavioral treatment in the past year (31.7 percent).

Nearly one out of four had not received any treatment (23 percent).

Severity of ADHD among children ages 2-17:

14.5 percent had severe ADHD

43.7 percent had moderate ADHD

41.8 percent had mild ADHD

Co-occuring conditions (children ages 2-17):

Two out of three children (63.8 percent) had at least one co-occuring condition.

Half of all children (51.5 percent) had behavioral or conduct problems.

One out of three children (32.7 percent) had anxiety problems.

One out of six children (16.8 perccent) had depression.

About one out of seven children (13.7 percent) had autism spectrum disorder.

About one out of 80 children (1.2 percent) had Tourette syndrome.

One in a hundred adolescents (1 percent) had a substance abuse disorder.

By race or ethnicity (children ages 2-17):

8.4 percent White

10.7 percent Black

6.6 percent Other

6.0 percent Hispanic/Latino

9.1 percent Non-Hispanic/Latino

Analysis of parent-reported data from the National Health Interview Survey (NHIS) 2011-2013 found the following (Pastor et al. 2015):

9.5% of children ages 4-17 years were ever diagnosed with ADHD

By age groups:

2.7% of children ages 4-5

9.5% of children ages 6-11

11.8% of children ages 12-17

By race/ethnicity:

11.5% non-Hispanic white children

8.9% non-Hispanic black children

6.3% Hispanic children

The same study found the rate of ADHD diagnosis increased from 7.0% in 1997-1999 to 10.2% in 2012-2014. During this period, prevalence increased among non-Hispanic white children from 8.5% to 12.5%, among non-Hispanic black children from 5.5% to 9.6%, and among Hispanic children from 3.8% to 6.4%.

The National Survey of Children's Health (NSCH) 2003-2011 -based on parent interviews-highlights the following data for children aged 4-17 (US CDC 2014):

5.1 million children (8.8% or 1 in 11 of this age group 4-17 years) have a current diagnosis of ADHD:

6.8% of children ages 4-10 (1 in 15)

11.4% of children ages 11-14 (1 in 9)

10.2% of children ages 15-17 (1 in 10)

The average age of current ADHD diagnosis was 6.2 years, including:

"Mild" ADHD diagnosed at 7 years,

"Moderate" ADHD diagnosed at 6.1 years, and

"Severe" ADHD diagnosed at 4.4 years.

3.5 million children (69% of children with current ADHD) were taking medication for ADHD.

Boys (12.1%) continue to be more than twice as likely than girls (5.5%) to have current ADHD.

Current ADHD prevalence rates vary between states, with Nevada having the lowest rate at 4.2% and Kentucky having the highest rate of 14.8%.

According to the parent reports, 6.4 million children (11% of this age group 4-17 years) have ever been diagnosed with ADHD, and rates of ever-diagnosed ADHD increased an average of approximately 5% per year from 2003 to 2011.

US States Children in Elementary School
According to a recent population-based study using DSM-IV criteria, 15.5% of school children enrolled in Grades 1 to 5 have ADHD. The study combined the results of rating scales filled out by teachers and telephone interviews of parents for 7,847 children (Rowland et al. 2015).
Adults
According to a screen for ADHD in 3,199 adults aged 18-44 from the National Comorbidity Survey Replication (NCS-R), 4.4% of US adults have ADHD. Of these adults with ADHD, 38% are women and 62% are men (Kessler et al. 2006).
References
Xu, Guifeng et al. (August 2018). Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016. JAMA Network Open. 2018;1(4):e181471.

Danielson, Melissa et al. (January 2018). Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. Journal of Clinical Child & Adolescent Psychology.

Fayyad J. et al. (May 2007). Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. British Journal of Psychiatry, 190(5):402-409.

Pastor, Patricia N. (August 28, 2015). QuickStats: Percentage of Children and Adolescents Aged 5-17 Years with Diagnosed Attention-Deficit/Hyperactivity Disorder (ADHD), by Race and Hispanic Ethnicity - National Health Interview Survey, United States, 1997-2014, Morbidity and Mortality Weekly Report (MMWR) 64(33):925-925.

Pastor, Pastor N. et al. (2015). Association between diagnosed ADHD and selected characteristics among children aged 4-17 years: United States, 2011-2013. NCHS data brief, no 201. Hyattsville, MD: National Center for Health Statistics.

Ronald C. Kessler et al. (April 2006). The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey Replication, American Journal of Psychiatry 163(5):71.

Rowland, Andrew et al. (September 2015). The Prevalence of ADHD in a Population-Based Sample. Journal of Attention Disorders v19(9):741-754.

Thomas, Rae et al. (April 2015). Prevalence of Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis. Pediatrics, 135(4), pp. e994-e1001.

U.S. Centers for Disease Control and Prevention (2014). Key Findings: Trends in the Parent-Report of Health Care Provider-Diagnosis and Medication Treatment for ADHD: United States, 2003-2011.

US. Census Bureau, Population Division. World Midyear Population by Age and Sex for 2013

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GLOBAL A meta-analysis of 175 research studies worldwide on ADHD prevalence in children aged 18 and under found an overall pooled estimate of 7.2% (Thomas et al. 2015). The US Census Bureau estimates 1,795,734,009 people were aged 5-19 worldwide in 2013. Thus, 7.2% of this total population is 129 million-a rough estimate of the number...

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Eating Issues and Body Image in Elementary Schools

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Eating Issues and Body Image in Elementary Schools

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Behavioral disorders also known as conduct disorders are one of the most common forms of disability among children and young adults and is the most frequently cited reason for referral to mental health services. The appearance of behavioral disorders is increasing dramatically in our K-12 classrooms. As a result, their presence severely constrains the ability of the school systems to educate students effectively. The prevalence of behavioral problems among children and young adults is substantial. Many surveys indicate that behavioral disorders vary among young adults, ranging from 2 and 6 percent among K-12 students. This percentage translates into 1.3 to 3.8 million cases of behavioral disorders among the school and pre-college population.

Behavior disorders have also been referred to in a variety of different terminologies, including but not limited to:

1. Emotional and Behavior Disorders (EBD)

2. Emotional Conflict (EC)

3. Serious Emotional Disturbance (SED)

Behavioral disorders become apparent when the student displays a repetitive and impact persistent pattern of behavior that results in the significant disruption of other students. Such disturbances may cause significant impairments in academic, social, and or occupational functioning. Among the characteristics of a behavioral disorder among children and adolescents are:

General Strategies

Multidisciplinary educational teams, including parents, must design programs to meet the individual behavioral and academic needs of identified SED students. Most students can benefit from supportive treatments provided in general education programs. For others, at least temporary placements in special education classrooms, schools, or institutional programs may be appropriate.

Special education programs usually attempt to provide a structured environment where students experience a high degree of success; rules and routines are predictable; and students are consistently rewarded for appropriate behavior. Behavior management techniques, such as positive reinforcement, token economies, contracting, and time-out, which rely on direct measurement and monitoring of behavioral change, are commonly used in SED programs. The assessment and systematic teaching of social skills through modeling, discussion, and rehearsal are frequently used to help students increase control over their behavior and improve their relations with others. In addition, supportive therapies involving music, art, exercise, and relaxation techniques, as well as affective education, individual, and group counseling are sometimes employed to improve self-understanding, self-esteem, and self-control. The following are strategies that may be effective with students with EBD:

Teacher Presentation

Laboratory

Group Interaction and Discussion

1. Acknowledge the contributions of the student with an emotional disorder.

2. Call for responses and participation commensurate with the student's socialization skills.

3. As the student's comfort level rises and when a safe topic is available, encourage the student to be a group spokesperson.

4. Along with the student, devise a contingency plan in which inappropriate forms of response are replaced by appropriate ones.

5. Gradually increase the challenges in the student's participation in group exercises while providing increased positive reinforcement.

6. Help the student to feel as though he or she has something worthwhile to contribute to the discussion.

7. Some students may experience considerable strain in social adjustment in a group context. It may be necessary to work gradually toward group activities. One can devise a strategy of progressing from spectatorship to one-to-one instruction and eventually to small group discussion.

8. Should monitor carefully to ensure that the nondisabled students do not dominate the discussion or detract in any way from the successful performance of the student with the behavioral disorder.

Reading

1. It is necessary to target specific pro-social behaviors for appropriate instruction and assessment to occur such as:

1. Taking turns, working with partner, following directions.

2. Reading in group or with others.

3. Increasing positive relationships by means of awards when they read appropriately.

4. Demonstrating appropriate reading

2. Instructional strategies involving self-control, self-reinforcement, self-monitoring, self-management, problem solving, cognitive behavior modification, and metacognitive skills should be focused on teaching students reading skills

Research

1. Review and discuss with the student the steps involved in a research activity. Think about which step(s) may be difficult for the specific functional limitations of the student and jointly devise accommodations for that student.

2. Use appropriate laboratory and field strategies.

3. Depending on the site of the research check the previous two sections.

4. Show clear examples of what the students should expect as an outcome of their research.

Field Experiences

1. Use appropriate general strategies.

2. Consider alternate activities/exercises that can be utilized with less difficulty for the student, but has the same or similar learning objectives.

3. In field activities acknowledge the contributions and assistance of the student with an emotional disorder.

4. Help the student to feel as though he or she has something worthwhile to contribute to the field trip.

5. Use a buddy system.

6. Gradually increase the challenges in the student's participation in field exercises while providing increased positive reinforcement.

7. Group participation in field activities is highly desirable because it enhances social contacts.

8. Make the student with the behavioral disorder become one of the field trip leader of an activity which can often reduce their disorder.

9. Special efforts should be made to get students with behavioral disorders to interact with other students.

10. You should encourage students to practice field skills during their free hours.

11. Every effort should be made to arouse the interest of such students in activities, so they will learn to perform the activities with success and pleasure with appropriate behaviors.

Testing

1. Be sensitive to the student's reactions to the various aspects of assessment.

2. For each student, accumulate in his or her portfolio several examples of work (quizzes, assignments, projects) that demonstrate knowledge of the subject matter or the unit of study.

3. Make special arrangements for the student with an emotional disorder according to what their special needs are and that they do not compromise the integrity of the testing situation.

4. Stay on top of student progress through informal assessment, don't wait until it's too late to discover that there is a problem.

5. Provide private room/smaller group setting/alternative test site (with proctor present); alternatively screens to block out distractions.

Organizations

Council for Exceptional Children-Council for Children with Behavior Disorders (CCBD)
The Council for Children with Behavioral Disorders (CCBD) is dedicated to supporting the professional development and enhancing the expertise of those who work on behalf of children with challenging behavior and their families. It is a division of the Council for Exceptional Children (CEC).

CCBD Foundation
The CCBD Foundation was founded in 1997 by the Council for Children with Behavioral Disorders (CCBD), to support its mission of improving the education of children and youth with emotional or behavioral disorders (EBD).

Resources

Council for Exceptional Children (Behavior Disorders/Emotional Disturbance)
The Council for Exceptional Children (CEC) page on EBD. The Council for Exceptional Children (CEC) is the largest international professional organization dedicated to improving the educational success of individuals with disabilities and/or gifts and talents.

BehaviorDisorder.org
The site offers information on behavior disorders, conduct disorders, and other behavior problems.

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Behavioral disorders also known as conduct disorders are one of the most common forms of disability among children and young adults and is the most frequently cited reason for referral to mental health services. The appearance of behavioral disorders is increasing dramatically in our K-12 classrooms. As a result, their presence severely constrains the ability of the school systems to educate students effectively.

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Council for Children with Behavioral Disorders

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Other Specified Eating Disorders

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Other Specified Feeding or 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.

Research into the severity of EDNOS/OSFED shows that the disorder is just as severe as other eating disorders based on the following:

Children hospitalized for EDNOS had just as many medical complications as children hospitalized for anorexia nervosa

Adults with 'atypical' or 'subclinical' anorexia and/or bulimia scored just as high on measures of eating disorder thoughts and behaviors as those with DSM-diagnosed anorexia nervosa and bulimia nervosa

People with EDNOS were just as likely to die as a result of their eating disorder as people with anorexia or bulimia

EVALUATION & DIAGNOSIS

Changes to the latest edition of the DSM were meant to clarify definitions of anorexia, bulimia, and binge eating disorder to more accurately diagnose eating disorders. Although this reduced the number of OSFED diagnoses, it remains a common diagnosis. In the DSM-5, a person must present with feeding or eating behaviors that cause clinically significant distress and impairment, but do not meet the full criteria for any of the other disorders.

A diagnosis might then be assigned that addresses the specific reason why the presentation does not meet the specifics of another disorder (e.g., bulimia nervosa - low frequency). The following are further examples for OSFED:

Atypical Anorexia Nervosa: All criteria are met, except despite significant weight loss, the individual's weight is within or above the normal range.

Binge Eating Disorder (of low frequency and/or limited duration): All of the criteria for BED are met, except at a lower frequency and/or for less than three months.

Bulimia Nervosa (of low frequency and/or limited duration): All of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behavior occurs at a lower frequency and/or for less than three months.

Purging Disorder: Recurrent purging behavior to influence weight or shape in the absence of binge eating.

Night Eating Syndrome: Recurrent episodes of night eating. Eating after awakening from sleep, or by excessive food consumption after the evening meal. The behavior is not better explained by environmental influences or social norms. The behavior causes significant distress/impairment. The behavior is not better explained by another mental health disorder (e.g. BED).

WARNING SIGNS & SYMPTOMS OF OSFED

Emotional and behavioral

In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns

Dramatic weight loss

Dresses in layers to hide weight loss or stay warm

Is preoccupied with weight, food, calories, fat grams, and dieting

Refuses to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)

Makes frequent comments about feeling "fat" or overweight despite weight loss

Complains of constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy

Denies feeling hungry

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

Appears uncomfortable eating around others

Develops food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn't allow foods to touch)

Skips meals or takes small portions of food at regular meals

Disappears after eating, often to the bathroom

Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

Fear of eating in public or with others

Steals or hoards food in strange places

Drinks excessive amounts of water or non-caloric beverages

Uses excessive amounts of mouthwash, mints, and gum

Hides body with baggy clothes

Maintains excessive, rigid exercise regimen - despite weather, fatigue, illness, or injury-due to the need to "burn off " calories

Shows unusual swelling of the cheeks or jaw area

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

Teeth are discolored, stained

Creates lifestyle schedules or rituals to make time for binge-and-purge sessions

Withdraws from usual friends and activities

Looks bloated from fluid retention

Frequently diets

Shows extreme concern with body weight and shape

Frequent checking in the mirror for perceived flaws in appearance

Has 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

Purges after a binge (e.g. self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)

Extreme mood swings

Noticeable fluctuations in weight, both up and down

Body weight is typically within the normal weight range; may be overweight

Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

Menstrual irregularities - missing periods or only having a period while on hormonal contraceptives (this is not considered a "true" period)

Difficulties concentrating

Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)

Dizziness

Fainting/syncope

Feeling cold all the time

Sleep problems

Cuts and calluses across the top of finger joints (a result of inducing vomiting)

Dental problems, such as enamel erosion, cavities, and tooth sensitivity

Dry skin

Dry and brittle nails

Swelling around area of salivary glands

Fine hair on body

Thinning of hair on head, dry and brittle hair (lanugo)

Cavities, or discoloration of teeth, from vomiting

Muscle weakness

Yellow skin (in context of eating large amounts of carrots)

Cold, mottled hands and feet or swelling of feet

Poor wound healing

Impaired immune functioning

HEALTH CONSEQUENCES OF OSFED

The health consequences of OSFED depend in part on which eating disordered behaviors are being used. It is important to recognize that OSFED is as serious as other eating disorders and should not be trivialized or underestimated. Health consequences of OSFED can be difficult to pinpoint, as it includes a number of conditions. Watch out for all of the signs already listed. The most important thing to look out for is attitudes about food and weight that conflict with a productive, satisfying life.

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Other Specified Feeding or Eating Disorder

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Other Specified Feeding or 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.

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Includes Anxiety, ADHD, & OCD

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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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Not all students who have disabilities require specialized instruction. For students with disabilities who do require specialized instruction in the United States, the IDEA controls the procedural requirements and an IEP is developed. "Special education" under IDEA means the child has been identified as having unique educational needs related to his/her disability and is entitled to an Individualized Education Program (IEP) to meet these needs.

The IDEA process is more involved than that of Section 504 of the Rehabilitation Act. The IDEA requires that measurable growth and progress towards written goals and objectives be documented.

For students with disabilities who do not require specialized instruction but need the assurance that they will receive equal access to public education and services, a document is created to outline their specific accessibility requirements. Section 504 is a federal civil rights law. The purpose of Section 504 is to protect persons with disabilities against discrimination for reasons related to their disabilities.

While students with a 504 plan do not require specialized instruction, and specific goals and objectives are not necessarily outlines nor is data tracked, the plan should be reviewed annually to ensure that the student is receiving the most effective accommodations for his/her specific circumstances.

Unlike IDEA, Section 504 does not guarantee that a child with a disability will receive an individualized educational program that is designed to meet the child's individual educational needs. Rather, it guarantees that accommodations will be made relative to their specific medical needs.

Eligibility for protections under Section 504 depends on the child in question having a physical or mental impairment which must substantially limit at least one major life activity. Major life activities include walking, seeing, hearing, speaking, breathing, learning, reading, writing, performing math calculations, working, caring for oneself, and performing manual tasks. Section 504 requires an evaluation that draws information from a variety of sources.

A child who receives Section 504 protections has fewer rights than the child who receives special education services under the IDEA. The child who receives special education services under the IDEA is automatically protected under Section 504.

Section 504 is designed to guarantee that children with disabilities will not be discriminated against. It is also important to understand that if your child does not qualify for special education services under IDEA, your child does not have the procedural protections that are available under the IDEA.

Under Section 504, the child with a disability may receive accommodations and modifications that are not available to children who are not disabled. These accommodations and modifications are also available under IDEA. For example; accommodations could include, but not be limited to, such things as:

Tests taken in a separate location with time limits waived or extended.

The use of a word processor due to fine motor, visual motor deficits.

Shortened assignments.

Standardized tests answers written directly in the test booklet and transferred onto answer sheet by teacher or assistant.

Class notes provided rather than having the student copy from the chalkboard or overhead.

Allowing the child to leave the classroom 2 to 3 minutes early to avoid crowded hallways.

Preferential seating in the classroom.

Provision of a daily assignment sheet to be filled out by the student and verified by the teacher for accuracy. The parent could then check to make sure that all the work is accomplished. This would assist with homework prioritizing and management.

Please note: These are simply examples. All or none of these may be suitable for your child.

Students with bipolar disorder may or may not have a need for specialized instruction provided within an IEP. For some students, simply being granted accommodations that make allowance for the side effects of medications, related anxiety issues, or results of mood changes is sufficient.

Students with bipolar disorder who are well-controlled on medication may or may not be plagued by racing thoughts, distracting thoughts, an inability to concentrate, decreased energy; all of which will require modifications in the teaching environment or instructional strategies.

For other students, the side effects of medications may be significant enough to require changes in instruction provided or curriculum modifications. Some of the common side effects of medications include: tremors (trembling of hands), blurred vision, loss of coordination, slurred speech, sedation, ataxia (unsteady movement), dizziness, seizures. Some students with bipolar disorder may also have one of a number of other disabilities that impacts their access to the general education curriculum; such as vision or hearing impairment, learning disability, processing problems, or other disability. The co-morbidity rates of ADHD, anxiety disorder, conduct disorder, oppositional-defiant disorder and learning disabilities in students with bipolar disorder tell us that we should explore all avenues available to meet the educational needs of our children.

The following accommodations are meant to serve as a resource for parents unsure of what possibilities exist:

Students on some medications may need:

increased access to water, unlimited access to restrooms (particularly students taking Lithium)

decreased reading assignments or having books on tape or computer screen-reading due to blurred vision

modified school arrival, shortened day, scheduling of core content during the student's most alert time, reducing homework and extending deadlines, providing notes, allowing longer or more frequent breaks, allowing exercise or other movement due to sleep impairment or to sedation of medications

provision of notes and listening guides, work monitoring, extended time on assignments, extra set of books for home use, breaking assignments into more manageable pieces, use of checklists, providing written instructions and/or other visual cues, use of word banks on fill-in types of tests and other modifications that aid retrieval/memory, testing in a separate room, or extended test time, use of multiple choice formats, use of oral exams rather than written demands, use of noise-canceling headsets, - all for impaired concentration, memory

reducing or discontinuing homework may be necessary for some students due to difficulties with concentration, sleep patterns, mood irritability. For these students it may be necessary to schedule a resource room period at the beginning of the day to get assignments ready for the day, or at the end of the day to complete assignments before leaving school

preferential seating can be used to help with vision, focus, reduce visual or auditory distraction, allow for discrete monitoring

and while a 504 plan will simply list the type of accommodation needed and the reasons for it/them, an IEP must contain objectives that are written with specific criteria; such as -Given a grade level reading assignment of 1 chapter with 4 comprehension questions, (name) will answer the questions with 60/70/80% accuracy. Or given an assignment containing 5 long division problems, (name) will complete 3/4/5 problems at 80% accuracy.

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Accommodations for Students with Bipolar Disorder and Related Disabilities - International Bipolar Foundation

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