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This link offers descriptions, symptoms, common behaviors, and related disorders for OCD. This link would be useful in identifying symptoms for the purpose of offering interventions and resources for teachers, students and families.

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Psychiatry.org - What Is Obsessive-Compulsive Disorder?

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Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things or cleaning, can significant…

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Link provides information about the causes of OCD and possible therapies to target the disorder.

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Credit: Julius-Maximilians-Universität Würzburg, JMU

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

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

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

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

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

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

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

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

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

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

Provided by Julius-Maximilians-Universität Würzburg

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

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Short film about OCD from kids' perspectives.

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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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(osmosis.org, n.d.)

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What Is Conduct Disorder?

Conduct disorder is an ongoing pattern of behavior marked by emotional and behavioral problems. Children with conduct disorder behave in angry, aggressive, argumentative, and disruptive ways.

Conduct disorder in children goes beyond bad behavior. It is a diagnosable mental health condition that is characterized by patterns of violating societal norms and the rights of others. It's estimated that around 3% of school-aged children have conduct disorder. It is more common in boys than in girls.﻿﻿

Conduct disorder extends beyond normal teenage rebellion. It involves serious behavior problems that are likely to raise alarm among teachers, parents, peers, and other adults. In order to qualify for a diagnosis of conduct disorder, children must exhibit at least three of these symptoms in the past year and at least one in the past six months:﻿﻿

Aggression Toward People and Animals

Bullying, threatening, or intimidating others

Initiating physical fights

Using a weapon that could cause serious harm

Physical cruelty to people

Physical cruelty to animals

Stealing while confronting a victim

Forced sexual activity

Property Destruction

Deliberate fire setting

Other destruction of property

Deceptiveness or Theft

Breaking or entering a house, car, or building

Lying for personal gain

Stealing without confronting the victim (such as shoplifting)

Serious Rule Violation

Staying out at night before the age of 13 years

Running away from home overnight at least twice

Truancy beginning before the age of 13

Conduct disorder isn't just a challenge for caregivers-it actually impairs a child's ability to function. Some areas where the condition may affect a child's life include:

Education: Children with conduct disorder misbehave so much that their education is affected. They usually receive frequent disciplinary action from teachers and may skip school. Children with conduct disorder may be at a higher risk of failure or dropping out of school.

Legal issues: Adolescents with conduct disorder are also more likely to have legal problems. Substance abuse, violent behavior, and a disregard for the law may lead to incarceration.

Relationships: Children with conduct disorder also have poor relationships. They struggle to develop and maintain friendships. Their relationships with family members usually suffer due to the severity of their behavior.

Sex: They may also engage in risky sexual behavior. Studies show that teens with conduct disorder are more likely to have multiple sexual partners and are less likely to use protection.﻿﻿

Conduct disorder in children can be diagnosed by a mental health professional or a physician. Often, a diagnosis is made after attempts to remedy behavior problems at school and at home aren't effective.

A professional may interview the child, review records, and ask that parents and teachers complete questionnaires about the child's behavior. Psychological testing and other assessment tools may also be used to evaluate the child.

Researchers aren't exactly sure why some children develop conduct disorder. A variety of biological, psychological, and social factors are likely involved. Quite often, those factors overlap. Some that may play a role include:

Brain abnormalities:Imaging studies suggest children with conduct disorder may have some abnormalities in certain areas of the brain. The pre-frontal cortex (which affects judgment) and the limbic system (which affects emotional responses) may be impaired.

Cognitive deficits:Low IQ, poor verbal skills, and impairment in executive functioning may make children more vulnerable to conduct disorder.

Genetics:Studies suggest that inherited genes may be responsible for about half of anti-social behavior.﻿﻿ Researchers aren't sure which specific genetic components contribute to conduct disorder.

Social issues: Poverty, disorganized neighborhoods, poor schools, family breakdown, parental mental illness, harsh parenting, and inadequate supervision are all strongly linked with conduct disorder.

Oppositional Defiant Disorder as a Precursor

Common Comorbid Conditions

Many children with conduct disorder have other mental health issues or cognitive impairments. These can include:

Self-harm

Substance misuse

Depression and anxiety

Posttraumatic stress disorder

Learning disability

Children with conduct disorder may be more likely to develop antisocial personality disorder later in life.

There are three subtypes types of conduct disorder. These subtypes are distinguished by the age at which symptoms first appear.

Childhood-onset indicates that the symptoms started before the age of 10.

Adolescent-onset indicates that the signs of the condition began during a child's teens.

Unspecified-onset indicates the age exact age that the symptoms first began is not clear.

The Diagnostic and Statistical Manual ( DSM-5), which is used to diagnose mental illnesses, also distinguishes between conduct disorder with or without "limited prosocial emotions."

Individuals with limited prosocial emotions are characterized by callousness and a lack of remorse and empathy. They are unconcerned about their performance at school or work and have shallow emotions. When present, their emotional expressions may be used to manipulate others.

Treatment for conduct disorder depends on several factors, such as a child's age and the severity of behavior problems. The most common treatment methods include:

Family therapy: Parents, siblings, and other family members may be invited to attend therapy with the child. Sometimes, improving the relationship between parents and a child may improve family interactions.

Medication: There isn't a medication that specifically treats conduct disorder. But sometimes doctors may prescribe medication to treat the disorder's symptoms or to address other underlying mental illness.﻿﻿

Parent training: Treatment often involves caregivers and parents. Parents may be taught behavior management strategies and techniques to increase safety in the home if a child is aggressive or violent.

Psychotherapy:Individual therapy may be helpful when a child could benefit from learning new skills, such as anger management and impulse control.

Residential placement:In cases where a child or adolescent's behavior has become out of control, treatment in a residential program may be necessary to keep everyone safe. A therapeutic environment may address substance abuse issues, sexualized behavior, or violence.

Early intervention is key to getting the most effective treatment, so it's important for parents, educators, and physicians to be aware of the signs of conduct disorder in children so that appropriate referrals and interventions can be put into place.

Research suggests that taking part in psychosocial treatments can help both children and families cope with the effects of conduct disorder. Such approaches often involve working with parents and caregivers to help them find effective ways of managing their child's behavior. This may include such things as:

Creating structure

Enforcing limits

Providing clear instructions

Rewarding positive behaviors

Using time-outs after inappropriate behaviors or outbursts

The ultimate goal of such training is to help parents and children interact more effectively. This can lead to less conflict and help children better regulate their behavior.

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Conduct Disorder in Children Can Cause Serious Behavior Problems

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Conduct disorder is an ongoing pattern of behavior marked by emotional and behavioral problems. Children with conduct disorder behave in angry, aggressive, argumentative, and disruptive ways. Conduct disorder in children goes beyond bad behavior. It is a diagnosable mental health condition that is characterized by patterns of violating societal norms and the rights of others.

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Written as a resources for parents, but this source provides useful information for anyone in education who encounters a student who struggles with oppositional defiance disorder.

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Strategies for addressing ADHD from the school counselor perspective

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Centers for Disease Control and Prevention

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Children sometimes argue, are aggressive, or act angry or defiant around adults. A behavior disorder may be diagnosed when these disruptive behaviors are uncommon for the child's age at the time, persist over time, or are severe. Because disruptive behavior disorders involve acting out and showing unwanted behavior towards others they are sometimes called externalizing disorders.

Oppositional Defiant Disorder

When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD usually starts before 8 years of age, but no later than by about 12 years of age. Children with ODD are more likely to act oppositional or defiant around people they know well, such as family members, a regular care provider, or a teacher. Children with ODD show these behaviors more often than other children their age.

Examples of ODD behaviors include

Often being angry or losing one's temper

Often arguing with adults or refusing to comply with adults' rules or requests

Often resentful or spiteful

Deliberately annoying others or becoming annoyed with others

Often blaming other people for one's own mistakes or misbehavior

Learn more about ODD
Conduct Disorder

Conduct Disorder (CD) is diagnosed when children show an ongoing pattern of aggression toward others, and serious violations of rules and social norms at home, in school, and with peers. These rule violations may involve breaking the law and result in arrest. Children with CD are more likely to get injured and may have difficulties getting along with peers.

Examples of CD behaviors include

Breaking serious rules, such as running away, staying out at night when told not to, or skipping school

Being aggressive in a way that causes harm, such as bullying, fighting, or being cruel to animals

Lying, stealing, or damaging other people's property on purpose

Learn more about CD
Treatment for disruptive behavior disorders

Starting treatment early is important. Treatment is most effective if it fits the needs of the specific child and family. The first step to treatment is to talk with a healthcare provider. A comprehensive evaluation by a mental health professional may be needed to get the right diagnosis. Some of the signs of behavior problems, such as not following rules in school, could be related to learning problems which may need additional intervention. For younger children, the treatment with the strongest evidence is behavior therapy training for parents, where a therapist helps the parent learn effective ways to strengthen the parent-child relationship and respond to the child's behavior. For school-age children and teens, an often-used effective treatment is a combination of training and therapy that includes the child, the family, and the school.

Get help finding treatment

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

Managing Symptoms: Staying Healthy

Being healthy is important for all children and can be especially important for children with behavior or conduct problems. In addition to behavioral therapy and medication, practicing certain healthy lifestyle behaviors may reduce challenging and disruptive behaviors your child might experience. Here are some healthy behaviors that may help:

Engaging in regular physical activity, including aerobic and vigorous exercise

Eating a healthful diet centered on fruits, vegetables, whole grains, legumes (for example, beans, peas, and lentils), lean protein sources, and nuts and seeds

Getting the recommended amount of sleep each night based on age

Strengthening relationships with family members

Prevention of disruptive behavior disorders

It is not known exactly why some children develop disruptive behavior disorders. Many factors may play a role, including biological and social factors. It is known that children are at greater risk when they are exposed to other types of violence and criminal behavior, when they experience maltreatment or harsh or inconsistent parenting, or when their parents have mental health conditions like substance use disorders, depression, or attention-deficit/hyperactivity disorder (ADHD). The quality of early childhood care also can impact whether a child develops behavior problems.

Although these factors appear to increase the risk for disruptive behavior disorders, there are ways to decrease the chance that children experience them. Learn about public health approaches to prevent these risks:

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Behavior or Conduct Problems in Children | CDC

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Children sometimes argue, are aggressive, or act angry or defiant around adults. A behavior disorder may be diagnosed when these disruptive behaviors are uncommon for the child's age at the time, persist over time, or are severe. Learn about behavior or conduct problems in children.

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“Conduct disorder” refers to a group of behavioral and emotional problems in youngsters.

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National Council for Special Education: Emotional and Behavior Disorders

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National Council for Special Education: Emotional and Behavior Disorders

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Think link is useful for providing information about Behavioral disorders and emotional disorders. This link is also useful for sharing with parents as a resources on information regarding special education services available for their child.

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My 11-year-old son, Craig, was suicidal. He set fires. He killed animals. He was a danger to himself and everyone around him. ... The people in the system of care really showed that they care about us as a family. They lifted us up and brought us closer. Today, Craig is on the honor roll at school. All the help from the men and women in the system of care has really paid off.

Students with emotional disturbance and/or behavioural problems may have conditions such as neurosis, childhood psychosis, hyperactivity, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD). Generally a student with emotional disturbance and/or behavioural problems will present with negative behaviours that impinge on their learning and often on their social development. (This category is not intended to include students whose conduct or behavioural difficulties can be dealt with in accordance with agreed school procedures on discipline.)

Emotional Disturbance and/or Behavioural Problems

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My 11-year-old son, Craig, was suicidal. He set fires. He killed animals. He was a danger to himself and everyone around him. ... The people in the system of care really showed that they care about us as a family. They lifted us up and brought us closer.

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(Next Step Houston, 2018)

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Overview

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

Signs and Symptoms

Risk Factors

Treatments and Therapies

Join a Study

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

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(Cuncic, 2019)

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By: Victoria E. Kress, Tahani Dari, and Matthew Paylo

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(Muhlheim, 2019)

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Early Detection and Intervention for Eating Issues

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Early Detection and Intervention for Eating Issues

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Teaching Strategies for Emotional Disturbances

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Teaching Strategies for Emotional Disturbances

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A useful resource for counselors to use in consultation with teachers regarding students struggling with an emotional disturbance.

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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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Error! You must specify a value for the Video ID, Width, Height and Anchor parameters to use this shortcode! 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.

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Book by Susanne Abraham that provides a vast amount of information on eating disorders. A beneficial resource for those who may encounter people struggling with an eating disorder.

Photo retrieved from https://www.karnacbooks.com/product/eating-disorders-the-facts-seventh-edition/38227/

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Because of the federal laws and regulations that govern the education of students with disabilities, a process has evolved over time that governs the special education referral process. The purpose of this module is to provide an overview to the "Special Education Process" so that the learner may understand the global procedures for providing a student with disabilities a free and appropriate education (FAPE).

PHASE ONE: Recognition

All students begin their educational careers with needs. For many, it is the need for guidance by a professional educator who can expand their knowledge and understanding of the world around them. While each student brings a different level of knowledge and skills to his or her first class, the individual's needs are typically met by a highly-qualified educator. However, there are children who have unique needs that are atypical for children of their age and may not be within the expertise of the general education classroom teacher. It is during this time that the teacher (or parent, administrator, or counselor) recognizes a consistent need or problem exhibited by the student. The recognition of a discrepancy in the student's academic, social/emotional, behavioral, and/or physical ability and his or her age may signal the need for additional academic or behavioral supports.

During this phase, it is important to call a meeting with the parents or guardians. The teacher should provide examples of the student's work and/or anecdotal classroom notes regarding the student's needs. In the meeting, the teacher and the parent/guardian should explore the following:

Is the issue a recurrent problem or new? The parents will be best able to present invaluable insight into the knowledge, skills, and needs of their child. The teacher should document when they recognized an issue.

Is the issue constant? All children may exhibit unique needs or problems at some point but it may only be an isolated episode for that day. The teacher should document any issue that is constant, providing dates and information about the behavior of concern or skill deficit exhibited by the student.

Is the issue appropriate for children of this age? How many kindergarten students have been seen crying the first days of school? This behavior is a typical occurrence and should not be confused with an atypical behavior. The teacher should have a strong understanding of the cognitive, behavioral, and physical development levels of typical students they teach.

It is possible that the problems that are being exhibited by the student may be "solved" with the careful execution of a cooperative plan of action between the teacher and the parents. The teacher and the parent should document their plan of action, strategies utilized with the student, and progress. The teacher should continue to collect student work samples and keep assessment data relevant to the student's unique needs. It is critically important that the teacher document all actions and strategies used in the classroom and the impact on the student.

The student's parents/guardians should be kept informed of any changes in the student's progress. If the teacher, after a period of time, determines the problem cannot be controlled with simple classroom interventions, then the teacher should notify the parents/guardians that they will be asking for outside help from a school-based pre-referral team.

PHASE TWO: Pre-referral

The pre-referral step in the special education process is more formal than providing simple and temporary accommodations for students. Pre-referral intervention is to identify, develop, and implement alternative education strategies for students who have recognized problems in the classroom before the student is referred to special education. Pre-referral intervention is typically conducted by a Student Centered Team (also called early intervention team, intervention assistance team, student support team, teacher assistance team, or instructional support team). The pre-referral team usually consists of the teacher, the parents/guardians, an administrator, other general education teachers, nurse, guidance counselor, and any other adult involved in the education of the student. The general education teacher provides background information regarding the problem exhibited by the student and the team works together to develop possible solutions.

Because of changes to IDEA in 2004, many states and independent school districts have begun using a more formal and systematic pre-referral process called response to intervention (RTI).

"RTI is a model designed to address the needs of all children through a continuum of services, which include:

High-quality instruction and tiered evidence-based or practice-based intervention strategies aligned with individual student needs;

Frequent monitoring of progress to make results-based academic or behavioral decisions; and

Application of child response data to important educational decisions (such as those regarding placement, intervention, curriculum, and instructional goals and methodologies)" (TEA, 2007).

RTI provides three levels of intervention for students who are experiencing problems. Generally, the first level (sometimes referred to as Tier 1) is focused on utilizing high-quality general education instruction in the core curriculum with all students. RTI theorizes that around 80% of all students will respond positively to core curriculum and behavior systems. The second level (or Tier 2) provides targeted group instruction or some form of group remediation to improve performance. The RTI model believes that second level services will improve performance for approximately 15% of all students. If performance does not improve in the second level, then students are moved to the third level which consists of intensive, individualized interventions.

Whether the school uses pre-referral teams or the more formal RTI process, the intent is to provide interventions that will help the student achieve success without entering special education. However, if these interventions do not improve the student's performance, then the student will be referred for an assessment to determine possible eligibility for special education services.

PHASE THREE: Referral for Special Education Evaluation

If, after interventions in the general education classroom, the student continues to experience difficulty, school personnel may refer the child for a special education evaluation. Referrals for determination of eligibility for special education services may be initiated by:

School personnel (including general education teachers, special education teachers, counselors, administrators, etc.);

Child's parent(s) or legal guardian(s);

Any other person involved in the education or care of the child.

The official referral begins the formal process of determining eligibility for special education services. Once a referral is provided, the school must obtain consent from the parent(s) or legal guardian(s) to begin the evaluation phase of the referral process.

PHASE FOUR: Special Education Evaluation

IDEA requires that students referred for special education services receive a nondiscriminatory multi-factored evaluation. The school district is required to complete the evaluation within 60 days of the referral date. The evaluation is to be conducted by a multidisciplinary team that will consist of individuals who can bring different perspectives and expertise to the evaluation. Some examples of team members include:

Educational Diagnostician (also called Psychometrist) or School Psychologist: These professionals are qualified to conduct all types of educational assessments including intelligence (IQ), achievement, behavior, etc.

Special Educators: These individuals are qualified to conduct some types of achievement and behavior evaluations as well as informal observations.

General Educators: These individuals provide documentation of the problems of the specific student.

Parent(s) or Legal Guardian(s): The parents or legal guardians provide valuable insight into the student's behavior and personality in other environments.*

Related Service Providers (Physical Therapist, Occupational Therapist, Audiologist, Orientation and Mobility Specialist, etc.): These specialists provide information pertaining to specific areas of concern that have been assessed.

Medical Doctors (including psychiatrists, ophthalmologists, and optometrists): Depending on the disability of the student, medical records can also be used in the determination of eligibility for special education services.

* Parents of students with developmental disabilities must decide whether to complete the legal process to become the legal guardian once their child reaches 18 years old, the age of majority. According to Texas state law, this process is separate from the required school transition planning process.

The evaluation must be comprehensive and use evaluation tools and strategies that are technically sound and accepted. Most students receive a battery of formal evaluations that measure:

Intelligence

Achievement

Behavioral

Disability-specific issues

Medical

However, informal observations and documentation of the student's past work should also be used during the eligibility determination meetings. Assessments may not be biased in regard to race, culture, language, or disability. The materials and procedures must be administered in the language and form most likely to provide accurate information on what the child knows and can do.

PHASE FIVE: Eligibility (FAPE)

IDEA states that each child is entitled to a Free Appropriate Public Education (FAPE.) Special education services are one way to accomplish that requirement for some students with disabilities. Within 30 days of the completion of the evaluation, the individuals that took part in the process thus far will meet to determine eligibility. In simple terms, a student is considered eligible for special education services if (1) the child has a disability as defined by IDEA which negatively impacts his/her educational performance, and (2) the child needs special education services in order to benefit from education.

Not all students are determined to be eligible for special education services. There are multiple reasons why a student may not qualify for special education services including not having a disability that negatively impacts his or her education. However, these students may need help to access the academic curricula. In these situations, the school will need to work out a plan to provide other services for the student.

If the team determines that the student is eligible for special education services, then a formal Individualized Education Program (IEP) team will be formed to develop a plan of special education services for the student.

PHASE SIX: IEP Meeting (IEP and LRE)

The Individualized Education Program (IEP) is a legal contract between the parents and the school district that describes the special education services to be provided by the local education agency which is the local school district. While IEP documents vary, the basic parts of an IEP include:

A student profile that provides background information about the student. The profile will include strengths and weaknesses of the student, information regarding performance in the classroom and on formal assessments, and the reason he or she is receiving special education services.

IEP initiation and duration dates: the goals expressly stated in an IEP begin on the date, stated in the IEP meeting, and are in effect until the date stated in the IEP. These IEP goals are reviewed, monitored and updated based on student progress. For most students, IEP goals are in place for one academic year.

A statement of "special instructional factors" (such as the need for assistive technology, braille, or transition services). If the student requires any of the special instructional factors, they should be addressed in the IEP.

A statement of special transportation needs;

A statement of opportunities to participate in nonacademic and extracurricular activities with their non-disabled peers

A statement of the frequency and method of reports of goal attainment for parents or guardians.

Benchmark pages are included and focus on specific areas that need special education services (such as reading, math, PE, etc.). The benchmark pages include: Present Levels of Academic Achievement and Functional Performance (PLAAFP) statements,

Measurable Annual Goals,

Evaluations used to measure annual goals,

Benchmarks to be achieved to meet the annual goals,

Special education and related services needed to achieve the annual goal (includes frequency of services, amount of time, location, and responsible agencies).

A Behavior Intervention Plan (BIP) if the student's behavior is a concern and a functional behavioral assessment has been done or needs to be conducted,

For students 16 years and older; the plans and activities for the student's transition from high school will be addressed

The signature page which provides a statement of least restrictive environment (LRE) and has the signatures of all members present at the meeting.

The benchmark pages are the "meat" of most IEPs and can be developed by any member of the team. Typically, these pages are developed by the special education teachers in collaboration with the parents, general education teachers, related service providers, and behavioral specialists.

In some school districts, the IEP meeting may be referred to as the ARD meeting. ARD stands for Admission, Review, and Dismissal. The IEP team (also called IEP committee or ARD committee) is formed for the purpose of 1) developing the IEP, the formal plan of special education services; 2) overseeing the implementation of the plan, 3) evaluating the effectiveness of the plan annually, and 4) developing future plans as needed. The IEP team can also meet as needed when unique issues present themselves during the academic year (such as with behavior issues).

The IEP team is composed of the following:

The parent(s) or legal guardian(s) of the student with a disability;

At least one general education teacher of the student if the student is or may be participating in the regular education environment for any classes;

At least one special education teacher of the student or a special education provider of the student;

A representative of the local educational agency (LEA) who is (1) qualified to supervise the needs of the student, (2) is knowledgeable of the general curriculum, (3) is knowledgeable about the availability of resources of the public agency, and (4) has the authority to commit agency resources; This person is frequently a principal or assistant principal of the student's campus.

An individual who can interpret the instructional implications of evaluations (typically an educational diagnostician, school psychologist, or specially-trained special education teacher);

The student, when appropriate; and

Other individuals asked to attend at the discretion of the school or the parent who have knowledge or special expertise regarding the student (such as related service providers and/or family members or family friends maintaining a close relationship with the student). Parents also have the right to invite an advocate if they so desire.

Depending on the age of the student, other individuals may be included in the meeting including rehabilitation or transition service providers or early intervention representatives.

PHASE SEVEN: IEP Implementation

Once the IEP is developed and signed by members of the IEP team it is the responsibility of the entire IEP team to ensure that the IEP is implemented. The IEP team may meet as frequently as needed to discuss the implementation of the IEP. School personnel are required to provide documentation of the mastery of benchmarks and annual goals. The IEP document is a "living" document and can be altered during the school term if needed. The IEP goals and benchmarks provide the objectives for the education of the student and prescribe what services will be provided by the local school district and school campus to achieve those objectives. However, it must be understood that school agencies are not required to meet all the goals within the school term, but they must provide evidence of a "good faith effort" toward achieving the goals.

PHASE EIGHT: Reevaluation

Each year, the IEP team is required to meet for the dual purpose of evaluating the implementation of the current IEP and to develop the next annual IEP. During these annual meetings, the IEP team should discuss the positive and negative elements of the special education services provided and determine, based on any new assessment data, what services should be provided in the upcoming school year.

While the IEP is redeveloped each year, the IEP team does not have to conduct the battery of assessments each year. At a minimum, the IEP team is to determine if formal evaluation is required every three years. However, the IEP team can ask that formal evaluations be conducted more frequently if needed.

There are times when, after the reevaluation takes place, it is determined that the student does not need special education services. One example of this might be young children who are provided speech and language services and have developed the ability to speak without problems. In this case, the IEP team will need to file appropriate documentation to support the fact that the student no longer is eligible for services and the IEP team will disband for this student.

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Special Education Referral Process - Project IDEAL

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Overview to the “Special Education Process”; the global procedures for providing a student with disabilities a free and appropriate education.

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IDEA - List of disability categories under IDEA

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IDEA - List of disability categories under IDEA

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At a glance

The Individuals with Disabilities Education Act (IDEA) requires public schools to provide special education services to eligible students.

IDEA covers 13 disability categories.

Not every student who struggles in school qualifies.

The Individuals with Disabilities Education Act (IDEA) requires public schools to provide special education and related services to eligible students. But not every child who struggles in school qualifies. To be covered, a child's school performance must be "adversely affected" by a disability in one of the 13 categories below.

1. Specific learning disability (SLD)

The "specific learning disability" (SLD) category covers a specific group of learning challenges. These conditions affect a child's ability to read, write, listen, speak, reason, or do math. Here are some examples of what could fall into this category:

SLD is the most common category under IDEA. In the 2018-19 school year, around 33 percent of students who qualified did so under this category.

2. Other health impairment

The "other health impairment" category covers conditions that limit a child's strength, energy, or alertness. One example is ADHD, which impacts attention and executive function.

3. Autism spectrum disorder (ASD)

ASD is a developmental disability. It involves a wide range of symptoms, but it mainly affects a child's social and communication skills. It can also impact behavior.

Various mental health issues can fall under the "emotional disturbance" category. They may include anxiety disorder, schizophrenia, bipolar disorder, obsessive-compulsive disorder, and depression. (Some of these may also be covered under "other health impairment.")

5. Speech or language impairment

This category covers difficulties with speech or language. A common example is stuttering. Other examples are trouble pronouncing words or making sounds with the voice. It also covers language problems that make it hard for kids to understand words or express themselves.

6. Visual impairment, including blindness

A child who has eyesight problems is considered to have a visual impairment. This category includes both partial sight and blindness. If eyewear can correct a vision problem, then it doesn't qualify.

Kids with a diagnosis of deafness fall under this category. These are kids who can't hear most or all sounds, even with a hearing aid.

The term "hearing impairment" refers to a hearing loss not covered by the definition of deafness. This type of loss can change over time. Being hard of hearing is not the same thing as having trouble with auditory or language processing.

Kids with a diagnosis of deaf-blindness have both severe hearing and vision loss. Their communication and other needs are so unique that programs for just the deaf or blind can't meet them.

10. Orthopedic impairment

An orthopedic impairment is when kids lack function or ability in their bodies. An example is cerebral palsy.

11. Intellectual disability

Kids with this type of disability have below-average intellectual ability. They may also have poor communication, self-care, and social skills. Down syndrome is one example of a condition that involves an intellectual disability.

12. Traumatic brain injury

This is a brain injury caused by an accident or some kind of physical force.

13. Multiple disabilities

A child with multiple disabilities has more than one condition covered by IDEA. Having multiple issues creates educational needs that can't be met in a program designed for any one disability.

Having a disability is not enough to qualify for special education. The disability has to have an "adverse effect" on a child's education.

Key takeaways

Each of the 13 disability categories in IDEA can cover a range of difficulties.

Dyslexia, dyscalculia, and written expression disorder fall under the "specific learning disability" category.

"Other health impairment" can cover ADHD.

About the author

About the author

Andrew M.I. Lee, JD is an editor and attorney who strives to help people understand complex legal, education, and parenting issues.

Reviewed by

Reviewed by

Rayma Griffin, MA, MEd has spent 40 years working with children with learning and thinking differences in the classroom and as an administrator.

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See a list of the 13 IDEA disability categories. Find out which disabilities can qualify kids for special education.

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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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Example referral process guide from Missouri Comprehensive School Counseling Program

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Mental Health and the Principal Perspective

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Mental Health and the Principal Perspective

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IMPACT OF MENTAL ILLNESS

Mental illnesses are disorders of brain function. They have many causes and result from complex interactions between a person's genes and their environment. Having a mental illness is not a choice or moral failing. Mental illnesses occur at similar rates around the world, in every culture and in all socio economic groups.

The statistics are staggering, 1 in 5 young people suffer from a mental illness, that's 20 percent of our population but yet only about 4 percent of the total health care budget is spent on our mental health.

MENTAL ILLNESSES

The impact is more than in statistics and factoids, it's in feelings and emotions. It's in our families, with our friends and in our communities. Having a mental disorder should not be any different than experiencing a physical illness. And it doesn't have to be; you can help make a difference.

A mental illness makes the things you do in life hard, like: work, school and socializing with other people. If you think you (or someone you know) might have a mental disorder, it is best to consult a professional as soon as possible. Early identification and effective intervention is the key to successfully treating the disorder and preventing future disability. A health care professional (doctor, mental health specialist, etc) will connect the symptoms and experiences the patient is having with recognized diagnostic criteria (DSM or ICD) to help formulate a diagnosis.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders. It is most commonly used in North America.

The ICD, part of the International Classification of Diseases produced by the World Health Organization (WHO), is another commonly-used guide, more so in Europe and other parts of the world.

These guides separate mental disorders into a number of categories. We've listed some of the most common mental disorders below. This list is not comprehensive, but is reflective of the most common diagnoses.

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Mental Disorders - Mental Health Literacy

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IMPACT OF MENTAL ILLNESS Mental illnesses are disorders of brain function. They have many causes and result from complex interactions between a person's genes and their environment. Having a mental illness is not a choice or moral failing. Mental illnesses occur at similar rates around the world, in every culture and in all socio economic groups.

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(National Alliance for Mental Illness [NAMI], 2020)

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(National Alliance for Mental Illness [NAMI], 2020)

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ASCA School Counselor Professional Standards & Competencies

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ASCA School Counselor Professional Standards & Competencies

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As a school counselor, it is important to be aware of and follow the national standards and competencies set forth by the ASCA. It is beneficial to keep the standards readily available in order to refer back to them regularly.

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Both Individualized Education Programs (IEPs) and 504 plans can offer formal help for K-12 students who are struggling in school. They're similar in some ways but very different in others. This chart compares them side by side to help you understand the differences.

A blueprint or plan for a child's special education experience at school.

A blueprint or plan for how the school will provide support and remove barriers for a student with a disability.

To get an IEP, there are two requirements: A child has one or more of the 13 disabilities listed in IDEA. The law lists specific challenges, like learning disabilities, ADHD, autism, and others. And the disability must affect the child's educational performance and/or ability to learn and benefit from the general education curriculum. The child must need specialized instruction to make progress in school.

To get a 504 plan, there are two requirements: A child has any disability. Section 504 covers a wide range of different struggles in school. And the disability must interfere with the child's ability to learn in a general education classroom. Section 504 has a broader definition of a disability than IDEA. (It says a disability must substantially limit one or more basic life activities. This can include learning, reading, communicating, and thinking.) That's why a child who doesn't qualify for an IEP might still be able to get a 504 plan.

There are strict legal requirements about who participates. With a few exceptions, the entire IEP team must be present for IEP meetings. The team must include:

The rules about who's on the 504 team are less specific than they are for an IEP. A 504 plan is created by a team of people who are familiar with the child and who understand the evaluation data and special services options. This might include:

* The child's parent or caregiver

* General and special education teachers

* The school principal

* The child's parent or caregiver

* At least one of the child's general education teachers

* At least one special education teacher

* A school psychologist or other specialist who can interpret evaluation results

* A district representative with authority over special education services

The IEP sets learning goals and describes the services the school will provide. It's a written document. Here are some of the most important things the IEP must include:

There is no standard 504 plan. Unlike an IEP, a 504 plan doesn't have to be a written document. A 504 plan generally includes the following:

* Specific accommodations, supports, or services for the child

* Names of who will provide each service

* Name of the person responsible for ensuring the plan is implemented

* The child's present levels of academic and functional performance - how the child is currently doing in school

* Annual education goals for the child and how the school will track progress

* The services the child will get - this may include special education, related, supplementary, and extended school year services

* The timing of services - when they start, how often they occur, and how long they last

* Any accommodations - changes to the child's learning environment

* Any modifications - changes to what the child is expected to learn or know

* How the child will participate in standardized tests

* How the child will be included in general education classes and school activities

When the school wants to change a child's services or placement, it has to tell families in writing before the change. This is called prior written notice. Notice is also required for any IEP meetings and evaluations. Families also have "stay put" rights to keep services in place while there's a disagreement about the IEP.

The school must notify families about an evaluation or a "significant change" in placement. Notice doesn't have to be in writing, but most schools do so anyway.

How to resolve disputes

IDEA gives families several ways to resolve disputes (usually in this order):

Section 504 gives families several options for resolving disagreements with the school:

* Mediation

* Alternative dispute resolution

* Impartial hearing

* Complaint to the Office for Civil Rights (OCR)

* Lawsuit

* Mediation

* Due process complaint

* Resolution session

* Civil lawsuit

* State complaint

* Lawsuit

And if you need help navigating special education law in your state, consider reaching out to your local Parent Training and Information Center. The people there can answer questions and give practical advice on issues specific to your area.

Do you want to learn more about how IEPs and 504 plans compare? Watch as an expert explains the differences between them.

About the author

About the author

The Understood Team is made up of passionate writers and editors. Many of them have kids who learn and think differently.

Reviewed by

Reviewed by

Andrew M.I. Lee, JD is an editor and attorney who strives to help people understand complex legal, education, and parenting issues.

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IEP vs. 504 Plan: What's the Difference?

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Individualized Education Programs (IEPs) and 504 plans are similar but different. See how they compare in what they provide and the processes and laws involved.

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ASCA Ethical Standards for School Counselors

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ASCA Ethical Standards for School Counselors

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Individuals with Disabilities Education Act

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Individuals with Disabilities Education Act (IDEA)

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The U.S. Department of Education’s Individuals with Disabilities Education Act website brings together department and grantee IDEA information and resources. The IDEA makes available a free appropriate public education to and ensures special education and related services to eligible children with disabilities.

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Abraham, S. (2016). Eating Disorders: The Facts: Vol. Seventh edition. OUP Oxford.

American School Counselor Association (2019). ASCA School Counselor Professional Standards & Competencies. Alexandria, VA: Author.

Bardick, A. & Bernes, K. (2005). A closer examination of bipolar disorder in school-age children. Professional School Counseling, 9(1), 72–77. https://doi.org/10.5330/prsc.9.1.k2153125rh611517

Cuncic, A. (2019).

Understanding the Causes of Social Anxiety Disorder [image].

https://www.verywellmind.com/social-anxiety-disorder-causes-3024749

Fritz, G. (ed). (2012). Oppositional defiance disorder: A guide for parents. The American Academy of Child and Adolescent Psychology, 28, 1-2.

Karl, S. (2014). Anorexia nervosa. American Counseling Association Practice Briefs. https://blackboard.angelo.edu/bbcswebdav/pid-2699677-dt-content-rid-25653751_2/courses/11451.202110/anorexia-nervosa.pdf

Kress, V., Dari, T., and Paylo, M. (2015). Depressive disorders in youth. American Counseling Association Practice Briefs.

Kress, V., Sedall, S., and Paylo, M. (2016). Counseling youth who have bipolar disorder. American Counseling Association Practice Briefs.

Muhlheim, K. (2019).

How to Cope With Eating Disorders During Pregnancy [image]. https://www.verywellmind.com/pregnancy-and-eating-disorders-4179037

National Alliance on Mental Illness [NAMI]. (2020). Teens and young adults. https://www.nami.org/Your-Journey/Teens-Young-Adults

Pincus, D., May, J., Whitton, S., Mattis, S., & Barlow, D. (2010). Cognitive-behavioral treatment of panic disorder in adolescence. Journal of Clinical Child & Adolescent Psychology 39(5), 638-649. doi: 10.108/15374416.2010.5011288

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School Counselor's Role in Addressing Eating Disorders

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School Counselor's Role in Addressing Eating Disorders

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Counseling Youth Who Have Bipolar Disorders

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Counseling Youth Who Have Bipolar Disorders

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By: Victoria E. Kress, Stephane Sedall, and Matthew Paylo

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VeryWell Mind clarifies the DSM-5 diagnosis criteria for panic disorder and differentiates panic disorder from agoraphobia, which had previously been linked together in earlier editions of the DSM.

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Panic disorder is classified as an anxiety disorder in DSM-5. According to the guidelines, in order to be diagnosed with a panic disorder, you must experience unexpected panic attacks on a regular basis.

What else does DSM-5 say about a panic disorder? How does the way it's diagnosed in DSM-5 compare to previous editions of the manual? Among the updates are clarification on the types of panic attacks and how agoraphobia is associated with panic disorder.

What Is the DSM-5?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American Psychiatric Association (APA) is the system used in the United States to diagnose mental health disorders. The DSM contains diagnostic criteria used by mental health professionals to classify and describe every known mental illness.

The 2013 release of DSM was the first significant update since 1994. Many changes were made in this fifth edition (DSM-5), including some updates to the diagnosis of panic disorder.

This system is not without controversy. Many disorders have overlapping symptoms. Some professionals question the validity of this type of classification system, while others feel there is a great deal of subjectivity in its application.﻿﻿

Despite these reservations, a diagnosis is often necessary for treatment, research, and insurance reimbursement. Many professionals feel that this system is far better than no system at all.

How DSM-5 Diagnoses a Panic Disorder

The diagnostic criteria for panic disorder are defined in the DSM-5. It is an anxiety disorder based primarily on the occurrence of panic attacks, which are recurrent and often unexpected.﻿﻿

In addition, at least one panic attack is followed by one month or more of the person fearing that they will have more attacks and causing them to change their behavior, which often includes avoiding situations that might induce an attack.﻿﻿

It's important to note that a panic disorder diagnosis must rule out other potential causes for the panic attack (or event that feels like one):﻿﻿

The attacks are not due to the direct physiological effects of a substance (such as drug use or a medication) or a general medical condition.

The attacks are not better accounted for by another mental disorder. These may include a social phobia or another specific phobia, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), or separation anxiety disorder.

Defining Panic Attacks

Since panic attacks are key to a panic disorder diagnosis, they are well-defined and specific. This is where the updates in the DSM-5 are significant.

The previous version (DSM-IV) classified panic attacks into three categories: situationally bound/cued, situationally predisposed, or unexpected/uncued. The DSM-5 simplifies the approach to classifying panic attacks by providing just two very clear categories: expected and unexpected panic attacks.﻿﻿

Expected panic attacks are those associated with a specific fear, like that of flying. Unexpected panic attacks have no apparent trigger or cue and may appear to occur out of the blue. According to DSM-5, a panic attack is characterized by four or more of the following symptoms (the presence of fewer than four symptoms may be considered a limited-symptom panic attack):﻿﻿

Palpitations, pounding heart, or accelerated heart rate

Sweating

Trembling or shaking

Sensations of shortness of breath or smothering

A feeling of choking

Chest pain or discomfort

Nausea or abdominal distress

Feeling dizzy, unsteady, lightheaded, or faint

Feelings of unreality (derealization) or being detached from oneself (depersonalization)

Fear of losing control or going crazy

Fear of dying

Numbness or tingling sensations (paresthesias)

Chills or hot flushes

Agoraphobia vs. Panic Disorder

In previous versions of DSM, agoraphobia was associated with panic disorder. With the updates of DSM-5, agoraphobia is now a separate and codable diagnosis. This is one of the biggest differences in the updates.

Within the update to agoraphobia, DSM-5 notes that a person must experience intense fear or anxiety in a minimum of two situations. These include being out in public, open spaces, and in crowds-essentially anywhere in which you're outside of the home.

It also notes that avoidance behaviors must be exhibited. These are a result of the fear of being in situations that may induce panic attacks or anxiety in which help may not be available or that it's difficult to flee.

Professional Diagnosis

It is important to know that the symptoms of panic disorder may mimic many other anxiety disorders and/or medical conditions. Only your doctor or mental health professional can diagnose panic disorder.

Panic Disorder Discussion Guide

Get our printable guide to help you ask the right questions at your next doctor's appointment.

Anxiety disorders such as panic disorder are among the most prevalent types of mental health conditions, but only around 20% of people who have symptoms of anxiety seek treatment. Because anxiety disorders are more common in women than men, experts now recommend that clinicians screen women and girls aged 13 and older for anxiety conditions.﻿﻿

When seeking professional help in order to evaluate your symptoms and potentially reach a diagnosis, remember that honesty is key. You may even see one therapist and decide you'd like to see a different one instead. Remember to do what you are comfortable with.

Although it may feel difficult at first to discuss your feelings, remember that your doctor is there to help you and that speaking openly about your condition is the first step toward managing your symptoms in a healthy way.

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DSM-5 Criteria for Diagnosing Panic Disorder

# data[].attributes.attachment_link.description
Panic disorder is classified as an anxiety disorder in DSM-5. According to the guidelines, in order to be diagnosed with a panic disorder, you must experience unexpected panic attacks on a regular basis. What else does DSM-5 say about a panic disorder? How does the way it's diagnosed in DSM-5 compare to previous editions of the manual?

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Study for the use of CBT to treat panic disorders in adolescents. With findings indicating that a peak for the onset of panic disorder may occur during adolescence, it is important to study treatment options for adolescents suffering from the disorder. The study indicated that CBT offers a potentially effective treatment option for adolescents who are suffering from panic disorder.

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Addressing Mental Health in School Crisis Prevention & Response

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Addressing Mental Health in School Crisis Prevention & Response

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A guide from West Virginia Schools on crisis response and prevention strategies. Example guide for school counseling programs.

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addressing mental health in school crisis prevention and response_1_

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Addressing Anxiety in Schools: Information for Counselors

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Addressing Anxiety in Schools: Information for Counselors