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What do mental health professionals do in schools. (n.d.). Angelo State University EDG 6327 Dysfunctional Behavior

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What do mental health professionals do in schools (1)

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What Are Signs of OCD in Children and Teens?

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All kids have worries and doubts. But kids with obsessive-compulsive disorder (OCD) often can't stop worrying, no matter how much they want to. And those worries frequently compel them to behave in certain ways over and over again.

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What Is OCD?

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

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

How Is OCD Treated?

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

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

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

What Signs Might Parents Notice?

Obsessions

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

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

germs, dirt, illness, injury, or harm

whether someone could get sick, hurt, or die

things that seem wrong, or out of place

whether bad thoughts might come true

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

Compulsions (Rituals)

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

Parents may notice that kids:

touch, tap, or step in unusual ways

arrange things over and over

repeat words, phrases, or questions

have many doubts, and trouble making choices

wash or clean more than needed

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

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

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

Feelings

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

Kids may seem:

anxious, worried

frustrated, irritable

sad, tired

upset when they can't do a ritual

to need constant reassurance from a parent that things are OK

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

How Can I Help My Child?

If you think your child may have OCD:

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

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

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

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

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

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

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

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Children with OCD have intrusive thoughts and worries that make them extremely anxious, and they develop rituals they feel compelled to perform to keep those anxieties at bay. This guide explains the often confusing behaviors that can be associated with OCD, and the treatments most effective for hel…

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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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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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When parents start googling behavior issues, one phrase tends to jump out: oppositional defiant disorder (ODD). It's easy to see why. "The words 'oppositional' and 'defiant' show up in parents' vocabulary fairly frequently," says David Anderson, PhD, a clinical psychologist at the Child Mind Institute. "It's one of the more aptly named diagnoses that exists."

Whether your child has oppositional defiant disorder (or ODD) or not, learning about the disorder can be helpful. That's because the behavior management strategies used in treatment are evidence-based techniques that all parents will benefit from knowing.

What is Oppositional Defiant Disorder (ODD)?

It is normal for children to be oppositional and defiant at least some of the time. In fact, it's a sign of healthy development. So when does a child have oppositional defiant disorder? The diagnosis should not be given, for example, to a toddler who has just discovered that her new favorite word is "no."

ODD is typically diagnosed around early elementary school ages and stops being diagnosed around adolescence. Kids who have ODD have a well-established pattern of behavior problems. Symptoms include:

Being unusually angry and irritable

Frequently losing their temper

Being easily annoyed

Arguing with authority figures

Refusing to follow rules

Deliberately annoying people

Blaming others for mistakes

Being vindictive

All children can have these symptoms from time to time. What distinguishes ODD from normal oppositional behavior is how severe it is, and how long it has been going on for. A child with ODD will have had extreme behavior issues for at least six months.

Another hallmark of ODD is the toll it takes on family relationships. Regular daily frustrations - ignored commands, arguments, explosive outbursts - build up over time, and these negative interactions damage the parent-child bond and reinforce hostile patterns of behavior.

Parenting Under Fire

"Kids who have behavioral issues push parents towards the extremes," says Dr. Anderson. "They push parents to become permissive and they push parents to become hyper-coercive in the hope that a larger amount of control will get the kid to listen."

Neither of these extremes make for ideal parenting. It is never a parent's intention to reinforce bad behavior, and we often don't realize when we're doing it. Here are two common scenarios:

You tell your child to stop playing a game and get ready for bed. He ignores your first two requests. By the third time you ask, you're so mad that you yell.

You tell your child to stop playing a game and get ready for bed. He throws a tantrum because he wants to keep playing. You don't want him to be so worked up before bedtime, so you back down and say he can play for another ten minutes - but then he has to go to bed.

In the first scenario, your child learns that yelling is an acceptable way to get a message across. More subtly, he might also be learning that he can continue ignoring those first few requests - when you escalate the situation is when he knows you're serious.

In the second scenario, your child has learned that throwing a tantrum might give him something that he wants, so he'll be more likely to do it again in the future.

Both of these scenarios can set families up for future conflicts, and the more they are repeated the more they become familiar patterns of behavior that are harder to break out of. Your child doesn't have to have ODD for these scenarios to happen, but repeated negative interactions like these make diagnosing a behavior disorder much more likely.

And just like parents aren't necessarily to blame, neither are the kids, says Dr. Anderson. "Through no conscious effort of the child, he learns through hundreds of trials that this is a way to continue getting what he wants."

This also explains why kids who have ODD might act out more at home. Dr. Anderson notes, "Kids who have ODD are likely to be more oppositional with people they know well, partly because the pathways are so well worn. Whereas in a place like school, where a kid has less control in general over their environment, the types of behaviors that are common to ODD may not pay off as much."

ADHD and Other Risk Factors

There is a very high overlap in kids who have ADHD who are also diagnosed with ODD. Depending on the study, the overlap could be 30 to 50 percent of kids with ADHD also have ODD.

Dr. Anderson explains the connection like this: "Kids with ADHD are biologically loaded to be distractible, to be impulsive, to have difficulty staying in one place for a little while. So kids with ADHD start off doing things that parents perceive as off limits. And then when those kids get negative feedback they start to become even more negatively oriented towards adults." These repeated patterns of negative interactions can lead to developing ODD.

But another pathway into developing ODD has more to do with a child's temperament and might be apparent early on. Children who had a lot of difficulty soothing themselves as toddlers and continue to struggle with an age-appropriate ability to control their emotions in the face of disappointment or frustration can sometimes develop ODD. The adults in their environment might be more inclined to accommodate their demands in order to keep the family functioning as harmoniously as possible.

Kids who have experienced a lot of life stress and trauma are also more likely to develop ODD.

Why Treatment is Important

It's important to get treatment to improve the parent-child relationship, which is crucial to the health and happiness of the entire household. It is also important for your child's future. Some children will grow out of oppositional defiant disorder, but others will continue to have behavior issues, which could lead to peer rejection and difficulty forming healthy relationships, not to mention continued family discord.

They'll also be less likely to achieve their potential. If something doesn't go their way, they might think it's anyone's fault but theirs. Dr. Anderson says they might also "retreat to the places where they know they can get what they want. That might mean that they try even less, push even more on the people who are closest to them, who they actually care about the most, causing even more frayed relationships."

A small percentage of kids with ODD go on to develop something called conduct disorder, which is a more severe behavior disorder that includes criminal acts like stealing, setting fires and hurting people. Getting treatment sooner rather than later improves a child's trajectory.

What Treatment for ODD Looks Like

Parents play a key role in treatment for oppositional defiant disorder. This might be surprising, since children are the ones given the diagnosis, but in ODD the parent-child relationship needs to be repaired, which means both parties need to make changes to get back on track.

All programs have certain goals in common, like helping parents find the middle ground between being too authoritative and too permissive. A behavioral therapist helps parents learn how to train their child's behavior through setting clear expectations, praising kids when they follow through and using effective consequences when they don't. Parents also learn to use these strategies consistently - one reason why behavior management strategies sometimes don't work is because parents try different, conflicting techniques, or don't stick to one program long enough to see gains. Parents and children will also learn problem solving skills they can rely on when they run into issues.

Parent training programs might include sessions with parents and children working together, or just parents alone. Some different programs include:

Parent-Child Interaction Therapy (PCIT)

Parent Management Training (PMT)

Defiant Teens

Positive Parenting Program (Triple P)

The Incredible Years

Clinicians might also recommend social skills training to help improve your child's peer relationships or cognitive behavioral therapy if she is struggling with anxiety or depression.

There is no FDA-approved medication for ODD, but medications are sometimes used as an adjunct to behavioral therapy. Anti-psychotic medications like Abilify (aripiprazole) and Risperdal (risperidone), which have been shown to reduce aggression and irritability, are frequently used in cases where a child is at risk of being removed from the school or home. Stimulant medication may be used if a child has excessive impulsivity, including those who have an ADHD diagnosis. Antidepressants (SSRIs) may be helpful if a child has underlying depression or anxiety.

Regardless of the treatment plan your therapist recommends, parents will need to provide a lot of encouragement. "Make no mistake, kids do not often just suddenly wake up with the insight that they wish their behavior was better and then ask all the adults in their life how they can change," warns Dr. Anderson. "They'll stick with whatever behavior is working for them, even if it's not working that well."

But once the family dynamic begins to change, and kids (and parents) begin to feel more confident in their ability to get along, everyone will be a lot happier.

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What Is Oppositional Defiant Disorder (ODD)? - Child Mind Institute

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Learn about the symptoms of ODD and how treatment can improve the parent-child relationship and improve a child's behavior.

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What Is ADHD?

Attention-deficit hyperactivity disorder, or ADHD, is a condition that makes it unusually difficult for children to concentrate, to pay attention, to sit still, to follow directions, and to control impulsive behavior. While all young children are at times distractible, restless, and oblivious to parents' and teachers' instructions, kids with ADHD behave this way much more often than other children their age. And their inability to settle down, focus, and follow through on tasks in age-appropriate ways makes it very hard for them to do what's expected of them at school. It can also lead to conflict at home and difficulty getting along with peers.

ADHD Symptoms

Symptoms of ADHD are divided into two groups: inattentive behaviors and hyperactive and impulsive behaviors.

Inattentive symptoms of ADHD:

Makes careless mistakes

Is easily distracted

Doesn't seem to be listening when spoken to directly

Has difficulty following instructions

Has trouble organizing

Avoids or dislikes sustained effort

Is forgetful, always losing things

Hyperactive or impulsive symptoms of ADHD:

Fidgeting or squirming, trouble staying in one place or waiting his turn

Excessive running and climbing

Trouble playing quietly

Extreme impatience

Always seems to be "on the go" or "driven by a motor"

Excessive talking or interrupting, blurting out answers

Some children exhibit only the first group ADHD of symptoms, and some exhibit only the latter. But the majority of those with an ADHD diagnosis have a combination of both, which can make it very difficult for them to function in school, and in other activities, and can create a lot of conflict at home.

How Are ADD and ADHD Different?

ADD, or attention-deficit disorder, is an older term for the disorder we now call ADHD, or attention-deficit hyperactivity disorder. It was called ADD up until 1987, when the word "hyperactivity" was added. Some people still use the old term, ADD, out of habit, or because it's a more familiar term than ADHD. Some use it to refer to kids with ADHD who aren't hyperactive.

Can a Child Who's Not Hyperactive Have ADHD?

Yes. Kids who have trouble focusing but are not unusually restless or impulsive have a more inattentive type ADHD. They tend to be diagnosed later because they are less prone to disruptive or problematic behavior that comes to the attention of teachers and parents. But kids who have inattentive symptoms may start to struggle in the middle of elementary school, when it becomes increasingly difficult for them to keep up.

Why Can Kids With ADHD Concentrate on Some Things? What Is ADHD Hyperfocus?

While ADHD is called an attention deficit disorder, experts say what's really disordered is the child's ability to control and direct what he's paying attention to. So many kids with ADHD are perfectly capable of intense focus on things that are very exciting to them, like video games, but they can't maintain that kind of focus on things that aren't immediately rewarding, like schoolwork or putting on their shoes or going to bed.

That intense concentration, sometimes called hyperfocus, is also the reason kids with ADHD often get upset when asked to stop doing something they are engaged in, like a favorite activity at school or playing a video game. They have what experts call an inability to "attention switch," which can cause a lot of conflicts with adults.

And speaking of video games: Because they are constantly stimulating and rewarding, experts say they can induce a kind of trance state in a child who has trouble regulating her attention. In that case, it's less a matter of hyperfocus than what one calls "screen suck."

What Is Executive Functioning?

Executive functions are the self-regulating skills that we all use to accomplish tasks, from getting dressed to doing homework. They include:

Planning

Organizing time and materials

Making decisions

Shifting from one situation to another

Controlling emotions

Learning from past mistakes

Most kids with ADHD have deficits in some executive functions, though not all children with executive function issues have ADHD.

Does ADHD Affect Kids Outside of School?

Yes. Their inattention and impulsivity also affects their friendships, extra-curricular activities, and family life. They may have trouble making and keeping friends because they interrupt constantly, and are prone to blowing up when they don't get their way. It's not uncommon for children with severe ADHD to be blackballed from playdates because they can't be counted on to behave. Kids with ADHD may have trouble playing on teams because they find it hard to focus and follow the rules.

At home, they may find themselves on a collision course with parents and siblings because they don't follow instruction, are impulsive, and melt down when they are asked to transition from some activity they enjoy to mealtime, homework time, or bedtime.

By the time kids with ADHD reach adolescence, their impulsivity can be dangerous, making them prone to car accidents, unsafe sex, and other risky behaviors.

Why Are Kids With ADHD Often Defiant or Demonstrate Disruptive Behavior?

Defiance and emotional outbursts are very common in kids with ADHD, though they are not, themselves, symptoms of ADHD.

Kids who have ADHD tend to become defiant when they are expected to do things that are hard for them, especially when it means stopping something that's pleasurable-like playing a video game. So things like homework, going to bed, getting dressed, and coming to dinner can become battlegrounds. These situations are difficult for them to tolerate because of inherit deficits in paying attention, tolerating a boring situation, reining in impulses, transitioning from a fun activity, and controlling their activity level. Since these situations are really challenging for them, they may try to avoid them. Unfortunately when it comes to ADHD parenting, the avoidance strategies that these kids typically use are disruptive behavior, tantrums, arguing, defiance, and power struggles.

Can You Grow Out of ADHD?

ADHD symptoms change as children get older, and it's estimated that about a third of children who are diagnosed with the attention-deficit hyperactivity disorder will no longer meet the criteria by the time they reach young adulthood.

In general, hyperactivity declines as kids move through elementary school, and inattention becomes the primary problem for them as the schoolwork they are expected to do becomes more demanding and their parents and teachers are not so closely supervising their activities. In adolescence, impulsivity also becomes a big concern, as it leads to car accidents, unsafe sex, and other risky behavior.

Children who are most likely to have ADHD that continues into adulthood are those whose symptoms are very severe in childhood, and those who also have another psychiatric disorder, like depression or anxiety.

ADHD Diagnosis

When is ADHD diagnosed?
Because the symptoms of ADHD can also be the result of other issues, such as anxiety, depression, or trauma, a professional diagnosing your child should carefully rule out other possible reasons for his behavior.

A child should receive an ADHD diagnosis only if he exhibits a variety of inattentive or impulsive behaviors

At a level that is abnormal for children his age

Over an extended period

In more than one setting-both at home and at school, for instance.
These behaviors must also be interfering significantly with schoolwork or social interaction.

How is an ADHD diagnosis done?
To make an accurate diagnosis, a clinician should collect information from several people who have observed your child, including you, other caregivers, and teachers.

Parents and teachers should be asked to fill out a rating scale, such as the SNAP, the Child Behavior Checklist, or Connor's Checklist, to capture an accurate assessment of the frequency of symptoms over a period of time. A child may be given a test called a Continuous Performance Test, which rates her ability to complete a repetitive task over a period of time and can give a more complex picture of her ADHD symptoms.

A child should not be diagnosed with ADHD just based on a parent's or teacher's report that she is overly active or distracted.

Who can diagnose ADHD?
ADHD can be diagnosed by any doctor or mental health professional, including:

Pediatricians

Psychiatrists

Clinical psychologists

Social workers

School psychologists

But in the majority of cases, only medical doctors like psychiatrists can prescribe medication to treat it. (Some states allow psychologists to prescribe, and nurse practitioners and physician's assistants often can, as well.) The overwhelming majority of ADHD diagnoses are made by pediatricians, though parents should be aware that many pediatricians don't have advanced training in psychiatric disorders, and an ADHD diagnosis should not be made in a quick office visit, based solely on a report that a child is having trouble concentrating in school. Inattention can be caused by other things, and giving a child ADHD medication won't address his problems if he doesn't have ADHD.

ADHD Medication Treatment

What is the most effective ADHD treatment?
Research shows that a combined approach of medication and behavioral therapy is the most effective treatment.

For moderate to severe cases of ADHD the first line of treatment is usually medication. ADHD medications called psychostimulants, which increase the amount of certain chemicals in the brain, help children focus and curb impulsivity and hyperactivity.

Behavioral therapies help kids rein in impulsive behavior and be better organized.

What are the kinds of stimulant medications for ADHD?
If a child has ADHD, studies show there's an over 80% chance that he will respond to stimulant medication with a significant reduction in symptoms.
There are two main classes of stimulant medications:

Methylphenidate-based medications
Ritalin, Methylin, Concerta, Metadate, Daytrana Patch

Dextroamphetamine-based medications
Adderall, Vyvanse, Dexedrine

Of the children who respond to stimulants, half will respond equally well to both groups of medications, and the other half will respond better to one or the other. There are many different release formulas for stimulant medications, which make them effective for different periods of time.

Immediate-release formulas
are effective for about 4 hours

Extended-release formulas
last as long as 14 hours.

Within the extended-release group, medications vary in the doses they deliver morning and afternoon. Some deliver 50 percent in the first half of the day and 50 percent in the second; others deliver just 30 percent in the first half and 70 percent in the second.

Finding the right dose
Since different children metabolize medication in different ways, the goal is to find the formula that delivers an effective dose over a desirable period of time for your child. Getting the right dosage for a particular child takes several weeks of trial. The clinician normally increases the dosage gradually until it becomes effective. If your child experiences undesirable side effects, it may mean that the dosage is too high, or the medication isn't right for her.

It's important to note that some children respond differently to the two different stimulants used in these medications-methylphenidate and dextroamphetamine. Changing from one to the other, or even to a different release formula of the same basic medicine, can help reduce or eliminate side effects.

Once an effective dosage is established, your child should be monitored periodically to make sure it's still meeting her needs as she grows.

Side effects of stimulant medications
Stimulant medications can be very effective in reducing symptoms of ADHD, but some kids do experience adverse side effects. They include:

Sleep issues
If medication is interfering with a child's sleep, it's because the medication is still active at bedtime.
If he's taking a short-acting formula, it may mean that he is taking a second or third dose too late in the day. If he's taking medication that lasts 12 or 14 hours, it may help to try one that's not quite as long-acting. Sleep issues caused by the medication tend to get better over time, so it's worth giving kids four to six weeks to see if they adjust. Trouble going to sleep may also be caused by kids being too stimulated at bedtime.

Are there non-stimulant medications for ADHD?
There are two types of medications that aren't stimulants that can help alleviate symptoms of ADHD. They are useful for kids who don't respond to stimulant medica-tions, or who experience adverse side effects from them.

Atomoxetine (sold as Strattera) is in a class of drugs called norepinephrine reuptake inhibitors.
Norepinephrine is a natural substance in the brain that is needed to control behavior.

Clonidine (Catapres, Nexicon) and guanfacine (Tenex) are called alpha-adrenergic agonists.
These medications were developed to lower high blood pressure, but at the doses given to kids for ADHD they rarely affect blood pressure.Both clonidine and guanfacine come in a 24-hour-release version (Kapvay and Intuniv), and they are sometimes used to treat tics.

Finally, omega fatty acids can also be helpful for ADHD, though not as helpful as stimulants or these other medications.

Should children stop taking ADHD medication during holidays and the summer?
Since children with ADHD don't need to perform academically during the summer or on extended holidays, parents sometimes seize the opportunity to take kids off their regular medication regimen, especially if they are experiencing side effects. Other parents avoid an interruption, fearing that their children's behavioral problems will rebound.

One reason to stay with treatment year-round is that ADHD doesn't only affect a child's performance in school. During the summer, children still have to get along with family and friends and function effectively in group activities like sports and camp.

However, if you are concerned that taking a stimulant medication may be slowing your child's growth, a summer break can allow him to catch up. And if you are concerned that he is underweight due to suppressed appetite, a summer without medication can help him put on some pounds.
For more on the pros and cons of a drug holiday, click here.

Behavioral Treatment for ADHD

What are the behavioral treatments for ADHD?
Behavior therapies do not eliminate the core symptoms of ADHD, but they can be very helpful in teaching children to manage them better. For example, children who have trouble finishing things and staying organized can learn techniques for completing tasks, keeping track of assignments, and getting their schoolwork done.

There's also a kind of behavior therapy for ADHD called parent training that can help reduce behavior problems that stem from ADHD in children. Parent-child interaction therapy and other forms of parent training teach parents how to work with their kids to cultivate good behaviors while minimizing impulsive or inattentive ones. Stimulated by more positive reinforcement, kids who have been out of control can learn to rein in their behavior and enjoy more rewarding relationships with parents and teachers.

As children get older, they often begin working more one-on-one with clinicians to strengthen their organizational skills and develop effective behavioral plans.

When a child is old enough, cognitive behavioral therapy can help teach her to control her behaviors by understanding how her thoughts and feelings influence them.
For more on behavioral therapy for kids with ADHD click here.
What can we do to help kids strengthen executive functions?
To bolster kids with weak skills in these areas, learning specialists teach a mix of specific strategies and alternative learning styles that complement or enhance a child's particular abilities.

With elementary school children, the educational specialist usually works with parents and kids together, to establish routines and tools to use to get work done successfully and with minimal conflict. For instance:

Checklists can be useful for anything from getting out of the house on time in the morning to doing homework after school to the bedtime routine. Since the steps necessary for completing a task often aren't obvious to kids with ADHD, defining them clearly ahead of time, and posting them prominently, makes a task less daunting and more achievable.
For more information on adolescents with ADHD, click here.
Assigning a time limit for each step, particularly if it is a bigger, longer-term project, helps kids manage their time and avoid underestimating how long it will take to do something.

Using a planner is essential for kids with ADHD who struggle to remember things like homework assignments.

A rewards chart at home, as well as at school, can help motivate kids who are easily distracted and struggle to acquire new skills.

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Parents Guide to ADHD in Children | Child Mind Institute

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Attention-deficit hyperactivity disorder, or ADHD, is a condition that makes it unusually difficult for children to concentrate, to pay attention, to sit still, to follow directions, and to control impulsive behavior. While all young children are at times distractible, restless, and oblivious to parents' and teachers' instructions, kids with ADHD behave this way much more often than other children their age.

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

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

1. Emotional and Behavior Disorders (EBD)

2. Emotional Conflict (EC)

3. Serious Emotional Disturbance (SED)

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

General Strategies

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

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

Teacher Presentation

Laboratory

Group Interaction and Discussion

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

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

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

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

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

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

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

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

Reading

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

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

2. Reading in group or with others.

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

4. Demonstrating appropriate reading

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

Research

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

2. Use appropriate laboratory and field strategies.

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

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

Field Experiences

1. Use appropriate general strategies.

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

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

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

5. Use a buddy system.

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

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

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

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

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

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

Testing

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

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

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

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

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

Organizations

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

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

Resources

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

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

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

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Childhood Schizophrenia: What Are the First Signs? | Child Mind Institute

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Early onset or childhood schizophrenia is rare enough that symptoms are often confused with something else. Advice for parents and caregivers.

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Bipolar disorder is a mood disorder characterized by dramatic highs and lows - periods of depression alternating with mania, or extremely elevated mood.

Bipolar disorder is most often diagnosed in adolescence or early adulthood, though it can be diagnosed in childhood or in later adulthood. The mean age of onset is 18, and between 15 and 19 is the most common period of onset. But the disorder's first signs are very often overlooked or mischaracterized. At the outset, bipolar symptoms are commonly mistaken for ADHD, depression, anxiety, borderline personality disorder and, in its more severe manifestations, as schizophrenia.

That's because the first symptoms of this disorder are unusually varied. Only over time does the pattern of alternating high and low moods become clear, meaning that in many cases people with bipolar disorder are left waiting months, or even years, for an accurate diagnosis. And that waiting can have serious consequences, including treatment that's not effective.

In some patients, the first sign of bipolar disorder is what appears to be a major depressive episode. Others experience full-blown mania or hypomania - a less extreme form of mania. Still others experience a confusing combination of symptoms called a "mixed episode," which has elements of both depression and mania.

Here is a closer look at what a first episode might look like:

Depression: When the first episode of bipolar disorder is depression, symptoms can develop slowly, reports Michael Strober, PhD, who is Distinguished Professor of Psychiatry, and Senior Consultant to the Youth Mood Disorders Treatment and Research Program at the David Geffen School of Medicine at UCLA. Bipolar depression usually includes not only the sadness or irritability we associate with depression, but delusions of failure, exaggerated feelings of guilt, mental confusion and profound physical slowness.

Despite these differences, Dr. Strober notes that symptoms of bipolar depression are often misdiagnosed as major depressive disorder early on, because alternating periods of mania (or hypomania) may not appear until months or years later.

Mania: Unlike the gradual descent into depression, when the initial episode is mania the onset can be "like a thunderclap," says Wendy Nash, MD, a child and adolescent psychiatrist. An initial manic episode might be characterized by grandiose thinking, risk-taking, accelerated speech and thought, and euphoria or irritability.

It's not unusual for the behavior to be so extreme that the patient ends up hospitalized - or even arrested. Dr. Nash gives an example of a college student who inexplicably shifts from normal behavior to overdrive: Suddenly they're up all night, hyper-talkative, loud, and combative, maybe even getting into fights, acting so rashly and erratically that police are called.

In younger children, mania may be misinterpreted as the hyperactivity and impulsivity of ADHD.

Hypomania: Sometimes the initial episode of bipolar disorder is the less extreme form of mania called hypomania, and these episodes are often missed, Dr. Nash notes. The person may be talkative, grandiose, highly productive, a little moody and irritable, but the symptoms aren't as disruptive or dangerous as in full-blown mania, and patients themselves don't perceive themselves as disordered.

"Hypomania is trickier to diagnose," adds Jill Emanuele, PhD, Senior Director of the Mood Disorders Center at the Child Mind Institute. "Adolescents with hypomania aren't as flagrantly out of control as those with full-fledged mania, who can be dangerously impulsive and reckless."

Mixed episode: Finally, some people with bipolar disorder experience what's called a mixed episode, which includes characteristics of both depression and mania. In a mixed episode, a patient has a depressed mood but racing thoughts and speech, agitation, and anxious preoccupations - what one patient describes as being over-caffeinated and tired at the same time.

In a mixed episode, obsessive negative thoughts can be misdiagnosed as anxiety, notes Dr. Strober.

Psychosis: Some first episodes of either mania or depression can be so severe they include psychotic symptoms - breaks from reality such as hallucinations or delusions. When this happens, it can be misdiagnosed as schizophrenia.

A diagnosis of bipolar disorder is based on a detailed history that tracks changes in mood over time; as one expert puts it, think of it as a movie, not a snapshot.

"You need to get the timeline of mood shifts," notes Dr. Emanuele, "and that takes a very careful diagnostic assessment." Without treatment, bipolar episodes usually last from several weeks to several months. Periods in between episodes, without symptoms of either mania or depression, can last weeks, months or years.

Interviewing family members or friends can be important, since patients themselves may not recognize manic or hypomanic symptoms as harmful or disordered. Eliciting a family history is also important because bipolar disorder is more common in people who have first-degree relatives (a parent or sibling) with the disorder.

To determine whether elevated or depressed moods meet the criteria for bipolar disorder, a clinician looks for these criteria:
Signs of mania:

Drastic personality changes

Excitability

Irritability

Inflated self-confidence

Extremely energetic

Grandiose/delusional thinking

Recklessness

Decreased need for sleep

Increased talkativeness

Racing thoughts

Scattered attention

Psychotic episodes, or breaks from reality

Signs of depression:

Depressed or irritable mood

Loss of interest or pleasure in things once enjoyed

Marked weight loss or gain

Decreased or increased need for sleep

Prolonged sadness

Restlessness

Lethargy

Fatigue

Feelings of hopelessness, helplessness, worthlessness

Excessive or inappropriate guilt

School avoidance

Avoids friends

Cloudy or indecisive thinking

Preoccupation with death, plans of suicide or an actual suicide attempt

Psychotic episodes - breaks from reality

These criteria describe the most severe form of the disorder, called bipolar I disorder. People may also be diagnosed with bipolar II disorder, in which less severe episodes of hypomania replace manic episodes.

One of the most concerning things about bipolar disorder is that the lifetime suicide risk is 15 times that of the general population. Factors which elevate this risk for individuals include the severity and persistence of depression and the presence of mixed episodes, which combine depressive symptoms and the activation of mania.

While medication has for many years been the first-line treatment for bipolar disorder, over the last several decades specialized forms of psychotherapy have been developed to work alongside medication. Research shows that the most effective treatment for bipolar disorder combines medication and psychotherapy.

Medication: The go-to treatment for bipolar disorder is usually a group of medications called mood stabilizers, including lithium and some drugs called anticonvulsants. Mood stabilizers are generally effective at treating manic symptoms and lowering the frequency and severity of both manic and depressive episodes. But the depression is tougher to treat than the mania, and antidepressants are sometimes added to treat bipolar depression. Given alone, antidepressants can trigger manic symptoms, so they need to be prescribed with great care.

Atypical antipsychotics are also used, especially in adolescents, Dr. Nash reports. While mood stabilizers are very effective in adults, she says, in adolescents an atypical antipsychotic is often more effective.

Many people with bipolar disorder take more than one medication and the drugs can have complex interactions, leading to significant side effects if they are not effectively monitored by an experienced clinician.

Therapy: Several forms of psychotherapy adapted for bipolar disorder have been shown to speed recovery from an acute episode of mania or depression, delay recurring episodes, decrease suicide attempts, and increase medication adherence.

"A major challenge to treatment is compliance with medication," notes Dr. Emanuele, and psychotherapy increases compliance. It also helps people make changes in their lives to avoid triggering symptoms. "Psycho-education helps people manage their lives with the disorder, and psychotherapy helps them deal with thoughts and feelings."

An NIMH-funded study of bipolar patients found that treatment with one of three psychotherapies along with medication "significantly enhance a person's chances for recovering from depression and staying healthy over the long term."

The three therapies are:

Family-focused therapy (FFT): FFT engages parents and other family members in keeping track of symptoms and improving communication and problem-solving in the home, to avoid spikes in family stress, which can lead to episodes.

Cognitive behavioral therapy (CBT): CBT focuses on helping the patient understand distortions in thinking and activity, and learn new ways of coping with the illness

Interpersonal and social rhythm therapy (IPSRT): IPSRT focuses on helping the patient stabilize daily routines and sleep/wake cycles, and solve key relationship problems, to avoid triggering an episode.

IPSRP, the most recent of these therapies, is based on the concept that a healthy person has regular social rhythms - when you get up, eat meals, go to school or work, see other people, sleep, etc. - and bipolar disorder may be caused by those rhythms being destabilized.

IPSRT focuses on helping patients reduce interpersonal stressors and disruptions to a stable lifestyle, in order to forestall new episodes of mania or depression. Patients learn to improve relationship skills and keep regular patterns of eating, socializing and sleeping.

While IPSRT was developed for adults, it has been adapted for adolescents and is especially suited to the latter, notes Ellen Frank, an expert in mood disorders treatment at the University of Pittsburgh who, with colleagues, developed the therapy. Adolescence is a particularly sensitive period for interpersonal turmoil, and adolescents are prone to chronic sleep deprivation and radical shifts in sleep patterns, she writes. "They often have very dysregulated sleep and social routines that would be especially harmful for a teenager with BD."

Contrary to earlier thinking, research shows that the course of the disorder is no different whether it develops before or after age 18, Dr. Strober reports.

Bipolar disorder is a chronic disorder, but with a combination of medications, psychotherapy, stress-management, a regular schedule and early identification of symptoms, many people live very well with the diagnosis.

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Bipolar Disorder: Why It's Often Misdiagnosed - Child Mind Institute

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Bipolar disorder often has its onset in adolescence, but the first episode is often misdiagnosed, until a pattern of manic and depressive episodes emerges.

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Overview

Bipolar disorder, also known as manic-depressive disorder, involves bouts of major depression and periods of mania-euphoria, poor judgment and extreme risk-taking activity-in an often-debilitating cycle. Onset usually occurs in adolescence or early adulthood. There are cases in children, but pediatric bipolar disorder presents differently from the adult form, with irritability and aggression the main symptoms of manic periods, rather than euphoria.

Until the revised DSM-5 came out in 2013, children who were chronically irritable and prone to severe tantrums were often diagnosed as bipolar, even though they did not experience these symptoms in the episodes characteristic of bipolar disorder, and they often did not go on to develop adult bipolar. These children are now diagnosed with disruptive mood dysregulation disorder (DMDD).

Symptoms of bipolar disorder

Signs of mania:

Drastic personality changes

Excitability

Irritability

Inflated self-confidence

Extremely energetic

Grandiose/delusional thinking

Recklessness

Decreased need for sleep

Increased talkativeness

Racing thoughts

Scattered attention

Psychotic episodes-breaks from reality

Signs of depression:

Depressed or irritable mood

Loss of interest or pleasure in things once enjoyed

Marked weight loss or gain

Decreased or increased need for sleep

Prolonged sadness

Restlessness

Lethargy

Fatigue

Feelings of hopelessness, helplessness, worthlessness

Excessive or inappropriate guilt

School avoidance

Avoids friends

Cloudy or indecisive thinking

Preoccupation with death, plans of suicide, or an actual suicide attempt

Psychotic episodes-breaks from reality

Treatment

Medication is essential to the treatment of bipolar disorder, as is the involvement of the whole family.

Pharmacological:

The first-line medication used to treat bipolar disorder is often a mood stabilizer such as lithium and various anticonvulsants, which are generally effective at treating manic symptoms and lowering the frequency and severity of both manic and depressive episodes. Other drugs may be prescribed to treat symptoms like psychosis (antipsychotics) or trouble sleeping (anti-anxiety drugs).

Many people with bipolar disorder take more than one medication and the drugs can have complex interactions, leading to significant side effects if they are not effectively monitored by an experienced clinician.

Psychotherapeutic

Bipolar is often treated with cognitive behavioral therapy in addition to medications. CBT helps children and adolescents with the disorder understand what triggers their episodes, how their thoughts influence their feelings, and how to control and manage them. Family therapy is often employed to engage parents and other family members in keeping track of symptoms and managing stress levels in the home, which can lead to episodes.

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Bipolar disorder, also known as manic-depressive disorder, involves bouts of major depression and periods of mania-euphoria, poor judgment and extreme risk-taking activity-in an often-debilitating cycle. Onset usually occurs in adolescence or early adulthood. There are cases in children, but pediatric bipolar disorder presents differently from the adult form, with irritability and aggression the main symptoms of manic periods, rather than euphoria.

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A Closer Examination of Bipolar Disorder in School-Age Children

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A Closer Examination of Bipolar Disorder in School-Age Children

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Bardick, A. D., & Bernes, K. B. (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

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American School Counselor Association. (n.d.). Appropriate and inappropriate activities for school counselors.

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Bulimia nervosa is an eating disorder characterized by out of control (aka "binge") eating offset by fasting, extreme exercise, or purging-voiding food by self-induced vomiting or other means. Kids with bulimia, unlike those with anorexia, often maintain a healthy weight-they can even be overweight-but the way they go about maintaining that weight is anything but healthy. Like anorexia, the vast majority of those diagnosed with bulimia are female, and onset is usually in adolescence.
Symptoms of bulimia nervosa:

Consuming much more in a given period than average

Having a "sense of lack of control" or "out-of-body" experience while bingeing

Compensating for the binge episode by vomiting, use of laxatives or diuretics, fasting, or excessive exercise

Having a self-image that is dominated by body weight and appearance.

Bingeing and purging that occurs on average once a week for 3 months

Bingeing and purging in secret

Signs your child might be bulimic:

Dehydration

Abnormal intake of water

Acid reflux from frequent self-induced vomiting

Scars on her fingers from vomiting

Deterioration of her teeth due to contact with stomach acids

Sore throats

Swollen glands

Sudden absences during meals

Routine trips to the bathroom right after eating

Long periods of not eating

Secretiveness around eating

Obsession with her weight and appearance

Treatment
Psychotherapy is the first line of treatment. Cognitive behavioral therapy is often used to help reduce the person's concerns about body image, help her understand what triggers her binge eating, and change unhealthy eating habits. Interpersonal therapy, which focuses on how the child's relationship with others affects her feelings and actions, is also used.

If behavioral models don't help, some antidepressants-particularly selective serotonin reuptake inhibitors or SSRIs-can help.

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Bulimia nervosa is an eating disorder characterized by out of control (aka "binge") eating offset by fasting, extreme exercise, or purging-voiding food by self-induced vomiting or other means. Kids with bulimia, unlike those with anorexia, often maintain a healthy weight-they can even be overweight-but the way they go about maintaining that weight is anything but healthy.

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All teenagers worry about their appearance. Self-esteem can be precarious during adolescence, and body consciousness comes with the territory. But if you've noticed that your child is fixated on weight, you're probably worried. So what is the difference between normal behavior and behavior that might indicate an eating disorder?

Distorted Body Image: While other people see a normal (or painfully skinny) kid, teenagers with eating disorders look into the mirror and see a different person entirely. They have a distorted perception of their own appearance, and no amount of reassurance from family and friends-all of them saying, "You're not fat"-will change that conviction.

Fixated on Appearance: Young people who develop eating disorders are extraordinarily focused on their appearance as a measure of self-worth. While other kids tend to stake their identities on their interests and accomplishments, these teenagers have their emotions, and their lives, wrapped up in thoughts of food and appearance.

Extreme Dieting: Anorexia nervosa, the most common eating disorder, is self-imposed starvation, usually by a young woman who is otherwise high-functioning. Personality types more likely to develop the disorder include athletes, perfectionists, and over-achievers. They are driven to maintain a dangerously low body weight because of a distorted self-image. Detecting anorexia can be very difficult because it typically affects high-performing kids.

Overeating: Kids with bulimia nervosa, the other most common eating disorder, indulge in periodic and usually secretive binges. Many kids with bulimia say they feel out of control during their binges and describe them as "out of body experiences." To compensate, many will purge afterward or diet strenuously. Teenagers with the disorder may be very influenced by body ideals perpetuated in media and popular culture. It can be difficult to diagnose the disorder because people with bulimia can have a normal body weight or may even be overweight.

What signs to look for

Kids with eating disorders often try to keep their unhealthy eating habits and behaviors a secret, but there are still some signs that parents might notice.

Signs of anorexia:

Losing weight unexpectedly and/or being dangerously thin (Despite their extreme thinness, kids with anorexia usually don't think that they are unhealthy and actually want to lose even more weight.)

Obsessing over calorie counts, nutritional facts, and diets

Spending many hours exercising to burn off calories

Skipping meals

Avoiding eating socially

Irregular periods, thinning hair, and constant exhaustion

Signs of bulimia:

Exercising excessively or using diet pills or laxatives

Going to the bathroom immediately after meals

Spending a lot of time in the bathroom

Having a sore throat, sore knuckles, discolored teeth, and poor enamel

Hoarding food in her room

Having large amounts of food that go missing at home

What can parents do?

Try to establish healthy eating habits. Make a routine of eating healthy, balanced meals as a family.

Discuss foods in terms of how healthy they are, not how "good" or "bad" they are.

Don't criticize your child's weight or appearance. Adolescence is a difficult time for most kids, and it's essential to provide them with a nurturing and supportive environment.

Some kids are more likely than others to develop eating disorders. Be extra vigilant if you have a family history of eating disorders or if you know that your child is under extreme pressure to look a certain way.

Eating disorders in children are very serious and can be deadly. If you think your child has an eating disorder, you should contact a doctor for help immediately.

Related: Eating Disorders in College Students
Eating Disorders: Why Are Girls More Affected?

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All teenagers worry about their appearance. Self-esteem can be precarious during adolescence, and body consciousness comes with the territory. But if you've noticed that your child is fixated on weight, you're probably worried. So what is the difference between normal behavior and behavior that might indicate an eating disorder?

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Anorexia nervosa is an eating disorder characterized by severe weight loss, a dangerously low body weight, and a distorted body image that drives an otherwise high-functioning person-usually a young woman-to starve herself. People with anorexia may keep themselves underweight by eating sparsely or through purging-by induced vomiting, laxative use, etc.-and exercising intensely, often without recognizing that their actions are unhealthy or that their perceptions of their bodies are not normal.
Symptoms:

Rejection of a healthy amount of food

Dramatic dieting

Compulsive exercise

A gross overvaluing of shape and weight as components of her identity

Extreme weight loss, abnormal thinness, brittle nails, hair loss, constipation, irregular menstruation, and swelling

Distorted body image-what the child sees in the mirror as unacceptably fat is, to anyone else, disturbingly thin

Treatment:
The first goal of any treatment is to restore your child to a healthy weight, and she should be immediately hospitalized for this purpose if she is in any medical danger.

Psychotherapy: The most successful treatments include cognitive behavioral therapy and family therapy to identify family patterns that may be contributing to the eating disorder.

Treatment is more effective when the disorder is caught early, and the longer a child stays at a healthy weight, the less likely she is to relapse.

Pharmacological: Some drugs, particularly antidepressants, have proven helpful, but they are most often targeted at another condition the child might also have, such as depression or obsessive-compulsive disorder. Treating the co-occurring disorder can make the therapy for anorexia more successful.

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Anorexia nervosa is an eating disorder characterized by severe weight loss, a dangerously low body weight, and a distorted body image that drives an otherwise high-functioning person-usually a young woman-to starve herself.

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Centers for Disease Control and Prevention

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Being mentally healthy during childhood means reaching developmental and emotional milestones and learning healthy social skills and how to cope when there are problems. Mentally healthy children have a positive quality of life and can function well at home, in school, and in their communities.

Mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions, which cause distress and problems getting through the day. Many children occasionally experience fears and worries or display disruptive behaviors. If symptoms are serious and persistent and interfere with school, home, or play activities, the child may be diagnosed with a mental disorder.

Mental health is not simply the absence of a mental disorder. Children who don't have a mental disorder might differ in how well they are doing, and children who have the same diagnosed mental disorder might differ in their strengths and weaknesses in how they are developing and coping, and in their quality of life. Mental health as a continuum and the identification of specific mental disorders are both ways to understand how well children are doing.

What are common childhood mental disorders?

Among the more common mental disorders that can be diagnosed in childhood are attention-deficit/hyperactivity disorder (ADHD), anxiety (fears or worries), and behavior disorders.

Learn more about childhood mental disorders, symptoms, and treatment.

Other childhood disorders and concerns that affect how children learn, behave, or handle their emotions can include learning and developmental disabilities, autism, and risk factors like substance use and self-harm.

Read more about related conditions.

What are the symptoms of childhood mental disorders?

Symptoms of mental disorders change over time as a child grows, and may include difficulties with how a child plays, learns, speaks, and acts, or how the child handles their emotions. Symptoms often start in early childhood, although some disorders may develop during the teenage years. The diagnosis is often made in the school years and sometimes earlier; however, some children with a mental disorder may not be recognized or diagnosed as having one.

Can childhood mental disorders be treated?

Childhood mental disorders can be treated and managed. There are many treatment options based on the best and most current medical evidence. Parents and doctors should work closely with everyone involved in the child's treatment-teachers, coaches, therapists, and other family members. Taking advantage of all the resources available will help parents, health professionals, and educators guide the child towards success. Early diagnosis and appropriate services for children and their families can make a difference in the lives of children with mental disorders.

Get help finding treatment

If you have concerns about a child, you can use these resources to help you find a healthcare provider familiar with treatment options.

Who is affected?

Childhood mental disorders affect many children and families. Boys and girls of all ages and ethnic/racial backgrounds and living in all regions of the United States experience mental disorders. Based on the National Research Council and Institute of Medicine report, which gathered findings from previous studies, it is estimated that in 2007, 13-20% of children living in the United States (up to 1 out of 5 children) experienced a mental disorder in a given year, costing individuals, families, and society an estimated $247 billion per year.

What is the impact of mental disorders in children?

Mental health is important to overall health. Mental disorders are chronic health conditions-conditions that last a long time and often don't go away completely-that can continue through the lifespan. Without early diagnosis and treatment, children with mental disorders can have problems at home, in school, and in forming friendships. Mental disorders can also interfere with a child's healthy development, causing problems that can continue into adulthood.

Public health includes mental health

Supporting children's mental health also includes making sure children meet developmental milestones, understanding what to do when there is a concern, supporting positive parenting strategies, and improving access to care.

CDC works with partner agencies to better understand mental health and mental disorders and the impact they have on children.
Read more about research on children's mental health.
What you can do

Parents: You know your child best. Talk to your child's healthcare professional if you have concerns about the way your child behaves at home, in school, or with friends.

Youth: It is just as important to take care of your mental health as it is to take care of your physical health. If you are angry, worried or sad, don't be afraid to talk about your feelings and reach out to a trusted friend or adult.

Healthcare professionals: Early diagnosis and appropriate treatment based on updated guidelines are very important. There are resources available to help diagnose and treat children's mental disorders.

Teachers/school administrators: Early identification is important so that children can get the help they need. Work with families and healthcare professionals if you have concerns about the mental health of a child in your school.

Resources

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Learn more about mental health, mental disorders, treatments, prevention, and public health research on children's mental health.

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This link defines emotional disturbance according to IDEA and takes a look at different types of disorders.

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Links updated, November 2021
This information in Spanish

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

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

anxiety disorders;

bipolar disorder (sometimes called manic-depression);

conduct disorders;

eating disorders;

obsessive-compulsive disorder (OCD); and

psychotic disorders.

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

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

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

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

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

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

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

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

Characteristics

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

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

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

Hyperactivity (short attention span, impulsiveness);

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

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

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

Learning difficulties (academically performing below grade level).

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

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

Causes

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

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

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

Frequency

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

Help for School-Aged Children

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

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

A Look at Specific Emotional Disturbances

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

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

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

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

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

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

Conduct Disorder

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

aggression to people and animals;

destruction of property;

deceitfulness, lying, or stealing; or

truancy or other serious violations of rules. (15)

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

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

family therapy;

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

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

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

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

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

According to the National Eating Disorders Association:

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

Obsessive-Compulsive Disorder

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

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

therapist trained in behavior therapy;

Cognitive Behavior Therapy (CBT);

medication (usually an antidepressant). (23)

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

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

More about School

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

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

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

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

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

Other Considerations

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

The Importance of Support

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

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

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

Resources of More Information

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

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

Anxiety Disorders

Autism

Bipolar Disorder

Conduct Disorder

Depression

Oppositional Defiant Disorder

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

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

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

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

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

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

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

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

National Eating Disorders Association
1.800.931.2237 | www.nationaleatingdisorders.org

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

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

References

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

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

5 | Ibid.

7 | Ibid.

11 | Ibid.

13 | Ibid.

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

15 | Ibid.

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

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

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It is usually expected that all children will experience some fear or anxiety from time to time.

New situations, challenging tasks, and even unfamiliar people can all lead to some anxiety in most children.

Other age-appropriate fears include:

stranger anxiety beginning at 7 to 9 months of age

fear of the dark, monsters, insects, and animals in preschoolers

fear of heights or storms in younger school-age children

worry about school and friends in older school-age children and teens

It takes a little more than occasional anxiety, which can be normal, to indicate true symptoms of an anxiety disorder, though.

As much as it is common to have occasional anxiety, it is also common for children to have anxiety disorders. In fact, anxiety disorders are more common than ADHD or childhood depression and are the most common psychiatric disorders in children.

Children with true anxiety symptoms have them on most days and they can include:

restlessness

fatigue

trouble concentrating

irritability

muscle tension

trouble sleeping (insomnia)

As part of a diagnosis of a generalized anxiety disorder (GAD), a child should have one of these symptoms for six months or more, and they should be triggered by more than one thing, such as being anxious about work, school, and friends.

Also, a child with a generalized anxiety disorder will have trouble controlling her feelings of worry and it will cause her distress and some kind of impairment. For example, she may be so irritable from not sleeping that she is having trouble keeping her friends or her grades are dropping because she can't concentrate.

Children with generalized anxiety disorder may also have somatic symptoms, such as headaches, abdominal pain, and muscle aches and pains.

In addition to a generalized anxiety disorder, children can have more specific phobias.​

They become anxious and worried, but only after very specific triggers, such as a thunderstorm, spiders, being left alone, or going in a swimming pool, etc. Although these children may cry and may cling to their parents if they are around or think they will be around something they are really afraid of, fortunately, most kids outgrow this type of anxiety disorder.

Like adults, children can also have other anxiety disorders, which range from separation anxiety and obsessive-compulsive disorder (OCD) to panic attacks.

While symptoms of separation anxiety are typically easy to recognize, a child who refuses to go to school, sleep alone, or go anywhere without a parent, other anxiety disorders can be a little harder to detect.

Children with OCD, for example, may have either recurrent consuming thoughts or impulses (obsessions) about certain things or repetitive behaviors or mental acts (compulsions) that they perform, such as washing their hands a lot, checking things over and over, or repeating certain words or phrases to themselves.

Although uncommon in children, panic attacks are another type of anxiety disorder that does become more common in later teen years. In addition to intense fear or discomfort, children having a panic attack should have four or more of the following symptoms:

palpitations or a fast heart rate

sweating

shaking

feeling short of breath

feeling choked

chest pain

nausea or abdominal pain

dizziness

numbness or tingling (paresthesias)

chills or hot flashes

fear of losing control

a feeling of unreality (derealization) or being detached from oneself (depersonalization)

Of all of the anxiety disorders in children, selective mutism is perhaps the one that is most commonly overlooked, as people think these children are just extremely shy. Children with selective mutism actually refuse to talk though and may only talk to close family members at home. At school or in other situations, they often become anxious and very uncomfortable when they are expected to talk.

Your pediatrician, a child psychologist, and/or a child psychiatrist can be helpful if your child has persistent anxiety symptoms.

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Common Childhood Anxiety Symptoms All Parents Should Know About

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It is usually expected that all children will experience some fear or anxiety from time to time. New situations, challenging tasks, and even unfamiliar people can all lead to some anxiety in most children.

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When children struggle with anxiety disorders, they can experience distress and dysfunction in every sphere of life. Despite potential to achieve in school and the desire to form strong, rewarding relationships with family and friends, their symptoms can interfere with their abilities, needs and dreams.

The Child Mind Institute's Anxiety Disorders Center specializes in the diagnosis and treatment of the full range of anxiety disorders and our clinicians feel comfortable treating the most difficult cases.

Conditions we treat include:

Agoraphobia

Body Dysmorphic Disorder

Generalized Anxiety Disorder

Illness Anxiety Disorder

Obsessive-Compulsive Disorder

Panic Disorder

Post-Traumatic Stress Disorder (PTSD)

Selective Mutism

Separation Anxiety Disorder

Social Anxiety Disorder

Specific Phobias

Tic Disorders (including chronic motor tic and chronic vocal tic disorders)

Tourette's Disorder

Trichotillomania, Skin Picking and Enuresis

We can often help families who have struggled to find effective treatment in the past. Our goal is to empower both children and their families to understand and overcome struggles with anxiety.

When medication may be helpful, our team works with board-certified child and adolescent psychiatrists at the Child Mind Institute or collaborates with your physician. Our psychiatrists offer expert consultation on whether medication can improve treatment outcome, and provide ongoing medication management when requested.

Treatments we provide:

Amanda G. Mintzer, PsyD

Child Mind Institute

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When children struggle with anxiety disorders, they can experience distress and dysfunction in every sphere of life. Despite potential to achieve in school and the desire to form strong, rewarding relationships with family and friends, their symptoms can interfere with their abilities, needs and dreams. The Child Mind Institute's Anxiety Disorders Center specializes in the diagnosis and treatment of the full range of anxiety disorders and our clinicians feel comfortable treating the most difficult cases.

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If you are feeling shyer than you'd like to be, you're in good company. A lot of kids - and adults - say they get anxious during social situations. Maybe it's speaking up in class or making a phone call or just trying something new. Whatever it is, if your anxiety is bothering you, there are some things you can try on your own to help with managing social anxiety.

Don't avoid things

Experts agree that avoiding situations that make us anxious can actually make things worse in the long run. "Getting out of something you didn't want to do might make you feel better in the moment," says Rachel Busman, PsyD, a psychologist, "but you will still feel anxious the next time you're asked to do it." And the things that make us anxious-talking to new people, giving presentations-aren't going to go away.

Push yourself

While leaving your comfort zone isn't easy, it can be very good for you. That's because our anxiety tends to go away when we start doing the things that make us anxious. So when a situation comes up that makes you nervous, like walking into the cafeteria alone or asking someone to be your lab partner, try to face your fear and see what happens. "Chances are the worst outcome that you fear won't happen," says Dr. Busman. "And if it does, you might find you have the skills to handle it."

As an experiment, try doing something that makes you nervous. It's fine to start small and ease yourself into it. Picking goals that feel realistic to you is important-you don't need to run for class president. If you think you might like to join a club, try just sitting in on a meeting at first. Or if you'd like to volunteer at the local animal shelter but you're feeling nervous about it, start by bringing a friend or family member along for company.

Whatever you do, you'll find that it gets easier over time. That's because by practicing the things that make you nervous you are actually expanding your ability to handle them. This is true even when things don't work out exactly like you might hope. For example, a lot of kids hesitate to ask teachers questions because they worry they're already supposed to know the answer. But if you decide to ask your teacher anyway and he responds, "You already learned that so go ask a friend," you'll probably find that hearing that isn't such a big deal after all. It's just another kind of practice.

Doing things like yoga and exercising can also help you regulate anxiety. Conversely, caffeine can make people feel more anxious, so you might want to cut back on soda and coffee in general, and especially before doing things that make you anxious. That can help with managing social anxiety.

But if you're feeling really anxious, and doing these things feels impossible for you, Dr. Busman says it's always a good idea to talk to your parents. "Tell them how you're feeling. Anxiety is something that you can definitely get help for, but telling someone that you need it is the first step."

This article was last reviewed or updated on April 7, 2023.

Rachel Ehmke is a freelance writer and the former managing editor at the Child Mind Institute. She holds a BA ... Read Bio

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Tips for Managing Social Anxiety - Child Mind Institute

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Kids with so much social anxiety that they're unable to do a lot of things they'd like to do should definitely talk to their parents about getting help.

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Paylo, M. J., Tahani, D., Kress, V. E. (2015). Treating anxiety disorders in youth. American Counseling Association Practice Briefs.

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How to Help a Child With an Anxiety Disorder 

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How to Help a Child With an Anxiety Disorder 

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

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By

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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How to Help a Child With an Anxiety Disorder

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

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Inside Higher Ed | Higher Education News, Events and Jobs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Students who suffer from Emotional and Behavioral Disorders, or EBD, often find it very difficult to control their behavior and focus on their work in the classroom. EBD students also commonly lack the impulse control and the emotional balance that is necessary to handle social interactions with other students effectively.

This can be challenging for you as their teacher, especially in an inclusive classroom where only a portion of the students have EBD-but there are ways to help all students in your classroom feel welcomed and ready to learn. EBD students' behavior can be moderated by implementing a classroom management plan that is specially tailored to meet the specific needs of these students.

Here are five effective strategies you can use to help EBD kids work well in an inclusive classroom.

1. Keep class rules/activities simple and clear

Your EBD students (as well as some of your more focused students) will most likely struggle if you impose a long list of complicated rules and demands. Try to keep your classroom guidelines broad and simple-no more than 3 to 5 main rules. Let students know about them on the first day of class, and post them in the classroom as well. An example list might be:

Along with simple and clear rules, there should be simple and clear teaching activities. Using activities that don't have complicated directions allow students with EBD to follow along and interact with the rest of the class. Some activity examples are:

By including clear activities in your classroom, your students will engage and interact with the lesson plan, ensuring that they learn alongside other students.

2. Reward positive behaviors

While you will, at times, have to discipline children for improper behavior, remember that rewarding positive behavior is ultimately far more effective in the long run. Many students with Emotional and Behavioral Disorder tend to take any discipline as a personal attack, and because of this, they often learn very little from it.

Try to celebrate the successes of these students more than you reprimand or punish their mistakes. When they receive positive feedback and rewards, they start to see that there is a positive benefit to good behavior. They will then start to see you as more of an ally than an adversary, and this will in turn motivate them to want to behave and do well in your classroom.

3. Allow for mini-breaks

A lot of EBD kids lack the emotional balance and maturity needed to remain focused and on-task for long periods. Instead of reprimanding these students for their lapses, build in short rest periods or mini-breaks into the school day.

Take time to periodically stop teaching and allow students to catch up if need be. Give them time to finish their assignment, and allow those who have finished to stretch, get out of their seats, and move around a bit. This will allow them to burn off any excess energy that might have built up from sitting still for a long period of time. (And it's good time for you to stretch, too!)

4. Fair treatment for all

Students with Emotional and Behavioral Disorders also often don't respond very well to situations that appear unfair to them. This can trigger a cascade of negative emotions and acting-out behavior.

To ensure that you are treating all of your students in a consistently fair manner, don't bend your established rules for any student. Enforce the expected consequences every time, with every student. Allowing exceptions opens you up to accusations of being unfair.

5. Use motivational strategies

Unfortunately, Emotional and Behavioral Disorder students tend to have had a lot of negative experiences in school. Therefore they often lack the desire or motivation to try to succeed.

To avoid disruptive or off-task behaviors, take some extra steps to motivate these students. Offer them incentives for academic successes, large and small. Celebrate their hard work, and praise their good efforts consistently. This can go a long way in giving these students the motivation to excel in your class.

While having EBD kids in your classroom can at first seem daunting, these are proven ways to help cultivate and keep a harmonious spirit of learning. More good news: many of these strategies for success can help your non-EBD students as well.

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Tips for Handling Emotional Behavior Disorder in Classrooms | Resilient Educator

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Emotional Behavior Disorder (EBD) can hinder classwork. With these tips, teachers can learn ways to help students learn at their own speed!

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Mindfulness for Students with Emotional/Behavioral Disorder

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Mindfulness for Students with Emotional/Behavioral Disorder

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Malow, M. S., & Austin, V. L. (2016). Mindfulness for students classified with emotional/behavioral disorder. Insights into Learning Disabilities, 13(1), 81–93.

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Mindfulness for Students with Emotional Behavioral Disorder

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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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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.

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ASCA School Counselor Professional Standards & Competencies

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ASCA School Counselor Professional Standards & Competencies

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Characteristics of Students with Emotional Disturbance Manifesting Internalizing Behaviors: A Latent Class Analysis

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Characteristics of Students with Emotional Disturbance Manifesting Internalizing Behaviors: A Latent Class Analysis

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Gage, N. A. (2013). Characteristics of students with emotional disturbance manifesting internalizing behaviors: A latent class analysis. education and treatment of children, 36(4), 127–145.

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Characteristics of Students with Emotional Disturbance Manifesting Internalizing Behaviors

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Suffering in Silence- Examining OCD in School Setting