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https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961

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Overview

Experiencing occasional anxiety is a normal part of life. However, people with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).

These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time. You may avoid places or situations to prevent these feelings. Symptoms may start during childhood or the teen years and continue into adulthood.

Examples of anxiety disorders include generalized anxiety disorder, social anxiety disorder (social phobia), specific phobias and separation anxiety disorder. You can have more than one anxiety disorder. Sometimes anxiety results from a medical condition that needs treatment.

Whatever form of anxiety you have, treatment can help.

Symptoms

Common anxiety signs and symptoms include:

Feeling nervous, restless or tense

Having a sense of impending danger, panic or doom

Having an increased heart rate

Breathing rapidly (hyperventilation)

Sweating

Trembling

Feeling weak or tired

Trouble concentrating or thinking about anything other than the present worry

Having trouble sleeping

Experiencing gastrointestinal (GI) problems

Having difficulty controlling worry

Having the urge to avoid things that trigger anxiety

Several types of anxiety disorders exist:

Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed.

Anxiety disorder due to a medical condition includes symptoms of intense anxiety or panic that are directly caused by a physical health problem.

Generalized anxiety disorder includes persistent and excessive anxiety and worry about activities or events - even ordinary, routine issues. The worry is out of proportion to the actual circumstance, is difficult to control and affects how you feel physically. It often occurs along with other anxiety disorders or depression.

Panic disorder involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). You may have feelings of impending doom, shortness of breath, chest pain, or a rapid, fluttering or pounding heart (heart palpitations). These panic attacks may lead to worrying about them happening again or avoiding situations in which they've occurred.

Selective mutism is a consistent failure of children to speak in certain situations, such as school, even when they can speak in other situations, such as at home with close family members. This can interfere with school, work and social functioning.

Separation anxiety disorder is a childhood disorder characterized by anxiety that's excessive for the child's developmental level and related to separation from parents or others who have parental roles.

Social anxiety disorder (social phobia) involves high levels of anxiety, fear and avoidance of social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others.

Specific phobias are characterized by major anxiety when you're exposed to a specific object or situation and a desire to avoid it. Phobias provoke panic attacks in some people.

Substance-induced anxiety disorder is characterized by symptoms of intense anxiety or panic that are a direct result of misusing drugs, taking medications, being exposed to a toxic substance or withdrawal from drugs.

Other specified anxiety disorder and unspecified anxiety disorder are terms for anxiety or phobias that don't meet the exact criteria for any other anxiety disorders but are significant enough to be distressing and disruptive.

When to see a doctor

See your doctor if:

You feel like you're worrying too much and it's interfering with your work, relationships or other parts of your life

Your fear, worry or anxiety is upsetting to you and difficult to control

You feel depressed, have trouble with alcohol or drug use, or have other mental health concerns along with anxiety

You think your anxiety could be linked to a physical health problem

You have suicidal thoughts or behaviors - if this is the case, seek emergency treatment immediately

Your worries may not go away on their own, and they may get worse over time if you don't seek help. See your doctor or a mental health provider before your anxiety gets worse. It's easier to treat if you get help early.

Causes

The causes of anxiety disorders aren't fully understood. Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to anxiety. Inherited traits also can be a factor.

Medical causes

For some people, anxiety may be linked to an underlying health issue. In some cases, anxiety signs and symptoms are the first indicators of a medical illness. If your doctor suspects your anxiety may have a medical cause, he or she may order tests to look for signs of a problem.

Examples of medical problems that can be linked to anxiety include:

Heart disease

Diabetes

Thyroid problems, such as hyperthyroidism

Respiratory disorders, such as chronic obstructive pulmonary disease (COPD) and asthma

Drug misuse or withdrawal

Withdrawal from alcohol, anti-anxiety medications (benzodiazepines) or other medications

Chronic pain or irritable bowel syndrome

Rare tumors that produce certain fight-or-flight hormones

Sometimes anxiety can be a side effect of certain medications.

It's possible that your anxiety may be due to an underlying medical condition if:

You don't have any blood relatives (such as a parent or sibling) with an anxiety disorder

You didn't have an anxiety disorder as a child

You don't avoid certain things or situations because of anxiety

You have a sudden occurrence of anxiety that seems unrelated to life events and you didn't have a previous history of anxiety

Risk factors

These factors may increase your risk of developing an anxiety disorder:

Trauma. Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders.

Stress due to an illness. Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future.

Stress buildup. A big event or a buildup of smaller stressful life situations may trigger excessive anxiety - for example, a death in the family, work stress or ongoing worry about finances.

Personality. People with certain personality types are more prone to anxiety disorders than others are.

Other mental health disorders. People with other mental health disorders, such as depression, often also have an anxiety disorder.

Having blood relatives with an anxiety disorder. Anxiety disorders can run in families.

Drugs or alcohol. Drug or alcohol use or misuse or withdrawal can cause or worsen anxiety.

Complications

Having an anxiety disorder does more than make you worry. It can also lead to, or worsen, other mental and physical conditions, such as:

Depression (which often occurs with an anxiety disorder) or other mental health disorders

Substance misuse

Trouble sleeping (insomnia)

Digestive or bowel problems

Headaches and chronic pain

Social isolation

Problems functioning at school or work

Poor quality of life

Suicide

Prevention

There's no way to predict for certain what will cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of symptoms if you're anxious:

Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.

Stay active. Participate in activities that you enjoy and that make you feel good about yourself. Enjoy social interaction and caring relationships, which can lessen your worries.

Avoid alcohol or drug use. Alcohol and drug use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your doctor or find a support group to help you.

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Learn the symptoms of this mental health condition, and ways to manage worry and fear that interfere with your daily activities.

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https://www.psycom.net/social-anxiety-how-to-help-kids

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Psycom.net - Mental Health Treatment Resource Since 1986

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Social anxiety disorder (social phobia) isn't simply a fear of making or interacting with friends. It's actually characterized by an intense fear of social situations in which the child might be judged or scrutinized by others.

Children with social anxiety disorder experience intense feelings of anxiety about a number of different triggers including speaking in front of others, reading out loud, fear about being evaluated by others, fear of offending others, fear of embarrassment, and fear conversing with unfamiliar individuals. Children with social anxiety disorder worry in a lot of social situations (school, teams, play dates, enrichment classes, and even family reunions.)

Social anxiety disorder can cause significant distress for children and has a negative effect on academic performance, social relationships, self-confidence, and other areas of functioning. Children with social anxiety disorder are likely to avoid engaging in things like sports or other group activities with their peers for fear of negative scrutiny or embarrassment.

Parents can help children with social anxiety disorder by understanding the nature of the disease and teaching them how to cope with their symptoms.

Article continues below

Symptoms of social anxiety disorder

The median age at onset of social anxiety disorder is 13 years, and 75% have an age at onset between 8 and 15 years. The disorder can emerge out of a childhood history of social inhibition or shyness but can also be triggered by a traumatic experience, including bullying. ¹ Approximately 15 million Americans suffer from social anxiety disorder. ²

The defining feature of social anxiety disorder includes marked fear or anxiety about one or more social situations in which the person might be subject to possible scrutiny by others. Examples include social interactions, being observed by others, and performing in front of others. ³

Other symptoms of social anxiety disorder include the following:

The person feels that he or she will act in a way or show anxiety symptoms that will be negatively evaluated

The social situations always trigger fear or anxiety (in children this can manifest as tantrums, clinging, crying, freezing up, or failure to speak)

Social situations are avoided or endured with intense feelings of fear and anxiety

The fear or anxiety is out of proportion to the actual threat

The fear, anxiety, and avoidance lasts for 6 months or more

Causes clinically significant distress in social, occupational (school), or other areas of functioning

Dread of social events that can occur weeks in advance

Excessive clinging to familiar people

Tantrums when faced with anxiety provoking social situations

Blaming others for perceived social failures

Physical symptoms: Blushing, racing heart, shaky voice, trembling, nausea, difficulty speaking

How to help your child cope with social anxiety disorder

The best first step to help your child cope with it is to name it. Children with social anxiety disorder know that they feel fearful and anxious in social situations, but they don't always know why. Helping them connect the dots between emotional responses, physical symptoms, and triggers is an important first step toward learning to cope. Educating your child about the ways in which anxiety impacts thinking and behavior is a powerful lesson in learning to work through negative emotions.

- Teach relaxation strategies

Kids need to learn a variety of tools to use when feeling anxious and overwhelmed. It's nearly impossible to use adaptive coping strategies when you're dealing with intense physical symptoms of anxiety, so the first step is with work on learning to calm the anxious response.

Deep breathing is the best way to calm rapid heart rate, shallow breathing and feeling dizzy. Teach your child to visualize blowing up a balloon while engaging the diaphragm in deep breathing. Count your child out to help slow the breathing (4 in, 4 hold, 4 out).

Guided imagery: Your child can take a relaxing adventure in her mind while engaging in deep breathing. Tell a quick story in a low and even voice to help your child find her center.

Progressive muscle relaxation: Anxious kids tend to tense their muscles when they're under stress. Teach your child to relax her muscles and release tension beginning with her hands and arms. Make a fist and hold it tight for five seconds, then slowly release. Move on to the arms, neck and shoulders, and feet and legs.

- Teach cognitive reframing

Kids with social anxiety disorder are often overwhelmed by negative beliefs that reinforce their anxious thoughts. Their beliefs tend to fall into the following categories:

Assuming the worst case scenario

Believing that others see them through a negative lens

Overreacting

Personalizing

Teach your child to recognize negative thoughts and replace them with positive ones. If your child tends to say things like, "My teacher thinks I'm stupid because I'm bad at reading," help him recognize the negative thought, ground it in reality (a teacher's job is to help kids learn not judge them on what they already know), and replace it with a positive thought ("I'm having a hard time reading but my teacher will help me get better.")

- Teach problem-solving skills

Children with social anxiety disorders tend to become masters of avoidance. They do what they can to avoid engaging in situations that cause the most anxiety. While this might seem like the path of least resistance, it can actually make the social anxiety worse over time.

Teach your child to work through feelings of fear and anxiety by developing problem-solving skills. If a child fears public speaking, for example, she can learn to practice several times at home in front of a mirror, have someone videotape her and watch it back, find the friendly face in the room and make eye contact, and use deep breathing to calm anxious feelings.

Help your child identify her triggers and brainstorm potential problem-solving strategies to work through those triggers.

- Work on friendship skills

While you can't make friends for your child, you can help your child practice friendship skills. Practice these skills using role play and modeling to help your child feel at ease with peers:

Greetings

Sliding in and out of groups

Conversation starters

Listening and responding

Asking follow up questions/making follow up statements

Seek professional help

If social anxiety disorder negatively affects your child's ability to attend school, socialize with peers in or out of school, or affects other areas of functioning, it's time to seek an evaluation from a licensed mental health professional. The good news is that social anxiety disorder is very treatable and kids can learn to cope with their symptoms and implement strategies that work across a wide variety of settings.

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Social Anxiety In Kids: Help Them Cope With Symptoms

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Social anxiety disorder (social phobia) isn't simply a fear of making or interacting with friends. It's actually characterized by an intense fear of social situations in which the child might be judged or scrutinized by others.

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Accommodations for Students with Anxiety

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Accommodations for Students with Anxiety

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https://www.understood.org/en/articles/at-a-glance-classroom-accommodations-for-anxiety

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It's not uncommon for students who learn and think differently to also struggle with anxiety. They might worry a lot or be withdrawn at school. They may hesitate to participate in the classroom, make frequent trips to the bathroom or the nurse's office, or even refuse to go to school at all. All of this can get in the way of learning.

What are some classroom accommodations for kids with anxiety? Here are strategies teachers can try.

Providing emotional support

Encourage the student to use self-calming or anxiety-reducing techniques that were taught by a counselor or therapist.

Allow the student to have a self-calming object or family pictures on hand.

Build in "call home" breaks (for students with separation anxiety).

Let the student seek help from a designated staff member with mental health expertise when feeling anxious.

Classroom setup, schedules, and routines

Provide classroom seating where the student is most comfortable (near a door, near the front of the room, near the teacher or a friend).

Let the student sit near the back of the room or by an exit during assemblies.

Assign the student a designated buddy for lunchtime, recess, and/or hallways.

Allow preferential grouping for field trips so the student is with a teacher or friends.

Provide a "take a break pass" to let the student walk down the hallway, get a drink, or leave the classroom when needed.

Create a plan for catching up after an absence or illness (for example, excusing missed homework or having a known time frame for making up work).

Give advance notice of planned substitute teachers or other changes in routine.

Give the student notice and extra time before upcoming transitions, like before recess and lunch, and rehearse transitions in a private or low-stress environment.

Giving instructions and assignments

Clearly state and/or write down classroom expectations and consequences.

Break down assignments into smaller chunks.

Check in frequently for understanding and "emotional temperature."

Provide a signal before calling on the student and a signal for the student to opt out of answering.

Offer written instructions in addition to spoken directions.

Exempt the student from reading aloud or demonstrating work in front of the class.

Let the student present projects to the teacher instead of to the entire class.

Introducing new concepts/lessons

Give extended time on tests and/or separate test-taking space to reduce performance anxiety.

Allow use of word banks, cheat sheets, or fact cards for tests (for students who freeze or "go blank" during in-class tests).

Set time limits for homework or reduce the amount of homework.

Assure that work not completed in that time won't count against the student.

Provide class notes via email or a school portal for the student to preview.

Give notice of upcoming tests (no "pop quizzes").

When students are being treated for anxiety, it's crucial for all of the people working with them to be in contact with their mental health providers about using school strategies like these. Together, you can all ensure the accommodations are a good fit for the student.

About the author

About the author

Amanda Morin is the author of "The Everything Parent's Guide to Special Education" and the former director of thought leadership at Understood. As an expert and writer, she helped build Understood from its earliest days.

Reviewed by

Reviewed by

Jerome Schultz, PhD is a clinical neuropsychologist and lecturer in the Harvard Medical School Department of Child Psychiatry.

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Accommodations for Students With Anxiety Disorders

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It's not uncommon for students who learn and think differently to also struggle with anxiety. They might worry a lot or be withdrawn at school. They may hesitate to participate in the classroom, make frequent trips to the bathroom or the nurse's office, or even refuse to go to school at all.

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https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Panic-Disorder-In-Children-And-Adolescents-050.aspx

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Panic Disorder In Children And Adolescents

Panic disorder is a common and treatable disorder. Children and adolescents with panic disorder have unexpected and repeated periods of intense fear or discomfort, along with other symptoms such as a racing heartbeat or feeling short of breath. These periods are called "panic attacks" and last minutes to hours. Panic attacks frequently develop without warning.

Symptoms of a panic attack include:

Intense fearfulness (a sense that something terrible is happening)

Racing or pounding heartbeat

Dizziness or lightheadedness

Shortness of breath or a feeling of being smothered

Trembling or shaking

Sense of unreality

Fear of dying, losing control, or losing your mind

More than 3 million Americans will experience panic disorder during their lifetime. Panic disorder often begins during adolescence, although it may start during childhood, and sometimes runs in families.

If not recognized and treated, panic disorder and its complications can be devastating. Panic attacks can interfere with a child's or adolescent's relationships, schoolwork, and normal development. Attacks can lead to not just severe anxiety, but can also affect other parts of a child's mood or functioning. Children and adolescents with panic disorder may begin to feel anxious most of the time, even when they are not having panic attacks. Some begin to avoid situations where they fear a panic attack may occur, or situations where help may not be available. For example, a child may be reluctant to go to school or be separated from his or her parents. In severe cases, the child or adolescent may be afraid to leave home. As with other anxiety disorders, this pattern of avoiding certain places or situations is called "agoraphobia." Some children and adolescents with panic disorder can develop severe depression and may be at risk of suicidal behavior. As an attempt to decrease anxiety, some adolescents with panic disorder will use alcohol or drugs.

Panic disorder in children can be difficult to diagnose. This can lead to many visits to physicians and multiple medical tests that are expensive and potentially painful. When properly evaluated and diagnosed, panic disorder usually responds well to treatment. Children and adolescents with symptoms of panic attacks should first be evaluated by their family physician or pediatrician. If no other physical illness or condition is found as a cause for the symptoms, a comprehensive evaluation by a child and adolescent psychiatrist should be obtained.

Several types of treatment are effective. Specific medications may stop panic attacks. Psychotherapy may also help the child and family learn ways to reduce stress or conflict that could otherwise cause a panic attack. With techniques taught in "cognitive behavioral therapy," the child may also learn new ways to control anxiety or panic attacks when they occur. Many children and adolescents with panic disorder respond well to the combination of medication and psychotherapy. With treatment, the panic attacks can usually be stopped. Early treatment can prevent the complications of panic disorder such as agoraphobia, depression and substance abuse.

For more information about panic disorder, visit the National Institute of Mental Health's website at www.nimh.nih.gov or call 1-800-64-PANIC.

See also: The Freedom from Fear's website www.freedomfromfear.org.

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Panic Disorder In Children And Adolescents

# data[].attributes.attachment_link.description
Panic Disorder In Children And Adolescents Panic disorder is a common and treatable disorder. Children and adolescents with panic disorder have unexpected and repeated periods of intense fear or discomfort, along with other symptoms such as a racing heartbeat or feeling short of breath. These periods are called "panic attacks" and last minutes to hours.

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https://www.hopkinsmedicine.org/health/conditions-and-diseases/obsessivecompulsive-disorder-ocd

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https://iocdf.org/about-ocd/

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What is OCD? | International OCD Foundation

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Obsessive compulsive disorder (OCD) is a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings.…

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https://anxietyintheclassroom.org/school-system/profession-specific-resources/teachers-classroom-accommodations-ocd-anxiety/

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Classroom Accommodations for Teachers | Anxiety In The Classroom

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Classroom accommodations can help teachers and students with anxiety/OCD keep their studies on track as they work to manage their disorder(s). Find out which accommodations might be most useful for your student.

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https://friscomentalcare.com/

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Healing Minds. Improving Lives - Mental Health Frisco TX

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Healing minds. Improving lives. Help is just a call away. Call us now. 214-551-7407 We believe the best mental care comes from multiple approaches and perspectives. Frisco Mental Health Services is an outpatient mental health clinic located in Frisco, TX. We provide comprehensive and cost-effective psychiatric care to patients as young as ten years old.

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

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

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https://statutes.capitol.texas.gov/Docs/ED/htm/ED.33.htm#A

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EDUCATION CODE



TITLE 2. PUBLIC EDUCATION



SUBTITLE F. CURRICULUM, PROGRAMS, AND SERVICES



CHAPTER 33. SERVICE PROGRAMS AND EXTRACURRICULAR ACTIVITIES



SUBCHAPTER A. SCHOOL COUNSELORS AND COUNSELING PROGRAMS



Sec. 33.002. CERTIFIED SCHOOL COUNSELOR. (a) From funds appropriated for the purpose or other funds that may be used for the purpose, the commissioner shall distribute funds for programs under this subchapter. In distributing those funds, the commissioner shall give preference to a school district that received funds under this subsection for the preceding school year and then to the districts that have the highest concentration of students at risk of dropping out of school, as described by Section 29.081. To receive funds for the program, a school district must apply to the commissioner. For each school year that a school district receives funds under this subsection, the district shall allocate an amount of local funds for school guidance and counseling programs that is equal to or greater than the amount of local funds that the school district allocated for that purpose during the preceding school year. This section applies only to a school district that receives funds as provided by this subsection.


(b) A school district with 500 or more students enrolled in elementary school grades shall employ a school counselor certified under the rules of the State Board for Educator Certification for each elementary school in the district. A school district shall employ at least one school counselor for every 500 elementary school students in the district.


(c) A school district with fewer than 500 students enrolled in elementary school grades shall provide guidance and counseling services to elementary school students by:


(1) employing a part-time school counselor certified under the rules of the State Board for Educator Certification;


(2) employing a part-time teacher certified as a school counselor under the rules of the State Board for Educator Certification; or


(3) entering into a shared services arrangement agreement with one or more school districts to share a school counselor certified under the rules of the State Board for Educator Certification.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995. Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 6.005(a), eff. Sept. 1, 2003.


Amended by:


Acts 2009, 81st Leg., R.S., Ch. 1328 (H.B. 3646), Sec. 39, eff. September 1, 2009.


Acts 2013, 83rd Leg., R.S., Ch. 443 (S.B. 715), Sec. 27, eff. June 14, 2013.


Acts 2013, 83rd Leg., R.S., Ch. 443 (S.B. 715), Sec. 28, eff. June 14, 2013.


Sec. 33.003. PARENTAL CONSENT. The board of trustees of each school district shall adopt guidelines to ensure that written consent is obtained from the parent, legal guardian, or person entitled to enroll the student under Section 25.001(j) for the student to participate in those activities for which the district requires parental consent.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.004. PARENTAL INVOLVEMENT. (a) Each school shall obtain, and keep as part of the student's permanent record, written consent of the parent or legal guardian as required under Section 33.003. The consent form shall include specific information on the content of the program and the types of activities in which the student will be involved.


(b) Each school, before implementing a comprehensive school counseling program under Section 33.005, shall annually conduct a preview of the program for parents and guardians. All materials, including curriculum to be used during the year, must be available for a parent or guardian to preview during school hours. Materials or curriculum not included in the materials available on the campus for preview may not be used.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Amended by:


Acts 2019, 86th Leg., R.S., Ch. 352 (H.B. 18), Sec. 1.10, eff. December 1, 2019.


Sec. 33.005. COMPREHENSIVE SCHOOL COUNSELING PROGRAMS. (a) A school counselor shall work with the school faculty and staff, students, parents, and the community to plan, implement, and evaluate a comprehensive school counseling program that conforms to the most recent edition of the Texas Model for Comprehensive School Counseling Programs developed by the Texas Counseling Association.


(b) The school counselor shall design the program to include:


(1) a guidance curriculum to help students develop their full educational potential, including the student's interests and career objectives;


(2) a responsive services component to intervene on behalf of any student whose immediate personal concerns or problems put the student's continued educational, career, personal, or social development at risk;


(3) an individual planning system to guide a student as the student plans, monitors, and manages the student's own educational, career, personal, and social development; and


(4) system support to support the efforts of teachers, staff, parents, and other members of the community in promoting the educational, career, personal, and social development of students.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995. Amended by Acts 2001, 77th Leg., ch. 1487, Sec. 2, eff. June 17, 2001.


Amended by:


Acts 2013, 83rd Leg., R.S., Ch. 443 (S.B. 715), Sec. 29, eff. June 14, 2013.


Acts 2019, 86th Leg., R.S., Ch. 352 (H.B. 18), Sec. 1.11, eff. December 1, 2019.


Sec. 33.006. SCHOOL COUNSELORS; GENERAL DUTIES. (a) The primary responsibility of a school counselor is to counsel students to fully develop each student's academic, career, personal, and social abilities.


(b) In addition to a school counselor's responsibility under Subsection (a), the school counselor shall:


(1) participate in planning, implementing, and evaluating a comprehensive developmental guidance program to serve all students and to address the special needs of students:


(A) who are at risk of dropping out of school, becoming substance abusers, participating in gang activity, or committing suicide;


(B) who are in need of modified instructional strategies; or


(C) who are gifted and talented, with emphasis on identifying and serving gifted and talented students who are educationally disadvantaged;


(2) consult with a student's parent or guardian and make referrals as appropriate in consultation with the student's parent or guardian;


(3) consult with school staff, parents, and other community members to help them increase the effectiveness of student education and promote student success;


(4) coordinate people and resources in the school, home, and community;


(5) with the assistance of school staff, interpret standardized test results and other assessment data that help a student make educational and career plans;


(6) deliver classroom guidance activities or serve as a consultant to teachers conducting lessons based on the school's guidance curriculum; and


(7) serve as an impartial, nonreporting resource for interpersonal conflicts and discord involving two or more students, including accusations of bullying under Section 37.0832.


(c) Nothing in Subsection (b)(7) exempts a school counselor from any mandatory reporting requirements imposed by other provisions of law.


(d) Except as provided by Subsection (e), the board of trustees of each school district shall adopt a policy that requires a school counselor to spend at least 80 percent of the school counselor's total work time on duties that are components of a counseling program developed under Section 33.005. For purposes of this subsection, time spent in administering assessment instruments or providing other assistance in connection with assessment instruments, except time spent in interpreting data from assessment instruments, is not considered time spent on counseling. Each school in the district shall implement the policy. A copy of the policy shall be maintained in the office of each school in the district and made available on request during regular school hours to district employees, parents of district students, and the public.


(e) If the board of trustees of a school district determines that, because of staffing needs in the district or at a school in the district, a school counselor must spend less than 80 percent of the school counselor's total work time on duties that are components of a counseling program developed under Section 33.005, the policy adopted under Subsection (d) shall:


(1) include the reasons why the counselor needs to spend less than 80 percent of the counselor's work time on duties that are components of the counseling program;


(2) list the duties the counselor is expected to perform that are not components of the counseling program; and


(3) set the percentage of work time that the counselor is required to spend on components of the counseling program.


(f) A school district may not include a provision in an employment contract with a school counselor under Chapter 21 that conflicts with the policy required by Subsection (d) or, except as provided by Subsection (g), has the effect of authorizing a school principal or school district superintendent to require a school counselor to generally perform duties that are not primarily related to a counseling function.


(g) A school district to which Subsection (e) applies may not include a provision in an employment contract under Chapter 21 with an affected school counselor that has the effect of requiring the counselor to generally perform a duty that is not primarily related to a counseling function unless the duty is specified in the district's policy under Subsection (e)(2).


(h) Each school district shall annually assess the district's compliance with the policy adopted under Subsection (d) and, on request by the commissioner, provide a written copy of the assessment to the agency on or before the date specified by the commissioner. The commissioner shall adopt rules to implement this subsection.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995. Amended by Acts 2001, 77th Leg., ch. 1487, Sec. 3, eff. June 17, 2001.


Amended by:


Acts 2013, 83rd Leg., R.S., Ch. 443 (S.B. 715), Sec. 30, eff. June 14, 2013.


Acts 2013, 83rd Leg., R.S., Ch. 443 (S.B. 715), Sec. 31, eff. June 14, 2013.


Acts 2017, 85th Leg., R.S., Ch. 522 (S.B. 179), Sec. 10, eff. September 1, 2017.


Acts 2021, 87th Leg., R.S., Ch. 938 (S.B. 179), Sec. 1, eff. September 1, 2021.


Sec. 33.007. COUNSELING REGARDING POSTSECONDARY EDUCATION. (a) Each school counselor at an elementary, middle, or junior high school, including an open-enrollment charter school offering those grades, shall advise students and their parents or guardians regarding the importance of postsecondary education, coursework designed to prepare students for postsecondary education, and financial aid availability and requirements.


(b) During the first school year a student is enrolled in a high school or at the high school level in an open-enrollment charter school, and again during each year of a student's enrollment in high school or at the high school level, a school counselor shall provide information about postsecondary education to the student and the student's parent or guardian. The information must include information regarding:


(1) the importance of postsecondary education;


(2) the advantages of earning an endorsement and a performance acknowledgment and completing the distinguished level of achievement under the foundation high school program under Section 28.025;


(3) the disadvantages of taking courses to prepare for a high school equivalency examination relative to the benefits of taking courses leading to a high school diploma;


(4) financial aid eligibility;


(5) instruction on how to apply for federal financial aid;


(6) the center for financial aid information established under Section 61.0776;


(7) the automatic admission of certain students to general academic teaching institutions as provided by Section 51.803;


(8) the eligibility and academic performance requirements for the TEXAS Grant as provided by Subchapter M, Chapter 56;


(9) the availability of programs in the district under which a student may earn college credit, including advanced placement programs, dual credit programs, joint high school and college credit programs, and international baccalaureate programs;


(10) the availability of education and training vouchers and tuition and fee waivers to attend an institution of higher education as provided by Section 54.366 for a student who is or was previously in the conservatorship of the Department of Family and Protective Services; and


(11) the availability of college credit awarded by institutions of higher education to veterans and military servicemembers for military experience, education, and training obtained during military service as described by the informational materials developed under Section 302.0031(h), Labor Code.


(b-1) When providing information under Subsection (b)(10), the school counselor must report to the student and the student's parent or guardian the number of times the counselor has provided the information to the student.


(b-2) Information provided under Subsection (b)(11) must explain to any student who is enlisted or intends to enlist in the armed forces of the United States the informational materials developed under Section 302.0031(h), Labor Code.


(c) At the beginning of grades 10 and 11, a school counselor certified under the rules of the State Board for Educator Certification shall explain the requirements of automatic admission to a general academic teaching institution under Section 51.803 to each student enrolled in a high school or at the high school level in an open-enrollment charter school who has a grade point average in the top 25 percent of the student's high school class.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 973 (S.B. 282), Sec. 2, eff. June 15, 2007.


Acts 2009, 81st Leg., R.S., Ch. 1342 (S.B. 175), Sec. 4, eff. June 19, 2009.


Acts 2013, 83rd Leg., R.S., Ch. 211 (H.B. 5), Sec. 29(a), effective beginning with the 2014-2015 school year.


Acts 2013, 83rd Leg., R.S., Ch. 211 (H.B. 5), Sec. 30(a), eff. June 10, 2013.


Acts 2017, 85th Leg., R.S., Ch. 481 (H.B. 2537), Sec. 1, eff. June 9, 2017.


Acts 2017, 85th Leg., R.S., Ch. 550 (S.B. 490), Sec. 1, eff. June 9, 2017.


Acts 2019, 86th Leg., R.S., Ch. 37 (H.B. 114), Sec. 1, eff. May 16, 2019.


Sec. 33.009. POSTSECONDARY EDUCATION AND CAREER COUNSELING ACADEMIES. (a) In this section, "coordinating board" means the Texas Higher Education Coordinating Board.


(b) The coordinating board shall develop and make available postsecondary education and career counseling academies for school counselors and other postsecondary advisors employed by a school district at a middle school, junior high school, or high school.


(c) In developing academies under this section, the coordinating board shall solicit input from the agency, school counselors, the Texas Workforce Commission, institutions of higher education, and business, community, and school leaders.


(d) An academy developed under this section must provide counselors and other postsecondary advisors with knowledge and skills to provide counseling to students regarding postsecondary success and productive career planning and must include information relating to:


(1) each endorsement described by Section 28.025(c-1), including:


(A) the course requirements for each endorsement; and


(B) the postsecondary educational and career opportunities associated with each endorsement;


(2) available methods for a student to earn credit for a course not offered at the school in which the student is enrolled, including enrollment in an electronic course provided through the state virtual school network under Chapter 30A;


(3) general academic performance requirements for admission to an institution of higher education, including the requirements for automatic admission to a general academic teaching institution under Section 51.803;


(4) regional workforce needs, including information about the required education and the average wage or salary for careers that meet those workforce needs; and


(5) effective strategies for engaging students and parents in planning for postsecondary education and potential careers, including participation in mentorships and business partnerships.


(d-1) An academy developed under this section may include information regarding social-emotional learning and indicators of behavioral issues.


(e) The coordinating board shall develop an online instructional program that school districts may use in providing the instruction in high school, college, and career preparation required by Section 28.016. The program must be structured for use as part of an existing course.


(f) Repealed by Acts 2021, 87th Leg., R.S., Ch. 1001 (H.B. 2827), Sec. 2, eff. June 18, 2021.


(g) A teacher of a course described by Section 28.016(c)(2) or (3) may attend an academy developed under this section.


(h) From funds appropriated for that purpose, a school counselor who attends the academy under this section is entitled to receive a stipend in the amount determined by the coordinating board. If funds are available after all eligible school counselors have received a stipend under this subsection, the coordinating board shall pay a stipend in the amount determined by the coordinating board to a teacher who attends the academy under this section. A stipend received under this subsection is not considered in determining whether a district is paying the school counselor or teacher the minimum monthly salary under Section 21.402.


(i) From available funds appropriated for purposes of this section, the coordinating board may provide to school counselors and other educators curricula, instructional materials, and technological tools relating to postsecondary education and career counseling.


(j) Repealed by Acts 2021, 87th Leg., R.S., Ch. 1001 (H.B. 2827), Sec. 2, eff. June 18, 2021.


Added by Acts 2015, 84th Leg., R.S., Ch. 988 (H.B. 18), Sec. 5, eff. June 19, 2015.


Amended by:


Acts 2019, 86th Leg., R.S., Ch. 961 (S.B. 504), Sec. 1, eff. June 14, 2019.


Acts 2021, 87th Leg., R.S., Ch. 1001 (H.B. 2827), Sec. 1, eff. June 18, 2021.


Acts 2021, 87th Leg., R.S., Ch. 1001 (H.B. 2827), Sec. 2, eff. June 18, 2021.


SUBCHAPTER B. LIBRARIES



Sec. 33.021. LIBRARY STANDARDS. The Texas State Library and Archives Commission, in consultation with the State Board of Education, shall adopt standards for school library services. A school district shall consider the standards in developing, implementing, or expanding library services.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.022. CONTRACT WITH COUNTY OR MUNICIPALITY. (a) A school district may enter into contracts with a county or municipality in which the district is located to provide joint library facilities.


(b) The board of trustees of the school district and the commissioners court of the county or governing body of the municipality must conduct public hearings before entering into a contract under this section. The hearings may be held jointly.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


SUBCHAPTER C. MISSING CHILD PREVENTION AND IDENTIFICATION PROGRAMS



Sec. 33.051. DEFINITIONS. In this subchapter:


(1) "Child" and "minor" have the meanings assigned by Section 101.003, Family Code.


(2) "Missing child" means a child whose whereabouts are unknown to the legal custodian of the child and:


(A) the circumstances of whose absence indicate that the child did not voluntarily leave the care and control of the custodian and that the taking of the child was not authorized by law; or


(B) the child has engaged in conduct indicating a need for supervision under Section 51.03(b)(2), Family Code.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 935 (H.B. 2398), Sec. 16, eff. September 1, 2015.


Sec. 33.052. MISSING CHILD PREVENTION AND IDENTIFICATION PROGRAMS. (a) The board of trustees of a school district or of a private school may participate in missing child prevention and identification programs, including fingerprinting and photographing as provided by this subchapter.


(b) The board of trustees of a school district may delegate responsibility for implementation of the program to the district's school administration or to the district's community education services administration.


(c) The chief administrative officer of each private primary or secondary school may participate in the programs and may contract with the regional education service center in which the school is located for operation of all or any part of the program through a shared services arrangement.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.053. FINGERPRINTS OF CHILDREN. (a) A missing child prevention and identification program may include a procedure for taking the fingerprints of each student registered in the school whose parent or legal custodian has consented in writing to the fingerprinting. Fingerprints obtained under this section may be used only for the identification and location of a missing child.


(b) The board of trustees of a school district or the chief administrative officer of a private school may establish a reasonable fee to cover the costs of fingerprinting not provided by volunteer assistance. The fee may not exceed $3 for each child fingerprinted. If the school charges a fee, the school may waive all or a portion of the costs of fingerprinting for educationally disadvantaged children.


(c) A representative of a law enforcement agency of the county or the municipality in which the school district is located or of the Department of Public Safety, or a person trained in fingerprinting technique by a law enforcement agency or the Department of Public Safety, shall make one complete set of fingerprints on a fingerprint card for each child participating in the program. If the school requests, the Department of Public Safety may provide fingerprint training to persons designated by the school.


(d) A fingerprint card shall include a description of the child, including the name, address, date and place of birth, color of eyes and hair, weight, and sex of the child.


(e) Except as provided by Section 33.054(b), the fingerprint card and other materials developed under this subchapter shall be made part of the school's permanent student records.


(f) A state agency, law enforcement agency, or other person may not retain a copy of a child's fingerprints taken under this program.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.0531. CHILD IDENTIFICATION PROGRAM. (a) The agency shall provide to all school districts and open-enrollment charter schools inkless, in-home fingerprint and DNA identification kits to be distributed through the district or school on request to the parent or legal custodian of any kindergarten, elementary, or middle school student.


(b) A parent or legal custodian who receives a fingerprint and DNA identification kit may submit the kit to federal, state, tribal, or local law enforcement to help locate and return a missing or trafficked child.


Added by Acts 2021, 87th Leg., R.S., Ch. 891 (S.B. 2158), Sec. 1, eff. September 1, 2021.


Sec. 33.054. PHOTOGRAPHS OF CHILDREN. (a) A participating school shall retain a current photograph of each child registered in the school whose parent or legal custodian has consented in writing. Photographs retained under this section may be used only for the identification and location of a missing child.


(b) The photograph shall be retained by the participating school until the photograph is replaced by a subsequently made photograph under this section or until the expiration of three years, whichever is earlier.


(c) On the request of a parent or legal custodian of a missing child, or of a peace officer who is engaged in the investigation of a missing child, a participating school may give to the parent, legal custodian, or peace officer a copy of that child's photograph held by the school under this section. Except as provided by this subsection, a photograph held under this section may not be given to any person.


(d) A participating school may charge a fee for making and keeping records of photographs under this section. If the school charges a fee, the school may waive this fee for educationally disadvantaged children.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.055. FINGERPRINTS AND PHOTOGRAPHS NOT USED AS EVIDENCE. (a) A child's fingerprint card made under Section 33.053 or a photograph of a child made or kept under Section 33.054 may not be used as evidence in any criminal proceeding in which the child is a defendant or in any case under Title 3, Family Code, in which the child is alleged to have engaged in delinquent conduct or in conduct indicating a need for supervision.


(b) This subchapter does not apply to the use by a law enforcement agency for an official purpose of a photograph published in a school annual.


(c) This subchapter does not prevent the use of a videotape or photograph taken to monitor the activity of students for disciplinary reasons or in connection with a criminal prosecution or an action under Title 3, Family Code.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.056. LIABILITY FOR NONPERFORMANCE. A person is not liable in any suit for damages for negligent performance or nonperformance of any requirement of this subchapter.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.057. DESTRUCTION OF FINGERPRINTS AND PHOTOGRAPHS. The agency shall adopt rules relating to the destruction of fingerprints and photographs made or kept under Section 33.053 or 33.054.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Amended by:


Acts 2021, 87th Leg., R.S., Ch. 891 (S.B. 2158), Sec. 2, eff. September 1, 2021.


SUBCHAPTER D. EXTRACURRICULAR ACTIVITIES



Sec. 33.081. EXTRACURRICULAR ACTIVITIES. (a) The State Board of Education by rule shall limit participation in and practice for extracurricular activities during the school day and the school week. The rules must, to the extent possible, preserve the school day for academic activities without interruption for extracurricular activities. In scheduling those activities and practices, a school district must comply with the rules of the board.


(b) A student enrolled in a school district in this state or who participates in an extracurricular activity or a University Interscholastic League competition is subject to school district policy and University Interscholastic League rules regarding participation only when the student is under the direct supervision of an employee of the school or district in which the student is enrolled or at any other time specified by resolution of the board of trustees of the district.


(c) A student who is enrolled in a school district in this state or who participates in a University Interscholastic League competition shall be suspended from participation in any extracurricular activity sponsored or sanctioned by the school district or the University Interscholastic League after a grade evaluation period in which the student received a grade lower than the equivalent of 70 on a scale of 100 in any academic class other than a course described by Subsection (d-1). A suspension continues for at least three school weeks and is not removed during the school year until the conditions of Subsection (d) are met. A suspension does not last beyond the end of a school year. For purposes of this subsection, "grade evaluation period" means:


(1) the six-week grade reporting period; or


(2) the first six weeks of a semester and each grade reporting period thereafter, in the case of a district with a grade reporting period longer than six weeks.


(d) Until the suspension is removed under this subsection or the school year ends, a school district shall review the grades of a student suspended under Subsection (c) at the end of each three-week period following the date on which the suspension began. At the time of a review, the suspension is removed if the student's grade in each class, other than a course described by Subsection (d-1), is equal to or greater than the equivalent of 70 on a scale of 100. The principal and each of the student's teachers shall make the determination concerning the student's grades.


(d-1) Subsections (c) and (d) do not apply to an advanced placement or international baccalaureate course, or to an honors or dual credit course in the subject areas of English language arts, mathematics, science, social studies, economics, or a language other than English. The agency shall review on a biennial basis courses described by this subsection to determine if other courses should be excluded from the requirement that a student be suspended from participation in an extracurricular activity under Subsection (c). Not later than January 1 of each odd-numbered year, the agency shall report the findings under this subsection to the legislature.


(e) Suspension of a student with a disability that significantly interferes with the student's ability to meet regular academic standards must be based on the student's failure to meet the requirements of the student's individualized education program. The determination of whether a disability significantly interferes with a student's ability to meet regular academic standards must be made by the student's admission, review, and dismissal committee. For purposes of this subsection, "student with a disability" means a student who is eligible for a district's special education program under Section 29.003(b).


(e-1) A student who is enrolled in a school district in this state or who participates in a University Interscholastic League competition shall be prohibited from participation in any future extracurricular activity sponsored or sanctioned by the school district or the University Interscholastic League if the state executive committee of the league determines that the student intentionally, knowingly, or recklessly causes bodily injury to a person serving as referee, judge, or other official of an extracurricular activity in retaliation for or as a result of the person's actions taken in performing the duties of a referee, judge, or other official of the extracurricular activity.


(e-2) A student prohibited from participation in an extracurricular activity under Subsection (e-1) may submit to the University Interscholastic League a request that the student be permitted to participate in future extracurricular activities sponsored or sanctioned by the University Interscholastic League if:


(1) the request is submitted at least:


(A) one year after the date the student engaged in the conduct that resulted in the prohibition under Subsection (e-1) if the student was enrolled in eighth grade or below at the time of the conduct; or


(B) two years after the date the student engaged in the conduct that resulted in the prohibition under Subsection (e-1) if the student was enrolled in ninth grade or above at the time of the conduct;


(2) the student:


(A) completed a course in anger management since engaging in the conduct that resulted in the prohibition under Subsection (e-1);


(B) completed any other course, activity, or action required by the school district in which the student is enrolled as a result of the conduct that resulted in the prohibition under Subsection (e-1); and


(C) demonstrates, to the satisfaction of the school district and the University Interscholastic League, that the student has been rehabilitated and is unlikely to again engage in the conduct described by Subsection (e-1); and


(3) a previous request submitted by the student under this section has not been denied during the school year in which the request is submitted.


(e-3) When determining whether to grant a request under Subsection (e-2), the University Interscholastic League:


(1) shall take into account the severity of the conduct that resulted in the prohibition under Subsection (e-1); and


(2) may set conditions for the student's future participation in extracurricular activities.


(e-4) The University Interscholastic League may prohibit a student from participating in any future extracurricular activity sponsored or sanctioned by the University Interscholastic League if the student violates a condition set by the University Interscholastic League under Subsection (e-3)(2).


(f) Except for a student prohibited from participation under Subsection (e-1), a student suspended under this section may practice or rehearse with other students for an extracurricular activity but may not participate in a competition or other public performance.


(g) An appeal to the commissioner is not a contested case under Chapter 2001, Government Code, if the issues presented relate to a student's eligibility to participate in extracurricular activities, including issues related to the student's grades, the school district's grading policy as applied to the student's eligibility, or the student's eligibility based on conduct described by Subsection (e-1). The commissioner may delegate the matter for decision to a person the commissioner designates. The decision of the commissioner or the commissioner's designee in a matter governed by this subsection may not be appealed except on the grounds that the decision is arbitrary or capricious. Evidence may not be introduced on appeal other than the record of the evidence before the commissioner.


(h) A request made under Subsection (e-2) is not a contested case subject to Chapter 2001, Government Code.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995. Amended by Acts 1999, 76th Leg., ch. 1482, Sec. 2, eff. June 19, 1999.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 1327 (S.B. 1517), Sec. 1, eff. June 15, 2007.


Acts 2021, 87th Leg., R.S., Ch. 824 (H.B. 2721), Sec. 1, eff. June 16, 2021.


Sec. 33.0811. SCHOOL DISTRICT POLICY ON ABSENCES TO PARTICIPATE IN EXTRACURRICULAR ACTIVITIES. (a) Notwithstanding Section 33.081(a), the board of trustees of a school district may adopt a policy establishing the number of times a student who is otherwise eligible to participate in an extracurricular activity under Section 33.081 may be absent from class to participate in an extracurricular activity sponsored or sanctioned by the district or the University Interscholastic League or by an organization sanctioned by resolution of the board of trustees of the district.


(b) A policy adopted by the board of trustees of a district under this section:


(1) prevails over a conflicting policy adopted under Section 33.081(a); and


(2) must permit a student to be absent from class at least 10 times during the school year.


Added by Acts 1999, 76th Leg., ch. 1482, Sec. 3, eff. June 19, 1999.


Sec. 33.0812. SCHEDULING EXTRACURRICULAR ACTIVITIES PROHIBITED IN CERTAIN CIRCUMSTANCES. (a) The State Board of Education by rule shall prohibit participation in a University Interscholastic League area, regional, or state competition:


(1) on Monday through Thursday of the school week in which the primary administration of assessment instruments under Section 39.023(a), (c), or (l) occurs; or


(2) if the primary administration of the assessment instruments is completed before Thursday of the school week, beginning on Monday and ending on the last school day on which the assessment instruments are administered.


(b) The commissioner shall determine the school week during the school year in which the primary administration of assessment instruments occurs for purposes of Subsection (a).


(c) The commissioner shall adopt rules to provide the University Interscholastic League with a periodic calendar of dates reserved for testing for planning purposes under this section. The periodic calendar must be provided at least every three years on or before May 1 of the year preceding the three-year cycle of reserved testing dates.


(d) In adopting rules under this section, the commissioner shall:


(1) include a procedure for changing, in exceptional circumstances, testing dates reserved under the periodic calendar;


(2) define circumstances that constitute exceptional circumstances under Subdivision (1) as unforeseen events, including a natural disaster, severe weather, fire, explosion, or similar circumstances beyond the control of school districts or the agency; and


(3) establish criteria for determining whether a University Interscholastic League area, regional, or state competition must be canceled if that event conflicts with a changed testing date.


(e) This section does not apply to testing dates on which assessment instruments are administered only to students retaking assessment instruments.


Added by Acts 2005, 79th Leg., Ch. 812 (S.B. 658), Sec. 1, eff. June 17, 2005.


Sec. 33.082. EXTRACURRICULAR ACTIVITIES; USE OF DISCRIMINATORY ATHLETIC CLUB. (a) An extracurricular activity sponsored or sanctioned by a school district, including an athletic event or an athletic team practice, may not take place at an athletic club located in the United States that denies any person full and equal enjoyment of equipment or facilities provided by the athletic club because of the race, color, religion, creed, national origin, or sex of the person.


(b) In this section, "athletic club" means an entity that provides sports or exercise equipment or facilities to its customers or members or to the guests of its customers or members.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.083. INTERSCHOLASTIC LEAGUES. (a) The rules and procedures of an organization sanctioning or conducting interscholastic competition, including rules providing penalties for rules violations by school district personnel, must be consistent with State Board of Education rules.


(b) The University Interscholastic League is a part of The University of Texas at Austin and must submit its rules and procedures to the commissioner for approval or disapproval. The funds belonging to the University Interscholastic League shall be deposited with The University of Texas at Austin for the benefit of the league and shall be subject to audits by The University of Texas at Austin, The University of Texas System, and the state auditor. Copies of annual audits shall be furnished, on request, to members of the legislature.


(c) The State Board of Education may seek an injunction to enforce this section.


(d) The University Interscholastic League shall file annually with the governor and the presiding officer of each house of the legislature a complete and detailed written report accounting for all funds received and disbursed by the University Interscholastic League during the preceding fiscal year. The form of the annual report and the reporting time are as provided by the General Appropriations Act.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995. Amended by Acts 1999, 76th Leg., ch. 1482, Sec. 4, eff. June 19, 1999.


Amended by:


Acts 2013, 83rd Leg., R.S., Ch. 1279 (H.B. 1675), Sec. 1.04, eff. June 14, 2013.


Sec. 33.0831. UNIVERSITY INTERSCHOLASTIC LEAGUE RULES: FISCAL IMPACT STATEMENT. (a) The legislative council of the University Interscholastic League may not take final action on a new or amended rule that would result in additional costs for a member school unless a fiscal impact statement regarding the rule has been completed in accordance with this section.


(b) For purposes of Subsection (a), final action by the legislative council means:


(1) submitting a rule to school superintendents, if the submission is required under the legislative council's procedures; or


(2) submitting a rule approved by the council to the commissioner for the commissioner's approval under Section 33.083(b), if the rule does not require submission to school superintendents under the legislative council's procedures.


(c) A fiscal impact statement regarding a rule must include:


(1) a projection of the costs to member schools of complying with the rule during the five-year period following the effective date of the rule; and


(2) an explanation of the methodology used to analyze the fiscal impact of the rule and determine the costs projection required by Subdivision (1).


(d) If a fiscal impact statement is prepared for a rule, a copy of the statement must be attached to the rule when it is submitted for approval to school superintendents, if applicable, and when it is submitted to the commissioner for approval.


Added by Acts 2011, 82nd Leg., R.S., Ch. 966 (H.B. 1286), Sec. 1, eff. September 1, 2011.


Text of section as added by Acts 2021, 87th Leg., R.S., Ch. 235 (H.B. 1080), Sec. 1



For text of section as added by Acts 2021, 87th Leg., R.S., Ch. 996 (H.B. 547), Sec. 1, see other Sec. 33.0832.



Sec. 33.0832. PARTICIPATION IN UNIVERSITY INTERSCHOLASTIC LEAGUE ACTIVITIES BY STUDENTS RECEIVING OUTPATIENT MENTAL HEALTH SERVICES. (a) This section applies to a student who:


(1) receives outpatient mental health services from a mental health facility, as defined by Section 571.003, Health and Safety Code; and


(2) is enrolled in a school district or open-enrollment charter school or otherwise receives public education services from a district or school.


(b) The University Interscholastic League shall ensure that league rules do not exclude from eligibility for participation in a league activity a student to whom this section applies based solely on the criteria described in Subsection (a)(1).


(c) A school district or open-enrollment charter school may not adopt or enforce policies that restrict participation in University Interscholastic League activities by a student to whom this section applies based solely on:


(1) the criteria described in Subsection (a)(1); or


(2) the student's absence during instructional time while receiving outpatient mental health services as described by Subsection (a)(1).


(d) This section does not exempt a student to whom this section applies from any eligibility requirement for participation in University Interscholastic League activities other than an eligibility requirement based solely on the criteria described in Subsection (a)(1).


Added by Acts 2021, 87th Leg., R.S., Ch. 235 (H.B. 1080), Sec. 1, eff. June 4, 2021.


Text of section as added by Acts 2021, 87th Leg., R.S., Ch. 996 (H.B. 547), Sec. 1



For text of section as added by Acts 2021, 87th Leg., R.S., Ch. 235 (H.B. 1080), Sec. 1, see other Sec. 33.0832.



Sec. 33.0832. EQUAL OPPORTUNITY FOR CERTAIN STUDENTS TO PARTICIPATE IN UNIVERSITY INTERSCHOLASTIC LEAGUE ACTIVITIES. (a) In this section:


(1) "League" means the University Interscholastic League.


(2) "Non-enrolled student" means a student who receives instruction as described by Section 29.916(a)(1) from a nonpublic school.


(b) Nothing in this section may be construed to affect the holding in Texas Educ. Agency v. Leeper, 893 S.W.2d 432 (Tex. 1994), classifying home schools as private schools. The legislature finds that a home school is a private school for purposes of this section.


(c) Except as provided by Subsection (i), a public school that participates in an activity sponsored by the league may provide a non-enrolled student, who otherwise meets league eligibility standards to represent that school in a league activity, with the opportunity to participate in the activity on behalf of the school in the same manner that the school provides the opportunity to participate to students enrolled in the school.


(d) A non-enrolled student who seeks to participate or participates in a league activity on behalf of a school is subject to the following relevant policies that apply to students enrolled in the school:


(1) registration for league activities;


(2) age eligibility;


(3) fees;


(4) insurance;


(5) transportation;


(6) physical condition;


(7) qualifications;


(8) responsibilities;


(9) event schedules;


(10) standards of behavior; and


(11) performance.


(e) A non-enrolled student may only participate in a league activity for the school in the school district that the student would be eligible to attend based on the student's residential address. A non-enrolled student who seeks to participate in a league activity on behalf of a school shall be required to establish minimum proof of residency acceptable to the district in the same manner as an applicant to attend a school in the district under Section 25.001.


(f) The parent or person standing in parental relation to a non-enrolled student is responsible for oversight of academic standards relating to the student's participation in a league activity. As a condition of eligibility to participate in a league activity during the first six weeks of a school year, a non-enrolled student must demonstrate grade-level academic proficiency on any nationally recognized, norm-referenced assessment instrument, such as the Iowa Test of Basic Skills, Stanford Achievement Test, California Achievement Test, or Comprehensive Test of Basic Skills. A non-enrolled student demonstrates the required academic proficiency by achieving a composite, core, or survey score that is within the average or higher than average range of scores, as established by the applicable testing service. For purposes of this subsection, a school district shall accept assessment results administered or reported by a third party.


(g) A non-enrolled student's demonstration of academic proficiency under Subsection (f) is sufficient for purposes of that subsection for the school year in which the student achieves the required score and the subsequent school year.


(h) After the first six weeks of a school year, the parent or person standing in parental relation to a non-enrolled student participating in a league activity on behalf of a public school must periodically, in accordance with the school's grading calendar, provide written verification to the school indicating that the student is receiving a passing grade in each course or subject being taught.


(i) A non-enrolled student is not authorized by this section to participate in a league activity during the remainder of any school year during which the student was previously enrolled in a public school.


(j) The league may not prohibit a non-enrolled student from participating in league activities in the manner authorized by this section.


(k) With respect to a non-enrolled student's education program, nothing in this section shall be construed to permit an agency of this state, a public school district, or any other governmental body to exercise control, regulatory authority, or supervision over a non-enrolled student or a parent or person standing in parental relation to a non-enrolled student beyond the control, regulatory authority, or supervision required to participate in a league activity.


(l) Subject only to eligibility requirements under this section for a non-enrolled student to participate in a league activity:


(1) the curriculum or assessment requirements, performance standards, practices, or creed of the education program provided to a non-enrolled student may not be required to be changed in order for the non-enrolled student to participate in a league activity; and


(2) for a non-enrolled student participating in an education program on January 1, 2021, the education program provided to that student may not be required to comply with any state law or agency rule relating to that education program unless the law or rule was in effect on January 1, 2021.


(m) Notwithstanding any other law, a non-enrolled student who participates in a league activity under this section is subject to the immunization requirements and exceptions of Section 38.001 in the same manner as a public school student.


Added by Acts 2021, 87th Leg., R.S., Ch. 996 (H.B. 547), Sec. 1, eff. September 1, 2021.


Sec. 33.0834. INTERSCHOLASTIC ATHLETIC COMPETITION BASED ON BIOLOGICAL SEX. (a) Except as provided by Subsection (b), an interscholastic athletic team sponsored or authorized by a school district or open-enrollment charter school may not allow a student to compete in an interscholastic athletic competition sponsored or authorized by the district or school that is designated for the biological sex opposite to the student's biological sex as correctly stated on:


(1) the student's official birth certificate, as described by Subsection (c); or


(2) if the student's official birth certificate described by Subdivision (1) is unobtainable, another government record.


(b) An interscholastic athletic team described by Subsection (a) may allow a female student to compete in an interscholastic athletic competition that is designated for male students if a corresponding interscholastic athletic competition designated for female students is not offered or available.


(c) For purposes of this section, a statement of a student's biological sex on the student's official birth certificate is considered to have correctly stated the student's biological sex only if the statement was:


(1) entered at or near the time of the student's birth; or


(2) modified to correct any type of scrivener or clerical error in the student's biological sex.


(d) The University Interscholastic League shall adopt rules to implement this section, provided that the rules must be approved by the commissioner in accordance with Section 33.083(b). The rules must ensure compliance with state and federal law regarding the confidentiality of student medical information, including Chapter 181, Health and Safety Code, and the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. Section 1320d et seq.).


Added by Acts 2021, 87th Leg., 3rd C.S., Ch. 2 (H.B. 25), Sec. 3, eff. January 18, 2022.


Sec. 33.084. INTERSCHOLASTIC LEAGUE ADVISORY COUNCIL. (a) The interscholastic league advisory council is composed of:


(1) two members of the State Board of Education appointed by the chair of the board;


(2) a member of the house of representatives appointed by the speaker of the house;


(3) a member of the senate appointed by the lieutenant governor;


(4) two members of the legislative council of the University Interscholastic League appointed by the chairman of the council;


(5) two public school board members appointed by the commissioner; and


(6) three members of the public appointed by the commissioner.


(b) A member of the advisory council serves at the will of the member's appointing authority.


(c) In appointing public members to the advisory council, the commissioner shall give special consideration to students, parents of students, and teachers.


(d) The advisory council shall select a chair from among its members and shall meet at the call of the chair.


(e) The advisory council shall review the rules of the University Interscholastic League and shall make recommendations relating to the rules to the governor, the legislature, the legislative council of the University Interscholastic League, and the State Board of Education.


(f) A member of the advisory council may not receive compensation but is entitled to reimbursement from the University Interscholastic League for transportation expenses and the per diem allowance for state employees in accordance with the General Appropriations Act.


(g) The advisory council shall study:


(1) University Interscholastic League policy with respect to the eligibility of students to participate in programs;


(2) geographic distribution of University Interscholastic League resources and programs; and


(3) gender equity.


(h) An action of the University Interscholastic League relating to the provision of additional programs of school districts may not be taken pending submission of a final report by the advisory council.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.085. AUTHORITY OF UNIVERSITY INTERSCHOLASTIC LEAGUE REGARDING ACTIVITIES INVOLVING SPORTS OFFICIALS. (a) In this section:


(1) "League" means the University Interscholastic League.


(2) "Sports official" means a person who officiates, judges, or in any manner enforces contest rules in any official capacity with respect to and during the course of an interscholastic athletic team competition and who is a member of a league-recognized local chapter or association of sports officials. The term includes a referee, umpire, linesman, judge, or any other person similarly involved in supervising competitive play. The term does not include a league board member or a league official who is acting in an official capacity to supervise, administer, or enforce the league constitution or league contest rules.


(b) The league may require a sports official, as a condition of eligibility to officiate a contest sponsored by the league, to:


(1) be registered with the league and comply with the registration requirements of Subsections (c) and (c-1);


(2) have completed initial and continuing education programs regarding league rules;


(3) be a member in good standing of a local chapter or association of sports officials recognized by the league for that purpose; and


(4) agree to abide by league rules, including fee schedules and travel reimbursement guidelines for payment by school districts or open-enrollment charter schools to a sports official.


(c) In registering with the league, a sports official must be required to provide directory information required by the league and undergo an initial criminal background check.


(c-1) To maintain registration with the league, a sports official must:


(1) maintain compliance with conditions of eligibility required by the league under Subsection (b); and


(2) undergo a subsequent criminal background check once every three years following the date of the initial criminal background check under Subsection (c).


(d) The league may not charge a sports official who completes a program under Subsection (b)(2) a fee for more than one program described by Subsection (b)(2).


(e) The league may charge and collect a registration fee only to defray the cost of registering sports officials and shall post the amount of the fee on the league's Internet website and make the information available at other places the league determines appropriate. The amount of the fee may not exceed the amount reasonably determined by the league to be necessary to cover the cost of administering registration.


(f) The league may revoke or suspend the league registration of a sports official determined by the league to have violated the provisions of the league constitution or contest rules governing sports officials or other league policy applicable to sports officials. Before the league may take action to revoke or suspend a sports official's registration, the league shall notify and consult with the local chapter or association of sports officials of which the sports official is a member. The local chapter or association may, on or before the 15th day after the date notice is received from the league, take action to adjudicate the alleged violation. If after the 15th day after the date notice is received from the league the local chapter or association has failed to take action against the sports official or takes action that the league finds to be insufficient, the league may take action against the sports official. The league shall adopt rules to provide a sports official with the opportunity for an appeals process before the league revokes or suspends the sports official's registration. In adopting rules under this subsection, the league shall make a determination of the actions and subsequent sanctions that would be considered sufficient under this subsection.


(g) The league may not sponsor or organize or attempt to sponsor or organize any association of sports officials in which the majority of the membership is composed of sports officials who officiate team sports.


(h) The league may set rates or fee schedules payable by a school district or open-enrollment charter school to a sports official.


(i) Before the league may take any action that amends rules related to the activities of sports officials, other than an action against an individual sports official under Subsection (f), the league must submit the proposed action for public review and comment, including:


(1) notifying registered sports officials of the proposed action by e-mail not later than the 30th day before the date set for action on the proposal; and


(2) posting the proposal on the league's Internet website for at least 30 consecutive days before the date set for action on the proposal.


Added by Acts 2013, 83rd Leg., R.S., Ch. 952 (H.B. 1775), Sec. 1, eff. June 14, 2013.


Amended by:


Acts 2017, 85th Leg., R.S., Ch. 335 (H.B. 1075), Sec. 1, eff. September 1, 2017.


Sec. 33.086. CERTIFICATION IN CARDIOPULMONARY RESUSCITATION AND FIRST AID. (a) A school district employee who serves as the head director of a school marching band or as the head coach or chief sponsor for an extracurricular athletic activity, including cheerleading, sponsored or sanctioned by a school district or the University Interscholastic League must maintain and submit to the district proof of current certification in first aid and cardiopulmonary resuscitation issued by the American Red Cross, the American Heart Association, or another organization that provides equivalent training and certification.


(b) Each school district shall adopt, in accordance with the policy adopted under Section 21.4515, procedures necessary for administering this section, including procedures for the time and manner in which proof of current certification must be submitted.


Added by Acts 1999, 76th Leg., ch. 396, Sec. 2.14(a), eff. Sept. 1, 1999. Amended by Acts 2003, 78th Leg., ch. 881, Sec. 1, eff. June 20, 2003.


Amended by:


Acts 2021, 87th Leg., R.S., Ch. 1045 (S.B. 1267), Sec. 14, eff. June 18, 2021.


Sec. 33.087. ELIGIBILITY OF STUDENTS PARTICIPATING IN JOINT CREDIT OR CONCURRENT ENROLLMENT PROGRAMS. A student otherwise eligible to participate in an extracurricular activity or a University Interscholastic League competition is not ineligible because the student is enrolled in a course offered for joint high school and college credit, or in a course offered under a concurrent enrollment program, regardless of the location at which the course is provided.


Added by Acts 2007, 80th Leg., R.S., Ch. 199 (H.B. 208), Sec. 1, eff. May 24, 2007.


Sec. 33.091. PREVENTION OF ILLEGAL STEROID USE; RANDOM TESTING. (a) In this section:


(1) "League" means the University Interscholastic League.


(2) "Parent" includes a guardian or other person standing in parental relation.


(3) "Steroid" means an anabolic steroid as described by Section 481.104, Health and Safety Code.


(b) The league shall adopt rules prohibiting a student from participating in an athletic competition sponsored or sanctioned by the league unless:


(1) the student agrees not to use steroids and, if the student is enrolled in high school, the student submits to random testing for the presence of illegal steroids in the student's body, in accordance with the program established under Subsection (d); and


(2) the league obtains from the student's parent a statement signed by the parent and acknowledging that:


(A) the parent's child, if enrolled in high school, may be subject to random steroid testing;


(B) state law prohibits possessing, dispensing, delivering, or administering a steroid in a manner not allowed by state law;


(C) state law provides that bodybuilding, muscle enhancement, or the increase of muscle bulk or strength through the use of a steroid by a person who is in good health is not a valid medical purpose;


(D) only a licensed practitioner with prescriptive authority may prescribe a steroid for a person; and


(E) a violation of state law concerning steroids is a criminal offense punishable by confinement in jail or imprisonment in the Texas Department of Criminal Justice.


(c) The league shall:


(1) develop an educational program for students engaged in extracurricular athletic activities sponsored or sanctioned by the league, parents of those students, and coaches of those activities regarding the health effects of steroid use; and


(2) make the program available to school districts.


(c-1) A school district shall require that each district employee who serves as an athletic coach at or above the seventh grade level for an extracurricular athletic activity sponsored or sanctioned by the league complete:


(1) the educational program developed by the league under Subsection (c); or


(2) a comparable program developed by the district or a private entity with relevant expertise.


(d) The league shall adopt rules for the annual administration of a steroid testing program under which high school students participating in an athletic competition sponsored or sanctioned by the league are tested at multiple times throughout the year for the presence of steroids in the students' bodies. The testing program must:


(1) require the random testing of a statistically significant number of high school students in this state who participate in athletic competitions sponsored or sanctioned by the league;


(2) provide for the selection of specific students described by Subdivision (1) for testing through a process that randomly selects students from a single pool consisting of all students who participate in any activity for which the league sponsors or sanctions athletic competitions;


(3) be administered at approximately 30 percent of the high schools in this state that participate in athletic competitions sponsored or sanctioned by the league;


(4) provide for a process for confirming any initial positive test result through a subsequent test conducted as soon as practicable after the initial test, using a sample that was obtained at the same time as the sample used for the initial test;


(5) require the testing to be performed only by an anabolic steroid testing laboratory with a current certification from the Substance Abuse and Mental Health Services Administration of the United States Department of Health and Human Services, the World Anti-Doping Agency, or another appropriate national or international certifying organization; and


(6) provide for a period of ineligibility from participation in an athletic competition sponsored or sanctioned by the league for any student with a confirmed positive test result or any student who refuses to submit to random testing.


(e) Results of a steroid test conducted under Subsection (d) are confidential and, unless required by court order, may be disclosed only to the student and the student's parent and the activity directors, principal, and assistant principals of the school attended by the student.


(f) From funds already appropriated, the agency shall pay the costs of the steroid testing program established under Subsection (d).


(g) The league may increase the membership fees required of school districts that participate in athletic competitions sponsored or sanctioned by the league in an amount necessary to offset the cost of league activities under this section.


(h) Subsection (b)(1) does not apply to the use by a student of a steroid that is dispensed, prescribed, delivered, and administered by a medical practitioner for a valid medical purpose and in the course of professional practice, and a student is not subject to a period of ineligibility under Subsection (d)(6) on the basis of that steroid use.


Added by Acts 2005, 79th Leg., Ch. 1177 (H.B. 3563), Sec. 1, eff. June 18, 2005.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 1292 (S.B. 8), Sec. 1, eff. June 15, 2007.


Acts 2007, 80th Leg., R.S., Ch. 1292 (S.B. 8), Sec. 2, eff. June 15, 2007.


Sec. 33.092. STUDENT ELECTION CLERKS AND EARLY VOTING CLERKS. A student who is appointed as a student election clerk under Section 32.0511, Election Code, or as a student early voting clerk under Section 83.012, Election Code, may apply the time served as a student election clerk or student early voting clerk toward:


(1) a requirement for a school project at the discretion of the teacher who assigned the project; or


(2) a service requirement for participation in an advanced academic course program at the discretion of the program sponsor or a school-sponsored extracurricular activity at the discretion of the school sponsor.


Added by Acts 2009, 81st Leg., R.S., Ch. 517 (S.B. 1134), Sec. 4, eff. September 1, 2009.


Amended by:


Acts 2013, 83rd Leg., R.S., Ch. 542 (S.B. 553), Sec. 2, eff. June 14, 2013.


Sec. 33.093. RECOGNITION OF PARTICIPATION IN SPECIAL OLYMPICS. If a school district allows high school students to earn a letter for academic, athletic, or extracurricular achievements, the district must allow high school students in the district to earn a letter on the basis of a student's participation in a Special Olympics event.


Added by Acts 2017, 85th Leg., R.S., Ch. 261 (H.B. 1645), Sec. 1, eff. May 29, 2017.


Sec. 33.094. FOOTBALL HELMET SAFETY REQUIREMENTS. (a) A school district may not use a football helmet that is 16 years old or older in the district's football program.


(b) A school district shall ensure that each football helmet used in the district's football program that is 10 years old or older is reconditioned at least once every two years.


(c) A school district shall maintain and make available to parents of students enrolled in the district documentation indicating the age of each football helmet used in the district's football program and the dates on which each helmet is reconditioned.


(d) The University Interscholastic League may adopt rules necessary to implement this section, provided that the rules must be approved by the commissioner in accordance with Section 33.083(b).


Added by Acts 2011, 82nd Leg., R.S., Ch. 239 (H.B. 675), Sec. 1, eff. September 1, 2011.


Sec. 33.096. CARDIAC ASSESSMENTS OF HIGH SCHOOL PARTICIPANTS IN EXTRACURRICULAR ATHLETIC ACTIVITIES. (a) A school district must provide a district student, who is required under University Interscholastic League rule or policy to receive a physical examination before being allowed to participate in an athletic activity sponsored or sanctioned by the University Interscholastic League, the following:


(1) information about sudden cardiac arrest and electrocardiogram testing; and


(2) notification of the option of the student to request the administration of an electrocardiogram, in addition to the physical examination.


(b) A student may request an electrocardiogram from any health care professional, including a health care professional provided through the student's patient-centered medical home, as defined by Section 533.0029, Government Code, a health care professional provided through a school district program, or another health care professional chosen by the parent or person standing in parental relation to the student, provided that the health care professional is:


(1) appropriately licensed in this state; and


(2) authorized to administer and interpret electrocardiograms under the health care professional's scope of practice, as established by the health care professional's Texas licensing act.


(c) The University Interscholastic League shall adopt rules as necessary to administer this section.


(d) The rules adopted under Subsection (c) must include:


(1) criteria under which a school district may request an exemption from the requirements of Subsection (a);


(2) variances that allow for a delay of the implementation of the requirement to notify students of the option to request an electrocardiogram under this section;


(3) procedures to ensure students receiving the required annual physical examination are notified of the option to request an electrocardiogram; and


(4) provisions to ensure that the requirements under this section are minimum standards that provide a school district with the option to implement a program that exceeds the standards required by this section.


(e) This section does not create a cause of action or liability or a standard of care, obligation, or duty that provides a basis for a cause of action or liability against a health care professional described by Subsection (b), the University Interscholastic League, a school district, or a district officer or employee for:


(1) the injury or death of a student participating in or practicing for an athletic activity sponsored or sanctioned by the University Interscholastic League based on or in connection with the administration or interpretation of or reliance on an electrocardiogram; or


(2) the content or distribution of the information required under Subsection (a) or the failure to distribute the required information under this section.


Added by Acts 2019, 86th Leg., R.S., Ch. 1023 (H.B. 76), Sec. 1, eff. September 1, 2019.


Sec. 33.097. INCLUSIVE SPORTS PROGRAM FOR STUDENTS WITH INTELLECTUAL DISABILITIES. (a) The University Interscholastic League shall ensure students with intellectual disabilities have an opportunity to participate in team athletic activities by establishing and maintaining an inclusive sports program.


(b) The University Interscholastic League shall adopt rules as necessary to establish, maintain, and expand the inclusive sports program. The rules must:


(1) accommodate inclusive team sports offered through the program at participating public middle schools, junior high schools, and high schools in the state;


(2) establish eligibility requirements for participation in each inclusive team sport offered through the program;


(3) identify best practices for school districts to incorporate inclusive sports; and


(4) require the program to incorporate activities that promote:


(A) bullying prevention;


(B) moral intelligence;


(C) character development;


(D) leadership development;


(E) physical fitness; and


(F) positive school culture.


(c) In adopting the rules under Subsection (b), the University Interscholastic League shall consider and incorporate as appropriate:


(1) federal guidance regarding providing access to extracurricular athletics for students with intellectual disabilities;


(2) guidance available from nationally recognized organizations that promote inclusion and acceptance among students with and without intellectual disabilities;


(3) information regarding inclusive sports programs that have been successfully implemented in this state, in other states, and by nonprofit organizations;


(4) input from school districts and the agency; and


(5) guidance provided by impacted stakeholders, including by parents of or persons standing in parental relation to students with intellectual disabilities.


(d) The University Interscholastic League may appoint a person to provide guidance on behalf of impacted stakeholders for purposes of Subsection (c)(5).


(e) In maintaining the inclusive sports program, the University Interscholastic League shall, to the greatest extent possible, require:


(1) students who participate in the inclusive sports program to be subject to the same rules and requirements as students who participate in other athletic programs offered by the league, including:


(A) grade and disciplinary requirements under Section 33.081(c); and


(B) requirements related to student safety in athletic activities under this chapter and Chapter 38; and


(2) team sports provided through the inclusive sports program to be organized similarly to other athletic programs offered by the league, including with respect to team practices, seasonal play, and local and statewide competitions.


(f) In addition to using funds available or appropriated for the purpose, the University Interscholastic League or a partner affiliated with the league may seek and accept gifts, grants, or donations of money from public and private sources for the purpose of establishing or expanding the inclusive sports program.


Added by Acts 2021, 87th Leg., R.S., Ch. 522 (S.B. 776), Sec. 2, eff. September 1, 2021.


SUBCHAPTER E. COMMUNITIES IN SCHOOLS PROGRAM



Sec. 33.151. DEFINITIONS. In this subchapter:


(1) Repealed by Acts 2007, 80th Leg., R.S., Ch. 1204, Sec. 4, eff. September 1, 2007.


(2) "Communities In Schools program" means an exemplary youth dropout prevention program.


(3) "Delinquent conduct" has the meaning assigned by Section 51.03, Family Code.


(4) "Student at risk of dropping out of school" means:


(A) a student at risk of dropping out of school as defined by Section 29.081;


(B) a student who is eligible for a free or reduced lunch; or


(C) a student who is in family conflict or crisis.


Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Renumbered from Labor Code Sec. 216.001 by Acts 1995, 74th Leg., ch. 655, Sec. 11.05, eff. Sept. 1, 1995. Amended by Acts 1997, 75th Leg., ch. 165, Sec. 6.69, eff. Sept. 1, 1997. Redesignated from Labor Code, Sec. 305.001 and amended by Acts 1999, 76th Leg., ch. 489, Sec. 3, eff. Sept. 1, 1999. Redesignated from Family Code, Sec. 264.751 and amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.118(a), eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1205, Sec. 1, eff. Sept. 1, 2003.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 1204 (H.B. 1609), Sec. 4, eff. September 1, 2007.


Sec. 33.152. STATEWIDE OPERATION OF PROGRAM. It is the intent of the legislature that the Communities In Schools program operate throughout this state. It is also the intent of the legislature that programs established under Chapter 305, Labor Code, as that chapter existed on August 31, 1999, and its predecessor statute, the Texas Unemployment Compensation Act (Article 5221b-9d, Vernon's Texas Civil Statutes), and programs established under this subchapter shall remain eligible to participate in the Communities In Schools program if funds are available and if their performance meets the criteria established by the agency for renewal of their contracts.


Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Renumbered from Labor Code Sec. 216.002 by Acts 1995, 74th Leg., ch. 655, Sec. 11.05, eff. Sept. 1, 1995. Redesignated from Labor Code Sec. 305.002 and amended by Acts 1999, 76th Leg., ch. 489, Sec. 3, eff. Sept. 1, 1999. Redesignated from Family Code Sec. 264.752 and amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.118(a), eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1205, Sec. 1, eff. Sept. 1, 2003.


Sec. 33.154. DUTIES OF COMMISSIONER. (a) The commissioner shall:


(1) coordinate the efforts of the Communities In Schools program with other social service organizations and agencies and with public school personnel to provide services to students who are at risk of dropping out of school or engaging in delinquent conduct, including students who are in family conflict or emotional crisis;


(2) set standards for the Communities In Schools program and establish state performance goals, objectives, and measures for the program, including performance goals, objectives, and measures that consider improvement in student:


(A) behavior;


(B) academic achievement; and


(C) promotion, graduation, retention, and dropout rates;


(3) obtain information to determine accomplishment of state performance goals, objectives, and measures;


(4) promote and market the program in communities in which the program is not established;


(5) help communities that want to participate in the program establish a local funding base;


(6) provide training and technical assistance for participating communities and programs; and


(7) adopt policies concerning:


(A) the responsibility of the agency in encouraging local businesses to participate in local Communities In Schools programs;


(B) the responsibility of the agency in obtaining information from participating school districts;


(C) the use of federal or state funds available to the agency for programs of this nature; and


(D) any other areas concerning the program identified by the commissioner.


(b) The commissioner shall adopt rules to implement the policies described by Subsection (a)(7) and shall annually update the rules.


(c) Notwithstanding any provision of this subchapter, if the commissioner determines that a program consistently fails to achieve the performance goals, objectives, and measures established by the commissioner under Subsection (a)(2), the commissioner may withhold funding from that program and require the program to compete through a competitive bidding process to receive funding to participate in the program.


Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Renumbered from Labor Code Sec. 216.012 by Acts 1995, 74th Leg., ch. 655, Sec. 11.05, eff. Sept. 1, 1995. Redesignated from Labor Code Sec. 305.012 and amended by Acts 1999, 76th Leg., ch. 489, Sec. 3, eff. Sept. 1, 1999. Redesignated from Family Code Sec. 264.754 by Acts 2003, 78th Leg., ch. 198, Sec. 2.118(a), eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1205, Sec. 1, eff. Sept. 1, 2003.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 1204 (H.B. 1609), Sec. 1, eff. September 1, 2007.


Sec. 33.155. COOPERATION WITH COMMUNITIES IN SCHOOLS, INC. The agency and Communities In Schools, Inc. shall work together to maximize the effectiveness of the Communities In Schools program.


Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Renumbered from Labor Code Sec. 216.013 by Acts 1995, 74th Leg., ch. 655, Sec. 11.05, eff. Sept. 1, 1995. Redesignated from Labor Code Sec. 305.013 and amended by Acts 1999, 76th Leg., ch. 489, Sec. 3, eff. Sept. 1, 1999. Redesignated from Family Code Sec. 264.755 and amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.118(a), eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1205, Sec. 1, eff. Sept. 1, 2003.


Amended by:


Acts 2007, 80th Leg., R.S., Ch. 1204 (H.B. 1609), Sec. 1, eff. September 1, 2007.


Sec. 33.156. FUNDING; EXPANSION OF PARTICIPATION. (a) The agency shall develop and implement an equitable formula for the funding of local Communities In Schools programs. The formula may provide for the reduction of funds annually contributed by the state to a local program by an amount not more than 50 percent of the amount contributed by the state for the first year of the program. The formula must consider the financial resources of individual communities and school districts. Savings accomplished through the implementation of the formula may be used to extend services to counties and municipalities currently not served by a local program or to extend services to counties and municipalities currently served by an existing local program.


(b) Each local Communities In Schools program shall develop a funding plan which ensures that the level of services is maintained if state funding is reduced.


(c) A local Communities In Schools program may accept federal funds, state funds, private contributions, grants, and public and school district funds to support a campus participating in the program.


Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Amended by Acts 1995, 74th Leg., ch. 76, Sec. 9.40(a), eff. Sept. 1, 1995. Renumbered from Labor Code Sec. 216.021 and amended by Acts 1995, 74th Leg., ch. 655, Sec. 11.05, eff. Sept. 1, 1995. Redesignated from Labor Code Sec. 305.021 and amended by Acts 1999, 76th Leg., ch. 489, Sec. 3, eff. Sept. 1, 1999. Redesignated from Family Code Sec. 264.756 and amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.118(a), eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1205, Sec. 1, eff. Sept. 1, 2003.


Sec. 33.157. PARTICIPATION IN PROGRAM. An elementary or secondary school receiving funding under Section 33.156 shall participate in a local Communities In Schools program if the number of students enrolled in the school who are at risk of dropping out of school is equal to at least 10 percent of the number of students in average daily attendance at the school, as determined by the agency.


Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Renumbered from Labor Code Sec. 216.022 and amended by Acts 1995, 74th Leg., ch. 655, Sec. 11.05, eff. Sept. 1, 1995. Redesignated from Labor Code Sec. 305.022 and amended Acts 1999, 76th Leg., ch. 489, Sec. 3, eff. Sept. 1, 1999. Redesignated from Family Code Sec. 264.757 and amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.118(a), eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1205, Sec. 1, eff. Sept. 1, 2003.


Sec. 33.158. DONATIONS TO PROGRAM. (a) The agency may accept a donation of services or money or other property that the agency determines furthers the lawful objectives of the agency in connection with the Communities In Schools program.


(b) Each donation, with the name of the donor and the purpose of the donation, must be reported in the public records of the agency.


Acts 1993, 73rd Leg., ch. 269, Sec. 1, eff. Sept. 1, 1993. Renumbered from Labor Code Sec. 216.031 by Acts 1995, 74th Leg., ch. 655, Sec. 11.05, eff. Sept. 1, 1995. Redesignated from Labor Code Sec. 305.031 and amended by Acts 1999, 76th Leg., ch. 489, Sec. 3, eff. Sept. 1, 1999. Redesignated from Family Code Sec. 264.758 and amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.118(a), eff. Sept. 1, 2003; Acts 2003, 78th Leg., ch. 1205, Sec. 1, eff. Sept. 1, 2003.


Sec. 33.159. AGENCY PERFORMANCE OF COMMUNITIES IN SCHOOLS FUNCTIONS REQUIRED. The agency, through the Communities In Schools State Office:


(1) must perform each function concerning the Communities In Schools program for which the agency is responsible; and


(2) may not contract with a private entity to perform a function described by Subdivision (1).


Added by Acts 2007, 80th Leg., R.S., Ch. 1204 (H.B. 1609), Sec. 2, eff. September 1, 2007.


SUBCHAPTER F. SAFETY REGULATIONS FOR CERTAIN



EXTRACURRICULAR ACTIVITIES



Sec. 33.201. APPLICABILITY. This subchapter applies to each public school in this state and to any other school in this state subject to University Interscholastic League rules.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.202. SAFETY TRAINING REQUIRED. (a) The University Interscholastic League shall develop and adopt an extracurricular activity safety training program as provided by this section. In developing the program, the league may use materials available from the American Red Cross, Emergency Medical Systems (EMS), or another appropriate entity.


(b) The following persons must satisfactorily complete the safety training program in accordance with the policy adopted under Section 21.4515:


(1) a coach, trainer, or sponsor for an extracurricular athletic activity; and


(2) a director responsible for a school marching band.


(c) The safety training program must include:


(1) certification of participants by the American Red Cross, the American Heart Association, or a similar organization or by the University Interscholastic League;


(2) current training in:


(A) emergency action planning;


(B) communicating effectively with 9-1-1 emergency service operators and other emergency personnel; and


(C) recognizing symptoms of potentially catastrophic injuries, including head and neck injuries, concussions, injuries related to second impact syndrome, asthma attacks, heatstroke, cardiac arrest, and injuries requiring use of a defibrillator; and


(3) a safety drill that incorporates the training described by Subdivision (2) and simulates various injuries described by Subdivision (2)(C).


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Amended by:


Acts 2019, 86th Leg., R.S., Ch. 439 (S.B. 1376), Sec. 2.01, eff. June 4, 2019.


Acts 2021, 87th Leg., R.S., Ch. 1045 (S.B. 1267), Sec. 15, eff. June 18, 2021.


Acts 2021, 87th Leg., R.S., Ch. 1045 (S.B. 1267), Sec. 24(9), eff. June 18, 2021.


Sec. 33.203. COMPLETION OF UNIVERSITY INTERSCHOLASTIC LEAGUE FORMS. (a) Each student participating in an extracurricular athletic activity must complete the University Interscholastic League forms entitled "Preparticipation Physical Evaluation--Medical History" and "Acknowledgment of Rules." Each form must be signed by both the student and the student's parent or guardian.


(b) Each form specified by Subsection (a) must clearly state that failure to accurately and truthfully answer all questions on a form required by statute or by the University Interscholastic League as a condition for participation in an extracurricular athletic activity subjects a signer of the form to penalties determined by the University Interscholastic League.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.204. CERTAIN UNSAFE ATHLETIC ACTIVITIES PROHIBITED. A coach, trainer, or sponsor for an extracurricular athletic activity may not encourage or permit a student participating in the activity to engage in any unreasonably dangerous athletic technique that unnecessarily endangers the health of a student, including using a helmet or any other sports equipment as a weapon.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.205. CERTAIN SAFETY PRECAUTIONS REQUIRED. (a) A coach, trainer, or sponsor for an extracurricular athletic activity shall at each athletic practice or competition ensure that:


(1) each student participating in the activity is adequately hydrated;


(2) any prescribed asthma medication for a student participating in the activity is readily available to the student;


(3) emergency lanes providing access to the practice or competition area are open and clear; and


(4) heatstroke prevention materials are readily available.


(b) If a student participating in an extracurricular athletic activity, including a practice or competition, becomes unconscious during the activity, the student may not:


(1) return to the practice or competition during which the student became unconscious; or


(2) participate in any extracurricular athletic activity until the student receives written authorization for such participation from a physician.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.206. COMPLIANCE; ENFORCEMENT. (a) In accordance with Chapter 552, Government Code, a school shall make available to the public proof of compliance for each person enrolled in, employed by, or volunteering for the school who is required to receive safety training described by Section 33.202.


(b) The superintendent of a school district or the director of a school subject to this subchapter shall maintain complete and accurate records of the district's or school's compliance with Section 33.202.


(c) A school campus that is determined by the school's superintendent or director to be out of compliance with Section 33.202, 33.204, or 33.205 with regard to University Interscholastic League activities shall be subject to the range of penalties determined by the University Interscholastic League.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.207. CONTACT INFORMATION. (a) The commissioner shall maintain an existing telephone number and an electronic mail address to allow a person to report a violation of this subchapter.


(b) Each school that offers an extracurricular athletic activity shall prominently display at the administrative offices of the school the telephone number and electronic mail address maintained under Subsection (a).


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.208. NOTICE REQUIRED. (a) A school that offers an extracurricular athletic activity shall provide to each student participating in an extracurricular athletic activity and to the student's parent or guardian a copy of the text of Sections 33.201-33.207 and a copy of the University Interscholastic League's parent information manual.


(b) A document required to be provided under this section may be provided in an electronic format unless otherwise requested by a student, parent, or guardian.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.209. INCORPORATION OF SAFETY REGULATIONS. The University Interscholastic League shall incorporate the provisions of Sections 33.203-33.207 into the league's constitution and contest rules.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.210. IMMUNITY FROM LIABILITY. This subchapter does not waive any liability or immunity of a school district or its officers or employees. This subchapter does not create any liability for or a cause of action against a school district or its officers or employees.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


Sec. 33.211. LIMITATION ON LIABILITY. A person who volunteers to assist with an extracurricular activity is not liable for civil damages arising out of an act or omission relating to the requirements under Section 33.205 unless the act or omission is willfully or wantonly negligent.


Added by Acts 2007, 80th Leg., R.S., Ch. 1296 (S.B. 82), Sec. 1, eff. June 15, 2007.


SUBCHAPTER G. EXPANDED LEARNING OPPORTUNITIES COUNCIL



Sec. 33.251. DEFINITION. In this chapter, "council" means the Expanded Learning Opportunities Council.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.252. EXPANDED LEARNING OPPORTUNITIES. (a) Expanded learning opportunities may be provided during:


(1) an extended school day;


(2) an extended school year; or


(3) structured learning programs outside of the regular school day, including before- and after-school programs and summer programs.


(b) Expanded learning opportunities may be provided by offering:


(1) rigorous coursework;


(2) mentoring;


(3) tutoring;


(4) physical activity;


(5) academic support; or


(6) educational enrichment in one or more subjects, including fine arts, civic engagement, science, technology, engineering, and mathematics.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.253. ESTABLISHMENT; PURPOSES. (a) The Expanded Learning Opportunities Council is established to:


(1) study issues concerning expanded learning opportunities for this state's public school students, including:


(A) issues related to creating safe places for children outside of the regular school day, improving the academic success of students who participate in expanded learning opportunities programs, and assisting working families; and


(B) other issues prescribed under Section 33.258; and


(2) make recommendations as provided by Section 33.259 to address issues studied under this subchapter.


(b) In conducting studies under this subchapter, the council shall focus on innovative, hands-on learning approaches that complement rather than replicate the regular school curriculum.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.254. SUNSET PROVISION. The council is subject to Chapter 325, Government Code (Texas Sunset Act). Unless continued in existence as provided by that chapter, the council is abolished and this subchapter expires September 1, 2027.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Amended by:


Acts 2015, 84th Leg., R.S., Ch. 938 (H.B. 3123), Sec. 2.01, eff. June 18, 2015.


Acts 2019, 86th Leg., R.S., Ch. 596 (S.B. 619), Sec. 4.02, eff. June 10, 2019.


Sec. 33.255. COMPOSITION. The council is composed of 13 members appointed by the commissioner as follows:


(1) two members of the public, including one representing the business community and one parent of a public school student participating in an expanded learning opportunities program in this state;


(2) two members who are involved in research-based expanded learning opportunities efforts in this state so that at least one is involved in efforts to extend the school day or school year and at least one is involved in efforts to provide out of school time before or after the regular school day or during the period in which school is recessed for the summer;


(3) one member representing law enforcement;


(4) one member representing the agency;


(5) one member who is an educator, other than a superintendent, at the elementary school level;


(6) one member who is an educator, other than a superintendent, at the middle or junior high school level;


(7) one member who is an educator, other than a superintendent, at the high school level;


(8) one member who is a public school superintendent;


(9) one member representing a foundation that invests in expanded learning opportunities;


(10) one member representing a nonprofit organization that provides programs concerning good nutrition and prevention of or intervention to address childhood obesity; and


(11) one member who is a provider representing summer camps.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.256. MEETINGS. (a) The council shall meet in person at least three times each year and may hold additional meetings by conference call if necessary.


(b) Section 551.125, Government Code, applies to a meeting held by conference call under this section, except that Section 551.125(b), Government Code, does not apply.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.257. COMPENSATION. A member of the council may not receive compensation for service on the council.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.258. POWERS AND DUTIES. (a) The council shall:


(1) study issues related to expanded learning opportunities for public school students;


(2) study current research and best practices related to meaningful expanded learning opportunities;


(3) analyze the availability of and unmet needs for state and local programs for expanded learning opportunities for public school students;


(4) analyze opportunities to create incentives for businesses to support expanded learning opportunities programs for public school students;


(5) analyze opportunities to maximize charitable support for public and private partnerships for expanded learning opportunities programs for public school students;


(6) analyze opportunities to promote science, technology, engineering, and mathematics in expanded learning opportunities programs for public school students;


(7) study the future workforce needs of this state's businesses and other employers; and


(8) perform other duties consistent with this subchapter.


(b) In carrying out its powers and duties under this section, the council may request reports and other information relating to expanded learning opportunities and students in expanded learning opportunities programs from the Texas Education Agency and any other state agency.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.259. STATEWIDE EXPANDED LEARNING OPPORTUNITIES PLAN; REPORT. (a) The council shall develop a comprehensive statewide action plan for the improvement of expanded learning opportunities for public school students in this state, including a timeline for implementation of the plan.


(b) The council shall submit to both houses of the legislature, the governor, and the agency on or before November 1 of each even-numbered year a written report concerning:


(1) the status of the development or implementation of the council's statewide action plan, as applicable;


(2) any action taken to further development or implementation of the plan;


(3) any area that needs improvement in implementing the plan;


(4) any recommended change to the plan; and


(5) programs and services that address expanded learning opportunities outside of the regular school day.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


Sec. 33.260. GIFTS, GRANTS, AND DONATIONS. The agency may accept on behalf of the council a gift, grant, or donation from any source to carry out the purposes of this subchapter.


Added by Acts 2013, 83rd Leg., R.S., Ch. 531 (S.B. 503), Sec. 1, eff. June 14, 2013.


SUBCHAPTER Z. MISCELLANEOUS PROVISIONS



Sec. 33.901. BREAKFAST PROGRAMS. (a) If at least 10 percent of the students enrolled in one or more schools in a school district or enrolled in an open-enrollment charter school are eligible for free or reduced-price breakfasts under the national school breakfast program provided for by the Child Nutrition Act of 1966 (42 U.S.C. Section 1773), the board of trustees of the school district or the governing body of the open-enrollment charter school shall either:


(1) participate in the national program and make the benefits of the national program available to all eligible students in the schools or school; or


(2) develop and implement a locally funded program to provide free meals, including breakfast and lunch, to each student eligible for free meals under federal law and reduced-price meals, including breakfast and lunch, to each student eligible for reduced-price meals under federal law, provided that the reduced price may not exceed the maximum allowable rate under federal law.


(a-1) A school district is permitted under Subsection (a) to participate in the national program at one or more campuses in the district and provide a locally funded program at one or more other campuses in the district.


(b) A school district campus or an open-enrollment charter school participating in the national school breakfast program provided by the Child Nutrition Act of 1966 (42 U.S.C. Section 1773) or providing a locally funded program in which 80 percent or more of the students qualify under the national program for a free or reduced-price breakfast shall offer a free breakfast to each student.


(c) The commissioner shall grant a waiver of the free breakfast requirements under Subsection (b), not to exceed one year, to a school district campus or an open-enrollment charter school if the board of trustees of the school district or the governing body of the open-enrollment charter school votes to request the waiver at the annual meeting of the board of trustees required under Section 44.004 or an annual meeting of the governing body called to adopt a budget for the open-enrollment charter school for the succeeding fiscal year. Before voting to request a waiver under this subsection, the board of trustees or the governing body shall list the waiver as a separate item for consideration on the meeting's agenda and provide an opportunity for public comment regarding the waiver at the meeting.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Amended by:


Acts 2013, 83rd Leg., R.S., Ch. 130 (S.B. 376), Sec. 1, eff. September 1, 2013.


Acts 2015, 84th Leg., R.S., Ch. 1250 (H.B. 1305), Sec. 1, eff. June 20, 2015.


Sec. 33.902. PUBLIC SCHOOL CHILD CARE. (a) In this section, "school-age students" means children enrolled as students in prekindergarten through grade 7.


(b) Repealed by Acts 2011, 82nd Leg., 1st C.S., Ch. 8, Sec. 21(3), eff. September 28, 2011.


(c) Repealed by Acts 2011, 82nd Leg., 1st C.S., Ch. 8, Sec. 21(3), eff. September 28, 2011.


(d) The Work and Family Policies Clearinghouse may distribute money appropriated by the legislature to any school district for the purpose of implementing school-age child care before and after the school day and during school holidays and vacations for a school district's school-age students. Eligible use of funds shall include planning, development, establishment, expansion, or improvement of child care services and reasonable start-up costs. The clearinghouse may distribute money to pay fees charged for providing services to students who are considered to be at risk of dropping out of school under Section 29.081. The Texas Workforce Commission shall by rule establish procedures and eligibility requirements for distributing this money to school districts.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995. Amended by Acts 1997, 75th Leg., ch. 118, Sec. 1, eff. Sept. 1, 1997.


Amended by:


Acts 2011, 82nd Leg., 1st C.S., Ch. 8 (S.B. 8), Sec. 21(3), eff. September 28, 2011.


Sec. 33.903. COMMUNITY EDUCATION CHILD CARE SERVICES. (a) The agency shall establish a pilot program for the development of community education child care services as provided by this section. From the total amount of funds appropriated to the agency, the commissioner shall withhold an amount specified in the General Appropriations Act and distribute that amount for programs under this section. A program established under this section is required only in a school district in which the program is financed by funds distributed under this section and any other funds available for the program.


(b) The legislature may make appropriations to the agency for the purpose of supporting before- and after-school child care programs in a school district that is operating a community education development project.


(c) The agency shall actively seek federal grants or funds to operate or expand a program established under this section.


(d) The State Board of Education by rule shall establish a procedure for distributing funds to school districts for child care programs under this section. The procedure must include a statewide competitive process by which the agency shall evaluate applications for child care programs submitted by eligible school districts and award funds to those districts whose applications the agency considers to possess the greatest merit. The State Board of Education by rule shall establish guidelines and objectives that the agency shall use in making evaluations for funding determination purposes. A school district is not entitled to administrative or judicial review of the agency's funding determination, except to the extent that the State Board of Education by rule provides for administrative review.


(e) The agency may not consider a school district's application for child care funding unless the application:


(1) contains a resolution by the district's board of trustees or governing body adopting a particular child care plan;


(2) states the anticipated funding requirements for the district's child care program and provides the agency with the data and any analysis used to prepare the funding estimate;


(3) includes or is accompanied by a statement outlining how the proposed project effectuates the goals of this section and complies with the guidelines and objectives established under Subsection (d);


(4) provides that the district will provide before- and after-school care between the hours of 7 a.m. and 6 p.m. for any student in kindergarten through grade eight whose parents or legal guardians work, attend school, or participate in a job-training program during those hours;


(5) specifies that the district's child care program outlined in the application will maintain a ratio of not less than one caregiver per 20 students in kindergarten through grade three and a ratio of not less than one caregiver per 25 students in grades four through eight and will provide age-appropriate educational and recreational activities and homework assistance; and


(6) states that the district has appointed a child care administrator.


(f) A school district's child care administrator shall administer and coordinate the program under the authority of the district superintendent or another administrator the superintendent designates. The child care administrator shall appoint a coordinator to oversee the child care activities at each school site under the authority of the school's principal. Each district is encouraged to collaborate with child care management system contractors and Head Start program providers.


(g) Each school district may provide full-day care for students on school holidays and teacher preparation days and during periods school is in recess, including summer vacation.


(h) A school district may supplement any funds received under this section with funds received through other government assistance programs, program tuition, or private donations. Any tuition charge may reflect only the actual cost of care provided to the student, and the agency or other appropriate governmental agency approved by the commissioner may audit a program to ensure compliance with this subsection. A school district shall use state funds awarded under this section to benefit educationally disadvantaged children before using those funds for the care of other children.


(i) A school district may not use funds awarded under this section for student transportation unless that transportation is incident to an activity related to the curriculum of the child care program.


(j) A school district may use funds awarded under this section to contract with a private entity for providing child care services. Each of those entities shall adhere to the requirements of this section. A contract under this subsection is not effective until approved by the agency. The agency shall review each contract to ensure that the services to be delivered comply with this section. Each contract shall be awarded without regard to the race or gender of the contracting party, notwithstanding any other law.


(k) Each school district receiving funds under this section shall adopt minimum training and skills requirements that each individual providing child care or staff assistance for a district program under this section must satisfy. The agency shall determine whether those minimum requirements fulfill the aims and policies of this section and shall suspend the payment of funds to any district whose minimum requirements fail to fulfill the aims and policies of this section. The State Board of Education by rule shall adopt criteria by which the agency shall evaluate district minimum training and skills requirements. Any suspension order is subject to Chapter 2001, Government Code. A district may seek review of a suspension order under the review process adopted under Subsection (m).


(l) The State Board of Education by rule may authorize a school district to receive technical and planning assistance from a regional education service center.


(m) The agency shall monitor and review programs receiving funds under this section and may suspend funds to a school district whose programs fail to comply with this section. The State Board of Education by rule shall adopt an administrative process to review a suspension. Both a suspension order and the administrative review process are subject to Chapter 2001, Government Code.


Added by Acts 1995, 74th Leg., ch. 260, Sec. 1, eff. May 30, 1995.


Sec. 33.9031. BEFORE-SCHOOL AND AFTER-SCHOOL PROGRAMS. (a) The board of trustees of a school district may establish before-school or after-school programs for students enrolled in elementary or middle school grades. A program established under this section may operate before, after, or before and after school hours.


(b) A student is eligible to participate in a school district's before-school or after-school program if the student:


(1) is enrolled in a public or private school; or


(2) resides within the boundaries of the school district.


(c) A school district shall conduct a request for proposals procurement process to enable the district to determine if contracting with a child-care facility that provides a before-school or after-school program, as defined by Section 42.002, Human Resources Code, to provide the district's before-school or after-school program would serve the district's best interests. Following the request for proposals procurement process, the district may enter into a contract with a child-care facility or implement a before-school or after-school program operated by the district. If the district enters into a contract with a child-care facility, the contract must comply with the requirements of Section 44.031 and may not exceed a term of three years.


(d) The board of trustees of a school district may adopt rules in accordance with Section 11.165 to provide access to school campuses before or after school hours for the purpose of providing a before-school or after-school program.


Added by Acts 2017, 85th Leg., R.S., Ch. 925 (S.B. 1566), Sec. 11, eff. September 1, 2017.


Sec. 33.904. LIAISON FOR CERTAIN CHILDREN IN CONSERVATORSHIP OF STATE. (a) Each school district and open-enrollment charter school shall:


(1) appoint at least one employee to act as a liaison officer to facilitate the enrollment in or transfer to a public school or open-enrollment charter school of a child in the district or area served by the charter school who is in the conservatorship of the state; and


(2) submit the liaison's name and contact information to the agency in a format and under the schedule determined by the commissioner.


(b) The agency shall provide information to the liaisons on practices for facilitating the enrollment in or transfer to a public school or open-enrollment charter school of children who are in the conservatorship of the state.


Added by Acts 2011, 82nd Leg., R.S., Ch. 725 (H.B. 826), Sec. 1, eff. September 1, 2011.


Amended by:


Acts 2013, 83rd Leg., R.S., Ch. 579 (S.B. 832), Sec. 1, eff. June 14, 2013.


For expiration of this section, see Subsection (f).



Sec. 33.906. WEBSITE INFORMATION CONCERNING LOCAL PROGRAMS AND SERVICES AVAILABLE TO ASSIST HOMELESS STUDENTS. (a) Except as provided by Subsection (e), each school that maintains an Internet website shall post on the website information regarding local programs and services, including charitable programs and services, available to assist students who are homeless.


(b) A school to which Subsection (a) applies shall make a good faith effort to compile information described by that subsection and shall post the information compiled in a format and style that is easily understandable by students or parents, as appropriate based on the grade levels the school offers.


(c) A representative of a local program or service available to assist students who are homeless may request to have information concerning the program or service posted on a school's website. A school may determine the information that is posted on the school's website and is not required to post information as requested by the representative.


(d) A school district is not liable for any harm to a student that results in connection with a local program or service referred to on the website of a district school as provided by this section.


(e) This section does not apply to a school within a school district that:


(1) has an enrollment of fewer than 3,000 students; and


(2) is primarily located in a county with a population of less than 50,000.


(f) This section expires September 1, 2025.


Added by Acts 2015, 84th Leg., R.S., Ch. 1035 (H.B. 1559), Sec. 1, eff. June 19, 2015.


Amended by:


Acts 2019, 86th Leg., R.S., Ch. 597 (S.B. 668), Sec. 1.09, eff. June 10, 2019.


Sec. 33.907. DONATION OF FOOD. (a) In this section:


(1) "Donate" has the meaning assigned by Section 76.001, Civil Practice and Remedies Code.


(2) "Nonprofit organization" has the meaning assigned by Section 76.001, Civil Practice and Remedies Code.


(b) A school district or open-enrollment charter school may allow a campus to elect to donate food to a nonprofit organization through a person who is directly and officially affiliated with the campus, including a teacher or counselor, or through a parent of a student enrolled at the campus. The donated food may be received, stored, and distributed on the campus. Food donated by the campus may include:


(1) surplus food prepared for breakfast, lunch, or dinner meals or snacks served from the campus cafeteria, subject to any applicable local, state, and federal requirements; or


(2) food donated to the campus as the result of a food drive or similar event.


(c) The type of food donated under Subsection (b)(1) may include:


(1) packaged unserved food that is packaged on the campus of a school district or open-enrollment charter school and has not been removed from the campus cafeteria;


(2) packaged served food if the packaging and food are in good condition;


(3) whole, uncut produce; and


(4) wrapped raw unserved produce.


(c-1) Food that by law must be maintained at a certain temperature for safety may not be donated unless the campus has maintained the food at the required temperature.


(d) Food donated under this section to a nonprofit organization may be distributed at the campus at any time. Campus employees may assist in preparing and distributing the food as volunteers for the nonprofit organization.


(e) Under this program, a school district or open-enrollment charter school may adopt a policy under which the district or charter school provides food at no cost to a student for breakfast, lunch, or dinner meals or a snack if the student is unable to purchase breakfast, lunch, or dinner meals or a snack.


(f) The commissioner may adopt rules as necessary to implement this section.


Added by Acts 2017, 85th Leg., R.S., Ch. 569 (S.B. 725), Sec. 1, eff. June 9, 2017.


Amended by:


Acts 2021, 87th Leg., R.S., Ch. 610 (S.B. 1351), Sec. 1, eff. September 1, 2021.


Sec. 33.908. GRACE PERIOD POLICY FOR EXHAUSTED OR INSUFFICIENT MEAL CARD OR ACCOUNT BALANCE. The board of trustees of a school district that allows students to use a prepaid meal card or account to purchase meals served at schools in the district shall adopt a grace period policy regarding the use of the cards or accounts. The policy:


(1) must allow a student whose meal card or account balance is exhausted or insufficient to continue, for a period determined by the board, to purchase meals by:


(A) accumulating a negative balance on the student's card or account; or


(B) otherwise receiving an extension of credit from the district;


(2) must require the district to notify the parent of or person standing in parental relation to the student that the student's meal card or account balance is exhausted;


(3) may not permit the district to charge a fee or interest in connection with meals purchased under Subdivision (1); and


(4) may permit the district to set a schedule for repayment on the account balance as part of the notice to the parent or person standing in parental relation to the student.


Added by Acts 2015, 84th Leg., R.S., Ch. 875 (H.B. 3562), Sec. 1, eff. June 18, 2015.


Amended by:


Acts 2017, 85th Leg., R.S., Ch. 925 (S.B. 1566), Sec. 12, eff. September 1, 2017.


Sec. 33.909. PURPLE STAR CAMPUS. (a) In this section, "military-connected student" has the meaning assigned by Section 25.006.


(b) The agency shall designate a school district campus as a Purple Star Campus if the campus applies and qualifies for the designation under this section.


(c) To qualify as a Purple Star Campus, a campus must:


(1) designate a staff member as a military liaison, whose duties include:


(A) identifying military-connected students enrolled at the campus through the Public Education Information Management System (PEIMS);


(B) serving as the point of contact between the campus and military-connected students and their families;


(C) determining appropriate campus services available to military-connected students; and


(D) assisting in coordinating campus programs relevant to military-connected students;


(2) maintain on the campus Internet website an easily accessible web page that includes resources for military-connected students and their families, including information regarding:


(A) relocation to, enrollment at, registration at, and transferring records to the campus;


(B) academic planning, course sequences, and advanced classes available at the campus;


(C) counseling and other support services available for military-connected students enrolled at the campus; and


(D) the military liaison designated under Subdivision (1) and the liaison's duties under that subdivision;


(3) maintain a transition program led by students, where appropriate, that assists military-connected students in transitioning into the campus;


(4) offer professional development for staff members on issues related to military-connected students; and


(5) offer at least one of the following initiatives:


(A) a resolution showing support for military-connected students and their families;


(B) recognition of the Month of the Military Child or Military Family Month with relevant events hosted by the campus; or


(C) a partnership with a local military installation that provides opportunities for active duty military members to volunteer at the campus, speak at an assembly, or host a field trip.


(d) To comply with a requirement under Subsection (c)(2), (4), or (5), a school district campus may partner with the district to provide:


(1) an Internet website web page required under Subsection (c)(2) if the campus does not have an Internet website;


(2) professional development required under Subsection (c)(4); or


(3) an initiative required under Subsection (c)(5).


(e) The agency shall adopt rules as necessary to administer this section.


Added by Acts 2019, 86th Leg., R.S., Ch. 269 (S.B. 1557), Sec. 2, eff. May 28, 2019.


Sec. 33.913. TUTORING PROGRAM. (a) A member of a nonprofit teacher organization or a person who is not a member but meets the requirements under Subsection (b) may participate in a tutoring program in accordance with this section to provide supplemental instruction to students in kindergarten through grade 12 on an individualized or small-group basis.


(b) To participate in the program as a tutor, a person must:


(1) be an active or retired teacher;


(2) apply for the position in a manner specified by the nonprofit organization;


(3) designate in the application whether the person plans to provide tutoring:


(A) for compensation, on a volunteer basis, or both; and


(B) in person, online, or both; and


(4) not be included in the registry of persons not eligible for employment by a public school under Section 22.092.


(c) The superintendent or chief executive officer of each school district or open-enrollment charter school or the person designated by the superintendent or chief executive officer shall:


(1) oversee the tutoring program within the district or school; and


(2) not later than the last day of each semester, submit a report to the board of trustees of the district or the governing body of the school that includes, with respect to that semester:


(A) the number of active or retired teachers who contacted the district or school to offer tutoring services to students in the district or school; and


(B) the number of active or retired teachers who were used by the district or school as a tutor on a volunteer basis or employed by the district or school to provide tutoring services for compensation.


(d) A school district or open-enrollment charter school may use any available local, state, or federal funds to provide compensation to a person participating in the program as a tutor who is providing tutoring for compensation under the program.


(e) If an active or retired teacher who has been approved for participation in the tutoring program contacts a school district or open-enrollment charter school to provide tutoring to students in the district or school and the district or school needs tutoring assistance, the district or school may:


(1) if the teacher is providing tutoring services on a volunteer basis, use the volunteer tutoring services provided by the teacher; or


(2) if the district or school has local, state, or federal funds for purposes of the tutoring program and the teacher is providing tutoring services for compensation, employ the teacher as a tutor.


(f) At least quarterly, each nonprofit organization participating in the tutoring program shall provide to the organization's members:


(1) a description of the tutoring program and guidance on how to participate in the program; and


(2) the contact information of each person described by Subsection (c) for the school district in which the member resides, any open-enrollment charter schools located within that district, and any adjacent districts.


(g) This section does not create a cause of action or liability or an obligation or duty that provides a basis for a cause of action or liability against a nonprofit teacher organization approved by the commissioner for the purpose of participating in the tutoring program for any action taken by a member of the organization participating in the program as a tutor.


Added by Acts 2021, 87th Leg., R.S., Ch. 806 (H.B. 1525), Sec. 15, eff. September 1, 2021.


Added by Acts 2021, 87th Leg., R.S., Ch. 880 (S.B. 1356), Sec. 2, eff. June 16, 2021.

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EDUCATION CODE CHAPTER 33. SERVICE PROGRAMS AND EXTRACURRICULAR ACTIVITIES

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https://www.dallasbehavioral.com/

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(972)-982-0897 Call us today for a no cost, confidential assessment.

The Dallas Difference

Service

We excel in sensitivity to the needs of those we serve.

Teamwork

One team, with one goal: Improving the well-being of clients served.

Attitude

Through positive energy we can, and we will, meet the needs of those we serve.

Respect

We are here to better the lives of others and recognize the value of each human being.

Standards

We pledge the highest standards of patient safety, and clinical safety.

Consider this a Warm Welcome to our Guests and Their Families!
Welcome to Dallas Behavioral Healthcare Hospital! We are a 116 bed inpatient facility located in Desoto Texas and we serve the surrounding communities of Southern Dallas County with a culture committed to compassion, dignity, and respect. Our unique design allows for smaller units focused on specific treatment modalities which center around a charming courtyard.

What has been traditionally referred to as mental illness has a far greater reach into the lives of our families than was once believed. You have my personal commitment as a clinician to continue to reduce stigma and bring to our community creative and integrated solutions. This includes helping those facing the stress and anxiety of coping with depression and other brain disorders, trauma faced in childhood, and the changes we experience as our bodies and brains age.

We have a great team. Since one in five Americans is affected by a behavioral health diagnoses at one point in their lives, our team's goal is to support you through these whether it be in our inpatient setting or through our growing outpatient programs. As a family therapist I am focused on family involvement which helps support our patients and supports the healing process. We encourage developing support systems!

Each life we touch matters. We are here for you. Please explore our site, keep up with our new programs and follow us on Linked In and Facebook to see the lovely smiles and commitment that radiates from our dedicated team. We look forward to being a part of your journey into improved health and healing, and to increasing awareness about mind wellness.

It is an honor and privilege to expand support and services to our region.

Sincerely,
Sally Anne Schneider, MS
Chief Executive Officer

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Dallas Area Mental Health Clinic & Psychiatric Hospital

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(972)-982-0897 Call us today for a no cost, confidential assessment. Service We excel in sensitivity to the needs of those we serve. Teamwork One team, with one goal: Improving the well-being of clients served. Attitude Through positive energy we can, and we will, meet the needs of those we serve.

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https://www.verywellmind.com/add-and-attention-deficit-disorders-2161810

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Attention deficit disorder (ADD) is a term that is sometimes used for one of the presentations of attention-deficit/hyperactivity disorder (ADHD). ADHD is a neurological disorder that causes a range of behavior problems such as difficulties with attending to instruction, focusing on schoolwork, keeping up with assignments, following instructions, completing tasks, and social interaction.

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), this condition is officially known as "attentional deficit/hyperactivity disorder, predominantly inattentive presentation."

Symptoms of ADD (Inattentive Type ADHD)

People with the inattentive type of ADHD struggle to pay attention or stay focused for long periods of time. Some of the symptoms of this type of ADHD include:

Being easily distracted

Difficulty following directions

Difficulty staying on task

Forgetfulness

Losing personal items such as keys or books

Not paying attention to details

Problems staying organized

Short attention span

Children with ADHD without the hyperactivity component may appear to be bored or disinterested in classroom activities. They may be prone to daydreaming or forgetfulness, work at a slow pace, and turn in incomplete work.

Their assignments, desks, and lockers may look disorganized. They may lose materials at school and at home or misplace schoolwork and fail to turn in assignments. This can frustrate teachers and parents and result in the child earning poor marks in class.

Symptoms in Kids vs. Teens vs. Adults

While symptoms of the condition are similar in kids, teens, and adults, they may also change over time. Children may be more likely to be affected by symptoms of hyperactivity. These symptoms may become more noticeable and disruptive when children are in classroom settings.

While symptoms change as people grow older, teens and adults are likely to continue to experience symptoms such as poor attention, difficultly remembering information, and troubles with organization.

Press Play for Advice On Improving Focus

ADD vs. ADHD: What's the Difference?

While many people continue to use the terms ADD and ADHD interchangeably, it's important to recognize that they are not the same. Here are some key points to be aware of:

ADD is an older term for what is now known as the inattentive type of ADHD.

The term ADHD has been used to describe both inattentive and hyperactive types since the mid-1990s.

However, some people continue to use the term ADD as a way to indicate that the condition does not include hyperactivity as a symptom.

The DSM-5 currently recognizes three subtypes of ADHD: inattentive type (sometimes casually called ADD), hyperactive-impulsive type, and combined type.

ADD (inattentive type ADHD) doesn't manifest itself in the same way that predominantly hyperactive-impulsive or combined types do. Children with these presentations have different symptoms.

Children with the other two presentations of ADHD, for example, tend to act out or exhibit behavior problems in class. Children with inattentive type ADHD are generally not disruptive in school. They may even sit in class quietly, but that doesn't mean their disorder isn't a problem and that they're not struggling to focus. In addition, not all children with inattentive type ADHD are alike.

Children with combined type ADHD display several symptoms of both hyperactive-impulsive type and inattentive type.

If you suspect your child has ADHD, talk to your child's school counselor, teacher, or physician about appropriate treatment. If you have any concerns, begin these discussions today. Earlier intervention can ensure that your child experiences fewer disruptions due to their condition.

Your child's pediatrician may recommend seeing a child psychologist who can do formal testing to see if your child fits the criteria for ADHD and, if so, where they fall on the spectrum. Not only can this testing help differentiate ADHD from other issues that may be causing difficulty with schoolwork, but it can be used to follow a child's response to interventions over time.

Primarily Inattentive ADHD (Previously ADD)

When people use the term ADD, they are likely referring to this type of ADHD. Some of the behaviors that someone with this type might experience include forgetfulness, problems with organization, difficulty listening, and lack of focus.

To be diagnosed with this type, a person must display six of the following nine symptoms:

Difficulty sustaining attention

Often seeming to not be listening

Failing to pay attention to details

Difficulty organizing tasks and activities

Frequently losing things

Getting easily distracted

Forgetfulness

Avoiding tasks that required sustained mental effort

Trouble following instructions

Hyperactive-Impulsive ADHD

This presentation of ADHD is characterized by hyperactive and impulsive behavior. To be diagnosed, a person must display six of the following symptoms:

Fidgeting hands and feet or squirming while seated

Running or climbing inappropriately or feelings of restlessness

Difficulty engaging in activities quietly

Seeming to always be on the go

Excessive talking

Blurting out responses

Problems taking turns

An inability to stay seated

Frequently interrupting others

Combined Type ADHD

This presentation of ADHD involves exhibiting symptoms of both the inattentive and hyperactive-impulsive types. To be diagnosed with this type of ADHD, a person must display six or more inattention symptoms and six or more hyperactive-impulsive ADHD symptoms.

Inattentive Type ADHD in Girls

There is no cure for ADHD, but treatment can help children manage their symptoms and improve daily functioning. Treatment for ADHD often involves medications, behavioral interventions, or a combination of the two. The type of treatment chosen depends on the child's symptoms and needs.

Medications

ADHD is often treated with one of three types of medication: psychostimulants, antidepressants, or non-stimulant drugs. These medications can help children with inattentive type ADHD (ADD) stay on task and focused.

Psychostimulants: Psychostimulants affect neurotransmitters in the brain, and may help to boost energy and increase alertness. The extended-release form is often recommended (instead of the immediate-release form). Psychostimulants include amphetamines such as Adderall and methylphenidates such as Ritalin and Concerta.

Antidepressants: Antidepressants also affect neurotransmitters in the brain, and may help to improve mood and attention. Common antidepressants prescribed for the inattentive presentation of ADHD include Wellbutrin (bupropion) and Effexor (venlafaxine).

Non-stimulant drugs: Non-stimulant medications can be helpful for those who experience unwanted side effects from stimulants and include Strattera (atomoxetine), Qelbree (viloxazine), and Intuniv (guanfacine). Non-stimulants affect a specific neurotransmitter, norepinephrine, and may help to regulate emotions and improve focus on specific tasks.

As with any medication, there are common side effects. Psychostimulants, antidepressants, and non-stimulants can cause dizziness, loss of appetite, upset stomach, and more. Be sure to talk to your doctor if you notice that your child is experiencing any unusual symptoms.

Behavior Management

Whether or not parents choose medication as a treatment option, most physicians and child psychologists suggest that a behavior intervention plan should be developed to help teach kids adaptive behavior skills and reduce off-task and inattentive behaviors.

Often, a combination of various methods is used, including:

Behavior therapy: With young children, a therapist will usually meet with you and your child. A session often includes the therapist facilitating a conversation with your child or even providing them with an activity to help them express their feelings. Your doctor or therapist might recommend family therapy so that all members of the family can learn healthy ways of managing your child's condition.

Parent training in behavior management: Recommended for parents of children under 12 years old, a therapist will train the parent to facilitate their child's behavior changes. You will learn strategies such as play therapy and talk therapy to allow your child to freely express their feelings and help them adopt healthy coping mechanisms to deal with tough emotions.

Behavioral interventions at school: Your child may meet the criteria for extra assistance under the Individuals With Disabilities Education Act (IDEA), or Section 504 of the Rehabilitation Act of 1973. Accommodations may include extra time on tests, additional break time, changes to their environment, positive reinforcement, and assignments made specifically for your child.

Behavioral peer interventions: With this approach, a therapist or trained professional will lead a group of children in activities that teach them how to interact constructively with their peers. Skills are taught such as having conversations, coping with teasing, and making friends. Parents and teachers may be trained to reinforce the lessons at home and at school.

Many people find that holistic methods are effective at managing the behavioral symptoms of ADHD in children. Engaging in regular physical exercise has been shown to boost mood, improve attention and executive functioning in adults and children with ADHD.

Studies have shown improved focus and emotional regulation in people with ADHD after they practiced yoga.

Diet may also play a role in managing behaviors of ADHD. There is some research that indicates fried food, added sugars, salt, and artificial ingredients may worsen behavioral problems and attention.

However, more studies are needed to understand how diet affects ADHD. Talk to your child's doctor to make sure they are getting adequate nutrition, regular meals, and a high intake of vegetables-all of which are linked with improved mood in children with ADHD.

A Word From Verywell

If you think that your child may have "ADD," it is important to talk to your child's doctor about inattentive type ADHD. Effective treatments are available that can help kids who struggle with inattention, and early intervention can prevent the disorder from taking a detrimental toll on their life.

Some parents fear the stigma associated with getting their child evaluated for ADHD. It's important to talk to your child so that they know that everyone has different skills and abilities. By getting treatment, you can help your child develop new skills and ways of coping with their symptoms.

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Symptoms of Attention Deficit Disorder Without Hyperactivity

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Attention deficit disorder (ADD) is a term that is sometimes used for one of the presentations of attention-deficit/hyperactivity disorder (ADHD). ADHD is a neurological disorder that causes a range of behavior problems such as difficulties with attending to instruction, focusing on schoolwork, keeping up with assignments, following instructions, completing tasks, and social interaction.

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Obsessive Compulsive Behaviors in the School Setting

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Obsessive Compulsive Behaviors in the School Setting

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https://www.counseling.org/docs/default-source/vistas/article_17.pdf?sfvrsn=fc3e0e4_12

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ADHD in the Classroom; Helping Students Succeed

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ADHD in the Classroom; Helping Students Succeed

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https://www.cdc.gov/ncbddd/adhd/school-success.html

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Centers for Disease Control and Prevention

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Children with attention-deficit/hyperactivity disorder (ADHD) experience more obstacles in their path to success than the average student. The symptoms of ADHD, such as inability to pay attention, difficulty sitting still, and difficulty controlling impulses, can make it hard for children with this diagnosis to do well in school.

To meet the needs of children with ADHD, schools may offer

ADHD treatments, such as behavioral classroom management or organizational training;

Special education services; or

Accommodations to lessen the effect of ADHD on their learning.

Classroom Treatment Strategies for ADHD Students

There are some school-based management strategies shown to be effective for ADHD students: behavioral classroom management and organizational training.

The behavioral classroom management approach encourages a student's positive behaviors in the classroom, through a reward systems or a daily report card, and discourages their negative behaviors. This teacher-led approach has been shown to influence student behavior in a constructive manner, increasing academic engagement. Although tested mostly in elementary schools, behavioral classroom management has been shown to work students of all ages.

Organizational training teaches children time management, planning skills, and ways to keep school materials organized in order to optimize student learning and reduce distractions. This management strategy has been tested with children and adolescents.

These two management strategies require trained staff-including teachers, counselors, or school psychologists-follow a specific plan to teach and support positive behavior.

The American Academy of Pediatrics (AAP) recommends that the school environment, program, or placement is a part of any ADHD treatment plan. AAP also recommends teacher-administered behavior therapy as a treatment for school-aged children with ADHD. You can talk to your child's healthcare provider and teachers about working together to support your child.

Special Education Services and Accommodations

Most children with ADHD receive some school services, such as special education services and accommodations. There are two laws that govern special services and accommodations for children with disabilities:

The Individuals with Disabilities Education Act (IDEA)

Section 504 of the Rehabilitation Act of 1973

The support a child with ADHD receives at school will depend on if they meet the eligibility requirements for one of two federal plans funded by IDEA and Section 504: an individualized education program (IEP) or a 504 Plan.

What are the main differences between the two Plans?

IEPs provide individualized special education services to meet the unique needs of the child.

A 504 Plan provides services and changes to the learning environment to meet the needs of the child as adequately as other students.
Learn more about IEP and 504 Plans [PDF - 2.75 MB]
Accommodations

IEP and 504 Plans can offer accommodations for students to help them manage their ADHD, including:

Extra time on tests;

Instruction and assignments tailored to the child;

Positive reinforcement and feedback;

Using technology to assist with tasks;

Allowing breaks or time to move around;

Changes to the environment to limit distraction; and

Extra help with staying organized.

There is limited information about which types of accommodations are effective for children with ADHD. However, there is evidence that setting clear expectations, providing immediate positive feedback, and communicating daily with parents through a daily report card can help.

What Teachers Can Do To Help

For teachers, helping children manage their ADHD symptoms can present a challenge. Most children with ADHD are not enrolled in special education classes, but do need extra assistance on a daily basis. The National Resource Center on ADHD provides information for teachers from experts on how to help students with ADHD.

Here are some tips for classroom success.

Communication

Give frequent feedback and attention to positive behavior;

Be sensitive to the influence of ADHD on emotions, such as self-esteem issues or difficulty regulating feelings;

Provide extra warnings before transitions and changes in routines; and

Understand that children with ADHD may become deeply absorbed in activities that interest them (hyper-focus) and may need extra assistance shifting their attention.

Assignments and Tasks

Make assignments clear-check with the student to see if they understand what they need to do;

Provide choices to show mastery (for example, let the student choose among written essay, oral report, online quiz, or hands-on project;

Make sure assignments are not long and repetitive. Shorter assignments that provide a little challenge without being too hard may work well;

Allow breaks-for children with ADHD, paying attention takes extra effort and can be very tiring;

Allow time to move and exercise;

Minimize distractions in the classroom; and

Use organizational tools, such as a homework folder, to limit the number of things the child has to track.

Develop a Plan That Fits the Child

Observe and talk with the student about what helps or distracts them (for example, fidget tools, limiting eye contact when listening, background music, or moving while learning can be beneficial or distracting depending on the child);

Communicate with parents on a regular basis; and

Involve the school counselor or psychologist.

Close collaboration between the school, parents, and healthcare providers will help ensure the child gets the right support.

Parent Education and Support

CDC funds the National Resource Center on ADHD (NRC), a program of Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD). The NRC provides resources, information, and advice for parents on how to help their child. Learn more about their services.

How to best advocate for your child

Understand your child's diagnosis, how it impacts their education, and what can be done at home to help.

Understand your child's IEP. If you have questions, don't be afraid to ask.

Speak with your child's teacher.

When possible, obtain written documentation from teachers, administrators, or other professionals working with your child.

Know your rights.

Play an active role in preparing your child's IEP or 504 Plan.

Keep careful records, including written documentation, communication between home and school, progress reports, and evaluations.

Try to maintain a good working relationship with the school while being a strong advocate for your child.

Communicate any concerns you may have about your child's progress or IEP or 504 Plan.

Encourage your child every day, and work with your child to create a system to help with homework and other school projects.

What every parent should know

More Information

Reference

1. Evans S, Owens J, Bunford N. Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology 2014;43(4):527-551 [Read overview]

2. DuPaul GJ, Chronis-Tuscano A, Danielson ML, Visser SN. Predictors of receipt of school services in a national sample of youth with ADHD. Journal of Attention Disorders Published online December 10, 2018. [Read summary]

3. Harrison JR, Bunford N, Evans SW, Owens JS. Educational accommodations for students with behavioral challenges: A systematic review of the literature. Review of Educational Research 2013;83(4):551-97.

4. Moore DA, Russell AE, Matthews J, Ford TJ, Rogers M, Ukoumunne OC, et al. School-based interventions for attention-deficit/hyperactivity disorder: A systematic review with multiple synthesis methods. Review of Education. Published online October 18, 2018.

5. https://chadd.org/for-parents/individuals-with-disabilities-education-act/

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To meet the needs of children with ADHD, schools may offer ADHD treatments, special education services, or accommodations to lessen the effect of ADHD on their learning.

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https://www.med.unc.edu/psych/cecmh/archived-old-pages/iii-what-are-psychotic-disorders/

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UNC Center for Excellence in Community Mental Health

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Psychotic disorders are mental illnesses that are characterized by psychotic symptoms, which can generally be described as a loss of contact with reality. These types of disorders include schizophrenia, schizoaffective disorder and schizophreniform disorder. These disorders affect a person’s ability to perceive the world and to process information. For simplicity, we will concentrate on schizophrenia in this manual. There is a wide range in severity for individuals with psychotic disorders. Some people with these types of disorders return to normal functioning with treatment; others have varying levels of disability.

Warning Signs of Psychosis

Family and friends can help people with schizophrenia and other psychotic disorders by learning to recognize the warning signs of psychosis. Early intervention may help slow the progress of the illness and minimize the risk of relapse and long-term effects. Although each person is unique, and no two people will experience the same symptoms, here are some common indications of psychosis:

Change in sleeping habits (too much or too little sleep)

Withdrawal from family and friends

Disorganized, hard-to-understand speech, or diminished verbal interaction with others

Lack of emotional response

Decreased motivation; inability to concentrate or focus

Exhibiting unusual behavior, hoarding objects, or wearing strange clothing

Suspiciousness or hostility

Having strange or unbelievable ideas, such as “My parents are poisoning my food.”

Hallucinations

While some of these symptoms can be attributed to other causes (depression, adolescence, etc.), if you notice these warning signs, contact a mental health professional.

Schizophrenia

Schizophrenia and Brain Function

Possible Causes of Schizophrenia

Medication for Schizophrenia

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III. What Are Psychotic Disorders? - UNC Center for Excellence in Community Mental Health

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Psychotic disorders are mental illnesses that are characterized by psychotic symptoms, which can generally be described as a loss of contact with reality. These types of disorders include schizophrenia, schizoaffective disorder and schizophreniform disorder. These disorders affect a person’s ability…

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https://www.nimh.nih.gov/health/topics/schizophrenia

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National Institute of Mental Health (NIMH)

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Learn about schizophrenia, including onset & symptoms, risk factors, treatments and therapies, how to help a loved one, & resources for more information.

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Schizoaffective Disorder: Symptoms, Diagnosis, and Treatment

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Schizoaffective Disorder: Symptoms, Diagnosis, and Treatment

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Schizoaffective disorder is a chronic mental health condition characterized primarily by symptoms of schizophrenia, such as hallucinations or delusions, and symptoms of a mood disorder, such as mania and depression.

Many people with schizoaffective disorder are often incorrectly diagnosed at first with bipolar disorder or schizophrenia. Because schizoaffective disorder is less well-studied than the other two conditions, many interventions are borrowed from their treatment approaches.

Schizoaffective is relatively rare, with a lifetime prevalence of only 0.3%. Men and women experience schizoaffective disorder at the same rate, but men often develop the illness at an earlier age. Schizoaffective disorder can be managed effectively with medication and therapy. Co-occurring substance use disorders are a serious risk and require integrated treatment.

Symptoms

The symptoms of schizoaffective disorder can be severe and need to be monitored closely. Depending on the type of mood disorder diagnosed, depression or bipolar disorder, people will experience different symptoms:

Hallucinations, which are seeing or hearing things that aren't there.

Delusions, which are false, fixed beliefs that are held regardless of contradictory evidence.

Disorganized thinking. A person may switch very quickly from one topic to another or provide answers that are completely unrelated.

Depressed mood. If a person has been diagnosed with schizoaffective disorder depressive type they will experience feelings of sadness, emptiness, feelings of worthlessness or other symptoms of depression.

Manic behavior. If a person has been diagnosed with schizoaffective disorder: bipolar type they will experience feelings of euphoria, racing thoughts, increased risky behavior and other symptoms of mania.

Causes

The exact cause of schizoaffective disorder is unknown. A combination of causes may contribute to the development of schizoaffective disorder.

Genetics. Schizoaffective disorder tends to run in families. This does not mean that if a relative has an illness, you will absolutely get it. But it does mean that there is a greater chance of you developing the illness.

Brain chemistry and structure. Brain function and structure may be different in ways that science is only beginning to understand. Brain scans are helping to advance research in this area.

Stress. Stressful events such as a death in the family, end of a marriage or loss of a job can trigger symptoms or an onset of the illness.

Drug use. Psychoactive drugs such as LSD have been linked to the development of schizoaffective disorder.

Diagnosis

Schizoaffective disorder can be difficult to diagnose because it has symptoms of both schizophrenia and either depression or bipolar disorder. There are two major types of schizoaffective disorder: bipolar type and depressive type. To be diagnosed with schizoaffective disorder a person must have the following symptoms.

A period during which there is a major mood disorder, either depression or mania, that occurs at the same time that symptoms of schizophrenia are present.

Delusions or hallucinations for two or more weeks in the absence of a major mood episode.

Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the illness.

The abuse of drugs or a medication are not responsible for the symptoms.

Treatment

Schizoaffective disorder is treated and managed in several ways:

Medications, including mood stabilizers, antipsychotic medications and antidepressants

Psychotherapy, such as cognitive behavioral therapy or family-focused therapy

Self-management strategies and education

Related Conditions

A person with schizoaffective disorder may have additional mental health conditions:

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Schizoaffective disorder is a chronic mental health condition characterized primarily by symptoms of schizophrenia, such as hallucinations or delusions, and symptoms of a mood disorder, such as mania and depression. Many people with schizoaffective disorder are often incorrectly diagnosed at first with bipolar disorder or schizophrenia.

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

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Centers for Disease Control and Prevention

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

Oppositional Defiant Disorder

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

Examples of ODD behaviors include

Often being angry or losing one's temper

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

Often resentful or spiteful

Deliberately annoying others or becoming annoyed with others

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

Learn more about ODD
Conduct Disorder

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

Examples of CD behaviors include

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

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

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

Learn more about CD
Treatment for disruptive behavior disorders

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

Get help finding treatment

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

Managing Symptoms: Staying Healthy

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

Engaging in regular physical activity, including aerobic and vigorous exercise

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

Getting the recommended amount of sleep each night based on age

Strengthening relationships with family members

Prevention of disruptive behavior disorders

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

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

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Behavior or Conduct Problems in Children | CDC

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

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116281/

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Clinical Points

■ Hallucinatory experiences and delusions are more common in our patients than we may realize and occur frequently in the pediatric population. While not a benign occurrence, psychotic symptoms do not necessarily portend the future development of schizophrenia.

■ Psychotic symptoms in children and adolescents can occur in the context of a bevy of psychiatric disorders other than schizophrenia (eg, depression, anxiety, attention-deficit/hyperactivity disorder, posttraumatic states, and autism spectrum disorders) or can be secondary to a wide variety of medical conditions.

■ The onset of psychosis is usually preceded by a period of nonpsychotic symptoms known as prodromal symptoms. In recent years, there has been substantial research in early intervention efforts (eg, with psychotherapy or antipsychotic medicines) focused on the early stages of schizophrenia and on young people with prodromal symptoms. At present, outcome data are insufficient to draw definitive conclusions.

■ The pharmacologic treatment of psychotic symptoms in a pediatric population is similar in many ways to the treatment of infection with antibiotics-the clinician needs to choose the proper medication at a sufficient dose and then await therapeutic results while monitoring for potential side effects.

Over the past decade, psychiatric illnesses and, in particular, psychotic disorders in children and adolescents have been recognized more frequently. This increase in recognition, combined with changing trends in the provision of mental health care, has led primary care physicians and pediatricians to increasingly serve as the principal treaters of psychiatrically ill youth and their families. Primary care providers and behavioral health services (eg, in colocated care, embedded care practices, patient-centered homes, and consultation) form the backbone of contemporary psychosis evaluation and management. It is unclear whether psychotic disorders in younger individuals are actually becoming more prevalent, or whether educational efforts directed at enhanced screening and treatment have improved case detection. Efficacious and safe interventions should be employed to maximize beneficial effects and to minimize medication-related complications, such as weight gain, diabetes, and heart disease.

The question for today's health care providers is not whether psychotic symptoms will be encountered in daily practice, but how to confidently and effectively diagnose and treat the conditions in which they manifest. In order to frame this discussion, several areas of inquiry will be explored: "Have you ever been unsure about whether a young person in your practice was psychotic or simply imaginative? Have you wondered how to evaluate such a patient (eg, with laboratory testing or with neuropsychological testing) and what resources to recommend? Have you been concerned about using antipsychotics in young people? Does the potential for adverse side effects of antipsychotics in the short-term or long-term concern you?" For practitioners faced with these concerns, the following discussion should prove useful.

WHAT IS PSYCHOSIS AND HOW COMMON IS IT IN YOUNG PEOPLE?

Narrowly defined, psychosis denotes the presence of either delusions (false implausible beliefs) or hallucinations (false perceptions involving any sensory modality). Broader definitions of psychosis include manifestations of thought disorders, behavioral disorganization, or catatonia. Family members, particularly parents, are often concerned that children who manifest delusions or hallucinations might have schizophrenia. Fortunately, most forms of psychosis in children and adolescents are not a result of schizophrenia.

Population-based surveys show that the prevalence of psychotic symptoms may be far greater than had been previously considered, with a meta-analysis suggesting a prevalence rate of 5%-8% in the general population (which is nearly 10 times higher than the prevalence of diagnosed psychotic disorders). Prevalence rates of such symptoms may be even higher among young people. In 2000, Poulton and colleagues reported that 14% of 11-year-old children endorsed psychotic symptoms upon interview and showed that these symptoms were associated with a 5-fold to 16-fold increased rate of psychotic illness in early adulthood (depending on the strength of the initial symptoms). Since then, large, population-based studies surveying psychotic symptoms among adolescents have found rates of 9%-14% in interview-based studies, and rates greater than 25% in some studies using self-report questionnaires. ⁻ Positive answers on self-report questionnaires have been validated on clinical interview. This emerging body of research suggests that a sizable minority of young people experience psychotic symptoms.

DOES THE PRESENCE OF PSYCHOTIC SYMPTOMS NECESSARILY PORTEND A DIAGNOSIS OF SCHIZOPHRENIA?

However, rather than being a harbinger of schizophrenia, psychotic symptoms in childhood and adolescence more likely accompany other psychiatric conditions (eg, major depression, bipolar disorder, or dissociative states). lists psychiatric disorders that can be accompanied by psychosis. Differentiating early-onset schizophrenia or childhood-onset schizophrenia from other psychiatric disorders has important treatment implications. For example, a pediatric patient with bipolar disorder often experiences hallucinations and delusions but also has the clinical characteristics of mania, depression, or both. In children with psychological trauma-related hallucinations (typically associated with nightmares and trance-like states), psychotic symptoms may quickly abate with psychotherapeutic and/or social interventions. Compared to traumatized children, children with schizophrenia are more apt to display a formal thought disorder, negative symptomatology (eg, apathy, social isolation), and impulsive aggression. Like children and adolescents with schizophrenia, those with autism spectrum disorders may also have odd beliefs (eg, believing that they are able to communicate with valued inanimate toys). Children with milder forms of autism (eg, Asperger's syndrome) may be misdiagnosed with psychosis due to their idiosyncratic beliefs, social awkwardness, and concrete thought process. Taking a comprehensive clinical history helps to disentangle diagnostic uncertainties.

Table 1

Psychotic symptoms have been associated with, or are secondary to, a wide variety of medical disorders as well. Psychosis may develop in response to central nervous system lesions, as a consequence of medical illness, or after traumatic injury or drug use. Recently, reports have linked a particularly severe form of new-onset psychosis-often associated with insomnia, catatonia, and autonomic instability-to antibodies against the glycine-binding NR ₁ subunits of the anti- N-methyl-d-aspartate (NMDA) receptor. Overall, studies from the adult literature show that about 3% of new-onset presentations of psychosis can be attributed to a medical condition., Therefore, before making a diagnosis of a primary psychotic disorder, secondary causes should be ruled out by a thorough-but not indiscriminate-medical workup.

WHAT ARE PRESENTING CHARACTERISTICS OF PSYCHOSIS IN CHILDREN AND ADOLESCENTS?

The most common manifestations in young people with psychosis are hallucinations, impaired functioning, flattened affect, and social withdrawal., Caregivers are more likely than the child patients themselves to report these problems to the clinician, as children often minimize, misinterpret, or avoid mentioning their symptoms. Hence, a comprehensive psychiatric assessment should include interviews with the child and his or her family members, review of records, information gathered from other involved adults (including a detailed description of the presentation and course of the psychotic symptoms), attention to developmental delays, a family psychiatric history, a history of abuse and/or neglect, and a mental status examination.,

Unlike adults, children with psychosis rarely demonstrate waxy flexibility or become catatonic. On the other hand, they can be emotionally reactive or agitated. The majority of children with childhood-onset schizophrenia often exhibit "soft" neurologic signs, including primitive reflexes, abnormal stereognosis, 2-point discrimination, and dysdiadochokinesia (impaired rapid alternating movements). Affected youth may manifest either a decreased or increased rate of eye blinking, as well as paroxysmal saccadic eye movements (inability to follow an object with smooth eye movements).

HOW ARE CHILDREN AND ADOLESCENTS DIAGNOSED WITH SCHIZOPHRENIA?

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5) made several changes to the category of schizophrenia, including raising the symptom threshold. A diagnosis of schizophrenia now requires 2 of the following conditions: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms such as affective flattening or paucity of thought or speech (in the manual's previous editions, the threshold was 1). To meet diagnostic criteria, symptoms must be present for at least 6 months (including at least 1 month of active symptoms); must result in deterioration in social, school-related, and self-care functioning; and should not be accounted for by a diagnosis of schizoaffective disorder, a mood disorder, a substance use disorder, or general medical conditions.

Additionally, an "attenuated psychosis syndrome" was included in the research section as a category for persons who do not meet criteria for a full-blown psychotic disorder but exhibit minor variations of relevant symptoms. This category seeks to identify individuals with an increased risk for developing a psychotic disorder, which may be significant for the implementation of effective early interventions.

Personality tests and projective tests should not be used to diagnose schizophrenia in youth; research indicates that tests, such as the Rorschach, do not increase the diagnostic accuracy in early-onset schizophrenia.

WHAT CAUSES SCHIZOPHRENIA IN CHILDHOOD AND ADOLESCENCE?

While there is no single confirmed etiology of childhood-onset or early-onset schizophrenia, it is likely that genetic, behavioral, and environmental factors all contribute to the development of this disease.

Genetic risk has been well-studied. First-degree relatives of patients with childhood-onset schizophrenia have a higher prevalence rate of schizophrenia and schizophrenia spectrum disorders, as well as impairment in smooth pursuit eye movements similar to those observed in patients with adult-onset schizophrenia. One study found that healthy siblings of patients with childhood-onset schizophrenia had decreased cerebral gray matter in the same pattern as was seen in the probands. In an investigation of youth identified as being at "high risk," the young relatives of patients with schizophrenia demonstrated an increased rate of Axis I psychopathology (eg, attention-deficit/hyperactivity disorder [ADHD], conduct disorder), soft neurologic signs, and a high level of outwardly expressed emotion. On neuropsychological examination, these "high-risk" nonprobands also demonstrated impairment in attention, spatial working memory, and executive function, as well as a volume reduction in the amygdala, hippocampus, and superior temporal gyrus.

WHICH NEURODEVELOPMENTAL AND NEUROBIOLOGICAL ABNORMALITIES ARE ASSOCIATED WITH YOUTH WHO DEVELOP SCHIZOPHRENIA?

Structural brain abnormalities are an established feature of schizophrenia, and recent evidence suggests a progressive nature of this pathology. Like adults with schizophrenia, youth with childhood-onset schizophrenia show bilateral enlargement of the lateral ventricles on neuroimaging. However, unlike adults, the abnormalities in brain morphology in patients with childhood-onset schizophrenia evolve during adolescence. Rapoport and associates, reported that adolescents with schizophrenia have significantly reduced frontal and temporal gray matter volumes compared with those observed in healthy age-matched controls. Moreover, youth with childhood-onset schizophrenia appear to lose more cortical gray matter compared to children who suffer from transient psychosis. Subsequent studies from this group have shown that the healthy siblings of afflicted patients also have reductions in cerebral volume and gray matter. Similar to patients with adult-onset schizophrenia, over the course of development, youth with childhood-onset schizophrenia appear to lose cortical thickness in prefrontal and temporal regions, regardless of their treatment with medications. In a systematic review of 66 articles comparing brain volume in patients with a first psychotic episode with the volume seen in healthy controls, a meta-analysis demonstrated that whole-brain and hippocampal volumes are reduced and that ventricular volumes are increased in affected patients compared to healthy controls. Future improvements in neuroimaging technology hold the potential to reveal more about neurobiological disturbances and their correlates in schizophrenia. Yet, at present, results of neuroimaging studies have not made the leap from bench to bedside.

WHICH NEUROTRANSMITTERS ARE THOUGHT TO BE INVOLVED IN SCHIZOPHRENIA?

The neurotransmitter most commonly implicated in the pathophysiology of schizophrenia is dopamine. Drugs that increase dopaminergic receptor activity (eg, cocaine, amphetamines) may induce an acute psychotic episode, whereas drugs that block postsynaptic D ₂ receptors help to alleviate psychotic symptoms. Furthermore, persons with schizophrenia also have fewer D ₁ receptors in the prefrontal cortex. Disturbances in a variety of other neurotransmitters such as glutamate, serotonin, and γ-aminobutyric acid (GABA) have been implicated in the pathophysiology of schizophrenia. Researchers are also interested in glutamate because phencyclidine (PCP or angel dust) is an NMDA/glutamine antagonist; NMDA receptor dysfunction can also cause psychotic symptoms. As mentioned earlier, anti-NMDA receptor antibodies, sometimes secondary to teratomas or autoimmune dysfunction, can cause psychosis in children, often in conjunction with autonomic instability and seizures. Serotonin may also be important; most second-generation antipsychotics share relatively potent antagonism of serotonin 5-HT 2A receptors coupled with relatively weaker antagonism of dopamine D ₂ receptors. Preliminary studies suggest that GABA may also play a role in the development of chronic psychotic syndromes. Overall, disrupted neurotransmission and cognitive functions are key components in the pathophysiology of schizophrenia; however, no single neurotransmitter is clearly responsible for the onset and progression of schizophrenia.

ARE THERE ENVIRONMENTAL RISKS FOR THE DEVELOPMENT OF SCHIZOPHRENIA?

It is clear now that "the grass is not greener," as data from 6 longitudinal studies in 5 countries have shown that regular cannabis use predicts an increased risk for schizophrenia and symptoms of psychosis. Cannabis use during early adolescence coupled with a specific genetic vulnerability and changes in brain development are correlated with risk for the development of schizophrenia and overall cognitive decline. However, the direction of the effect has been called into question. Some suggest that individuals with psychosis use cannabis to alleviate their psychotic symptoms or to improve their mood. Others, however, suggest that cannabis causes or exacerbates psychotic symptoms. A pooled analysis of 35 studies showed a dose-response effect, with greater risk of psychosis in people who used cannabis most frequently. Moreover, individuals with schizophrenia who are moderate to heavy cannabis users show a greater brain volume reduction over a 5-year follow-up compared with nonusers.

Despite the fact that fewer adolescents believe that regular cannabis use is harmful to their health and increasingly permissive state laws governing the use of medical marijuana, the medical literature presents clear evidence for a neurotoxic effect of cannabis on the adolescent brain. These findings highlight the importance of efforts targeting adolescent cannabis use, including policy measures and psychoeducation in the doctor's office.

HOW CAN ONE DISTINGUISH PRIMARY PSYCHOSIS FROM SECONDARY PSYCHOSIS?

A thorough medical workup is essential for distinguishing between primary and secondary psychotic disorders. lists medical disorders that have been associated with psychosis. Although there is no generally agreed-upon medical evaluation that every patient with psychosis should undergo,, screening tests should be ordered on the basis of a patient's personal and family history, as well as on the basis of one's clinical suspicion of conditions. Blanket testing for rare disorders may increase the risk of false-positive or false-negative results. On the other hand, the search for medical etiologies of psychosis may be expanded in the face of atypical presentations or when cases are refractory to standard treatments.

Table 2

Infections

Creutzfeldt-Jakob disease

Herpes encephalitis

Human immunodeficiency virus infection

Lyme disease

Subacute bacterial endocarditis

Sydenham's chorea

Metabolic disturbances

Adrenocortical insufficiency

Cushing's disease

Hypercalcemia or hypocalcemia

Hypermagnesemia or hypomagnesemia

Hypernatremia or hyponatremia

Hyperthyroidism

Hypoglycemia

Hypokalemia

Hypophosphatemia

Lactic acidosis

Panhypopituitarism

Parathyroid disease

Thyroid storm

Neurologic

Cerebral neoplasms

Cerebrovascular disease

Cerebral lipidoses

Complex partial auras or seizures

Creutzfeldt-Jakob disease

Encephalitis (including anti- N-methyl-d-aspartate receptor encephalitis)

Focal lesions of temporal and parietal lobe

Generalized seizures

Hepatic encephalopathy

Herpes encephalitis

Multiple sclerosis

Normal pressure hydrocephalus

Temporal arteritis

Postnoxic encephalopathy

Posttraumatic encephalopathy

Fragile X syndrome

Klinfelter's syndrome

Metachromic leukodystrophy

Prader-Willi syndrome

Velocardiofacial syndrome

Wilson's disease

Vitamin deficiencies

Folate deficiency

Niacin deficiency

Vitamin B ₁₂ deficiency

Vitamin D insufficiency

Medications

Drug classes that can cause hallucinations or delusions

Amphetamine-like drugs

Anabolic steroids

Angiotensin-converting enzyme inhibitors

Anticholinergics

Antidepressants (both tricyclic antidepressants and selective serotonin reuptake inhibitors)

Antiepileptics

Barbiturates

Benzodiazepines

β-adrenergic blockers

Calcium channel blockers

Cephalosporins

Corticosteroids (prednisone, cortisone, adrenocorticotropic hormone, others)

Dopamine receptor agonists

Fluoroquinolone antibiotics

Nonsteroidal antiinflammatory drugs

Procaine derivatives (procainamide, procaine, penicillin G)

Salicylates

Sulfonamides

Alcohol toxicity/withdrawal

Illicit use of drugs (including prescribed medications)

Amphetamines

Glue sniffing/ingestion

Lysergic acid diethylamide

Methamphetamine (crystal meth)

Phencyclidine hydrochloride (PCP)

Psilocybin (mushrooms)

Toxicologic causes

Carbon monoxide poisoning

Heavy metal poisoning (eg, mercury, lead)

Key tests in the pediatric population () may include drug screens (to rule out medication or substance-related psychosis), laboratory studies (to rule out infections, metabolic disturbances, certain genetic conditions, or vitamin deficiencies), an electroencephalogram (EEG), and structural neuroimaging (eg, magnetic resonance imaging [MRI] or computed axial tomography [CT] scanning). The clinical relevance of a given EEG tracing can be difficult to discern, as almost half of the patients with new-onset psychosis will have EEG abnormalities of unclear significance. Furthermore, EEGs read as "normal" may not capture an interictal psychosis. Likewise, incidental and non-clinically meaningful MRI findings are found in approximately 20% of the non-psychiatrically ill population. Recent guidelines suggest that structural neuroimaging should not be obtained routinely during an evaluation for a first episode of psychosis. Despite the low yield of neuroimaging, counter arguments supporting its judicious use emphasize that patients and families feel reassured by negative scans. Conversely, neuroimaging can rule out rare etiologies for psychosis (eg, brain tumors) and help patients and families understand and accept the psychotic symptoms as manifestations of a psychiatric disorder.

Table 3

Electroencephalogram

Imaging studies (eg, magnetic resonance imaging or computed tomography of the brain) in select patients based on clinical suspicion

Laboratory studies

Antinuclear antibodies

Blood urea nitrogen/creatinine

Calcium and phosphorus

Ceruloplasmin (for Wilson's disease)

Complete blood count

Electrolytes

Erythrocyte sedimentation rate

FTA-Abs (for syphilis)-preferred over rapid plasma reagin

Human immunodeficiency virus screening

Liver function tests

Thyroid-stimulating hormone

Urinalysis

Urine (and/or serum) drug screen

HOW SHOULD PSYCHOSIS DUE TO AN UNDERLYING MEDICAL CONDITION BE TREATED?

The optimal treatment for secondary psychosis is treatment of the underlying medical or neurologic condition. Concomitant treatment of the secondary psychosis (usually with an antipsychotic agent) can protect both the patient and the treatment team while medical treatment is administered. Notably, most guidelines for dosing antipsychotics are based on the treatment of patients with schizophrenia and bipolar disorder. Patients treated for psychosis related to medical causes are often antipsychotic naive and sensitive to the sedating properties of lower-potency antipsychotics and to the extrapyramidal effects of higher-potency antipsychotics.

WHAT DOES THE FIRST EPISODE OF PSYCHOSIS INVOLVE?

Once functionally impairing psychotic symptoms develop-defined in terms of symptom severity and duration-a patient is no longer considered to be in the prodromal phase of illness, but instead diagnosed with an episode of psychosis. Clinically, the demarcation between prodromal (or "attenuated") symptoms and frank psychosis is rarely clear-cut, particularly in a patient with brief or intermittent bouts of mild psychotic symptoms. Moreover, few patients receive emergency treatment for psychosis. The median duration of untreated psychosis refers to the lag between the development of symptoms and the initiation of treatment. This lag time can range from 4 to 50 weeks in first episodes, and can extend longer when mood symptoms or illicit drug use cloud the diagnostic picture. The availability of mental health resources, socioeconomic factors, and cultural attitudes toward mental illness can also affect the time to treatment. Most studies show that a longer duration of untreated psychosis is associated with worse clinical outcomes. This observation has spurred increased research interest into interventions that target the period prior to, or immediately after, the development of a psychotic disorder. The hope is that these targeted interventions might forestall the onset of psychosis or improve long-term outcomes.

WHAT PSYCHOSOCIAL TREATMENTS ARE AVAILABLE FOR YOUTH WITH PSYCHOSIS OR SCHIZOPHRENIA?

Cognitive-behavioral techniques that evaluate evidence for beliefs or thinking through explanations surrounding a patient's perceptions can help to alter dysfunctional behaviors. A consistent framework with similar words/techniques used at home, at school, and with friends may allow the patient to employ a standardized approach to events across settings and to diminish misperceptions of daily events and interactions.

Research data supporting psychosocial treatments in pediatric psychotic disorders are scant. There is a controlled study comparing cognitive-behavioral therapy (CBT) with no antipsychotic to a monitoring program in prodromal patients. CBT was associated with less progression to psychosis; however, the results of this study were limited by methodological flaws. The PACE (Personal Assessment and Crisis Evaluation) trial randomly assigned prodromal patients (aged 14-28 years) to risperidone plus CBT versus a needs-based intervention of supportive therapy and psychotropics other than antipsychotics. At 6 months, 3 of 31 patients in the risperidone plus CBT group converted to psychosis, whereas 10 of 28 patients in the supportive therapy and nonneuroleptic pharmacotherapy group converted to psychosis. Since the average risperidone dose used in this study was relatively low (1.3 mg/d), there is a suggestion that CBT was a vital ingredient to the protective effects seen in this study.

WHAT DOES THE PHARMACOTHERAPY OF SCHIZOPHRENIA IN YOUTH INVOLVE?

Pharmacologic treatment for schizophrenia in youth remains an area of active research, with several large multisite trials completed within the past few years. Six, 6-week, randomized, placebo-controlled studies of second-generation antipsychotics for early onset schizophrenia have been completed thus far. They showed that aripiprazole, olanzapine, paliperidone, quetiapine, and risperidone-but not ziprasidone-were superior to placebo. In these controlled studies, aripiprazole, olanzapine, paliperidone, quetiapine, and risperidone, were superior to placebo with regard to improvement in the Positive and Negative Syndrome Scale (PANSS) total score.

In terms of atypical antipsychotic dosing, typically, these medications are initiated at a low dose and gradually titrated upward to achieve efficacy. Risperidone, for example, is generally started at 0.25 mg twice a day and can be increased every 1 to 2 days in association with close observation. In general, olanzapine and quetiapine are more sedating; their dosing is usually started at 2.5 to 5 mg/d and 25 to 50 mg/d, respectively. As most antipsychotic medications have a relatively long half-life, they typically do not need be administered more than twice daily. For patients maintained on antipsychotics, clinicians should monitor weight, vital signs, and relevant laboratory results (eg, triglycerides, cholesterol, fasting glucose, and prolactin levels).

Newer atypical antipsychotics (eg, asenapine, iloperidone, lurasidone) may eventually have a role in the treatment of patients with childhood-onset or early onset schizophrenia and in patients deemed at-risk of developing schizophrenia due to genetic and/or environmental factors. However, at present, there is little evidence to support the safety, tolerability, or efficacy of these agents in the pediatric population.

In sum, current pharmacologic research for early-onset and childhood-onset schizophrenia focuses on the identification of antipsychotic agents that will provide optimal efficacy without also causing undue adverse events. Many typical and atypical antipsychotics have been shown (based on open trials, randomized clinical trials, and head-to-head comparisons) to be efficacious in the treatment of early-onset and childhood-onset schizophrenia; however, they are well known to cause side effects such as weight gain, extrapyramidal symptoms, and metabolic abnormalities.

WHAT IS THE ROLE OF LONG-ACTING (INJECTABLE) ANTIPSYCHOTICS IN CHILDHOOD-ONSET SCHIZOPHRENIA?

In the near future, as many as 4 new atypical antipsychotic long-acting therapy formulations may become available. In clinical situations wherein adherence with oral preparations has proven difficult, it is reasonable-especially in older adolescents-to consider using a long-acting medication. Risperidone long-acting therapy has been shown to be efficacious and well tolerated in the treatment of schizophrenia, including those with newly diagnosed schizophrenia. Short-term and long-term studies found that risperidone long-acting therapy was associated with low rates of discontinuation related to adverse events and few reports of pain from injections. Evidence for newer long-acting injectables (eg, olanzapine, paliperidone) remains limited. The available evidence suggests that long-acting injectable antipsychotics can be used safely and effectively in early stages of the illness and that they may be associated with better outcomes than with oral medications. However, this is largely supported by evidence from naturalistic cohort studies and by a small number of controlled trials of risperidone long-acting injection. Given the paucity of data of long-acting therapy in the adolescent population, the use of these preparations in adolescents remains empiric. provides the side effect risk profiles of common second-generation antipsychotic medications used in children and adolescents.,

Table 4

Second-Generation Antipsychotics
(trade name)

Anticholinergic

Diabetes

Hyperlipidemia

Hyperprolactinemia

Hypotension

Sedation

Tardive Dyskinesia

Weight
Gain

WHAT ARE THE ADVERSE EFFECTS OF ANTIPSYCHOTICS?

In reviewing the available randomized, controlled studies and head-to-head comparisons of antipsychotics, Schimmelmann and colleagues noted, "Antipsychotics are efficacious in the treatment of early-onset schizophrenia. The lack of evidence for efficacy differences between various antipsychotics (except for clozapine for treatment-refractory early-onset schizophrenia) suggests that a primum non nocere principle should be applied when choosing and antipsychotic."(p228) Therefore, the side effect profile of the antipsychotics often dictates the choice of pharmacologic agent for young people with psychotic symptoms. Antipsychotic therapy has been linked to a bevy of metabolic changes (eg, dyslipidemia, weight gain, plasma prolactin increases), sedation, extrapyramidal symptoms, and dyskinesias (see ). With the exception of tardive dyskinesia, young people with schizophrenia seem more likely to experience these side effects from atypical neuroleptics compared with their adult counterparts. Children and adolescents may gain weight, even when treated with antipsychotics that are considered "weight-neutral" in adults. Similarly, there are reports of prolactin elevations in youth treated with prolactin-sparing agents such as quetiapine.

Other common adverse effects of antipsychotics include drowsiness and anticholinergic effects (eg, dry mouth, nasal congestion, blurred vision), particularly with the low-potency phenothiazines. Caregivers can usually manage the short-term adverse effects of antipsychotics with adjustments of dose and timing of administration. One can avoid undue sedation by using less sedating agents and by prescribing most of the daily dose at bedtime. One should not confuse drowsiness with impaired cognition; drowsiness can usually be corrected by adjusting the dose and the timing of administration. Furthermore, there is no evidence that antipsychotics adversely affect cognition when used in low doses. One can minimize anticholinergic effects by choosing a medium-potency or high-potency antipsychotic.

Extrapyramidal Side Effects

Extrapyramidal side effects such as acute dystonia, akathisia (motor restlessness), and parkinsonism (bradykinesia, tremor, and lack of facial expressions) are more commonly seen with use of high-potency agents (eg, butyrophenones, thioxanthenes) and have been reported in up to 75% of children receiving these agents. The extent to which antiparkinsonian agents (eg, anticholinergic drugs such as benztropine, trihexyphenidyl, antihistamines, and the antiviral agent amantadine) should be used prophylactically when antipsychotics are introduced is controversial, although coadministration has been shown to reduce the incidence of extrapyramidal side effects by a factor of 7.

Other Movement Disorders

Abrupt cessation of antipsychotic drugs can cause withdrawal dyskinesias (typically benign, but occasionally more pronounced) and a syndrome of deteriorating behavior. As with adults, the long-term administration of antipsychotic drugs can produce tardive dyskinesia. Although children appear generally less likely to develop tardive dyskinesia than adults, the fact that tardive dyskinesia is potentially irreversible prompts caregivers to evaluate the benefits of such medications, including documenting a clear indication and identifying target symptoms; to periodically discontinue the drug to assess continued need; and to monitor closely to ensure early detection. Current practice parameters recommend monitoring neurologic side effects with standardized scales (eg, Abnormal Involuntary Movement Scale or Simpson Angus Scale) at baseline and periodically during any treatment regimen requiring antipsychotic agents.

Akathisia

Akathisia is a movement disorder characterized by anxiety and an inability to sit still; it can be a side effect of either antipsychotics or antidepressants. Akathisia may be particularly problematic in young patients because of underrecognition or misdiagnosis as ADHD or agitation. Caregivers should consider akathisia in the differential when a child or adolescent starts an antipsychotic and becomes acutely agitated with an associated inability to sit still (and/or with aggressive outbursts).

Treatment of akathisia involves reduction of the offending agent to the lowest effective dose and then using either a benzodiazepine (eg, lorazepam, 0.5 to 1 mg 3 times per day) or a β-blocker. Although all β-blockers are likely to be effective, propranolol, initiated at 10 mg 2 or 3 times per day with an increase every few days until the desired effect is achieved, is a good choice. Alternately, betaxolol hydrochloride, a long-acting β ₁-selective adrenergic antagonist with few medication interactions, may be useful.

Neuroleptic Malignant Syndrome

Little is known about the potentially lethal neuroleptic malignant syndrome in children and adolescents; however, preliminary evidence indicates that its presentation is similar to that in adults. This syndrome may be difficult to distinguish from primary central nervous system pathology, concurrent infection, anti-NMDA receptor encephalitis, or other, more benign, side effects of antipsychotic treatment, including extrapyramidal side effects or anticholinergic toxicity. Neuroleptic syndrome is a life-threatening medical emergency; treatment is largely supportive but can include dopamine reuptake inhibitors like amantadine, similar to strategies used in adults.

WHAT STRATEGIES ARE HELPFUL FOR NONRESPONDERS?

A unique head-to-head randomized controlled trial of olanzapine and clozapine in the treatment of patients with childhood-onset schizophrenia showed that clozapine led to a statistically significant reduction in all outcome measures (particularly negative symptoms of schizophrenia) even when compared to another atypical agent.

WHAT STRATEGIES ARE AVAILABLE FOR EARLY INTERVENTION AND PREVENTION OF CHILDHOOD-ONSET SCHIZOPHRENIA?

The notion of early intervention and perhaps even prevention of schizophrenia remains at the forefront of early-onset psychosis research. Further research in this area is ongoing. However, at present, the literature does not support clear treatment guidelines for these vulnerable patients.

CONCLUSION

Clinicians should be vigilant and consider psychotic illnesses when evaluating children and adolescents with emotional and behavioral disturbances. Given the high developmental, financial, and functional toll associated with chronic psychotic illness, clinicians should employ a variety of diagnostic and treatment modalities to mitigate the risks associated with this illness. These modalities may include performing careful psychiatric and physical examinations, relevant laboratory testing, neuropsychological testing, and employing relevant cognitive therapies, as well as the use of antipsychotic and other pharmacologic interventions. Advances in the understanding of childhood-onset and early-onset schizophrenia, as well as the elucidation of prodromal psychotic symptomatology, will benefit both children and adults.

Footnotes
LESSONS LEARNED AT THE INTERFACE OF MEDICINE AND PSYCHIATRY
The Psychiatric Consultation Service at Massachusetts General Hospital (MGH) sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Dr Stevens is physician-in-charge at Westpark (Dearborn), Henry Ford Health Systems, Dearborn, Michigan, and clinical assistant professor at Wayne State University, Detroit, Michigan. Dr Prince is director of child psychiatry at North Shore Medical Center in Salem, Massachusetts, and an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts. Dr Prager is director of the Child Psychiatry Emergency Service at Massachusetts General Hospital, Boston, and assistant professor of psychiatry (child psychiatry) at Harvard Medical School, Boston, Massachusetts. Dr Stern is chief of the Avery D. Weisman Psychiatry Consultation Service at Massachusetts General Hospital, Boston, and the Ned H. Cassem professor of psychiatry in the field of psychosomatic medicine/consultation at Harvard Medical School, Boston, Massachusetts.

Dr Prince has received honoraria from the American Physician Institute and has provided expert legal reviews in malpractice cases. Dr Stern is an employee of the Academy of Psychosomatic Medicine, has served on the speaker's board of Reed Elsevier, is a stock shareholder in WiFiMD (Tablet PC), and has received royalties from Mosby/Elsevier and McGraw Hill. Drs Stevens and Prager report no conflicts of interest related to the subject of this article.

References

1. Freudenreich O. Psychotic Disorders: A Practical Guide. Philadelphia, PA: Lippincott Williams and Wilkens; 2008.

20. McDonell M, McClellan J. Early-onset schizophrenia. In: Mash E, Barkley R, editors. Assessment of Childhood Disorders. 4th ed. New York, NY: Guilford Press; 2007. pp. 526-550.

26. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Washington, DC: American Psychiatric Press; 2013.

28. Kodish I, McClellan J. In: Handbook of Psychological Assessment, Case Conceptualization, and Treatment: Vol. 2, Children and Adolescents. Hersen M, Reitman D, editors. Hoboken, NJ: John Wiley & Sons; 2008. pp. 405-443.

42. Millichap JJ, Goldstein JL, Laux LC, et al. Ictal asystole and anti- N-methyl-d-aspartate receptor antibody encephalitis. Pediatrics. 2011;127(3):e781-e786.

49. Freudenreich O, Goff DC. Psychotic patients. In: Stern TA, Fricchione GH, editors. Massachusetts General Hospital Handbook of General Hospital Psychiatry. Amsterdam, The Netherlands: Elsevier Science Publishers; 2010.

52. Structural neuroimaging in first-episode psychosis. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008 Feb. 24 p. (technology appraisal guidance; no. 136) http://www.guideline.gov/content.aspx?id=12284. Accessed December 4, 2013.

54. Marshall M, Rathbone J. Early intervention for psychosis. Cochrane Database Syst Rev. 2011;(6):CD004718. [ PMC free article]

60. Xia J, Merinder LB, Belgamwar MR. Psychoeducation for schizophrenia. Cochrane Database Syst Rev. 2011;(6):CD002831. [ PMC free article]

61. Jones C, Cormac I, Silveira da Mota Neto JI, et al. Cognitive behaviour therapy for schizophrenia. Cochrane Database Syst Rev. 2004;(4)(CD000524)

71. Yan J. FDA advisors back additional antipsychotics for use in teens. Psychiatr News. 2009;44(13):1-29.

80. Celano CM, Beach SR, Huffman JC, et al. Side effects profiles of psychotropic medications from cardiovascular and other side effects of psychotropic medications. In: Stern TA, Herman JB, Gorrindo T, editors. The Massachusetts General Hospital Psychiatry Update and Board Preparation. 3rd ed. Boston, MA: MGH Psychiatry Academy Publishing; 2012.

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Psychotic Disorders in Children and Adolescents: A Primer on Contemporary Evaluation and Management

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■ Hallucinatory experiences and delusions are more common in our patients than we may realize and occur frequently in the pediatric population. While not a benign occurrence, psychotic symptoms do not necessarily portend the future development of schizophrenia.

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https://www.verywellmind.com/signs-of-conduct-disorder-in-children-4127239

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What Is Conduct Disorder?

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

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

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

Aggression Toward People and Animals

Bullying, threatening, or intimidating others

Initiating physical fights

Using a weapon that could cause serious harm

Physical cruelty to people

Physical cruelty to animals

Stealing while confronting a victim

Forced sexual activity

Property Destruction

Deliberate fire setting

Other destruction of property

Deceptiveness or Theft

Breaking or entering a house, car, or building

Lying for personal gain

Stealing without confronting the victim (such as shoplifting)

Serious Rule Violation

Staying out at night before the age of 13 years

Running away from home overnight at least twice

Truancy beginning before the age of 13

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

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

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

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

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

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

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

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

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

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

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

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

Oppositional Defiant Disorder as a Precursor

Common Comorbid Conditions

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

Self-harm

Substance misuse

Depression and anxiety

Posttraumatic stress disorder

Learning disability

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Creating structure

Enforcing limits

Providing clear instructions

Rewarding positive behaviors

Using time-outs after inappropriate behaviors or outbursts

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

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Conduct Disorder in Children Can Cause Serious Behavior Problems

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

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https://psychiatry.org/patients-families/disruptive-impulse-control-and-conduct-disorders/what-are-disruptive-impulse-control-and-conduct

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Psychiatry.org - What are Disruptive, Impulse Control and Conduct Disorders?

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Learn about disruptive, impulse control and conduct disorders, including symptoms, risk factors and treatment options

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https://medlineplus.gov/ency/article/001529.htm

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American Psychiatric Association website. Schizophrenia spectrum and other psychotic disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013:87-122.

Freudenriech O, Brown HE, Holt DJ. Psychosis and schizophrenia. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 28.

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Brief psychotic disorder: MedlinePlus Medical Encyclopedia

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American Psychiatric Association website. Schizophrenia spectrum and other psychotic disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013:87-122. Freudenriech O, Brown HE, Holt DJ. Psychosis and schizophrenia. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds.

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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.

Schizophrenia is a mental health condition that can cause teenagers and young adults to lose touch with reality. They see, hear or believe things that aren't real or true. This is called psychosis. People with schizophrenia think and act in ways that don't make sense to other people. Many people with schizophrenia think that someone or something is reading their mind or trying to hurt them. These false beliefs are called paranoid delusions. Some also see things that aren't there, which are called hallucinations.

Schizophrenia is very rare in young children, but they can show some early signs. It is more often diagnosed in teenagers and young adults.

What are the symptoms of schizophrenia?

Kids with schizophrenia have strange thoughts and behaviors. Some signs include:

Ideas that don't make sense

Believing things that aren't true

Seeing, hearing or feeling things that aren't there

Seeming distracted

Speaking in ways that other people can't understand

Thinking that others want to hurt them

Hearing voices that tell them what to do

Thinking strangers know them or are talking about them

Believing that TV shows are sending them special messages

Trouble with regular tasks, such as eating, bathing and going to school

Withdrawing from friends and family

Not showing a lot of feelings

Moving around way too much or way too little

How is schizophrenia diagnosed?

Before diagnosing schizophrenia, a mental health professional will rule out other possible causes of the strange thoughts and behavior. This includes drug or alcohol abuse, medical issues and other mental health problems. Kids are only diagnosed with schizophrenia if they have had symptoms for at least six months. The symptoms also have to interfere with their regular lives.

It can be hard to tell schizophrenia apart from other mental health disorders. Sometimes, kids with schizophrenia are incorrectly diagnosed with conduct disorder because their delusions make them behave aggressively. It's important to get a thorough assessment that looks closely at the child's physical and mental health, as well as their family history.

What are the risk factors for schizophrenia?

Children are more likely to have schizophrenia if someone in their family has it or if there were problems during pregnancy or at birth. However, most children with these risk factors don't have schizophrenia.

How is schizophrenia treated?

Schizophrenia is usually treated with therapy and medication.

The recommended treatment is a special program called Coordinated Specialty Care. This should be done in the first two or three years after the child shows signs of schizophrenia. It can decrease symptoms in the future by a lot and help with many of the problems linked to this illness.

Coordinated Specialty Care teaches kids how to deal with their symptoms. It also helps them build a group of people who can help them. The treatment includes:

Low doses of antipsychotic medication

Cognitive behavioral therapy for psychosis (CBTp)

Family education and support

Learning skills for school and work

Children with schizophrenia are at risk of developing other disorders, including:

Obsessive-compulsive disorder (OCD)

Depression

Panic disorder

Post-traumatic stress disorder (PTSD)

Problems with drugs or alcohol, which can make symptoms of schizophrenia worse

We have over 60 guides and 700 articles available to help you (in Spanish too!).
Subscribe and get a curated selection weekly.

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Quick Guide to Schizophrenia - Child Mind Institute

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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. Schizophrenia is a mental health condition that can cause teenagers and young adults to lose touch with reality. They see, hear or believe things that aren't real or true.

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https://www.hopkinsmedicine.org/health/conditions-and-diseases/conduct-disorder

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What is conduct disorder in children?

Conduct disorder is a type of behavior disorder. It's when a child has antisocial behavior. He or she may disregard basic social standards and rules. He or she may also:

Be irresponsible

Skip school or run away (delinquent behavior)

Steal or do other things to violate the rights of others

Physically harm animals or other people, such as committing assault or rape

These behaviors sometimes happen together. But one or more may occur without the others.

What causes conduct disorder in a child?

Experts believe that many factors play a role in conduct disorder. These are:

Brain damage

A traumatic event

Genes

Child abuse

Past school failure

Social problems

Some children with conduct disorders seem to have a problem in the frontal lobe of the brain. This interferes with a child's ability to plan, stay away from harm, and learn from negative experiences.

Some experts believe that a series of traumatic experiences occurs for a child to develop a conduct disorder. These experiences then often lead to depressed mood, behavior problems, and involvement in a deviant peer group.

Which children are at risk for conduct disorder?

A conduct disorder is more common in boys than in girls. It is also more likely to develop in children or teens who come from homes that are:

Children with these mental health problems are also more likely to have conduct disorder:

Children or teens who are considered to have a difficult temperament are more likely to develop behavior problems.

What are the symptoms of conduct disorder in a child?

Most symptoms seen in children with conduct disorder also happen at times in children without this problem. But in children with the disorder, these symptoms occur more often. They also interfere with learning, school adjustment, and sometimes with the child's relationships.

Each child's symptoms may vary. But the 4 main groups of behaviors are:

Aggressive conduct

Intimidating behavior

Bullying

Physical fights

Cruelty to others or animals

Using a weapon

Forcing someone into sexual activity, rape, or molestation

Destructive conduct

Intentionally destroying property (vandalism)

Arson

Deceitfulness

Violation of rules or age-appropriate norms

These symptoms may look like other mental health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

How is conduct disorder diagnosed in a child?

A child psychiatrist or qualified mental health expert can diagnose a conduct disorder. He or she will talk with parents and teachers about the child's behavior and may observe the child. In some cases, your child may need mental health testing.

If you notice symptoms of conduct disorder in your child or teen, you can help by seeking a diagnosis right away. Early treatment can often prevent future problems.

How is conduct disorder treated in a child?

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

Treatment for conduct disorder may include:

Cognitive-behavioral therapy. A child learns how to better solve problems, communicate, and handle stress. He or she also learns how to control impulses and anger.

Family therapy. This therapy helps make changes in the family. It improves communication skills and family interactions.

Peer group therapy. A child develops better social and interpersonal skills.

Medicines. These are not often used to treat conduct disorder. But a child may need them for other symptoms or disorders, such as ADHD.

How can I help prevent conduct disorder in my child?

Experts don't know exactly why some children develop conduct disorder. Things such as a traumatic experience, social problems, and biological factors may be involved. To reduce the risk for this disorder, parents can learn positive parenting strategies. This can help to create a closer parent-child relationship. It can also create a safe and stable home life for the child.

How can I help my child live with conduct disorder?

Early treatment for your child can often prevent future problems. Here are things you can do to help your child:

When should I call my child's healthcare provider?

Call your healthcare provider right away if your child:

Feels extreme depression, fear, anxiety, or anger toward him or herself or others

Feels out of control

Hears voices that others don't hear

Sees things that others don't see

Can't sleep or eat for 3 days in a row

Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help

Call 911 if your child has suicidal thoughts, a suicide plan, and the means to carry out the plan.
Key points about conduct disorder in children

Next steps

Tips to help you get the most from a visit to your child's healthcare provider:

Know the reason for the visit and what you want to happen.

Before your visit, write down questions you want answered.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

Ask if your child's condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if your child does not take the medicine or have the test or procedure.

If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your child's provider after office hours. This is important if your child becomes ill and you have questions or need advice.

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Conduct disorder is a type of behavior disorder. It's when a child has antisocial behavior. He or she may disregard basic social standards and rules. He or she may also: Be irresponsible Skip school or run away (delinquent behavior) Steal or do other things to violate the rights of others Physically harm animals or other people, such as committing assault or rape These behaviors sometimes happen together.

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Tips for Teachers: Working with Students with Obsessive Compulsive Disorder (OCD)

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Tips for Teachers: Working with Students with Obsessive Compulsive Disorder (OCD)

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https://childmind.org/guide/teachers-guide-to-ocd-in-the-classroom/

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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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Tips for Teachers: Working with Students with Oppositional Defiant Disorder (ODD)

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Tips for Teachers: Working with Students with Oppositional Defiant Disorder (ODD)

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https://www.edutopia.org/article/6-ways-help-students-odd

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Offering kids choices, safe spaces, and positive reinforcement can help teachers avoid problems-or manage them when they arise.

Elliott Golden / The iSpot

Most children will, at times, argue and test limits. Yet some kids are defiant and hostile to a degree that interferes with their daily lives-behavior that's sometimes diagnosed as Oppositional Defiant Disorder, or ODD, according to a story by WeAreTeachers.

"Students with ODD disrupt their own lives and often the lives of everyone nearby," write the report's authors. "[They] push the limits of defiance far beyond reason. Their problem behavior is much more extreme than that of their peers, and it happens much more often."

According to the American Academy of Child & Adolescent Psychiatry, kids with ODD exhibit "an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the child's day-to-day functioning," for six months or more. Symptoms like frequent temper tantrums, excessive arguing with adults, and mean and hateful speech when upset, are usually seen across multiple settings, but especially at home or school. While a direct cause remains unclear, "biological, psychological, and social factors may have a role," the academy notes. Up to 16 percent of children may have the disorder, and children with ADHD are especially prone.

Though a teacher's first reaction to ODD might be to react defensively, this can backfire and create a power struggle with the student, say experts. Instead, teachers who've worked with students with ODD recommend a set of strategies that will address challenging behavior, and help you start building relationships with hard-to-reach students.

"We all have the capacity to learn, change, and grow," writes special education teacher Nina Parrish. "When given the right tools and environment, students with problematic behavior can learn more productive strategies that will help them have positive and effective interactions with others."

1. Be Calm and Consistent: As a new teacher, Parrish says she quickly learned that reacting with anger when her students with ODD acted out made the behavior worse and students became "amused or encouraged by upsetting an adult." Instead, Parrish recommends trying to keep a positive tone to your voice, adopting neutral body language, and being "cautious about approaching the student or entering their personal space as this might escalate the situation."

Consistency with words and actions is also important when working with kids with ODD. Teacher Brandy T. tells WeAreTeachers she routinely uses the same set of "trigger words" so her students know she's serious. When students in her class begin to argue with her, "I simply say either, 'not now,' 'later,' or 'fix the issue.'" When her students hear 'fix the issue,' for example, she says that's the signal to "go to their chill-out space if they need to calm down."

2. Reinforce Positive Behavior: For all kids, but especially children with ODD, it's important to "switch your focus from recognizing negative behavior to seeking out demonstrations of positive behavior," writes Parrish. She sends home positive notes when students show behavior improvements, even if they're small gains.

Additionally, consider offering students the opportunity to earn certain privileges, suggests WeAreTeachers, rather than "taking those privileges away as punishment." For example, give kids the opportunity to earn rewards-like a bit of iPad time or lunch with a teacher.

3. Find Out What's Going On: Behaviors, notes Parrish, help students "obtain something desirable, or escape something undesirable." She suggests thinking about behavior as feedback, or a way of communicating, an approach that's "helped me work more effectively as a teacher with students who display problem behaviors." Figuring out factors that contribute to students with ODD acting out can help you develop a plan for addressing their difficult behaviors in the classroom.

Sometimes, it's a matter of picking up on a student's signals that their emotions are building long before things reach a breaking point. When students who've experienced trauma are beginning to feel upset, they often show physical signs of their mounting distress: balling up fists, withdrawing from classroom interaction, or clenching their jaw, writes Micere Keels, an associate professor at the University of Chicago and a trauma-informed educator.

"Many educators tend to ignore students' increasing signs of agitation, hoping they'll eventually calm down. But when disregarded, these minor behaviors can quickly escalate," writes Keels, who also recommends identifying students' triggers, like touch or emotionally difficult anniversaries, to avoid situations entirely.

4. Create a Safe Reset Space: Kids with ODD "can learn to recognize when they're feeling overwhelmed and getting ready to challenge or defy," according to WeAreTeachers. "Giving them a safe space to calm down and rethink their choices can be beneficial."

At Fall-Hamilton Elementary, a trauma-informed school in Nashville, Tennessee, for example, every classroom has a nook-called a peace corner-with a comfortable seat, a timer, and items like stuffed animals, sensory squeeze toys, and simple drawing and writing supplies. It's a spot where kids can take a break and reset. The school also recognizes that teachers may need a time out too. Using a strategy called Tap-in/Tap-Out, teachers can ask a colleague via text message to briefly cover their class if they are about to lose their cool.

"A dysregulated adult cannot regulate a dysregulated child," says school principal Mathew Portell. "Use strategies that honor the student's emotions and need for space while also getting their systems to calm in a safe way."

5. Offer Choices: It's important to "affirm your students' autonomy by giving them choices," writes Keels, about best practices for de-escalation. When kids feel respected, "their sense of belonging and mood will often improve."

She recommends avoiding ultimatums like "You better sit back down or I'll send you to the office." Instead, clearly communicate expectations and limits so kids understand. You might say, "I see you're upset, but it's not OK to yell at me. You can either go get a drink of water and come back in five minutes, or sit in the reading chair and I will check in with you in five minutes," says Keels.

In the heat of the moment, it's important to avoid an argument, teacher Holli A. tells WeAreTeachers. "State your choices, then walk away," she says. "Give the student time to process and decide which choice to make. If they don't like the choices, don't engage. When they try to argue, repeat the choices, and walk away again. If the student still will not choose, they do not get to participate in their preferred activity."

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

Though teachers can feel the need to create boundaries with students, simply talking with them informally can build invaluable connections that influence their behavior in the classroom, says middle school math teacher Cicely Woodard.

Woodard says she intentionally makes herself approachable to students and tries to learn interesting details about them. "Some of my students tell me stories about their lives during the five minutes between classes," Woodard says. "I stop what I am doing, look them in the eyes, and listen."

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Offering kids choices, safe spaces, and positive reinforcement can help teachers avoid problems-or manage them when they arise.

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Mental Health Services in Dallas & Plano

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Mental Health Services in Dallas & Plano

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https://www.childrenandfamilies.org/mental-health-services-all-ages.html

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Services are provided by a staff consisting of Board Certified Psychiatrists, Advanced Psychiatric Nurse Practitioners, Licensed Clinical Social Workers, Licensed Professional Counselors, and other Qualified Mental Health Professionals.

Services may take place in one of our clinics or in a community setting, depending on the service being provided, and as appropriate to the needs of the child, adult, or family. Potential settings include:

Client services begin with complete psychiatric evaluations. Clients are then provided with a diagnosis and provided with treatment options for comprehensive care. Individuals in need of medication are also provided with appropriate prescriptions and medication management services.

Psychiatric Evaluations

30- 45 minute evaluation conducted by one of our 14 Board Certified Psychiatrists as well as 5 APNs

Bio-Psychosocial Assessment

Family history

Mental health history

Social history

Medical history

Symptom Assessment

Abuse, Neglect, & Exploitation

Mental Status Examination

Diagnosis & Treatment Recommendations Provided

Follow-up Care

Vitals are taken

Ongoing re-evaluation of response to medication and progress

E-prescriptions​​

​​
Individualized screenings are clinical assessments that include symptom assessments, medication assessments, and financial eligibility screening to improve access to affordable mental health services for low-income families. Based on the screening, individuals are provided with a service plan.

Outpatient mental health counseling, including individual therapy, family, and group therapy are provided by licensed mental health professionals.

​Motivational Interviewing

CBT (Cognitive Behavioral Therapy)​

​
A Child & Family team member meets seriously mentally ill adults where they are to assist with building life skills to ensure they can be successful in school, the work-place, social situations, at home and in all other areas of the individual's life.
​

A Child & Family team member meets seriously emotionally disturbed children and their families where they are to assist with building life skills to ensure they can be successful in school, the community, social situations, at home and in all other areas of the individual's life.

​Treatment modalities

START (Skillstreaming & Aggression Replacement Training)

Nurturing Parenting

Barkley's Defiant Child & Barkley's Defiant Teen

Seeking Safety

PAYA (Preparing Adolescents for Young Adulthood)​​

​​
Ensures each client and family (when applicable) receive necessary psychiatric, social, vocational, educational, and other support essential for achieving stability. Each client is assigned to a specific type of case management, based upon an assessment of the client's needs.

Child & Family team members meet clients where they are to facilitate remote delivery of physician services. This enables clients to receive quality care, a proper diagnosis, and continued treatment in areas lacking mental healthcare professionals.

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Services are provided by a staff consisting of Board Certified Psychiatrists, Advanced Psychiatric Nurse Practitioners, Licensed Clinical Social Workers, Licensed Professional Counselors, and other Qualified Mental Health Professionals. Services may take place in one of our clinics or in a community setting, depending on the service being provided, and as appropriate to the needs of the child, adult, or family.

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https://psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders

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https://www.verywellmind.com/living-with-adhd-4157276

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Tips for Teachers: Working with Students with ADD & ADHD

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Tips for Teachers: Working with Students with ADD & ADHD

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https://www.edutopia.org/article/setting-students-adhd-success

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Students with attention-deficit/hyperactivity disorder benefit from these easy-to-implement strategies-and so do their peers.

©Shutterstock/Monkey Business Images

Teachers often come to the classroom with an unclear understanding of attention-deficit/hyperactivity disorder, and they are rarely provided with strategies that detail how to work with students who have been diagnosed with ADHD, even though such students make up an increasingly large number of their students-11 percent and growing as of 2011, according to data gathered by the Centers for Disease Control and Prevention.

As a special education teacher and tutor who coaches struggling students (many with ADHD), I have found several classroom strategies to be effective.

Create Urgency

I often hear parents or other advocates urge teachers to accommodate students with ADHD by giving them a lengthy or indefinite amount of time to turn in assignments. This creates a situation where deadlines are unclear, yet most of the students with ADHD that I have worked with need a clear deadline to create the urgency and adrenaline necessary to complete the task.

Provide deadlines: I teach students time management skills by breaking projects into chunks, each with a detailed description, rubric, and due date. For example, a research paper might have a separate due date for a topic, completed research, outline, rough draft, and final paper. I grade each step in the process, and each grade contributes to the final grade. This teaches students how to break up large projects to ensure timely completion.

Time tasks: Timing tasks that could be rote and boring-like learning math facts and letter sounds, increasing reading fluency, and memorizing vocabulary-turns what could potentially be a tedious task into a game or competition with oneself. Timing is used not to create anxiety but to increase performance over time-students are never graded on timed activities and don't share their scores. Instead they're challenged to beat the clock and to do better than they did last time. Graphing scores as a visual reminder of progress helps students learn about goal setting and develop a growth mindset.

Activate Interest

Students with ADHD are often capable of focusing intensely on something they're interested in. They can play video games or make their own YouTube videos for hours, but they need help connecting class content with their interests to achieve that focus.

Engage students' passions: My students are more engaged when they see that I'm passionate about a subject. We all want to know why we should learn something. Providing a hook to each lesson in the form of a story, game, or question gets students excited to figure out a problem.

For example, when we learn about making inferences, I bring in an assortment of strange looking objects or pictures of objects viewed from strange angles. Students do a gallery walk and write down observations about the objects-facts like, "it is metal," or "it is green." They also list any prior knowledge they have. They use the facts and their prior knowledge to make inferences about what the objects are.

This activity helps students have a more concrete basis for understanding how to make an inference when they're reading. It also usually leads to interesting discussions on how prior knowledge can greatly impact understanding.

Give students choices: Giving kids a choice in the books they read, activities they complete for a grade (visual art display, paper, slide or video presentation, blog, skit, podcast, etc.), and the ways they learn a skill encourages participation.

Allow for Breaks and Movement

I've found that taking breaks results in more focus for all of my students, but especially those with ADHD.

Use brain breaks: Students will take breaks anyway, so making breaks a reward is an easy way to keep them on task. I try to help them increase their focus to 15 to 25 minutes of working time, and after periods of concentration, they receive a short break. During the break, students can stretch, sharpen their pencils, get supplies, talk quietly to a friend, or rest. This timing method, sometimes called the Pomodoro Technique, helps students increase focus over time.

Let students move: I find that I get more out of students if I give them a chance to dance, stretch, or exercise before they have to sit down and work quietly. This can be led by the teacher, a short video, or a student. Usually it's brief and structured, like a game of Simon Says or a set of 10 jumping jacks and a few standing toe touches.

It's important to plan for transitions back to work-I flip the lights and use a hand signal. When I do this, students know to immediately return to their seats, mirror the hand signal, and be silent. Occasionally, I give out a reward to the first two students who are sitting attentively.

Provide Structure

I believe all students thrive when they know what to expect. For students with ADHD, having an orderly environment is essential.

Have clear expectations: Establishing a routine that stays the same even when activities change makes children feel secure. Rules can be taught through an activity with an example and non-example or by acting them out. This strategy is also useful for highlighting age-appropriate social skills like how to listen when someone is presenting or how to determine the appropriate amount of personal space.

Teach study skills explicitly: Students know they can Google facts, but teaching them how to learn creates relevance. Regardless of what subject is being taught, it's possible to incorporate study skills lessons-how to take notes, read a textbook, or study. Students will need these skills in the future when they're required to learn on their own.

You may have noticed that these strategies will help not just students with ADHD-they're useful for all students because they encourage the development of executive functions such as self-regulation.

We rarely look at ADHD as an advantage, but I've found that having students with ADHD in my classroom challenges me to update the way I teach so that my curriculum is more versatile, interesting, and compatible with the skills all students will need in an increasingly fast-paced world.

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Setting Students With ADHD Up for Success

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Students with attention-deficit/hyperactivity disorder benefit from these easy-to-implement strategies-and so do their peers.

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(Alsterberg, 2017)

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2 Tex. Ed. Code §33.002-33.009

Alsterberg, E. (2017, December 5). Understanding dysfunctional patterns of thought and behavior [online image]. https://ericalsterbergbooks.com/understanding-dysfunctional-patterns-thought-behavior/

American School Counselor Association. (2016). ASCA Ethical standards for school counselors. https://www.schoolcounselor.org/getmedia/f041cbd0-7004-47a5-ba01-3a5d657c6743/Ethical-Standards.pdf

Commonwealth of Australia. (2015). Attention Deficit Hyperactivity Disorder. Response Ability.

Hanie, E. H. & Stanard, R. P. (2009). Students with anxiety: The role of the professional school counselor. Georgia School Counselors Association Journal, 16(1), 49-55.

KidsHealth. (2022). ADHD [online image]. https://kidshealth.org/en/parents/adhd.html

National Alliance on Mental Illness. (n.d.). Mental health conditions seen in childhood [online image]. https://www.nami.org/Blogs/NAMI-Blog/October-2019/Mental-Health-Conditions-Seen-in-Childhood

Pertuit, T., Trusty, J., and Ballard, M. (2014). Suffering in silence: Examining obsessive compulsive behaviors
in the school setting. Vistas Online. American Counseling Association. https://www.counseling.org/docs/default-source/vistas/article_17.pdf?sfvrsn=fc3e0e4_12

Porter, L. (2022). How to improve your working memory when you have ADD [online image]. Verywell Mind. https://www.verywellmind.com/add-and-working-memory-20796

Texas Education Agency. (2018). The Texas model for comprehensive school counseling programs (5th ed.). Texas Counseling Association. https://tea.texas.gov/sites/default/files/Pub_2018_Texas-Model_5th-Edition.pdf

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https://my.clevelandclinic.org/health/diseases/14938-depression-in-children

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Depression in Children: Symptoms, Suicide Signs & Treatment

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Learn how to spot the signs of depression and anxiety in children. Medication, therapy and other treatments can help them feel better.

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(National Alliance on Mental Illness, n.d.)

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https://www.nimh.nih.gov/health/topics/depression

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National Institute of Mental Health (NIMH)

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Learn about depression, including types, signs and symptoms, risk factors, treatments and therapies, and things you can do to help during treatment.

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Childhood Depression: What Parents Need to Know

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Childhood Depression: What Parents Need to Know

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

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It's normal for kids to feel sad, act grouchy, or be in a bad mood at times. But when a sad or bad mood lasts for weeks or longer, and when there are other changes in a child's behavior, it might be depression.

Therapy can help children who are going through sadness or depression. And there are things parents can do, too. Getting the right care can prevent things from getting worse and help a child feel better.

If sadness has lasted for weeks or longer, talk about it with your child's doctor.

How Can I Tell if My Child Is Depressed?

If a child is depressed, parents may notice some of these signs:

Sad or bad mood. A child may seem sad, lonely, unhappy, or grouchy. It can last weeks or months. A child may cry more easily. They may have more tantrums than before.

Being self-critical. Kids going through depression may complain a lot. They may say self-critical things like, "I can't do anything right." "I don't have any friends." "I can't do this." "It's too hard for me."

Lack of energy and effort. Depression can drain a child's energy. They might put less effort into school than before. Even doing little tasks can feel like too much effort. Kids may seem tired, give up easily, or not try.

Not enjoying things. Kids don't have as much fun with friends or enjoy playing like before. They may not feel like doing things they used to enjoy.

Sleep and eating changes. Kids may not sleep well or seem tired even if they get enough sleep. Some may not feel like eating. Others may overeat.

Aches and pains. Some children may have stomach aches or other pains. Some miss school days because of not feeling well, even though they aren't sick.

What Causes Child Depression?

Different things can lead to depression. There is no single cause. Some children have genes that make them more sensitive to depression. They may have other family members who have been depressed.

Some children go through stressful things. Some have faced loss, trauma, or hardships. Some go through serious health conditions. These things can lead to sadness or grief - and sometimes to depression.

Having extra support during and after hard times helps protect children from depression or lessen the effects. But even when they have good support, some children get depressed. Therapy can help them heal, feel better, and get back to enjoying things.

Is Your Child Depressed?

How can parents know what's typical moodiness and when there is a problem? Learn the signs of depression and ways to help your child feel better.

What Is the Therapy for Child Depression?

The therapy for child depression is cognitive behavioral therapy (CBT). Therapists help kids feel welcome and supported. They have kids talk about what they think and feel. They may use stories, play, lessons, or workbooks. These tools can help children feel at ease and get the most from CBT. When possible, a child's therapy includes their parent.

If a child has gone through a loss, trauma, or other difficult events, the therapy will include things that help a child heal from that, too. And if a parent is dealing with their own loss or depression, the child's therapist can help them get the care and support they need.

What Should I Do if I Think My Child Is Depressed?

If you think your child is depressed:

Talk with your child about sadness and depression. Kids might not know why they are so sad and why things seem so hard. Let them know you see that they're going through a hard time and that you're there to help. Listen, comfort, offer your support, and show love.

Set up a visit with your child's doctor. Let your child's doctor know if sad or bad moods seem to go on for a few weeks. By itself, this doesn't always mean a child is depressed. Tell your child's doctor if you have also noticed changes in your child's sleep, eating, energy, or effort. Tell them if your child is dealing with a loss, a big stress, or hardship.

The doctor will do a physical exam. A full exam lets the doctor check for health issues that could cause your child's symptoms. They can also check for depression. Your child's doctor may refer you to a child therapist. The doctor's office might have a child therapist on staff.

Set up a visit with a child therapist. A child therapist (mental health doctor) will spend time talking with you and your child. They will do an in-depth check for depression by asking questions and listening. The therapist can explain how therapy can help your child.

Take your child to therapy visits. The therapist may suggest a few visits, or more. Therapy can take time, but you will see progress along the way.

Be patient and kind. When your child acts moody or difficult, try to stay patient. Talk with your child's therapist about the best ways to respond when your child acts this way. Often, it helps to connect with your child in a calm way, then guide them to better behavior. Instead of feeling bad, this lets kids feel proud of doing better. It lets them see that you're proud of them, too.

Enjoy time together. Spend time with your child doing things you both can enjoy. Go for a walk, play a game, cook, read stories, make a craft, watch a funny movie. Spend time outdoors if you can. These things gently encourage positive moods. They help you and your child feel close.

Date reviewed: September 2021

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Childhood Depression: What Parents Need to Know (for Parents)

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When a sad or bad mood lasts for weeks or longer and there are other changes in a child's behavior, it might be depression. Learn the signs of depression and what parents can do to help their child.

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https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955

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Overview

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

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

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

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

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

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

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

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

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

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

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

Mania and hypomania

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

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

Abnormally upbeat, jumpy or wired

Increased activity, energy or agitation

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

Decreased need for sleep

Unusual talkativeness

Racing thoughts

Distractibility

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

Major depressive episode

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

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

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

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

Either insomnia or sleeping too much

Either restlessness or slowed behavior

Fatigue or loss of energy

Feelings of worthlessness or excessive or inappropriate guilt

Decreased ability to think or concentrate, or indecisiveness

Thinking about, planning or attempting suicide

Other features of bipolar disorder

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

Symptoms in children and teens

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

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

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

When to see a doctor

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

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

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

When to get emergency help

Suicidal thoughts and behavior are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.

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

Causes

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

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

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

Risk factors

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

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

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

Drug or alcohol abuse

Complications

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

Problems related to drug and alcohol use

Suicide or suicide attempts

Legal or financial problems

Damaged relationships

Poor work or school performance

Co-occurring conditions

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

Anxiety disorders

Eating disorders

Attention-deficit/hyperactivity disorder (ADHD)

Alcohol or drug problems

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

Prevention

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

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

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

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

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

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

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https://psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders

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https://ibpf.org/articles/accommodations-for-students-with-bipolar-disorder-and-related-disabilities/

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

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

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

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

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

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

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

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

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

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

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

Shortened assignments.

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

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

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

Preferential seating in the classroom.

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

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

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

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

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

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

Students on some medications may need:

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

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

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

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

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

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

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

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

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Error! You must specify a value for the Video ID, Width, Height and Anchor parameters to use this shortcode! Not all students who have disabilities require specialized instruction. For students with disabilities who do require specialized instruction in the United States, the IDEA controls the procedural requirements and an IEP is developed.

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https://www.jbrf.org/

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The Clinician's Pathway Program (CPP) and its assessment tools, the CBQ and JJ, were developed by Dr. Demitri Papolos. By clicking the links below you will leave www.jbrf.org and be redirected to the research site that contains the CPP and the CBQ & JJ assessments. If you have any questions or concerns regarding these tools please direct them to Dr. Papolos's system administrator at CPP@drpapolos.com To Set Up a New CPP Account To Access an Existing CPP Account
Scoring for assessments within the CPP is a fee-based service offered by the private practice of Demitri Papolos, M.D.; this service is independent of JBRF but may be accessed through the JBRF website. Dr. Papolos developed the CBQ & JJ measures and their automated scoring report with the support of JBRF. Questions and/or concerns with regard to the scored report should be addressed to CPP@drpapolos.com

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JBRF - Juvenile Bipolar Research Foundation

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The Clinician's Pathway Program (CPP) and its assessment tools, the CBQ and JJ, were developed by Dr. Demitri Papolos. By clicking the links below you will leave www.jbrf.org and be redirected to the research site that contains the CPP and the CBQ & JJ assessments.

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https://www.nationaleatingdisorders.org/

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https://www.pacarepartnership.org/uploads/MH_fact_sheet_minn07.pdf

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Oppositional Defiant Disorder in Children

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Oppositional Defiant Disorder in Children

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What is oppositional defiant disorder (ODD) in children?

Oppositional defiant disorder (ODD) is a type of behavior disorder. It is mostly diagnosed in childhood. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures. They are more troubling to others than they are to themselves.

What causes ODD in a child?

Researchers don’t know what causes ODD. But there are 2 main theories for why it occurs:

Developmental theory. This theory suggests that the problems start when children are toddlers. Children and teens with ODD may have had trouble learning to become independent from a parent or other main person to whom they were emotionally attached. Their behavior may be normal developmental issues that are lasting beyond the toddler years.

Learning theory. This theory suggests that the negative symptoms of ODD are learned attitudes. They mirror the effects of negative reinforcement methods used by parents and others in power. The use of negative reinforcement increases the child’s ODD behaviors. That’s because these behaviors allow the child to get what he or she wants: attention and reaction from parents or others.

Which children are at risk for ODD?

ODD is more common in boys than in girls. Children with the following mental health problems are also more likely to have ODD:

Mood or anxiety disorders

Conduct disorder

Attention-deficit/hyperactivity disorder (ADHD)

What are the symptoms of ODD in a child?

Most symptoms seen in children and teens with ODD also happen at times in other children without it. This is especially true for children around ages 2 or 3, or during the teen years. Many children tend to disobey, argue with parents, or defy authority. They may often behave this way when they are tired, hungry, or upset. But in children and teens with ODD, these symptoms happen more often. They also interfere with learning and school adjustment. And in some cases, they disrupt the child’s relationships with others.

Symptoms of ODD may include:

Having frequent temper tantrums

Arguing a lot with adults

Refusing to do what an adult asks

Always questioning rules and refusing to follow rules

Doing things to annoy or upset others, including adults

Blaming others for the child’s own misbehaviors or mistakes

Being easily annoyed by others

Often having an angry attitude

Speaking harshly or unkindly

Seeking revenge or being vindictive

These symptoms may look like other mental health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

How is ODD diagnosed in a child?

If you notice symptoms of ODD in your child or teen, you can help by seeking a diagnosis right away. Early treatment can often prevent future problems.

A child psychiatrist or qualified mental health expert can diagnose ODD. He or she will talk with the parents and teachers about the child’s behavior and may observe the child. In some cases, your child may need mental health testing.

How is ODD treated in a child?

Early treatment can often prevent future problems. Treatment will depend on your child’s symptoms, age, and health. It will also depend on how bad the ODD is.

Children with ODD may need to try different therapists and types of therapies before they find what works for them. Treatment may include:

Cognitive-behavioral therapy. A child learns to better solve problems and communicate. He or she also learns how to control impulses and anger.

Family therapy. This therapy helps make changes in the family. It improves communication skills and family interactions. Having a child with ODD can be very hard for parents. It can also cause problems for siblings. Parents and siblings need support and understanding.

Peer group therapy. A child develops better social and interpersonal skills.

Medicines. These are not often used to treat ODD. But a child may need them for other symptoms or disorders, such as ADHD.

How can I help prevent ODD in my child?

Researchers don’t know what causes ODD. But certain approaches can help prevent the disorder. Young children be helped by early intervention programs that teach them social skills and how to deal with anger. For teens, talk therapy (psychotherapy), learning social skills, and getting help with schoolwork can all help reduce problem behaviors. School-based programs can also help to stop bullying and improve relationships among teens.

Parent-management training programs are also important. These programs teach parents how to manage their child’s behavior. Parents learn positive reinforcement methods, and also how to discipline their child.

How can I help my child live with ODD?

Early treatment for your child can often prevent future problems. Here are things you can do to help:

Keep all appointments with your child’s healthcare provider.

Take part in family therapy as needed.

Talk with your child’s healthcare provider about other providers who will be involved in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, and psychiatrists. Your child’s care team will depend on his or her needs and how serious the disorder is.

Tell others about your child’s conduct disorder. Work with your child’s healthcare provider and school to develop a treatment plan.

Reach out for support. Being in touch with other parents who have a child with ODD may be helpful. If you feel overwhelmed or stressed out, talk with your child’s healthcare provider. He or she may direct you to a support group for caregivers of children with ODD.

When should I call my child’s healthcare provider?

Call your child’s healthcare provider right away if your child:

Feels extreme depression, fear, anxiety, or anger toward him or herself or others

Feels out of control

Hears voices that others don’t hear

Sees things that others don’t see

Can’t sleep or eat for 3 days in a row

Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help

Call 911 if your child has suicidal thoughts, a suicide plan, and the means to carry out the plan.

Key points about ODD in children

Oppositional defiant disorder (ODD) is a type of behavior disorder. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures.

Developmental problems may cause ODD. Or the behaviors may be learned.

A child with ODD may argue a lot with adults or refuse to do what they ask. He or she may also be unkind to others.

A mental health expert often diagnoses ODD.

Therapy that helps the child interact better with others is the main treatment. Medicines may be needed for other problems, such as ADHD.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

Know the reason for the visit and what you want to happen.

Before your visit, write down questions you want answered.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

Ask if your child’s condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if your child does not take the medicine or have the test or procedure.

If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

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Oppositional Defiant Disorder (ODD) in Children

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Oppositional defiant disorder (ODD) is a type of behavior disorder. It is mostly diagnosed in childhood. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures.

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https://healthy-kids.com.au/parents/developing-positive-eating-behaviours/

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Teaching kids positive eating behaviours during childhood can set them up with healthy eating habits for life. Developing a positive relationship with food, as well as a balanced approach to eating, can lead to better health outcomes in the long run.

Nowadays, an alarming 25 per cent of Australian children are being classified as overweight or obese ¹. This is the direct result of a number of behaviours including 1,2:

Higher than recommended consumption of 'occasional' or 'extra' foods that are high in added fat, sugar and salt, especially fried potatoes, sugar-sweetened soft drinks, ice cream, cordials, meat pies and margarine.

Lower than recommended consumption of fruit and vegetables.

More food being purchased away from the home (e.g. take away).

Evening meals being eaten in front of the television.

In increase in screen time (iPads, TV, computers).

A decrease in the amount of incidental activity such as walking to and from school.

A drop in outdoor playtime.

What can parents do?
Parents often underestimate their role in the development of healthy eating habits. Speaking positively to your children about healthy foods and role modelling balanced eating is the first step in helping kids develop a healthy relationship with food. And remember, actions speak louder than words! Children watch, listen and learn through observation, and then follow what they see. Set your children up for life by being a positive role model and create healthy habits from the start.

How?

Enjoy all foods in moderation.

Don't binge on 'occasional' or 'extra' foods.

Cook meals at home and try to encourage your children to help you. Involve your kids in the menu planning and shopping, too.

Talk about healthy foods from the five food groups and what they do for your body. For instance, "this apple is so crunchy and delicious - it's flesh is helping to keep me stay regular and it's filling me up with its nutritious sweetness." Or "these carrot sticks contain a super nutrient called beta carotene that helps my eyes stay sharp and focused. Or "this delicious glass of milk contains calcium - it helps my bones and teeth stay strong."

Ensure your child's diet is balanced and contains a variety of foods from all the five food groups.

Encourage your kids to eat a nutritious breakfast every day using foods from the five food groups.

Encourage water instead of soft drink and or other drinks containing added sugars. Toss in lemon or lime wedges to flavour water.

Avoid negative language around less healthy foods such as 'bad' or 'fattening'. It's not the type of food that's bad, it's the amount and how often the food is eaten that can be problematic. Instead, refer to these foods as "occasional" or "extra" foods and keep portion sizes small.

Place a limit on the number of "occasional" or 'extra' foods eaten each week. These foods shouldn't be eaten daily. Make sure the whole family sticks to this rule and have other, more nutritious snacks available.

Fill your fridge and pantry with a variety of healthy foods that are easily accessible such as whole fruit, whole grain crackers with slices of reduced-fat cheese, reduced-fat yoghurt or pre-sliced veggie sticks with hummus or reduced fat cream cheese.

Discourage eating in front of the TV or computer as this is often done mindlessly without paying attention to hunger cues and can result in the consumption of unnecessary kilojoules (energy).

As often as possible, eat together at the dinner table and turn off the TV, even if the whole family isn't present.

Be mindful and listen to hunger cues. Most children are great at eating to their hunger so let your child stop eating when they don't want anymore. Kids will eat when they're hungry regardless of the food on offer, so always have healthy options available.

Children start to form food likes and dislikes from an early age, so always offer variety. It may take many attempts for your child to like a new food, so don't give up. Offer small amounts and try presenting it in a fun engaging way.

Avoid using food as a reward or bribe, or holding back on foods as punishment. Use activities or trips to the park as alternatives.

Don't forget about physical activity!

Being physically active is an important part of a healthy lifestyle. Here are some tips to get your family on track:

Limit all screen time to two hours or less a day.

Make time for your kids to play outside or be active for at least an hour every day.

Be a role model and make physical activity a family event by going for a bush walk, playing family cricket, playing in the park or kicking a ball around.

Start increasing incidental exercise such as walking to school or the shops, taking the stairs (not the lift), sweeping the path or doing some gardening.

Choose "active" presents such as balls or kites to replace DVD's, and play station games.

If you have tried and tested tips to help develop positive eating habits why not share them on our Healthy Kids Facebook page.
References 1 - Australian Institute of Health and Welfare 2012. Australia's food & nutrition 2012. Cat. no. PHE 163. Canberra: AIHW. 2 - www.healthykids.nsw.gov.au

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Teaching kids positive eating behaviours during childhood can set them up with healthy eating habits for life. Developing a positive relationship with food, as well as a balanced approach to eating, can lead to better health outcomes in the long run. Nowadays, an alarming 25 per cent of Australian children are being classified as overweight or obese 1.

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https://ibcces.org/blog/2019/03/12/teachers-fight-depression-mental-health-disorders/

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Educators Can Take Action To Help Fight Depression

So what can educators do to support students who are struggling with depression? Although serious depression may require external professional help, support can be provided in the school setting.

Depression is Not a Choice; Depressed Students Want to Succeed Too

First, remember that depressed children are not choosing to underperform or withdraw. They want to be successful and often are seeking guidance and support from teachers and others, but lack the ability to articulate their needs.

Learning How to Address Depression as a Teacher

Understandably, educators without significant mental health backgrounds may feel uncertain and uncomfortable approaching and interacting with students with depression; though all educators should remember that providing support and compassion does not necessitate training in therapy or counseling.

6 Actionable Steps To Help Students with Depression

1. Develop a Working and Collaborative Relationship with the Student

Do not be afraid to talk with students with depression about how they feel. In fact, saying nothing says a lot, and asking about how they feel will almost never cause harm.

Many times, they are seeking someone who cares about them and can recognize their pain without them having to seek help on their own, although it might not seem that way. Above all, don't give up on them!

2. Avoid Negative Techniques

Strategies such as punishment, sarcasm, disparagement, passive-aggression, or other negative techniques are ineffective and likely will only reinforce feelings of incompetence and low self-esteem, which may worsen the symptoms of depression.

Remember that these students are not choosing to be depressed.

They want to feel better and do well, just as you want them to do well. When depressed, students lack the personal resources to do their best work and overcome their challenges.

3. Make Adjustments or Accommodations in Assignments or Tasks

Do not lower expectations or give unearned grades. However, educatiors can give more time, break assignments into smaller pieces, offer extra help in setting up schedules or study habits, provide flexibility in assignment schedules, or pair the student with others who express an interest in helping as part of a range of classroom adjustments.

4. Plan for Success

To the extent possible, arrange experiences so that the student can be successful and receive recognition for successes. Scheduling pleasant activities and providing opportunities for successful leadership are examples. It is very important that depressed students feel accepted as a part of the school and that teachers believe in their competence.

5. Consult With Your School Psychologist, School Counselor, or School Social Worker

School-employed mental health personnel can provide suggestions of ways to support specific students, either through consultation, direct services, or collaborating with the family or other community agencies.

The world is changing quickly, and so is the research on depression and other neuro-cognitive disorders. A mental health certification through IBCCES will show you how to apply the latest research in the classroom with evidence based research and treatment. This helps educators to feel more comfortable addressing mental health disorders in students (which about 1 in 5 struggle with) and helps students to get the care they need to succeed.

Depression can impact many aspects of a student's performance at school, including both academic achievement and social relationships.

While students with depression can benefit significantly from mental health services, they can also greatly benefit from support by caring adults in their school settings that they interact with on a daily basis.

Understanding, patience, compassion, knowledge of the nature and course of depression, a desire to help, and a commitment to improving outcomes can be major factors in helping students with depression to succeed in school and life.

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6 Ways Teachers Can Help Fight Depression and Mental Health Disorders

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Depression has affected more than 10 percent of teenagers in the last year, yet most educators are not prepared to help students deal with depression.

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School Counselors & Students' Mental Health

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School Counselors & Students' Mental Health

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The prevalence of mental illness in children has reached an all time high, and it's a public health issue that up until recently has been widely ignored. According to the Centers for Disease Control and Prevention, ¹ an estimated 1 in 5 children are diagnosed with "mental disorders such as ADHD, Tourette syndrome, behavioral issues, mood and anxiety disorders, autism spectrum disorders, or substance abuse disorders."

Left undiagnosed or untreated, children's mental disorders can cause a number of problems both at home and in the classroom, affecting the way children learn, behave, and handle their emotions. Despite this, nearly 80 percent of adolescents who would benefit from mental health treatment do not receive it, and this disproportionately affects children of color and the uninsured.²

This gap in treatment for students can be explained by a number of factors. Counselors, parents, and teachers are constantly battling with challenges that include mental health stigma, budget constraints, inadequate insurance coverage, and availability of mental health services in the community.³

For students who do receive a diagnosis, schools are often the first providers of mental health resources. ⁴

The Role of the School Counselor

Throughout the week, many students spend more time in the classroom than they spend with their parents. As such, teachers, counselors, and other school staff are among the first to notice concerning changes in behavior that could signal a mental or behavioral health issue.
While teachers arguably spend the most time with their students, a study by the research journal School Psychology Quarterly found that a mere 34 percent of teachers surveyed felt that they had the skills needed to identify mental health issues in students and find resources for students with mental health conditions. ⁵

As such, school counselors become a crucial part of the education team, collaborating with teachers, administrators, parents, and social workers to ensure that each student receives the care and resources necessary to succeed in their academic and personal lives. ⁶
School counselors allocate much of their focus to designing and implementing programs which promote the academic and personal success for all of their students. These responsibilities include:

Enhancing the awareness of mental health in their schools, and aiming to remove shame and stigma

Provide external referrals, which may include short-term counseling or crisis intervention

Recognize and respond to warning signs, such as sudden changes in grades or attendance, disciplinary problems, or visible problems at home

Provide individual focus to students about issues surrounding their mental health, academic well being, and social and emotional needs

Provide resources and support for teachers, administrators, and parents ⁷

Barriers to Mental Health Treatment

Counselors are a vital part of the educational team, and in an ideal world, children would have adequate access to school counselors. But when districts are confronted with budget cuts, counselors are often among the first to be laid off.

As it stands, the national student-to-counselor ratio is much higher than the average 250-1 ratio recommended by the American School Counselors Association. ⁸ At some schools, the student-to-counselor ratio is as high as 781:1. ⁹

Additionally, counselors must also operate based on the mental health services readily available in their communities, and not all communities are equally prepared to handle mental health concerns.

When left unmet, students mental health needs can pose serious barriers to social and educational development. Counselors are a necessary part of an educational staff, as they have the unique qualifications required to provide education, intervention, and referral services to children, parents, and teachers. Although school counselors typically do not act as long-term therapists, they help foster an environment where mental health stigma is erased, help bridge the gap between student and community resources, and make sure the developmental needs of all students are met.

Students who obtain their Master's Degree in Counseling from Wake Forest University Online enter the field prepared to help students, parents, and teachers manage student mental health.

¹ http://www.cdc.gov/features/childrensmentalhealth/

² http://www.ncbi.nlm.nih.gov/pubmed/12202276

³ http://www.edweek.org/ew/articles/2014/06/20/36cottle.h33.html

4 http://digitalcommons.brockport.edu/cgi/viewcontent.cgi?article=1599&context=ehd_theses

5 https://edsource.org/2013/task-force-recommends-including-mental-health-training-in-teacher-credential/33503

6 http://www.mn2020.org/issues-that-matter/education/dont-forget-school-counselors-in-mental-health-debate

7 http://www.schoolcounselor.org/asca/media/asca/positionstatements/ps_studentmentalhealth.pdf

8 https://www.counseling.org/government-affairs/public-policy/public-policy-news-view/position-papers/2013/02/11/student-support-act-reducing-the-student-to-counselor-ratio

9 http://www.counseling.org/PublicPolicy/PDF/2010-2011_Student_to_Counselor_Ratio.pdf

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How Counselors Help Students Manage Their Mental Health - WFU Online Counseling

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The prevalence of mental illness in children has reached an all time high, and it's a public health issue that up until recently has been widely ignored. According to the Centers for Disease Control and Prevention, ¹ an estimated 1 in 5 children are diagnosed with "mental disorders such as ADHD, Tourette syndrome, behavioral issues, mood and anxiety disorders, autism spectrum disorders, or substance abuse disorders."

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http://www.worrywisekids.org/node/29

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Children with social phobia are not just a little "shy," rather they are painfully uncomfortable in any situation where they could be embarrassed or feel they are being evaluated. They may see these threats even in relatively safe situations. These children often wish they had more friends but find it hard to do the things that are required to make new friends or maintain these'friendships. Often time adolescents will say they like being alone and don't need friends. For some kids it's better not to know than take the risk they will be rejected.

Children with social anxiety appear uncomfortable and may choose to withdraw or not talk to prevent the risk of embarrassment. They are often successful at being invisible, in that while they may not actually incur the social rejection that they fear, they may be unnoticed by their peers and have a socially neglected status because of their voluntary isolation, (eating lunch in the bathroom or alone at a table, avoiding recess by going to the library or helping the teacher).

Fears being humiliated, embarrassing or laughed at in everyday situations

Avoid social contact or endures with great distress

Physical symptoms of anxiety- racing heart, sweaty palms, difficulty concentrating, stomachaches

Avoid eye contact, conversation with others

May be terrified of using the telephone, ordering in a restaurant, eating in a cafeteria

May be unable to raise a hand in class, do book reports or presentations, or ask for help which would require being the focus of attention

Avoidance of gym class or using school or public bathroom

Hesitant to go to friend's houses or talk to friend's parents

Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally based panic. In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from contact. Persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.

Clinically significant distress or impairment in important areas of functioning.

Duration of at least 6 months

The treatment focus for Social Phobia is similar to GAD with focus on addressing physical symptoms, identifying anxious thoughts and development of coping thoughts, and problem solving. Children learn that the worry voice is a disruptive internal critic, by devaluing that voice and "firing the judge," they can learn to turn attention away from self and toward others and focus on the task rather than who is watching. The early in vivo experiences may be smiling and making eye contact with a familiar peer, later making a phone call to a peer to invite them over, and moving up to giving a presentation in front of others.

Brought to you by The Children's and Adult Center for OCD and Anxiety.

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Children with social phobia are not just a little "shy," rather they are painfully uncomfortable in any situation where they could be embarrassed or feel they are being evaluated. They may see these threats even in relatively safe situations.

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https://files.eric.ed.gov/fulltext/EJ871914.pdf

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https://www.connecticutchildrens.org/health-library/en/teens/anxiety-tips/

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https://childmind.org/article/classroom-anxiety-in-children/

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https://www.psychiatry.org/patients-families/depression/what-is-depression

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

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Centers for Disease Control and Prevention

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Learn about different types of mental disorders in children, including symptoms, treatment, and what can be done to prevent them.

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The School Counselor's Role in Addressing Eating Disorders

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The School Counselor's Role in Addressing Eating Disorders

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The School Counselor's Role in Addressing Eating Disorders

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https://mentalhealthhotline.org/texas/

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More than one in five Texan residents suffer from some form of mental illness, any given year. There are about half a million Texan adults suffering from a serious mental illness, around 23,000 alone in Montgomery County. Furthermore, half the mental health disorders suffered in-state begin around age 14.

Fortunately, there’s help. No shortage of providers (or shortage of funds) should ever prevent you from getting the help you deserve. The following resources are free of charge, confidential, and available to all Texas residents. Help yourself or someone you love today.

The National Mental Health Hotline

If you need to connect with a mental health specialist, call 1-866-903-3787 right now. A trained professional will take your call and assist you however she or he can. A world of resources is waiting for you. The hotline is available to all US residents and operates on a 24/7 basis.

Texas HHS

The state Department of Health and Human Services offers a hotline for all residents to connect with a trained professional. Call 855-937-2372 today for more information. There is also a list of mental health hotlines on their website. You may also search specifically by county by clicking here.

NAMI Helpline & More

The National Alliance on Mental Illness provides a wealth of resources, including the NAMI Helpline, which can be reached by calling 1-800-950-6264 or by emailing info@nami.org. Although the helpline is only available Monday through Friday from 10AM until 8PM EST, there is a 24/7 text-line available. Simply text ‘NAMI’ to 741-741 for assistance.

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Texas Mental Health Hotline | 866-903-3787

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Call the Texas Mental Health Hotline at 866-903-3787 now for free mental health crisis support. We’re available 24/7 to help so call now.