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Students who have participated in sports tend to experience positive effects such as healthier lifestyles, enhanced skills in teamwork, improved discipline and decision-making skills [1]. However, can a coach or teacher play a key roll in eating disorder prevention?

Sports environments, however, can increase the risk of eating disorders among some students. Coaches and teachers are in a unique position to help identify and prevent eating disorders and other disordered behaviors.

Eating disorders primarily fall into three categories, Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. For these disorders to be diagnosed, they should cause significant occupational and academic impairments, impair physical and psychological functioning and show a persistent disturbance in eating patterns.

Athletes at Risk

Students athletes seem to be at a higher risk because eating disorders know no bounds within a sport. It can affect anyone, of any age, in any sport. However, it does typically affect more females than males [1].

Lean sports such as running, swimming, wrestling, etc. and sports that are judged on appearances such as figure skating, gymnastics, etc. tend to have higher rates of eating disorders, but no sport is immune to an eating disorder.

Genetics can also play a role in the development of eating disorders. There are strong indicators of genetic tendencies for eating disorders in epidemiological research, and family and twin studies have found in heritability estimates that there is a 76% higher chance to develop anorexia and 83% higher chance to develop bulimia [1].

Socio-cultural factors also play a role in developing an eating disorder. For example, if you are in a culture that focuses on diets and exercise or appearance, the odds of developing disordered eating habits increase.

Relationships are Pivotal for Eating Disorder Prevention

The relationship of a coach with an athlete can be especially important when trying to prevent an eating disorder. The athlete is influenced by the coach's motivation, their body image, their relationship with the team, the training, their competitiveness, etc.

Athletes and coaches spend a significant amount of time together during the week, especially if the coach is also one of the athlete's teachers. The coach or teacher can have a substantial influence on an athlete's beliefs, perceptions, and behaviors.

The relationship between motivation, conflict, and performance has also been shown to increase or decrease disordered eating in athletes [1].

If the conflict is high between the coach and athlete, and there is little support then typically the athlete may begin to show signs of disordered eating.

Additionally, if there is a performance-centered or judgment based environment, there is often a higher rate of disordered eating among athletes.

Thin Equals Fast or Does It

The perception of the 'thin body ideal' is also another risk factor for eating disorders among athletes. It is often a misperception among sports teams that being thin, or the right body shape will increase sports performance.

Also, there is frequently the expectation to look a specific way because the athlete is in a particular sport. The wrestler's body has to be below his/her ideal weight class, the dancer's or cheerleader's body has to be this preconceived small shape, the gymnast's body has to be ..., the swimmer's body has to be ..., etc. This can create a distorted body image and disordered eating patterns in the athlete as they strive for 'perfect' unrealistic expectations.

Dieting is What Athletes Do

Dieting and excessive training can be seen as normal in the athletic environment. Many athletes play several different sports and therefore they are in various year-round training programs.

Depending on the sport, athletes will often follow different dieting guidelines, and this is considered as a standard way of living. These behaviors often can be misperceived by trainers or coaches as athletic behaviors, but these actions can often be a form of disordered eating.

Mindfulness Practice in Middle School

One school in North Carolina works on practicing mindful eating with middle schoolers. At this school, for one class time during the week these students work on breathing practices, how to recognize satiety and hunger signals, and what food texture and tastes are like [2].

According to researchers at Kenyon College, engaging in prevention programs like mindful eating can prevent people from developing eating disorders [2].

Middle school programs that incorporate mindfulness also work to integrate reframing techniques to help youth reframe their thoughts with the use of dietetics and food science teachers.

Some schools bring in short-term prevention programs or leadership training such as The Body Positive, Girls on the Run and Girls in the Know that explore healthy lifestyles, body image, and self-care education.

These programs are often led by professional therapists, dietitians, and physicians in local communities that volunteer their time to these organizations. Other programs have guest speakers who are recovering from an eating disorder and share their personal story.

Prevention Is Possible

Working on changing the social environment through educational awareness of disordered eating, unhealthy eating patterns, obsessive exercise, etc. can help prevent eating disorders.

Another way to prevent unhealthy social atmospheres is to change the conversations from performance and appearance driven to team and quality driven.

When coaches and teachers start to focus on the team or class as a whole, talents of the person, as well as performance, it enhances the student's or athlete's self-confidence and self-worth.

Inviting dieticians to talk at schools on a regular basis about nourishment for the athlete's body, mindful eating practices, and self-care are important for all students regardless of the age or if they are in athletics.

Being able to have the student and athlete focus all of their senses on how their body is feeling, what emotions they are sensing, and how their food tastes is a great tool to use in preventing disordered eating patterns.

Engaging a school counselor or a therapist to work with a student in school or on the team or the team as a whole can help with prevention efforts. School therapists can offer educational sessions on healthy versus unhealthy eating behaviors, and provide one-on-one counseling.

Coaches and teachers can play a major role in helping a student-athlete become aware of school resources, knowing what to do when an athlete is struggling, and knowing how to support that person is important in preventing eating disorders.
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice. Libby currently works as a counselor at Fontbonne University and is an Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies. References:
[1] Thompson, R. (n.d.). Mind, Body and Sport: Eating Disorders. Retrieved January 18, 2018, from http://www.ncaa.org/sport-science-institute/mind-body-and-sport-eating-disorders
[2] Fraga, J. (n.d.). How schools are using 'mindful eating' to help prevent eating disorders. Retrieved January 18, 2018, from https://namimc.org/schools-using-mindful-eating-help-prevent-eating-disorders/
The opinions and views of our guest contributors, are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals. We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help. Published on March 22, 2018.

Published onEatingDisorderHope.com
Tagged as: prevention, Athletics, School

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How Can Teachers & Coaches Help with Eating Disorder Prevention?

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Students who have participated in sports tend to experience positive effects such as healthier lifestyles, enhanced skills in teamwork, improved discipline and decision-making skills [1]. However, can a coach or teacher play a key roll in eating disorder prevention? Sports environments, however, can increase the risk of eating disorders among some students.

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Eating disorders are characterized by an unhealthy relationship with food and eating habits that impair physical health or social functioning. They usually develop in adolescence, and they are more common in girls than boys.

By using this site, you agree to our Terms of Use and Online Privacy Statement, which describes our use of cookies. By using this site without adjusting your settings, you agree to our use of cookies. Read More

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Eating disorders are characterized by an unhealthy relationship with food and eating habits that impair physical health or social functioning. They usually develop in adolescence, and they are more common in girls than boys. By using this site, you agree to our Terms of Use and Online Privacy Statement, which describes our use of cookies.

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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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K'STAR
1101 19th St.
Hondo, Tx
830-426-2878
Open 24 hours a day, Monday-Friday
K'STAR offers services for children and parents free of charge. This might be a good resource for someone who does not have the financial means to pay for counseling or therapy.

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South Texas  Rural Health Services
1010 W. Hondo Ave.
830-663-5450
Monday-Friday 9-6
This local community resource can offer counseling for individuals in the Devine area. Fees are on a sliding scale based on income and health insurance.

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ASCA Ethical Standards for School Counselors

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ASCA Ethical Standards for School Counselors

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

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

Listen for ongoing or severe traumatic stress symptoms.

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

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

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

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

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

Steps for making a referral

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

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

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

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

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

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

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

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

Keep the door open.

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

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

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

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

Effective mental health treatment for traumatic stress

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

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

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

Do you have experience working with children after trauma?

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

What is your success rate?

How do you work with parents?

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

Online resources - help in finding a mental health professional

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

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

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

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

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

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

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

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When and How to Refer for Mental Health Care

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

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Center for Parent Information and Resources

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Center for Parent Information and Resources

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The site offers resources for parents of children with disorders.

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Meetings to write, review, or revise a child's IEP typically bring together a team of people who meet in person at least once a year. Now, because of coronavirus, school closures, and social distancing, IEP teams are meeting , either in conference calls or via the Internet. This collection of tip sheets on planning for and participating in virtual meetings was developed collaboratively by six OSEP-funded technical assistance centers, and includes an infographic about virtual IEP meetings (available in English and Spanish); a sample agenda (also available in English and Spanish); technology tips for all participants; suggestions for hosting a virtual meeting; and tips for those participating in a virtual meeting. Read more about (and download) the tip sheets here.

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

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Meetings to write, review, or revise a child's IEP typically bring together a team of people who meet in person at least once a year. Now, because of coronavirus, school closures, and social distancing, IEP teams are meeting , either in conference calls or via the Internet.

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Child Mind Institute | Transforming Children’s Lives.

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

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Understanding LGBTQ+ Identity: A Toolkit for Educators

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The Understanding LGBTQ+ Identity: A Toolkit for Educators Collection offers a series of digital media resources to help administrators, guidance counselors, and educators understand and effectively address the complex and difficult issues faced by LGBTQ students.

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Disability Fact Sheet

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

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

What is Oppositional Defiant Disorder (ODD)?

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

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

Being unusually angry and irritable

Frequently losing their temper

Being easily annoyed

Arguing with authority figures

Refusing to follow rules

Deliberately annoying people

Blaming others for mistakes

Being vindictive

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

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

Parenting Under Fire

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

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

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

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

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

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

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

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

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

ADHD and Other Risk Factors

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

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

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

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

Why Treatment is Important

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

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

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

What Treatment for ODD Looks Like

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

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

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

Parent-Child Interaction Therapy (PCIT)

Parent Management Training (PMT)

Defiant Teens

Positive Parenting Program (Triple P)

The Incredible Years

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

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

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

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

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

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

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Children with anxiety disorders are overwhelmed by feelings of intense fear or worry that they are out of proportion to the situation or thing that triggers them. These emotional fears can be focused on separating from parents, physical illness, performing poorly, or embarrassing themselves. Or they can be attached to specific things, like dogs or insects or bridges.

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OCD: Obsessive-Compulsive Disorders

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Anxiety Disorders in Children | Social Disorders | Child Mind Institute

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Children with anxiety disorders are overwhelmed by feelings of intense fear or worry that they are out of proportion to the situation or thing that triggers them. These emotional fears can be focused on separating from parents, physical illness, performing poorly, or embarrassing themselves.

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Bipolar disorder, also known as manic-depressive disorder, is characterized by bouts of major depression and periods of mania - euphoria, poor judgment, and extreme risk-taking activity - in an often debilitating cycle. Onset usually occurs in mid-to-late adolescence, though there are cases in children. Explore information about bipolar disorder, including the best treatments for children and adolescents and advice for parents raising kids with difficult behavior.

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Bipolar disorder, also known as manic-depressive disorder, is characterized by bouts of major depression and periods of mania - euphoria, poor judgment, and extreme risk-taking activity - in an often debilitating cycle. Onset usually occurs in mid-to-late adolescence, though there are cases in children.

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Kids with depression is are sad, empty or irritable in mood for a prolonged period of time, and there are usually changes in their energy level, affect, interests, ability to concentrate, and patterns of sleeping and eating. These childhood mood disorders differ in the intensity, the timing, and the length of time symptoms persist.

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Childhood Depression and Mood Disorders | Child Mind Institute

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Kids with depression is are sad, empty or irritable in mood for a prolonged period of time, and there are usually changes in their energy level, affect, interests, ability to concentrate, and patterns of sleeping and eating. These childhood mood disorders differ in the intensity, the timing, and the length of time symptoms persist.

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These disorders are grouped together because they include preoccupations - fears, perceived needs or flaws - and repetitive, obsessive behaviors. Some children have insight into the fact that their obsessive and compulsive beliefs are not realistic, and some are convinced that they are true.

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Obsessive Compulsive Disorders | Obsessive Behavior | Child Mind Institute

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These disorders are grouped together because they include preoccupations - fears, perceived needs or flaws - and repetitive, obsessive behaviors. Some children have insight into the fact that their obsessive and compulsive beliefs are not realistic, and some are convinced that they are true.

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Schizophrenia is a disorder characterized by distorted perceptions of reality. These distortions include hallucinations and delusions, as well as what's called "disorganized" thinking and speech, which means that thoughts are disconnected, and answers might be unrelated to questions. Schizophrenia is rare in childhood. Onset is usually late adolescence or early adulthood.

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Schizophrenia and Psychosis | Child Mind Institute

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Schizophrenia is a disorder characterized by distorted perceptions of reality. These distortions include hallucinations and delusions, as well as what's called "disorganized" thinking and speech, which means that thoughts are disconnected, and answers might be unrelated to questions. Schizophrenia is rare in childhood. Onset is usually late adolescence or early adulthood.

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

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Generalized Anxiety Disorder in Teens and Children

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Generalized Anxiety Disorder in Teens and Children

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Symptoms and Strategies for Generalized Anxiety Disorder (GAD) in Children and Teens

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Centers for Disease Control and Prevention

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Many children have fears and worries, and may feel sad and hopeless from time to time. Strong fears may appear at different times during development. For example, toddlers are often very distressed about being away from their parents, even if they are safe and cared for. Although fears and worries are typical in children, persistent or extreme forms of fear and sadness could be due to anxiety or depression. Because the symptoms primarily involve thoughts and feelings, they are sometimes called internalizing disorders.

Anxiety

When a child does not outgrow the fears and worries that are typical in young children, or when there are so many fears and worries that they interfere with school, home, or play activities, the child may be diagnosed with an anxiety disorder. Examples of different types of anxiety disorders include

Being very afraid when away from parents (separation anxiety)

Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias)

Being very afraid of school and other places where there are people (social anxiety)

Being very worried about the future and about bad things happening (general anxiety)

Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)

Anxiety may present as fear or worry, but can also make children irritable and angry. Anxiety symptoms can also include trouble sleeping, as well as physical symptoms like fatigue, headaches, or stomachaches. Some anxious children keep their worries to themselves and, thus, the symptoms can be missed.

Related conditions include Obsessive-Compulsive Disorder and Post Traumatic Stress Disorder.
Learn more about anxiety in children
Depression

Occasionally being sad or feeling hopeless is a part of every child's life. However, some children feel sad or uninterested in things that they used to enjoy, or feel helpless or hopeless in situations they are able to change. When children feel persistent sadness and hopelessness, they may be diagnosed with depression.

Examples of behaviors often seen in children with depression include

Feeling sad, hopeless, or irritable a lot of the time

Not wanting to do or enjoy doing fun things

Showing changes in eating patterns - eating a lot more or a lot less than usual

Showing changes in sleep patterns - sleeping a lot more or a lot less than normal

Showing changes in energy - being tired and sluggish or tense and restless a lot of the time

Having a hard time paying attention

Feeling worthless, useless, or guilty

Showing self-injury and self-destructive behavior

Extreme depression can lead a child to think about suicide or plan for suicide. For youth ages 10-24 years, suicide is among the leading causes of death. Read about youth suicide prevention.

Some children may not talk about their helpless and hopeless thoughts, and may not appear sad. Depression might also cause a child to make trouble or act unmotivated, causing others not to notice that the child is depressed or to incorrectly label the child as a trouble-maker or lazy.
Learn more about depression in children
Treatment for anxiety and depression

The first step to treatment is to talk with a healthcare provider such as your child's primary care provider, or a mental health specialist, about getting an evaluation. The United States Preventive Services Taskforce recommends screening for anxiety in children aged 8 to 18 years and for depression in adolescents aged 12 to 18 years. Some of the signs and symptoms of anxiety or depression in children could be caused by other conditions, such as trauma. Specific symptoms like having a hard time focusing could be a sign of attention-deficit/hyperactivity disorder (ADHD). It is important to get a careful evaluation to get the best diagnosis and treatment. Consultation with a health provider can help determine if medication should be part of the treatment. A mental health professional can develop a therapy plan that works best for the child and family. Behavior therapy includes child therapy, family therapy, or a combination of both. The school can also be included in the treatment plan. For very young children, involving parents in treatment is key. Cognitive-behavioral therapy is one form of therapy that is used to treat anxiety or depression, particularly in older children. It helps the child change negative thoughts into more positive, effective ways of thinking, leading to more effective behavior. Behavior therapy for anxiety may involve helping children cope with and manage anxiety symptoms while gradually exposing them to their fears so as to help them learn that bad things do not occur.

Treatments can also include a variety of ways to help the child feel less stressed and be healthier like nutritious food, physical activity, sufficient sleep, predictable routines, and social support.

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 depression or anxiety. In addition to getting the right treatment, leading a healthy lifestyle can play a role in managing symptoms of depression or anxiety. Here are some healthy behaviors that may help:

Prevention of anxiety and depression

It is not known exactly why some children develop anxiety or depression. Many factors may play a role, including biology and temperament. But it is also known that some children are more likely to develop anxiety or depression when they experience trauma or stress, when they are maltreated, when they are bullied or rejected by other children, or when their own parents have anxiety or depression.

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

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Anxiety and Depression in Children | CDC

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Although fears and worries are typical in children, persistent or extreme forms of fear and sadness could be due to anxiety or depression. Learn about anxiety and depression in children.

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Adolescents who present with symptoms that suggest a psychotic disorder pose a number of diagnostic and treatment challenges. This article attempts to provide a practical guide to the assessment and management of adolescents with severe psychotic illness, including schizophrenia, schizophrenia-like disorders, and bipolar disorder. Epidemiology, differential diagnosis, causes, and predisposing factors will also be covered in the context of a comprehensive framework for assessment and management.
Prevalence of psychosis in adolescence
Five percent of adults with schizophrenia report onset of psychosis before age 15 years. ¹ Despite the lack of precise incidence and prevalence rates from childhood or adolescent population-based studies, it is generally agreed that the prevalence of psychotic disorders increases markedly during adolescence.

Gillberg and colleagues ² estimate the prevalence of psychosis in 13- to 19-year-olds as 0.54%, increasing from 0.9 per 10,000 at age 13 years to 17.6 per 10,000 at age 18 years. 2 Male preponderance has been reported in some studies, but this is not a consistent finding and may be related to lack of robust data.

Adult bipolar disorder prevalence is estimated at 1%. However, community studies in adolescents have indicated a prevalence of 0.5% to 1%, which varies with age and diagnostic criteria. Complete ascertainment of cases in this age group remains a concern: many episodes are only recognized in retrospect. ³⁻⁶

The diagnosis of schizophrenia-early-onset psychosis in adolescents younger than 18 years-is based on the same criteria as for adults. The diagnostic criteria focus on 3 characteristic symptoms ⁷:

* Reality distortion (hallucinations and delusions).
* Disorganization.
* Psychomotor poverty (for example, poverty of speech, poor motivation, social withdrawal, and a flat affect).
Diagnostic criteria and atypical presentations
DSM-IV diagnosis of schizophrenia requires a 6-month period of disturbance that can include both a prodromal period of deterioration before the onset of psychotic symptoms and a residual phase. However, active psychotic symptoms must be present for at least 1 month. One important modification of criteria from those used in adults is that a failure to achieve age-appropriate interpersonal, academic, or occupational progress can substitute for significant deterioration in self-care and social, educational, or occupational functioning below premorbid levels.

In episodes lasting between 1 and 6 months, a diagnosis of schizophreniform disorder may be made. Briefer episodes that have a sudden onset and that resolve rapidly to the premorbid level of functioning within a month without evidence of an organic cause are diagnosed as brief psychotic disorders, according to DSM-IV criteria. Because classical schizophrenia may eventually develop in some patients with this diagnosis, ongoing follow-up is required. The presence of a clear stressor is sometimes associated with a brief reactive psychosis, although, without further follow-up, this presumption cannot be used to make a definitive diagnosis. ⁸

Affective disorder in adolescents (whether manic, depressive, or mixed) can present with psychotic symptoms such as delusions, hallucinations, or thought disorder. It may be relatively easy to distinguish affective disorder from schizophrenia when the patient has symptoms that are mood-congruent with affective episodes and no clear negative symptoms. A firm diagnosis of affective disorder may be more difficult to establish in adolescents who present with bizarre and persecutory delusions, mood incongruent hallucinations with lability of mood, or significant functional deterioration. The diagnostic uncertainty in such cases may have to be accepted and shared with parents and/or caregivers while awaiting a clarification as the clinical picture evolves. Pointers to possible schizophrenia might be the insidious onset of affective symptoms with difficulties in premorbid adjustment and functioning, a family history of schizophrenia, and the presence of a significant thought disorder. ⁹

Concurrent presentation of schizophrenic and affective symptoms that meet criteria for schizoaffective disorder appears to carry a short-term clinical course and a longer-term prognosis intermediate between schizophre-nia and affective disorder.

Acute psychotic, manic, or hypomanic symptoms may also present in association with substance misuse or with organic conditions that need to be distinguished by a careful history, physical examination, and appropriate investigations. A period of enforced abstinence may be necessary to determine whether symptoms are truly enduring.

Induced delusional disorder (folie deux) may be encountered in adolescents in a close or enmeshed emotional relationship with a psychotic parent or caregiver or sibling. In this setting, psychotic beliefs may be shared rather than actually experienced by the adolescent. ¹⁰
The prodromal phase
Adolescents occasionally present with nonspecific psychotic symptoms, such as odd beliefs, mistrust of others, and magical thinking. These overvalued ideas lead to a decline in interpersonal and school functioning. Whether this represents the prodromal phase of a severe psychotic disorder is difficult to answer prospectively. However, frank psychosis develops in up to 40% of affected patients within 12 months of symptom onset. 11 A positive family history of psychosis and marked impairment of functioning with evolving psychosis-like symptoms are considered to be risk factors for psychotic illness. Adolescent schizophrenia, in particular, is associated with motor or language developmental delays and premorbid cognitive and social impairments that seem to merge with the onset of an insidious psychotic illness. ¹²

While research in psychological and pharmacological interventions is ongoing, specific clinical management is limited to continued monitoring to identify those who may be at risk for a psychotic episode and to address specific presenting problems with practical and psychotherapeutic support. 8,13 A high index of suspicion should be maintained for adolescents who manifest the risk factors mentioned above so that prompt treatment can be initiated at the onset of a clear psychotic episode.

Notwithstanding the ongoing debate about the role of active pharmacological and psychological treatment of prodromal symptoms of schizophrenia, any treatment option at this stage requires an explanation to the patient and his or her parent or caregiver. This should include information about the incomplete evidence base and a detailed discussion of the relative risks and benefits. The goal is to actively involve the patient and his family in making treatment decisions. ¹¹ A conservative approach to treatment at this stage is advised. Psychosocial and other benign options should be employed before antipsychotics. ¹⁴
References
1. Asanrow RF, Asanrow JR. Childhood-onset schizophrenia: editor's introduction. Schizophr Bull. 1994;20:591-597.
2. Gillberg C, Wahlström J, Forsman A, et al. Teenage psychoses-epidemiology, classification and reduced optimality in the pre-, peri- and neonatal periods. J Am Acad Child Adolesc Psychiatry. 1986;27:87-98.
3. Carlson GA. Annotation: child and adolescent mania-diagnostic considerations. J Child Psychol Psychiatry. 1990;31:331-341.
4. Geller B, Luby J. Child and adolescent bipolar disorder: a review of the past 10 years [published correction appears in J Am Acad Child Adolesc Psychiatry. 1997;36:1642]. J Am Acad Child Adolesc Psychiatry. 1997;36:1168-1176.
5. Volkmar FR. Childhood and adolescent psychosis: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1996;35:843-851.
6. Harrington R, Myatt T. Is preadolescent mania the same condition as adult mania? A British perspective. Biol Psychiatry. 2003;53:961-969.
7. Liddle PF. The symptoms of chronic schizophrenia: a re-examination of the positive-negative dichotomy. Br J Psychiatry. 1987;151:145-151.
8. Clark AF. Schizophrenia and schizophrenia-like disorders. In: Gillberg C, Harrington R, Steinhausen C, eds. Clinician's Deskbook of Child and Adolescent Psychiatry. Cambridge, UK: Cambridge University Press; 2006:79-109.
9. Clark AF. Proposed treatment for adolescent psychosis, 2: bipolar illness. Adv Psychiatr Treatment. 2001;7:143-149.
10. Munro A. Persistent delusional symptoms and disorders. In: Gelder MG, Lopez-Ibor JG Jr, Andreason NC, eds. New Oxford Textbook of Psychiatry. Oxford, UK:Oxford University Press; 2000:651-676.
11. Yung AR, McGorry PD. Prediction of psychosis: setting the stage. Br J Psychiatry. 2007;51:s1-s8.
12. Hollis C. Adolescent schizophrenia. Adv Psychiatr Treatment. 2000;6:83-92.
13. Phillips LJ, McGorry PD, Yung AR, et al. Prepsychotic phase of schizophrenia and related disorders: recent progress and future opportunities. Br J Psychiatry. 2005;48(suppl):s33-s44.
14. McGorry PD, Hickie IB, Yung AR, et al. Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Aust N Z J Psychiatry. 2006;40:616-622.
15. Kaufman J, Birmaher B, Brent D, et al. Kiddie-SADS-Present and Lifetime Version (K-SADS-PL). Pittsburgh: Western Psychiatric Institute and Clinic; 1996.
16. Clark AF. Psychotic disorders. In: Gowers S, ed. Clinical Practice in Adolescent Psychiatry. London: Arnold; 2001:193-210.
17. McClellan J, Werry, J; American Academy of Child and Adolescent Psychiatry. Practice parameters for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. 1997;36(suppl 10):157S-176S.
18. American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry. 1997;154(suppl 4):1-63.
19. McClellan J, Werry J; American Academy of Child and Adolescent Psychiatry. Practice parameters for the assessment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 1994;33:616-635.
20. Altman H, Collins M, Mundy P. Subclinical hallucinations and delusions in nonpsychotic adolescents. J Child Psychol Psychiatry. 1997;38:413-420.
21. Kolvin I. Studies in the childhood psychoses, I: diagnostic criteria and classification. Br J Psychiatry. 1971;118:381-384.
22. Lewis S, Lieberman J. CATIE and CUtLASS: can we handle the truth? Br J Psychiatry. 2008;192:161-163.
23. Kowatch RA, Fristad M, Birmaher B, et al; Child Psychiatric Workgroup on Bipolar Disorder. Treatment guidelines for children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2005;44:213-235.

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Adolescents who present with symptoms that suggest a psychotic disorder pose a number of diagnostic and treatment challenges. This article attempts to provide a practical guide to the assessment and management of adolescents with severe psychotic illness, including schizophrenia, schizophrenia-like disorders, and bipolar disorder. 1

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