# data[].attributes.attachment_link.description
Whether you want to better manage stress, understand a mental health disorder, or learn why we dream, get the guidance you need to be healthy and happy.

# data[].attributes.headline
Adolescent Girls and Body Image Issues: Ideas for Counselors

# data[].attributes.subject
Adolescent Girls and Body Image Issues: Ideas for Counselors

# data[].attributes.attachment_link.readable_text
What Is Oppositional Defiant Disorder?

Oppositional defiant disorder (ODD) is a psychiatric disorder that typically emerges in childhood, between ages 6 and 8, and can last throughout adulthood.

ODD is more than just normal childhood tantrums, and the frequency and severity of ODD causes difficulty at home and at school. What's more, children with ODD often also struggle with learning problems related to their behavior.

There are two types of oppositional defiant disorder:

Childhood-onset ODD: Present from an early age, and requires early intervention and treatment to prevent it from progressing into a more serious conduct disorder

Adolescent-onset ODD: Begins suddenly in the middle- and high-school years, causing conflict at home and in school

Children with ODD display behaviors that are challenging for parents and educators. For example, they demonstrate aggression and purposeful misbehavior. They usually have difficulty interacting appropriately with peers and adults. Being argumentative and defiant is also a common problem in children with ODD.

Common signs and symptoms of ODD include:

Being easily annoyed

Causing conflict

Frequent temper tantrums

Low tolerance for frustration

Lying

Moodiness and unprovoked anger

Noncompliance with even simple requests

No sense of conscience

Purposeful irritation of others

According to the DMS-5, a diagnosis of ODD requires a child to have at least four symptoms from the following categories. The symptoms must occur for at least six months and have a negative impact on social, educational, or occupational functioning:﻿﻿

Angry/irritable mood:Often loses their temper, is often angry or resentful, is often touchy or easily annoyed

Argumentative/defiant behavior:Often argues with authority figures or adults, actively defies or refuses to comply with requests from authority figures or with rules, often deliberately annoys others, often blames others for his or her mistakes

Vindictiveness: Has been spiteful or vindictive at least twice within the past six months

Your healthcare provider may assess the severity of your child's ODD using the following scale from the DSM-5:﻿﻿

Mild: Symptoms are confined to only one setting.

Moderate:Some symptoms will be present in at least two settings.

Severe:Symptoms will be present in three or more settings.

While there is no known cause, ODD has been linked to a combination of biological, psychological, and social factors.﻿﻿

Biological factors include:

A parent with a history of attention-deficit/hyperactivity disorder (ADHD), ODD, or CD

A parent with a mood disorder (such as depression or bipolar disorder)

A parent with a substance use disorder

A mother who smoked during pregnancy

Abnormal levels of neurotransmitters in the brain

Exposure to toxins

Impairment in the part of the brain responsible for reasoning, judgment, and impulse control

Poor nutrition

Psychological factors include:

A neglectful or absent parent

A poor relationship with one or more parent

Difficulty or an inability to form social relationships or process social cues

Social factors include:

Abuse or neglect

Chaotic environment

Family instability (such as divorce or frequent moves)

Inconsistent discipline

Lack of supervision

Poverty

Uninvolved parents

Sometimes ODD occurs in conjunction with other behavior disorders or mental health issues, including attention-deficit/hyperactive disorder (ADHD), anxiety disorders, depression, bipolar disorder, and language disorders.﻿﻿

It is important that intervention begins as early as possible with children with ODD. Without proper intervention, ODD may develop into a conduct disorder.﻿﻿

Treatment often involves the following:

Cognitive problem-solving skills therapy:Children will learn to manage specific symptoms of ODD and toidentify and solve problems that arise from living with ODD.

Family therapy: Parents, siblings, and other family members may be invited to attend therapy with the child in order to improve family interactions and relationships.

Parent training: Parents or caregivers may be taught behavior management strategies and techniques to reduce misbehavior in the home.

Psychotherapy:Individual therapy can help a child learn new skills, such as anger management and impulse control.

Social skills training:Formal social skills training can be effective in helping the child with ODD to interact with peers and adults.

Medication

While medication alone is not a recommended treatment for ODD, your child may need medication to treat the symptoms of other coexisting conditions like ADHD, anxiety, and mood disorders.

Behavior modification methods can be effective ways to reduce behavior problems in children. Sometimes a clinician will meet with caregivers separately to provide training on the following parenting techniques that can reduce misbehavior.

Treatment will often focus on one or two behavior problems, but the focus should be on reinforcing pro-social behaviors (i.e., keeping hands and feet to self, demonstrating respectful disagreements, etc.).

Form a Positive Relationship

The first step in treatment is building a positive relationship with your child. Most treatments for ODD begin with the parent engaging with the child in child-led play with the parent providing positive reinforcement and engagement.

Set Expectations

Children with ODD often have a goal of annoying parents and teachers and will misbehave to provoke a negative response. It is especially important to set clear expectations rules and to apply them consistently.

Establish a Routine

Having a routine can help children with ODD cope with activities at home such as transitioning from dinner to homework to bedtime. Applying rules and following routines consistently and fairly are important for that reason.

Discipline and Rewards

Provide specific, labeled praise and rewards for the prosocial behaviors you want to see. If the child responds to behavior management systems, use stickers, tokens, or a behavior chart to show progress toward behavior goals. Allow the child to identify rewards they would like to earn.

As the child demonstrates success, offer reinforcement such as spending time in a preferred activity, verbal praise, edible rewards, or items from a prize box.

Social Interaction

When the child interacts with others, make sure there is adequate supervision to ensure that rules can be enforced, and adults can help them interact appropriately. It can be helpful to have the school's counselor to work with peers to help them learn to respond appropriately to the child's behaviors.

Parents can also help their child better cope with ODD by doing their best to:

Avoid giving direct praise that could result in misbehavior, especially if the child has the tendency to do the opposite of what you want them to do. For example, saying, "I like the way you're keeping your hands to yourself," could provoke the child to become physically aggressive.

Resist the urge to argue or lecture the child, and try to keep your own temper under control.

Avoid letting your child see you become angry, as this may be rewarding to them.

Use a matter-of-fact tone of voice without emotion, simply stating the rule that was broken and what the consequences will be.

Be consistent and avoid getting into a verbal argument with the child over consequences or what happened.

Allow the child to have a place to vent their frustrations. Provide a pillow to punch or to yell into.

Support for Parents

Raising a child with ODD can be emotionally taxing and it's important to seek out opportunities to talk with other parents. No matter how thoughtful and understanding your family and friends, there is something special about talking with other parents who understand day-to-day living with a child with ODD.

In addition to emotional support, online support communities or Facebook groups can help ensure that you're educated on the latest findings and approaches to managing ODD.

A Word From Verywell

The prognosis for recovery from ODD is unclear. Some children will mature and symptoms of the disorder will subside into adulthood. Others will carry the disorder into adulthood. Meeting the complex needs of these children will require the cooperation of parents and school personnel as well as mental health professionals.

A cooperative, consistent effort at home and school will improve the likelihood of a positive outcome for these children, especially when intervention begins at an early age.

# data[].attributes.attachment_link.description
Oppositional defiant disorder (ODD) is a psychiatric disorder that typically emerges in childhood, between ages 6 and 8, and can last throughout adulthood. ODD is more than just normal childhood tantrums, and the frequency and severity of ODD causes difficulty at home and at school.

# data[].attributes.headline
Cultural Differences in OCD in Young Adults

# data[].attributes.subject
Cultural Differences in OCD in Young Adults

# data[].attributes.attachment_link.readable_text
"We initially chose IRIS because of the past experiences and their credible research-based, high-quality modules that align with specific areas of growth and need to support a state-directed corrective action plan in our region."

# data[].attributes.attachment_link.description
"We initially chose IRIS because of the past experiences and their credible research-based, high-quality modules that align with specific areas of growth and need to support a state-directed corrective action plan in our region."

# data[].attributes.attachment_link.readable_text
Obsessive-compulsive disorder (OCD) is an anxiety condition in which a child is plagued by unwanted thoughts, images or impulses (called obsessions) that he attempts to fend off or neutralize by performing compulsions (ritualized or repeated behaviors).
Symptoms:

Ritualized or compulsive behavior such as repeated hand washing, locking and relocking doors, or touching things in a certain order

Extreme or exaggerated fears of contamination, family members being hurt or harmed, or doing harm themselves.

Use of "magical thinking," particularly in young children. ("If I touch everything in the room, Mom won't be killed in a car accident.")

Repeatedly seeking assurances about the future

Intolerance for certain words or sounds

Causes:

Brain dysfunction (particularly in an area called the basal ganglia)

Genetics (the disorder appears to run in families)

Environmental factors (children who see adults consistently responding to stress with compulsive behavior can develop similar behaviors)

Treatment:
OCD is best treated with cognitive behavior therapy (CBT), specifically exposure and response prevention, which habituates a child to the objects of his obsession by exposing him to them in small increments, thereby reducing his anxiety.

If the OCD is severe, it is often treated with a combination of CBT and medication, which can reduce anxiety enough to allow the child to react better to exposure therapy.

# data[].attributes.attachment_link.title
Quick Facts on Obsessive-Compulsive Disorder (OCD)

# data[].attributes.attachment_link.description
Obsessive-compulsive disorder (OCD) is an anxiety condition in which a child is plagued by unwanted thoughts, images or impulses (called obsessions) that he attempts to fend off or neutralize by performing compulsions (ritualized or repeated behaviors).

# data[].attributes.attachment_link.readable_text
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.

More Topics

All

Latest

Quick Facts

ADHD

Autism Spectrum Disorder

Depressive and Mood Disorders

Diagnosis

Medication

Personality Disorders

Schizophrenia and Psychosis

Teenagers

Treatment

Young Adults

# data[].attributes.attachment_link.description
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.

# data[].attributes.attachment_link.readable_text
A 10-year-old boy named James has an outburst in school. Upset by something a classmate says to him, he pushes the other boy, and a shoving-match ensues. When the teacher steps in to break it up, James goes ballistic, throwing papers and books around the classroom and bolting out of the room. He is finally contained in the vice principal's office, where staff members try to calm him down. Instead, he kicks the vice principal in a frenzied effort to escape. The staff calls 911, and James ends up in the Emergency Room.

To the uninitiated, James looks like a boy with serious anger issues. It's not the first time he's flown out of control. The school insists that his parents pick him up and take him home for lunch every day because he's been banned from the cafeteria.

But what's really going on? "It turns out, after an evaluation, that he is off the charts for social anxiety," reports Jerry Bubrick, PhD, a child psychologist at the Child Mind Institute. "He can't tolerate any - even constructive - criticism. James is terrified of being embarrassed, so when a boy says something that makes him uncomfortable, he has no skills to deal with it, and he freaks out. Flight or fight."

James's story illustrates something that parents and teachers may not realize - that disruptive behavior is often generated by unrecognized anxiety. A child who appears to be oppositional or aggressive may be reacting to anxiety-anxiety they may, depending on their age, not be able to articulate effectively, or not even fully recognize.

"Especially in younger kids with anxiety you might see freezing and clinging kind of behavior," says Rachel Busman, PsyD, a clinical psychologist, "but you can also see tantrums and complete meltdowns."

Anxiety manifests in a surprising variety of ways in part because it is based on a physiological response to a threat in the environment, a response that maximizes the body's ability to either face danger or escape danger. So while some children exhibit anxiety by shrinking from situations or objects that trigger fears, some react with overwhelming need to break out of an uncomfortable situation. That behavior, which can be unmanageable, is often misread as anger or opposition.

"Anxiety is one of those diagnoses that is a great masquerader," explains Laura Prager, MD, director of the Child Psychiatry Emergency Service at Massachusetts General Hospital. "It can look like a lot of things. Particularly with kids who may not have words to express their feelings, or because no one is listening to them, they might manifest their anxiety with behavioral dysregulation."

The more commonly recognized symptoms of anxiety in a child are things like trouble sleeping in his own room or separating from his parents, avoidance of certain activities. "Anyone would recognize those symptoms," notes Dr. Prager, co-author of Suicide by Security Blanket, and Other Stories from the Child Psychiatry Emergency Service. But in other cases the anxiety can be hidden.

"When the chief complaint is temper tantrums, or disruption in school, or throwing themselves on the floor while shopping at the mall, it's hard to know what it means," she explains. "But it's not uncommon, when kids like that come in to the ER, for the diagnosis to end up being a pretty profound anxiety disorder."

It's not uncommon for children with serious undiagnosed anxiety to be disruptive at school, where demands and expectations put pressure on them that they can't handle. And it can be very confusing to teachers and other staff members to "read" that behavior, which can seem to come out of nowhere.

Nancy Rappaport, MD, a Harvard Medical School professor who specializes in mental health care in school settings, sees anxiety as one of the causes of disruptive behavior that makes classroom teaching so challenging. "The trouble is that when kids who are anxious become disruptive they push away the very adults who they need to help them feel secure," notes Dr. Rappaport. "And instead of learning to manage their anxiety, they end up spending half the day in the principal's office."

Dr. Rappaport sees a lot of acting out in school as the result of trauma at home. "Kids who are struggling, not feeling safe at home," she notes, "can act like terrorists at school, with fairly intimidating kinds of behavior." Most at risk, she says, are kids with ADHD who've also experienced trauma. "They're hyper-vigilant, they have no executive functioning, they misread cues and go into combat."

When a teacher is able to build a relationship with a child, to find out what's really going on with them, what's provoking the behavior, she can often give them tools to handle anxiety and prevent meltdowns. In her book, The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students, Dr. Rappaport offers strategies kids can be taught to use to calm themselves down, from breathing exercises to techniques for distracting themselves.

"When a teacher understands the anxiety underlying the opposition, rather than making the assumption that the child is actively trying to make her miserable, it changes her approach," says Dr. Rappaport, "The teacher is able to join forces with the child himself and the school counselor, to come up with strategies for preventing these situations."

If it sounds labor-intensive for the teacher, it is, she notes, but so is dealing with the aftermath of the same child having a meltdown.

Anxiety also drives a lot of symptoms in a school setting that are easily misconstrued as ADHD or defiant behavior.

"I'll see a child who's having difficulty in school: not paying attention, getting up out of their seat all the time, asking a lot of questions, going to the bathroom a lot, getting in other kids' spaces," explains Dr. Busman. "The behavior is disrupting other kids, and is frustrating to the teacher, who's wondering why they ask so many questions, and why they're so wrapped up in what other kids are doing, whether they're following the rules."

People tend to assume what's happening with this child is ADHD inattentive type, but it's commonly anxiety. Kids with OCD, mislabeled as inattentive, are actually not asking all those questions because they're not listening, but rather because they need a lot of reassurance.

"It probably occurs more than we think, either anxiety that looks disruptive or anxiety coexisting with disruptive behaviors," Dr. Busman adds. "It all goes back to the fact that kids are complicated and symptoms can overlap diagnostic categories, which is why we need to have really comprehensive and good diagnostic assessment."

First of all, good assessment needs to gather data from multiple sources, not just parents. "We want to talk to teachers and other people involved with the kid's life," she adds, "because sometimes kids that we see are exactly the same at home and at school, sometimes they are like two different children."

And it needs to use rating scales on a full spectrum of behaviors, not just the area that looks the most obvious, to avoid missing things.

Dr. Busman also notes that a child with severe anxiety who's struggling in school might also have attention or learning issues, but they might need to be treated for the anxiety before they can really be evaluated for those. She uses the example of a teenager with OCD who is doing terribly in school. "She's ritualizing three to four hours a day, and having constant intrusive thoughts - so we need to treat that, to get the anxiety under control before we ask, how is she learning?"

# data[].attributes.attachment_link.title
How Anxiety Leads to Problem Behavior - Child Mind Institute

# data[].attributes.attachment_link.description
A 10-year-old boy named James has an outburst in school. Upset by something a classmate says to him, he pushes the other boy, and a shoving-match ensues. When the teacher steps in to break it up, James goes ballistic, throwing papers and books around the classroom and bolting out of the room.

# data[].attributes.attachment_link.title
Angry Kids: Dealing With Explosive Behavior - Child Mind Institute

# data[].attributes.attachment_link.description
Learn more about anger management for kids. We offer tips on explosive behavior in children and explain how to deal with anger.

# data[].attributes.attachment_link.readable_text
You are not alone. We are here for you!

Growing up is tough. Getting diagnosed with bipolar can make it feel harder. While being diagnosed with bipolar at your age might feel really scary, it has its advantages. Young people tend to learn new habits faster and can adapt easier. One of the keys to living with bipolar disorder is learning to monitor and be aware of what is going on inside. In reality, this is a skill we all need, but you will hone these skills sooner. A strong sense of who you are and how you feel will help you in many other parts of your life, such as relationships, school, and work.

You probably are feeling very different from your friends, it's important to know that you're not alone and that you can create a support network who appreciates you for who you are. Having bipolar disorder is not your fault. Just because your brain is different, doesn't mean it's bad or wrong. Being diagnosed with bipolar, along with the other challenges of being your age can feel like a lot at first. You might even be afraid to talk about what you are going through. Find your people - choose friends who support a healthy lifestyle and want you to be well. Going to peer support groups helps you see you're not alone. Read the stories of hope and recovery on the International Bipolar Foundation website. Maybe someday you'll write your own for us! Reaching out is key. Don't be afraid to use your voice and ask for help. We would love to hear from you! You might also want to speak to your school counselor because you may even be able to get special accommodations at your school to make balancing your many priorities easier. As you get older and become more of an expert on yourself, living with bipolar will get easier.

# data[].attributes.attachment_link.title
Youth with Bipolar Disorder - International Bipolar Foundation

# data[].attributes.attachment_link.description
Growing up is tough. Getting diagnosed with bipolar can make it feel harder. While being diagnosed with bipolar at your age might feel really scary, it has its advantages. Young people tend to learn new habits faster and can adapt easier.

# data[].attributes.headline
Accommodations Relevant for Bipolar Disorder

# data[].attributes.subject
Accommodations Relevant for Bipolar Disorder

# data[].attributes.attachment_link.readable_text
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. "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.

# data[].attributes.attachment_link.title
Accommodations for Students with Bipolar Disorder and Related Disabilities - International Bipolar Foundation

# data[].attributes.attachment_link.description
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.

# data[].attributes.attachment_link.readable_text
Depending on how data are gathered and how diagnoses are made, as many as 27% of some population groups may be suffering from depression at any one time (NIMH, 2001; data for older adults).

Behaviorist Theory

Behaviorism emphasizes the importance of the environment in shaping behavior. The focus is on observable behavior and the conditions through which individuals" learn behavior, namely classical conditioning, operant conditioning, and social learning theory.

Therefore depression is the result of a person's interaction with their environment.

For example, classical conditioning proposes depression is learned through associating certain stimuli with negative emotional states. Social learning theory states behavior is learned through observation, imitation, and reinforcement.

Operant Conditioning

Operant conditioning states that depression is caused by the removal of positive reinforcement from the environment (Lewinsohn, 1974). Certain events, such as losing your job, induce depression because they reduce positive reinforcement from others (e.g., being around people who like you).

Depressed people usually become much less socially active. In addition, depression can also be caused by inadvertent reinforcement of depressed behavior by others.

For example, when a loved one is lost, an important source of positive reinforcement has lost as well. This leads to inactivity. The main source of reinforcement is now the sympathy and attention of friends and relatives.

However, this tends to reinforce maladaptive behavior, i.e., weeping, complaining, and talking of suicide. This eventually alienates even close friends leading to even less reinforcement and increasing social isolation and unhappiness. In other words, depression is a vicious cycle in which the person is driven further and further down.

Also, if the person lacks social skills or has a very rigid personality structure, they may find it difficult to make the adjustments needed to look for new and alternative sources of reinforcement (Lewinsohn, 1974). So they get locked into a negative downward spiral.

Critical Evaluation

Behavioral/learning theories make sense in terms of reactive depression, where there is a clearly identifiable cause of depression. However, one of the biggest problems for the theory is that of endogenous depression. This is depression that has no apparent cause (i.e., nothing bad has happened to the person).

An additional problem of the behaviorist approach is that it fails to consider cognitions (thoughts) influence on mood.

Psychodynamic Theory

During the 1960s, psychodynamic theories dominated psychology and psychiatry. Depression was understood in terms of the following:

1. inwardly directed anger (Freud, 1917),

2. introjection of love object loss,

3. severe super-ego demands (Freud, 1917),

4. excessive narcissistic, oral, and/or anal personality needs (Chodoff, 1972),

5. loss of self-esteem (Bibring, 1953; Fenichel, 1968), and

6. deprivation in the mother-child relationship during the first year (Kleine, 1934).

Freud's psychoanalytic theory is an example of the psychodynamic approach. Freud (1917) prosed that many cases of depression were due to biological factors.

However, Freud also argued that some cases of depression could be linked to loss or rejection by a parent. Depression is like grief in that it often occurs as a reaction to the loss of an important relationship.

However, there is an important difference because depressed people regard themselves as worthless. What happens is that the individual identifies with the lost person so that repressed anger towards the lost person is directed inwards towards the self. The inner-directed anger reduces the individual's self-esteem and makes him/her vulnerable to experiencing depression in the future.

Freud distinguished between actual losses (e.g., the death of a loved one) and symbolic losses (e.g., the loss of a job). Both kinds of losses can produce depression by causing the individual to re-experience childhood episodes when they experience loss of affection from some significant person (e.g., a parent).

Later, Freud modified his theory stating that the tendency to internalize lost objects is normal and that depression is simply due to an excessively severe super-ego. Thus, the depressive phase occurs when the individual's super-ego or conscience is dominant. In contrast, the manic phase occurs when the individual's ego or rational mind asserts itself, and s/he feels control.

In order to avoid loss turning into depression, the individual needs to engage in a period of mourning work, during which s/he recalls memories of the lost one.

This allows the individual to separate himself/herself from the lost person and reduce inner-directed anger. However, individuals very dependent on others for their sense of self-esteem may be unable to do this and so remain extremely depressed.

Critical Evaluation

Psychoanalytic theories of depression have had a profound impact on contemporary theories of depression.

For example, Beck's (1983) model of depression was influenced by psychoanalytic ideas such as the loss of self-esteem (re: Beck's negative view of self), object loss (re: the importance of loss events), external narcissistic deprivation (re: hypersensitivity to loss of social resources) and oral personality (re: sociotropic personality).

However, although highly influential, psychoanalytic theories are difficult to test scientifically. For example, its central features cannot be operationally defined with sufficient precision to allow empirical investigation. Mendelson (1990) concluded his review of psychoanalytic theories of depression by stating:

"A striking feature of the impressionistic pictures of depression painted by many writers is that they have the flavor of art rather than of science and may well represent profound personal intuitions as much as they depict they raw clinical data" (p. 31).

Another criticism concerns the psychanalytic emphasis on the unconscious, intrapsychic processes, and early childhood experience as being limiting in that they cause clinicians to overlook additional aspects of depression. For example, conscious negative self-verbalization (Beck, 1967) or ongoing distressing life events (Brown & Harris, 1978).

Cognitive Explanation of Depression

This approach focuses on people's beliefs rather than their behavior. Depression results from systematic negative bias in thinking processes.

Emotional, behavioral (and possibly physical) symptoms result from cognitive abnormality. This means that depressed patients think differently from clinically normal people. The cognitive approach also assumes changes in thinking precede (i.e., come before) the onset of a depressed mood.

Beck's (1967) Theory

One major cognitive theorist is Aaron Beck. He studied people suffering from depression and found that they appraised events in a negative way.

Beck (1967) identified three mechanisms that he thought were responsible for depression:

1. The cognitive triad (of negative automatic thinking)

2. Negative self schemas

3. Errors in Logic (i.e. faulty information processing)

The cognitive triad is three forms of negative (i.e., helpless and critical) thinking that are typical of individuals with depression: namely, negative thoughts about the self, the world, and the future. These thoughts tended to be automatic in depressed people as they occurred spontaneously.

For example, depressed individuals tend to view themselves as helpless, worthless, and inadequate. They interpret events in the world in an unrealistically negative and defeatist way, and they see the world as posing obstacles that can't be handled.

Finally, they see the future as totally hopeless because their worthlessness will prevent their situation from improving.

As these three components interact, they interfere with normal cognitive processing, leading to impairments in perception, memory, and problem-solving, with the person becoming obsessed with negative thoughts.

Beck believed that depression-prone individuals develop a negative self-schema. They possess a set of beliefs and expectations about themselves that are essentially negative and pessimistic. Beck claimed that negative schemas might be acquired in childhood as a result of a traumatic event. Experiences that might contribute to negative schemas include:

Death of a parent or sibling.

Parental rejection, criticism, overprotection, neglect, or abuse.

Bullying at school or exclusion from a peer group.

However, a negative self-schema predisposes the individual to depression, and therefore someone who has acquired a cognitive triad will not necessarily develop depression.

Some kind of stressful life event is required to activate this negative schema later in life. Once the negative schema is activated, a number of illogical thoughts or cognitive biases seem to dominate thinking.

People with negative self-schemas become prone to making logical errors in their thinking, and they tend to focus selectively on certain aspects of a situation while ignoring equally relevant information.

Beck (1967) identified a number of systematic negative biases in information processing known as logical errors or faulty thinking. These illogical thought patterns are self-defeating and can cause great anxiety or depression for the individual.
For example:

1. Arbitrary Inference: Drawing a negative conclusion in the absence of supporting data.

2. Selective Abstraction: Focusing on the worst aspects of any situation.

3. Magnification and Minimisation: If they have a problem, they make it appear bigger than it is. If they have a solution they make it smaller.

4. Personalization: Negative events are interpreted as their fault.

5. Dichotomous Thinking: Everything is seen as black and white. There is no in between.

Such thoughts exacerbate and are exacerbated by the cognitive triad. Beck believed these thoughts or this way of thinking become automatic.

When a person's stream of automatic thoughts is very negative, you would expect a person to become depressed. Quite often these negative thoughts will persist even in the face of contrary evidence.

Critical Evaluation

Alloy et al. (1999) followed the thinking styles of young Americans in their early 20s for six years. Their thinking style was tested, and they were placed in either the 'positive thinking group' or 'negative thinking group'.

After six years, the researchers found that only 1% of the positive group developed depression compared to 17% of the 'negative' group. These results indicate there may be a link between cognitive style and the development of depression.

However, such a study may suffer from demand characteristics. The results are also correlational. It is important to remember that the precise role of cognitive processes is yet to be determined. The maladaptive cognitions seen in depressed people may be a consequence rather than a cause of depression.

Learned Helplessness

Martin Seligman (1974) proposed a cognitive explanation of depression called learned helplessness.

According to Seligman's learned helplessness theory, depression occurs when a person learns that their attempts to escape negative situations make no difference.

Consequently, they become passive and will endure aversive stimuli or environments even when escape is possible.

Seligman based his theory on research using dogs.

A dog put into a partitioned cage learns to escape when the floor is electrified. If the dog is restrained whilst being shocked, it eventually stops trying to escape.

Dogs subjected to inescapable electric shocks later failed to escape from shocks even when it was possible to do so. Moreover, they exhibited some of the symptoms of depression found in humans (lethargy, sluggishness, passive in the face of stress, and appetite loss).

This led Seligman (1974) to explain depression in humans in terms of learned helplessness, whereby the individual gives up trying to influence their environment because they have learned that they are helpless as a consequence of having no control over what happens to them.

Although Seligman's account may explain depression to a certain extent, it fails to take into account cognitions (thoughts). Abramson, Seligman, and Teasdale (1978) consequently introduced a cognitive version of the theory by reformulating learned helplessness in terms of attributional processes (i.e., how people explain the cause of an event).

The depression attributional style is based on three dimensions, namely locus (whether the cause is internal - to do with a person themselves, or external - to do with some aspect of the situation), stability (whether the cause is stable and permanent or unstable and transient) and global or specific (whether the cause relates to the "whole" person or just some particular feature characteristic).

In this new version of the theory, the mere presence of a negative event was not considered sufficient to produce a helpless or depressive state. Instead, Abramson et al. argued that people who attribute failure to internal, stable, and global causes are more likely to become depressed than those who attribute failure to external, unstable, and specific causes.

This is because the former attributional style leads people to the conclusion that they are unable to change things for the better.

Critical Evaluation

Gotlib and Colby (1987) found that people who were formerly depressed are actually no different from people who have never been depressed in terms of their tendencies to view negative events with an attitude of helpless resignation.

This suggests that helplessness could be a symptom rather than a cause of depression. Moreover, it may be that negative thinking generally is also an effect rather than a cause of depression.

Humanist Approach

Humanists believe that there are needs that are unique to the human species. According to Maslow (1962), the most important of these is the need for self-actualization (achieving our potential). The self-actualizing human being has a meaningful life. Anything that blocks our striving to fulfill this need can be a cause of depression. What could cause this?

1. Parents impose conditions of worth on their children. I.e., rather than accepting the child for who s/he is and giving unconditional love, parents make love conditional on good behavior. E.g., a child may be blamed for not doing well at school, develop a negative self-image and feel depressed because of a failure to live up to parentally imposed standards.

2. Some children may seek to avoid this by denying their true selves and projecting an image of the kind of person they want to be. This façade or false self is an effort to please others. However, the splitting off of the real self from the person you are pretending to cause hatred of the self. The person then comes to despise themselves for living a lie.

3. As adults, self-actualization can be undermined by unhappy relationships and unfulfilling jobs. An empty shell marriage means the person is unable to give and receive love from their partner. An alienating job means the person is denied the opportunity to be creative at work.

References

Abramson, L. Y., Seligman, M. E., & Teasdale, J. D. (1978). Learned helplessness in humans: critique and reformulation. Journal of abnormal psychology, 87(1), 49.

Alloy, L. B., Abramson, L. Y., Whitehouse, W. G., Hogan, M. E., Tashman, N. A., Steinberg, D. L., ... & Donovan, P. (1999). Depressogenic cognitive styles : Predictive validity, information processing and personality characteristics, and developmental origins. behavior research and therapy, 37(6), 503-531.

Beck, A. T. (1967). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press.

Beck, A. T., Epstein, N., & Harrison, R. (1983). Cognitions, attitudes and personality dimensions in depression. British Journal of Cognitive Psychotherapy.

Bibring, E. (1953). The mechanism of depression.

Brown, G. W., & Harris, T. (1978). Social origins of depression: a reply. Psychological Medicine, 8(04), 577-588.

Chodoff, P. (1972). The depressive personality: A critical review. Archives of General Psychiatry, 27(5), 666-673.

Fenichel, O. (1968). Depression and mania. The Meaning of Despair. New York: Science House.

Freud, S. (1917). Mourning and melancholia. Standard edition, 14(19), 17.

Gotlib, I. H., & Colby, C. A. (1987). Treatment of depression: An interpersonal systems approach. Pergamon Press.

Klein, M. (1934). Psychogenesis of manic-depressive states: contributions to psychoanalysis. London: Hogarth.

Lewinsohn, P. M. (1974). A behavioral approach to depression.

Maslow, A. H. (1962). Towards a psychology of being. Princeton: D. Van Nostrand Company.

National Institute of Mental Health. (2001). Depression research at the National Institute of Mental Health http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml.

Seligman, M. E. (1973). Fall into helplessness. Psychology today, 7(1), 43-48.

Seligman, M. E. (1974). Depression and learned helplessness. John Wiley & Sons.

# data[].attributes.attachment_link.description
Depression is a mood disorder that prevents individuals from leading a normal life at work, socially, or within their family. Seligman (1973) referred to

# data[].attributes.attachment_link.title
New Treatment for Kids with Obsessive Compulsive Disorder-Mayo Clinic

# data[].attributes.headline
Scholastic: Spotting and Treating Anxiety in Children

# data[].attributes.subject
Scholastic: Spotting and Treating Anxiety in Children

# data[].attributes.attachment_link.readable_text
Marla Booth* thought she was giving her daughter Madison a leg up by sending her to a well-regarded private school. But instead of coming home every day filled with excitement about what she was learning, her third-grader would dissolve into tears as she faced up to three hours of homework each night.

It took time for the Severn, MD, mom to realize it, but the school's celebrated focus on exceeding standards wasn't helping her daughter get ahead - rather, it was making her ill. "Madison's problems stemmed from anxiety," Booth can today admit.

All kids have their share of concerns. "To a certain extent, anxiety is a normal part of development," says Stephen Whiteside, Ph.D., a clinical pediatric psychologist at the Mayo Clinic. Some fears, like the ones preschoolers have of monsters, crop up so predictably that they're considered milestones. But Madison is one of a growing number of kids who are grappling with more serious forms of anxiety that, left unchecked, can have lasting effects, both emotionally and biologically.

"So many children are now experiencing levels of stress that come close to meeting the criteria for an anxiety disorder," says Tamar E. Chansky, Ph.D., author of Freeing Your Child From Anxiety. Meanwhile, nearly 20 percent of kids have actually been diagnosed with one - everything from minor phobias, like a fear of dogs, to generalized anxiety, which is when kids worry about everything that could go wrong. "Ten years ago, it was 13 percent. That's a big jump in a decade," she says.

While better detection plays a part in the rising rates of children's anxiety (pediatricians now know what symptoms to look for in order to diagnose), experts believe that the numbers also reflect a general societal shift. In other words, adults are stressed, too - and our kids are feeling our pain. "Anxiety has become a way of life, and it's contagious," says Madeline Levine, Ph.D., author of Teach Your Children Well.

The weak economy is one pervasive source of stress to families. In tough times, insecurity over money and jobs can unnerve even the steadiest households. Teachers add tension, too, especially during state-wide testing season. Because the results can determine a school's funding, it's no surprise that a culture of anxiety springs up around these exams and spills over to the students.

"Doing well in school is a good thing, but when second-graders are so afraid that they freeze up during their math test, something has gone very wrong," says Chansky.

Anxious parents can also increase kids' stress by being overprotective or over-controlling, which sends children the message that they're not capable of handling things on their own. "When your fourth-grader forgets his homework, do you call the teacher or let him handle the situation?" Levine asks. "At that age, a child can explain it to the teacher on his own. It's a learning experience."

Even parents' well-meaning efforts to make sure kids excel can leave them "so overscheduled that they have little time to just play," something that's critical for maintaining emotional balance, adds Levine. Instead of feeling prepared for the school day, kids may end up feeling scared, as Madison did.

Over time, such fear doesn't just take an emotional toll, it affects children biologically, which can have serious long-term consequences. Studies show that the stress hormone cortisol, which floods the body during periods of anxiety, shrinks the brain over time, reducing a kid's ability to cope. And because anxious kids are often too caught up in their thoughts to concentrate, they tend to struggle in school.

Fortunately, even in an anxious era, parents haven't doomed their kids to a life of stress. Thanks to more effective therapies, anxiety is more treatable than ever - and awareness is increasing, which means parents and doctors are now better prepared to quickly decode its sneakier signs and take action before those worries begin to spiral out of control.

That's exactly what Booth did. After months of anguish, she ultimately made the tough decision to pull her daughter out of private school. A less pressure-filled environment, it turns out, was key to raising a star student. Today, "Madison says she loves school again," Booth happily reports.

Sometimes anxiety doesn't look like anxiety at all. Symptoms of serious stress can be both behavioral and physical. In little kids, panic often erupts into tantrums. Older kids may act out, using aggressiveness as a way to cover up a fear of being judged by classmates. Physical symptoms can include restlessness, fatigue, back pain, sweating, and - most commonly - head- and stomachaches.

When 4-year-old Lucas Fonovich started melting down every time anyone mentioned visiting Grandma, his mom, Nicole, was mystified: They'd been traveling on planes since he was a baby. She and her husband did some digging, and eventually, "we realized he was afraid of the plane going too fast," recalls the Chandler, AZ, mom. They read books and talked up the joys of travel. As they boarded their next flight, the pilot overheard Lucas mentioning his concerns and invited him to sit in the cockpit. "The pilot explained that he only went fast at takeoff," says Fonovich. "Lucas hasn't been afraid to fly since."

If anxiety prevents kids from going to school and making friends, it's time to see an expert, says Rachel Busman, Psy.D., a therapist in New York City. Cognitive behavior therapy (CBT), which replaces negative thoughts with targeted coping strategies, is typically the first line of treatment. But when a child is so anxious she can't focus on the therapy, clinicians may also turn to medication.

Eight-year-old Grace Cohen* was born cautious - slow to try new activities or play with new kids, says her mom, Dina, of Scarsdale, NY. But when Grace started school, her natural reserve morphed into something more concerning. First, she became so afraid of dogs she'd do anything to avoid one. Then her fears multiplied: separation anxiety, "mean" friends, bees. "By second grade, the teacher was pulling her off my body when I dropped her off in the morning," Cohen recalls. That's when she took her daughter for an evaluation. For Grace, the combination of an antidepressant and CBT was a game-changer. Within months, "people commented how Grace seemed happier and more relaxed," says Cohen. "Now, Grace is learning to face her fears and that is giving her confidence in every aspect of her life."

* Names have been changed .

It's perfectly okay when kids . . .

worry about an upcoming test

want to be tucked in at night

hang back for the first half-hour of a party

keep an eye out for bees or dogs

It's a red flag when they . . .

vomit, lose sleep, or cry from stress

wind up in your bed every night

refuse to go to parties or leave your side

need to be coaxed outside because they're afraid of being stung or attacked

These long-term strategies teach kids that things aren't as scary as they seem.

1. Keep calm. Overreacting spooks kids even more, so take the long view: "If you don't give kids the chance to confront their fears, they'll be anxious every time there's a challenge," says Stephen Whiteside, Ph.D., of the Mayo Clinic.

2. Be empathetic. Explain that anxiety is normal, and share your story: "When I was a kid, I was terrified of tests. But I learned that the best way to get rid of my fear was to face it." Then, help him do it. Say, "I see you're scared about going to school. I'll hold you, then walk into class with you," says Lawrence Cohen, Ph.D., author of The Opposite of Worry.

3. Take small steps. Break down challenges so they're more manageable. "If your child is afraid to sleep alone, check in every few minutes before she nods off, slowly extending the time between check-ins over days or weeks," advises Whiteside. This method, known as gradual supportive exposure, is one of the best ways to extinguish a specific fear.

1. Have your kid tense and relax each muscle group, working up from the toes.
Why it works: Your child releases tension, and when the body relaxes, the brain does, too.

2. Tell your child to pay attention to the noises around him until he hears five different sounds.
Why it works: Focusing his thoughts helps your child stay in the moment rather than worry about the future.

3. Grade-schoolers can write down (or dictate) their fears and stash them in a shoebox.
Why it works: Writing worries helps minimize them and gives kids permission to let 'em go.

4. Tell your child to remember a time he faced a scary situation and overcame it or learned something hard.
Why it works: Picturing a previous success makes anyone feel more confident.

5. Tell your kid to pretend she's holding a slice of pizza. Have her inhale the aroma by breathing in deeply through the nose and cool the pizza by blowing out through the mouth.
Why it works: Focused breathing sends the brain a message that it's time to relax.

6. Download some anti-anxiety apps. Try the Meditation Jar (iTunes, free). Set the timer, shake the phone, and watch the particles settle.
Why it works: This app gives kids something to gaze at as they quiet down (or breathe).

# data[].attributes.attachment_link.title
How to Spot and Treat Anxiety in Children

# data[].attributes.attachment_link.description
Experts say that kids today are more anxious than ever. Find out why and what to do if you see signs of anxiety in your child.

# data[].attributes.headline
Eating Disorders Identification and Education for Elementary Students

# data[].attributes.subject
Eating Disorders Identification and Education for Elementary Students

# data[].attributes.headline
CBT Study for Elementary Anxiety Disorders

# data[].attributes.subject
CBT Study for Elementary Anxiety Disorders

# data[].attributes.body
A to Z index of useful information that could help guide students and parents.

# data[].attributes.attachment_link.title
Child Mind Institute | Transforming Children’s Lives.

# data[].attributes.attachment_link.description
The Child Mind Institute is an independent nonprofit dedicated to transforming the lives of children struggling with mental health and learning disorders.