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Separation anxiety disorder: Children feel extremely upset when they have to be away from parents or caregivers. This anxiety goes beyond what other kids their age normally feel.

Symptoms of separation anxiety include:

Worry about parents or caregivers getting sick or dying

Refusing to leave home or go to school

Fear of sleeping or being alone

Nightmares about separation

Physical symptoms (such as headaches or stomachaches) before an upcoming separation

Children with separation anxiety disorder show symptoms for at least four weeks.

Social anxiety disorder: Children with social anxiety disorder feel extremely self-conscious around other people. They are so afraid of being embarrassed that they avoid social situations and even speaking in class.

Symptoms of social anxiety disorder in children include:

Avoiding most social situations or feeling terrible when they have to participate in them

Physical symptoms like shaking, sweating or trouble breathing in social situations

In young children, tantrums and crying in social situations

Fear of others seeing their anxiety and judging them for it

For a child to be diagnosed with social anxiety disorder, their worry must be so extreme that it interferes with daily life.

Selective mutism: Children with selective mutism have a hard time speaking in some situations, like at school. These kids aren't just shy. Their anxiety is so bad that they feel frozen and are not able to speak.

To get a diagnosis of selective mutism, the child must:

Be able to speak in some situations but not others

Have had the problem for at least a month

Have problems with school and social activities as a result

Children are not diagnosed with selective mutism if their trouble speaking is caused by a communication disorder or language barrier.

Generalized anxiety disorder: Children with generalized anxiety disorder worry about a lot of everyday things. Their worry is not caused by anything specific and it is bad enough to get in the way of daily life.

Symptoms of generalized anxiety disorder in children include:

Restlessness

Feeling on edge

Feeling tired much of the time

Problems concentrating

Feeling angry

Trouble sleeping

To be diagnosed with generalized anxiety disorder, children must experience symptoms most days for at least six months.

Panic disorder: Children with panic disorder have frequent, unexpected panic attacks. Panic attacks cause physical feelings that can make kids think they are dying or having a heart attack.Children are diagnosed with panic disorder when they experience at least one panic attack and show other signs including:

Constant fear of more panic attacks

A big change from normal behavior after the panic attacks, like avoiding places that remind them of an attack

When diagnosing a child with panic disorder, a professional also rules out medical causes and other disorders like PTSD.

Obsessive-compulsive disorder (OCD): Children with OCD have thoughts and worries that make them very anxious. They develop rules for themselves that they feel they must follow to control the anxiety.

Obsessions are the unwanted thoughts that make kids feel upset and anxious.

Compulsions are the rules kids feel they have to follow to get rid of their anxiety.

Children can be diagnosed with OCD when they have obsessions, compulsions or both.

Specific phobia: Kids with specific phobias are very afraid of one or more specific things. This fear is of something that isn't normally considered dangerous. Phobias disrupt kids' lives when they go out of their way to avoid the things they're afraid of.

Common phobias in children include:

Animals or insects

Parts of the natural world, like water or heights

Blood or shots

Specific situations, like crowds or tight spaces

Others including vomiting, choking or loud sounds

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Quick Guide to Anxiety in Children - Child Mind Institute

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Download our free guide to different kinds of anxiety in children. Anxiety causes an extreme feeling of unease in kids. While some anxiety in stressful situations is normal, it becomes a disorder if it lasts a long time or gets in the way of daily life.

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

Credit... Getty Images

By

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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How to Help a Child With an Anxiety Disorder

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

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Addressing Anxiety in Schools- Info for Counselors

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

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

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

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

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

What signs to look for

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

Signs of anorexia:

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

Obsessing over calorie counts, nutritional facts, and diets

Spending many hours exercising to burn off calories

Skipping meals

Avoiding eating socially

Irregular periods, thinning hair, and constant exhaustion

Signs of bulimia:

Exercising excessively or using diet pills or laxatives

Going to the bathroom immediately after meals

Spending a lot of time in the bathroom

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

Hoarding food in her room

Having large amounts of food that go missing at home

What can parents do?

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

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

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

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

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

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

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

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Overview

Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, school work, and relationships.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and various phobia-related disorders.

Signs and Symptoms

Risk Factors

Treatments and Therapies

Join a Study

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Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time.

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ASCA National Model: A Framework for School Counseling Programs

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ASCA National Model: A Framework for School Counseling Programs

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Eating Issues in Schools - Detection, Management, and Consultation with Allied Professionals

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The School Counselor's Role in Addressing Eating Disorders

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

Rejection of a healthy amount of food

Dramatic dieting

Compulsive exercise

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

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

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

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

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

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

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

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

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Overview

A child with binge eating disorder regularly consumes unusually large amounts of food in relatively short periods of time, with the feeling that her overeating is out of her control. Children or teens affected by the disorder overeat compulsively, often in secret, and with great embarrassment or guilt. Binge eaters can be of normal weight, overweight, or obese. Unlike bulimia, binge eating does not involve "purging," via self-induced vomiting or other means.

Symptoms of binge eating disorder:

Eating unusually large quantities of food

Eating when not hungry

Eating rapidly

Eating to the point of uncomfortable fullness

Eating in shame or in secret

Feeling depressed, anxious, or ashamed about eating habits

Gaining and losing weight repeatedly

Treatment and Prognosis

Treatments for binge eating disorder include psychotherapy, behavioral weight loss programs, and medication. The primary goal of treatment, to reduce or eliminate bingeing behavior, may go hand in hand with the goal of weight loss. However, not all children and teens with the disorder need to lose weight.

Cognitive behavioral therapy (CBT) can help patients deal with the issues that may trigger binge eating, such as a negative body image, anxiety, or depression. A form of CBT called interpersonal therapy may assist with binge eating that is triggered by difficult relationships with others, including family members.

While there is no medication specifically to treat binge eating, there is some limited evidence that antidepressants and the anticonvulsant topiramate (Topamax) may be helpful when treating particularly resistant cases.

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A child with binge eating disorder regularly consumes unusually large amounts of food in relatively short periods of time, with the feeling that her overeating is out of her control. Children or teens affected by the disorder overeat compulsively, often in secret, and with great embarrassment or guilt.

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

Consuming much more in a given period than average

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

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

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

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

Bingeing and purging in secret

Signs your child might be bulimic:

Dehydration

Abnormal intake of water

Acid reflux from frequent self-induced vomiting

Scars on her fingers from vomiting

Deterioration of her teeth due to contact with stomach acids

Sore throats

Swollen glands

Sudden absences during meals

Routine trips to the bathroom right after eating

Long periods of not eating

Secretiveness around eating

Obsession with her weight and appearance

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

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

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

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Definition

Students with emotional disorders are a very heterogeneous group with a wide range of issues that are unique to each individual. However, there are some key characteristics that are used to define this disability category, mostly relating to issues of personal identity and emotional well-being. An emotional disorder may be present if a student responds to a situation with an inappropriate behavior or emotion, and particularly, if this emotion is depression or long term unhappiness. Students with emotional disorders typically have a very difficult time maintaining personal relationships with others, and these personal problems lead to physical symptoms in time. If the student has difficulty learning, but there is no intellectual or sensory cause of this difficulty, then an emotional disorder may be to blame. This disability category does include some mental illnesses such as schizophrenia.

It should be noted that one or more of the previously mentioned characteristics has to be present for an extended period of time, and must have a negative impact on the student's academic performance before being considered an emotional disorder. Signs of an emotional disorder need to be taken seriously, as they can lead to physical aggression and self-injurious behavior. However, care must also be taken to recognize the difference between emotional disturbance and general teenage angst. There are as many causes of emotional disturbance in children as there are children in this category, but they can generally be divided into either biological causes, environmental causes, or a combination of the two.

Prevalence

The U.S. Department of Education reports 5,971,495 students receiving special education services in the 2003-2004 school year. Of that number, roughly 7.7%, or 461,055 students, received special education services based on a classification of emotional disturbance. However, within this group of 461,055 students, there was a definite disproportionally between gender, race and socioeconomic background. African-American students were far more likely to be diagnosed as emotionally disturbed than white students, reflecting possible race bias in this category. Research has pointed to a direct correlation between low income status and emotional disorders, but the exact reasons for this correlation are unknown.

Characteristics

Each student with an emotional disturbance will have characteristics that are unique to that individual. However, these students will all share deficits in three specific areas, namely emotional development, behavioral development, and cognitive development.

These students may have specific emotional characteristics/conditions such as anxiety disorder, mood disorder, oppositional defiant disorder, conduct disorder, and schizophrenia. Not addressing any one of these disorders with the appropriate support system could have potentially tragic results. Behavioral characteristics of an emotional disorder include externalizing behavior and conversely internalizing behavior. The former can result in problem behavior and physical aggression while the latter results in depression and anxiety. Finally, students with emotional disorders have a number of academic issues as well, and each year half of the students in this category drop out of school entirely.

One intriguing possible contributing factor to emotional disturbance can be found in deficits in communication. An estimated 71% of students with emotional disorders also have expressive and receptive language disorders that impact their ability to understand and communicate with peers and adults.

Impact on Learning

Students with emotional disorders can be found at every level of cognitive functioning, but the majority of these students tend to have low average intelligence. Most achieve below grade level in academic achievement, with the greatest deficits in both math and spelling. Many have a coexisting learning disability of some type. Students that exhibit externalizing behaviors are at the greatest risk for continued deficits in academic functioning. Students with emotional disorders are less likely to attend post-secondary school than students in many other disability categories. An effective educational program for students with emotional disorders will provide emotional and behavioral supports that foster the replacement of problem behaviors with more appropriate behaviors. Positive behavior support systems are one especially effective strategy to achieve this goal, as are the implementation of wraparound services.

Teaching Strategies

Wraparound planning is a collaborative process that has shown great promise in supporting students with emotional disorders, both in research and in more practical application. This planning process brings all of the involved service providers (i.e., adult rehabilitation services, mental health services, guidance counselor) and individuals together to create a natural support system that is founded on the strengths of the individual student and the community in which that student lives. The family is an integral part of this process, and the overall goal is to devise a program that will capitalize on the strengths and interests of the student while utilizing community resources for placement and intervention.

Generally, academic achievement and problem behaviors often go hand-in-hand for students with emotional disorders. To put this another way, the more difficulty they have with a classroom task, the more likely that maladaptive behavior will result. Supporting the academic performance of these students will thus have the added benefit of decreasing externalizing and internalizing behaviors. Best practices for students with emotional disorders are often best practices for all students. A strategy such as allowing students to choose between classroom tasks, for example, is an effective way to decrease problem behaviors in general. Consistent and specific praise is also a great technique to utilize with all students in the classroom, but can be particularly effective with students with emotional disorders.

It is very important to not make assumptions about any family of a child with an emotional disorder. Many emotional disorders have an organic cause, and the parents of the child may well be loving and supportive in every way. However, some of these students have indeed been abused in some fashion in their young lives, and this too can be a cause of emotional or behavioral issues. Trust can be a very large issue for these children. Forming a relationship with these students that is built on empathy, trust, and mutual respect can often be the solution to many problem behaviors, and can have a lasting impact of the emotional development of the child.

Assistive Technology

Some modification in instruction will be necessary to allow a student with an emotional disorder to demonstrate mastery in a number of academic areas, and most especially in the area of writing. Word processing software can be an excellent supplementary aid for these students, allowing them to edit and revise their work as they produce it. These programs can strengthen spelling skills and writing cohesion simply by making the writing process easier overall. Of particular benefit are word processing programs that read the text as it is typed, providing an additional audio cue for the student.

Organizations

There are a number of excellent organizations that can help support classroom instruction for students with emotional and behavioral disabilities. The information presented in this module is intended as just a very brief description of emotional disorder and its impact on learning. Much more in-depth information and instructional strategies can be accessed through the following organizations:

American Academy of Child and Adolescent Psychiatry

The AACAP (American Academy of Child and Adolescent Psychiatry) is the leading national professional medical association dedicated to treating and improving the quality of life for children, adolescents, and families affected by these disorders. Composed of over 7,500 child and adolescent psychiatrists and other interested physicians, its members actively research, evaluate, diagnose, and treat psychiatric disorders and pride themselves on giving direction to and responding quickly to new developments in addressing the health care needs of children and their families.

Public Information Office
3615 Wisconsin Ave., NW
Washington, DC 20016-3007

Web: www.aacap.org

Center on Positive Behavioral Interventions and Supports

The OSEP-funded National Technical Assistance Center on Positive Behavior and Intervention Supports was established to address the behavioral and discipline systems needed for successful learning and social development of students. The Center provides capacity-building information and technical support about behavioral systems to assist states and districts in the design of effective schools.

5262 University of Oregon
Eugene, OR 97403-5262

Email: pbis@oregon.uregon.edu
Web: www.pbis.org

Center for Disability and Development

Dept. of Educational Psychology
4225 Texas A&M University
College Station, TX 77843-4225

Council for Exceptional Children

The Council for Exceptional Children (CEC) is the largest international professional organization dedicated to improving educational outcomes for individuals with exceptionalities, students with disabilities, and/or the gifted. CEC advocates for appropriate governmental policies, sets professional standards, provides continual professional development, advocates for newly and historically underserved individuals with exceptionalities, and helps professionals obtain conditions and resources necessary for effective professional practice.

1110 North Glebe Road, Suite 300
Arlington, VA 22201-5704

Federation of Families for Children's Mental Health

This organization is dedicated exclusively to helping children with mental health needs and their families achieve a better quality of life. They provide leadership to develop and sustain a nationwide network of family-run organizations; focus the passion and cultural diversity of our membership to be a potent force for changing how systems respond to children with mental health needs and their families; help policy-makers, agencies, and providers become more effective in delivering services and supports that foster healthy emotional development for all children.

1101 King Street, Suite 420
Alexandria, VA 22314

Email: ffcmh@ffcmh.org
Web: www.ffcmh.org

National Alliance for the Mentally Ill (NAMI)

NAMI is the National Alliance on Mental Illness, the nation's largest grassroots organization for people with mental illness and their families. NAMI is dedicated to the eradication of mental illnesses and to the improvement of the quality of life for persons of all ages who are affected by mental illnesses. NAMI members and friends work to fulfill our mission by providing support, education, and advocacy.

Colonial Place Three
2107 Wilson Boulevard, Suite 300
Arlington, VA 22203-3754

Web: www.nami.org

Mental Health America

Mental Health America is dedicated to helping ALL people live mentally healthier lives. They work to fulfill this mission by education the public about ways to preserve and strengthen mental health; advocating for access to effective care; fostering innovation in research, practice, services and policy; and providing support to individuals and families.

2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22311

Web: www.nmha.org

National Mental Health Information Center

The National Mental Health Information Center was developed for users of mental health services and their families, the general public, policy makers, providers, and the media. They provide free information about mental health via a toll-free number, their website, and more than 600 publications.

P.O. Box 42557
Washington, DC 20015

Web: www.mentalhealth.org

References

Hunt, N., and Marshall, K. (2006). Exceptional children and youth. Boston, MA: Houghton Mifflin Company.

National Dissemination Center for Children with Disabilities (2004). Fact Sheet 5. Retrieved February 1, 2008 from www.nichcy.org/pubs/factshe/fs5txt.htm.

Turnbull, A., Turnbull, R. & Wehmeyer, M. L. (2007). Exceptional lives. Special education in today's schools. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.

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Students with emotional disorders typically have a hard time maintaining relationships, and these personal problems may lead to physical symptoms in time.

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Since adolescents are often moody, it can be difficult to recognize when your child has become depressed and might need help. The thing people tend to notice first is withdrawal, or when the teenager stops doing things they usually like to do. There might be other changes in their mood, including sadness or irritability. Or in their behavior, including appetite, energy level, sleep patterns, and academic performance. If several of these symptoms are present, be vigilant about the possibility of teen depression.

This is especially important because by the time family members and other people around a teenager note their lack of interest in most things-or what we call anhedonia-they've usually been depressed for some time. Depression is an internalizing disorder, i.e. one that disturbs a patient's emotional life, rather than an externalizing one, which takes the form of disruptive or problematic behavior. As such, it takes a while not only for others to recognize it but often for the patient themselves to realize that their thinking, and emotional responses, are disturbed.

Note that there are actually two kinds of depression. In major depressive disorder -the most familiar form of depression-the symptoms occur in what may be severe episodes that tend to last from seven to nine months. But there is also another form of depression called dysthymia, in which the symptoms are milder, but they last longer, even years. So while the experience of dysthymia may be less debilitating for the child at any given moment, the risk is that there is more accrued damage and more time in which the child is kept out of the healthy development process.

When a teenager is depressed, their suffering isn't the only reason it's important to get help. In addition to the disorder itself, there are add-on effects that may cause lifelong issues. With depression symptoms comes low energy and poor concentration, two factors that are likely to have a significant impact on social and academic functioning.

It's easy to see the effects of poor academic functioning: falling behind in school undermines a child's confidence and self-image and can impact their future if it's prolonged. But social learning is just as critical as academic learning in adolescence. Deficits in social skills not only put depressed teens behind their peers but in themselves can compound their depression.

It's important to understand that a teenager who is depressed may also develop anxiety and may need to be treated for two separate disorders. It may be that depression leads to anxiety-the negative state of mind of a depressed teenager lends itself to uncertainty. If you're not feeling good about yourself, confident, secure, or safe, anxiety may find fertile ground. It may also be because the regions of the brain affected by anxiety and depression are close together and mutually affected.

Two serious problems that are directly associated with teenage depression and anxiety are suicidal thinking (or behavior) and substance abuse. Suicide is the third leading cause of death among adolescents and young adults aged 15 to 24, and we know that most kids who commit suicide have been suffering from a psychiatric illness. Especially at risk are teenagers who hide their depression and anxiety from parents and friends. That's why it's important to be alert to signs of these disorders-withdrawal, changes in school performance, eating habits, sleeping patterns, things they enjoy doing-even when teenagers aren't forthcoming about how they feel.

Similarly, the majority of teenagers who develop substance abuse problems also have a psychiatric disorder, including, most commonly, anxiety or depression, which is another important reason to get treatment in a timely way.

Fortunately, early involvement of health care professionals can shorten the period of illness and decrease the likelihood of missing important life lessons.

The most common treatment a mental health professional is apt to use is some form of cognitive behavioral therapy, and depending on how young the child is, it may involve teaching the parents as well. Cognitive behavioral therapy is based on the idea that a person suffering from a mood disorder is trapped in a negative pattern of thought. Depressed kids tend to evaluate themselves negatively, interpret the actions of others in a negative way, and assume the darkest possible outcome of events. In CBT, we teach sufferers to challenge those negative thoughts, recognize the pattern and train themselves to think outside it. And in many cases, we see real improvement.

If the depression is moderate to severe, treatment may involve medications such as antidepressants. A combination of psychotherapy and medication usually works better than either alone.

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What Are the Symptoms of Depression in Teenagers? - Child Mind Institute

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What are teen depression symptoms? Child Mind Institute provides information on how to tell if your teenager is just moody or depressed, and how to address the issue.

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Counseling Youth Who Have Bipolar Disorders

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Students with Disabilities & Section 504 of the Rehab Act of 1973

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At a glance

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

IDEA covers 13 disability categories.

Not every student who struggles in school qualifies.

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

1. Specific learning disability (SLD)

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

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

2. Other health impairment

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

3. Autism spectrum disorder (ASD)

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

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

5. Speech or language impairment

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

6. Visual impairment, including blindness

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

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

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

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

10. Orthopedic impairment

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

11. Intellectual disability

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

12. Traumatic brain injury

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

13. Multiple disabilities

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

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

Key takeaways

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

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

"Other health impairment" can cover ADHD.

About the author

About the author

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

Reviewed by

Reviewed by

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

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

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Overview

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

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

Symptoms of bipolar disorder

Signs of mania:

Drastic personality changes

Excitability

Irritability

Inflated self-confidence

Extremely energetic

Grandiose/delusional thinking

Recklessness

Decreased need for sleep

Increased talkativeness

Racing thoughts

Scattered attention

Psychotic episodes-breaks from reality

Signs of depression:

Depressed or irritable mood

Loss of interest or pleasure in things once enjoyed

Marked weight loss or gain

Decreased or increased need for sleep

Prolonged sadness

Restlessness

Lethargy

Fatigue

Feelings of hopelessness, helplessness, worthlessness

Excessive or inappropriate guilt

School avoidance

Avoids friends

Cloudy or indecisive thinking

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

Psychotic episodes-breaks from reality

Treatment

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

Pharmacological:

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

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

Psychotherapeutic

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

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

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A Closer Examination of Bipolar Disorder in School-Age Children

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Overview

Attention-deficit hyperactivity disorder, or ADHD, is a condition that makes it unusually difficult for kids to concentrate on tasks, to pay attention, to sit still, and to control impulsive behavior. While some children exhibit mostly inattentive behaviors and others predominantly hyperactive and impulsive, the majority of those with ADHD have a combination of both, which may make it very difficult for them to function in school, and create a lot of conflict at home.

Symptoms of Hyperactive or Impulsive ADHD

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

Excessive running and climbing

Trouble playing quietly

Extreme impatience

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

Excessive talking or interrupting, blurting out answers

Symptoms of Inattentive ADHD

Makes careless mistakes

Is easily distracted

Has difficulty following instructions

Doesn't seem to be listening when spoken to directly

Has trouble organizing

Avoids or dislikes sustained effort

Is forgetful, always losing things

Treatment and Prognosis

In most cases, the first line of treatment for ADHD is medication which helps children concentrate and limit impulsiveness. Psychostimulants such as methylphenidate (Ritalin) and dextroamphetamine (Adderall) are commonly used to stimulate the production of neurotransmitters that regulate attention and impulse control.

Behavior therapy is sometimes used in combination with medication. Parent-child interaction therapy and other forms of parent training teach parents how to cultivate good behaviors while minimizing impulsive or inattentive ones. When a child is old enough, cognitive behavioral therapy can help teach a child to control his behaviors by understanding how his thoughts and feelings influence them.

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Attention-deficit hyperactivity disorder, or ADHD, is a condition that makes it unusually difficult for kids to concentrate on tasks, to pay attention, to sit still, and to control impulsive behavior.

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What is oppositional defiant disorder (ODD) in children?

Oppositional defiant disorder (ODD) is a type of behavior disorder. It is mostly diagnosed in childhood. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures. They are more troubling to others than they are to themselves.

What causes ODD in a child?

Researchers don't know what causes ODD. But there are 2 main theories for why it occurs:

Developmental theory. This theory suggests that the problems start when children are toddlers. Children and teens with ODD may have had trouble learning to become independent from a parent or other main person to whom they were emotionally attached. Their behavior may be normal developmental issues that are lasting beyond the toddler years.

Learning theory. This theory suggests that the negative symptoms of ODD are learned attitudes. They mirror the effects of negative reinforcement methods used by parents and others in power. The use of negative reinforcement increases the child's ODD behaviors. That's because these behaviors allow the child to get what he or she wants: attention and reaction from parents or others.

Which children are at risk for ODD?

ODD is more common in boys than in girls. Children with the following mental health problems are also more likely to have ODD:

Mood or anxiety disorders

Conduct disorder

Attention-deficit/hyperactivity disorder (ADHD)

What are the symptoms of ODD in a child?

Most symptoms seen in children and teens with ODD also happen at times in other children without it. This is especially true for children around ages 2 or 3, or during the teen years. Many children tend to disobey, argue with parents, or defy authority. They may often behave this way when they are tired, hungry, or upset. But in children and teens with ODD, these symptoms happen more often. They also interfere with learning and school adjustment. And in some cases, they disrupt the child's relationships with others.

Symptoms of ODD may include:

Having frequent temper tantrums

Arguing a lot with adults

Refusing to do what an adult asks

Always questioning rules and refusing to follow rules

Doing things to annoy or upset others, including adults

Blaming others for the child's own misbehaviors or mistakes

Being easily annoyed by others

Often having an angry attitude

Speaking harshly or unkindly

Seeking revenge or being vindictive

These symptoms may look like other mental health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

How is ODD diagnosed in a child?

If you notice symptoms of ODD in your child or teen, you can help by seeking a diagnosis right away. Early treatment can often prevent future problems.

A child psychiatrist or qualified mental health expert can diagnose ODD. He or she will talk with the parents and teachers about the child's behavior and may observe the child. In some cases, your child may need mental health testing.

How is ODD treated in a child?

Early treatment can often prevent future problems. Treatment will depend on your child's symptoms, age, and health. It will also depend on how bad the ODD is.

Children with ODD may need to try different therapists and types of therapies before they find what works for them. Treatment may include:

Cognitive-behavioral therapy. A child learns to better solve problems and communicate. He or she also learns how to control impulses and anger.

Family therapy. This therapy helps make changes in the family. It improves communication skills and family interactions. Having a child with ODD can be very hard for parents. It can also cause problems for siblings. Parents and siblings need support and understanding.

Peer group therapy. A child develops better social and interpersonal skills.

Medicines. These are not often used to treat ODD. But a child may need them for other symptoms or disorders, such as ADHD.

How can I help prevent ODD in my child?

Researchers don't know what causes ODD. But certain approaches can help prevent the disorder. Young children be helped by early intervention programs that teach them social skills and how to deal with anger. For teens, talk therapy (psychotherapy), learning social skills, and getting help with schoolwork can all help reduce problem behaviors. School-based programs can also help to stop bullying and improve relationships among teens.

Parent-management training programs are also important. These programs teach parents how to manage their child's behavior. Parents learn positive reinforcement methods, and also how to discipline their child.

How can I help my child live with ODD?

Early treatment for your child can often prevent future problems. Here are things you can do to help:

Keep all appointments with your child's healthcare provider.

Take part in family therapy as needed.

Talk with your child's healthcare provider about other providers who will be involved in your child's care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, and psychiatrists. Your child's care team will depend on his or her needs and how serious the disorder is.

Tell others about your child's conduct disorder. Work with your child's healthcare provider and school to develop a treatment plan.

Reach out for support. Being in touch with other parents who have a child with ODD may be helpful. If you feel overwhelmed or stressed out, talk with your child's healthcare provider. He or she may direct you to a support group for caregivers of children with ODD.

When should I call my child's healthcare provider?

Call your child's healthcare provider right away if your child:

Feels extreme depression, fear, anxiety, or anger toward him or herself or others

Feels out of control

Hears voices that others don't hear

Sees things that others don't see

Can't sleep or eat for 3 days in a row

Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help

Call 911 if your child has suicidal thoughts, a suicide plan, and the means to carry out the plan.

Key points about ODD in children

Oppositional defiant disorder (ODD) is a type of behavior disorder. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures.

Developmental problems may cause ODD. Or the behaviors may be learned.

A child with ODD may argue a lot with adults or refuse to do what they ask. He or she may also be unkind to others.

A mental health expert often diagnoses ODD.

Therapy that helps the child interact better with others is the main treatment. Medicines may be needed for other problems, such as ADHD.

Next steps

Tips to help you get the most from a visit to your child's healthcare provider:

Know the reason for the visit and what you want to happen.

Before your visit, write down questions you want answered.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

Ask if your child's condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if your child does not take the medicine or have the test or procedure.

If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your child's provider after office hours. This is important if your child becomes ill and you have questions or need advice.

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Oppositional Defiant Disorder (ODD) in Children

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Oppositional defiant disorder (ODD) is a type of behavior disorder. It is mostly diagnosed in childhood. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures.

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National Institute of Mental Health (NIMH)

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Learn about obsessive-compulsive disorder, including signs and symptoms, risk factors, treatments and therapies, and links to other resources to learn more.

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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.

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Quick Facts on Obsessive-Compulsive Disorder (OCD)

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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).

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School Mental Health Referral Pathways Toolkit

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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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National Institute of Mental Health (NIMH)

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What is schizophrenia?

Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which can be distressing for them and for their family and friends. The symptoms of schizophrenia can make it difficult to participate in usual, everyday activities, but effective treatments are available. Many people who receive treatment can engage in school or work, achieve independence, and enjoy personal relationships.

What are the signs and symptoms of schizophrenia?

What are the risk factors for schizophrenia?

How is schizophrenia treated?

How can I find help for schizophrenia?

How can I find a clinical trial for schizophrenia?

Where can I learn more about schizophrenia?

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Learn about schizophrenia, including onset & symptoms, risk factors, treatments and therapies, how to help a loved one, & resources for more information.

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Childhood Schizophrenia: What Are the First Signs?

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There are fewer more frightening or challenging psychiatric conditions for a family to face than psychosis, an extreme mental state in which impaired thinking and emotions cause a person to lose contact with reality. This could mean hearing or seeing things that aren't there (hallucinations), or believing things that aren't true (delusions).

The illness most often associated with psychosis, schizophrenia, usually doesn't show up until very late adolescence or early adulthood. Recently, however, experts in the field have been working to identify high-risk kids who show symptoms that could serve as early warning signs of psychosis, and several academic centers have been set up to focus on this crucial period when it may be possible to change the trajectory of mental illness.

Not all the kids who are identified with what experts call "prodromal" symptoms will progress, or "convert" to full-blown psychotic illness. But early intervention has been shown to improve outcomes for those who do. And since psychotic symptoms cause disruption across a teenager's life, from school to friendships to family, researchers are hoping quick action can prevent impairment and prolong typical functioning.

What's more, some of the approaches that show promise in delaying onset of psychosis or mitigating symptoms include fairly simple lifestyle changes like stress reduction and sleep hygiene, and managing co-occurring disorders like anxiety. The key: identifying at-risk kids earlier when these low-impact measures are still effective.

What are "prodromal" symptoms?

Prodromal symptoms are "attenuated" or weak symptoms of psychosis. Moreover, "they are a warning sign," says Dr. Christoph Correll, the medical director of the Recognition and Prevention Program (RAP) at Zucker Hillside Hospital in Queens, NY, which specializes in diagnosing and treating early symptoms of mental illness in teenagers and young adults. "These signs can happen in people who don't go on to develop psychosis-but if we follow these people who are in the risk state based on these watered-down versions, one third will probably go on to develop psychosis. That's a lot more than in the general population."

Prodromal symptoms occur on a spectrum from very, very mild to severe and can include:

Withdrawing from friends and family/feeling suspicious of others

Changes in sleeping or eating patterns

Less concern with appearance, clothes or hygiene

Difficulty organizing thoughts or speech

Loss of usual interest in activities or of motivation and energy

Development of unusual ideas or behaviors

Unusual perceptions, such as visions or hearing voices (or even seeing shadows)

Feeling like things are unreal

Change in personality

Feelings of grandiosity (belief he has a superpower, etc)

In some cases, these symptoms represent the early stages of a disorder, and will eventually convert. In others, the symptoms actually fade or remain mild. Dr. Tiziano Colibazzi is a psychiatrist at Columbia Presbyterian's COPE clinic (Center for Prevention and Evaluation), which was established to research and treat prodromal symptoms. "We can identify a group of people that are at clinically high risk," says Dr. Colibazzi. "What we can't do is narrow that group down further to identify the 30 percent who will convert."

First step if you feel your child is at risk: An evaluation

The right treatment for prodromal symptoms depends entirely on how severe they are when they are diagnosed. The first step is a proper and complete diagnosis by a mental health professional with experience in assessing psychotic illness.

If you see marked changes in motivation, thinking, and/or behavior in your child, the first place to start is with her pediatrician to rule out a medical illness. Substance use also needs to be ruled out as the cause of any behavior changes in adolescents. After that, you're going to want to have your child evaluated by a qualified psychiatrist or psychologist. This in itself might be a multi-step process.

"You can't just look at the kid once and get a bit of a history and then know what's going on, " says Dr. Correll. "Kids develop; symptoms develop. And the trajectory-how things change, get better or worse, what other symptoms add on to it-will be highly informative in telling us something about the prognosis, what we expect to happen."

One aid to predicting the evolution and severity of symptoms, notes Dr. Colibazzi, is the patient's ability to doubt his symptoms. If your child retains the self-awareness to know that it's his mind that is playing tricks on him, it's an indication that symptoms are still in the very early stages. As symptoms become more severe, the patient's beliefs (whether paranoid, grandiose or hallucinatory) become increasingly difficult to challenge.

Lifestyle and mental health options

Psychotic symptoms and illnesses have been shown to vary quite a bit depending on the environment-the health of our bodies, our interpersonal relationships, our mindsets. As with any illness, but particularly important in at-risk youth, healthy living is key. Regardless of the severity of prodromal symptoms, Dr. Correll says that your child's outcome can be improved by making sure your kid sticks to a routine that includes:

Eating well

Getting regular exercise

Adhering to a regular sleep schedule

Reducing stress as much as possible

Staying away from drugs-particularly marijuana, which can interact with prodromal symptoms and increase the risk for psychosis significantly

Also, don't forget to address depression and anxiety. According to Dr. Correll, "adults who eventually developed schizophrenia identified a three to five year period during which they experienced depression or anxiety before developing the prodromal symptoms of psychosis and then developed full-blown psychosis." "So treating the depression early," he says, "might actually interrupt the progression from depression to psychosis in some patients."

Treatment for prodromal psychotic symptoms

Dr. Correll recommends trying several approaches. Mild symptoms call for more low-key treatments including:

Psycho-education: teaching both the kid and the family more about the symptoms and the illness.

Therapy, particularly cognitive behavioral therapy: "CBT can be good to change one's thinking patterns," says Correll, "and also to address developing self-esteem. We have to be careful that kids with a psychiatric diagnosis don't self-stigmatize and get into a hopeless or negative mode where they feel they can't achieve."

Lifestyle adjustments: Assessing whether the current school environment is best for the child. Perhaps a therapeutic social group to help the child cope.

Reducing Stress: Stress is often a trigger for symptoms, so reducing stress in these kids' lives is crucial and may prevent or delay conversion to psychotic illness.

Understanding prodromal symptoms and monitoring kids who are at high risk for psychotic illness means that parents can do more for their kids than wait for symptoms to get worse or merely hope for the best. Early monitoring and intervention can give high-risk kids an advantage, which researchers hope will eventually change the odds when it comes to psychotic illness.

"The duration of untreated psychosis does actually seem to affect the course of the illness," Dr. Colibazzi says. The longer the illness goes untreated, the greater the chance that it will cause serious disruption in all areas of the patient's life. "So it is reasonable to think that just following someone very closely and treating them very early, as soon as they develop symptoms, would be helpful."

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Psychosis Symptoms and Signs in Teens | Child Mind Institute

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There are fewer more frightening or challenging psychiatric conditions for a family to face than psychosis, an extreme mental state in which impaired thinking and emotions cause a person to lose contact with reality. This could mean hearing or seeing things that aren't there (hallucinations), or believing things that aren't true (delusions).

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In this 2-part podcast series, NAMI Chief Medical Officer Dr. Ken Duckworth guides discussions on early psychosis that offer insights from individuals, family members and mental health professionals. Read the transcript.
Note: Content includes discussions on topics such as suicide attempts and may be triggering.

Most people think of psychosis as a break with reality. In a way it is. Psychosis is characterized as disruptions to a person's thoughts and perceptions that make it difficult for them to recognize what is real and what isn't. These disruptions are often experienced as seeing, hearing and believing things that aren't real or having strange, persistent thoughts, behaviors and emotions. While everyone's experience is different, most people say psychosis is frightening and confusing.

Psychosis is a symptom, not an illness, and it is more common than you may think. In the U.S., approximately 100,000 young people experience psychosis each year. As many as 3 in 100 people will have an episode at some point in their lives.

Early or first-episode psychosis (FEP) refers to when a person first shows signs of beginning to lose contact with reality. Acting quickly to connect a person with the right treatment during early psychosis or FEP can be life-changing and radically alter that person's future. Don't wait to take the first step and prepare yourself with information by reviewing these tip sheets:

What is Early and First-Episode Psychosis?
Early Psychosis: What's Going on and What Can You Do?
Encouraging People to Seek Help for Early Psychosis
Early Intervention: Tips for School Staff and Coaches

Symptoms

Early warning signs before psychosis

Early psychosis or FEP rarely comes suddenly. Usually, a person has gradual, non-specific changes in thoughts and perceptions, but doesn't understand what's going on. Early warning signs can be difficult to distinguish from typical teen or young adult behavior. While such signs should not be cause for alarm, they may indicate the need to get an assessment from a doctor.

Encouraging people to seek help for early psychosis is important. Families are often the first to see early signs of psychosis and the first to address the issue of seeking treatment. However, a person's willingness to accept help is often complicated by delusions, fears, stigma and feeling unsettled. In this case, families can find the situation extremely difficult, but there are engagement strategies to help encourage a person to seek help.

It's important to get help quickly since early treatment provides the best hope of recovery by slowing, stopping and possibly reversing the effects of psychosis. Early warning signs include the following:

A worrisome drop in grades or job performance

Trouble thinking clearly or concentrating

Suspiciousness or uneasiness with others

A decline in self-care or personal hygiene

Spending a lot more time alone than usual

Strong, inappropriate emotions or having no feelings at all

Signs of early or first-episode psychosis

Determining exactly when the first episode of psychosis begins can be hard, but these signs and symptoms strongly indicate an episode of psychosis:

Hearing, seeing, tasting or believing things that others don't

Persistent, unusual thoughts or beliefs that can't be set aside regardless of what others believe

Strong and inappropriate emotions or no emotions at all

Withdrawing from family or friends

A sudden decline in self-care

Trouble thinking clearly or concentrating

Such warning signs often point to a person's deteriorating health, and a physical and neurological evaluation can help find the problem. A mental health professional performing a psychological evaluation can determine if a mental health condition is involved and discuss next steps. If the psychosis is a symptom of a mental health condition, early action helps to keep lives on track.

Psychosis

Psychosis includes a range of symptoms but typically involves one of these two major experiences:

Hallucinations are seeing, hearing or feeling things that aren't there, such as the following:

Hearing voices (auditory hallucinations)

Strange sensations or unexplainable feelings

Seeing glimpses of objects or people that are not there or distortions

Delusions are strong beliefs that are not consistent with the person's culture, are unlikely to be true and may seem irrational to others, such as the following:

Believing external forces are controlling thoughts, feelings and behaviors

Believing that trivial remarks, events or objects have personal meaning or significance

Thinking you have special powers, are on a special mission or even that you are God.

Causes

We are still learning about how and why psychosis develops, but several factors are likely involved. We do know that teenagers and young adults are at increased risk of experiencing an episode of psychosis because of hormonal changes in their brain during puberty.

Several factors that can contribute to psychosis:

Genetics. Many genes can contribute to the development of psychosis, but just because a person has a gene doesn't mean they will experience psychosis. Ongoing studies will help us better understand which genes play a role in psychosis.

Trauma. A traumatic event such as a death, war or sexual assault can trigger a psychotic episode. The type of trauma-and a person's age-affects whether a traumatic event will result in psychosis.

Substance use. The use of marijuana, LSD, amphetamines and other substances can increase the risk of psychosis in people who are already vulnerable.

Physical illness or injury. Traumatic brain injuries, brain tumors, strokes, HIV and some brain diseases such as Parkinson's, Alzheimer's and dementia can sometimes cause psychosis.

Mental health conditions. Sometimes psychosis is a symptom of a condition like schizophrenia, schizoaffective disorder, bipolar disorder or depression.

Diagnosis

A diagnosis identifies an illness; symptoms are components of an illness. Health care providers draw on information from medical and family history and a physical examination to diagnose someone. If causes such as a brain tumor, infection or epilepsy are ruled out, a mental illness might be the reason.

If the cause is related to a mental health condition, early diagnosis and treatment provide the best hope of recovery. Research shows that the earlier people experiencing psychosis receive treatment, the better their long-term quality of life.

Treatment

Early or first-episode psychosis

Early treatment of psychosis, especially during the first episode, leads to the best outcomes.

Research has shown significant success using a treatment approach called Coordinated Specialty Care (CSC). CSC uses a team of health professionals and specialists who work with a person to create a personal treatment plan based on life goals while involving family members as much as possible.

CSC has the following key components:

Case management

Family support and education

Psychotherapy

Medication management

Supported education and employment

Peer support

SAMHSA maintains an Early Serious Mental Illness (ESMI) Treatment Locator as a source of information for family members who are seeking CSC programs in the US. Portions of their website are available in Spanish.

Psychosis treatment

Traditional treatment for psychosis involves psychotherapy and medication. Several types of therapy have successfully helped individuals learn to manage their condition. In addition, medication targets symptoms and helps reduce their impact.

Related Conditions

Psychosis can be related to several mental health conditions:

# data[].attributes.attachment_link.description
In this 2-part podcast series, NAMI Chief Medical Officer Dr. Ken Duckworth guides discussions on early psychosis that offer insights from individuals, family members and mental health professionals. Read the transcript. Note: Content includes discussions on topics such as suicide attempts and may be triggering. Most people think of psychosis as a break with reality.