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Mental Health Related Lesson Plans for Educators 

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Mental Health Related Lesson Plans for Educators 

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Addressing Student Mental Health Needs by Providing Directand Indirect Services and Building Alliancesin the Community

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What Parents Need to Know About Confidentiality

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Bridging Students to the Community

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By Jacqueline Zeller , Ph.D.

To address students' mental health needs, school counselors and other school-based student support staff can connect youth and their families to resources in the community. You can also take steps to help increase the likelihood referrals will be successful.

Developing Referral Lists
In developing a referral list of community-based mental health professionals, include a provider's capacity to treat clients with particular presenting problems, ability to work with multicultural populations and comfort with languages other than English. Note logistical factors, such as a provider's hours, location and accessibility by public transportation, affordability and accepted insurance plans.

Ideally, such lists are updated fairly often. You may want to visit agencies or speak with providers by phone to gain a sense of their approaches or take a field trip during a professional development day.

Serving as a Bridge
Even with a referral list of qualified and well-matched community practitioners, making a successful referral can still be challenging. To increase ties among students, families and community-based providers, invite local mental health providers to parent workshops, school-based family events and select classroom lessons focusing on mental-health-related topics.

For example, as part of a school's focus on wellness, community-based professionals could offer strategies to de-stress and discuss warning signs of when students may need more support. These more informal introductions help the school-based staff become a bridge connecting families and students to outside agencies. Community providers are often invested in such activities if it can increase their referrals and decrease their no-show rates.

School counselors can also help to connect students and families to services by addressing common barriers and concerns. Try to create an open dialogue that allows families to feel heard and engages them in a process of mutual problem solving, recognizing their strengths. Authors McKay and Gopalan and colleagues have written about many of the barriers and strategies highlighted here.

Provide students a developmentally appropriate explanation of the reasons a student might be referred to outside mental health services. Understanding the student's and family's feelings and concerns about accessing mental health services is important, as is assessing whether outside mental health services (as opposed to other supports) are the best match for the family.

Address common concerns and questions: Does the student have fears about being labeled "crazy" or being singled out? Does the family feel blamed by the school or a previous provider? What are the family's opinions about medication? What are the family and student hoping for in an outside practitioner? How does the parent or guardian view the child's functioning? Are there concerns about privacy? By listening to and addressing the family's unique needs, concerns and questions, you'll be more likely to provide a successful referral.

If parents want help addressing practical barriers, include the family and student, when appropriate, as much as possible in the process so they can more independently access resources in the future. For example, with the parents' permission, you might make the initial phone contact to an outside provider while the parents are in the room.

Following Up
Once you've made a referral, particularly with more severe cases, be sure to follow up. To share information with an outside provider, you'll need consent to exchange information. You can also connect directly with families or students to check on progress of referrals. If you have significant concerns about a student even after an outside referral, consider the nature of the outside services and whether other supports might be warranted. When students are transitioning back from an out-of-school mental health setting, it is particularly important that school counselors and/or related school staff connect with the student, family and outside providers to make a transition plan for the student's return to school. When students are receiving regular counseling both inside and outside of school, it is important that school staff and the provider connect.

Systems such as checklists and standardized approaches can assist the referral and follow-up processes. A school checklist of steps for referral processes, required documents (such as releases of information), strategies for record-keeping of contacts and most frequently asked questions can make the process more efficient for all involved. Checklists can also help teachers and school counselors efficiently share information about student progress with outside providers. Schools can invite outside mental health practitioners to key meetings (when permissions are in place) to maintain meaningful connections between providers. Other school staff may be able to help in the referral process: perhaps a student support team member can take the role of managing outside partnerships and connecting with providers about students' progress.

Connecting with the School-Based Team
When assisting families and students who have greater mental health needs, remember to work as a team with other school staff in connecting students and families to resources. School psychologists, school social workers, other school counselors and student support team members can help identify potential referral sources, connect students and families to resources, support follow-up and support one another's work with students. Nurturing your school-based connections with school-based colleagues is important for supporting both students and staff.

Jacqueline Zeller, Ph.D., is with the Harvard Graduate School of Education's Prevention Science and Practice/CAS in Counseling Program. She can be reached at zellerja@gse.harvard.edu. Contact the author for references for this article.

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Bridging Students to the Community | American School Counselor Association (ASCA)

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By Jacqueline Zeller , Ph.D. To address students' mental health needs, school counselors and other school-based student support staff can connect youth and their families to resources in the community. You can also take steps to help increase the likelihood referrals will be successful.

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Process to Refer Students to External Assistance

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Process to Refer Students to External Assistance

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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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ASCA Ethical Standards for School Counselors

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ASCA Ethical Standards for School Counselors

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Addressing Mental Health in School Crisis Prevention & Response

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Purpose - ADHD: RESOURCES FOR PROFESSIONAL SCHOOL COUNSELORS

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This website is a tool for all professional school counselors who supervise, assess, and work with students who are both pre-diagnosed and diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). This forum covers the beginning stages of diagnosing a child using reliable and valid assessments, to creating/ implementing interventions based on theoretical backgrounds, and finally, providing resources to students and families alike.

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A Group Counseling Intervention for Children with Attention Deficit Hyperactivity Disorder

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By: Linda D. Webb and Robert. D Myrick

A theoretical framework is presented to increase school counselor understanding of students with attention deficit hyperactivity disorder (ADHD) and support a counselor intervention. This article outlines a six-session group counseling intervention to help students with ADHD understand its effects on their classroom performance and to learn and practice a repertoire of school success skills. The unit is based on the theme of a journey with ADHD students who learn they are different travelers in the world of education and often take alternate routes to their destinations (academic, personal-social, and career goals). Fourteen elementary school counselors received training, delivered the intervention, and completed a post-intervention survey. Student and teacher reports of school success behaviors from the intervention pilot are also reported.

Attention deficit hyperactivity disorder (ADHD)is a diagnostic label used to describe people who have developmentally inappropriate levels of inattention, hyperactivity, and impulsivity. They find it difficult to complete routine tasks or concentrate for an extended period of time. They frequently fidget and have difficulty inhibiting behaviors that can distract others. An estimated 3% to 5% of the school age population has ADHD (American Psychiatric Association, 1994) with boys outnumbering girls (Kauffman, 1993; Barkley, 1990). It is one of the most commonly diagnosed and studied disorders among children, and it is receiving increased attention by school administrators, teachers, and counselors (Barkley, 1998; Shaywitz & Shaywitz, 1992).

ADHD students often have problems in school where rules and procedures require them to sit still, be attentive, and stay focused on academic tasks and classroom discussions. They may receive some assistance from special education teachers who typically have smaller classes and who rely on the use of behavioral techniques in managing students. However, between 85% and 90% of ADHD students are still served in general education classrooms for all or part of the day (Montague & Wagner, 1997). The regular classroom teacher works with a larger number of students at one time and usually lacks the training related to working with learning disorders. Some special education strategies may seem too impractical or time consuming, and many teachers are unsure of what to do and need support.

School counselors and ADHD students

School counselors, as behavioral and relationship specialists, can provide support for ADHD students and their teachers. The American School Counselor Association published a position statement that strongly encourages the involvement of school counselors in the multidimensional treatment of these students (ASCA, 1994). Others in the field (Erk, 1995; Lavin, 1997; Schweibert, Sealander & Tollerud, 1995) have also addressed the need.

Myrick (2002) described a developmental school guidance and counseling program with the goal of helping all students learn more effectively and efficiently. Counselors provide such interventions as individual counseling, small group counseling, large group guidance, peer facilitator training, and consultation with parents, teachers, and administrators. Sometimes certain student populations such as those with ADHD are targeted for special attention and one or more counselor interventions.

Braswell and Bloomquist (1991) recommend group counseling more often than individual counseling for most ADHD children. Group sessions closely approximate real-life peer relationship situations; group members can help each other acquire skills and make generalizations. Group counseling activities that elicit the behaviors and feelings associated with academic and social problems enable counselors to intervene and assist children who are low performers in school and have difficulties with their peers. Interventions applied consistently within the school setting seem to be the most effective.

Understanding ADHD in a learning environment

During the past decade, researchers linked the causes of ADHD to neurological and genetic factors. It appears that these factors may play a more important role than social or environmental ones, making the disorder a treatable but not necessarily curable one (Barkley, 1998; Teeter & Semrud-Clikeman, 1995). This also suggests that the disorder might be managed but it is not likely to disappear. Barkley identified impulsivity as a hallmark of the disorder. Impulsive behavior is also frequently seen in cases in which students are referred to school administrators for discipline. The greatest number of classroom problems and referrals associated with ADHD are related to behaviors that often cause conflicts with teachers and other students (Zentall, 1995). Counselors want to help ADHD students gain the most from school by helping them manage their behavior and adjust to rules and procedures.

Although the onset of ADHD for most children is prior to age 4, it is most often diagnosed when a child is in elementary school (McKinney, Montague, & Hocutt, 1993). This is when children are introduced to the structure and demands of the educational system. How students learn to manage themselves and the learning environment during their first few years of school often determines how successful they will be in later years.

As many as 56% of ADHD students may require academic tutoring, up to 30% may repeat a grade, and 30% to 40% may be placed in special education programs. As many as 46% of ADHD students may be suspended from school with up to 35% dropping out completely and not finishing high school (Barkley, DuPaul, & McMurray, 1990; Barkley, Fischer, Edelbrock, & Smallish, 1990; Weiss & Hechtman, 1993). In addition, without assistance students may develop emotional problems laden with anger, aggression, depression, and anxiety (McKinney et al., 1993; Reeve, 1990). These can lead to oppositional defiant and conduct disorders (Biederman, Faraone, & Lapey, 1992) and result in troublesome conflicts.

Learning skills such as listening, attending, following directions, and exhibiting social competence have a strong correlation with successful social and academic achievement in school (Cartledge & Milburn, 1978; Eisenberg et al., 1997; Masten & Coatworth, 1998). Because ADHD students cannot sustain their attention and are easily distracted, they have difficulty doing academic tasks, completing homework, and acting appropriately with peers and teachers. Lack of success and repeated confrontations can lower self-esteem. Increased anxiety and frustration follow. Inconsistent performance in school, low test scores, disorganized desks and backpacks, and disruptive behavior are additional problems (DuPaul & Stoner, 1994; Reeve, 1990; Zentall, 1993) that draw counselors' attention.

ADHD intervention

The most common treatment for ADHD is medication (Epstein, Singh, Luebke, & Stout, 1991). Sixty percent to 90% of children diagnosed with the disorder receive stimulant medication for prolonged periods during their school careers (Whalen & Henker, 1991). Short-term enhancements in behavioral functioning have been found in about 75% of those being treated with stimulant medication (DuPaul & Rapport, 1993; Kavale, 1992; Whalen & Henker). Even though the medication has no effect on academic attainment per se, productivity in school may improve as a result of controlling behaviors that interfere with learning and classroom performance (Montague & Wagner, 1997).

The metaphor of a journey provided opportunities to construct group activities that were fun and enabled participants to reflect on personal management skills.

Stimulant medication does not teach appropriate behaviors, but it does increase the probability of a child displaying appropriate behaviors that are already in their repertoire. According to Barkley (1998), the difficulty for ADHD students is not knowing what to do, but doing what they know. In addition, it has been shown that there is a difference between possessing a skill and using it effectively (Stein, Szumowski, Blondis, & Roizen, 1995). An intervention that targets school success behaviors, including practice and application, increases the chances of improved behavior for students who take stimulant medication. Researchers Weiss & Hechtman, (1993) found the long-term prognosis for ADHD children treated with stimulant medication alone was the same as those receiving no treatment.

A recent study sponsored by the National Institute of Mental Health (MTA Cooperative Group, 1999) reported that a carefully managed protocol of stimulant medication and behavioral intervention was effective in treating ADHD symptoms. The combination resulted in improved social skills, parent-child relations, and academic achievement. It was also reported that in some circumstances, behavioral/psychosocial interventions alone produced these same results. While school counselors often help to identify behaviors symptomatic of ADHD, diagnosing and medically treating ADHD are not school counselor functions. However, helping students understand and manage their behavior and their relationships with others to maximize their learning potential is an important school counselor function.

The widespread use of stimulant medication and the emphasis on behavioral modification by teachers and parents raises another question. Should ADHD students feel less responsibility for the outcomes of their behavior? They may falsely conclude that what happens during the school day is the result of their medication and teachers' efforts, rather than their own choices and actions. This external locus of control can lead students to disclaim personal responsibility for what they do and lay a foundation for making excuses when problems or difficulties arise. Research findings (Linn & Hodge, 1982) support this external locus-of-control finding for ADHD students along with the need for explicit external cues.

However, Barkley (1998) suggests that ADHD is not an excuse or a reason to dismiss the consequences of one's actions, but rather an explanation as to why it is necessary for those with the disorder to increase awareness of life's behavioral contingencies. Helping students understand how their disorder affects school performance may be one way for ADHD students to begin to see themselves as having the capacity to manage themselves in their environment (Goldstein & Goldstein, 1998). ADHD students need additional counselor intervention strategies that (a) help them understand ADHD, (b) provide a repertoire of skills to enhance learning, and (c) help them understand the importance of external cues. Cognitive behavioral methods promote a shift from caregivers (teachers and parents) to the ADHD students themselves. The student is in the best position to recognize signs of problems before they occur and to take actions that help manage their lives.

Between 85% and 90% of ADHD students are served in general education classrooms for all or part of the day.

A Basic Counseling Theory

Rational Emotive Behavior Therapy (REBT; Ellis & MacLaren, 1998) provides a theory for developing a group guidance unit that helps students learn how ADHD affects learning behaviors and classroom performance. It offers a rationale for increasing student awareness and the value of practicing school success skills. The theory assumes that an ADHD student cannot exhibit a behavior that has not been learned.

REBT emphasizes behavioral change and self-regulation along with the examination and possible modification of thoughts, beliefs, feelings, and expectations. It is an approach that supports recent treatment interventions for children with ADHD (Ellis & Wilde, 2002; Schweibert et al., 1995). It is assumed that, while the primary symptoms of the disorder are difficult to ameliorate, it may be possible to help children develop competencies that lower the risk of serious secondary difficulties (Braswell, 1993). According to Myrick (2002), this approach also lends itself to brief counseling that is so often used in schools.

The journey: a group counseling intervention

What follows is a description of a small group counseling intervention that has been used with ADHD students. The intervention focuses on increased understanding of the disorder and how it impacts school performance. It was assumed that students needed to face their disorders and recognize that it is part of who they are. Further, the disorder by itself will not keep them from their personal, academic, or career goals. To the contrary, many individuals who have ADHD have made valuable and significant contributions to society. The secret to success is being able to manage one's thoughts, feelings, and behaviors.

Fourteen elementary school counselors from one school district delivered the intervention consisting of six small group sessions designed for about six students per group. Each session had a specific objective related to thoughts, behaviors, and skills that focused on school and personal achievement and began with a review of the previous session and a check on application of skills. Sessions ended with tasks for practice and an encouraging summary statement. The unit culminated with snacks, juice, and talk about the group experience as well as a review of plans for utilizing strategies.

The sessions were based on the theme of a journey that students might imagine they were taking. Of course, the journey required preparation and the ability to recognize certain road signs and to manage the vehicle in such a way that the students would arrive safely at their final destination. Because the students had ADHD, they would be a different kind of traveler and, at times, take a different route than others, although they would eventually arrive at the same destination. The metaphor of a journey provided opportunities to construct group activities that were fun and enabled participants to reflect on goals and goal setting, the influence of personal characteristics on achieving goals, and personal management skills. As they considered skills needed to move them along on their imaginary journey, they also thought about how the skills were related to the academic, personal, social, and career goals shared by all students their age.

Preparing for the journey

The counselor begins the unit by telling students that they have been selected for the group because they have been identified as different kind of learners: They have ADHD. They are asked, "What do you know about ADHD?"

Discussion and clarification help the students identify ADHD symptoms and how the symptoms are manifested in school, which often makes them learn in different ways than others. They are, in one sense, a different traveler in the education world. It is explained that sometimes they take the same road as others while learning things and then, at other times, they will go another way, perhaps taking some detours, even though everyone is trying to get to the same place. The counselor leads the participants through a series of structured learning activities. Special efforts are made to focus on what students experience (their feelings) and how those feelings are related to behaviors (their actions). Students discuss what they believe to be true about themselves and others, and how they can manage their thoughts, feelings, and behaviors. Once introductory activities are completed, the journey begins.

1. Our Journey
Activity: Map Quest

1. Students will gain increased knowledge of ADHD.

2. Students will identify behaviors associated with ADHD and the effect of these behaviors on school success.

3. Students will be given an opportunity to discuss their own ADHD diagnosis and express associated feelings.

2. Pack It Up
Activity: Messy Bag

Students will learn and practice strategies to support the need for Activity: Messy Bag better organization as related to school success.

3. Stop Lights & Traffic Cops
Activity: The Signs Around Us

1. Students will learn and practice behaviors associated with attending.

2. Students will identify school situations in which attending is important.

3. Students will identify school situations in which attending is difficult.

4. Using Road Signs As a Guide
Activity: Reading Classroom Cues

1. Students will learn to recognize, create, and use external cues in the classroom.

2. Students will gain awareness of the need for strategies to support school success.

5. Road Holes and Detours
Activity: When Things Don't Go Right

1. Students will identify school situations that are particularly difficult.

2. Students will identify ways to improve school situations that are difficult.

6. Roadside Assistance & Being Your Own Mechanic
Activity: Increasing Control Of Our Success

1. Students will identify sources of support at school.

2. Students will be given the opportunity to experience the feelings of "being in control."

3. Students will associate increased practice of a skill with improvement of that skill.

4. Students will gain increased knowledge of the use of medication in treating some ADHD cases.

Session One:

Our Journey. Participants begin their journey as they explore a variety of paths to reach a single destination in Map Quest; they talk about goals and places to go. As they discover the link between an objective and school success, students realize that not all students must take the same journey through school; however, they can each achieve success and arrive at the same destination. Summary statements include: "Having ADHD doesn't mean you can't be successful as a student; however, it does mean that you might have to find some ways to get there (success) that will be a little different than the routes others take. You will need to learn to be a different kind of traveler and do some things to help yourself become successful. If you do, you will have more control over where you are going and how you will get there."

Session Two:

Pack It Up. Students experience the "messy bag.' The counselor begins the session by rummaging through a bag or backpack, throwing things left and right and creating havoc. It is a demonstration of the chaos that comes from being cluttered and disorganized. Students explore their own bags and the need for organization. Being orderly will probably remain a difficult task to learn, but students may have more insight as to why others are continually trying to organize them. Organizational skills are introduced, demonstrated, and practiced. The session closes with a brief summary statement: "Keeping things organized is important. It is one way for you to help yourself on your journey to school success.

Session Three:

Stop Lights and Traffic Cops. Students embark on an imaginary "car ride' to heighten their awareness of the need to attend and pay attention to the signs around them. As they pretend to drive a car, signs are flashed in front of them, and they have to navigate obstacles in the room. They then play the "paying attention' game. A participant wins the game by keeping his or her eyes focused on an object, a book, or perhaps a person who is walking around the room such as a teacher might do for various time intervals. Time intervals are increased from a few seconds until a one-minute interval is reached. The counselor summarizes by saying, "Having ADHD makes paying attention and listening more difficult, but it can be done. Learning and remembering strategies like we practiced today help us notice important things along the way and let us take control during our journey."

Many individuals who have ADHD have made valuable and significant contributions to society.

Session Four:

Using Road Signs as a Guide. Students identify familiar road signs (cards) that cue behavior on the road before they identify signs in their classroom that may help to cue behavior or remember something. Students each develop their own cue to support increased success in the classroom. Summarizing remarks include, "Students with ADHD can be successful in school and get things done - using cues and reminders in your classroom and making up your own are ways to do it."

Session Five:

Road Holes and Detours. Students imagine things that could go wrong on a road trip, including obstacles to getting to their destination (construction, detours, holes in the road, etc). Students generate school situations (many times generated by their own behavior) that create obstacles to success in school. The counselor teaches and demonstrates selected cognitive behavioral strategies before giving students an opportunity for practice. The counselor closes with, "We know there will be holes in the road for ADHD students. There are holes in the road for all students, but your map is marked and you can expect them. You are learning ways to get around obstacles and difficult situations at school and go on with your journey."

Session Six:

Roadside Help and Being Your Own Mechanic. Students explore the idea of breaking down on the road and becoming their own mechanic. Previously learned skills and attitudes are reviewed as tools they will need to get back on the road. Sometimes one has to ask for assistance from someone else when necessary tools are not in the toolbox. However, most of the time, students will have the tools they need to stay or get back on track. Knowing that they can fix things and be their own mechanic is an empowering experience. They are more responsible for managing their own vehicle. The topic of medication is introduced. Doctors and parents usually determine if medication is an appropriate intervention. If students have been prescribed medication, they are encouraged to help themselves by taking the medication, as if it were a tool, and working on the self-management strategies.

The final session summary includes, "We know that all students can be successful in school and that not everyone must be the same kind of traveler or learner. During our sessions we have learned about ADHD and some of the skills and attitudes that will help us in our travels as we journey through school. We have talked about the value of being organized, using cues and strategies to help us remember things, paying attention, and thinking before we act. We also practiced some skills and tried using them in school and at home. With the right kind of attitudes and skills, we can reach our destination-school success."

Support for the group counseling intervention

School Counselor Survey

School counselors completed a survey at the conclusion of the intervention implementation. The survey contained 11 items that were answered on a 5-point Likert-type scale. All 14 surveys were returned. Counselors (100%) supported the appropriateness of unit content, sessions, and outline, and would recommend the unit to other counselors. All counselors (100%) also agreed that the unit contributed to their own understanding of ADHD students and was an effective strategy for this population. Most counselors reported increased confidence with regard to teacher consultation (93%) and changed counselor perceptions (71%). A large majority (93%) of counselors also believed that students participating in the unit changed their views of themselves as students. The results of the counselor reports are shown in Table 1.

School Success Inventory

Students participating in the group intervention were asked to rate their own school success behaviors, pre- and post-intervention, using the School Success Inventory-Student Form (SSI-SF; Cuthbert, 1987). The SSI-SF is a paper-pencil measure containing 12 items that represent each of the six classroom behaviors of attending, listening, volunteering,using self control, interacting, and assessing oneself. This instrument uses a Likert-type scale to score students' self-report of their ability to demonstrate these school success behaviors; lower scores indicate a greater report that school success skills are being used.

At the end of the 6-week intervention, the student ratings on the SSI-SF were not significantly different from a control group of ADHD students (Webb, 1999). However, in a previous pilot intervention that lasted an additional 6 weeks, when the group counseling intervention was implemented in conjunction with teacher direction for practice and feedback of school success behaviors learned in the group, mean ratings of these skills improved significantly (Webb, 1998). Outcomes for the pilot's multi-treatment approach were also measured by having students complete the SSI-SF pre- and post-intervention. In addition, teachers completed a teacher form (SSI-TF) pre- and post-intervention. The teacher's form of this instrument is based on observation of the student's exhibited behavior. Mean student ratings improved by 12.33 points, and teacher ratings improved by an average of 13.55 points. Dependent t tests found both improvements to be significant (. =.05); Tables 2 and 3 provide more statistical information. It was noted that while the duration of the counseling intervention was also 6 weeks during the pilot, teachers continued to practice and provide feedback to students over a 12-week period prior to post-test completion. Providing direction to teachers about practice and feedback of school success behaviors that students learned in the group-along with an extended period for practice-appear to have played a significant role.

Conclusions

Research and theory were provided to increase school counselor understanding and to support a 6- week group counseling intervention for ADHD students as part of a multi-treatment approach to help improve the students' success in school. Counselors enjoyed delivering this intervention to students with ADHD. The intervention provided the teachers some direction, was helpful in their work, and was perceived as impacting student awareness and perception of self with regard to ADHD. A longer, 12- week intervention that combined teachers' reinforcement in the classroom of success skills learned in the group yielded significant improvement in student and teacher ratings of school success behaviors. Perhaps examining the effectiveness of the unit delivered in conjunction with teacher intervention aimed at providing practice and feedback of targeted skills on classroom behavior and academic performance after a longer period of time would yield the most relevant outcomes. With a nation of teachers, parents, and counselors turning their eyes to the needs of ADHD students and wondering how to help them gain the most from school, a small group counseling intervention as part of the treatment is appealing. It can be fun and give students a language of self-help that enables them to be more responsible for their actions and to manage themselves in the school environment.
References
References

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American School Counselor Association. (1994). Position statement: Attention deficit hyperactivity disorder. Alexandria, VA: Author.

Barkley, R. A. (1990). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guilford.

Barkley, R. A. (1998). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (2nd ed.). New York: Guilford.

Barkley, R. A.,DuPaul, G. J., & McMurray,M. B. (1990). A comprehensive evaluation of attention deficit disorder with and without hyperactivity. Journal of Consulting and Clinical Psychology, 58, 775-789.

Barkley, R. A., Fischer,M., Edelbrock, C. S., & Smallish, L. (1990). The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8 year prospective follow- up study. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 546-557.

Biederman, J., Faraone, S.V., & Lapey, K. (1992). Comorbidity of diagnosis in attention-deficit hyperactivity disorder. In G. Weiss (Ed.), Child and adolescent psychiatric clinics of North American: Attention-deficit hyperactivity disorder (pp. 335-360). Philadelphia: Saunders.

Braswell, L. (1993). Cognitive-behavioral groups for children manifesting ADHD and other disruptive behavior disorders. In J. E. Zins & M. J. Elias (Eds.), Promoting student success through group interventions. New York: The Hawthorn Press.

Braswell, L., & Bloomquist,M. L. (1991). Cognitive-behavioral therapy for children with ADHD: Child, family and school interventions. New York: Guilford.

Cartledge, G., & Milburn, J. F. (1978).The case for teaching social skills in the classroom: A review. Review of Educational Research, 48, 133-156.

Cuthbert,M. I. (1987).Developmental guidance activities for school success skills: A comparison of modeling and coaching. Doctoral Dissertation, University of Florida, Gainesville.

DuPaul, G. J., & Rapport, M.D. (1993).Does methylphenidate normalize the classroom performance of children with attention deficit disorder? Journal of the American Academy of Child and Adolescent Psychiatry, 32, 190-198.

DuPaul, G. J., & Stoner, G. (1994). ADHD in the schools: Assessment and intervention strategies. New York: Guilford.

Eisenberg, N., Gutrie, I., Fables, R., Reiser,M., Murphy, B., Homren, R., et al. (1997).The relations of regulations and emotionality to resiliency and competent social functioning in elementary school children. American Psychologist, 53, 205-220.

Ellis, A., & MacLaren, C. (1998). Rational-emotive behavior therapy. Atascadero, CA: Impact.

Ellis, A., & Wilde, J. (2002). Case studies in Rational Emotive Behavior Therapy with children and adolescents. Upper Saddle River, NJ:Merrill Prentice-Hall.

Epstein, M. H., Singh, N. N., Luebke, J., & Stout, C. E. (1991). Psychopharmacological intervention: Teacher perceptions of psychotropic medication for students with learning disabilities. Journal of Learning Disabilities, 24, 477-483.

Erk, R. R. (1995). A diagnosis of attention deficit disorder:What does it mean for school counselors? The School Counselor, 42, 292-299.

Goldstein, S., & Goldstein, M. (1998). Managing attention-deficit hyperactivity disorder in children: A guide for practitioners. New York:Wiley.

Kauffman, J. M (1993). Characteristics of emotional and behavioral disorders of children and youth (5th ed.). New York: Merrill.

Kavale, K. (1992).The efficacy of stimulant drug treatment for hyperactivity: A meta-analysis. Journal of Learning Disabilities, 15, 280-289.

Lavin, P. (1997). A daily classroom checklist for communicating with parents of children with attention deficit hyperactivity disorder. The School Counselor, 44, 315-318.

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Masten, A., & Coatworth, J. (1998).The development of competence in favorable and unfavorable environments: Lessons from research on successful children. American Psychologist, 53, 205-220.

McKinney, J.D.,Montague,M., & Hocutt, A.M. (1993).

Educational assessment of children with attention deficit disorder. Exceptional Children, 60(2), 125-131.

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Myrick, R.D. (2002).Developmental guidance and counseling: A practical approach (4th ed.).Minneapolis, MN: Educational Media Corp.

MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention deficit hyperactivity disorder. Archives of General Psychiatry, 56(12), 1073-1086.

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Schweibert,V. L., Sealander, K. A., & Tollerud,T. R. (1995).

Attention deficit hyperactivity disorder: An overview for school counselors. Elementary School Guidance and Counseling, 29, 249-259.

Shaywitz, S. E., & Shaywitz, B. A. (Eds.). (1992). Attention deficit disorder comes of age: Toward the twenty-first century. Austin,TX: Pro-Ed.

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Adaptive skills dysfunction in ADD and ADHD children. Journal of Child Psychology and Psychiatry and Allied Disciplines, 36, 663-670.

Teeter, P. A., & Semrud-Clikeman, M. (1995). Integrating neurobiological, psychosocial, and behavioral paradigms: A transactional model for the study of ADHD. Archives of Clinical Neuropsychology, 10, 433-461.

Webb, L.D. (1998). [Counselor interventions for helping ADHD students]. Unpublished raw data.

Webb, L.D. (1999). A group counseling intervention for children with attention deficit hyperactivity disorder.Doctoral Dissertation, University of Florida, Gainesville.

Weiss, G., & Hechtman, L. (1993). Hyperactive children grown up: ADHD in children, adolescents and adults (2nd ed.). New York: Guilford.

Whalen, C. K., & Henker, B. (1991).Therapies for hyperactive children: Comparisons, combinations, and compromises. Journal of Consulting and Clinical Psychology, 59, 126-137.

Zentall, S. S. (1993). Research on the educational implications of attention deficit hyperactivity disorder. Exceptional Children, 60(2), 143-153.

Zentall, S. S. (1995).Modifying classroom tasks and environments. In S.Goldstein (Ed.), Understanding and managing children's classroom behavior. New York:Wiley.

Linda D. Webb and Robert. D Myrick (2006)

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A Group Counseling Intervention for Children with Attention Deficit Hyperactivity Disorder

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LD OnLine is the leading website on learning disabilities, learning disorders and differences. Parents and teachers of learning disabled children will find authoritative guidance on attention deficit disorder, ADD, ADHD, dyslexia, dysgraphia, dyscalculia, dysnomia, reading difficulties, speech and related disorders.

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Strategies for ADHD: How Counselors Help Today’s Students Succeed

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As an elementary school counselor, you will create a nurturing environment in which children develop the knowledge, habits, and emotional skills to succeed in middle school, high school, and beyond.

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NYU Steinhardt's Online Master's in School Counseling prepares aspiring school counselors to pursue certification and employment in public and private schools.

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Do you remember growing up in a world without smart phones and tablets? Our students today will most likely never know what it's like to be more than one touch away from family, friends, and new ideas. Technology geared towards children sometimes gets a bad rap, but these 7 apps are winners in my book! They help students name feelings, practice deep breathing exercises, and more. These 7 apps are wonderful tools to have at your disposal when working with tech-savvy students in any counseling setting. They are great for check-in/check-out, de-escalation, and individual sessions.

1. Settle Your Glitter by Momentous Institute
Imagine my surprise when I found this app after spending a great deal of time and craft supplies on perfecting my calming bottle collection! This app leads students through mindful breathing exercises as the glitter settles and offers time for comparing strength of feelings before and after the exercise.

3. Breathing Bubbles by Momentous Institute
This is one of my favorite apps to use with kids who worry. When the user selects worry as the current feeling, the app asks if the user would like to release a worry or receive a joy. Students can then practice calming breathing exercises.

4. iTouchiLearn Feelings for Preschool Kids Free by Staytoooned
As the title states, this is a great app for young children who are learning to identify feelings. This app is also helpful for students who struggle to recognize facial expressions in others. Users are given a scenario (like the picture below) and asked to select the emoticon that matches how the character is feeling.

6. TF-CBT Triangle of Life by Allegheny Health Network
This is an awesome app that introduces CBT through a safari game. Animals describe their experiences and learn about how thoughts, feelings, and behaviors are related. Students also learn how to challenge automatic negative thoughts!

7. FOCUS On the Go! by University of California, Los Angeles
I am a big fan of the FOCUS programs, and this app is a great extension. Students work with Buddy Bear to practice identifying feelings and gathering tools they can use for calming!

What other apps are you using with your students? Let me know in the comments - I'm always looking for more!

To see my follow up post with 7 more apps to use in school counseling, click the picture below:

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7 Apps to Use in School Counseling - Counselor Keri

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Spread the word: 198 Shares Facebook Twitter Email More Do you remember growing up in a world without smart phones and tablets? Our students today will most likely never know what it's like to be more than one touch away from family, friends, and new ideas.

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Facebook: High School Counselor's Network

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Facebook: High School Counselor's Network

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This group is for school counselors, school psychologists, and school social workers. New members will be asked 1-3 very quick questions requiring short and simple answers. We do this to be sure our...

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 Mental Health Disorder Fact Sheet for the Classroom

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 Mental Health Disorder Fact Sheet for the Classroom

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Implications and classroom strategies

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Factors educators should consider in working with students with Bipolar Disorder.

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Children, teens and college students all face certain challenges at school, and these can be even more difficult if they also have bipolar disorder. Drowsiness from medications and trouble concentrating are only a few of the problems that commonly plague bipolar students.

Laws are in place to help ensure that bipolar children and teens are able to succeed in school. There are also some things that students, parents and teachers can do. With hard work, patience and plenty of communication, it is possible for students to manage their bipolar symptoms and even graduate from college. ¹

Bipolar Disorder and the Classroom

There are two laws that are designed to protect bipolar students in the classroom.

The Individuals with Disabilities Education Act (IDEA) states that all schools must identify any students with special needs. It goes on to require schools to provide educational services from kindergarten to the 12th grade or the student is 22 years of age.

Section 504 of the 1973 Rehabilitation Act requires schools to make the necessary adjustments to accommodate all students, including those with a learning impairment.
How Schools Can Help
The Child and Adolescent Bipolar Foundation stresses that it is also important to remember that every student is different. This means that their needs are unique. While these laws are in place to protect students with bipolar disorder, flexibility and open lines of communication are just as important. ²

Reducing the amount of homework, and extending deadlines and time limits on assignments and tests.

If the bipolar student is having difficulty sleeping at night or fatigue is a problem, allow them to start school an hour or two later.

Provide assistance if the bipolar disorder is making it difficult for the student to focus or sit still in the classroom.

Ensure that there is constant communication between teachers and parents concerning the student's progress and behavior in class.

Have tutoring in place if the student's bipolar disorder symptoms result in extended absences.
If a student is falling behind in class, most educational experts recommend enrolling them in summer school.
Record lectures in class when the student isn't able to concentrate due to their bipolar disorder symptoms.

Allow the student to have full access to the bathroom and water fountain at school. This can be especially helpful in preventing classroom disruptions during a manic episode.

There are several things schools can do to help bipolar children and teens succeed in the classroom. These include,

Schools, parents and students are also finding that participating in art, music and even sports programs can be beneficial. Some students with bipolar disorder find that these "enrichment" programs can relieve some of the stress and challenges associated with school. This often makes it a little easier for them to control their symptoms.

It has also been noted that bipolar disorder students often perform better academically in a smaller size class. Fewer distractions can make it easier for them to concentrate, especially during a manic episode.
Tips on Managing Bipolar Disorder at College
If you think that you might have bipolar disorder it is important to speak with a licensed health care professional immediately. It is the best way to prevent any problems that could interfere with your ability to get an education.

Remember that bipolar disorder is a treatable illness. This means that you have to take charge of your care. If you don't take care of yourself, you won't be able to control your bipolar disorder.

Exercise is an important tool in managing bipolar disorder symptoms. Just walking to class should be able to provide you with at least 20 minutes of exercise each day.

Try to manage your homework so you can stay on a consistent sleep schedule. It might mean that you have to miss a few parties, but it is worth it when you are able to avoid a manic episode.

Eating a healthy diet is also important. It can also be difficult when you are away at college. Most universities have registered dieticians on staff at the campus medical center, and they can help you create a nutritious meal plan that fits your tastes and budget.

One tip to remember is that students with bipolar disorder do not have a learning disability, and in most cases do not need to be placed in a special education class.

Doing so often causes the student additional stress, and can make it even more difficult for them to successfully manage their symptoms.
See here for a list of bipolar disorder support groups.
Bipolar Disorder and College

Unfortunately college isn't any easier for students with bipolar disorder. The stress of being away from home, along with the pressures of college can easily trigger a manic episode.

Bipolar disorder often manifests in teens and adults ages 15 to 24, and some mental health experts tie this to the increase in academic pressure that usually occurs around this time. A greater emphasis is placed on grades and when this is combined with all of the other new experiences college typically brings, many students find it overwhelming.

According to the National Institute for Mental Health, almost half of those diagnosed with bipolar disorder experienced their first onset of symptoms before the age of 25.

You are not alone if this applies to you. There are also steps you can take to manage your bipolar disorder at college.

College for students with bipolar disorder is tough. This doesn't mean that you can't succeed. You might have to make some adjustments to your overall "life plan" and accept that it will take a little longer to graduate, and successfully control your bipolar disorder. There is nothing wrong with taking your time, especially if it helps you stay mentally and physically healthy!

Support for Bipolar Disorder at School
¹ ² https://www.jbrf.org/page-for-families/educational-issues-facing-children-with-bipolar-disorder/ https://www.bphope.com/kids-children-teens/how-your-childs-bipolar-disorder-can-affect-the-school-day/
There are several bipolar disorder support groups for parents and students to take advantage of.

Along with licensed therapists and counselors, family and friends are often the best source of support for bipolar disorder students at any age. Peer counseling groups can become a vital support network, especially for college students dealing with the stress of being away from home for the first time.

Having a strong network of support is essential for the success of any student with bipolar disorder regardless of their age.

Bipolar Disorder and Success at School

Whether you are a student with bipolar disorder or a parent of one, it is possible to have success at school.

It will take the combined efforts of educators, parents and the student, but you can graduate with your friends even if you are dealing with bipolar disorder. Just because it makes school a little harder doesn't mean that you have to give up.

If you believe that a school is discriminating against bipolar disorder it is important that you understand your rights. There are laws in place that are designed to ensure that everyone receives a quality education, regardless of their physical or mental disabilities.

References:

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Children, teens and college students all face certain challenges at school, and these can be even more difficult if they also have bipolar disorder.

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How Counselors Help Students Manage Their Mental Health

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The prevalence of mental illness in children has reached an all time high, and it's a public health issue that up until recently has been widely ignored. According to the Centers for Disease Control and Prevention, ¹ an estimated 1 in 5 children are diagnosed with "mental disorders such as ADHD, Tourette syndrome, behavioral issues, mood and anxiety disorders, autism spectrum disorders, or substance abuse disorders."

Left undiagnosed or untreated, children's mental disorders can cause a number of problems both at home and in the classroom, affecting the way children learn, behave, and handle their emotions. Despite this, nearly 80 percent of adolescents who would benefit from mental health treatment do not receive it, and this disproportionately affects children of color and the uninsured.²

This gap in treatment for students can be explained by a number of factors. Counselors, parents, and teachers are constantly battling with challenges that include mental health stigma, budget constraints, inadequate insurance coverage, and availability of mental health services in the community.³

For students who do receive a diagnosis, schools are often the first providers of mental health resources. ⁴

The Role of the School Counselor

Throughout the week, many students spend more time in the classroom than they spend with their parents. As such, teachers, counselors, and other school staff are among the first to notice concerning changes in behavior that could signal a mental or behavioral health issue.
While teachers arguably spend the most time with their students, a study by the research journal School Psychology Quarterly found that a mere 34 percent of teachers surveyed felt that they had the skills needed to identify mental health issues in students and find resources for students with mental health conditions. ⁵

As such, school counselors become a crucial part of the education team, collaborating with teachers, administrators, parents, and social workers to ensure that each student receives the care and resources necessary to succeed in their academic and personal lives. ⁶
School counselors allocate much of their focus to designing and implementing programs which promote the academic and personal success for all of their students. These responsibilities include:

Enhancing the awareness of mental health in their schools, and aiming to remove shame and stigma

Provide external referrals, which may include short-term counseling or crisis intervention

Recognize and respond to warning signs, such as sudden changes in grades or attendance, disciplinary problems, or visible problems at home

Provide individual focus to students about issues surrounding their mental health, academic well being, and social and emotional needs

Provide resources and support for teachers, administrators, and parents ⁷

Barriers to Mental Health Treatment

Counselors are a vital part of the educational team, and in an ideal world, children would have adequate access to school counselors. But when districts are confronted with budget cuts, counselors are often among the first to be laid off.

As it stands, the national student-to-counselor ratio is much higher than the average 250-1 ratio recommended by the American School Counselors Association. ⁸ At some schools, the student-to-counselor ratio is as high as 781:1. ⁹

Additionally, counselors must also operate based on the mental health services readily available in their communities, and not all communities are equally prepared to handle mental health concerns.

When left unmet, students mental health needs can pose serious barriers to social and educational development. Counselors are a necessary part of an educational staff, as they have the unique qualifications required to provide education, intervention, and referral services to children, parents, and teachers. Although school counselors typically do not act as long-term therapists, they help foster an environment where mental health stigma is erased, help bridge the gap between student and community resources, and make sure the developmental needs of all students are met.

Students who obtain their Master's Degree in Counseling from Wake Forest University Online enter the field prepared to help students, parents, and teachers manage student mental health.

¹ http://www.cdc.gov/features/childrensmentalhealth/

² http://www.ncbi.nlm.nih.gov/pubmed/12202276

³ http://www.edweek.org/ew/articles/2014/06/20/36cottle.h33.html

4 http://digitalcommons.brockport.edu/cgi/viewcontent.cgi?article=1599&context=ehd_theses

5 https://edsource.org/2013/task-force-recommends-including-mental-health-training-in-teacher-credential/33503

6 http://www.mn2020.org/issues-that-matter/education/dont-forget-school-counselors-in-mental-health-debate

7 http://www.schoolcounselor.org/asca/media/asca/positionstatements/ps_studentmentalhealth.pdf

8 https://www.counseling.org/government-affairs/public-policy/public-policy-news-view/position-papers/2013/02/11/student-support-act-reducing-the-student-to-counselor-ratio

9 http://www.counseling.org/PublicPolicy/PDF/2010-2011_Student_to_Counselor_Ratio.pdf

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How Counselors Help Students Manage Their Mental Health - WFU Online Counseling

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The prevalence of mental illness in children has reached an all time high, and it's a public health issue that up until recently has been widely ignored. According to the Centers for Disease Control and Prevention, ¹ an estimated 1 in 5 children are diagnosed with "mental disorders such as ADHD, Tourette syndrome, behavioral issues, mood and anxiety disorders, autism spectrum disorders, or substance abuse disorders."

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A Closer Examination of Bipolar Disorder in School-Age Children.

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Bipolar Disorder: Educational Implications for Secondary Students

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Warning Signs of Mental Health

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Tips for creating body positive classroom environment

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It is widely accepted, from preschool to high school, that teachers and school staff play a big part in helping students to develop positive self-esteem. Many of those same teachers may not be aware that one of the most significant factors in an individual's overall self-esteem is body image. So why does the way we see/think/feel about our bodies matter so much and what does that have to do with our classrooms? Consider the following:

31% of adolescents do not engage in classroom debate for fear of drawing attention to how they look.

20% of teens say they stay away from class on days when they lack confidence about their appearance.

On days when they feel bad about their looks, 20% of 15 to 17 year old girls will not give an opinion and 16% will avoid school altogether.²

A study of more than 11,000 teens found that students who saw themselves as overweight (regardless of actual weight) had lower academic performance than those who did not. 3 This is important because it means the perception of being overweight - likely because of cultural bias and negative stereotypes that come with that - was a more significant determinant of academic performance than medically defined obesity.

If the way kids feel about their bodies impacts attendance, classroom engagement, academic performance and individual self-esteem, it makes a lot of sense for schools to be paying attention to body image. Below are just a few ways you can work to establish a school environment that is body positive and doesn't reinforce harmful weight stigma, appearance ideals or the diet mentality.

6 Guidelines for a Body Positive Classroom

Representation matters.
Do a thorough scan of books, posters and other materials around your classroom. Do they include a wide representation of people with diverse bodies - both in weight and shape but also skin color, gender presentation and physical ability? Will all kids see themselves represented in the positive imagery around your classroom?

If your class involves physical fitness or health messaging, consider whether your resources show kids and adults of all shapes and sizes being active or just thin/muscular people? Are fatter bodies exclusively used in imagery meant to deter or shame people for specific behaviors? If you're in need of new imagery, check out these inclusive stock fitness photos from The Body Positive Fitness Alliance.

Above all, remember that kids who feel good about their bodies, regardless of their weight, are more likely to engage in healthy behaviors and less likely to engage in risky or harmful behaviors like smoking and bingeing. ⁴ To help bring body positivity into your class, add books and resources to your lesson plan or syllabus that promote body acceptance and provoke age appropriate conversations about the natural diversity of bodies. Messaging that focuses on 1) how health behaviors can make us feel, or 2) developing gratitude for the functionality of our bodies as opposed to what they weigh or look like, can promote self-care and confidence. A list of age-specific body positive resources is included at the end of this post - please scroll down to check it out!

Leave all personal diet-talk at the door and enforce that rule with fellow teachers and school staff.
We know that kids are listening to the adults around them even when we don't think they are. Casual background discussions about cutting out carbs, trying a new "cleanse" or berating oneself for eating a cupcake are not as innocent as you might think. When little ears - or even mature high school ears - overhear their favorite teacher or respected mentor talking about food and bodies in critical or shameful ways they can internalize those messages. There are many reasons why we encourage adults not to introduce kids to dieting, including the fact that kids who diet are up to 18 times more likely to develop an eating disorder. ⁵

Furthermore, there is no long-term evidence that any fad diets like keto, paleo, Whole30, Atkins or otherwise lead to reliable or sustainable weight loss. In fact, diets have been associated with longterm weight gain. Specifically, adolescent girls who diet are at 324% greater risk for obesity than those who do not. ⁶
Normalize the variety of healthy body changes that take place before and during puberty.
For example, it's completely normal (and necessary) for a young girls' body to store up extra fat before she gets her period for the first time. It's also common for boys and girls to gain weight and fill out just prior to growth spurts in height. Remember this happens at very different times for different kids. If they experience these normal changes as abnormal or bad, it puts them at risk for body dissatisfaction and disordered eating. But If kids (and teachers and parents) can learn to anticipate these changes they may be more likely to trust their bodies as they grow and mature.

Incorporate MEDIA LITERACY into your curriculum.
It doesn't matter if you teach preschool story time or AP Literature, there are countless opportunities to talk about how to handle cultural messages kids receive about beauty, appearance, health, and weight. The Center for Eating Disorders provides body image and media literacy workshops for educators and parents as well as arts-based campaigns like the Love Your Tree campaign. We also encourage school staff to pursue training in evidence-based prevention programs such as The Body Project and to work with local organizations to incorporate student activism projects that challenge the thin ideal and inspire brands to do better.
Weight-based bullying is more common than all other forms of teasing. Establish a policy against weight-based bullying and actively work to reduce body commentary in general.
What's the difference between a teacher proclaiming " you look amazing! Have you lost weight?" and a student teasing her classmate for " packing on the pounds " over the summer? Not much actually. They both reinforce a negative bias towards larger bodies and establish an unnecessary focus on appearance/size. In our culture it is assumed that saying something one thinks is "nice" about someone's body is a good thing but praising specific aspects of one's appearance can be just as detrimental for the school community as a whole because it reinforces the dangerous appearance ideals. Consider the following scenarios:
Malik gets nicknamed "string bean" by the principal because he had a growth spurt and grew much taller and slimmer than his peers. Malik was already feeling self-conscious about his height and knows the principal was just kidding around but now he does everything he can to avoid seeing him in the hallways. Dean came back to school a size smaller and friends are requesting her "weight loss secrets". They don't know she was in treatment for an eating disorder over the summer and has developed heart problems and other health complications as a result.
So what is a school or classroom policy that addresses all of the situations above? Something similar to "We just don't comment on other peoples bodies" can be the most effective message to dissuade body-talk (praising or teasing) among students and staff.

Encourage colleagues - administrators, school nurses, coaches and physical education teachers - to review the evidence for any interventions they are implementing with regard to weight, health or nutrition.
Every school should be asking whether there is quality, health-focused research to back up the intervention and d oes this program have the potential to do more harm than good? The truth is, m any of these practices lack research and may have harmful consequences, yet many schools and childcare centers continue to implement them. Examples of such campaigns and curriculums currently include:

Publicly weighing kids in gym or health class

Giving kids assignments that require them to count calories and track their food

Hosting "Biggest Loser" weight-loss competitions among school staff

Sending home BMI report cards for students or calculating BMI in class.

Shaming kids' lunch items or teaching very young kids to label food items as good/bad or healthy/junk.

When it comes to BMI report cards, even the Centers for Disease Control (CDC) notes in their report that "Little is known about the outcomes of BMI measurement programs, including effects on weight-related knowledge, attitudes, and behaviors of youth and their families. As a result, no consensus exists on the utility of BMI screening programs for young people. ⁷ "

There is no indication that providing kids and parents with BMI information leads to any significant behavior change or improved health outcomes. Furthermore, unless safeguards are solidly in place, a risk of harm exists when children are simply told there is something wrong with their body size. Risks for body comparison and weight-based teasing also increase. ⁸

What else are you doing to reduce weight-based teasing and make your classroom a safe place for students of all shapes and sizes? Tweet us @CEDSheppPratt today and share your experiences.
Body Positive Resources: For School Administrators: Preschool/Elementary Kids & Parents: Middle School: High School/College:
Links to References:

1. Ignoring it doesn't make it stop.

2. Beyond stereotypes: rebuilding the foundations of beauty beliefs.

3. Perception of Overweight is Associated with Poor Academic Performance in US Adolescents

4. Does Body Satisfaction Matter? Five-year Longitudinal Associations between Body Satisfaction and Health Behaviors in Adolescent Females and Males

5. Onset of adolescent eating disorders: population based cohort study over 3 years

6. Risk Factors for Body Dissatisfaction in Adolescent Girls: A Longitudinal Investigation

7. A Report on the Facts and Concerns About BMI Screening in Schools

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Is your school or classroom a body-positive space for students?

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It is widely accepted, from preschool to high school, that teachers and school staff play a big part in helping students to develop positive self-esteem. Many of those same teachers may not be aware that one of the most significant factors in an individual's overall self-esteem is body image .

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Pacer Center Resources

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

Section 504 of the Rehabilitation Act of 1973 (commonly referred to as Section 504) is a federal law designed to protect the rights of individuals with disabilities in programs and activities that receive federal financial assistance. Those programs include public school districts, institutions of higher education, and other state and local education agencies. To qualify under Section 504, a student must have a disability and that disability must limit a major life function. The Americans with Disabilities Act Amendments of 2008 (ADA) broadened the definition of disability in the ADA as well as in Section 504.

How does Section 504 define disability and major life functions?

Under Section 504, disability is defined broadly. A student is determined to have a disability if he or she has a physical or mental impairment affecting a body system.

This impairment or disability must substantially limit one or more major life activities. These activities include such things as walking, seeing, hearing, speaking, breathing, learning, working, caring for oneself, performing manual tasks, eating, sleeping, standing, lifting, bending, reading, concentrating, thinking, communicating, and more.

When determining whether a student has a physical or mental impairment, the school district must not consider the improvement of a disability caused by a "mitigating measure" such as medication, hearing aids, prosthetics, mobility devices, or other means. The language on mitigating measures was added in the ADA Amendments Act of 2008.

Does Section 504 require schools to do evaluations?

Yes. The school must conduct an evaluation to determine if the student has a disability as defined under this act. Based on documented information from varied sources, decisions must be made by a group of school personnel who are knowledgeable about the child, the meaning of the data, and the placement options.

Section 504 Flow Chart

How does a school determine if a child is eligible for services either under IDEA, the Individuals with Disabilities Education Act, or under Section 504? The adapted Minnesota Department of Education chart below gives you an idea of how the two processes work.

Does the disability substantially limit one or more major life activities? Under Section 504, disability is defined broadly. A student is determined to have a disability if he or she has a physical or mental impairment affecting a body system. The Code of Federal Regulations (CFR) defines a physical or mental impairment as "any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological; musculoskeletal; special sense organs; respiratory, including speech organs; cardiovascular; reproductive; digestive; genitourinary; hemic and lymphatic; skin; and endocrine; or any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities."

This impairment or disability must substantially limit one or more major life activities. These activities include such things as walking, seeing, hearing, speaking, breathing, learning, working, caring for oneself, performing manual tasks, eating, sleeping, standing, lifting, bending, reading, concentrating, thinking, communicating, and more. The legislation also states that the school district must not consider the improvement caused by a "mitigating measure" such as medication, hearing aids, prosthetics, mobility devices, or other means when determining whether a student has a physical or mental impairment.

Determine an education plan comparable to that provided to non-disabled students: School districts are required to provide students with disabilities appropriate educational services designed to meet the individual needs of students as adequately as the needs of students without disabilities are met.

Accommodations: When a child is determined to be eligible for services under Section 504, the school must eliminate barriers to his or her access to full participation in school activities, including the general education curriculum. Barriers often are eliminated by providing accommodations to the student. Accommodations must give the child meaningful equal opportunities, consider his or her functional limitations, and offer different ways to show what he or she knows. Examples of accommodations include testing in a quiet room, preferential seating, digital textbooks, tailored homework assignments, or a sign language interpreter for a track meet.

What happens if my child is eligible?

Section 504 requires a school district to provide a free appropriate public education (FAPE) to each eligible student in its jurisdiction, regardless of the nature or severity of the disability. Under Section 504, an appropriate education for a student with a disability could consist of education in a regular classroom, education in a regular classroom with supplementary services, or special education and related services. A child who has a disability but does not qualify for special education services under the Individuals with Disabilities Education Act (IDEA) may still be entitled to services or accommodations under Section 504.

The school must provide a plan for providing reasonable accommodations and other services so a child may participate fully in the school setting. Parents are usually invited to a meeting where the plan is developed. Putting the plan in writing is an effective way to document what services the school will be providing.

What are accommodations under Section 504?

When the school determines that a child is eligible for services under Section 504, the school must eliminate barriers to his or her access to full participation in school activities, including the general education curriculum. The school can often eliminate barriers by providing accommodations for a student. Accommodations must give the child meaningful equal opportunities, consider his or her functional limitations, and offer alternative methods of performance. Examples of accommodations include testing in a quiet room, preferential seating, digital textbooks, tailored homework assignments, and a sign language interpreter for a track meet.

What responsibilities do schools have under Section 504?

To provide assurance that they do not discriminate, schools must designate an employee to ensure compliance, provide grievance procedures, identify and locate all children with disabilities who receive education within the district, and provide notice of the district's Section 504 responsibilities and procedural safeguards to parents.

The district also must give parents a copy of procedural safeguards within the school district. Procedural safeguards include the parents' right to:

receive notice of action regarding identification, evaluation, and placement of their child with a disability

review records

request an impartial hearing

have a review procedure

Did you find this helpful?

Learn more

To learn more about this subject or to request a Section 504 evaluation, parents are encouraged to call their school district's Section 504 coordinator. Parents may also request a copy of the district's 504 policy including grievance procedures if they do not agree with the district's implementation of Section 504.

What if there appears to be a violation of Section 504?

Section 504 complaints in Minnesota are investigated by:

Office for Civil Rights/Chicago
U.S. Department of Education
Citigroup Center, Suite 1475
500 W. Madison St.
Chicago, IL 60661-4544

Phone: 312-730-1560

TDD: 312-730-1609 or 1-877-521-2172

Fax: 312-730-1576

Email: [email protected]

Additional Resource - Print Version

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Section 504 of the Rehabilitation Act of 1973 - PACER Center

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Section 504 of the Rehabilitation Act of 1973 (commonly referred to as Section 504) is a federal law designed to protect the rights of individuals with disabilities in programs and activities that receive federal financial assistance. Those programs include public school districts, institutions of higher education, and other state and local education agencies.

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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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Individuals with Disabilities Education Act

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Individuals with Disabilities Education Act

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Individuals with Disabilities Education Act (IDEA)

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The U.S. Department of Education’s Individuals with Disabilities Education Act website brings together department and grantee IDEA information and resources. The IDEA makes available a free appropriate public education to and ensures special education and related services to eligible children with disabilities.

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During my first year as a high school counselor, a parent came to speak to me about her daughter. The student was a bright and beautiful young lady with a bubbly personality who I had the pleasure of meeting prior to her mother's visit. Although she was thin (she was a dancer), I hadn't noticed just had thin she had become in the last month. In that meeting, mom shared with me her concerns about her daughter's well being and how she had just been diagnosed with Anorexia Nervosa. During our time together, we discussed a safety plan for her at school, particularly during lunchtime. For a year, my office would be a place where this student could visit, eat, talk, and even rest. Although I was not a specialist in eating disorders, I knew what this family was experiencing. Unfortunately, my family had dealt with the painful reality of an eating disorder by one of my sisters. Though I could not make her symptoms go away or "talk" her out of her feelings about herself, just being there was powerful.

As a school counselor, you may or may not work with a student who has an eating disorder. Regardless, being aware of the symptoms of an eating disorder is an important step in assisting students in their road to recovery. In 2010, Lynn Shellcross wrote an article about the growing problem of eating disorders among elementary school aged children. When eating disorders are not identified early in students, they have the potential of growing into high school students who are at risk for serious illness and even death. Shellcross referenced researchers who found it imperative that counselors, whether school, mental health, college, or family, have an understanding of the deadliness of eating disorders. In order to understand eating disorders, counselors must be aware that it is not about food, but the student's inability to control the world around them. Students who suffer from an eating disorder often present in our office with anxiety and go to great links to hide their disorder. Having knowledge about eating disorders and the importance of early detection is important in identifying students who may be suffering from this mental health issue.

What is an Eating Disorder?

According to the National Eating Disorders Association, eating disorders are "serious but treatable illnesses with medical and psychiatric aspects." The DSM-5 recognizes several types of eating disorders in their diagnosis including: Anorexia Nervosa, Bulimia, Binge Eating Disorder, and Other Specified Feeding or Eating Disorder (OSFED). Although people with eating disorders concentrate on food and weight, the reality is that eating disorders often coexist with depression, anxiety, and obsessive compulsive disorder. According to the Academy for Eating Disorders, there are nine truths people, particularly school staff, should know about eating disorders.

These truths include:

Although a student may look healthy, he or she may be extremely ill.
Parents are not to blame, and should be considered allies in recovery.
An eating disorder diagnosis is a health crisis that disrupts daily life functioning (including academic success).
Having an eating disorder is not a choice, but is a serious "biologically influenced illness." Eating disorders affect students of "all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses."
Eating disorders increase the risk for both suicide and death due to medical complications.
Biology and environmental factors can enhance the development of eating disorders.
Biology alone does not predict the development eating disorders.
Early detection and intervention are important for full recovery!

See Kati Morton's videos about the different types of eating disorders.

Recognizing an Eating Disorder

Since school staff are with students at least seven hours a day, we are at an advantage of identifying when a student is experiencing a mental or physical illness. In fact, early detection of an eating disorder is the first step to treatment and healing. So, who are the students we should be most concerned about having an eating disorder? According to the BodyWise Eating Disorder Booklet, there are signs that educators should be aware of in adolescents who are at risk for developing an eating disorder (students experiencing these signs may or may not have an eating disorder).

Be aware of the following students:

complain about their bodies being too fat even if they appear to be normal weight or thin

talk about being on a diet or avoiding certain foods because they are too fattening

overweight and appear sad

teased about their weight

obsessed about maintaining a low weight to enhance their performance in sports, modeling, or dancing

Other signs and symptoms include:
Physical Emotional Behavioral

Weight loss or fluctuation Complaints about being too fat Constant dieting
Constantly feeling faint, tired, or cold Comments about feeling worthless Constant exercising
Dry hair/skin Frequently going to the bathroom Perfectionism

Not only is early detection important for the student to get treatment, but it is important to prevent a student from academic failure. According to the National Eating Disorders Association, an eating disorder can profoundly impact a student's cognitive function and the ability to learn. Some of the impacts on their ability to learn include:

low iron levels which decrease memory function

irritability caused by headaches, lethargy, or nausea

reduction in concentration and focus due to constant dieting

obsessive thoughts with grades due to perfectionist tendencies

withdrawal, apathy, and social isolation from feelings of self worthlessness

increased absenteeism as a result of physical illness

If this is the first time you have considered learning more or promoting eating disorders awareness, this post may have some helpful information for you!
National Eating Disorder Awareness Week

This week is National Eating Disorders Awareness Week. Both the National Eating Disorders Association (NEDA) and Anorexia Nervosa & Associated Disorders have created booklets with guidelines for teachers, school nurses, school psychologists, coaches, and counselors who work with students identified as having an eating disorder, their friends, and their parents. In addition to promoting awareness, NEDA and ANRED are encouraging early detection for students through a three minute screening and self help screening.

Want to get involved? Check out these events.

February 22nd - Google Hangout-Early Intervention and Eating Disorders (2 PM EST)

February 22nd- Twitter Chat-Awareness to Action 8 PM EST)

February 23rd - Twitter Chat-Getting Healthy: The Many Faces of Eating Disorder Recovery

February 24th-Day of Action-Promoting Education Regarding Eating Disorders

Need more information? Check out these additional resources.

Booklets & Pamphlets for Educators
NEDA Educator Booklet
ANAD School Guidelines
National Institute of Mental Health Brochure on Eating Disorders (Downloadable)

Guidelines for School Counselors
Cutting, Eating Disorders and Confidentiality

Facts and Webinars About Eating Disorders
Anorexia Fact sheet
Binge Eating Disorder Fact Sheet
Athletes and Eating Disorders
Fast Facts on Eating Disorders
Kati Morton's Videos on Eating Disorders
Webinars on Eating Disorders
The Truth About Eating Disorders
NEDIC Webinars

What Does Recovery Look Like Webinar

Referral Information

Eating Disorder Referral Information (US)
Eating Disorder Information (UK)

Websites and Associations
Academy for Eating Disorders Facebook Page
Eating Disorder Foundation
International Association of Eating Disorders Professionals Foundation - Offers courses and certifications in eating disorder education.
EDAC - Eating Disorders Association of Canada
ANZAED - Australia and New Zealand Academy for Eating Disorders
Eating Disorders Hope
Teens Health
Chats and Conferences
Twitter Chat - March 9th-12:00 PM-Treatment and Recovery
ANAD Eating Disorder Conference - September 9, 2016
International Conference on Eating Disorders - May 5-7, 2016, San Francisco, CA

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It's Not About Food: Eating Disorders Awareness

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During my first year as a high school counselor, a parent came to speak to me about her daughter. The student was a bright and beautiful young lady with a bubbly personality who I had the pleasure of meeting prior to her mother's visit.

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The School Counselor’s Role in Addressing Eating Disorder Symptomatology Among Adolescents

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Real people. Real breakthroughs. For more than 3 decades, Marc David has helped millions discover the true causes of their unwanted eating habits like overeating, binge eating, emotional eating and the inability to lose weight. In this unscripted show, Marc coaches real clients using his unique blend of psychology and nutrition. THEN he peels back the curtain to explain why he asked the questions he asked. Whether you want to transform your relationship with food or learn how you can help ot ...

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Real people. Real breakthroughs. For more than 3 decades, Marc David has helped millions discover the true causes of their unwanted eating habits like overeating, binge eating, emotional eating and the inability to lose weight. In this unscripted show, Marc coaches real clients using his unique blend of psychology and nutrition.

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Spotting and supporting eating disorders in school: recommendations from school staff

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Eating Disorder Intervention, Prevention, and Treatment: Recommendations for School Counselors

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What is your favorite school counseling anxiety resource? Testing season aside, students are experiencing record rates of anxiety. School counselors are leaders in the building to help students and staff understand and effectively manage anxiety.

Staff Book Study

Last year, my building focused on learning more about anxiety and how to better support students emotionally. We used Anxiety and Depression in the Classroom: A Teacher's Guide to Fostering Self-Regulation in the Classroom for a book study, and it is incredible. Written by a clinical psychologist, it explains clearly anxiety disorders, and provides straightforward tools and activities for educators. It sparked amazing discussions, gave everyone another perspective on supporting children, and provided concrete suggestions that staff implemented immediately. A truly wonderful resource to build confidence in supporting the emotional wellbeing of students.

- Gretchen at Speckled Moose Counseling

Engaging Videos

GoZen is an incredible program to help students build skills to manage anxiety! The program has animated videos that teach students how to change the way they think about problems, challenge their negative thinking patterns, and avoid cognitive distortions (or Thought Holes, as the program calls them). The videos are really engaging and practical with short exercises that can be practiced daily to reinforce learning. There are programs for both schools and parents, so it's also a great resource to recommend to parents who are looking for ways to help their children manage anxiety at home.

- Keri from Counselor Keri

Informative Website

Anxiety BC is a wonderful resource to help students develop coping skills to manage their anxiety. This website has a ton of information on anxiety disorders (handouts and videos), suggested treatment strategies, and worksheets. It's simple to navigate and I like that I have resources readily available to send home with students to give directions on how to practice what we worked on in session at home, and to keep parents updated on the strategies their child has learned.

- The Sunny Sunshine Student Support Store

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Favorite School Counseling Anxiety Resource - Confident Counselors

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What is your favorite school counseling anxiety resource? Testing season aside, students are experiencing record rates of anxiety. School counselors are leaders in the building to help students and staff understand and effectively manage anxiety. Last year, my building focused on learning more about anxiety and how to better support students emotionally.

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Anxiety and Depression Association of America

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Anxiety and depression are treatable, but 80 percent of kids with a diagnosable anxiety disorder and 60 percent of kids with diagnosable depression are not getting treatment, according to the 2015 Child Mind Institute Children's Mental Health Report.

Anxiety is a normal part of childhood, and every child goes through phases. A phase is temporary and usually harmless. But children who suffer from an anxiety disorder experience fear, nervousness, and shyness, and they start to avoid places and activities.

A child who sees a scary movie and then has trouble falling asleep or has a similar temporary fear can be reassured and comforted. But that is not enough to help a child with an anxiety disorder get past his or her fear and anxiety.

Anxiety disorders affect one in eight children. Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance abuse.

Anxiety disorders often co-occur with depression as well as eating disorders, attention-deficit/hyperactivity disorder (ADHD), and others.

With treatment and support, your child can learn how to successfully manage the symptoms of an anxiety disorder and depression and live a normal childhood.

The following sections will help you get started:

Additional Resources

KidsHealth
Non-Military PTSD
Child Mind Institute
Families for Depression Awareness
Families USA
Georgetown Center for Children and Families
The Henry J. Kaiser Family Foundation
Selective Mutism Group
Selective Mutism Foundation
WorryWiseKids.org
Red Sox Foundation and Massachusetts General Hospital Home Base Program - for military families in New England
Talking to Children About Terrorism and War
Helping Children Cope During Deployment
The National Child Traumatic Stress Network
Children and Grief
Active Minds
National Eating Disorders Association

Spread The Word

Please tweet, post on Facebook, or add the links to your own website - whatever works to get the word out that you are not alone and help is here!

@Got_Anxiety
#Anxiety disorders affect one in eight children. Help is here. http://www.adaa.org/living-with-anxiety/children/treatment

Learn the #depression #symptoms in kids. http://www.adaa.org/living-with-anxiety/children/anxiety-and-depression

Learn how to choose a #child #therapist. http://www.adaa.org/living-with-anxiety/children/treatment/choosing-therapist-your-child

Tips for parents and caregivers to help children manage anxiety disorders. http://www.adaa.org/living-with-anxiety/children/tips-parents-and-caregivers

#Depression in #children and #teens is a risk factor for #suicide. Learn about treatment. http://www.adaa.org/living-with-anxiety/children/treatment

Anxiety is a normal part of childhood, but children who suffer from an anxiety disorder show fear, nervousness, and shyness and start to avoid places and activities. Help is here. http://www.adaa.org/living-with-anxiety/children/treatment

Separation anxiety, phobias, OCD, social anxiety, and more. Learn the symptoms and how to help children with anxiety disorders. http://www.adaa.org/living-with-anxiety/children/childhood-anxiety-disorders

Get tips for parents and caregivers to help children manage anxiety disorders. http://www.adaa.org/living-with-anxiety/children/tips-parents-and-caregivers

Childhood depression is a risk factor for suicide. Learn about treatment. http://www.adaa.org/living-with-anxiety/children/treatment

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Anxiety and depression are treatable, but 80 percent of kids with a diagnosable anxiety disorder and 60 percent of kids with diagnosable depression are not getting treatment, according to the 2015 Child Mind Institute Children's Mental Health Report. Anxiety is a normal part of childhood, and every child goes through phases.

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Since it is Mental Health Awareness Month, I decided to write a post regarding a common mental health disorder that students are exhibiting in school. Unfortunately, school counselors are often unaware of how to help students and families who face this disorder. In this post, I hope to give some insight to school counselors about the mood disorder anxiety.

A few weeks ago, a colleague shared her concerns about a ninth grader who was skipping class and failing several of her courses. When my friend confronted the student about her grades and skipping, the student told her that she suffered from anxiety and felt uncomfortable around large groups of students. My colleague decided to meet with the guardian of the student to come up with a plan to help her when she was feeling anxious. During the meeting, the guardian was resistant to many of my colleague's suggestions and felt that the student was truly unable to properly function in a classroom. My colleague told the guardian that she understood her concerns for her child, but she was worried for the student's safety as she was constantly missing class and no one knew her whereabouts. When the guardian asked the student where she was going, the student burst into tears and accused the guardian of not caring about her, threatened to run away, and got up to leave the room. Instantly, the guardian backed down and told the counselor that her child needed time to regain her composure. Calmly, my colleague listened to the parent, but insisted a plan was needed to make sure the student was safe and academically successful. Frustrated, the parent excused herself and left with her child leaving my colleague scratching her head.

According to Healthy Place, anxiety disorders are a group of illnesses including generalized anxiety disorder, phobias, panic disorders, post-traumatic stress disorder, social disorder, and obsessive compulsive disorder. Researchers believe that anxiety is a biological disorder that runs in families and may manifest from a series of risk factors like brain chemistry, genetics, personality, and life events.

School counselors are generally the first line of defense when identifying mental health disorders in teens. Being able to properly identify and refer families to proper treatment is imperative for student recovery. Although anxiety is treatable, 80 percent of
How to Help a Student Who Suffers from Anxiety?
youth are not getting treatment! Also, anxiety disorders are generally accompanied by other disorders like depression, ADHD, or eating disorders.

In my opinion, I don't think the student or parent was trying to be difficult. In their research, Hanie and Stanard found that students with anxiety are often misunderstood by parents and school staff. Students with anxiety typically try to avoid difficult situations, desperately want their anxiety to stop, and often feel people are against them. In fact, this student was using the same ineffective coping mechanisms she has probably used over and over to deal with her anxiety. Dr. Katharina Manassis found that school refusal is a major concern of students who have mood disorders. She found that when students begin to miss school for long periods of time, they need to work with a professional (therapist) to create a plan to return to school.

So, how can counselors assist students who miss school due to their anxiety? Some suggestions from Dr. Manassis include:
In addition to assisting students in school, school counselors should refer the student to an outside referral. Dr. Manassis suggests that students should see a therapist regularly regarding their anxiety. Some therapies for students with anxiety often include:
Dr. Manassis warns that home school should not be a recommendation for students as it often becomes a lifestyle for the student. Also, changing schools may not always be the best solution as transition can be stressful for the student. Dr. Manassis says that changing schools should only be considered if the school is toxic (i.e. bullying is present).

Helpful Tips When Students Are Having Anxiety
Therapist and Mental Health Vlogger, Kati Morton, gives some additional tips school counselors can give students. These suggestions include:
1. Stay busy! Anxiety often appears when students are quiet and allow their minds to run with thoughts.
2. Help students focus on the area where they feel the worry and use deep breathing.
3. Suggest that students begin to exercise - anxiety thrives when we have a lot of pent up energy.
4. Suggest the student have an emergency contact list to reach out when he or she is anxious. Having at least five people is important so that if someone cannot answer, the student has a back up contact.
5. Consider seeing a psychiatrist if his or her anxiety is not improving.

Worry Wise Kids has a list of accommodations that schools can put into place if a student is exhibiting symptoms of anxiety. Some tips include: See more suggestions in this article,

Seat students away from other students who may be disruptive or distracting.

Allow the student to present class presentations to the teacher alone or allow the student to videotape the lesson at home to show to the teacher.

Allow extended time on tests.

Create a cool down pass (with a time limit of 5-10 minutes) for the student to wash his or her face or get water.

Sample Accommodations for Students with Anxiety.
Do you need additional resources for assisting students with mood disorders? Here are some resources you may find helpful to use with your students.

Mental Health First Aid is designed to work with adolescents between the ages of 12-18 and introduces the participants to the unique risks and warning signs of those who work with adolescents. In addition, the course helps build understanding of the importance of early intervention and teaches participants how to work with youth experiencing a mental health crisis. Not only is this course appropriate for those who work with youth, but the course is also appropriate for older adolescents (ages 16 or older) as to encourage peer to peer interaction.

work with adolescents between the ages of 12-18 and introduces the participants to the unique risks and warning signs of those who work with adolescents. In addition, the course helps build understanding of the importance of early intervention and teaches participants how to work with youth experiencing a mental health crisis. - See more at: http://forhighschoolcounselors.blogspot.com/2013/11/youth-mental-health-first-aid.html#sthash.n41Fd0Qq.dpuf

Check out my post on how to use coloring books to help calm anxious students.
Mental Health Resources for School Counselors

Check out resources from my post about Mental Health Awareness Week, 2014.

Ten Things to do for a Panic Attack

SAMSHA Guidelines in Responding to a Mental Health Crisis
Tips to Promote Social-Emotional Health Among Teens
How to Work Effectively with Police When Youth Are in Mental Health Crisis.pdf

Training Opportunities for Schools

Songs About Mental Illness
300 Famous People Who Suffer From Mental Illness
Famous People Who Suffer from Mental Illness PowerPoint
CDC Mental Health Resources
CDC Human Development and Disabilities Resources
National Institute on Drug Abuse
Free Resources for High School Staff on Teen Drug Abuse
Office of Juvenile Justice and Delinquency
National Child Traumatic Stress Network

ACA Suicide Assessment
Disaster Mental Health Training for School Counselors
Youth Mental Health First Aid Training
The Current State of School Based Mental Health
Training on Teen Mental Health Concerns and Strategies for High School Staff
Way s for Teachers and Schools to Build Resilience in Youth
Understanding and Reducing Aggressive Behavior in Youth
Many Youths With Autism Lack Options After High School
Adolescents with a History of Maltreatment Have a Unique Service Need That May Affect Their Transition to Adulthood
Mental Health and Drug Abuse
Adolescent Mental Health Information
The Role of High School Mental Health Providers in Preventing Suicides
Webinar on Working with Homeless Youth and Runaways
Building Resilience in Teens
Resources for Students

Strength of Us-online community for young adults created by NAMI and other young adults. Young adults receive peer support and resources for issues that they are facing due to their mental health issues.

Organizations focusing on Mental Health

NAMI-National Alliance on Mental Illness
Center for Health and Health Care in Schools-School Based Mental Health
NIMH-National Institute on Mental Heath

Hope you found some helpful information to assist you in working with anxious students. If you have resources, please feel free to share and I will add them to my resource lists!

Getting Accommodations in College

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Helping Students With Anxiety: Resources for School Counselors

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Since it is Mental Health Awareness Month, I decided to write a post regarding a common mental health disorder that students are exhibiting in school. Unfortunately, school counselors are often unaware of how to help students and families who face this disorder.

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ASCA SchoolCounselor

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Address Student Anxiety | American School Counselor Association (ASCA)

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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.

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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Inside Higher Ed | Higher Education News, Events and Jobs

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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High School Counselor Role & Responsibilities

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High School Counselor Role & Responsibilities

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Obsessive Compulsive Disorder Resource Center
Last updated February 2018
Obsessive-Compulsive Disorder (OCD) is seen in as many as 1-3% of children and adolescents. OCD is characterized by recurrent intense obsessions and/or compulsions that cause severe distress and interfere with day-to-day functioning.

Obsessions are repetitive and persistent thoughts, impulses, or images that are unwanted and cause marked anxiety or distress. Frequently, they are unrealistic or irrational. They are not simply excessive worries about real-life problems or

preoccupations. Compulsions are repetitive behaviors or rituals (like hand washing, keeping things in order, checking something over and over) or mental acts (like counting or repeating words silently).

In OCD, the obsessions or compulsions cause significant anxiety or distress, or they interfere with the child's normal routine, academic functioning, social activities, or relationships.
Choose a topic:

Introducing Obsessive Compulsive Disorder
A short cartoon video explaining OCD for older kids, teens, and their families from the perspective of a young girl with OCD

Ask the Expert: CBT for OCD
A 1-minute explanation of treatments for OCD for patients and their families, by Columbia University Medical Center OCD expert, Dr. Blair Simpson

Treatment for Children with OCD
A 3-minute summary of one teenager's experience with OCD and the treatment he received

OCD Strategies with Dr. Rynn of Columbia University on the Conquer Worry Radio Show, Oct. 19, 2014
A 45-minute audio recording for the public on the basics of anxiety and OCD in children and adolescents

Keynote for the FIU Center for Children and Families
A 75-minute presentation by John Piacentini, PhD, on the basics of OCD for professionals and families who want to have a more advanced understanding of the disorder

Dr. Eli Lebowitz of the Yale Child Study Center explains how to create effective exposures for professionals who treat OCD in a 15-minute video

Dr. Michael Jeneke provides brief explanation of PANS/PANDAS for physicians

A 20-minute video briefly describing PANS/PANDAS for professionals

Journal of the American Academy of Child & Adolescent Psychiatry:
April 2015 - Volume 54 - Issue 4 - pp 251-262
Assessment and Management of Treatment-Refractory Obsessive-Compulsive Disorder in Children
http://www.jaacap.com/article/S0890-8567(16)31160-1/pdf

Obsessive-compulsive and tic-related disorders.
Martin E Franklin et al., Child And Adolescent Psychiatric Clinics, 2012
http://www.childpsych.theclinics.com/article/S1056-4993(11)00015-0/abstract

March JS (1995), Cognitive-behavioral psychotherapy for children and adolescents with OCD: a review and recommendations for treatment. Journal of the American Academy of Child and Adolescent Psychiatry 34:7-18
http://www.jaacap.com/article/S0890-8567(09)63847-8/abstract

Tic-Related Obsessive-Compulsive Disorder (OCD): Phenomenology and Treatment Outcome in the Pediatric OCD Treatment Study II
http://www.jaacap.com/article/S0890-8567(14)00691-1/abstract

Telephone Cognitive-Behavioral Therapy for Adolescents With Obsessive-Compulsive Disorder: A Randomized Controlled Non-inferiority Trial
http://www.jaacap.com/article/S0890-8567(14)00664-9/fulltext

Case Study: A New Infection-Triggered, Autoimmune Subtype of Pediatric OCD and Tourette's Syndrome
http://www.jaacap.com/article/S0890-8567(09)63789-8/abstract

Early Childhood OCD: Preliminary Findings From a Family-Based Cognitive-Behavioral Approach
http://www.jaacap.com/article/S0890-8567(09)62426-6/abstract

Therapist-Guided, Internet-Delivered Cognitive-Behavioral Therapy for Adolescents With Obsessive-Compulsive Disorder: A Randomized Controlled Trial
http://www.jaacap.com/article/S0890-8567(16)31857-3/abstract

Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: the Pediatric OCD Treatment Study (POTS) randomized controlled trial.
https://www.ncbi.nlm.nih.gov/pubmed/15507582

IACAPAP Online Textbook of Child and Adolescent Mental Health: OCD chapter
http://iacapap.org/wp-content/uploads/F.3-OCD-072012.pdf

Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome

Find a child and adolescent psychiatrist in your area

Related Websites
Live Free OCD

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Obsessive Compulsive Disorder Resource Center

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Obsessive Compulsive Disorder Resource Center Last updated February 2018 Obsessive-Compulsive Disorder (OCD) is seen in as many as 1-3% of children and adolescents. OCD is characterized by recurrent intense obsessions and/or compulsions that cause severe distress and interfere with day-to-day functioning. Obsessions are repetitive and persistent thoughts, impulses, or images that are unwanted and cause marked anxiety or distress.

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OCD in the Classroom

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares.

Children who have obsessive-compulsive disorder (OCD) are plagued with unwanted thoughts, images or impulses that are difficult to suppress, causing them great stress and worry. These are called obsessions. To alleviate the anxiety caused by their obsessive thoughts, they perform repetitive, ritualized actions called compulsions. A child with OCD might need to line things up, touch things in a certain order when leaving the room or wash his hands repeatedly.

Obsessions Common in Kids With OCD

Contamination: Kids with this obsession are sometimes called "germaphobes." In schools, this plays out with kids worrying about other kids sneezing and coughing, touching things that might be dirty or getting sick in many different ways. This is the most common obsession seen in children.

Magical thinking: This is a kind of superstition, like "step on a crack, break your mother's back," taken to extremes. For example, kids might worry that their thoughts can cause someone to get hurt, or get sick. A child might think, "Unless my things are lined up in a certain way, mom will get in a car accident."

Catastrophizing: Some kids easily jump to the conclusion that something terrible has happened. For example, if her parents are five minutes late picking her up, a girl who is catastrophizing might tell herself that they've decided to abandon her.

Scrupulosity: This is when kids have obsessive worries about offending God or being blasphemous in some way.

What ifs: Kids may be plagued by a lot of different kinds of thoughts about bad things they could do. "What if I hurt someone? What if I stab someone? What if I kill someone?"

The "just right feeling": When OCD first develops, from about 6 to 9 years of age, kids may not know why they are doing something, but just that they need to do it until they get what we call the "just right feeling." So: "I'll line these things up until it just kind of feels right, and then I'll stop." And then over time - in the 9- to 12-year-old range - it evolves into magical thinking and becomes more superstitious in nature.

Behaviors You Might See in Students With OCD

Frequent requests to go to the bathroom: This could be to wash hands, if someone near the child was coughing or sneezing, or if she touched something that she perceives as contaminated. She could be washing items-pens, pencils, backpacks, books. It could also be an excuse to get out the classroom and just be away from everyone, and have some respite.

Constant reassurance-seeking: This takes the form of repetitive questions. "Are you sure that's the answer? Could you tell me again? Did you hear what I said?" Checking doors, windows, lockers, desks. Over and over and over again.

Getting stuck on tasks: Sometimes kids with OCD will need to finish something to completion, or understand it to completion, before they're able to move on. So if a child is working out what he did wrong on a math test, and the teacher says, "Now let's open the textbook and start a new chapter," he's not going to be able to shift gears.

Retracing: If a child leaves the classroom and worries that she left a pencil behind, she'll go back into the classroom and go to her desk and check. If she had a bad thought as she went through the doorway, she might have to "fix it" by going back through the doorway again saying a good word. If she had a bad thought when she went down a flight of stairs on the way to class, she might need to go back up that same stairway at the end of the period, even if it means being late to her next class.

Obsessive erasing: A child could be erasing a lot because the letters have to look perfect. Or he could have used a word that disturbs him. For example, if he has a fear of vomiting and he's written the word vomit, he might not be able to stand seeing that word, so he erases it. Kids start having erasers worn down to the metal. Teachers start to see holes in the paper. Words will be drawn over on the back of the page. A lot of different areas of writing become problematic.

Behaviors Often Confused With Another Disorder

Some behaviors associated with OCD are easy to confuse with ADHD, learning problems or being oppositional.

Distraction: If a child is busy thinking that if she doesn't turn the pen cap and count to four the right way then her mom is going to get sick, she's not going to be paying attention in class. And if her teacher calls on her to answer a question, her distraction might look like ADHD, but it isn't.

Slowness on exams, papers and tasks: Sometimes when kids take a long time, they're struggling with the perfectionism of needing to do things the right way. This could look like learning problems, or inattention, but it isn't.

Avoidance: Teachers might see a child who doesn't want to sit on the floor, or pick things up that touched the floor, or get his hands dirty in art class. He may avoid a lot of playground activities - kids with germ fears will view the playground the way some adults view the subway: it's gross. Why touch anything there?

Tapping and touching symmetrically: If a child sits down at her desk and she accidentally kicks the chair of the kid next to her with her right foot, she's going to have to then kick it with her left foot. That might look like somebody who's being oppositional, or somebody who's got too much energy, but actually it's OCD.

Complaints of anxiety and fatigue: There's one interesting theory that kids with OCD are smarter than other kids. And if you consider how much thinking they're doing, they're really using their brain more frequently than a lot of other kids are. But when that's coupled with a lot of anxiety, you can have a lot of fatigue. So it's common for kids with OCD to want to come home and take a nap after school.

How to Help Students With OCD

For children struggling with OCD, functioning in school can be complicated and very difficult. Here are some things you can do to help them, and the class as a whole, focus on learning:

Seating arrangement: If the school has noisy hallways, you might not want to have a child with OCD sit by the door. You might have her sit in the front, where she's less able to hear the noise and can stay more focused on her work. On the other hand, a child who has very observable symptoms, and doesn't want other kids to see her fidgeting with her hands, rocking or getting up a lot, might be better off closer to the door, toward the back of the room.

Extended time for tests and papers: If writing is a problem for a child who needs to find the perfect way to say something, he's going to need more time to finish those essay questions or papers.

Laptops for writing: If writing and rewriting/erasing is really problematic for a child, consider letting her use a laptop for taking notes, and having all assignments be typed instead of handwritten.

Private testing rooms: Research is quite clear that kids with OCD do better, are less overwhelmed and are more in control of their thoughts and their reactions if they're in a quiet place away from the other kids.

Skip reading out loud: Kids who feel they need to read perfectly may have to go back and reread sentences or whole paragraphs over and over to make sure they've got them right. So reading becomes a very laborious task, and reading in front of the class can become a nightmare. So if we know doing this is a problem for children, we can spare them.

Books on tape: If kids get so hung up reading that it takes forever, listening to the books can be a solution.

Break homework into chunks: If looking at a whole page of math makes kids feel overwhelmed and anxious - think of the potential for mistakes! - the problems can be broken up over four pages. It helps kids stay focused on doing the problems instead of worrying.

How to Minimize Behavioral Problems

Plan an escape route: Try working out a communication system so that if the student feels symptoms coming on, she can signal to you and leave the classroom, or go to a protected place in the classroom, without interrupting the class. It can prevent an embarrassing and disruptive blowup of symptoms in the classroom, and the other kids picking on or bullying her about it.

Be aware of triggering events: It's very important for teachers to know what kind of things might trigger the symptoms. Fatigue is a huge piece of OCD, and it can be exacerbated by medication. So it's important to know that if a child is drowsy in class, and maybe he's putting his head down, it's not because he's being oppositional or disrespectful, but because he's overwhelmed with fatigue.

Advance notice: Irritability and frustration are two of the longer-lasting things that kids with OCD are feeling on a daily basis. Changes in schedule can be very disruptive for a child with OCD, so it can be helpful for teachers to give advance notice of things. Kids who know what to expect are less likely to be thrown by the change.

Children with OCD are often teased and bullied because of their symptoms. Kids feel very uncomfortable about their rituals, knowing that they're being watched. It can be helpful to educate the whole class about what's going on, especially if a child is going to be in the same school for a number of years, and it can inspire a surprising amount of support from other children.

Peer understanding program: A peer understanding program includes a presentation in the classroom that explains (with the child participating) what OCD is. The child might say, "Listen, I have OCD. It's an anxiety disorder. It makes me think that my hands are dirty and I have to wash my hands a lot, so if you see me getting up and going to the sink to wash my hands, that's why." Psychologists can role-play with the teacher and child ahead of time, to anticipate questions his classmates might ask, and how to answer them.

A buddy system: A buddy is like a peer coach who sits next to the child and prompts him to keep up with note taking and staying on task. It can be great for the buddy, to foster a sense of confidence and pride and to be able to help someone in need, and great for fostering friendship.

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Lo sentimos, la página que usted busca no se ha podido encontrar. Puede intentar su búsqueda de nuevo o visitar la lista de temas populares. Children who have obsessive-compulsive disorder (OCD) are plagued with unwanted thoughts, images or impulses that are difficult to suppress, causing them great stress and worry.

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The School Counselor & Discipline (ASCA)

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The School Counselor & Discipline (ASCA)

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Conduct Disorders: Resources for Educators

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Conduct Disorders: Resources for Educators

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Suffering in Silence: Examining Obsessive Compulsive Behaviors in the School Setting

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Depression: Lesson/Activities for 9-12 Grade 

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Depression: Lesson/Activities for 9-12 Grade 

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Depression: Supporting Students at School

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Effective Interventions for Children and Adolescents With Conduct Disorder.

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Live OCD Free is awesome! For less than the cost of one therapy session, you can have a great self-help tool if you are unable to get help from a specialist. Or, if you are working with a therapist, it provides many tools to assist you while you are working on your own. We are looking forward to using Live OCD Free and conducting research on it at the OCD Institute. So far, patients are telling me that it is great.
-- Michael Jenike, M.D., Medical Director of the OCD Institute at McLean Hospital

I find that using the app really helps me control my tics. I was able to go almost 20 minutes without today. I don't know what it is, but once I stop using the app, the ticking starts up almost immediately. Knowing the app is on in the background mentally keeps me focused on not ticking. I know it sounds funny, but it's almost like I don't want to let it down.
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-- Lisa, North Carolina

Click on the graphic below to learn about Alexanda's story on YouTube:
Alexandra wants nothing more than to lead a revolution against this insidious, debilitating monster we call OCD! To help others see how much hope there is with proper treatment, Alex is documenting her progression through recovery. Regular updates to Alex's progress will be posted to our Blog "OCD: Real Stories, Real Help."

"Alex is truly one of the bravest young OCD sufferers I have ever met, and I will be eternally grateful for the gift of hope she offers."
-- Dr. Kristen Mulcahy

I believe I have had OCD since the age of 5. My symptoms consist mainly of intrusive thoughts. I started using the Live OCD Free app after a stay at an intensive residential treatment program. The app has helped me maintain the progress I made while there and has helped me to continue to make progress. Every day is still a struggle, but having the app with me helps, especially when I feel that I'm about to give in to a ritual.
-- Jenna, Massachusetts

Live OCD Free is the need of the day for OCD sufferers. With regular usage of the app, one will feel the reduction in symptoms of OCD week after week. Moreover, it is a do it yourself kit which is economical and wise. In case one is in a country or city with no resources, this app is your OCD specialist available to you 24 hours at home. One can use it at home, on airports and while traveling anywhere. I recommend every OCD sufferer to have an access to this app . I would recommend every psychiatrist and psychologist to have this app and give it to their patients. Thank you for this app as I am happier, leading a life of my dreams as I am experiencing lesser OCD symptoms! My control on OCD has been far better after the usage of this app.
-- Anoop, New Delhi, India

I have battled OCD symptoms - mainly checking and counting rituals - for nearly 20 years. I started using the Live OCD Free app about three months ago and my anxiety decreased right away. It is like having a therapist right there with me. It holds me accountable. Having the Live OCD Free app by my side is a constant reminder to keep working through the challenges so I can get better. It is fun and easy to use. The app is helping me improve my quality of life because I am giving in to fewer compulsions.
-- Lynn, New York

We set up the Live OCD Free app with my son's therapist. It really helped to map out a treatment plan. It gave us a visual list of the goals he wanted to accomplish and a path to get there. We found the message recording feature most helpful. We are able to record words, phrases and stories that my son was too afraid to say. As part of his exposure treatment, we listen to the recordings in the car and at home. Using the app in conjunction with therapy has dramatically improved our son's quality of life. The difference is remarkable.
-- Bridget, Massachusetts

I've been using the Live OCD Free app for about two and a half months. Having an assignment to do helps me to work on my exposure challenges. It allows me to actively fight against my OCD in between visits with my therapist. I've noticed that my anxiety has decreased. I still have work to do, but the Live OCD Free app is a helpful tool that has kept me on track.
-- Dianne, Massachusetts

I have all of the self help books for OCD, but the app is different. It's tactile and it brings words into action. I have a series of challenges to work through and having the app makes me excited to practice. The app makes it so much easier.
-- Stacey, Massachusetts

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Live OCD Free is an interactive application designed to help sufferers with Obsessive Compulsive Disorder. It is available for the iPhone and iPad, through the Apple App Store. The App provides an interactive self-help tool for those who do not have access to an OCD specialist.