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What is OCD? | International OCD Foundation

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

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OCD and Anxiety Disorders: Crash Course Psychology #29

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Schizophrenia and Dissociative Disorders: Crash Course Psychology #32

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The video links are helpful.

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What is bipolar disorder? - Helen M. Farrell

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CHADD - Improving the lives of people affected by ADHD

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Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) is the nation's leading nonprofit organization serving people affected by ADHD.

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School Staff Resources for Pychotic Disorders

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School Staff Resources for Pychotic Disorders

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School staff can play an important role in helping children with psychotic disorders live more normal lives, according to Dr. Jonathan R. Stevens and Dr. Jefferson B. Prince.

"School interventions often involve optimizing the environment to minimize undue stress to the patient, which increases vulnerability to psychotic episodes, and to match the level of stimulation with the patient's level of arousal. Across conditions contributing to psychosis, school staff efforts to identify precipitants surrounding episodes or deterioration can be useful in determining appropriate home and classroom expectations," they wrote in the January issue of Child and Adolescent Psychiatric Clinics of North America.

They noted several early warning signs of psychosis that may present at school: changes in thinking; mood; behavior; physicality; social changes, including withdrawal or isolation from friends and family; changes in functioning; students' perception; and persistent false beliefs (delusions), suspicion, and paranoia.

"Although data on psychosocial treatments in youth psychotic disorders in schools are scant, psychosocial treatment remain a mainstay of the overall treatment plan, and school staff have an essential role in caring for a child with psychosis," wrote Dr. Stevens and Dr. Prince, both of the pediatric inpatient psychiatry unit of MassGeneral for Children at North Shore in Lynn, Mass ( Child Adolesc. Psychiatric Clin. N. Am. 2012;21:187-200 [doi:10.1016/j.chc.2011.09.008]).

In the school setting, the goals of psychosocial interventions are largely to anticipate problems and to develop strategies that better allow the student to cope. Interventions include developing trust and rapport among the student, family, treatment team, and school staff; developing strategies that support and enhance reality testing for the student; developing strategies that support academic, psychological, and social adjustment; developing a monitoring system to reduce the likelihood of relapse and to respond if it occurs; identifying barriers to treatment; and supporting the student's autonomy, relatedness, and competency.

"Parents and other caregivers can help identify the patient's progression toward psychosis, which may provide specific topics for school staff to 'check in' with the patient to monitor the patient's reality testing," the researchers wrote. Strategies should address both positive (delusions, hallucinations) and negative (withdrawal, decreased interactions) symptoms. Treatment for positive symptoms may include anchoring activities with others as part of their daily routine. "When a patient with psychotic symptoms is agitated, distressed, or unsure of what is and is not 'real,' simplifying the environment, decreasing expectations, and diminishing stimulation are often required," they wrote. For negative symptoms, regular social interactions with others and structured familiar activities can help diminish isolation. These interactions need to be carefully configured and supported by staff because these students may be inclined to withdraw or avoid interactions.

Psychosocial treatments for students with psychosis typically involve either multimodal treatment programs or specific psychosocial interventions. Multimodal treatments programs can provide a comprehensive array of service, such as community outreach/early detection efforts; inpatient and outpatient treatment; individual, group, or family therapy; and case management.

Specific psychosocial interventions have been studied, including individual cognitive behavioral therapy, group programming, and family interventions. "Providing youth suffering psychosis with 'cognitively oriented' individual psychotherapy appears to help these youth adjust to their condition, resume usual developmental tasks, as well as improve symptoms of anxiety and depression," wrote Dr. Stevens and Dr. Prince. CBT can help students target specific thoughts and beliefs that intensify their symptoms and compromise their function at school.

In particular, a "safe and private space" can be designated, which allows the student to decompress initially as practice with CBT techniques can then more easily be internalized and generalized. The more specific and frequent the practice sessions are, the more likely they will take hold and be helpful to the student.

Family and school intervention programs can emphasize psychoeducation, the need to identify warning signs, stress management techniques, the importance of attributing maladaptive behavior to the illness rather than to "bad behaviors" or "laziness," communication skills training, and the reduction of high expressed emotion, the researchers noted.

Dr. Stevens and Dr. Prince outlined specific tasks for the school team, teachers and support staff, and administrators. The school team needs to stay connected; stay positive; remember that children dealing with psychosis are children first, and often unable to understand their perceptions or why they are changing so differently from peers; and refer children who show early warning signs to mental health clinicians.

Teachers and support staff should break tasks down into smaller steps, minimize distractions, and have a plan to redirect the student to help him or her return to the task at hand; give short, concise directions; assist with planning and organizational skills; provide modifications and accommodations to the school; and provide support with social problems.

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School Staff Can Aid Treatment of Psychotic Children

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School staff can play an important role in helping children with psychotic disorders live more normal lives, according to Dr. Jonathan R. Stevens and Dr. Jefferson B. Prince. "School interventions often involve optimizing the environment to minimize undue stress to the patient, which increases vulnerability to psychotic episodes, and to match the level of stimulation with the patient's level of arousal.

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Definition of Pychotic Disorders (Child Specific

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Definition of Pychotic Disorders (Child Specific

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Psychosis (Schizophrenia)

Schizophrenia and other psychotic disorders are medical illnesses that result in strange or bizarre thinking, perceptions (sight, sound), behaviors, and emotions. Psychosis is a brain-based condition that is made better or worse by environmental factors - like drug use and stress. Children and youth who experience psychosis often say "something is not quite right" or can't tell if something is real or not real. It is an uncommon psychiatric illness in young children and is hard to recognize in its early phases.

The appearance of symptoms of psychosis before age 12 is rare (less than one-sixtieth as common as the adult-onset type), but studying these cases is important for understanding this disorder. For those who might develop psychotic disorders or schizophrenia as adults (adult-onset), it is not uncommon for them to start experiencing early warning signs during puberty or adolescence. The period of time when an adolescent experiences the early warning signs of psychosis is called prodrome. During this time, youth recognize that their experiences (hearing or seeing things that are not there) are strange or concerning. They may not easily admit these problems unless asked. Being aware of the early warning signs and offering support is crucial.

Childhood-onset - Most children with schizophrenia show delays in language and other functions long before their psychotic symptoms (hallucinations, delusions, and disordered thinking) appear. In the first years of life, about 30% of these children have transient symptoms of pervasive developmental disorder, such as rocking, posturing, and arm flapping. Childhood-onset of psychosis may present with poor motor development, such as unusual crawling, and children may be more anxious and disruptive compared to those with later onset.

It is especially important to pay attention to sudden changes in thoughts and behaviors. Keep in mind that the onset of several of the symptoms below, and not just any one change, indicates a problem that should be assessed. The symptoms below should not be due to recent substance use or another medical condition.

Early Warning Signs:

Feeling like their brain is not working

Feeling like their mind or eyes are playing tricks on them

Seeing things and hearing voices that are not real

Hearing knocking, tapping, clicking or their named being called

Vivid and bizarre thoughts and ideas

Sudden and bizarre changes in emotions

Peculiar behavior that seem unusual

Increased sensitivity to light, sounds, smells or touch

Concept that people are "out to get them"

Fearfulness or suspicion that isn't warranted

Severe problems in making and keeping friends

Difficulty speaking, writing, focusing or managing simple tasks

The behavior of children with this illness may change over time. Psychosis can develop gradually or suddenly. Children and youth may begin talking about strange fears and ideas. They may start to cling to parents or say things that do not make sense. Others who used to enjoy relationships with peers may become more shy or withdrawn or seem to be in their own world.

Treatment

Early diagnosis and medical treatment are important. It is especially important that children and youth with the problems and symptoms listed above receive a complete evaluation. These children may need individual treatment plans involving other professionals. A combination of medication and individual therapy, family therapy, and specialized programs (wraparound services, early psychosis treatment) is often necessary. Changes in life style (keeping stress low, taking fish oils), additional supports (therapy and school support) and psychiatric medication can be helpful for many of the symptoms and problems identified.

Making the choice about whether or not to use medications can be difficult. Second-generation (atypical) antipsychotic drugs are usually tried first because they may cause fewer side effects than standard drugs. Serious side effects of second-generation antispychotic drugs can include weight gain, diabetes and high chloresterol. Currently, the Food and Drug Administration approves the use of two second-generation drugs in children ages 13-17, Risperidone (Risperdal) and Aripiprazole (Abilify).

Parents need to ask their family physician or pediatrician to refer them to a child and adolescent psychiatrist who is specifically trained and skilled at evaluating, diagnosing, and treating children with schizophrenia.

To learn more visit:

Other Resources

National Alliance on Mental Illness - Early Onset Schizophrenia

Email Address: info@psychosisprevention.org

Website URL: http://psychosisprevention.org/

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Psychosis (Schizophrenia) in Children and Youth

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Psychosis (Schizophrenia) Schizophrenia and other psychotic disorders are medical illnesses that result in strange or bizarre thinking, perceptions (sight, sound), behaviors, and emotions. Psychosis is a brain-based condition that is made better or worse by environmental factors - like drug use and stress.

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What is oppositional defiant disorder (ODD) in children?

What causes ODD in a child?

Which children are at risk for ODD?

What are the symptoms of ODD in a child?

How is ODD diagnosed in a child?

How is ODD treated in a child?

How can I help prevent ODD in my child?

How can I help my child live with ODD?

When should I call my child's healthcare provider?

Key points about ODD in children

Next steps

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

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

Before your visit, write down questions you want answered.

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

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

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

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

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

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

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

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

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

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

A mental health expert often diagnoses ODD.

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

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

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

Feels out of control

Hears voices that others don't hear

Sees things that others don't see

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

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

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

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

Keep all appointments with your child's healthcare provider.

Take part in family therapy as needed.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Symptoms of ODD may include:

Having frequent temper tantrums

Arguing a lot with adults

Refusing to do what an adult asks

Always questioning rules and refusing to follow rules

Doing things to annoy or upset others, including adults

Blaming others for the child's own misbehaviors or mistakes

Being easily annoyed by others

Often having an angry attitude

Speaking harshly or unkindly

Seeking revenge or being vindictive

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

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

Mood or anxiety disorders

Conduct disorder

Attention-deficit/hyperactivity disorder (ADHD)

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

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

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

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

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What You Should Know About Oppositional Defiant Disorder

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Tips to help you get the most from a visit to your child's healthcare provider: Know the reason for the visit and what you want to happen. Before your visit, write down questions you want answered. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests.

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Both Individualized Education Programs (IEPs) and 504 plans can offer formal help for K-12 students who are struggling in school. They're similar in some ways but very different in others. This chart compares them side by side to help you understand the differences.

A blueprint or plan for a child's special education experience at school.

A blueprint or plan for how the school will provide support and remove barriers for a student with a disability.

To get an IEP, there are two requirements: A child has one or more of the 13 disabilities listed in IDEA. The law lists specific challenges, like learning disabilities, ADHD, autism, and others. And the disability must affect the child's educational performance and/or ability to learn and benefit from the general education curriculum. The child must need specialized instruction to make progress in school.

To get a 504 plan, there are two requirements: A child has any disability. Section 504 covers a wide range of different struggles in school. And the disability must interfere with the child's ability to learn in a general education classroom. Section 504 has a broader definition of a disability than IDEA. (It says a disability must substantially limit one or more basic life activities. This can include learning, reading, communicating, and thinking.) That's why a child who doesn't qualify for an IEP might still be able to get a 504 plan.

There are strict legal requirements about who participates. With a few exceptions, the entire IEP team must be present for IEP meetings. The team must include:

The rules about who's on the 504 team are less specific than they are for an IEP. A 504 plan is created by a team of people who are familiar with the child and who understand the evaluation data and special services options. This might include:

* The child's parent or caregiver

* General and special education teachers

* The school principal

* The child's parent or caregiver

* At least one of the child's general education teachers

* At least one special education teacher

* A school psychologist or other specialist who can interpret evaluation results

* A district representative with authority over special education services

The IEP sets learning goals and describes the services the school will provide. It's a written document. Here are some of the most important things the IEP must include:

There is no standard 504 plan. Unlike an IEP, a 504 plan doesn't have to be a written document. A 504 plan generally includes the following:

* Specific accommodations, supports, or services for the child

* Names of who will provide each service

* Name of the person responsible for ensuring the plan is implemented

* The child's present levels of academic and functional performance - how the child is currently doing in school

* Annual education goals for the child and how the school will track progress

* The services the child will get - this may include special education, related, supplementary, and extended school year services

* The timing of services - when they start, how often they occur, and how long they last

* Any accommodations - changes to the child's learning environment

* Any modifications - changes to what the child is expected to learn or know

* How the child will participate in standardized tests

* How the child will be included in general education classes and school activities

When the school wants to change a child's services or placement, it has to tell families in writing before the change. This is called prior written notice. Notice is also required for any IEP meetings and evaluations. Families also have "stay put" rights to keep services in place while there's a disagreement about the IEP.

The school must notify families about an evaluation or a "significant change" in placement. Notice doesn't have to be in writing, but most schools do so anyway.

How to resolve disputes

IDEA gives families several ways to resolve disputes (usually in this order):

Section 504 gives families several options for resolving disagreements with the school:

* Mediation

* Alternative dispute resolution

* Impartial hearing

* Complaint to the Office for Civil Rights (OCR)

* Lawsuit

* Mediation

* Due process complaint

* Resolution session

* Civil lawsuit

* State complaint

* Lawsuit

And if you need help navigating special education law in your state, consider reaching out to your local Parent Training and Information Center. The people there can answer questions and give practical advice on issues specific to your area.

Do you want to learn more about how IEPs and 504 plans compare? Watch as an expert explains the differences between them.

About the author

About the author

The Understood Team is made up of passionate writers and editors. Many of them have kids who learn and think differently.

Reviewed by

Reviewed by

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

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IEP vs. 504 Plan: What's the Difference?

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Individualized Education Programs (IEPs) and 504 plans are similar but different. See how they compare in what they provide and the processes and laws involved.

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Individuals with Disabilities Education Act

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Sec. 300.8 (c) - Individuals with Disabilities Education Act

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Statute/Regs Main » Regulations » Part B » Subpart A » Section 300.8 » c (c) Definitions of disability terms. The terms used in this definition of a child with a disability are defined as follows: (1) (i) Autism means a developmental disability significantly affecting verbal and nonverbal communicat…

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The National Institute of Mental Health (NIMH) is the lead federal agency for research on mental disorders

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National Institute of Mental Health - Depression

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National Institute of Mental Health - Depression

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National Institute of Mental Health (NIMH)

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Learn about depression, including types, signs and symptoms, risk factors, treatments and therapies, and things you can do to help during treatment.

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Children, like adults also suffer from depression, although their symptoms may not be the same. Additionally, children respond well to treatment. Depression is defined as an illness when the feelings of depression persist and interfere with a child or adolescent's ability to function.

About 5 percent of children and adolescents in the general population suffer from depression at any given point in time. Children under stress, who experience loss, or who have attention problems, learning, conduct or anxiety disorders are at a higher risk for depression. Depression also tends to run in families.

The behavior of depressed children and teenagers may differ from the behavior of depressed adults. Child and adolescent psychiatrists advise parents to be aware of signs of depression in their youngsters.

If one or more of these signs of depression persist, parents should seek help:

Frequent sadness, tearfulness, crying.

Hopelessness.

Decreased interest in activities; or inability to enjoy previously favorite activities.

Persistent boredom; low energy.

Social isolation, poor communication.

Low self esteem and guilt.

Extreme sensitivity to rejection or failure.

Increased irritability, anger, or hostility.

Difficulty with relationships.

Frequent complaints of physical illnesses such as headaches and stomachaches.

Frequent absences from school or poor performance in school.

Poor concentration.

A major change in eating and/or sleeping patterns.

Talk of or efforts to run away from home.

Thoughts or expressions of suicide or self destructive behavior.

A child who used to play often with friends may now spend most of the time alone and without interests. Things that were once fun now bring little joy to the depressed child. Children and adolescents who are depressed may say they want to be dead or may talk about suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed adolescents may abuse alcohol or other drugs as a way to feel better.

Children and adolescents who cause trouble at home or at school may also be suffering from depression. Because the youngster may not always seem sad, parents and teachers may not realize that troublesome behavior is a sign of depression. When asked directly, these children can sometimes state they are unhappy or sad.
(This information has been made available from the Los Angeles Network of Care)
Some Consequences of Depression

Once a young person has experienced an episode of depression, he or she is at risk for developing another episode of depression within the next 5 years (Center for Mental Health Services).

Depression in childhood may predict more severe depressive illness in adulthood (National Institute of Mental Health).

Depression in children and adolescents is associated with an increased risk for suicidal behaviors (National Institute of Mental Health).

What can Parents/Caregivers Do?

If parents or other adults in a young person's life suspect a problem with depression, they should:

Know the warning signs of depression and note how long problems have been going on, how often they occur, and how severe they seem.

See a mental health professional or the child's doctor for evaluation and diagnosis.

Get accurate information from libraries, hotlines and other sources.

Ask questions about treatments and services.

Talk to other families or find a family network organization.

It is important for people who have questions about, or are not satisfied with, the mental health care their children receive to discuss their concerns with the provider, ask for more information and seek help from other sources.

GET HELP

Depression is treatable. Early diagnosis and treatment are essential for depressed children. Depression is a real illness that requires professional help. Comprehensive treatment often includes both individual and family therapy. For example, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of individual therapy shown to be effective in treating depression. Treatment may also include the use of antidepressant medication. For help, parents should ask their physician to refer them to a qualified mental health professional, who can diagnose and treat depression in children and teenagers.
(This information has been made available by the American Academy of Child & Adolescent Psychiatry) For further information on child depression, please see the following resources:

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Child Depression Ages 6-12 - The Whole Child

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Children, like adults also suffer from depression, although their symptoms may not be the same. Additionally, children respond well to treatment. Depression is defined as an illness when the feelings of depression persist and interfere with a child or adolescent's ability to function.About 5 percent of children and adolescents in the general population suffer from ...

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School Mental Health Referral Information 

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School Mental Health Referral Information 

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Evidence Based Strategies for Those With ADHD 

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Evidence Based Strategies for Those With ADHD 

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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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Child Mind Institute | Transforming Children’s Lives.

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

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A common question asked of clinicians is, "What's the difference between bipolar disorder (also known as manic depression) and plain old depression? It's a simple question to answer, because depression can either be a stand-alone diagnosis, or a part of another disorder, like bipolar. Therefore a mental health professional is going to examine whether there are other symptoms present (or have occurred in the past), to see if the depression is just depression, or whether it's a part of a larger disorder.

Bipolar Includes Mania & Depression

If bipolar disorder includes a depressed mood, what else does bipolar include? We can find the answer to this question by looking at the old name for bipolar disorder, manic depression. The old name is pretty descriptive - bipolar is a combination of mania and depression, alternating in cycles.

What is mania? If we examine the symptoms associated with mania, we see that it includes the following:

Inflated self-esteem or grandiosity

Decreased need for sleep (e.g., one feels rested after only 3 hours of sleep)

More talkative than usual or pressure to keep talking

Flight of ideas or subjective experience that thoughts are racing

Attention is easily drawn to unimportant or irrelevant items

Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

If three or more of these symptoms are present, then a person is considered to have a "manic episode" (or, if it is of less severity and length, a "hypomanic episode"). A manic episode also needs to have lasted for at least a week (a hypomanic episode, just four days) in order to be diagnosed. If an individual has signs that suggest he or she is having or has had a manic or hypomanic episode, in addition to episodes of severe depression, then typically that individual will quality for a bipolar diagnosis.

Depression Has no Mania

In ordinary depression, which clinicians refer to as "major depression" (sorry, there's no equivalent "minor depression"), no manic or hypomanic episode is prevalent and the individual has no record or indication of having a manic or hypomanic episode in the past. A depressive episode is characterized by the following symptoms:

Depressed mood most of the day, nearly every day

No interest or pleasure in all, or almost all, activities most of the day, nearly every day

Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

Insomnia (inability to sleep) or hypersomnia (sleeping too much) nearly every day

Psychomotor agitation or retardation nearly every day

Fatigue or loss of energy nearly every day

Feelings of worthlessness or excessive or inappropriate guilt nearly every day

Diminished ability to think or concentrate, or indecisiveness, nearly every day

Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Five or more of these symptoms for longer than two weeks are needed in order to qualify for a depressive diagnosis, with no accompanying manic episode.

What's the Difference Between Bipolar Disorder and Depression?

Related Articles

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What's the Difference Between Bipolar Disorder and Depression? | Psych Central

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A common question asked of clinicians is, "What's the difference between bipolar disorder (also known as manic depression) and plain old depression? It's a simple question to answer, because depression can either be a stand-alone diagnosis, or a part of another disorder, like bipolar.

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Questions Kids Have About Pediatric Bipolar Disorder

WHAT IS BIPOLAR DISORDER?

Bipolar disorder is an illness. It effects your energy, moods, thoughts, and the way you act.
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It can make your body feel heavy and tired or light and energetic. ƒIt can make your mood feel sad and depressed, silly or very happy, angry or irritable, anxious or scared. It can make your thoughts too slow or too fast. This makes it difficult to concentrate.ƒ It can make you act in ways that are different from your usual personality. A quiet person may talk too much or a friendly person might not want to be around any people. This can be very confusing to you, your family and friends. Researchers are still learning about what causes bipolar disorder. They have discovered that it can be inherited. You didn't do anything bad to get this illness. There is no cure for bipolar disorder yet, so doctors can't make it go away completely. We all wish they could. The good news is that there is treatment for bipolar disorder. You, your doctor and parents will have to decide how to manage this illness in a way that will give you the best life.

Treatment usually includes: medication, therapy, changes in your lifestyle, and reducing your stress. All these things work together to help you become stable and stay that way!

HOW CAN I COPE?
Nobody likes to find out that they have an illness, but sometimes it can be a relief to find out that there is help. Many kids have already struggled for a long time before getting the help they need. Kids with bipolar disorder may think that they are the only ones who feels this way. You are not alone! Some experts believe that there are almost a million other kids in America who have bipolar disorder.

If you are reading this, then you have an advantage. You are taking the first steps to manage your illness by learning about bipolar disorder. Kids can start to take charge of their illness by "charting" their moods. This means you record or mark down how you feel at different times of the day and how your body is reacting to treatment. This helps you understand your mood swings and helps your parents and doctors know how you are doing with your treatment. Talking to your parents and doctors about how you feel is important.

Always tell someone you trust if you feel like hurting yourself

or letting yourself get hurt.

This can be a symptom of your illness and is not something to be embarrassed about. Your doctor may need to change your medicine to help you get rid of these feelings.

Pediatric Bipolar Disorder

The Bipolar Child & Anxiety (podcast with Dr. Ed Plimpton)

Parent's Medication Guide for Bipolar Disorder in Children & Adolescents

CAN I BE SUCCESSFUL?
Do you think that having bipolar disorder will stop you from being successful? Think again! Here are some of the things people with bipolar disorder have accomplished.

ƒWalking On the Moon, Inventing New Products, Acting in Movies, Making Movies, Recording Music, Writing Books and Articles, Playing Professional Sports, Painting Pictures, Reporting the News on TV, Being a Successful Business Person, Being a Doctor, Helping Other People, Being a Great Mom or Dad

Why can people with bipolar disorder do so many amazing things? Every brain is different. Those differences can make some things harder like controlling your emotions. But those differences can also make some things easier like being creative. So find out what your brain is good at and plan on being successful!

Our mission is to help young people and adults understand more about childhood bipolar disorder. Please join us in erasing the stigma and easing the burden.

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Questions Kids Have About Pediatric Bipolar Disorder WHAT IS BIPOLAR DISORDER? Bipolar disorder is an illness. It effects your energy, moods, thoughts, and the way you act. ƒ It can make your body feel heavy and tired or light and energetic.

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From Dr. Tamar Chansky Creator of Worrywisekids.org

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Resource: The World of Abnormal Psychology

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Teacher resources and professional development across the curriculum