# data[].attributes.headline
Educator Support for Students with Disabilities

# data[].attributes.subject
Educator Support for Students with Disabilities

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

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

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

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

# data[].attributes.attachment_link.title
Home - ADDA - Attention Deficit Disorder Association

# data[].attributes.attachment_link.description
Empowering adults with adhd to live their best lives A Different Brain Requires a Different Approach Whether you're newly diagnosed, wondering if you have ADHD, or simply ready to take charge of your life - we're here to help. Have ...

# data[].attributes.attachment_link.readable_text
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.

# data[].attributes.attachment_link.title
When and How to Refer for Mental Health Care

# data[].attributes.attachment_link.description
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.

# data[].attributes.attachment_link.title
Black and White High School Classroom Newsletter

# data[].attributes.headline
The School Counselor's Role in Addressing Eating Disorders

# data[].attributes.subject
The School Counselor's Role in Addressing Eating Disorders

# data[].attributes.attachment_link.readable_text
Eating disorders are complex and affect all kinds of people. Risk factors for all eating disorders involve a range of biological, psychological, and sociocultural issues. These factors may interact differently in different people, so two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms. Still, researchers have found broad similarities in understanding some of the major risks for developing eating disorders. The factors listed below may be applicable to those with anorexia nervosa, bulimia nervosa, binge eating disorder, or OSFED. Information on ARFID and pica risk factors are listed separately.

BIOLOGICAL

Having a close relative with an eating disorder. Studies of families have found that having a first-degree relative (like a parent or sibling) with an eating disorder increases a person's risk of developing an eating disorder.

Having a close relative with a mental health condition. Similarly, issues like anxiety, depression, and addiction can also run in families, and have also been found to increase the chances that a person will develop an eating disorder. Learn more >

History of dieting. A history of dieting and other weight-control methods is associated with the development of binge eating.

Negative energy balance. Burning off more calories than you take in leads to a state of negative energy balance. Many people report that their disorder began with deliberate efforts to diet or restrict the amount and/or type of food they were eating in the form of dieting, other causes can include growth spurts, illness, and intense athletic training.

Type 1 (insulin-dependent) diabetes. Recent research has found that approximately one-quarter of women diagnosed with type one diabetes will develop an eating disorder. The most common pattern is skipping insulin injections, known as diabulimia, which can be deadly.

PSYCHOLOGICAL

Perfectionism. One of the strongest risk factors for an eating disorder is perfectionism, especially a type of perfectionism called self-oriented perfectionism, which involves setting unrealistically high expectations for yourself.

Body image dissatisfaction. Body image encompasses how you feel both about and in your body. It's sadly not uncommon to dislike your appearance, but people who develop eating disorders are more likely to report higher levels of body image dissatisfaction and an internalization of the appearance ideal.

Personal history of an anxiety disorder. Research has shown that a significant subset of people with eating disorders, including two-thirds of those with anorexia, showed signs of an anxiety disorder (including generalized anxiety, social phobia, and obsessive-compulsive disorder) before the onset of their eating disorder.

Behavioral inflexibility. Many people with anorexia report that, as children, they always followed the rules and felt there was one "right way" to do things.

SOCIAL

Weight stigma. The message that thinner is better is everywhere, and researchers have shown that exposure to this can increase body dissatisfaction, which can lead to eating disorders. Weight stigma is discrimination or stereotyping based on a person's weight, and is damaging and pervasive in our society.

Teasing or bullying. Being teased or bullied - especially about weight - is emerging as a risk factor in many eating disorders. The harmful effects of bullying have received increased attention in recent years, starting an important national conversation. 60% of those affected by eating disorders said that bullying contributed to the development of their eating disorder. Weight shaming needs to be a significant part of anti-bullying discussions, particularly in the context of the widespread anti-obesity messaging.

Appearance ideal internalization. Buying into the message of the socially-defined "ideal body" may increase the risk of an eating disorder by increasing the likelihood of dieting and food restriction.

Acculturation. People from racial and ethnic minority groups, especially those who are undergoing rapid Westernization, may be at increased risk for developing an eating disorder due to complex interactions between stress, acculturation, and body image. Within three years after western television was introduced to Fiji, women, previously comfortable with their bodies and eating, developed serious problems: 74% felt "too fat;" 69% dieted to lose weight; 11% used self-induced vomiting; 29% were at risk for clinical eating disorders.

Limited social networks. Loneliness and isolation are some of the hallmarks of anorexia; many with the disorder report having fewer friends and social activities, and less social support. Whether this is an independent risk factor or linked to other potential causes (such as social anxiety) isn't clear.

Historical trauma, or intergenerational trauma, describes the "massive cumulative group trauma across generations," like with Jewish Holocaust survivors, Native American populations, and Indigenous groups that experienced European colonization. Research shows health consequences including "anxiety, intrusive trauma imagery, depression, elevated mortality rates from cardiovascular diseases as well as suicide and other forms of violent death, psychic numbing and poor affect tolerance, and unresolved grief" (Brave Heart, 1999). Similarities between the effects of eating disorders and historical trauma points to a need for more research and information that addresses these systems of oppression.

Diabulimia

Diabulimia refers to an eating disorder in a person with diabetes, typically Type I Diabetes, wherein the person purposefully restricts insulin in order to lose weight.

Body Image & Eating Disorders

People with negative body image have a greater likelihood of developing an eating disorder and are more likely to suffer from feelings of depression, isolation, low self-esteem, and obsessions with weight loss.

# data[].attributes.attachment_link.description
Eating disorders are complex and affect all kinds of people. Risk factors for all eating disorders involve a range of biological, psychological, and sociocultural issues. These factors may interact differently in different people, so two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms.

# data[].attributes.attachment_link.readable_text
There are two kinds of behavioral interventions that can help children with ADHD manage their symptoms of hyperactivity, impulsiveness, and inattention. These ADHD therapies don't affect the core symptoms, but they teach children skills they can use to control them. Some focus on strategies for staying organized and focused. Others aim at cutting down on the disruptive behaviors that can get these children into trouble at school, make it difficult for them to make friends, and turn family life into a combat zone.

Some children, especially those with severe ADHD symptoms, benefit from behavioral therapy along with medication; for others, the training may make enough difference to enable them to succeed in school and function well at home without medication.

One important reason for kids to participate in behavioral therapy (whether or not they also take medication) is that ADHD medications stop working when you stop taking them, while behavioral therapy can teach children skills that will continue to benefit them as they grow up.

For behavior problems

For kids whose impulsive behavior is creating conflict at home and getting them into trouble at school, therapy can help them rein in the behavior that's problematic and establish more positive relationships with the adults in their lives. It's called, generally, parent training, because it involves working with parents and children together. It trains parents to interact differently with children, in order to elicit desirable behavior on the part of the child and discourage behavior that's causing them trouble.

Parent training is not just for children with ADHD, but since kids with ADHD are often prone to tantrums, defiance, and tuning out parental instructions, it can substantially improve their lives, and the wellbeing of their whole families. Though it focuses on interaction with parents, it's also been shown to reduce outbursts and other problem behaviors at school, as the skills kids learn in responding to very predictable parental interactions are transferrable to other settings. The training is generally done by clinical psychologists.

There are several kinds of parent training that have been shown to be effective, including Parent-Child Interaction Therapy (PCIT), Parent Management Training (PMT), Positive Parenting Program (Triple P). They all teach parents how to use praise, or positive reinforcement, more effectively, as well as consistent consequences when kids don't comply with instructions. They result in better behavior on the part of children, decreased arguing and tantrums, better parent-child interactions, and reduced parental stress.

Young children with ADHD often find themselves scolded or punished much more than they are praised, so a clear way to earn positive attention from the most important people in their lives can be a big motivator. It's not unusual for kids who've been negatively affected by their behavior problems-kicked out of preschool, black-listed from play dates-to make dramatic improvements through parent training.

School interventions

Young children with ADHD can benefit from systems that encourage positive behavior, like the "Daily Report Card." These approaches pinpoint specific goals for behavior in school, give kids feedback on how they're doing, and reward them for meeting those goals successfully.

Parents and teachers work together on the Daily Report Card. Teachers choose goals for an individual child based on the behaviors that present the biggest challenges for them. Goals might involve academic work (finishing tasks), behavior towards peers (reducing teasing or fighting) and adherence to classroom rules (not interrupting, staying in their seat, following instructions). The teacher rates the child's performance each day on each goal. They get a star or a check for each positive behavior, and if they get enough during the day, there is a prize for them when they get home-coveted screen time or some other small reward.

This kind of system can be very helpful for children from preschool to as old as 12.

For attention problems

The other broad area of behavioral help for kids with ADHD includes skills-based interventions to teach techniques they can use to stay on top of their schoolwork and manage their responsibilities at home. This kind of training, which is done by learning specialists, teaches kids skills to maximize their strengths and compensate for their weaknesses.

Children with ADHD tend to be weak in what we call "executive functioning." Executive functions are the self-regulating skills that we all use to accomplish tasks, from getting dressed to doing homework. They include planning, organizing time and materials, making decisions, shifting from one situation to another, controlling our emotions and learning from past mistakes.

To bolster kids with weak skills in these areas, learning specialists teach a mix of specific strategies and alternative learning styles that complement or enhance a child's particular abilities.

With elementary school children, the learning specialist usually works with parents and kids together, to establish routines and tools to use to get work done successfully and with minimal conflict. For instance:

Checklists can be useful for anything from getting out of the house on time in the morning to doing homework after school to the bedtime routine. Since the steps necessary for completing a task often aren't obvious to kids with ADHD, defining them clearly ahead of time, and posting them prominently, makes a task less daunting and more achievable.

Educational therapists also recommend assigning a time limit for each step, particularly if it is a bigger, longer-term project. Deadlines can sneak up on all of us, but kids with ADHD are particularly susceptible to underestimating how long it will take to do something.

Using a Planner is essential for Kids with ADHD who have what's called poor working memory, which means it is hard for them to remember things like homework assignments.

A rewards chart at home, as well as at school, can help motivate kids who are easily distracted and struggle to acquire new skills.

For middle and high school aged students, educational therapists work with kids to develop systems for tackling the work, both organizationally and academically. For kids with ADHD, managing their time and school materials can be a huge issue-not leaving enough time to study or complete projects, forgetting to use their planner, losing track of assignments. Materially, their backpacks may be a disaster, notes Michael Rosenthal, PhD, a neuropsychologist. Specific skills like studying, memorizing, note-taking, and doing assignments on time can all be addressed.

And executive functions apply to academics, as well as managing homework, explains Dr. Rosenthal. Reading, writing and math all involve skills kids may be weak in. A middle schooler might be a perfectly fluent reader, he explains, but at the same time have difficulty capturing the point of each paragraph or summarizing what they've read. Writing requires organizing thoughts into a narrative, imagining what the intended audience needs to know, staying on topic, and writing to a chosen length, among other skills. Math requires multi-step operations, and word problems require extracting the information important to solve the problem. These are all skills that educational therapists can focus on with children to strengthen their learning strategies.

Spelling out the rationale

While a child is learning new skills, they need to understand how they will help them. "Kids with attention problems, in particular, are very pragmatic in a way about how much effort to put into things," explains Matthew Cruger, PhD, director of the Child Mind Institute's Learning and Development Center. "We think of it as 'neuroeconomics' - they save their energy for things they are confident will pay off." A good educational therapist will structure skill building so that kids score successes. "When kids put hard work into something, they expect a return, and if they don't see the return, it's doubly frustrating," says Dr. Cruger. "They'll think, 'You see, it wasn't a good idea to try.'"

The bottom line

The frustrating thing about behavioral interventions like parent training and Daily Report Card is that they are labor-intensive for parents and teachers, in addition to the kids themselves. "Parents may have the preconception that when they bring a child for therapy the child is going to be doing the work," notes Jill Emanuele, PhD, Senior Director of the Mood Disorders Center at the Child Mind Institute. "But this takes a huge investment on the part of parents." On the other hand, she adds, "the training can be a huge help to parents, too, who often come to us feeling burned out and ineffective in handling these kids. They develop a lot of confidence."

There is evidence that these parent and teacher-based interventions do improve the outcome for children with ADHD, though they don't directly affect symptoms. "Ideally, these environmental adjustments will alter the developmental trajectory of the child or adolescent with ADHD," explains ADHD specialist Russell Barkley, PhD. "However, such interventions are not expected to produce fundamental changes in the underlying deficits of ADHD, rather they only prevent an accumulation of failures and problems secondary to ADHD."

The strongest gains, Dr. Barkley notes, are in children who are particularly defiant or oppositional. "Thus, researchers and clinicians should anticipate," he notes, "that long-term studies are more likely to find treatment effects on problems secondary to ADHD than on deficits specific to ADHD."

Teenagers with ADHD

Once children with ADHD reach adolescence, there is less evidence for the effectiveness of behavioral training. Several studies have failed to show results for cognitive behavioral therapy for teens with ADHD, Dr. Barkley explains, but CBT does have a role for kids with ADHD who develop secondary problems like conduct disorder and oppositional defiant disorder.

And Dr. Emanuele notes that since ADHD puts kids at risk for developing an anxiety or mood disorder, many of them are treated with CBT for those disorders. In some cases, she notes, kids have actually outgrown their ADHD symptoms but they're still struggling.

Frequently Asked Questions

Is there behavior therapy for kids with ADHD?

What are the types of non-drug ADHD therapies for kids?

What is the treatment for kids with ADHD?

# data[].attributes.attachment_link.title
Behavioral Treatments for Kids With ADHD - Child Mind Institute

# data[].attributes.attachment_link.description
Learn behavioral treatments for ADHD in children. Child Mind Institute explains how study strategies and behavior training can help kids stay organized and control behaviors.