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Bardick, A. & Bernes, K. (2005). A closer look at Bipolar Disorder in children. Retrieved from https://www.schoolcounselor.org/asca/media/asca/ASCAU/Mental-Health-Specialist/CauseForConcern.pdf

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What it's like Living with Schizophrenia/Schizoaffective Disorder

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In the midst of hectic schedules, remembering to take care of our emotional well-being sometimes falls to the bottom of our priority list. This is especially true for children, who aren't yet aware of how important their mental health is. Even with exposure to this concept, mental health is complex and overwhelming. While trying to navigate the trials and tribulations of growing up, expecting your child to be mindful of fitting in mental health promotion into their day can be a reach.

Nearly of children in the US have a diagnosable mental health condition - an emotional or behavioral disorder that gets in the way of them living their best life and reaching their full potential. And, some suggest that these numbers are increasing. Now more than ever, there is a clear need for taking precaution with your child's mental health , which can begin with their personal routine.

Healthy routines build coping skills and mindsets that promote resiliency as children develop. Think of these positive, early habits as "vaccinations" for the soul; they can help prevent or ameliorate a more serious mental health condition from developing.

Since the concept of self-care is still too complicated for most children to understand, it's important for parents and other adult caregivers to figure out ways to seamlessly incorporate it into their week. There are a variety of activities that you and your child can do that provide significant mind and body benefits without feeling like an intense, therapeutic routine..
1.) Create a Winning Family Routine
Children crave structure and a successful family contributes to the well being of the entire household. Routines give children a sense of security and predictability limits anxiety, making transitions throughout the day easier and limiting power struggles. Regular daily routines that emphasize consistent wake up, eating, homework, bedtime, play, and chore schedules will provide the structure they need to understand and predict their world.

One of the overlooked elements of family routines for children, however, is building in "slow down" time. And regular, built in "slow down" time during the day allows children to learn how to make mindful choices. Even the youngest of children can integrate mindfulness into their "slow down" time with activities like yoga and deep breathing, routines that can help wire their brain for success .
2.) Focus on Sleep
is one of the most crucial ingredients for learning, performance and mental health and good sleep starts with a consistent and early bedtime. The hours of sleep before midnight lend themselves to more deep non-REM sleep, making them much more beneficial for young children, so sticking with an early bedtime of 7-8pm provides children with more deep sleep and higher levels of concentration the next day. Sleep deprivation is a huge contributor of mental health issues for children, especially teenagers. Even the typical teenager requires 9 hours of sleep each night, and while activities may dictate the need for a slightly later bedtime, ensuring a full night of rest will go a long way in helping teenagers' mood and academic performance .
3.) Get healthy together 4.) When in doubt, write it out
For some, verbalizing emotions can difficult. This could be due to an inability to understand how to articulate certain, confusing feelings, or just because saying them aloud is intimidating and vulnerable.

Identifying and expressing feelings is something that needs to be , and this can be acquired as early as age 3. Helping children to verbalize emotions is as simple as teaching feeling words and discussing the emotions of characters in your child's favorite stories. These simple strategies can go a long way in benefitting your child's social relationships and help seeking behaviors . Children who use emotion-related words were found to be better-liked by their classmates . And the ability to use words to express emotions gives young children a valuable tool in gaining the assistance or social support of others .

J ournaling is an excellent practice to introduce to your child around the age of 6-7 , as it provides a private space in which they can write out their thoughts and work through them. Expressive writing like journaling helps to manage and reduce stress by allowing your child to map out their emotions and make sense of what they are experiencing. This can help them explore solutions to their life challenges and prioritize certain aspects that are causing them the most stress.
5.) Express yourself (creatively)
is a practice that is both mentally and physically Art therapy beneficial to individuals of all ages. Through creativity, the practice enables your child to reconnect with their emotions and work towards understanding them. This provides significant cognitive support, leading to stronger mental health, as well as physical benefits due to its relaxing properties. Practices like painting, coloring, or molding clay won't appear as a chore to your child, motivating them to work on their mental health!

Bring music into the mix: encouraging your child to practice creating music, whether it be through songwriting or playing an instrument, will help with cognitive development, which can lead to a greater sense of self-awareness. Helping your child remain connected with their emotions will make coping with mental health concerns an easier feat.

In general, listening to music can have a tremendously positive impact on your child's mental health. Music, through its rhythmic appeal, engages your child's brain, specifically the neocortex, which reduces stress and lowers impulsivity . If your child is struggling with severe anxiety or depressive episodes, play softer or more uplifting music to counter these dips in mood.

Dance: In addition to art and music, expressive therapies such as dance can be impactful resources for your child's mental health promotion. Performing arts serve as powerful outlets for expressing emotion in a healthy and constructive way, and the opportunity to be creative will motivate your child to fit it into their self-care routine. is particularly beneficial due to the brain's response to aerobic exercise. As your child dances through their emotions, they will also be elevating their endorphins, which boosts their mood!

One of the overlooked elements of family routines for children, however, is building in "slow down" time. And regular, built in "slow down" time during the day allows children to learn how to make mindful choices. Even the youngest of children can integrate mindfulness into their "slow down" time with activities like yoga and deep breathing, routines that can help wire their brain for success .

6.) Play to promote mental health
Ample time for "play" is one of the most important ingredients in healthy child (and adult) development. Play provides opportunities to think creatively, engage with others, and regulate impulses.

Regular doses of play that involve physical activity and exercise should be incorporated into your child's routine, as this is an excellent way to tap into endorphins and boost their mood. Engaging in physical activity , especially outdoors, can help your child release stress that may have built up in their body. Taking this time outside in has been found to specifically reduce depression. Carve out time in the week to go on a hike or walk around the neighborhood. If your child prefers to be a part of organized sports, find an opportunity in the area for them to join a league. The socialization will give them additional mental health benefits!
7.) Foster social skills
Just like adults, young people need to feel a sense of belonging in order to thrive. Feeling like you're part of the something larger than oneself is key when it comes to mental health. Some children may fill their cup by having a few close friends, whereas others will feel most alive when engaging regularly in larger group activities. Figure out what works best for your child, recognizing and honoring their particular personality style, strengths and vulnerabilities.

As a parent, you can be mindful of modeling prosocial behavior within your family and community. You can also introduce social skill building activities that may benefit your child. For example, check out this list of 17 evidence-based " " from Gwen Dewar, PhD., of ParentingScience.com. Even if your child appears to have a high Social skills activities for children and teens EQ (social-emotional intelligence quotient), the growing never stops; there's always more to learn about being a thoughtful, compassionate, and connected human being...especially during these times of socio-cultural division and potential for .

Most problems in life cannot be solved with formulae or memorized answers of the type learnt in school. They require the judgment, wisdom and creative ability that come from life experiences. For children, those experiences are embedded in play. -Peter Gray, Ph.D., Bio-Psychologist
8.) Collaborate on screen time
What children are watching and playing also needs to be developmentally appropriate and consistent with your families values. It can be hard to monitor everything your child sees on screen, but there are resources to help you better understand the media your child has access to. Common Sense Media is a comprehensive online resource for parents that rates movies, tv shows and video games by developmental age. It also provides a comprehensive review of the content, including levels of sex, violence, drugs/alcohol references and consumerism, so that you can discuss the content with your child after watching.

The American Academy of Pediatrics recommends creating a "Family Media Plan" - a joint collaboration among caregivers and children that reflects on the pros and cons of media usage as individuals and a family. You can try their free tools known as "Create Your Family Media Plan" and "Media Time Calculator" at healthychildren.org .
In Conclusion
Talk to your child to introduce the concept of self-care and explore what types of activities they'd like to include in their routine. Creating a routine of self-care activities that they look forward to doing is key to encouraging them to place their mental health first!

We also recommend that you regularly consult with your family doctor, child's teachers, and other key figures in their life on how they're doing and ways to enhance their mental well-being. Below is some additional, important information from the National Institute for Mental Health (NIMH) about children and mental health.

"** Children and Mental Health - Points to Remember (from the )

Always seek immediate help if a child engages in unsafe behavior or talks about wanting to hurt him or herself or someone else.

Seek help when a child's behavior or emotional difficulties last for more than a few weeks and are causing problems at school, at home, or with friends.

A thorough evaluation can help determine if treatment is necessary, and which treatments may be most effective.

Early treatment can help address a child's current difficulties and can also help prevent more serious problems in the future.

When to Seek Help

Even under the best of circumstances, it can be hard to tell the difference between challenging behaviors and emotions that are consistent with typical child development and those that are cause for concern. It is important to remember that many disorders like anxiety, attention deficit hyperactivity disorder and depression, do occur during childhood. In fact, many adults who seek treatment reflect back on how these disorders affected their childhood and wish that they had received help sooner. In general, if a child's behavior persists for a few weeks or longer, causes distress for the child or the child's family, and interferes with functioning at school, at home, or with friends, then consider seeking help. If a child's behavior is unsafe, or if a child talks about wanting to hurt him or herself or someone else, then seek help immediately.

Young children may benefit from an evaluation and treatment if they:

Have frequent tantrums or are intensely irritable much of the time

Often talk about fears or worries

Complain about frequent stomach aches or headaches with no known medical cause

Are in constant motion and cannot sit quietly ( when they are watching videos or playing video games)

Sleep too much or too little, have frequent nightmares, or seem sleepy during the day

Are not interested in playing with other children or have difficulty making friends

Struggle academically or have experienced a recent decline in grades

Repeat actions or check things many times out of fear that something bad may happen.

Older children and adolescents may benefit from an evaluation if they:

Have lost interest in things that they used to enjoy

Have low energy

Sleep too much or too little, or seem sleepy throughout the day

Are spending more and more time alone, and avoid social activities with friends or family

Fear gaining weight, or diet or exercise excessively

Engage in self-harm behaviors (e.g., cutting or burning their skin)

Smoke, drink, or use drugs

Engage in risky or destructive behavior alone or with friends

Have thoughts of suicide

Have periods of highly elevated energy and activity, and require much less sleep than usual

Say that they think someone is trying to control their mind or that they hear things that other people cannot hear.

First Steps for Parents

If you are concerned about your child, where do you begin?

Talk with your child's teacher. What is the child's behavior like in school, daycare, or on the playground?

Talk with your child's pediatrician. Describe the behavior, and report what you have observed and learned from talking with others.

Ask for a referral to a mental health professional who has experience and expertise dealing with children.**"

**Source: https://www.nimh.nih.gov/health/publications/children-and-mental-health/index.shtml#pub2
Contributor: this article was a collaboration between Jumo Health and HealthyPsych. Jumo Health is an organization based in London and NYC, that produces health resources for children and families in 50 countries and 30 languages. Disclaimer: the content provided here and throughout HealthyPsych.com is for informational purposes only and is not intended as medical advice. Please consult directly with your medical provider on your specific needs. Our full disclaimer and terms of use can be found here: Terms of Use.

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Self-Care for Kids: 8 Practical Ways to Promote your Child's Mental Health on a Daily Basis

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In the midst of hectic schedules, remembering to take care of our emotional well-being sometimes falls to the bottom of our priority list. This is especially true for children, who aren't yet aware of how important their mental health is. Even with exposure to this concept, mental health is complex and overwhelming.

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What Symptoms Should You Look for?

Schizophrenia is the most chronic and debilitating of all psychiatric conditions. It is also the most widespread form of psychosis.

The symptoms of childhood onset schizophrenia are essentially the same as adult symptoms, but the degree of impairment tends to be greater when symptoms appear early in life. Symptoms can have a profound impact on a child's behavior and development.

Symptoms of schizophrenia vary depending on the age of the child. The earliest indications of childhood schizophrenia may include developmental problems, such as:

Language delays

Late or unusual crawling

Late walking

Other abnormal motor behaviors - for example, rocking or arm flapping

Some of these signs and symptoms are also common in children with developmental disorders such as autism. That's why one of the first steps in diagnosing psychosis is ruling out developmental disorders.

In teenagers, schizophrenia's symptoms are closer to those found in adults. Isolating those symptoms can still be a challenge, as some of the early symptoms of schizophrenia in teenagers are common for typical development during the teen years. These symptoms include:

Withdrawal from friends and family

A drop off in performance at school

Trouble sleeping

Irritability or depressed mood

Lack of motivation

Strange behavior

Substance use

Compared with the symptoms of schizophrenia in adults, teens may be:

Less likely to have delusions

More likely to have visual hallucinations

As young people with schizophrenia pass through their teen years, typical symptoms of the disorder begin to appear. These may include:

Delusions. These are false beliefs that are not based in reality. Delusions occur in most people with schizophrenia.

Hallucinations. These usually involve seeing or hearing things that don't exist. Hearing voices is the most common hallucination.

Disorganized thinking. Effective communication can be impaired, and answers to questions may be partially or completely unrelated.

Extremely disorganized or abnormal motor behavior. This behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.

Negative symptoms. This refers to a reduced ability or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion. Also, the person may have reduced ability to engage in activities, such as a loss of interest in everyday activities, social withdrawal or the lack of ability to experience pleasure.

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Schizophrenia is the most chronic and debilitating of all psychiatric conditions. It is also the most widespread form of psychosis. The symptoms of childhood onset schizophrenia are essentially the same as adult symptoms, but the degree of impairment tends to be greater when symptoms appear early in life.

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Behavioral disorders also known as conduct disorders are one of the most common forms of disability among children and young adults and is the most frequently cited reason for referral to mental health services. The appearance of behavioral disorders is increasing dramatically in our K-12 classrooms. As a result, their presence severely constrains the ability of the school systems to educate students effectively. The prevalence of behavioral problems among children and young adults is substantial. Many surveys indicate that behavioral disorders vary among young adults, ranging from 2 and 6 percent among K-12 students. This percentage translates into 1.3 to 3.8 million cases of behavioral disorders among the school and pre-college population.

Behavior disorders have also been referred to in a variety of different terminologies, including but not limited to:

1. Emotional and Behavior Disorders (EBD)

2. Emotional Conflict (EC)

3. Serious Emotional Disturbance (SED)

Behavioral disorders become apparent when the student displays a repetitive and impact persistent pattern of behavior that results in the significant disruption of other students. Such disturbances may cause significant impairments in academic, social, and or occupational functioning. Among the characteristics of a behavioral disorder among children and adolescents are:

General Strategies

Multidisciplinary educational teams, including parents, must design programs to meet the individual behavioral and academic needs of identified SED students. Most students can benefit from supportive treatments provided in general education programs. For others, at least temporary placements in special education classrooms, schools, or institutional programs may be appropriate.

Special education programs usually attempt to provide a structured environment where students experience a high degree of success; rules and routines are predictable; and students are consistently rewarded for appropriate behavior. Behavior management techniques, such as positive reinforcement, token economies, contracting, and time-out, which rely on direct measurement and monitoring of behavioral change, are commonly used in SED programs. The assessment and systematic teaching of social skills through modeling, discussion, and rehearsal are frequently used to help students increase control over their behavior and improve their relations with others. In addition, supportive therapies involving music, art, exercise, and relaxation techniques, as well as affective education, individual, and group counseling are sometimes employed to improve self-understanding, self-esteem, and self-control. The following are strategies that may be effective with students with EBD:

Teacher Presentation

Laboratory

Group Interaction and Discussion

1. Acknowledge the contributions of the student with an emotional disorder.

2. Call for responses and participation commensurate with the student's socialization skills.

3. As the student's comfort level rises and when a safe topic is available, encourage the student to be a group spokesperson.

4. Along with the student, devise a contingency plan in which inappropriate forms of response are replaced by appropriate ones.

5. Gradually increase the challenges in the student's participation in group exercises while providing increased positive reinforcement.

6. Help the student to feel as though he or she has something worthwhile to contribute to the discussion.

7. Some students may experience considerable strain in social adjustment in a group context. It may be necessary to work gradually toward group activities. One can devise a strategy of progressing from spectatorship to one-to-one instruction and eventually to small group discussion.

8. Should monitor carefully to ensure that the nondisabled students do not dominate the discussion or detract in any way from the successful performance of the student with the behavioral disorder.

Reading

1. It is necessary to target specific pro-social behaviors for appropriate instruction and assessment to occur such as:

1. Taking turns, working with partner, following directions.

2. Reading in group or with others.

3. Increasing positive relationships by means of awards when they read appropriately.

4. Demonstrating appropriate reading

2. Instructional strategies involving self-control, self-reinforcement, self-monitoring, self-management, problem solving, cognitive behavior modification, and metacognitive skills should be focused on teaching students reading skills

Research

1. Review and discuss with the student the steps involved in a research activity. Think about which step(s) may be difficult for the specific functional limitations of the student and jointly devise accommodations for that student.

2. Use appropriate laboratory and field strategies.

3. Depending on the site of the research check the previous two sections.

4. Show clear examples of what the students should expect as an outcome of their research.

Field Experiences

1. Use appropriate general strategies.

2. Consider alternate activities/exercises that can be utilized with less difficulty for the student, but has the same or similar learning objectives.

3. In field activities acknowledge the contributions and assistance of the student with an emotional disorder.

4. Help the student to feel as though he or she has something worthwhile to contribute to the field trip.

5. Use a buddy system.

6. Gradually increase the challenges in the student's participation in field exercises while providing increased positive reinforcement.

7. Group participation in field activities is highly desirable because it enhances social contacts.

8. Make the student with the behavioral disorder become one of the field trip leader of an activity which can often reduce their disorder.

9. Special efforts should be made to get students with behavioral disorders to interact with other students.

10. You should encourage students to practice field skills during their free hours.

11. Every effort should be made to arouse the interest of such students in activities, so they will learn to perform the activities with success and pleasure with appropriate behaviors.

Testing

1. Be sensitive to the student's reactions to the various aspects of assessment.

2. For each student, accumulate in his or her portfolio several examples of work (quizzes, assignments, projects) that demonstrate knowledge of the subject matter or the unit of study.

3. Make special arrangements for the student with an emotional disorder according to what their special needs are and that they do not compromise the integrity of the testing situation.

4. Stay on top of student progress through informal assessment, don't wait until it's too late to discover that there is a problem.

5. Provide private room/smaller group setting/alternative test site (with proctor present); alternatively screens to block out distractions.

Organizations

Council for Exceptional Children-Council for Children with Behavior Disorders (CCBD)
The Council for Children with Behavioral Disorders (CCBD) is dedicated to supporting the professional development and enhancing the expertise of those who work on behalf of children with challenging behavior and their families. It is a division of the Council for Exceptional Children (CEC).

CCBD Foundation
The CCBD Foundation was founded in 1997 by the Council for Children with Behavioral Disorders (CCBD), to support its mission of improving the education of children and youth with emotional or behavioral disorders (EBD).

Resources

Council for Exceptional Children (Behavior Disorders/Emotional Disturbance)
The Council for Exceptional Children (CEC) page on EBD. The Council for Exceptional Children (CEC) is the largest international professional organization dedicated to improving the educational success of individuals with disabilities and/or gifts and talents.

BehaviorDisorder.org
The site offers information on behavior disorders, conduct disorders, and other behavior problems.

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Behavioral disorders also known as conduct disorders are one of the most common forms of disability among children and young adults and is the most frequently cited reason for referral to mental health services. The appearance of behavioral disorders is increasing dramatically in our K-12 classrooms. As a result, their presence severely constrains the ability of the school systems to educate students effectively.

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All kids have their ups and downs, but if your child is unusually irritable, sad or withdrawn for a prolonged period of time she may be showing signs of depression. Depression is more than moodiness - it can affect all parts of a child's life, including behavior, appetite, energy level, sleep patterns, relationships and academic performance. In this section you'll find expert information on spotting and understanding different kinds of depression in children and adolescents, and how to get the most effective treatment for your child.

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Childhood and Teen Depression | Child Mind Institute

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All kids have their ups and downs, but if your child is unusually irritable, sad or withdrawn for a prolonged period of time she may be showing signs of depression. Depression is more than moodiness - it can affect all parts of a child's life, including behavior, appetite, energy level, sleep patterns, relationships and academic performance.

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Parent Resources for a child with anxiety

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Parent Resources for a child with anxiety

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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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From Dr. Tamar Chansky Creator of Worrywisekids.org

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Eating Disorders in Teens

In the United States, as many as 10 in 100 young women suffer from an eating disorder. Disordered eating related to stress, poor nutritional habits, and food fads are relatively common problems for youth. In addition, two psychiatric eating disorders, anorexia nervosa and bulimia, are on the increase among teenage girls and young women and often run in families. These two eating disorders also occur in boys, but less often.

Parents frequently wonder how to identify symptoms of anorexia nervosa and bulimia. These disorders are characterized by a preoccupation with food and a distortion of body image. Unfortunately, many teenagers hide these serious and sometimes fatal disorders from their families and friends.

Symptoms and warning signs of anorexia nervosa and bulimia include the following:

A teenager with anorexia nervosa is typically female, and a perfectionist and a high achiever in school. At the same time, she suffers from low self-esteem, irrationally believing she is fat regardless of how thin she becomes. Desperately needing a feeling of mastery over her life, the teenager with anorexia nervosa experiences a sense of control only when she says "no" to the normal food demands of her body. In a relentless pursuit to be thin, the girl starves herself. This often reaches the point of serious damage to the body, and in a small number of cases may lead to death.

The symptoms of bulimia are usually different from those of anorexia nervosa. The patient binges on large quantities of high-caloric food and/or purges her body of dreaded calories by self-induced vomiting, extreme exercise, or laxatives. The binges may alternate with severe diets, resulting in dramatic weight fluctuations. Teenagers may try to hide the signs of throwing up by runing water while spending long periods of time in the bathroom. Frequent vomiting can cause a serious threat to the patient's physical health, including dehydration, hormonal imbalance, the depletion of important minerals, and damage to vital organs.

Binge eating can also occur on its own without the purging of bulimia and can lead to eventual purging. Children with binge eating disorder also require treatment from a mental health professional.

Avoidant/Restrictive Food Intake Disorder (or ARFID) is another eating disorder which can occur in younger children or adolescents. It involves a disturbance in eating or feeding which includes substantial weight loss or a lack of expected weight gain, and nutritional deficiencies. ARFID can lead to dependence on a feeding tube or dietary supplements.

With comprehensive treatment, most children and teenagers can recover from disordered eating. The child and adolescent psychiatrist is trained to evaluate, diagnose, and treat these psychiatric disorders. Treatment for eating disorders usually requires a team approach, including individual therapy, family therapy, working with a primary care physician, working with a nutritionist, and medication. Many children and adolescents also suffer from other problems including depression, anxiety, and substance abuse. It is important to recognize and get appropriate treatment for these problems as well.

Research shows that early identification and treatment leads to more favorable outcomes. Parents who notice symptoms of anorexia or bulimia in their teenagers should ask their family physician or pediatrician for a referral to a child and adolescent psychiatrist.

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medical issues affecting youth mental health

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Eating Disorders in Teens In the United States, as many as 10 in 100 young women suffer from an eating disorder. Disordered eating related to stress, poor nutritional habits, and food fads are relatively common problems for youth.

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ADHD & the Brain

No. 121; February 2017

Attention-Deficit/Hyperactivity Disorder (ADHD) is a condition where people have difficulty with inattention, hyperactivity, impulsivity, regulating their mood, and organization. For example, a child or teen with ADHD may have trouble in school and home with paying attention, concentrating, losing things, following directions, sitting still, acting without thinking, or getting mad and frustrated easily.

ADHD is a brain disorder. Scientists have shown that there are differences in the brains of children with ADHD and that some of these differences change as a child ages and matures.

Brain Structure
Research has shown that some structures in the brain in children with ADHD can be smaller than those areas of the brain in children without ADHD.

The brain is an organ that controls thinking, feeling, and behavior. The brain is divided into sections called lobes.

The front of the brain behind the forehead is the frontal lobe. The frontal lobe is the part of the brain that helps people to organize, plan, pay attention, and make decisions. Parts of the frontal lobe may mature a few years later in people with ADHD.

The frontal lobe is the area of the brain responsible for:

Problem Solving

Memory

Language

Motivation

Judgment

Impulse control

Social behavior

Planning

Decision-making

Attention

Ability to delay gratification

Time perception

Networks
The brain is made up of nerve cells called neurons that transmit signals in the brain. Signals travel through the brain in groups of nerve cells called "networks." Researchers have identified several major networks that work differently in people with ADHD. These networks are involved in reward, focus, planning, attention, shifting between tasks, and movement.

Neurotransmitters
There are chemicals that help to transmit signals from one nerve cell to the next throughout the networks in the brain. These chemicals are called neurotransmitters. Dopamine and norepinephrine are two neurotransmitters that may play a role in ADHD.

While scientists have shown that there are differences in the brain size, networks, neurotransmitters, and brain development of children with ADHD, they do not fully understand how these differences lead to the cause and the symptoms of ADHD. Treatments for ADHD are thought to work in part by altering the levels of the neurotransmitters and changing how the networks function.

If your child has problems with attention, hyperactivity, or impulsivity, talk to your pediatrician or family doctor. They can perform an evaluation and start treatment or help with a referral to a qualified mental health professional.

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Attention Deficit Hyperactivity Disorder (ADHD) is a condition where people have difficulty with inattention, hyperactivity, impulsivity, regulating their mood and organization.

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Parent Resources for children with disabilities

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Parent Resources for children with disabilities

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Finding the motivation to make positive lifestyle changes can be hard for anyone. For teenagers, it can be especially difficult when parents are the ones telling them to do it. But if they've fallen into unhealthy habits like vaping or alcohol abuse, change can be beneficial. Motivational interviewing is a form of therapy that creates a safe, non-judgmental environment for teens to establish their own goals and values and see how changing unhealthy behaviors can benefit them in the long run.

This series of articles comes from the Child Mind Institute, with most available in English and Spanish. Why might teens be resistant to therapy and how can parents and others to help them get the treatment they need? The articles explain how motivational interviewing can help teens gain the self-confidence to make important behavioral changes. To read more about motivational interviewing, and to connect with the articles in both English and Spanish, please visit CPIR's abstract.

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Center for Parent Information and Resources | Your Central Hub for Parent Centers Serving Families of Children With Disabilities

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Finding the motivation to make positive lifestyle changes can be hard for anyone. For teenagers, it can be especially difficult when parents are the ones telling them to do it. But if they've fallen into unhealthy habits like vaping or alcohol abuse, change can be beneficial.

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Parent Resources about dysfunctional behaviors

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Parent Resources about dysfunctional behaviors

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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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Hi, my name is Lauren and I live with schizophrenia/schizoaffective disorder. This is a channel dedicated to increasing knowledge around schizophrenia, schiz...

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Bipolar disorders, or manic-depressive illness, is a group of disorders characterized by the presence of pronounced high-energy phases known as manic episodes. Typically, unusual shifts in mood and energy manifest in increased activity levels and impair ability to function. The impairment created by bipolar disorder can be severe and can result in damaged relationships, poor job or school performance, and even suicide.

There are several different types of bipolar disorder. Bipolar I disorder refers to a condition in which an individual experiences a full-blown manic episode for at least one week and may or may not also experience depression. The manic symptoms may be so severe that hospitalization is required. Bipolar II refers to the presence of a current or past hypomanic episode, which is a slightly less severe form of mania lasting at least four consecutive days, as well as the presence of a current or past episode of major depression. Cyclothymic disorder, or cyclothymia, refers to recurring hypomanic and depressive mood shifts over at least a two-year period in adults.

According to the National Institute of Mental Health, an estimated 4.4 percent of adults in the United States experience a bipolar disorder at some point in their lifetime. The condition occurs with equal frequency among males and females. The median age of onset is 25 years. Nevertheless, a bipolar disorder may begin in childhood or may have its onset late in life. Bipolar disorders are typically chronic conditions and require lifelong management. More than 90 percent of people who have a single manic episode go on to have recurrent episodes of mania or depression.

People experiencing a manic episode are often described as excessively cheerful or "feeling on top of the world." Often, however, the dominant mood during a manic episode is irritability. Additionally, persons experiencing mania may display suddenly inflated self-esteem, decreased need for sleep, talkativeness and distractibility, and often engage in activities that have high potential for painful consequences (gambling, heavy spending, sexual indiscretions). Hypomania is similar to mania in that the disturbance in mood and the change in functioning are observable by others, but the episode is not severe enough to cause major impairment in social or occupational functioning or to require hospitalization.

During a manic episode, an person may start multiple new projects and feel that they are capable of accomplishing anything, regardless of their level of experience or talent. One of the most common features of mania is a decreased need for sleep; a person might go days without sleep, yet not feel tired. Often, a manic person's thoughts race faster than they can be expressed; the result may be abrupt shifts in topic and pressured and incoherent speech. Sometimes during a manic episode people display hostility and angry tirades, particularly if an attempt is made to interrupt them.

Children who are at risk for bipolar disorder (because a parent has the disorder) display a developmental sequence beginning with symptoms that are not specific to bipolar disorder, notably sleep problems and anxiety. The condition progresses from minor mood disorder to major depressive disorder in adolescence, with full-blown bipolar disorder developing in the transition to adulthood, typically with an episode of mania or hypomania or a first episode of psychosis following an episode of depression.

It is characteristic of the condition that those who are experiencing mania do not perceive that they are ill or in need of treatment and resist engaging with treatment. Diagnosis and treatment are incredibly important; the lifetime risk of suicide among individuals with bipolar disorder is at least 15 times that of the general population. Bipolar disorder is often not recognized, or may be confused with other conditions, and people may suffer for years before they receive appropriate treatment.

Symptoms

According to the DSM-5, a manic episode is manifest in an excessively euphoric, expansive, or irritable mood for most of a day, every day for at least a week, and is accompanied by abnormally and persistently increased activity and energy. In addition, three (or four if the dominant mood is irritability) of the following signs must be present

Inflated self-esteem or grandiosity, including unrealistic beliefs in one's abilities and powers

Decreased need for sleep

Unusual talkativeness or pressure to keep talking

Flight of ideas or the sense that thoughts are racing

Distractibility

Increased goal-directed activity, such as work or school projects, or purposeless activity (psychomotor agitation)

Involvement in activities that are likely to to have painful consequences, such as buying sprees, sexual indiscretions, poor business investments.

In addition, the mood disturbance is sufficient to cause significant impairment in social or occupational functioning or to require hospitalization to prevent self-harm, or because there are psychotic features.

What's more, the episode is not explainable by ingestion of a medication, drug of abuse, or medical condition.

The more moderate form of mania, called hypomania, similarly involves an unequivocal change in functioning, albeit for four or more days, but there is typically not significant social or occupational impairment. Indeed, the person may feel good and highly productive, making it difficult for the person or those around him or her to identify a hypomanic episode.

Bipolar disorders are typically marked by the occurrence of at least one depressive episode. A depressive episode is characterized by depressed mood, or loss of pleasure or interest, or feelings of hopelessness for at least two weeks. According to the DSM-5, at least five of the following symptoms are also present:

The sad, anxious, or empty mood is present most of the day, every day

Loss of interest or pleasure in all or most activities is present most of the day, every day

Unintended weight gain or loss

Insomnia or excessive sleep

Observable restlessness (psychomotor agitation) or slowing down (psychomotor retardation)

Fatigue of less of energy nearly every day

Feelings of guilt or worthlessness

Diminished ability to concentrate, or indecisiveness

Recurrent thoughts of death or suicide, or suicide attempts

the symptoms cause distress or impairment in functioning. And They are not due to the effects of a substance or medical condition.

Sometimes, severe episodes of mania or depression include symptoms of psychosis. Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the president or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. For this reason, bipolar disorder is sometimes incorrectly diagnosed as schizophrenia.

In some people, however, symptoms of mania and depression may occur together in what is called bipolar disorder with mixed features. Symptoms of mixed features often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.

Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention from a health professional. Talk about suicide should be taken seriously. Risk for suicide appears to be higher early in the course of the illness. Recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Episodes of mania and depression typically recur across the life span. Between episodes, most people with a bipolar disorder are free of symptoms, but as many as one-third have some residual symptoms. A small percentage experience chronic unremitting symptoms despite treatment.

When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than men.

People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated. Without treatment, however, mood cycling can increase in frequency and severity.

Both children and adolescents can develop bipolar disorder; the condition is most likely to affect the children of parents who have the illness. Children and young adolescents often experience very fast mood swings between depression and mania multiple times a day. Mania in children is most likely to manifest as irritability with proneness to destructive tantrums. The occurrence of mixed symptoms is also common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.

Bipolar disorder in children and adolescents can be hard to distinguish from other problems that may occur in these age groups. Irritability and aggressiveness can also be symptoms of attention-deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder.

Alcohol and drug abuse are very common among people with bipolar disorder. Many factors may contribute to the substance abuse problems, including self-medication of symptoms; nevertheless, mood symptoms can be brought on or perpetuated by substance abuse. There may exist risk factors that influence the occurrence of both bipolar disorder and substance-use disorders. Co-occurring substance abuse, when present, is an important part of an overall treatment plan.

Anxiety disorders, such as panic attacks and social anxiety disorder, also may co-occur in people with bipolar disorder, and they may respond to treatments used for bipolar disorder or they may require separate treatment.

Causes

The cause of bipolar disorder is the subject of much research, and the consensus among scientists is that there is no single cause. Rather, many factors act together to produce the illness.

Genetics play a role. One of the strongest risk factors for developing bipolar disorder is having a family history of the illness: Risk of the condition is increased 10-fold among adult relatives of individuals with bipolar I and bipolar II disorders. However, no specific genes have been linked to the condition. Rather, as with many other mental illnesses, multiple genes, each with a small effect, contribute to the likelihood of developing the disorder. There is some evidence that mood, anxiety and psychotic disorders occur with greater frequency in the families of those with bipolar disorders than in the general population. Studies of identical twins, who share all the same genes, indicate that factors other than genes-such as highly stressful events-also play a role in precipitating bipolar disorder. Many genes likely act together in combination with factors in a person's environment.

Brain-imaging studies show that the brains of people with bipolar disorders may differ from those of healthy individuals. For example, researchers have identified several brain regions marked by reduced thickness of the cortex. Other studies show that processing of sensory stimuli is impaired during episodes of mania and depression and may underlie errors in perception.

Treatment

Even in the most severe cases, bipolar disorders are highly treatable conditions. The sooner treatment begins, the greater the likelihood of reducing the severity and frequency of manic and depressive episodes. Because bipolar disorders are lifelong conditions, treatment is also lifelong and aimed not just at treating symptoms but also at preventing recurrence of symptoms. Most people with bipolar disorders can achieve substantial stabilization of their mood swings and related symptoms

The most effective treatment strategy combines medication and psychotherapy. In addition, patients are often instructed to keep a chart of daily mood symptoms, treatments, sleep patterns, and life events. Such tracking has been shown to help patients and their families to better understand and manage the illness; mood changes can often be spotted in time to prevent a full-blown episode. Even when there are no breaks in treatment, mood changes can occur and should be reported immediately to the doctor, who may make adjustments to the treatment plan.
Medications
While primary-care physicians who do not specialize in psychiatry may prescribe psychotropic medications, it is recommended that people with bipolar disorder see a psychiatrist for treatment. Several types of medication are commonly used the treat bipolar disorders.

Mood stabilizers are generally prescribed to control manic episodes. Lithium is perhaps the best-known mood stabilizer. The first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, it is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.Other types of mood stabilizer include the anticonvulsants lamotrigine (Lamictal), valproic acid (Depakene), divalproex sodium (Depakote), and carbemazepine (Tegretol and others). Valproate was FDA-approved in 1995 for treatment of mania.

Anticonvulsant medications may be combined with lithium, or with each other, for maximum effect. Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression.

Sometimes treatment with antidepressants results in mood-switching, prompting a manic or hypomanic episode or rapid cycling. Mood-stabilizing medications generally are required, alone or in combination with antidepressants, to protect agains such a switch.

Children and adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine are also used.

Women with bipolar disorder who wish to conceive or who become pregnant face special challenges due to possible effects of mood stabilizing medications on the developing fetus and the nursing infant. A skilled clinician can help such women weigh the benefits and risks of all available treatment options.

Antipsychotic medications are also often used to help control manic and depressive symptoms in bipolar disorder, and some help to stabilize mood as well. Antipsychotic drugs include olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal) among others.

If insomnia is a problem, a high-potency benzodiazepine medication such as clonazepam or lorazepam may be helpful. However, because these medications may be habit-forming, they are best prescribed short-term. Other types of sedative medications, such as zolpidem, are sometimes used instead.

Omega-3 fatty acids found in fish oil are under study for their usefulness, alone or when added to conventional medications, for long-term treatment of bipolar disorder.

Effective management of bipolar disorder may involve changes to the treatment plan at various times over the course of illness. Any changes in type or dose of medication should be made under the guidance of a psychiatrist. To avoid adverse reactions, patients should tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements they may be taking.

People with bipolar disorder, particularly those with rapid mood cycling, often have abnormal thyroid gland function. Because too much or too little thyroid hormone alone can lead to mood and energy changes, thyroid levels are usually carefully monitored by a physician. Lithium treatment may cause low thyroid levels in some people, resulting in the need for thyroid supplementation.

All medications have side effects. Depending on the medication, side effects may include weight gain, nausea, tremors, reduced sex drive, anxiety, hair loss, movement problems, or dry mouth. Getting the right balance of treatment benefits may require physician-monitored adjustment in dosage or type of medication. Medication should not be changed or stopped without the psychiatrist's guidance.
Psychotherapy
Studies have documented that several kinds of psychotherapy provided to patients and their families can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas. Psychotherapeutic interventions commonly used for bipolar disorder are cognitive behavioral therapy, psychoeducation, family therapy, and interpersonal and social rhythm therapy (IPSRT). IPSRT emphasizes the importance of establishing stable daily patters of sleeping and waking, as prolonged wakefulness is a known trigger for manic episodes.

A licensed psychologist, social worker, or counselor typically provides such therapies and often works in concert with the psychiatrist to monitor patient progress. Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness.

Psychoeducation involves teaching people with bipolar disorder about the condition and its treatment and how to recognize signs of relapse so that early intervention can be sought before a full-blown episode occurs. Psychoeducation is also often helpful for family members.

Family therapy helps reduce the level of family distress that may contribute to or result from the ill person's symptoms.

Interpersonal and social rhythm therapy help people with bipolar disorder both to improve relationships and to regulate daily routines. Maintaining a daily routine and sleep schedule can help protect against manic episodes.
Electroconvulsive Therapy
In critical situations, such as psychosis or suicidal thought, where medication, psychosocial treatment, and the combination of these interventions prove ineffective or work too slowly to relieve severe symptoms, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, or mixed episodes. The possibility of long-lasting memory problems has been significantly reduced with modern ECT techniques.

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

Miklowitz, David, The Bipolar Disorder Survival Guide, Third Edition, 2019, Guilford Press, 444p.

Joseph J. ShafferJr, Casey P. Johnson, Jess G. Fiedorowicz, Gary E. Christensen, John A. Wemmie, Vincent A. Magnotta. Impaired sensory processing measured by functional MRI in Bipolar disorder manic and depressed mood states. Brain Imaging and Behavior, June 2018.

National Institute of Mental Health

Duffy, A, Goodday, S, Keown-Stoneman, C, Grof, P. The Emergent Course of Bipolar Disorder: Observations Over Two Decades From the Canadian High-Risk Offspring Cohort, The American Journal of Psychiatry, December 2018.

National Institutes of Health

Centers for Disease Control and Prevention

Find a therapist who can help with bipolar disorder

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Bipolar disorders, or manic-depressive illness, is a group of disorders characterized by the presence of pronounced high-energy phases known as manic episodes. Typically, unusual shifts in mood and energy manifest in increased activity levels and impair ability to function.

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Bipolar Disorders in School Age Children- Research

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Bipolar Disorders in School Age Children- Research

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As the word suggests, bibliotherapy combines two of our favorite topics - reading and psychology - so it seemed a particularly appropriate topic to highlight in this post.

The term itself was coined only about a century ago by Samuel Crothers, a Unitarian minister who wrote an article in the Atlantic Monthly describing how relevant books could be used as an effective adjunct to medical or psychological treatment. However, the idea of bibliotherapy has existed from ancient times. The library at Thebes in ancient Greece had written over its door, "Healing place of the soul," and people have always instinctively recognized the power of stories to not only entertain and inform but also to comfort and guide.
What Is Bibliotherapy?
Bibliotherapy is most easily defined as facilitating psychological growth and healing through reading. Most people in the field recognize two distinct branches of bibliotherapy, though the exact dividing line between them is not easily drawn.

Developmental bibliotherapy is used mainly in community or educational settings, to help children or adults address common life issues. For example, Gregory and Vessay explain how school nurses can help children address issues of bullying through bibliotherapy, while a 2006 study by Frieswijk et al. demonstrated how bibliotherapy can positively affect self-care behaviors in somewhat frail, community-living seniors, thus decreasing their probability of future institutionalization.

Clinical or therapeutic bibliotherapy is the use of books in a professional therapy context to treat a diagnosed emotional disorder or ameliorate the negative life impact of a diagnosed emotional, mental or physical disorder. Therapeutic bibliotherapy is most often used as an adjunct to more traditional medical or psychological therapies, as in a just-reported study that successfully used poetry therapy to reduce anxiety and PTSD in patients recovering from a heart attack.

But it can be used as a stand-alone therapy as well, as it was in a 2004 study that compared the effectiveness of self-administered bibliotherapy with traditional short-term (12-20 sessions) psychotherapy for 60 older adults diagnosed with depression, and found both were equally effective in reducing clinician's ratings of depression, both immediately post-treatment and at a three-month follow-up.
How Is It Done?
Bibliotherapy is more of a general concept than a single, rigorously defined therapeutic method. As in the final example cited above, bibliotherapy can sometimes be as simple as "prescribing books" - that is, telling a student, client, or patient to read a particular book that you believe will help them. More often, bibliotherapy is facilitated through interaction with a helper or guide, either one-on-one, as in a counseling situation, or in a group of people who are dealing with similar issues and reading and responding to a text together.

The pioneering work of Sadie Peterson Delaney with World War I veterans at the VA Hospital in Tuskegee is an excellent example of both types. Delaney was a librarian by training, but bibliotherapy can also be successfully facilitated by many other helping professionals, including doctors, psychologists, social workers, school counselors, teachers, and community workers.

One can even practice bibliotherapy on oneself, as we suspect many avid readers do, returning to favorite books that they know will lift their spirits when life looks generally grey, or, more urgently, seeking written advice or inspiration to help them face significant life challenges, such as a cancer diagnosis or the loss of a loved one. Indeed, therapeutic texts can be of many different types: Narrative fiction is the original and traditional genre used in bibliotherapy, with poetry a close second, but self-help books are now just as popular, while biographies and memoirs can also be very helpful if written by or about someone who struggled with or triumphed over circumstances similar to those readers face.

Of course, therapeutic texts need not be complete books; short stories have been found effective in bibliotherapy, especially with participants whose attention span may be limited by age or cognitive impairment, while several practitioners have written about using comic books, and both teachers and therapists often use picture books to help young children develop and cope with difficult circumstances.
How Does It Work?
There is much discussion in the theoretical literature on bibliotherapy about whether its beneficial effects derive from the actual reading of the text itself or from the interaction, discussion, and sharing around the text that typically accompanies that reading. It seems likely the answer is both.

But most people in the field agree that the process works through the familiar therapeutic stages of identification, catharsis, and insight. In the first stage, the reader forms an affiliation with a character or characters in the text, identifying with their problems and goals. Catharsis comes about as the reader follows the characters through the text, experiencing from a safer, once-removed position their emotions, struggles, and hopes as they work toward the eventual resolution. Insight is the conscious recognition of similarities between the characters or situations in the text and the reader's own characteristics and circumstances, and the subsequent decision to apply ideas or lessons from the text to the reader's own thoughts and actions.

Many scholars add a fourth stage, universalization, in which the text helps readers realize that they are not alone, but that many others share similar problems and concerns and have found ways to deal with them. In this respect, bibliotherapy, even if undertaken alone or one-on-one, offers an important benefit more often associated with group therapy.
Who Can It Help?
Professional articles about bibliotherapy have tended more toward the anecdotal, recounting individual case studies or describing how a particular program or practitioner makes use of bibliotherapy. But some studies using experimental and quasi-experimental methods have found statistically significant evidence of the effectiveness of bibliotherapy with such disparate populations as depressed adults, children with internalizing and externalizing disorders, and perfectionists.

The number of such rigorous studies is gradually growing, and 2019 looks to be the "year of bibliotherapy" - a number of studies have been published just this year on the use of bibliotherapy with refugee children who have suffered trauma, children with intellectual disabilities, victims of sexual abuse, adults with dementia, children with OCD, and pre-service teachers.

If you want to know more about this growing field, which combines traditional aspects of literature - character, theme, emotion, and plot - with therapeutic functions more often ascribed to clinical psychology, here are a few good places to start:

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Bibliotherapy: Using Books to Help and Heal

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As the word suggests, bibliotherapy combines two of our favorite topics - reading and psychology - so it seemed a particularly appropriate topic to highlight in this post. The term itself was coined only about a century ago by Samuel Crothers, a Unitarian minister who wrote an article in the Atlantic Monthly describing how relevant books could be used as an effective adjunct to medical or psychological treatment.

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Model School District Policy on Suicide Prevention

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Model School District Policy on Suicide Prevention

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American Foundation for Suicide Prevention

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The Model School District Policy on Suicide Prevention gives educators and school administrators a comprehensive way to implement suicide prevention policies in their local community.

In collaboration with the American School Counselor Association, the National Association of School Psychologists, and The Trevor Project, the program is research-based and easily adaptable for middle and high schools.

There are specific, actionable steps to support school personnel; sample language for student handbooks; suggestions for involving parents and guardians in suicide prevention; and guidance for addressing in-school suicide attempts.

In addition to educators and school leaders, school-based mental health professionals such as counselors and psychologists are essential in putting a policy into practice to enhance the whole school environment.

More than half of all states in the U.S. currently require that educators receive training to prevent suicide. With recommendations rooted in best practices, the Model School District Policy on Suicide Prevention can complement state law requirements and help schools achieve an inclusive, comprehensive suicide prevention plan.

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Model School District Policy on Suicide Prevention

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The Model School District Policy on Suicide Prevention gives educators and school administrators a comprehensive way to implement suicide prevention policies in their local community. In collaboration with the American School Counselor Association, the National Association of School Psychologists, and The Trevor Project, the program is research-based and easily adaptable for middle and high schools.

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Student Crisis Intervention Flow Chart Example

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Student Crisis Intervention Flow Chart Example

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Student Crisis Intervention - Westwood Protocol Flow Chart

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Teacher Flow Chart for Student Issues - Sheet1

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Just Ask. You Can Save a Life.

The Columbia-Suicide Severity Rating Scale (C-SSRS), the most evidence-supported tool of its kind, is a simple series of questions that anyone can use anywhere in the world to prevent suicide.

Get the Questions

Effective For Everyone

The C-SSRS can be used by anyone, anywhere. The Columbia Lighthouse Project provides the scale in more than 100 country-specific languages for use by:

"The advent of the C-SSRS and its dissemination could be seen as really a watershed moment, like the introduction of antibiotics. [The C-SSRS] has played a comparable role when it comes to mental illness and perhaps its most tragic consequence, suicide."

Former President, American Psychiatric Association

IF YOU OR SOMEONE YOU KNOW IS IN CRISIS, CALL 988

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The Lighthouse Project The Columbia Lighthouse Project

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The Columbia-Suicide Severity Rating Scale (C-SSRS), the most evidence-supported tool of its kind, is a simple series of questions that anyone can use anywhere in the world to prevent suicide. Get the Questions The C-SSRS can be used by anyone, anywhere.

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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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Understanding the Section 504 eligibility criteria. What is the eligibility criteria? What is it not? Is 504 simply, "provide a medical diagnosis begets a 504 plan?" or is it not? Hi, I'm John Comegno from the Comegno Law Group. Today, we're going to be talking about what the criteria is, why understanding what the Section 504 eligibility criteria is is crucial to compliant delivery and implementation of Section 504's mandate.

In other segments we've spoken to the difference between 504 and IEP. We've spoken about what 504 is. We recognized that 504 is not about expanding rights, it's not about changing the experience, it's not about creating educational rights, it's about protecting educational rights.

What does that mean? How does one find themselves eligible? How is the student with the broken leg eligible, but the student with the sprained ankle not eligible? Or is the student with the sprained ankle eligible and the student with the broken leg not eligible? Is 504 eligibility focused on mental health issues? Is it focused on medical diagnosis?

The student who used to be specific learning disability (SLD) eligible for an IEP but has been declassified, no longer found eligible, do they automatically receive a 504 plan? Is the 504 plan a consolation price? We speak specifically to that issue in another segment. But the answer to these questions turns on understanding what the eligibility criteria is. 504 is not about producing a piece of paper like a medical diagnosis, like a former IEP, even like a former 504 plan and automatically receiving a new 504 plan. 504 is about preventing discrimination. It's about enabling access through the provision of 504 reasonable accommodation. The trigger, the determinant, the decision as to how and when and why that 504 plan is required, how that individual, that student or that employee is eligible, involves an understanding of the criteria.

What is the eligibility criteria, and how does it fit in to this mandate under 504, this direction, thou shall not discriminate? Again, 504 doesn't define the players, doesn't define the process, doesn't define who sits at the table, how and when and why and where. It simply says, "No otherwise qualified individual with a disability on account of that disability shall be excluded, denied benefit, treated differently." It doesn't come out and say, "This is the eligibility criteria." How do we determine what the eligibility criteria is when we look to, then, what the definition of disability is?

We'll speak later somewhat to these concepts of, "regarded as" and "record of impairment." But for best practice purposes, for making sure that we're compliant in how we're implementing Section 504, we need to consider, at the table, what the definition of disability is. That definition of disability has two prongs. Those prongs need to be answered by current, objective, clear, sound data. Since we don't have regulations that define that, that means that you, your schools, your districts, your institutions have to be consistent vertically and horizontally, and I did not just bless you.

How do we look at that definition at the elementary level? How do we answer the question of what the eligibility criteria is at the elementary level? It has to be the same at the middle. It has to be the same at the high school. Horizontally, Elementary A can't simply accept the medical diagnosis without plugging into a criteria while Elementary B doesn't ask the questions at all, and will evaluate through special education, but then provide a 504 plan. Over at Elementary C, they don't even provide 504 plans. It's a recipe for disaster. It's a recipe for failure.

We need to recognize that there is an eligibility criteria. We need to understand what it is objectively, and we need to implement it consistently. Let's remember what I refer to as the "Comegno, so what?" which is born out of empathy, care, consideration and love. So what? Billy's got ADHD. So what? Johnny broke his leg. So what? Now, I'm not saying, "So what?" flippantly. What I'm saying is, "What's the impact?" That's the question you need to ask because the eligibility criteria focuses on impact.

Remember our key principles, our governing best practice points: need, process, progress.

What does that individual need? There is no presumptive eligibility under 504. That means that an individual that comes in with a diagnosis is not automatically entitled to a plan. It means we need to ask the questions. It means we need to recognize what the criteria is.

In another segment, we're going to speak to otherwise qualified. Otherwise qualified is a battlefield today. Otherwise qualified is a place where many institutions can avoid 504 exposure. Otherwise qualified for our purposes right now simply means that one is able to complete the essential tasks or duties of their position regardless of accommodation when we speak to employee. Otherwise qualified for a student means that they have a right to be in our school, in our public schools, pre-K to 12. They're of the right age and they're in the right grade. For college, university, they've been accepted. Assuming that those factors apply, those individuals are otherwise qualified. Again, if you have more questions on otherwise qualified, tune in to that segment. It's a compelling issue today.

Here, we're going to talk beyond otherwise qualified to the eligibility criteria. What are the questions? How many prongs are there? There are two. They're not three. They're not four. Five is right out. Two prongs, two questions. No presumptive eligibility. No prescription blank diagnosis begets a plan. We need a yes to both of these questions. If we do not have a yes to both of these questions, then the individual is not eligible. What's the first question? The first question is, whether or not there's a physical or mental impairment. We're going to define what that is. That typically is provided through medical diagnosis, but we need to ask the question of what's the impact of that physical or mental impairment? There is a physical or mental impairment and that physical or mental impairment substantially limits one or more major life activity. There's impact. There's need.

504 prohibits discrimination. It prohibits discrimination and exclusion, lack of access when we consider the impact of their physical or mental impairment, physical or mental impairment which substantially limits one or more major life activity.

Let's define those terms. Physical impairment. The feds recognized in 1973 with passage of the Rehabilitation Act and defining disability that, if they had also given to us regulations that listed every disease and condition and syndrome and disorder which equaled physical impairment, then that direction would be outdated by 1974, maybe earlier. Instead, what the feds clarified in defining what physical impairment is, and we see this in the regulations, what they did was to note all the physical systems. They note neurological, musculoskeletal, special sense organs, respiratory, cardiovascular. All the systems are noted with the conditioning language that any disease or condition, any disfigurement, any loss affecting any one or more of those body systems equals physical impairment. You know what? That's anything because all the systems are referenced and the words "any" is used. Any means any. Any. Any issue affecting anybody system equals physical impairment.

For my purposes as a disability rights litigator, as an educator and educational law attorney, as an attorney representing primarily schools, that means that the diagnosis itself typically isn't the issue. The issue is how current is that diagnosis? Does that diagnosis have validity? Do we have data that we'll take us from simply the diagnosis towards the second prong? But for our purposes, physical impairment means any issue affecting any physical system.

What about mental impairment? That's second half of the first question, physical or mental impairment. We're up to the DSM-5 now. Any disorder listed in the DSM-5 may equal mental impairment. Cognitive impairment, brain syndrome, dystonia, oppositional defiant disorder, obsessive compulsive disorder, or attentional difficulties, somatoform disorder, anything that we may see diagnosed from the DSM may constitute a mental impairment.

What about specific learning disabilities? What about dyslexia now that we have certain normed, national definitions? What about processing difficulties? What about difficulties in computation and comprehension, those special ed-ish difficulties? Might we see those as mental impairments that might make one eligible for 504 protection? The answer is yes. We may plug in those difficulties in the first end of that criteria, just like we might plug in any other medical condition. Please don't think that the criteria only involves medical diagnosis. It involves any physical, any mental impairment. But we need to plug in to the next prong. We need to look at substantial impairments, substantial limitation of major life activity. We'll talk about that in a moment.

I want to talk about an interesting case before we get to there, looking at physical or mental impairment. There's a case at a Central District of California, that case is still pending, involving Compton Unified, an area of LA that's plagued with violence and poverty. A class of current and former students challenged, essentially, whether or not one needed to have a standalone diagnosis of physical or mental impairment in order to be considered for 504 eligibility, with the argument that, in depressed communities, the trauma experienced by members of the community, again, in a socioeconomically distressed community, one where we've got the plague of illegal substances, violence, issues with nutrition, issues with housing, sustenance, family structure, whether or not the impact in the so-called "complex trauma" that those individuals have been subjected to could result in so-called neurobiological effects constituting a physical or mental impairment. That trauma then substantially are limited to major life activities.

Plaintiffs allege that they were denied certain benefits of certain programs on account of how they presented, how their learning style was impacted by that trauma, how they functioned independent of one another, how they functioned with one another, how their ability to develop peer relationships, how their ability to follow relationships with authority figures was impacted, whether or not those facts could present as 504 eligibility. Interestingly, the court said yes. The court said, considering the impact of that trauma, the plaintiffs, at a minimum, had alleged sufficient claims under 504 for the case continue. Let's keep our eyes out for a decision. Let's pay attention to where that case goes. That's trending. That's current.

Our takeaway, though as we continue on in our discussion of the eligibility criteria, let's remember, we need current, present, objective data as to physical or mental impairment in order to check off the first box of the eligibility criteria. Assuming that we have that data, we then ask the question of whether and how that physical or mental impairment substantially limits one or more major life activity.

What are the major life activities? Well, the major life activities are the major life activities, like listening to me, like watching me, like being able to focus long enough to process the information that we're discussing in this program. Those are all major life activities. We had a list of the biggies in the beginning, in the Rehabilitation Act, back in 1973, things like, caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, working and learning.

Folks, don't fall in the hole of just learning. We should never be speaking of a 504 major life activity as only involving learning. (You may be thinking) but, we're in a public school, all that matters is learning. We're in a public school. Therefore, the only major life activity at play is whether or not the student is making progress, whether or not the student is learning in the classroom. That's not entirely true because the law speaks to and the eligibility criteria speak to one or more major life activity, one or more. Learning is one, so is walking up the steps to get on a school bus, so is sitting on that school bus and developing appropriate peer relations so one could ride that bus safely to school, or climbing off that school bus, or being able to walk down the sidewalk to get into the school, or walk through the hallways, how one sees, one hears, one's ability to attend and to focus, to comply with rules.

Federal courts have clarified that any activity one engages in routinely may constitute major life activity. Any function one performs routinely may constitute, may be considered to be, a major life activity.

So, where are we? Let's remember the eligibility criteria for 504 is different than the eligibility criteria for IDEA. Let's remember that there is a criteria. Let's remember that that eligibility criteria has two prongs. It's not just medical, it may also be so-called educational. Physical or mental impairment impact, physical or mental impairment that substantially limits one or more major life activity. We should not be finding eligibility or providing plans for students or employees for whom we do not have data that satisfies that eligibility criteria. But if we do have data that satisfies that eligibility criteria plugged in consistently, we ought to and need to develop plans that provide reasonable accommodation.

In other segments, we're going to talk about reasonable accommodations. We're going to talk about collecting data. We're going to talk about how we take our understanding of a compliant criteria process and plug it into day-to-day delivery of 504 accommodation. Let's remember, there's an equation, there's criteria. Physical or mental impairment, substantial limitation, major life activity.

Thank you for tuning in. Be careful out there. I'm John Comegno.

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Understanding Section 504 - Section 504 in Education | Frontline

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Understanding the Section 504 eligibility criteria. What is the eligibility criteria? What is it not? Is 504 simply, "provide a medical diagnosis begets a 504 plan?" or is it not? Hi, I'm John Comegno from the Comegno Law Group.

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Virtual School Counseling - Better Together

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During the physical school closures, we find that the needs of our students AND staff has changed to some degree. We can SEARCH and SHARE lessons that work for an eLearning platform. Thank you so much for sharing!! This could really help us all!!