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We can all agree that the last few weeks have been challenging. School counselors across the state are feeling overwhelmed and unsure. Your TSCA board is busy planning supports and resources to serve you as we move forward into uncharted and uncertain waters. In the meantime,we've provided some information and resources about what to do next.

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ADHD in the Classroom Effective Intervention Strategies

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Use of Website Blog Commenting

ADAA provides this Website blogs for the benefit of its members and the public. The content, view and opinions published in Blogs written by our personnel or contributors - or from links or posts on the Website from other sources - belong solely to their respective authors and do not necessarily reflect the views of ADAA, its members, management or employees. Any comments or opinions expressed are those of their respective contributors only. Please remember that the open and real-time nature of the comments posted to these venues makes it is impossible for ADAA to confirm the validity of any content posted, and though we reserve the right to review and edit or delete any such comment, we do not guarantee that we will monitor or review it. As such, we are not responsible for any messages posted or the consequences of following any advice offered within such posts. If you find any posts in these posts/comments to be offensive, inaccurate or objectionable, please contact us via email at [email protected] and reference the relevant content. If we determine that removal of a post or posts is necessary, we will make reasonable efforts to do so in a timely manner.

ADAA expressly disclaims responsibility for and liabilities resulting from, any information or communications from and between users of ADAA's blog post commenting features. Users acknowledge and agree that they may be individually liable for anything they communicate using ADAA's blogs, including but not limited to defamatory, discriminatory, false or unauthorized information. Users are cautioned that they are responsible for complying with the requirements of applicable copyright and trademark laws and regulations. By submitting a response, comment or content, you agree that such submission is non-confidential for all purposes. Any submission to this Website will be deemed and remain the property of ADAA.

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Please note that there is a review process whereby all comments posted to blog posts and webinars are reviewed by ADAA staff to determine appropriateness before comments are posted. ADAA reserves the right to remove or edit a post containing offensive material as defined by ADAA.

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Influences of Cultural Differences in the Diagnosis and Treatment of Anxiety and Depression

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Use of Website Blog Commenting ADAA provides this Website blogs for the benefit of its members and the public. The content, view and opinions published in Blogs written by our personnel or contributors - or from links or posts on the Website from other sources - belong solely to their respective authors and do not necessarily reflect the views of ADAA, its members, management or employees.

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Obsessive Compulsive Disorder and the School Counselor

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Obsessive Compulsive Disorder and the School Counselor

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Advanced Academics includes courses, programs, assessments, services and supports that provide opportunities for students to demonstrate college and career readiness and earn postsecondary credit.

TEA continues to work with the Office of the Governor, Texas Department of State Health Services (DSHS) and the Texas Division of Emergency Management (TDEM) to coordinate and plan the state's response to COVID-19. The TEA website contains up-to-date guidance and academic supports.
AP Resources and Review Sessions
The College Board is developing tools to mitigate the impact of school closures on students in the Advanced Placement Program. All AP students and teachers will be able to access and use the free online review resources provided to every student. Resources will be made easily accessible to AP students and teachers through mobile phones and other devices. These include free online AP lessons and review sessions from some of the top AP teachers in the country.

If a student does not have Internet or a device for AP review and testing? Request support here before April 24.

Link to Free Online AP Classes and Review - Quick tips to access lessons: (1) select "Playlists" from the tool bar across the top, (2) Click the "All Playlist" drop-down for a list of subjects, (3) Select the "View Full Playlist" tab under any course to see all available sessions.

AP teachers who are already providing remote instruction can also continue to leverage AP Classroom. Within AP Classroom, free-response questions that were only available for in-classroom use due to security concerns will now be unlocked.Teachers will be able to assign questions to students digitally.

2020 AP Exam Administration
For the 2020 exam administration only, students can take a 45-minute online free-response exam at home. Educator-led development committees are currently selecting the exam questions that will be administered. Exams will be given from May 11-22 with makeup test available from June 1-5.

View the full 2020 AP testing schedule.

To help support teachers and schools that are struggling to collect and score student work for course grades, the College Board will provide every AP teacher with their students' responses from the online exams by May 26.

AP Coordinators can register for live training on April 10 to learn more about exams.

Read more about 2020 AP testing and resources in the College Board's latest announcement at View as webpage.

The May 2020 examinations for the IB Diploma Programme and Career-related Programme candidates will no longer be held. Depending on what a student registered for, the student will be awarded a Diploma or a Course Certificate that reflects the student's standard of work. This is based on the student's coursework and the established assessment expertise, rigor and quality control already built into the programmes.

Full details and FAQs can be found on the IB COVID-19 (Coronavirus) update page.

Most colleges have moved their coursework online for students to complete at home either temporally or for the remainder of the semester. It is important for dual credit instructors to connect with the college and college instructors of the course to ensure rigor and student outcomes are met.

The college must ensure that a dual credit course and the corresponding course offered at the main campus of the college are equivalent with respect to the curriculum, materials, instruction, and method/rigor of student evaluation. Regular academic policies, services and supports applicable to courses taught at the college's main campus must also apply to dual credit courses TAC Rule §4.85.

The College Board cancelled the May 2, 2020 SAT and SAT Subject Test administration. Makeup exams for the March 14 administration (scheduled for March 28) were also canceled. Students who registered for May, whose March test centers were closed, or who do not receive March scores because of any irregularities will receive refunds. The June 6, 2020 SAT and SAT Subject Test administration have not been cancelled; however, the College Board will continue to assess its status. The most current information regarding SAT administrations can be found on their SAT Coronavirus Updates website.

To help students keep their college readiness skills sharp when many schools are closed, the College Board and Khan Academy will continue to provide free resources online, including full-length practice tests and personalized learning tools at khanacademy.org/sat.

ACT, Inc. rescheduled its April 4 national test date to June 13. All students registered for the April 4 test date will receive an email from ACT with instructions on rescheduling to June 13 or a future national test date. The most current information regarding ACT administrations can be found on their COVID-19 website.

Virtual resources for students include ACT Academy, a free online classroom with personalized practice, and ACT Online Prep, a highly targeted ACT preparatory program that students can now access at a reduced price of $9.98/person.

For all TSIA 1.0 testing, the Texas Higher Education Coordinating Board is encouraging testing centers to utilize Examity, College Board's Online proctoring partner. Examity is offering a reduced proctor fee of $20 per test session. The THECB expects services to be live starting April 17, 2020, and to move quickly to full capacity by end of April. They also expect to add more remote proctor options as they become available.

Additionally, the TSIA2 release date is postponed to 9/28/20. All TSIA 2.0 trainings through May 31, 2020 are cancelled. The THECB is working to reschedule all sessions as well as exploring alternative delivery methods. All institutions will be notified with new training dates once they have been established.

For more information, THECB has a website that is regularly updated with COVID-19 sensitive information. Please check their website and FAQs frequently as this is an evolving situation.

In light of this rapidly evolving situation, TEA decided to expand the college preparation assessment reimbursements to include summer testing administrations for the 2019-2020 academic year.
Eligible Students for Reimbursement

Seniors who take either the SAT, ACT, or TSIA from September 1, 2019 - August 31, 2020 are eligible for reimbursement.

Juniors who take either the SAT, ACT, or TSIA from January 1, 2020 - August 31, 2020 are eligible for reimbursement.

TEA will also reimburse TSIA proctor fees for the 2019-2020 school year. The reimbursement FAQ will provide additional updates on the webpage as they come.

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Advanced Academics includes courses, programs, assessments, services and supports that provide opportunities for students to demonstrate college and career readiness and earn postsecondary credit. TEA continues to work with the Office of the Governor, Texas Department of State Health Services (DSHS) and the Texas Division of Emergency Management (TDEM) to coordinate and plan the state's response to COVID-19.

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Psychotic disorders such as schizophrenia are recognized as a group of illnesses that have the ability to affect a person's mind, which can lead to changes in one's capacity to think clearly, make rational judgments or decisions, respond emotionally, communicate effectively, understand reality from imagination, and behave appropriately in public. ¹

About 1% of the world's population suffers from a psychotic disorder, which affects men and women equally. ² The symptoms of psychotic disorders can sometimes be so severe to the point that they significantly impair a person's ability to engage in normal functioning because it disturbs their ability to stay in touch with reality. As a consequence, they cannot meet the demands or obligations of everyday life. However, for the most part, even the most severe psychotic disorders can be treated.

There are many types of psychotic disorders, such as delusional disorder, schizoaffective disorder (symptoms of both schizophrenia and a mood disorder), and substance-induced psychotic disorder. But one of the most debilitating and costly of all adult psychiatric disorders is schizophrenia. The condition is considered to be a psychotic thought disorder that is characterized by a mixture of symptoms that involve perception, cognition, emotions, behavior, attention, concentration, motivation, and judgment. ³

Schizophrenia still continues to be an illness that defies a conclusive explanation from the scientific and research communities, but major strides have been made with regards to pharmacological agents that are available to treat the major negative and positive symptoms. The negative or deficit symptoms of schizophrenia can include blunted affect (lack of emotional reactivity), social withdrawal, poverty of speech, or psychomotor retardation. 4

The cognitive symptoms of the symptoms of schizophrenia affect attention, memory and executive function. The positive symptoms consist of delusions, hallucinations, agitation, or disorganized speech.

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An Overview of Psychotic Disorders and Treatment - Psychiatry Advisor

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Psychotic disorders such as schizophrenia are recognized as a group of illnesses that have the ability to affect a person's mind, which can lead to changes in one's capacity to think clearly, make rational judgments or decisions, respond emotionally, communicate effectively, understand reality from imagination, and behave appropriately in public.

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Lorem Ipsum

In this year's report we take a look at the teenage years, highlighting unique factors that make adolescence exciting, important, and potentially dangerous - including its role as a significant risk period for mental health disorders.

The report is guided and organized according to three main concepts:

The adolescent brain develops until at least age 25.

Most mental health disorders have onset before 24.

Encouraging understanding of adolescent mental health through education and anti-stigma programs will change lives.

This report explores specific issues including:

smartphones and social media

substance use and abuse

anxiety and depression

ADHD

psychotic episodes and schizophrenia

suicide and self-harm

unique challenges in adolescent mental health care

evidence-based educational and therapeutic approaches for adolescents

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In this year's report we take a look at the teenage years, highlighting unique factors that make adolescence exciting, important, and potentially dangerous - including its role as a significant risk period for mental health disorders. The report is guided and organized according to three main concepts: The adolescent brain develops until at least age ...

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Anxiety Disorders and Latinos - The Role of Family Cohesion and Family Discord

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The causes of depression are as confounding to researchers as the doctors and mental health professionals who treat it, and perhaps most of all, the 300 million people in the world who have it.

Genetics may indicate a risk for depression, but do not always determine whether a person will develop this all-too-common mental health disorder. There is no "number one cause" of depression, and even more complex is the relationship between genetics, depression, and other known contributing factors.

If you were told you have a "depression gene," you might worry you will become depressed. However, having a genetic predisposition to a condition does not always mean you will get it.﻿﻿﻿﻿﻿ It simply means you may be more susceptible to it than someone who doesn't have the same genetic makeup.

The Role of Genetics In Depression

As far as researchers know, it's the interplay of genes and other factors (such as environment and trauma) that determine whether someone develops depression.﻿﻿﻿﻿﻿

Some studies have indicated that someone with a first-degree relative diagnosed with depression (a parent, sibling, or child) could be three times more likely to be diagnosed with depression in their lifetime compared to the general population.﻿﻿﻿﻿﻿﻿﻿

However, it's important to note that while studies have suggested a clear link within families, these findings don't account for those who develop depression without a family history.

Studies have suggested there is a heritable component to depression.﻿﻿﻿﻿﻿﻿ Some research has also indicated that women may be more susceptible to the genetic influences associated with depression than men.﻿﻿﻿﻿﻿﻿

Understanding Genetic Variations

Heredity is a complex interplay of many factors, not just individual genes. When studying depression or other health conditions, researchers often look for changes in genes called variants. These changes are classified according to the effect (if any) they have on the gene.

Eye color is an example of how variants affect genes. Changes in certain genes that affect melanin production, as well as several other genes, determine what color your eyes are. You inherit a combination of genes, each with their own unique variants, from your parents.

Heritability is a complex process, even for a seemingly simple trait like eye color. For conditions like depression, research has not yet determined the full implications of genetic variations.

Demystifying the "Depression Gene"

Having a genetic variant can make it more likely-but not definitive-that you will develop a condition associated with that variant.

If a gene associated with a specific condition is altered, it may be more (or less) likely to contribute to the development of that condition. A benign genetic variant is less likely to influence the condition than a pathogenic variant.

In some cases, researchers identify a genetic variant but don't know what (if any) effect it has. These variants are referred to as having "unknown significance."

Several large genome-wide studies have proposed potential genetic connections to major depressive disorder.﻿﻿﻿﻿﻿﻿ In 2017, researchers identified two new genetic variants associated with depression.﻿﻿﻿﻿﻿﻿

A 2018 study published in the journal Nature Genetics identified several genetic variants that appeared to be associated with symptoms of depression and, in some cases, physical differences in the brain.﻿﻿﻿﻿﻿

Scientists believe it's more likely that all the different genes and genetic variants each make a small contribution to a person's overall risk. Research has indicated that genes may be passed down in different ways (modes of inheritance), which is another factor that could affect someone's genetic predisposition to depression.﻿﻿﻿﻿﻿

Can Genetics Affect Mental Health Treatment?

Depression can be treated with medication, psychotherapy, and other interventions like cognitive behavioral therapy (CBT). Some people may be prescribed a combination of treatments.

Your genes may influence how well a specific treatment works for you. For example, research has indicated that certain genes might affect how well your body absorbs, uses, and excretes alcohol and drugs, including antidepressant medications.﻿﻿﻿﻿

Several genes are known to influence drug metabolism, but the results from these studies are primarily of interest to doctors and researchers.﻿﻿﻿﻿

Furthermore, doctors and scientists don't fully know how useful this information may be for consumers. Talk to your doctor before using your genomic health information to make decisions about your health care, including your depression treatment.

Genetics factors aside, if you've been diagnosed with depression and are trying to decide on a treatment, keep in mind that the process can take time. You may need to try more than one type of therapy before finding the right fit. You might even need to adjust or change your treatment plan over time.

Before starting a medication for depression, tell your health care provider about any medications, vitamins, or herbal remedies you already take. These products can interact with antidepressants and affect how well they work or even cause serious side effects.﻿﻿﻿

As you try different approaches, stay in touch with your doctor and your mental health care team. Be sure to let them know if you experience any side effects.

Does Heritability of Depression Affect Children?

People with depression might be concerned they will pass on the condition to their children. While there could be a heritable component to depression, genetics is not the only determinant.﻿﻿﻿﻿ Other factors contribute to risk, while some can be protective.

A child who has a parent with depression may have a genetic predisposition but will not necessarily become depressed. Other factors, including environmental factors or "triggers," are also involved.﻿﻿﻿

On the other hand, a child who does not have a family member with depression and is not genetically predisposed to the condition may become depressed if they are exposed to a triggering event such as experiencing a trauma.

Non-Genetic Causes of Depression

Genetics is one of several potential causes of depression. Knowing the possible causes can help you better understand depression, but remember that depression can also develop in the absence of a clear cause and be difficult to pinpoint. Other known factors that contribute to all forms of depression and other mental health conditions include:

Brain chemistry: People with depression sometimes have lower levels of neurotransmitters (brain chemicals that affect mood and well-being). The neurotransmitters they have might be inefficient or function poorly.

Changes in brain structure: The brains of people with depression may be physically and structurally different from the brains of people who are not depressed.﻿﻿

Hormones: Conditions like pregnancy, thyroid disorders, and menopause can affect hormone levels. Low or high levels of hormones may trigger symptoms of depression, particularly in someone who is genetically susceptible.

Extreme stress: Situational depression, or adjustment disorder with depressed mood, may develop in someone who is in a highly stressful situation or experiences trauma.﻿﻿

A Word From Verywell

Having a genetic predisposition to depression can exacerbate these factors and may influence when someone becomes depressed as well as how long symptoms may last. However, it's important to remember that depression can develop in anyone-even someone who isn't genetically predisposed and isn't susceptible to known risk factors.

Identifying the signs of depression and being able to recognize them in yourself and others is crucial to ensuring the condition doesn't go untreated.

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How Genetics Can Play a Role in Depression

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The causes of depression are as confounding to researchers as the doctors and mental health professionals who treat it, and perhaps most of all, the 300 million people in the world who have it. Genetics may indicate a risk for depression, but do not always determine whether a person will develop this all-too-common mental health disorder.

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Depression is a very real and treatable illness. But myths, misunderstandings, and stigma continue to be barriers to treatment for many, and the consequences of untreated depression can be life-threatening. Understanding the facts about depression, on the other hand, can save lives. Here are seven things everyone should know about depression and depressive disorders.

Depression Doesn't Always Have a "Good" Reason

Sometimes people become depressed for what seems like a "good" reason-maybe they lost their job or a close friend passed away-but with clinical depression, there doesn't necessarily have to be a reason for how you feel. The chemicals in the brain that are responsible for mood control may be out of balance causing you to feel bad even though everything in your life is going well.

Many Factors Can Cause Depression

The causes of depression aren't completely understood, but it is believed that the best explanation for it is that it is probably caused a combination of factors, such as an underlying genetic tendency towards the condition and certain environmental factors that can act as triggers.

Having a parent and grandparent with depression increases the risk of depression,﻿﻿ suggesting that genetics plays a big role. The rates of depression are also higher among those who have a history of substance use.﻿﻿ Other factors linked to depression include brain chemistry imbalances, hormones, seasonal changes, stress, and trauma.

Brain Chemistry Imbalances

Depression has been linked to an imbalance in the neurotransmitters that impact mood regulation. This includes dopamine, serotonin, and norepinephrine. The theory is that having too much or too little of these neurotransmitters can cause (or contribute to) depression.

Any flux in the production or function of hormones-for example, pregnancy, menstruation, menopause, or thyroid issues-could contribute to depression.

Seasonal Changes

Major depressive disorder with seasonal patterns (seasonal affective disorder) is triggered by disruptions in the circadian rhythm of the body.﻿﻿ A change in seasons can also disrupt sleep, which can contribute to a depressed mood.

Stress and Trauma

The loss of a loved one, trauma and abuse, chronic stress, and big life changes (such as a divorce or losing a job) can trigger depression.Researchers blame this on the high levels of the hormone cortisol that are secreted during these stressful, traumatic times.﻿﻿ Cortisol affects the neurotransmitter serotonin and can trigger depression.

Depression Is More Than Ordinary Sadness

Sadness is a part of being human, a natural reaction to painful circumstances. All of us will experience sadness at some point in our lives. Depression, however, is an illness with many more symptoms than an unhappy mood.

When sadness turns into depression, there are some telltale signs, including:

Changes in appetite, weight, and sleep patterns

Decreased sex drive

Feeling anxious, hopeless, or helpless

Feeling irritable and restless

Persistent feelings of sadness or an "empty" mood

Physical symptoms (such as headaches, digestive issues, body aches, and pain) that don't subside with treatment

Loss of interested in actives you once enjoyed

Low energy or feelings of fatigue

Trouble with concentration, memory, and decision-making

Unfortunately, you can't just snap yourself out of depression. If you recognize these signs, seek help from a mental health professional.

Children Are Not Immune to Depression

A myth exists that says childhood is always a joyful, carefree time in our lives. While children don't experience the same problems that adults do, like work-related stress or financial pressures, this doesn't mean that they can't become depressed. Childhood brings its own unique set of stresses, such as bullying and the struggle for peer acceptance.

Depression Is a Real Illness

You are not weak or crazy. Depression is a real illness that researchers believe is caused mainly by imbalances in certain chemicals within your brain called neurotransmitters. Some experts are even starting to frame depression as a systemic disease.

The following neurotransmitters play an important role in regulating your mood as well as being involved in many other functions throughout your body:

Dopamine: Helps regulate emotion, memory, thinking, motivation, and reward

Norepinephrine: What makes your heart rate and blood pressure sore during a "fight or flight" response or stressful time

Serotonin: The "feel-good" chemical that helps regulate your mood and plays a role in your overall sense of well-being

Researchers are continuing to learn more about what causes these imbalances as well as other neurotransmitters like acetylcholine, GABA, and glutamate﻿,﻿﻿ which may also play a role in depression.

Depression Is Treatable

There are several very effective treatment options available for depression, including medications and psychotherapy. In addition, there are new treatments being developed all the time that are proving to be effective in cases where other treatments have failed.

While your treatment should be tailored to best suit your symptoms and overall health, a combination of medication, psychotherapy, and lifestyle changes is often used to help alleviate symptoms of depression.

Depending on your unique situations, you may participate in individual, group, family, or couples psychotherapy. While there are many types of therapeutic approaches, the following have been study-proven to treat depression:﻿﻿

Behavioral activation

Cognitive-behavioral therapy

Interpersonal therapy

Problem-solving therapy

Psychodynamic therapy

Social skills therapy

Supportive counseling

Medications

Especially when used in conjunction with psychotherapy, there are many medications that have been found effective in the treatment of depression. Again, since depression treatment is not a one-size-fits-all approach, it may take some trial and error to find the medication that alleviates your symptoms with the fewest side effects.

The classes of medications commonly prescribed to treat depression include:

Monoamine oxidase inhibitors (MAOIs): Including Marplan (isocarboxazid), Nardil (phenelzine), and Parnate (tranylcypromine)

Norepinephrine and dopamine reuptake inhibitors (NDRIs): Including Wellbutrin (bupropion)

Selective serotonin reuptake inhibitors (SSRIs): Including Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), Celexa (citalopram), and Luvox (fluvoxamine)

Serotonin and norepinephrine reuptake inhibitors (SNRIs): Including Effexor (venlafaxine), Cymbalta (duloxetine), and Pristiq (desvenlafaxine)

Tricyclic antidepressants (TCAs): Including Elavil (amitriptyline), Tofranil (imipramine), and Pamelor (nortriptyline)

Lifestyle Changes

In addition to therapy and medication, there are some lifestyle changes that can help you better manage symptoms of depression as well as medication side effects. Here are a few areas to focus on, but first consult your mental health professional to find out if they are right for you.

Diet: There's no cure-all diet for depression, but there are certain foods that you can eat (and avoid) that play a role in mood and emotional regulation. Processed foods, alcohol, caffeine, sugar, and refined grains can hijack your mental health while whole foods like fruits and vegetables, fish,﻿﻿ turkey, chicken, beans, nuts, and seeds can provide mood-boosting benefits.

Exercise: A good workout out can help lift your mood, reduce stress, and alleviate symptoms of depression.﻿﻿ The type of exercise you choose should be based on your fitness level, health, and preferences. Your routine can include aerobic exercise (such as jogging, swimming, cycling, brisk walking, elliptical trainer) and mind-body exercises like yoga and tai chi.

Stress management: Stress can trigger depression and intensify its symptoms. Long-term habits like good nutrition, regular exercise, proper sleep, and meditation build resilience. Incorporate daily stress management techniques once you find what works for you. A support group or mental health professional can provide useful ideas.

Untreated Depression Is a Common Cause of Suicide

The proper diagnosis and treatment of depression is very important in preventing suicides. According to the National Alliance on Mental Illness, 45% of those who commit suicide are suffering from some sort of mental illness﻿.﻿﻿ And this includes people with undiagnosed, untreated, or under-treated depression.

If You or Someone You Love Has Depression

If you or someone you love is showing signs of depression, you may wonder what steps to take. You may want to begin by learning more about depression, including symptoms and treatment as well as myths, misunderstandings, and stigma. This can provide a better picture of what to expect and make you a more well-informed patient or caregiver.

You should also set an appointment with your primary care physician who will give a physical exam, run any blood tests to rule out any medical conditions that mimic depression, and provide a reference to a mental health professional for further treatment. During the visit, you can also ask for some recommendations of reputable sources of information and support.

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7 Facts Everyone Should Know About Depression

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Depression is a very real and treatable illness. But myths, misunderstandings, and stigma continue to be barriers to treatment for many, and the consequences of untreated depression can be life-threatening. Understanding the facts about depression, on the other hand, can save lives. Here are seven things everyone should know about depression and depressive disorders.

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The term dysfunctional is defined as "abnormal or impaired functioning" on the part of an individual person, between people in any sort of relationship, or amongst members of a family. Poor functioning refers to both behavior and relationships that aren't working and have one or more negative, unhealthy aspects to them, such as poor communication or frequent conflict.

This is a term used often by mental health professionals for interactions between people and is often used to describe any relationship in which there are significant problems or struggles. Dysfunctional relationships or situations are often the impetus for getting help in psychotherapy. Many families develop dysfunctional aspects when trying to cope with a troubled teen because family members are forced to adapt to the teen's emotional or behavioral problems that impact them on a daily basis.

A troubled teen who expresses anger by hitting others

A teenage couple that deals with conflict by not speaking to each other

A family in which a parent is drinking daily and family members are afraid to talk about what's happening

A teenager with a dual-diagnosis who uses drugs to deal with their symptoms rather than deal with what is causing them

In dysfunctional families, there are a variety of patterns that can occur. Here are the most common:

Parents or teens abuse alcohol and/or drugs

One or both parents have compulsive behavior, such as gambling or overworking, that leads to difficulties for the rest of the family

One or both parents threaten or actually carry out violence that may or may not involve the children

One or both parents treat the children as possessions and as if the children are only around for the parents' own personal needs or satisfaction

One or both parents are extremely strict to the point of not giving their children autonomy and exerting tight control over their lives

One or both parents are unable to provide or simply stop providing emotional and/or physical and financial support

Many families have times when these patterns occur, but it is when they start to become the norm that dysfunction occurs.

When dysfunctional patterns become the standard in a family, the detrimental effects on the children are great and can be carried on into their adult relationships. Some of these potential and damaging effects for children are:

Having to take sides in a parental conflict

Actions of parents not matching their words, which causes a distorted reality

Being rejected or being favored

Having rigid controls put over everything from who their friends are to how they dress

Having parents that are either way too involved and overly protective or parents who are uninvolved and disinterested

Being ridiculed or ignored when sharing thoughts or feelings

Being physically abused

Feeling like they have to be the adult in the situation

If your family is experiencing dysfunction for any reason, seeking out family therapy may be a good option. Family therapy has been shown to be extremely effective in learning new ways to communicate, solving problems between family members and becoming sources of support and strength to each other.

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How Dysfunctional Behavior Affects Families

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The term dysfunctional is defined as "abnormal or impaired functioning" on the part of an individual person, between people in any sort of relationship, or amongst members of a family. Poor functioning refers to both behavior and relationships that aren't working and have one or more negative, unhealthy aspects to them, such as poor communication or frequent conflict.

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Teaching Strategies for Students with ADHD

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When Mae Lynn Reyes-Rodríguez was a graduate student in psychology at the University of Puerto Rico in the early 1990s, she learned there were no studies of how many Latinos suffered from anorexia, bulimia or binge eating disorder.

A quarter century later, research on eating disorders primarily remains focused on white women, says Reyes-Rodríguez, now a clinical psychologist at the University of North Carolina Center of Excellence for Eating Disorders in Chapel Hill.

"Eating disorders have the highest mortality of any mental health condition," she says. "We need more research, especially clinical trials with diverse populations, because [right] now we are generalizing all research findings from Caucasians."

According to the National Eating Disorders Association, eating disorders affect up to 30 million people in the U.S. - two-thirds of them women. While there is more recognition that eating disorders affect people of all races and ethnicities, Reyes-Rodríguez says racially and ethnically diverse communities don't have equal access to treatments.

"We need to develop culturally sensitive treatments," she says.

Sometimes, immigrant parents try to guilt their kids into eating, even once they are full, by saying things like, 'When I was growing up, I didn't have this food. You have to eat it.' They're small messages, but they are deep.

That's exactly what self-described "chubby warrior" Gloria Lucas is doing. Her struggle with compulsive overeating began when she was 17. She also battled bulimia. But because talking about eating disorders was taboo in her Mexican-Americancommunity, her family didn't know how to respond. "My parents didn't have any clue [about my eating disorder]," she says. "They still don't quite understand it to this day."

Lucas, now 24, says therapy and traditional 12-step recovery programs were not "culturally relevant" for her. Many times, she says, the professionals did not understand cultural factors that can influence eating disorders among communities of color and indigenous and migrant women.

"Sometimes, immigrant parents try to guilt their kids into eating, even once they are full, by saying things like, 'When I was growing up, I didn't have this food. You have to eat it.' They're small messages, but they are deep," she says.

"It's something I have to unlearn - if I'm full, I don't have to eat it all. That's OK," she says.

And Lucas notes that women of color can struggle with body image in a culture where prevailing beauty standards primarily value thin, white women.

Lucas founded Nalgona Positivity Pride, a "body positive" site for communities of color. Since July, Nalgona (which translates to "big butt" in Spanish) has hosted a semimonthly eating disorder support group in Los Angeles for people from diverse backgrounds.

Lucas' work is especially important in a community that has negative associations with mental health treatment. Reyes-Rodriguez says that cultural and language barriers prevent many Latinas from receiving the care they need to recover from eating disorders, and cultural norms may be putting Latina women at particular risk for developing them.

"The majority of immigrant women, and some U.S.-born Latinas, are given cultural messages that they have to eat all the food on their plate," Reyes-Rodriguez says.

In many Latino families, she says, food is also used to comfort children. "These cultural values could lead to losing the self-awareness of body cues to hunger and satiety, and potentially promoting distorted eating behaviors or binge eating disorder - which is one of the most prevalent eating disorders in the Latino population," Reyes-Rodriguez says.

And yet, the misconception that eating disorders affect only white women is widespread - even in the medical community. As Slate reported last year, research has indicated that clinicians are less likely to diagnose eating disorders in women of color, further bolstering the myth that only white women get them.

Lynn Chen, a Cresskill, N.J., native raised by Taiwanese parents, says she received mixed messages as a child: She was encouraged to eat large quantities of food but remain skinny.

Nalgona Positivity Pride is just one of many initiatives that aim to challenge this false notion.As with Latinos, few studies have been conducted on eating disorders among Asian-Americans and Pacific Islanders.

Lynn Chen, 38, wants to change that. She co-founded Thick Dumpling Skin, an organization that aims to "create a community for Asian-Americans to discuss their past, present, and future relationships with their bodies," as the group's website puts it.

Chen, a Cresskill, N.J., native raised by Taiwanese parents, says she received mixed messages as a child: She was encouraged to eat large quantities of food but remain skinny.

Growing up, she struggled with binge eating. During the worst times, Chen, an actress, would have what she called "last supper" days. She'd make sure she didn't have anything scheduled and would begin eating starting in the morning and ending in the evening.

"It could have been carrots and hummus or cookies, whatever was easy to eat. Some days, I was on a set where there were snacks as far as the eyes can see. I'd be eating my feelings all day long," recalls Chen. She wouldn't purposefully purge, but there were a handful of times she began involuntarily throwing up for days.

"I have been binge eating my whole life," Chen says, adding that she also struggled with anorexia after being cast in a soap opera in 2004. "The dieting became anorexia. I'd go through a period of binge eating and a period of starvation."

Chen, like Lucas, hopes to bring awareness of eating disorders to diverse communities. By sharing her stories, she hopes young women can avoid the confusion and pitfalls she struggled with growing up.

She recently went on a five-day food tour in Taiwan. "I warned everyone, my white husband included... 'They're going to want to stuff you [with food]. It's a cultural thing. You're going to have to be OK saying 'no,' " Chen recalled.

She says she felt the tour guide was shaming her for not eating all the food she was served. "I told her, 'Listen, I have an eating disorder. I'm not eating more than I feel comfortable with."
Carmen Cusido is a freelance writer based in New Jersey. This story was produced in collaboration with Feet In 2 Worlds, an immigration journalism project of the Center for New York City Affairs at The New School.

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'Eat Up': How Cultural Messages Can Lead To Eating Disorders

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When Mae Lynn Reyes-Rodríguez was a graduate student in psychology at the University of Puerto Rico in the early 1990s, she learned there were no studies of how many Latinos suffered from anorexia, bulimia or binge eating disorder.

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Overview

There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people's eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Signs and Symptoms

Risk Factors

Treatments and Therapies

Join a Study

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There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people's eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder.

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Bulimia Nervosa Signs, Symptoms, and Treatment Guide

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No one knows any sure way to prevent bulimia nervosa. Adhering to some lifestyle guidelines may reduce the risk of a person developing the disorder, but so many factors may influence the disorder's development, including genetics, that it's difficult to know what can prevent it. Nonetheless, a healthy attitude toward eating and self-perceptions about body size and shape are important, as is maintaining good mental health. Education and awareness of eating disorders may help identify problems early and offer the best chance for appropriate treatment and recovery.

Ways to reduce the risk of bulimia nervosa

Education about and awareness of the disorder and associated risk factors

Early intervention if risk factors are identified

Knowledge and maintenance of healthy eating habits

Cultivation of a positive self-image of the body

Maintenance of good mental health

Counseling as needed to identify and resolve areas of conflict and stress

Balancing school, work, social life, rest, and exercise

Encouraging the at-risk person to develop close relationships with trusted friends, mentors (teachers/coaches), and family where possible could play a significant role in the reduction of risk for bulimia nervosa and other mental health disorders.

Cure, recovery, or remission?

Some controversy surrounds use of the term "cure" for any eating disorder, including bulimia nervosa. Most experts treating eating disorders consider bulimia nervosa, like many other mental health disorders, to be chronic illnesses requiring ongoing surveillance. They prefer the terms "remission" and "recovery" because the risk factors for the behavior may persist and relapse or multiple relapses can occur over an individual's lifetime.

Nonetheless, treatment for bulimia nervosa can reduce and even halt the hallmark behaviors in many patients, as well as provide the skills and tools needed to recognize and deal with potential triggers for relapse. The amount and type of treatment required to achieve a successful long-term outcome and the chances of relapse vary widely among individuals. Also, the definitions that different clinicians use to define remission may vary. These variations affect the reported remission rates in the medical literature, according to researchers from the University of Toronto, Canada, who studied the impact of different definitions on reported relapse rates. They proposed using standard definitions for partial and full relapses: partial relapse would be two symptom episodes per month for two months (which by DSM-5 standards would be considered a diagnosis of Other Specified Feeding or Eating Disorder); full relapse would be defined as meeting the full DSM-5 diagnostic criteria for the disorder. Thus, from this definition, the implied definition of remission is fewer than two episodes per month.

Published scientific data on remission rates are scarce, since few long-term studies have been done. Nonetheless, available data from several studies show that about half to three-fourths of patients who received treatment for bulimia nervosa and achieved a remission were in remission five years later. For shorter time periods, the remission rates reported in published studies varied more widely. Some clinicians have reported anecdotally that self-recovery is possible, although little scientific evidence from well-conducted studies is available to really determine the effectiveness of self-recovery. Several published studies show that dropout rates were higher for self-help psychological interventions than for other treatment interventions that involved interaction with professionals experienced in treating eating disorders.

What are the positive and negative indications for recovery?

Researchers have identified some indicators that may predict chances for a successful recovery. Individuals who are self-confident, realistic, and goal-oriented and who make early progress in therapy usually respond well to the overall treatment plan. Individuals who begin treatment with a low body mass index, have a history of obesity, and show signs of depression may respond less well to therapy.

Triggers for relapse

Many situations and feelings can trigger bulimic behavior: extreme emotional distress, anxiety, depression, dieting, exposure to certain foods (especially high-sugar or high-fat foods), or sudden dissatisfaction with body image. People with bulimia nervosa have reported extreme mood changes before, during, and after binge eating and purging or nonpurging compensatory behavior. They have also reported feeling depressed or anxious before binge eating and then feeling temporary relief or even euphoria afterward. These feelings are often followed by feelings of guilt, shame, and self-loathing. Then purging or excessive exercise occurs to regain feelings of self-control.

Low self-esteem and fulfilling deep emotional needs can be factors affecting bulimic episodes. Triggers can be something an affected individual really wants and gets, like being named captain of a sports team or achieving a high score on a test...and then a boyfriend or girlfriend says something to undermine that confidence.

Bulimic episodes in male and female athletes participating in sports that focus on aesthetics (such as gymnastics, figure skating, or dance) or weight class (such as rowing or wrestling) might be triggered by the stress of an upcoming competition or performance pressure from coaches or teammates. Military personnel could experience bulimic episodes after post-traumatic flashbacks or combat exposure. In addition to the triggers listed above, bulimic episodes in LGBT individuals could be triggered by rejection or fear of rejection after coming out; harassment or violence at work, school, or in the community; or negative beliefs about themselves due to their sexual orientation or gender identity.

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No one knows any sure way to prevent bulimia nervosa. Adhering to some lifestyle guidelines may reduce the risk of a person developing the disorder, but so many factors may influence the disorder's development, including genetics, that it's difficult to know what can prevent it.

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Teachers are often the first to notice that a child might have a learning disorder. Sometimes the signs are easy to spot - a student who just isn't making headway in reading, for example. Or a child who, despite obvious effort, can't seem to master the times tables. But the signs are not always as clear, and many children, embarrassed that they are struggling to do things that seem easy for other kids, go to pains to hide their difficulties.

Here are some less-obvious signs of learning disorders in children to watch for in the classroom.

If you notice that a student who seems as if he should be succeeding, but he isn't -either in one specific subject or in his overall school performance - it could be a sign that he has learning disorder.

This is often described as a discrepancy between ability and aptitude i.e. a gap between what it seems a student should be able to do and what he's actually able do.

Some examples of how this gap might appear in the classroom include:

A student who writes fantastic essays but has serious difficulty getting through basic math assignments, or vice versa.

A kid who's great at answering questions in class but can't get her point down on paper.

A student whose intelligence is obvious in person, but isn't reflected on his report card.

Kids who aren't doing as well in school as expected may appear to be lazy or just not applying themselves, when in fact they may be struggling with a learning disorder. Adults with learning issues recall being told repeatedly, before they were diagnosed, that they weren't trying hard enough. Kids who look like they're not trying may actually be trying very hard, but failing, or trying to hide an embarrassing deficiency.

If a student constantly has to be reminded what to do next, you might think he's not paying attention, but it could be a sign that he's having difficulty with what's called " working memory " - holding, processing and building on new information. This is a common issue for kids with learning disorders.

Other signs to watch for include:

Difficulty following directions - especially if the student is hearing the information for the first time or there are several steps to remember

Daydreaming

Difficulty copying from the board

Trouble remembering assignments and doing them correctly

Students with learning disorders often try conceal their struggles from teachers and peers. Even if they're managing to keep up with school work, with extra effort, it may be taking a big toll on their self esteem. If a student comes across as excessively shy during class - hanging back during group projects, sitting in the back row, or doing everything in his power to avoid being called on during class - he may be trying to hide a learning issue.

It's also important to remember that hiding doesn't always look like what it is. In fact, for some kids it may look just the opposite. Where some students shrink down, hoping to go unnoticed, others act out, drawing attention away from deficits by becoming the class clown, being defiant, or pretending to be "too cool" to care how they're doing in school.

Students with learning disorders often struggle to get homework in on time - or at all. Homework troubles happen for a number of reasons.

A child may feel embarrassed to hand in work that is incorrect or unfinished.

Total wipe-out. Kids who struggle with memory and organization may have simply forgotten there was an assignment due at all.

Lost! Even when homework does get done, it still has to make it from home to school .

Every kid is bound to miss an assignment once in a while, but if a student routinely fails to turn in her homework it's time to take a closer look at what's going on.

Kids with learning disabilities often struggle with time management, transitions and organization. These timing troubles can cause problems both in school and at home. Tell-tale signs to watch for include:

A child who always seems to take 'too long' to complete tasks - from assignments to putting on his shoes after gym.

A student's who's parents report that it takes him hours to get through his homework at night.

A kid who's chronically late to school (I missed the bus - again!) or always seems to be rushing from one class to another.

Most kids will have test anxiety now and then, but if a student seems to have more trouble than expected it can be a clue that he has a learning disorder. Some things to watch for:

A student who always ends up scrambling to finish the test on time - or routinely exceeds the time limit - regardless of reminders.

A child who's always the last one still working on a timed assignment.

Very messy handwriting

Serious pre-test anxiety

A student who fails numerous tests despite having studied

School can be an emotional minefield for students with learning disorders. From struggling to keep up with peers to falling behind on schoolwork, the opportunities to feel bad about themselves can be overwhelming.

Kids with learning disorders often struggle with feelings of shame, embarrassment, and low-self esteem. If a child often seems to be down on himself, depressed, or frustrated at school, an undiagnosed learning disorder could be a cause.

Kids with learning disorders may develop serious school-related anxiety. Especially before they are diagnosed, when they don't understand why they keep up with their peers.

Additionally, kids with learning disorders often struggle with "self-regulation," meaning they lack the tools to manage and process emotions and are easily overwhelmed - which can lead to outbursts. For example, a student who flies off the handle when he's asked to stay in his seat, or is reduced to tears when asked to try a challenging assignment.

Students with learning disorders often go to great lengths to avoid school situations that trigger anxiety or stress. Some signs of avoidance to watch for include:

Excessive absences

Staying home "sick" on days when there are tests or other important assignments

Refusal to participate in challenging activities

Making frequent trips to the bathroom or asking to go to the nurse when faced with stressful assignments or tests

Cutting class, or skipping school entirely

Helping students with learning disabilities get the attention and support they need to do better and feel better will benefit that child- both in school and out - for years to come.

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Tips for Recognizing Learning Disorders in the Classroom - Child Mind Institute

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Learn how to identify learning disabilities in the classroom. Child Mind Institute offers tips for helping children with learning disabilities in school.

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ADAA is committed to highlighting the importance of culture, identity and inclusion for the incredibly diverse community members who have roots in Latin America. ADAA will use the term Latiné ₁ to further our commitment to inclusion and our acknowledgment of identity within the community. Culture and heritage have historically remained important to the community. However, having to uphold these traditional norms can often include the stress of being held to extremely high standards, pushed to work hard, or even told not to speak Spanish in public to avoid experiences of judgment or discrimination. These stressors can eventually cause mental health struggles that should be addressed and not silenced.

Ultimately, it is important to note that ADAA wants to provide a space where all individuals can learn more about anxiety and depression while having the right to identify with language that captures who they are and makes them feel welcome. Click here to translate this page to Spanish.

ADAA encourages you to share your story about identity and mental health here.
1. Why Latiné? Compared to the term Latinx that was created as a gender-neutral alternative to Latino or Latina, the term Latiné also removes gender from Spanish, by replacing it with the gender-neutral Spanish letter E. The term Latiné pushes beyond gender binaries and acknowledges the intersecting identities of the community, which includes men, women, gender non-conforming, non-binary, trans, queer, agender and gender-fluid individuals.
While Latiné communities can be impacted by the same mental health disorders as other communities - including generalized anxiety disorder, major depression, posttraumatic stress disorder (PTSD), and alcoholism - they experience additional health disparities such as access and quality of treatment that can affect the way they receive mental health care. With over 61 million Latinx/Hispanic individuals living in the U.S, nearly 10 million of those people are living with mental health conditions. ⁸ While Only 20% of the Latiné community who experience symptoms of a psychological disorder talk to a doctor about their symptoms and only 10% contact a mental health professional.

Although evidence-based treatments for depression and anxiety disorders such as Cognitive Behavioral Therapy (CBT) show effectiveness in Latiné populations, the community underutilizes these treatments. ² Members of the Latiné community have expressed greater comfort in speaking to primary care physicians or mental health professionals concerning mental illness compared with the White community. ⁶ Regardless, there are still many socioeconomic disparities that impact the Latiné community with approximately 34% of Hispanic/Latiné adults with mental illness receiving treatment each year compared to the U.S. average of 45%, due to many unique barriers to care. ⁷
The Impact of Silence
There are a few barriers within the community that can hinder proper mental health care treatment. One of the main barriers is silence. There is a stigma surrounding mental health and illness that causes members of the Latiné community to remain silent about mental health issues in fear of embarrassment or shame. Also, as religion is so important to the culture, the community members experiencing issues might choose to seek out prayer or faith-based solutions rather than clinical treatment. Unfortunately, the silence only compounds the range of experiences such as immigration, acculturation, trauma, and generational conflicts ⁵ that may result in mental health struggles.
Language Barriers
Another large barrier to treatment and care within the community is language. There can be uncertainty about how to access services for themselves or for their loved ones because of language barriers - not only because many medical professionals do not speak Spanish, but also because there is a lack of health professionals that identify as Hispanic/Latiné. Unfortunately, those that do not can have a hard time understanding the cultural issues that Latiné communities face. It is also important to note that other barriers can include lack of health insurance, legal status, and misdiagnosis. ¹

It is important to find a provider who demonstrates an understanding of culture and identity within Latiné communities. Cultural competence or understanding is necessary when providing quality care and support. Research has shown that a lack of cultural competence in mental health care can result in misdiagnosis and inadequate treatment.

When meeting with a potential provider, whether it be a mental health professional or a primary care doctor, ask questions to get a sense of their level of cultural sensitivity:

Have you treated other members of the Latiné community?

Have you received training in cultural competence?

How do you plan to take your beliefs and practices into account when suggesting treatment⁴?

It may also be beneficial to ask whether there are Spanish-speaking professionals available in their practice if that helps you feel more welcomed and heard.

Learn more about finding the right therapist.

Below are resources where you can find help from Latiné/Hispanic mental health providers:

ADAA Encuentre Soporte en Línea

ADAA tiene un grupo de apoyo en línea anónimo que es uno a uno. Este grupo de apoyo es un lugar amigable y seguro para que las personas compartan sus experiencias con la salud mental. Como miembro, puede conectarse con otras personas que experimentan ansiedad y depresión y trastornos relacionados, contribuir a conversaciones en curso o iniciar su propia conversación con una pregunta o publicar una historia sobre su experiencia.

Haga clic aquí para suscribirse hoy.

These ADAA resources-blog posts, webinars, articles, and community stories-provide helpful information, support, and opportunities to learn more about mental health within Latiné/Hispanic communities.

From ADAA professionals:

From ADAA's Public Community
Additional Mental Health Support Trending Articles
2020-2022:

1. National Alliance on Mental Illness (NAMI). Hispanic/Latinx. Nami.org. https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Hispanic-Latinx

2. National Center of Biotechnology Information (NCBI). Treatment Engagement and Response to CBT Among Latinos with Anxiety Disorders in Primary Care. Pubmed.ncbi.nlm.nih.gov. https://pubmed.ncbi.nlm.nih.gov/24660674/

3. Medical Mistrust, Perceived Discrimination, and Satisfaction with Health Care Among Young-Adult Rural Latinos, NCBI

4. National Alliance on Mental Illness (NAMI). Hispanic/Latinx. Nami.org. https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Hispanic-Latinx

5. Mental Health America (MHA). Latinx/Hispanic Communities And Mental Health. Mhanational.org. https://www.mhanational.org/issues/latinxhispanic-communities-and-mental-health

6. Wiley Online Library. Stigmatizing Attitudes Toward Mental Illness Among Racial/Ethnic Older Adults in Primary Care. Wiley.com. https://onlinelibrary.wiley.com/doi/10.1002/gps.3928

7. National Alliance on Mental Illness (NAMI). Hispanic/Latinx. Nami.org. https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Hispanic-Latinx

8. file:///Users/tiaraj./Desktop/2022-BIPOC-MHM-Toolkit.pdf

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Latinx/Hispanic Communities | Anxiety and Depression Association of America, ADAA

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While Latino communities display a similar susceptibility to mental illness as that of the general population, they experience health disparities that affect the way they receive mental health care, such as the access and quality of treatment.

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Findings on impact of childhood temperament could help with anxiety prevention efforts

* Press Release

A new study has identified early risk factors that predicted heightened anxiety in young adults during the coronavirus (COVID-19) pandemic. The findings from the study, supported by the National Institutes of Health and published in the Journal of the American Academy of Child and Adolescent Psychiatry, could help predict who is at greatest risk of developing anxiety during stressful life events in early adulthood and inform prevention and intervention efforts.

The investigators examined data from 291 participants who had been followed from toddlerhood to young adulthood as part of a larger study on temperament and socioemotional development. The researchers found that participants who continued to show a temperament characteristic called behavioral inhibition in childhood were more likely to experience worry dysregulation in adolescence (age 15), which in turn predicted elevated anxiety during the early months of the COVID-19 pandemic when the participants were in young adulthood (around age 18).

"People differ greatly in how they handle stress," said Daniel Pine, M.D., a study author and chief of the National Institute of Mental Health (NIMH) Section on Development and Affective Neuroscience. "This study shows that children's level of fearfulness predicts how much stress they experience later in life when they confront difficult circumstances, such as the pandemic."

Behavioral inhibition is a childhood temperament characterized by high levels of cautious, fearful, and avoidant responses to unfamiliar people, objects, and situations. Previous studies have established that children who display behavioral inhibition are at increased risk of developing anxiety disorders later. However, less research has investigated the specific mechanisms by which a stable pattern of behavioral inhibition in childhood is linked to anxiety in young adulthood.

The authors of this study hypothesized that children who demonstrate a stable pattern of behavioral inhibition may be at greater risk for worry dysregulation in adolescence-that is, difficulties managing worry and displaying inappropriate expressions of worry-and this would put them at greater risk for later heightened anxiety during stressful events like the pandemic.

In the larger study, behavioral inhibition was measured at ages 2 and 3 using observations of children's responses to novel toys and interaction with unfamiliar adults. When the children were 7 years old, they were observed for social wariness during an unstructured free play task with an unfamiliar peer. Worry dysregulation was assessed at age 15 through a self-report survey. For the current study, the participants, at an average age of 18, were assessed for anxiety twice during the early months of the COVID-19 pandemic after stay-at-home orders had been issued (first between April 20 and May 15 and approximately a month later).

At the first assessment, 20% of the participants reported moderate levels of anxiety symptoms considered to be in the clinical range. At the second assessment, 18.3% of participants reported clinical levels of anxiety. As expected, the researchers found that individuals with high behavioral inhibition in toddlerhood who continued to display high levels of social wariness in childhood reported experiencing dysregulated worry in adolescence, and this ultimately predicted increased anxiety in young adulthood during a critical stage of the pandemic. This developmental pathway was not significant for children who showed behavioral inhibition in toddlerhood but displayed low levels of social wariness later in childhood.

"This study provides further evidence of the continuing impact of early life temperament on the mental health of individuals," said Nathan A. Fox, Ph.D., Distinguished University Professor and director of the Child Development Lab at the University of Maryland, College Park, and an author of the study. "Young children with stable behavioral inhibition are at heightened risk for increased worry and anxiety, and the context of the pandemic only heightened these effects."

The findings suggest that targeting social wariness in childhood and worry dysregulation in adolescence may be a viable strategy for the prevention of anxiety disorders. The findings also suggest that targeting dysregulated worry in adolescence may be particularly important for identifying those who might be at risk for heightened anxiety during stressful life events like the COVID-19 pandemic and preventing that heightened anxiety.

Reference:

Zeytinoglu, S., Morales, S., Lorenzo, N. E., Chronis-Tuscano, A., Degnan, K. A., Almas, A. N., Henderson, H., Pine, D. S., Fox, N. A. (2021) A Developmental Pathway from Early Behavioral Inhibition to Young Adults' Anxiety During the COVID-19 Pandemic. Journal of the American Academy of Child and Adolescent Psychiatry. doi: 10.1016/j.jaac.2021.01.021

Grant:

About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.
NIH...Turning Discovery Into Health

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Study Identifies Risk Factors for Elevated Anxiety in Young Adults During COVID-19 Pandemic

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Findings on impact of childhood temperament could help with anxiety prevention efforts * Press Release A new study has identified early risk factors that predicted heightened anxiety in young adults during the coronavirus (COVID-19) pandemic.

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Children with Generalized Anxiety Disorder Do Not Have Peer Problems-Just Fewer Friends

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The following article is a part of conference coverage from the American Psychiatric Association Annual Meeting 2021, held virtually from May 1 to 3, 2021. The team at Psychiatry Advisor will be reporting on the latest news and research conducted by leading experts in psychiatry. Check back for more from the APA 2021.

Black and Hispanic children diagnosed with childhood-onset schizophrenia are at one-third higher risk of demonstrating suicidal behavior, according to study results presented at the American Psychiatric Association annual meeting, held virtually from May 1 to May 3, 2021.

The study investigators performed a cross-sectional study using data from a nationwide sample of pediatric psychiatric patients to evaluate the risk for suicidal behavior in patients with childhood-onset schizophrenia vs other psychiatric disorders and to identify RR by demographic parameters.

Data were analyzed for a sample of 39,615 pediatric psychiatric inpatients aged 6 to 12 years. The investigators compared children with a primary schizophrenia diagnosis (n=2140) to children with other psychiatric conditions (n=37,475). Suicidal behavior among the cohorts was identified as the codiagnosis of suicide and intentional self-inflicted injury. Logistic regression analysis was performed to measure the risk for suicidal behavior in the childhood-onset schizophrenia cohort vs the nonschizophrenia cohort. The RR for suicidal behavior was further evaluated by race and socioeconomic strata.

A primary diagnosis of childhood-onset schizophrenia was prevalent in 5.4% of the total inpatient sample. Compared with the non-schizophrenia cohort, Black patients had 1.4 times higher odds for childhood-onset schizophrenia (95% CI, 1.24-1.57) and Hispanic patients had 1.3 times higher odds (95% CI, 1.13-1.46). The risk for childhood-onset schizophrenia appeared to increase with decreasing median household income: children from families with a household income below the 25th percentile were 1.4 times (95% CI, 1.22-1.66) more likely to receive a schizophrenia diagnosis than children from higher-income families.

After controlling for demographics and comorbidities, the investigators found that there was statistically no significant difference in the risk for suicidal behavior between the pediatric psychiatric cohorts. However, a statistically significant increase in the risk for suicidal behavior was reported among Black (RR 1.33; 95% CI, 1.09-1.63) and Hispanic (RR 1.31; 95% CI, 1.06-1.63) patients in the childhood-onset schizophrenia cohort vs the non-schizophrenia cohort.

The study investigators suggested that Black and Hispanic children with a schizophrenia diagnosis are 31% and 33% more likely to be at risk for suicidal behavior. In order to prevent childhood suicides, the researchers indicated that clinicians should identify at-risk groups and individuals early on.
Reference
Prabhudesai S, Patel R. Verma S. Suicidal behavior in childhood-onset schizophrenia: Perceptions from 39,615 psychiatric inpatients from the United States. Presented at: APA annual meeting May 1-3, 2021. Abstract/Poster: 4029.

Topics:
APA 2021 Child and Adolescent Psychiatry Health Disparity Schizophrenia And Psychoses Suicide and Self-Harm

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APA 2021: Suicidal Behavior Risk in Childhood-Onset Schizophrenia Elevated by Race - Psychiatry Advisor

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The following article is a part of conference coverage from the American Psychiatric Association Annual Meeting 2021, held virtually from May 1 to 3, 2021. The team at Psychiatry Advisor will be reporting on the latest news and research conducted by leading experts in psychiatry. Check back for more from the APA 2021.

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Schizophrenia and psychotic disorders

"I started to hear voices and messages on the radio and television, and also through the newspaper. The delusion was completely real to me."

Overview

A psychotic disorder involves a disconnection from reality. Psychosis is a group of related symptoms that seriously affect how you think, feel, and behave.

Experiencing symptoms of psychotic disorders can lead to confusion and feeling misunderstood. Psychotic episodes, and the feelings that come with them, can get in the way of work, relating to family and friends, studying, and managing a home.

People with psychosis often have hallucinations. This involves seeing or hearing things that seem very real, but others cannot sense. Some people may have delusions - strongly held beliefs that aren't true, like being spied on, or being famous. Psychosis can be a short, one-off event with an obvious trigger, such as distressing experiences or substance misuse. For other people it can be a longer lasting challenge, and have no obvious trigger.

The most common and well known psychotic disorder is schizophrenia. There are many other mental illnesses that have psychosis as their core symptom, such as brief psychotic disorder and schizoaffective disorder. However, people can also experience psychosis as part of other disorders, such as epilepsy or bipolar disorder. Psychotic episodes can be caused by some drugs as well. Violence is not a symptom of psychotic illnesses.

People with severe forms of psychosis can live fulfilling lives. Some need long-term support to achieve this. Others mainly need help when symptoms are worse, and some don't need much support at all.

To find out if you might have a psychotic disorder, it's important to have an assessment with a clinical psychologist or a psychiatrist.

Taking action for change

You can come up with an individual treatment and support plan with the help of your GP and specialist mental health professionals, such as psychiatrists or mental health caseworkers. Involving your family as well can be helpful. You can use the National Health Services Directory to find a health professional near you.

Often your plan will include medications, such as antipsychotic medication. It's a good idea to let your doctor know whether you think medication is working for you and if you experience any side effects.

Counselling can help you manage mental illness and teach skills to notice and try to stop the things that might trigger your psychosis - such as stress or other intense feelings like anxiety, anger or sadness. Talk therapy such as Cognitive Behaviour Therapy (CBT) can help you identify and change unhelpful thoughts and behaviour. Learning relaxation and stress reduction techniques can help prevent new psychosis in the future.

Life skills programs can help you learn how to improve relationships with important people in your life, or learn useful skills for home, working, or studying. Healthy lifestyle coaching to quit smoking, lessen drug and alcohol intake, as well as exercise and improving your diet can make you feel better physically and emotionally.

A closer look

Around 1 in 10 people have had a hallucination at some time in their lives, but only 1 in 100 Australians will develop psychosis. If you have an odd experience, there is no need to panic. Check if others are sharing the experience, and look at things like sleep and drug use that could be causing them. If they keep happening, it can help to speak with someone you trust about them.

Despite what you may have seen in movies, people diagnosed with schizophrenia do not have a 'split personality'. It can be helpful to talk to people with similar experiences. You are not alone; there are forums where you can learn from people who may have experienced what you are experiencing.

People with schizophrenia may find it more difficult to recognise emotion in faces, particularly emotions such as fear or surprise. People with schizophrenia can learn to recognise emotion in faces better, and this may improve their ability to interact with others. Programs, apps, and online courses can also help manage symptoms of schizophrenia.

In Australia, around 64,000 people have psychosis and are in contact with public mental health services (4.5 per 1000 people). More males than females have psychosis, and most have their first episode of psychosis in their late teens or early adulthood. Around the world, 7 out of every 1000 people have schizophrenia at some point in their lives. Help can initially come from a GP or a mental health professional.

Psychosis and its symptoms can make it more difficult for someone to translate thoughts into actions. They might become very tired as a result, and tasks that seem simple to most people may be extreme hurdles for them. Some people with psychosis may need professional help to manage symptoms and make life easier.

Helping someone with this condition

People with psychosis may need emotional support to deal with unwanted symptoms. It helps to keep in touch with friends and family and continue activities they enjoy, or try new ones. For a first episode of psychosis, family support may be recommended to help family members know how to support the person.

They may also need practical support in accessing medical care and disability services. Be aware that people with psychosis may have difficulties in communicating. Some may show unusual physical gestures, or a lack of emotional expression.

In supporting someone else, it is important to look after yourself as well. You can find information on maintaining your wellbeing on our meaningful life pages. You can also find information on caring for someone with a mental health condition on our support for carers page.

Lived experience

It was so confusing and scary when I first got ill, especially as it happened quite quickly for me. One day I was well, and the next I just felt really strange. I remember saying to my mum before I was diagnosed, that it felt like my brain wasn't connecting to my thoughts. We saw a doctor soon after that.

My daughter has an excellent care team. All three of them speak to each other and they all speak with me too. She trusts them, which has been one of the most important things.

When my wife was psychotic, she believed other people were imposters, that World War 3 had broken out, and other bizarre delusions. Even voices telling her to harm herself. Thank goodness, she's always had the insight to recognise that these thoughts are caused by the illness and aren't true. It's an enormous help at these times that she always trusts me and her doctor.

Kamal (formerly Tim)

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Mental health conditions - Schizophrenia and psychotic disorders

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Schizophrenia and psychotic disorders "I started to hear voices and messages on the radio and television, and also through the newspaper. The delusion was completely real to me." A psychotic disorder involves a disconnection from reality. Psychosis is a group of related symptoms that seriously affect how you think, feel, and behave.

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Depression symptoms may be situational because something happened that made you feel very sad. For example, you may have a problem at work or school or with another person in your life. COVID19 may certainly be a situation that causes sadness and depression. This typically doesn't meet the criteria for a diagnosis of depression otherwise known as major depressive disorder. Therapy can certainly help with processing feelings, hurts, and emotional upsets. You can learn skills to help eleviate the sadness and maybe even learn to become more resiliant to those situations that caused those sad feelings in the first place.

However, a clinical diagnosis of Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living. More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with psychotherapy, medication or both.

What is a manic episode? A manic episode is not a disorder in and of itself, but rather is diagnosed as a part of a condition called bipolar disorder. A manic episode is an emotional state characterized by a period of at least one week where an elevated, expansive, or unusually irritable mood exists. A person experiencing a manic episode is usually engaged in significant goal-directed activity beyond their normal activities. People describe a manic mood as feeling very euphoric, "on top of the world," and being able to do or accomplish anything. The feeling is like extreme optimism - but on steroids.

Sometimes the manic mood is more irritable than it is elevated, especially if the person's wishes are curtailed or denied altogether. Often a person in the midst of mania will engage in multiple projects at the same time, with little premeditation or thought going into them, and finishing none of them. They may work on these projects at all hours of the day, with little regard for sleep or rest.

A person's change in mood is typically associated with manic symptoms that should be observable by others (e.g., friends or relatives of the individual) and must be uncharacteristic of the individual's usual state or behavior. In other words, they're acting in a way that isn't typical of themselves, and other people recognize it.

The manic feelings the person experiences should be severe enough to cause difficulty or impairment in their ability to function at work, with friends or family, at school, or other important areas in their life. Symptoms also cannot be the result of substance use or abuse (e.g., alcohol, drugs, medications) or caused by a general medical condition.

bipolar mania can be diagnosed if you experience at least three of the following symptoms for no less than a week:

I use a custom treatment plan for every patient, but often choose from Cognitive Behavior therapy, Dialectical Behavior therapy, Hypnotherapy, Mindfulness and stress management techniques. I begin by helping you to become aware of signs that you are experiencing stressful symptoms and then help to identify areas in your life that are triggers and stressors of those symptoms. I also offer specific therapies such as those indecated below:

Family-focused therapy (FFT) includes both the individual and their parents, spouse, or other family members. FFT typically lasts about 12 sessions (depending on the family's needs). Early sessions focus on education about the condition: its symptoms and how they cycle over time, its causes, how to recognize the early warning signs of new episodes, and what to do as a family to prevent the episodes from getting worse. Later sessions focus on communication and problem solving skills, especially to address family conflicts. Research indicates that people with bipolar disorder who take part in FFT and medication after an episode have less severe mood symptoms and better functioning over 1-2 year periods than those who get medications and briefer treatments or case management.

IPSRT is an individual therapy in which the person with BD keeps daily records of their bed times, wake times, and activities, and the effects of changes in these routines on their moods. The therapist coaches the person on how to regulate their daily routines and sleep-wake cycles as a way to stabilize moods. The person and his/her therapist identify one or more interpersonal problem areas (e.g., conflicts with coworkers; difficulty sustaining friendships) and discuss potential solutions to prevent similar problems from emerging in the future.

Cognitive behavioral therapy (CBT) is an individual therapy focused on the relationship between a person's thoughts, feelings and behaviors. CBT teaches people to:

Dialectical behavior therapy is a skill-based approach that includes both individual and group therapy. It teaches mindfulness and acceptance skills, such as the ability to experience moment-to-moment thoughts, emotions and their accompanying physical sensations from an observer's stance, without negative judgment. It also teaches distress tolerance, emotion regulation and interpersonal effectiveness.

Frequency and duration of therapy will depend on the individual. Typically therapy is one session per week, but an individual experiencing more intense symptoms would benefit from 2 or more sessions per week. It may be suggested to join a group for a more well-rounded therapy experience. Most people feel better ever after the first session, and notice significant change within 2 to 3 months of therapy.

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Depression symptoms may be situational because something happened that made you feel very sad. For example, you may have a problem at work or school or with another person in your life. COVID19 may certainly be a situation that causes sadness and depression.

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A mood disorder, also referred to as an affective disorder, is a condition that severely impacts your mood and its related functions. Mood disorder is a broad term that's used to include all the different types of depressive and bipolar disorders, both of which affect your mood. If you have symptoms of a mood disorder, your moods may range from extremely low ( depressed) to extremely high or irritable (manic).

Types of Mood Disorders

With the most recent update of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) in 2013, mood disorders are now separated into bipolar disorder and related disorders and depressive disorders.

In general, the main types of mood disorders include:

Major depressive disorder: This is what we often hear referred to as major depression or clinical depression. It involves periods of extreme sadness, hopelessness, or emptiness accompanied by a variety of physical, cognitive, and emotional symptoms.

Bipolar I disorder: Also referred to in the past as "manic depression," if you have mania, you experience euphoric and/or irritable moods and increased energy or activity. During manic episodes, you also regularly engage yourself in activities that can very result in painful consequences for you and/or someone else.

Bipolar II disorder: For diagnosis, you must have had at least one episode of current or past hypomania, which is a less severe form of mania, and at least one episode of current or past major depression, but no history of any manic episodes. The criteria for episodes of mania, hypomania, and major depression remain the same.

Cyclothymic disorder:Diagnosis requires a two-year history minimum of many episodes of not-quite hypomania and not-quite major depression.

Other: There are other categories of mood disorders that include substance/medication and medically induced mood disorders. There are also the diagnosis of "other specified" and "unspecified" mood disorders that don't exactly meet criteria for the other mood disorders.

New Mood Disorders

There are three new depressive disorders included in the DSM-V, including:

Disruptive mood dysregulation disorder: This depressive disorder was added to the DSM-Vfor children up to 18 years of age who exhibit persistent irritability and anger and frequent episodes of extreme temper outbursts without any significant provocation.

Persistent depressive disorder: This diagnosis is meant to include both chronic major depressive disorder that has lasted for two or more years and what was previously known as dysthymic disorder or dysthymia, a lower grade form of depression.

Premenstrual dysphoric disorder: This diagnosis is based on the presence of specific symptoms in the week before the onset of menstruation, followed by the resolution of these symptoms after onset. The symptoms must include one or more of the following: mood swings, irritability or anger, depressed mood or hopelessness, and anxiety or tension, as well as one or more of an additional seven symptoms, with a total of at least five symptoms.

Mood disorders can lead to difficulty in keeping up with the daily tasks and demands of life. Some people, especially children, may have physical symptoms of depression, like unexplained headaches or stomachaches. Because there are various types of mood disorders, they can have very different effects on your life.

In general, symptoms may include:

Loss of interest in activities you once enjoyed

Eating more or less than usual

Difficulty sleeping or sleeping more than usual

Fatigue

Crying

Anxiety

Feeling "flat," like you just don't have the energy to care

Feeling isolated, sad, hopeless, and worthless

Difficulty concentrating

Problems making decisions

Feelings of guilt

Irritability

Thoughts of dying and/or suicide

With mood disorders, these symptoms are ongoing and eventually start to affect your daily life in a negative way. They're not the sporadic thoughts and feelings that everyone has on occasion.

No one knows the exact causes of mood disorders, but a variety of factors seem to contribute to them and they tend to run in families. Chemical imbalances in your brain are the most likely cause. Stressful life events like death, divorce, or trauma can also trigger depression, especially if you've already had it before or there's a genetic component.

Mood disorders should be properly evaluated and treated by a mental health professional, such as a psychiatrist. If any of the symptoms above have been interfering with your life, particularly if you are having suicidal thoughts, you should seek help immediately.

Your doctor will be able to diagnose you by performing a physical exam and lab tests to rule out any physical reasons for your symptoms, as well as a psychiatric evaluation.

Millions of people experience mood disorders and are successfully treated, helping them live a better quality of life. Treatments for mood disorders can include psychotherapy, also known as talk therapy, as well as medications to help regulate the chemical imbalances in your brain. A combination of psychotherapy and medication is often the best course of action to get you on the road to feeling better.

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Mood Disorders Classifications According to the DSM-V

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A mood disorder, also referred to as an affective disorder, is a condition that severely impacts your mood and its related functions. Mood disorder is a broad term that's used to include all the different types of depressive and bipolar disorders, both of which affect your mood.