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Parent Center for Families of Children with Disabilities

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Parent Center for Families of Children with Disabilities

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

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

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

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

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Definition

Students with emotional disorders are a very heterogeneous group with a wide range of issues that are unique to each individual. However, there are some key characteristics that are used to define this disability category, mostly relating to issues of personal identity and emotional well-being. An emotional disorder may be present if a student responds to a situation with an inappropriate behavior or emotion, and particularly, if this emotion is depression or long term unhappiness. Students with emotional disorders typically have a very difficult time maintaining personal relationships with others, and these personal problems lead to physical symptoms in time. If the student has difficulty learning, but there is no intellectual or sensory cause of this difficulty, then an emotional disorder may be to blame. This disability category does include some mental illnesses such as schizophrenia.

It should be noted that one or more of the previously mentioned characteristics has to be present for an extended period of time, and must have a negative impact on the student's academic performance before being considered an emotional disorder. Signs of an emotional disorder need to be taken seriously, as they can lead to physical aggression and self-injurious behavior. However, care must also be taken to recognize the difference between emotional disturbance and general teenage angst. There are as many causes of emotional disturbance in children as there are children in this category, but they can generally be divided into either biological causes, environmental causes, or a combination of the two.

Prevalence

The U.S. Department of Education reports 5,971,495 students receiving special education services in the 2003-2004 school year. Of that number, roughly 7.7%, or 461,055 students, received special education services based on a classification of emotional disturbance. However, within this group of 461,055 students, there was a definite disproportionally between gender, race and socioeconomic background. African-American students were far more likely to be diagnosed as emotionally disturbed than white students, reflecting possible race bias in this category. Research has pointed to a direct correlation between low income status and emotional disorders, but the exact reasons for this correlation are unknown.

Characteristics

Each student with an emotional disturbance will have characteristics that are unique to that individual. However, these students will all share deficits in three specific areas, namely emotional development, behavioral development, and cognitive development.

These students may have specific emotional characteristics/conditions such as anxiety disorder, mood disorder, oppositional defiant disorder, conduct disorder, and schizophrenia. Not addressing any one of these disorders with the appropriate support system could have potentially tragic results. Behavioral characteristics of an emotional disorder include externalizing behavior and conversely internalizing behavior. The former can result in problem behavior and physical aggression while the latter results in depression and anxiety. Finally, students with emotional disorders have a number of academic issues as well, and each year half of the students in this category drop out of school entirely.

One intriguing possible contributing factor to emotional disturbance can be found in deficits in communication. An estimated 71% of students with emotional disorders also have expressive and receptive language disorders that impact their ability to understand and communicate with peers and adults.

Impact on Learning

Students with emotional disorders can be found at every level of cognitive functioning, but the majority of these students tend to have low average intelligence. Most achieve below grade level in academic achievement, with the greatest deficits in both math and spelling. Many have a coexisting learning disability of some type. Students that exhibit externalizing behaviors are at the greatest risk for continued deficits in academic functioning. Students with emotional disorders are less likely to attend post-secondary school than students in many other disability categories. An effective educational program for students with emotional disorders will provide emotional and behavioral supports that foster the replacement of problem behaviors with more appropriate behaviors. Positive behavior support systems are one especially effective strategy to achieve this goal, as are the implementation of wraparound services.

Teaching Strategies

Wraparound planning is a collaborative process that has shown great promise in supporting students with emotional disorders, both in research and in more practical application. This planning process brings all of the involved service providers (i.e., adult rehabilitation services, mental health services, guidance counselor) and individuals together to create a natural support system that is founded on the strengths of the individual student and the community in which that student lives. The family is an integral part of this process, and the overall goal is to devise a program that will capitalize on the strengths and interests of the student while utilizing community resources for placement and intervention.

Generally, academic achievement and problem behaviors often go hand-in-hand for students with emotional disorders. To put this another way, the more difficulty they have with a classroom task, the more likely that maladaptive behavior will result. Supporting the academic performance of these students will thus have the added benefit of decreasing externalizing and internalizing behaviors. Best practices for students with emotional disorders are often best practices for all students. A strategy such as allowing students to choose between classroom tasks, for example, is an effective way to decrease problem behaviors in general. Consistent and specific praise is also a great technique to utilize with all students in the classroom, but can be particularly effective with students with emotional disorders.

It is very important to not make assumptions about any family of a child with an emotional disorder. Many emotional disorders have an organic cause, and the parents of the child may well be loving and supportive in every way. However, some of these students have indeed been abused in some fashion in their young lives, and this too can be a cause of emotional or behavioral issues. Trust can be a very large issue for these children. Forming a relationship with these students that is built on empathy, trust, and mutual respect can often be the solution to many problem behaviors, and can have a lasting impact of the emotional development of the child.

Assistive Technology

Some modification in instruction will be necessary to allow a student with an emotional disorder to demonstrate mastery in a number of academic areas, and most especially in the area of writing. Word processing software can be an excellent supplementary aid for these students, allowing them to edit and revise their work as they produce it. These programs can strengthen spelling skills and writing cohesion simply by making the writing process easier overall. Of particular benefit are word processing programs that read the text as it is typed, providing an additional audio cue for the student.

Organizations

There are a number of excellent organizations that can help support classroom instruction for students with emotional and behavioral disabilities. The information presented in this module is intended as just a very brief description of emotional disorder and its impact on learning. Much more in-depth information and instructional strategies can be accessed through the following organizations:

American Academy of Child and Adolescent Psychiatry

The AACAP (American Academy of Child and Adolescent Psychiatry) is the leading national professional medical association dedicated to treating and improving the quality of life for children, adolescents, and families affected by these disorders. Composed of over 7,500 child and adolescent psychiatrists and other interested physicians, its members actively research, evaluate, diagnose, and treat psychiatric disorders and pride themselves on giving direction to and responding quickly to new developments in addressing the health care needs of children and their families.

Public Information Office
3615 Wisconsin Ave., NW
Washington, DC 20016-3007

Web: www.aacap.org

Center on Positive Behavioral Interventions and Supports

The OSEP-funded National Technical Assistance Center on Positive Behavior and Intervention Supports was established to address the behavioral and discipline systems needed for successful learning and social development of students. The Center provides capacity-building information and technical support about behavioral systems to assist states and districts in the design of effective schools.

5262 University of Oregon
Eugene, OR 97403-5262

Email: pbis@oregon.uregon.edu
Web: www.pbis.org

Center for Disability and Development

Dept. of Educational Psychology
4225 Texas A&M University
College Station, TX 77843-4225

Council for Exceptional Children

The Council for Exceptional Children (CEC) is the largest international professional organization dedicated to improving educational outcomes for individuals with exceptionalities, students with disabilities, and/or the gifted. CEC advocates for appropriate governmental policies, sets professional standards, provides continual professional development, advocates for newly and historically underserved individuals with exceptionalities, and helps professionals obtain conditions and resources necessary for effective professional practice.

1110 North Glebe Road, Suite 300
Arlington, VA 22201-5704

Federation of Families for Children's Mental Health

This organization is dedicated exclusively to helping children with mental health needs and their families achieve a better quality of life. They provide leadership to develop and sustain a nationwide network of family-run organizations; focus the passion and cultural diversity of our membership to be a potent force for changing how systems respond to children with mental health needs and their families; help policy-makers, agencies, and providers become more effective in delivering services and supports that foster healthy emotional development for all children.

1101 King Street, Suite 420
Alexandria, VA 22314

Email: ffcmh@ffcmh.org
Web: www.ffcmh.org

National Alliance for the Mentally Ill (NAMI)

NAMI is the National Alliance on Mental Illness, the nation's largest grassroots organization for people with mental illness and their families. NAMI is dedicated to the eradication of mental illnesses and to the improvement of the quality of life for persons of all ages who are affected by mental illnesses. NAMI members and friends work to fulfill our mission by providing support, education, and advocacy.

Colonial Place Three
2107 Wilson Boulevard, Suite 300
Arlington, VA 22203-3754

Web: www.nami.org

Mental Health America

Mental Health America is dedicated to helping ALL people live mentally healthier lives. They work to fulfill this mission by education the public about ways to preserve and strengthen mental health; advocating for access to effective care; fostering innovation in research, practice, services and policy; and providing support to individuals and families.

2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22311

Web: www.nmha.org

National Mental Health Information Center

The National Mental Health Information Center was developed for users of mental health services and their families, the general public, policy makers, providers, and the media. They provide free information about mental health via a toll-free number, their website, and more than 600 publications.

P.O. Box 42557
Washington, DC 20015

Web: www.mentalhealth.org

References

Hunt, N., and Marshall, K. (2006). Exceptional children and youth. Boston, MA: Houghton Mifflin Company.

National Dissemination Center for Children with Disabilities (2004). Fact Sheet 5. Retrieved February 1, 2008 from www.nichcy.org/pubs/factshe/fs5txt.htm.

Turnbull, A., Turnbull, R. & Wehmeyer, M. L. (2007). Exceptional lives. Special education in today's schools. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.

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Students with emotional disorders typically have a hard time maintaining relationships, and these personal problems may lead to physical symptoms in time.

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Individuals with Disabilities Education Act

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Individuals with Disabilities Education Act (IDEA)

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

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Accommodations for Students with BiPolar Disorder

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Accommodations for Students with BiPolar Disorder

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Not all students who have disabilities require specialized instruction. For students with disabilities who do require specialized instruction in the United States, the IDEA controls the procedural requirements and an IEP is developed. "Special education" under IDEA means the child has been identified as having unique educational needs related to his/her disability and is entitled to an Individualized Education Program (IEP) to meet these needs.

The IDEA process is more involved than that of Section 504 of the Rehabilitation Act. The IDEA requires that measurable growth and progress towards written goals and objectives be documented.

For students with disabilities who do not require specialized instruction but need the assurance that they will receive equal access to public education and services, a document is created to outline their specific accessibility requirements. Section 504 is a federal civil rights law. The purpose of Section 504 is to protect persons with disabilities against discrimination for reasons related to their disabilities.

While students with a 504 plan do not require specialized instruction, and specific goals and objectives are not necessarily outlines nor is data tracked, the plan should be reviewed annually to ensure that the student is receiving the most effective accommodations for his/her specific circumstances.

Unlike IDEA, Section 504 does not guarantee that a child with a disability will receive an individualized educational program that is designed to meet the child's individual educational needs. Rather, it guarantees that accommodations will be made relative to their specific medical needs.

Eligibility for protections under Section 504 depends on the child in question having a physical or mental impairment which must substantially limit at least one major life activity. Major life activities include walking, seeing, hearing, speaking, breathing, learning, reading, writing, performing math calculations, working, caring for oneself, and performing manual tasks. Section 504 requires an evaluation that draws information from a variety of sources.

A child who receives Section 504 protections has fewer rights than the child who receives special education services under the IDEA. The child who receives special education services under the IDEA is automatically protected under Section 504.

Section 504 is designed to guarantee that children with disabilities will not be discriminated against. It is also important to understand that if your child does not qualify for special education services under IDEA, your child does not have the procedural protections that are available under the IDEA.

Under Section 504, the child with a disability may receive accommodations and modifications that are not available to children who are not disabled. These accommodations and modifications are also available under IDEA. For example; accommodations could include, but not be limited to, such things as:

Tests taken in a separate location with time limits waived or extended.

The use of a word processor due to fine motor, visual motor deficits.

Shortened assignments.

Standardized tests answers written directly in the test booklet and transferred onto answer sheet by teacher or assistant.

Class notes provided rather than having the student copy from the chalkboard or overhead.

Allowing the child to leave the classroom 2 to 3 minutes early to avoid crowded hallways.

Preferential seating in the classroom.

Provision of a daily assignment sheet to be filled out by the student and verified by the teacher for accuracy. The parent could then check to make sure that all the work is accomplished. This would assist with homework prioritizing and management.

Please note: These are simply examples. All or none of these may be suitable for your child.

Students with bipolar disorder may or may not have a need for specialized instruction provided within an IEP. For some students, simply being granted accommodations that make allowance for the side effects of medications, related anxiety issues, or results of mood changes is sufficient.

Students with bipolar disorder who are well-controlled on medication may or may not be plagued by racing thoughts, distracting thoughts, an inability to concentrate, decreased energy; all of which will require modifications in the teaching environment or instructional strategies.

For other students, the side effects of medications may be significant enough to require changes in instruction provided or curriculum modifications. Some of the common side effects of medications include: tremors (trembling of hands), blurred vision, loss of coordination, slurred speech, sedation, ataxia (unsteady movement), dizziness, seizures. Some students with bipolar disorder may also have one of a number of other disabilities that impacts their access to the general education curriculum; such as vision or hearing impairment, learning disability, processing problems, or other disability. The co-morbidity rates of ADHD, anxiety disorder, conduct disorder, oppositional-defiant disorder and learning disabilities in students with bipolar disorder tell us that we should explore all avenues available to meet the educational needs of our children.

The following accommodations are meant to serve as a resource for parents unsure of what possibilities exist:

Students on some medications may need:

increased access to water, unlimited access to restrooms (particularly students taking Lithium)

decreased reading assignments or having books on tape or computer screen-reading due to blurred vision

modified school arrival, shortened day, scheduling of core content during the student's most alert time, reducing homework and extending deadlines, providing notes, allowing longer or more frequent breaks, allowing exercise or other movement due to sleep impairment or to sedation of medications

provision of notes and listening guides, work monitoring, extended time on assignments, extra set of books for home use, breaking assignments into more manageable pieces, use of checklists, providing written instructions and/or other visual cues, use of word banks on fill-in types of tests and other modifications that aid retrieval/memory, testing in a separate room, or extended test time, use of multiple choice formats, use of oral exams rather than written demands, use of noise-canceling headsets, - all for impaired concentration, memory

reducing or discontinuing homework may be necessary for some students due to difficulties with concentration, sleep patterns, mood irritability. For these students it may be necessary to schedule a resource room period at the beginning of the day to get assignments ready for the day, or at the end of the day to complete assignments before leaving school

preferential seating can be used to help with vision, focus, reduce visual or auditory distraction, allow for discrete monitoring

and while a 504 plan will simply list the type of accommodation needed and the reasons for it/them, an IEP must contain objectives that are written with specific criteria; such as -Given a grade level reading assignment of 1 chapter with 4 comprehension questions, (name) will answer the questions with 60/70/80% accuracy. Or given an assignment containing 5 long division problems, (name) will complete 3/4/5 problems at 80% accuracy.

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Accommodations for Students with Bipolar Disorder and Related Disabilities - International Bipolar Foundation

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From Dr. Tamar Chansky Creator of Worrywisekids.org

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Most children and parents will have some distress or upset - so how do I know when a child or family needs additional help?

Ask your patients (and their parents) about reactions and coping.

Listen for ongoing or severe traumatic stress symptoms.

Consider a referral for a more thorough evaluation with a mental health professional if:

Traumatic stress reactions are severe or prolonged (more than a month).

Traumatic stress reactions interfere with recovery or with returning to normal activities.

Consider: Is the child participating in daily activities to the extent possible given their medical condition? Are stress reactions interfering with treatment adherence? Are new fears or worries troubling the child or parent?

Steps for making a referral Effective mental health treatment for traumatic stress Online resources - help in finding a mental health professional Distinguishing between types of mental health professionals
Therapist Resource Guide: There are many ongoing stressors that children and families endure after diagnosis of an illness or an injury. This guide focuses specifically on medical traumatic stress and responses that children and families may have.

Steps for making a referral

Mention concerns you have identified.
Say something like: "I'm concerned that (you are / your child is) having these upsetting thoughts and feelings. It might be useful to talk with a specialist who can help your family more."

Involve child and family in making a plan.
Ask for their ideas about what is needed now
Say something like: "What issues or difficulties are impacting you / your family the most right now? What would help make things better?"

Ask for permission to offer advice. Present advice as range of possibilities; be sure to incorporate patient/family ideas

Say something like: "I have some suggestions that have helped other patients in the past in situations similar to yours. May I share them with you?"

Range of possibilities might include: patient education materials / websites; speaking with social worker, local clergy, school counselor; seeking out support group, referral to therapist / community mental health center.

Ask about their readiness to act on this now or in the future.
Say something like: "Is this (suggested plan) something you would be willing to do when you leave today, or if you need it next week...month?"

Ask about barriers to potential plans / referrals, and strategies to overcome barriers.
Say something like: "What kinds of things would interfere with following-up on this plan we just discussed? How can we work through this so you end up getting the help you need.?"

Involve the child and parent in setting the agenda*:*Adapted from Wissow et al. (2008)

Keep the door open.

If your patient or their parents are not quite ready to act on a suggested referral now, arrange to follow up to see how your patient is doing.

You might say: "I'd like to talk with you again in a few weeks to see how things are going."

Promote continuity of care.
If your care for this patient is ending, ask permission to communicate your concerns about traumatic stress reactions or risk factors to the child's primary care provider, or to other providers who will continue to take care of this patient.

Facilitating collaboration between pediatric health care and mental health providers: The American Academy of Pediatrics Task Force on Mental Health has developed tools to facilitate collaboration between pediatric health care providers and mental health professionals, including a Physician Referral and Feedback Form template

Effective mental health treatment for traumatic stress

There are very good and helpful treatments for children who continue to have traumatic stress symptoms.
What treatment approaches are effective?
Evidence-based treatments include cognitive-behavioral treatment approaches, and in particular Trauma-Focused Cognitive Behavior Therapy (TF-CBT).

Click here for a fact sheet about effective treatments for youth trauma from the National Child Traumatic Stress Network.

A recent article includes informative summaries of effective mental health treatments for child traumatic stress symptoms, and guidance for health care professionals:
Cohen, J, Kelleher, K, Mannarino, A.. Identifying, treating, and referring traumatized children: The role of pediatric providers. Archives of Pediatric and Adolescent Medicine 2008;162(5):447-452 How can I help parents find effective treatment for their child?
When helping parents find a counselor or therapist to help their child with traumatic stress symptoms, you might suggest that they ask prospective therapists questions such as:

Do you have experience working with children after trauma?

What is your approach to working with this type of problem?

What is your success rate?

How do you work with parents?

The National Child Traumatic Stress Network offers useful tips and information about finding a mental health professional to help children and their families after trauma.

Online resources - help in finding a mental health professional

The National Child Traumatic Stress Network (NCTSN) has trauma-trained, child mental health professionals and community-based treatment centers in 35 states in the US. For information about or referral to a NCTSN center near you, please go to the NCTSN Organizational Members site.
American Psychological Association - Psychologist Locator National Association of Social Workers - Find a Licensed Social Worker American Academy of Child and Adolescent Psychiatrists - Psychiatrist Finder Anxiety Disorders Association of America - Find a Therapist Sidran Institute Help Desk - Locate Trauma Resources ISTSS Clinician Directory - Find a Clinician, Counselor or Mental Health Professional
Distinguishing between types of mental health professionals

Psychologists are professionals who have earned a doctoral degree (Ph.D. or Psy.D.) after 4-6 years of graduate-level training in human behavior and development, psychological testing and evaluation, and psychotherapy. Psychologists are licensed by the state in which they practice.

Psychiatrists are physicians (M.D. or D.O.) who have completed medical school, plus additional advanced training in the evaluation and treatment of psychiatric disorders and emotional and behavioral problems. Psychiatrists are licensed by the state in which they practice. As medical doctors, psychiatrists can prescribe and monitor medications.

Clinical Social Workers are professionals who have earned a master's degree (M.S.W.) after 2-3 years of graduate training. Clinical Social Workers are licensed by the state in which they practice (LCSW or similar credential - varies by state).

Marriage and Family Therapists are professionals who have completed a master's degree (M.A. or M.S.) after 2-3 years of graduate training. Some Marriage and Family Therapists have completed a required amount of clinical hours and passed a state-administered examination to become licensed marriage and family therapist (LMFT).

Licensed Professional Counselors (LPC) & Licensed Mental Health Counselors (LMHC) are mental health professionals who have earned a master's degree (M.A. or M.S.) after 2-3 years of graduate training and have obtained a required amount of clinical experience and passed a state-administered licensing examination.

For more information on the training and credentialing of mental health professionals, see Mayo Clinic: Mental health providers.

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When and How to Refer for Mental Health Care

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Pediatric providers can follow specific steps to determine if and how to refer a child and familiy for further mental health services after a medically traumatic event. Providers can also become familiar with current evidence-based treatments and online resources for mental health services for traumatic stress.

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Generalized anxiety disorder ( GAD) can be a challenge to diagnose. People consider panic attacks a hallmark of all anxiety disorders, and GAD is different in that there are generally no panic attacks associated with it. Without panic attacks present, we may think we are "just worrying too much." Our struggles of constant worry may be minimized or dismissed and, in turn, not properly diagnosed or treated.

Most of us feel worried at some point in our lives and experience situations that can cause us to feel anxious, so what are professionals looking for to help determine if someone struggles with GAD? An evaluation of symptom criteria, as outlined in The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (also known as the DSM-5), is the first step-they look for factors like excessive, hindering worry paired with a variety of physical symptoms, then use proven diagnostic assessments to make a diagnosis and rule out other possibilities.

The DSM-5 outlines specific criteria to help professionals diagnose generalized anxiety disorder. Having a standard set of symptoms to reference when assessing clients helps them to more accurately diagnose mental health concerns and, in turn, create a more effective plan of care.

When assessing for GAD, clinical professionals are looking for the following:

1. The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least 6 months and is clearly excessive. Excessive worry means worrying even when there is no specific threat present or in a manner that is disproportionate to the actual risk. Someone struggling with GAD experiences a high percentage of their waking hours worrying about something. The worry may be accompanied by reassurance-seeking from others. In adults, the worry can be about job responsibilities or performance, one's own health or the health of family members, financial matters, and other everyday, typical life circumstances. In children, the worry is more likely to be about their abilities or the quality of their performance (for example, in school).

2. The worry is experienced as very challenging to control. The worry in both adults and children may easily shift from one topic to another.

3. The anxiety and worry are accompanied with at least three of the following physical or cognitive symptoms (In children, only one symptom is necessary for a diagnosis of GAD):

Edginess or restlessness

Tiring easily; more fatigued than usual

Impaired concentration or feeling as though the mind goes blank

Irritability (which may or may not be observable to others)

Increased muscle aches or soreness

Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep)

Many individuals with GAD also experience symptoms such as sweating, nausea, or diarrhea.

The anxiety, worry, or associated symptoms make it hard to carry out day-to-day activities and responsibilities. They may cause problems in relationships, at work, or in other important areas.

These symptoms are unrelated to any other medical conditions and cannot be explained by the effect of substances including a prescription medication, alcohol, or recreational drugs.

These symptoms are not better explained by a different mental disorder.

During an assessment, your clinician will use the diagnostic criteria, standardized assessments, and their clinical judgment to make a diagnosis.

Generally, they will ask about your symptoms in an open-ended way, but you may also be asked to complete self-report questionnaires. These typically brief measures can help determine the diagnosis (as the Generalized Anxiety Disorder Scale-7 does) or severity of symptoms.

In specialized care settings, like an anxiety disorders clinic, standardized assessment tools are sometimes used to evaluate symptoms. In this case, your clinician gives you a semi-structured interview. The interview is likely to include a standardized set of questions, and your answers will help your clinician to make an accurate diagnosis.

Commonly used and well-validated diagnostic interviews for adults include the Structured Clinical Interview for DSM Disorders (SCID) and the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5). There is a child version of the ADIS, in which both parent and child are asked about the child's symptoms. These interviews also evaluate the presence of other associated conditions such as depression.

Remember to be honest with your provider at the first visit-both when filling out forms and discussing your symptoms face-to-face. Being upfront and honest can help determine what is happening and put together a plan of care specifically tailored to your needs.

If you are wondering whether you or your child might suffer from GAD, you can consider completing a brief online self-screening tool for adults or for children provided by the Anxiety and Depression Association of America (ADAA). If you do this, you should still speak with a mental health professional or your physician for a proper diagnosis and treatment.

Many people struggle with GAD experience symptoms for a long time before seeking help. Reaching out for a diagnosis can feel challenging, especially when anxiety feels so constant and widespread. Contacting a mental health or other clinical provider is a courageous step that can help clarify what is happening and, in turn, lead to creating a plan of care that can help you find relief and regain a sense of well-being.

When deciding to seek help, something to consider is how difficult it is to feel any sense of calm, comfort, and reassurance around your worry. If you find yourself constantly seeking reassurance from others, or repeatedly trying different methods of stress management and relaxation to no avail, it may be worth contacting a professional.

Also, know that no experience of a panic attack is another primary reason people don't seek help. The worry is chronic and concerning but, because there are no periods of acute panic attacks, they simply chalk the challenges up to being a "worry wart." They may even be told this by others when seeking reassurance or trying to find comfort. Remember, GAD is different in that panic attacks aren't typically present, so don't let this factor stop you from reaching out.

Additionally, take note of the physical symptoms that are accompanying your worry. As the anxiety continues, you may find more and more challenges with things like headaches, digestion, restlessness, and fatigue. When we feel this way we are not able to live our best life. Should you find that your worry feels excessive and begins leading to other physical symptoms, you may benefit from talking with a mental health or other care providers.

Take time to research and seek out providers who specialize in the treatment of anxiety. Because anxiety is present in so many mental health conditions, you will want to talk with someone who understands the specific criteria required so you can be accurately diagnosed and treated.

Primary care physicians can often provide referrals to trusted and specialized mental health providers. Otherwise, to find a psychotherapist in your area, consult referral resources such as:

The American Psychiatric Association is a national organization of psychiatrists that can also provide recommendations for local providers who are able to provide psychiatric evaluation and prescribe medications.

Anxiety symptoms can be found in many categories of mental health conditions listed in the DSM-5, such as within mood disorders, eating disorders, and cognitive disorders. Within the category of anxiety disorders there are many symptoms that will overlap and anxiety conditions can sometimes be confused with one another.

While sitting with a mental health provider, they will be seeking information that will help them to best diagnose your condition. A differential diagnosis means to distinguish one condition from another when there are symptoms that overlap.

Some conditions that may need to be ruled out include:

Although some of these conditions are discussed more casually by the general public, there are specific criteria that would need to be met in order for one of these (or other conditions) to be properly diagnosed. It is important for you to sit with a qualified professional to determine what is happening for you and to be offered a plan of care that can best help.

Additionally, there can be other behaviors and symptoms that can be present with anxiety. When someone engages in self-sabotaging behavior, such as procrastination, they can be perceived as struggling with self-regulation and behavioral conditions. Overlooking elements of anxiety related to this behavior can end up creating an obstacle for someone to receive effective treatment.

Sitting with a qualified professional to determine an accurate diagnosis is key. Having the willingness to reach out for help, being honest with your provider and participating actively in treatment can help you regain a sense of well-being.

Remember, GAD is a treatable condition. There is no need for you (or your child) to worry in silence. Treatment, particularly psychotherapy, self-help approaches, or other therapies, will teach you a variety of ways to cope with your anxiety. There are also medications that can help.

View Article Sources

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Washington, D.C.: American Psychiatric Association; 2013.

Brown, TA, Barlow DH. Treatments That Work: Anxiety and Related Disorders Interview Schedule for DSM-5. New York: Oxford University Press, 2014.

First MB, Williams JBW, Benjamin LS, Spitzer RL, First MB. SCID-5-PD: Structured Clinical Interview for DSM-5® Personality Disorders. Arlington, VA: American Psychiatric Association Publishing; 2016.

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How Is Generalized Anxiety Disorder Diagnosed Using the DSM-5?

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Generalized anxiety disorder ( GAD) can be a challenge to diagnose. People consider panic attacks a hallmark of all anxiety disorders, and GAD is different in that there are generally no panic attacks associated with it. Without panic attacks present, we may think we are "just worrying too much."

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You indicate the behaviors that are making you concerned about your child by answering a series of questions. The Symptom Checker analyzes your answers to give you a list of psychiatric or learning disorders that are associated with those symptoms.

Since individual symptoms can reflect more than one disorder, this tool will give you a range of possibilities and guide you toward next steps. This tool cannot diagnose your child, but it can help you inform yourself about possible diagnoses and will offer information and articles to help you learn about them, to facilitate a conversation with a professional.

Remember, this tool is not a substitute for a diagnostic evaluation by a medical or mental health professional. If you believe your child has a psychiatric or learning disorder, please consult a professional.

We do not collect any personally identifiable information.

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Are you worried about your child? Our Symptom Checker can help you inform yourself about possible diagnoses and will offer you helpful information and articles.

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Depressive disorder, frequently referred to simply as depression, is more than just feeling sad or going through a rough patch. It's a serious mental health condition that requires understanding and medical care. Left untreated, depression can be devastating for those who have it and their families. Fortunately, with early detection, diagnosis and a treatment plan consisting of medication, psychotherapy and healthy lifestyle choices, many people can and do get better.

Some will only experience one depressive episode in a lifetime, but for most, depressive disorder recurs. Without treatment, episodes may last a few months to several years.

An estimated 16 million American adults-almost 7% of the population-had at least one major depressive episode in the past year. People of all ages and all racial, ethnic and socioeconomic backgrounds experience depression, but it does affect some groups more than others.

Symptoms

Depression can present different symptoms, depending on the person. But for most people, depressive disorder changes how they function day-to-day, and typically for more than two weeks. Common symptoms include:

Changes in sleep

Changes in appetite

Lack of concentration

Loss of energy

Lack of interest in activities

Hopelessness or guilty thoughts

Changes in movement (less activity or agitation)

Physical aches and pains

Suicidal thoughts

Causes

Depression does not have a single cause. It can be triggered by a life crisis, physical illness or something else-but it can also occur spontaneously. Scientists believe several factors can contribute to depression:

Trauma. When people experience trauma at an early age, it can cause long-term changes in how their brains respond to fear and stress. These changes may lead to depression.

Genetics. Mood disorders, such as depression, tend to run in families.

Life circumstances. Marital status, relationship changes, financial standing and where a person lives influence whether a person develops depression.

Brain changes. Imaging studies have shown that the frontal lobe of the brain becomes less active when a person is depressed. Depression is also associated with changes in how the pituitary gland and hypothalamus respond to hormone stimulation.

Other medical conditions. People who have a history of sleep disturbances, medical illness, chronic pain, anxiety and attention-deficit hyperactivity disorder (ADHD) are more likely to develop depression. Some medical syndromes (like hypothyroidism) can mimic depressive disorder. Some medications can also cause symptoms of depression.

Drug and alcohol abuse. Approximately 30% of people with substance abuse problems also have depression. This requires coordinated treatment for both conditions, as alcohol can worsen symptoms.

Diagnosis

To be diagnosed with depressive disorder, a person must have experienced a depressive episode lasting longer than two weeks. The symptoms of a depressive episode include:

Loss of interest or loss of pleasure in all activities

Change in appetite or weight

Sleep disturbances

Feeling agitated or feeling slowed down

Fatigue

Feelings of low self-worth, guilt or shortcomings

Difficulty concentrating or making decisions

Suicidal thoughts or intentions

Treatments

Although depressive disorder can be a devastating illness, it often responds to treatment. The key is to get a specific evaluation and treatment plan. Safety planning is important for individuals who have suicidal thoughts. After an assessment rules out medical and other possible causes, a patient-centered treatment plans can include any or a combination of the following:

Psychotherapy including cognitive behavioral therapy, family-focused therapy and interpersonal therapy.

Medications including antidepressants, mood stabilizers and antipsychotic medications.

Exercise can help with prevention and mild-to-moderate symptoms.

Brain stimulation therapies can be tried if psychotherapy and/or medication are not effective. These include electroconvulsive therapy (ECT) for depressive disorder with psychosis or repetitive transcranial magnetic stimulation (rTMS) for severe depression.

Light therapy, which uses a light box to expose a person to full spectrum light in an effort to regulate the hormone melatonin.

Alternative approaches including acupuncture, meditation, faith and nutrition can be part of a comprehensive treatment plan, but do not have strong scientific backing. Read more on our treatment page.

Reviewed August 2017

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Depressive disorder, frequently referred to simply as depression, is more than just feeling sad or going through a rough patch. It's a serious mental health condition that requires understanding and medical care. Left untreated, depression can be devastating for those who have it and their families.

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Bipolar disorder, also known as manic depression, is a chronically recurring condition involving moods that swing between the highs of mania and the lows of depression.

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National Institute of Mental Health (NIMH)

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Overview

Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms:

Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.

Hyperactivity means a person may seem to move about constantly, including in situations when it is not appropriate, or excessively fidgets, taps, or talks. In adults, hyperactivity may mean extreme restlessness or talking too much.

Impulsivity means a person may act without thinking or have difficulty with self-control. Impulsivity could also include a desire for immediate rewards or the inability to delay gratification. An impulsive person may interrupt others or make important decisions without considering long-term consequences.

Signs and Symptoms

Risk Factors

Treatment and Therapies

Join a Study

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Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. People with ADHD experience an ongoing pattern of the following types of symptoms: Inattention means a person may have difficulty staying on task, sustaining focus, and staying organized, and these problems are not due to defiance or lack of comprehension.

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Everyone says "you're so funny." Are you funny?

Jerry: I like to think I am. Using humor kind of softens a lot of what we do. If I can get a kid to laugh and see how ridiculous his thoughts and obsessions are, he'll be that much more engaged in treatment.

When did you feel that this might be something you want to do as a career?

Jerry: When I was about nine years old, growing up in Minnesota, I was hanging out in my back yard with some friends in the middle of winter. Everything was white, covered in snow, and a dog, a black lab, was running towards us. Something in my brain just clicked and I had this panicked thought that the dog was going to attack us. So I got up instinctively and ran towards the house, and now the dog was chasing me and he thought we were playing. I made it into my house and closed the door and I saw him jumping and barking and having a great time, but I was terrified. For a year after that I was terrified of dogs. I wouldn't go to someone's house if there was a dog; I would cross the street to avoid them.

And then my parents instinctively did something that made me not afraid anymore. We got a dog. I remember watching my sisters play with him. He was licking them and they were having a great time. And I got more and more brave, and I reached over and started petting him, too. I knew from that experience that I wanted to be in a profession that helped people. My dad was a surgeon so I thought maybe I could be a physician. I took an organic chemistry class in college and it did not go well; I dropped the class. So medicine was out, but I found psychology. It all just made sense. I knew I wanted to go to grad school and I wanted to specialize in anxiety.

Were there any experiences early on in your career that were particularly profound?

Jerry: I did my post-doctoral training at a place called the Bio Behavioral Institute in New York. They were hard-core behaviorists, pioneers in the field, and I really developed my niche in OCD and anxiety with them. But they were uncompromising. We would have sessions in dumpsters with people who were afraid of germs. It was fascinating to see how people would find the courage to do these things because they had faith that the treatment would work. It was very rewarding. It's definitely not a 9-to-5 job, thinking about creative ways to get people to face their fears.

Why did you decide specifically to focus on working with young people?

Jerry: In part because I love young people so much. I've always bonded with kids. I can pick up a screaming baby and kind of soothe it. People call me the baby whisperer. I'm an adult but I have the sense of humor of a twelve-year-old boy at times, so I can relate to kids. And I always feel if we can get to people when they're young and give them strategies and skills - like what my parents indirectly taught me about overcoming fear - then we can pave the road to a lifetime of happiness.

When you started applying what you were learning to kids, how was it different and exciting?

Jerry: The thing I learned while working with kids is that you can't use the psychobabble that you use with adults. You have to break the topics down into a language the kids can understand. And I found that the more I did that, and the more that they were understanding the conceptual models of what we were doing and really making progress, then I would start to use the same metaphors and language with adults. Working with kids made me more effective working with adults because we had to talk about things in real language. In this field, we tend to take simple ideas and put crazy language to them because it makes us feel more important or something. But with kids you can't do that.

Kids like to call you out.

Jerry: Yes. You can't mess around with a kid. They don't necessarily have the same filter that adults would have. I could say something pretty boneheaded right now and you might think, "Maybe I shouldn't mention it." But a nine-year-old is going to come out and say "that's stupid, why did you say that?" (Laughs.) So they keep you on your toes.

How did you become the OCD guy?

Jerry: When I was in training, I wrote a book on compulsive hoarding, which got my name out into the OCD community because hoarding was associated with OCD at the time. I met a lot of the leaders in the field and pioneers in the field, and the more I got to know OCD, the more I bonded with OCD. Maybe because of my own phobias and my training, I understood how OCD worked. It's very synonymous in presentation and style in treatment response to phobias.

When a kid walks into your office, how does the conversation go?

Jerry: I ask about their interests and what they like and if they're sports fans. It's a way to bond and get to know them. There's a school of thought that you shouldn't disclose a whole lot about your personal life to your patients - that you're the doctor and they're the patient and it's all about them. But that doesn't always work with kids. They have to understand a little bit about who you are. So I talk a lot about my past, my fear of dogs. I talk a lot about sports and the teams I like. I'm from Minnesota so unfortunately I'm used to losing a lot in sports. And that helps kids kind of feel more comfortable with me. The sessions don't always feel so clinical, they're also kind of establishing more of a personal relationship. Normally in sessions my tie is loose, my collar is unbuttoned, my sleeves are rolled up, and I'm not the doctor, I'm Jerry.

How does it feel being involved in changing a kid's life?

Jerry: Well, I think that's why we all get in this line of work. I like getting paid for doing what I do but really the reason is knowing that you're making a difference in someone's life. And that they come to us in a very acute crisis mode. Their lives are in shambles. They're not going to school, and if they are, they're not doing very well. They're not going out with their friends, they're caught up in their symptoms, their rituals, their avoidances. So they come to us at a very troubled time. Often times they've been to different therapists and doctors and nothing's really worked. We hear a lot that we are sometimes their last hope. So to be able to connect with someone, to have them believe that I'm going to be able to make a difference in their life, is very powerful. It puts a lot of responsibility onto me, which I welcome and respect. I think they see that and it allows them to commit to the relationship and to the treatment. It feels amazing to see someone who's really struggling become the person they used to be. And parents saying, "We have him back. He's back to being our son." It's very powerful.

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Why Jerry Uses Humor with His OCD Patients | Child Mind Institute

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Jerry: I like to think I am. Using humor kind of softens a lot of what we do. If I can get a kid to laugh and see how ridiculous his thoughts and obsessions are, he'll be that much more engaged in treatment.

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When a friend or family member develops a mental health condition, it's important to know that you're not alone. Many Americans have experienced caring for a person with mental illness. 1 in 25 Americans lives with a serious mental health condition. Mental health professionals have effective treatments for most of these conditions, yet in any given year, only 60% of people with a mental illness get mental health care.

As a result, family members and caregivers often play a large role in helping and supporting them. Millions of people have experienced the thoughts and questions you might be having now.

You may be trying to help a family member who doesn't have access to care or doesn't want help. Or you may want to learn how to support and encourage someone who has been hospitalized or experienced a similar mental health crisis.

We realize that the challenges of mental illness do not only affect an individual's family members but also friends, teachers, neighbors, coworkers and others in the community. Here we use the terms family member and caregiver interchangeably to refer to someone giving emotional, financial or practical support to a person with a mental health condition. Whether you're providing a lot of assistance or very little, the information here can help you better understand the issues that you might face.

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When a friend or family member develops a mental health condition, it's important to know that you're not alone. Many Americans have experienced caring for a person with mental illness. 1 in 25 Americans lives with a serious mental health condition.

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Learn about anxiety disorders, including symptoms, risk factors, treatment options and answers to your questions.

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ANRED - Anxorexia & Eating Disorders Information and Resources

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ANRED provided comprehensive information about anorexia nervosa, bulimia, binge eating disorder, and other less well-known eating disorders. We retain the site's original intent, which is to be an objective resource for those seeking information about eating disorders.