# data[].attributes.body
The American School Counselor Association's Mindsets and Behaviors (ASCA) handout is a series of guidelines to help students with positive mindsets and behaviors that lead to success during the formative school years as well as after graduation (ASCA, 2014).

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School Counselor's Referral Process Guide

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School Counselor's Referral Process Guide

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This helps school counselors with assessing student and staff needs, the referral process, and how to utilize small groups effectively in the public school setting (Missouri Professional School Counselors and Counselor Educators, 2015).

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The Texas Model for Comprehensive School Counseling Programs

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The Texas Model for Comprehensive School Counseling Programs

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This is the blueprint for designing, developing, implementing, and refining a comprehensive school counseling program (CSCP) within the state of Texas. Included in The Texas Model for Comprehensive School Counseling book (TEA, 2018) are guidelines for the school counselor's role, different components of a CSCP, and various regulations and procedures.

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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)  https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596

American School Counselor Association (2014). ASCA
student standards; mindsets and behaviors for student success. https://www.schoolcounselor.org/getmedia/7428a787-a452-4abb-afec-d78ec77870cd/Mindsets-Behaviors.pdf

American School Counselors Association. (2016a).  Appropriate and inappropriate activities for school counselors. https://www.schoolcounselor.org/getmedia/8fe536c2-7a32-4102-8ce7-42e9b0683b3b/appropriate-activities-of-school-counselors.pdf

American School Counselors Association. (2016b). ASCA ethical standards for school counselors. https://www.schoolcounselor.org/getmedia/f041cbd0-7004-47a5-ba01-3a5d657c6743/Ethical-Standards.pdf

Bidik, G., Sisman, F. (2021).  School-based mental health programs for improving psychosocial well-being in children and adolescents: Systemic review.  Journal of Psychiatric Nursing, 12(4), 350-361.
https://doi.org/10.14744/phd.2021.14471

Boston MindCare. (2022).  4 types of bipolar disorder.  Boston MindCare, LLC. https://bostonmindcare.com/4-types-of-bipolar-disorder/

Mayo Clinic. (2021, February 16).  Diseases & conditions: Bipolar disorder.  Mayo Clinic Patient Care & Health Information. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955

Missouri Professional School Counselors and Counselor Educators. (2015). Professional school counselor small group counseling guide: A professional school counselor’s guide to planning, implementing, and evaluating school-based counseling groups. Retrieved from https://www.missouricareereducation.org/doc/smallgroup/SmallGroupCounseling.pdf

National Center on Birth Defects and Developmental Disabilities. (2022, April 19).  What is children’s mental health?  Centers for Disease Control and Prevention. https://www.cdc.gov/childrensmentalhealth/basics.html

National Eating Disorders Association. (2022).  NEDA Toolkit for Educators.  NEDA Feeding Hope.
https://www.nationaleatingdisorders.org/sites/default/files/Toolkits/EducatorToolkit.pdf

Puliafico, A., & Robin, J. (2017).  The OCD workbook for kids: Skills to help children manage obsessive thoughts and compulsive behaviors.  Instant Help.

Texas Administrative Code, 19. Tex. Admin. Code § 239.15 (2017). https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=T&app=9&p_dir=N&p_rloc=187036&p_tloc=&p_ploc=1&pg=23&p_tac=&ti=19&pt=7&ch=239&rl=15

Texas Education Agency (2018). The Texas model for comprehensive school counseling

programs (5th ed.). Texas Counseling Association.

https://tea.texas.gov/sites/default/files/Pub_2018_Texas-Model_5th-Edition.pdf

Tobin, R., & House, A. (2016).  DSM-5® Diagnosis in the Schools.  The Guilford Press.

Understood for All Inc. (n.d.). The difference between IEPs and 504 plans.  https://www.understood.org/en/articles/the-difference-between-ieps-and-504-plans

Verywellmind (2022). Mental Health from A to Z. Dot Dash Meredith, Inc.. https://www.verywellmind.com/mental-health-a-z-4797402

Wender, P., & Tomb, D. (2017).  ADHD: A guide to understanding symptoms, causes, diagnosis, treatment, and changes over time in children, adolescents, and adults (2nd ed.).  Oxford University Press.

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Which Mental Disorders are on the Schizophrenic Spectrum?

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Which Mental Disorders are on the Schizophrenic Spectrum?

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Treatment Options for Children with Schizophrenia

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Treatment Options for Children with Schizophrenia

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These mental disorders are outside of the scope of a PSC. The best course is referral to licensed therapists and community mental health clinicians.

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Mental Disorders on the Schizophrenic spectrum have symptoms where there is a breakdown between thoughts, emotions, and behaviors.  This breakdown leads to irrational perception, behaviors and emotions inconsistent with the thoughts, and a psychotic break from reality into fantasy and delusion; a breakdown of rational thought (APA, 2013).

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Resource for Working with Students with Obsessive-Compulsive Disorder (OCD)

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Resource for Working with Students with Obsessive-Compulsive Disorder (OCD)

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This activity book gives counselors and teachers simple activities to help children with OCD from young learners to high schoolers. Some of the suggested activities are metacognitive exercises where obsessions (sticky thoughts) are replaced with affirmations (Puliafico & Robin, 2017). Educating stakeholders, advocating for accomodations, and providing clubs that promote positive community are other methods that Puliafico & Robin (2017) promote.

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The American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) (2013) lists ADHD and Oppositional Defiance Disorder (ODD) under the umbrella term of Conduct Disorders.  Conduct Disorders are categorized under Neurodevelopmental Disorders or disorders that affect the brain’s growth and development.  ADHD symptoms and/or behaviors vary in intensity, presentation, and duration, but last six or more months in more than one setting (Wender & Tomb, 2017).  ADHD symptoms also causes social, emotional, or behavioral impairment (Wender & Tomb, 2017).

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A resource for teachers to identify Conduct Disorder symptoms within the classroom setting and ways to work with those students.

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This fact sheet gives a definition of Attention-Deficit Hyperactivity Disorder (ADHD) and signs of ADHD along with the process to get ADHD diagnosed.

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The National Eating Disorder Association (NEDA) is a group that provides information and toolkits about eating disorders to help educators support students and aid in the detection, prevention, and interventions for students with eating disorders (2022).

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Trauma is triggered by exposure to actual or threatened death, serious injury, or sexual violence, and lots of intrusive symptoms related to the traumatic event (APA, 2013).

Red Flags for kids are: repetitive play, frightened dreams without recognizable context, and a pattern of avoiding things that remind him or her about the trauma.  Mood are altered and energy levels change (APA, 2013).

Examples of Trauma and Stressor-Related Disorders:
- Post-Traumatic Stress Disorder (PTSD)
-Adjustment Disorder
-Reactive Attachment Disorder
-Disinhibited Social Engagement Disorder
-Unclassified and Unspecified Trauma Disorders
(APA, 2013)

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Substance Abuse and Mental Health Services Administration (SAMHSA)

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Substance Abuse and Mental Health Services Administration (SAMHSA)

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SAMHSA is a national resource and a first step for those who need help with mental illness. They have support personnel and can help locate resources for referral or treatment.

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Substance Abuse and Mental Health Services Administration

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Frequently Asked Questions - What is SAMHSA’s National Helpline?

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Echo is a website that outlines steps for supporting those who have experienced trauma. There are online courses, parenting programs, free resources, trauma trainings, and news and events.

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What would we do if we could see every psychological wound ever inflicted as a physical bruise? We would see a lot of black and blue people walking around! We might also be more careful of each other, understanding the degree of suffering we each have endured.

One of the hardest things when you are in a relationship is that there is no trauma map to refer to and even as we get to know someone's history and the things that activate past trauma, we are often bewildered or downright indignant when trauma rears its head and our loved ones lash out, retreat, get emotional for no understandable reason, or unfairly blame us for all kinds of wrongdoing.

How do you negotiate these and other manifestations of trauma? We have put together a infographic based on relationship lessons learned by trauma survivors and those who love them.

1. Predictability: Everyone loves surprises! Not. Trauma survivors often prefer predictability because that feels safer.

2. Space: Allow time for the survivor to calm down and take perspective. Remember that we trauma survivors often have difficulty regulating our emotions and take longer to calm down. Maybe support self-soothing, for example suggesting you both go for a walk, maybe stay well clear! If the survivor is caught up in the fight/flight response you may be mistaken for the enemy.

3. Perspective: Be aware when 'the past is intruding into the present.' Don't take responsibility for what is not yours... gently. You can own any insensitivity or lack of consideration that has provoked the reaction and yet separate it from whatever past trauma is fueling what would otherwise appear to be a disproportionate response. Remember there is no such thing as 'over-reacting' - the reaction is in direct proportion to the pain experienced in the past rather than in response to what's happening now.

4. Rid 'over-reacting,' 'over-sensitive,' 'over'-anything from your vocabulary.

5. Language: Don't refer to 'your upbringing, your problem, issues, behavior.' This sounds like judgment or at the very least like the trauma survivor is somehow broken or the problem. Call it for what it is - trauma.

6. Be kind, loving, patient... But empathetically set limits - you have needs too! It's okay to talk about when the survivor's reactions hurt you too. "I love you and I understand how scared/angry/sad you are... and it's not okay to hurt me." Whatever our trauma history, we must all learn to be accountable when we hurt others.

7. Reciprocity: Most of us had parents who lacked skills in listening, empathy, tolerating uncomfortable feelings, empowerment... Give what you also need to receive [because that's the best way of making sure you get it back. Make sure that you are getting these things somewhere in your life. If the survivor is your friend or romantic partner, be sure that there is a two-way street. However much you love someone who has experienced trauma, it is unhealthy if you become a savior, therapist, or martyr.

8. Control and choice. Big trigger when a survivor is denied these. Confer, collaborate cooperate. Unilateral moves even when benevolent will not be appreciated! Trauma is about getting hurt when you had no power or control over the situation, and it is immensely activating when the trauma survivor experiences that powerlessness again. If you want one way to ensure one of the fight/flight/freeze/collapse survival responses, taking away control is the way to do it!

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How to Support Someone Who Has Experienced Trauma - Echo

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What would we do if we could see every psychological wound ever inflicted as a physical bruise? We would see a lot of black and blue people walking around! We might also be more careful of each other, understanding the degree of suffering we each have endured.

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Coping thoughts is an easy strategy to teach students who suffer from Separation Anxiety Disorder (SAD). Students are taught to recognize their anxiety and replace anxious thoughts with positive self-talk or coping thoughts (Bidik, 2021).

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According to the American Psychiatric Association (APA), there are numerous disorders that fall under the umbrella term of "Anxiety Disorders" (2013).  Some of these disorders are: Separation Anxiety, Selective Mutism, Specific Phobia, Panic Disorder, Agoraphobia, Generalized Anxiety Disorder, Substance and Medication-Induced Anxiety Disorder, and other Anxiety Disorders (specified and unspecified).

The DSM-5 gives more information on the presentation of different types of anxiety, but verywellfamily.com is a great resource for infographics and articles about mental wellness and mental illness that is user-friendly for family and staff education.

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Back-to-school anxiety is normal and understandable. Many kids may feel anxious about going back to school after a long summer break. Others may feel nervous about starting school for the first time.

Regardless of what the case may be, parents can help ease the transition back to school by being able to recognize the symptoms of stress and anxiety and implementing some creative strategies.

Reasons Kids Might Be Stressed or Anxious

Some kids' worries are rooted in a fear of the unknown, especially if they will be in a new building or a new school district. They also may be worried about making friends or have concerns about the workload and whether or not they have the skills needed to be successful.

COVID-Related Concerns

For students who spent months out of traditional in-person classrooms due to the COVID-19 pandemic, going back to school may feel extra intimidating or even scary. This may be especially true if they had classes online throughout the entirety of 2020.

They might be worried about everything from wearing masks and being unvaccinated to wondering if they will still have the same friends after being gone so long. They also may feel uncertain about what school will be like now and whether or not they will even know their way around.

Concerns About Friends, Bullies, and More

Sometimes, kids are anxious or worried about the upcoming school year because of experiences with bullies. For many kids, this time away from school was a welcome reprieve from mean behavior and cutting remarks. So, as the new school year approaches, they may begin to worry that they will have to go through the same experiences again.

Kids also might be stressed about appearance-related issues. Children from underserved communities and/or those living in poverty may worry about not having the right clothes or supplies. Other kids may worry about how others will view them especially if they have experienced weight changes, are now wearing glasses, have developed acne, or have recently gone through puberty.

Other common stressors include having a falling-out with a close friend, getting cut from a sports team, dealing with a new learning environment, being assigned to a difficult teacher, and not getting into higher-level courses.

COVID-19 and Kids' Stress Levels

COVID-19 continues to top the list of reasons why kids are experiencing increased anxiety and stress. Many kids and teens are experiencing feelings of fear, anxiety, and uncertainty as they struggle to come to terms with the continued experience of living through the pandemic.

Even as many parts of life are opening up and returning to "normal," kids may still be harboring fears. It's not uncommon for people-including young people-to struggle with psychosocial issues following outbreaks of infectious diseases.

For instance, a study of the aftermath of an Ebola outbreak found that an increased number of people reported experiencing mental health issues like anxiety and depression. Meanwhile, another study conducted following the outbreak of the swine flu found that children receiving mental health care are particularly psychologically vulnerable to epidemics like COVID-19.

Not only have they been limited in terms of who they can see and spend time with, but they also have had to deal with grief over many of their favorite activities being canceled. Likewise, many families have experienced increased economic hardship or uncertainty due to the pandemic. And, some students have had relatives get sick or even die from COVID-19. Both of these scenarios can leave kids feeling stressed and anxious.

Even if these situations don't apply to your family, your kids may know someone who has had these experiences. Naturally, these realities (or simply worrying they may happen) can create a lot of stress, which some kids may direct into anxiety about going to school.

Most kids also are trying to process the information they overhear or see on social media about the risks associated with getting sick from the coronavirus. This information-some of which may be inaccurate-may cause them to worry about getting COVID-19 and passing it on to the people they love.

Even as we emerge from the worst of COVID-19 in the United States, kids may be hearing about the new variants to the disease and wondering how that will impact them, their families, and their friends.

Questions about vaccine safety and who is vaccinated and who isn't also may bring stress. Particularly, kids who are younger than 12-who are not eligible for the vaccine-may worry that they are unprotected and may get sick.

COVID-19 Prevention in Schools

Even with all of these safety precautions, kids may still experience stress and anxiety. While it may be disconcerting to see your child's stress and anxiety levels rise as the school year approaches-especially after the hard year they just came through-it's also important to know that these feelings are not uncommon.

Be on the lookout for anxiety and stress. And make sure you are doing what you can to help alleviate uncomfortable feelings.

How to Identify Anxiety

While anxiety regarding returning to school is common, it's also not something that should be ignored. For this reason, you need to be able to identify when your kids are struggling with stress and anxiety.

Signs of Anxiety

If your child's anxiety lasts longer than two weeks and interferes with their daily life, this could be a sign of an anxiety disorder. Talk to your child's doctor about your concerns.

Untreated anxiety puts kids at risk for poor school performance, difficulty maintaining friendships, and even depression. And as kids get older, untreated anxiety can even lead to substance abuse.

Tips for Dealing With Stress and Anxiety

The best way to address stress and anxiety is often simply to encourage your child to talk to you about what is troubling them. Listen without judgment and validate their feelings. Sometimes, expressing their feelings is all a child needs to feel better.

Another great way to ease some of your child's anxiety about going back to school is to get your home ready for the transition. Strategies such as planning school lunches ahead of time or establishing a comfortable homework area can help make kids feel more in control and relieve some of their anxious feelings.

Foster Familiarity

As the school year approaches, it's important to help your child feel more comfortable about their new school environment. One of the things that can cause back-to-school anxiety for kids is not knowing what to expect.

Help them become more acclimated to new routines and unfamiliar surroundings by talking through what they might expect to see. Allow them to ask questions and answer them honestly.

Another option to help build your child's comfort level is to make a couple of trips to and from school. Whether your child will walk, take a school bus, or be driven to school, helping them become familiar with the route may help ease back-to-school anxiety.

Even if your child is already familiar with the route to school, making a pre-first-day run will remind them where the school is, and help them feel more connected to where they will go on the first day back. This exercise is even important for first-time drivers. Teens need to know how to get to school and where to park their car.

You also should go over the basics with your kids. For instance, talk about where they will put their jacket as well as how lunch will be handled. You could even talk about how bathroom breaks are handled in the building. Knowing the answers to some of these questions will help your child feel more comfortable in their new classroom.

Be Positive

One way to help ease anxiety and stress about starting school is to remind your kids about what makes going to school great. Aside from learning new things and participating in extracurricular activities, there is a lot that is good about school.

For starters, there's the swag-fun new school supplies and clothes. There are also friends, teachers, and staff members they haven't seen in a while. Remind your kids what they can look forward to about school, such as time with friends, the playground, gym class, art class, or visits to the library.

Assure Them They Aren't Alone

Remind your kids that they're not the only ones who may be nervous about starting school again. Other students are likely to be just as anxious as they are about the first day of school. Reassure them too, that the teacher knows kids are nervous, and will probably spend time helping students feel more comfortable as they settle into the classroom.

If your child is concerned about reconnecting with friends they haven't seen in months, arrange some playdates. Helping your children reconnect with old friends or strengthen bonds with new ones not only reduces anxiety and stress but also can help your child start the year off on the right foot.

Do what you can to reconnect them with their peers-even if it's virtually for now. In some schools, you can get a class list, which can help you in knowing who to connect with.

But if your school district restricts access to this list, try posting in school community groups online in order to connect with other parents with children in your child's class. If your child is anxious about not being in the same class with old friends, reassure them that they can still stay in touch.

Make an Effort to Be Present

As your child transitions back to school, make every effort to be there for them, especially during the first few weeks. One way to do that is to try to be home more during the back-to-school time if that's possible for you.

Right before school starts and during the first days back, try to make it a point to be available to support your child through this transition. If you work away from home, try to arrange your hours so that you're able to drop your child off at school as well as be there after school if you can.

Alternatively, if you can't be there, ask another trusted relative, friend, or caregiver to fill this role for your child. Leaving them an encouraging note in their backpack or calling them before they leave for school can help them feel more secure, too.

You can also plan a special time to do something fun together to celebrate after their first day. Giving them something to look forward to, while also honoring that going back to school is hard for them, can help them feel more at ease.

If you're a stay-at-home parent, try to focus more on your child and put nonessential items on the back burner when they are home. Spend some time talking to your child about their day, such as what they liked and what they might have questions about.

Promote Healthy Living

One of the best ways to combat anxiety and stress is to address eating, sleeping, and exercise habits. Make sure kids get enough sleep and eat a balanced diet. Getting adequate sleep and eating healthy food, especially a balanced breakfast, is important for brain function, mood, and the ability to focus and pay attention in school.

Likewise, your kids need plenty of opportunities to burn off steam. Some kids like playing active sports while others enjoy a quiet afternoon reading or journaling. Every kid is different. So, make sure you're choosing activities that are truly stress-relievers for your child.

Know When to Get Outside Help

You know your child best. If you sense that their back-to-school anxiety may be rooted in something more serious, such as an anxiety disorder or a problem with a bully, talk with your child, your child's teacher, and the school counselor.

And remember, you need to relax as well. Back-to-school time can be just as hectic and stressful for parents. Take care of yourself by eating right and getting enough sleep and exercise during this transitional phase.

Remind yourself that any anxiety or stress you or your child may be feeling is usually temporary. Before you know it, your family will likely be deep into the back-to-school groove.

A Word From Verywell

The key to supporting your kids when they are stressed or anxious about the upcoming school year is to be there for them. Listen to their concerns without minimizing their feelings or trying to fix the situation. Allow them the space to process their feelings without judgment.

Sometimes, just knowing that someone understands what they're experiencing is enough to help kids get through a challenging situation. Other times, they need a little extra help. In these situations, talk to your child's doctor or seek help from a mental health professional. With the right help and treatment, your child can learn to manage their stress and anxiety.

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Tips to Ease Back-to-School Anxiety and Stress

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Back-to-school anxiety is normal and understandable. Many kids may feel anxious about going back to school after a long summer break. Others may feel nervous about starting school for the first time. Regardless of what the case may be, parents can help ease the transition back to school by being able to recognize the symptoms of stress and anxiety and implementing some creative strategies.

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The Texas Administrative Code (2017) lays out the legal and state regulations for a comprehensive school counseling program, school counselor certificate standards, the role of the school counselor, and learner-centered knowledge, skills, and professional development requirements.

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(a) School Counselor Certificate Standards. The knowledge and skills identified in this section must be used by an educator preparation program in the development of curricula and coursework and by the State Board for Educator Certification as the basis for developing the examination required to obtain the School Counselor Certificate. The standards also serve as the foundation for the professional growth plan and continuing professional education activities required by § of this title (relating to Requirements to Renew the Standard School Counselor Certificate).

(g) Standard VI. Learner-Centered Professional Development: The certified school counselor continues professional development, demonstrating a commitment to learn, to improve the profession, and to model professional ethics and personal integrity. The certified school counselor must:

(1) use reflection, self-assessment, and interactions with colleagues to promote personal professional development;

(2) use counseling-related research techniques and practices as well as technology and other resources to facilitate continued professional growth;

(3) strive toward the highest level of professionalism by adhering to and modeling professional, ethical, and legal standards;

(4) apply research-based practice to improve the school guidance and counseling program;

(5) engage in ongoing professional development to improve the school guidance and counseling program; and

(6) engage in continued professional development experiences to learn and apply concepts, skills, and practices related to increasing college and career readiness and promoting postsecondary opportunities and preparation for all learners.

Notes

The provisions of this §239.15 adopted to be effective January 23, 2001, 26 TexReg 761; amended to be effective December 23, 2009, 34 TexReg 9201; Amended by Texas Register, Volume 42, Number 50, December 15, 2017, TexReg 7149, eff.

State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.

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19 Tex. Admin. Code § 239.15 - Standards Required for the School Counselor Certificate

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(a) School Counselor Certificate Standards. The knowledge and skills identified in this section must be used by an educator preparation program in the development of curricula and coursework and by the State Board for Educator Certification as the basis for developing the examination required to obtain the School Counselor Certificate.

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This is a snapshot of ideas that fall within and those that fall outside of the realm of a Professional School Counselor's duties. The American School Counselor's guidelines help the school counselor to advocate for his or her position and the proper utilization of his or her focus on the comprehensive school counseling program.

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This text is authored by the American Psychiatric Association (2013) and gives diagnostic criteria for different mental disorders.  Although the diagnosis of mental disorders falls outside of the role of the Professional School Counselor (PSC), the DSM-5 allows the PSC to research about different disorders in order to correctly refer students and educational stakeholders to the appropriate community or school system resources.

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This website explains the symptoms of anxiety, the differences between anxiety disorders, and gives families and educators simple and effective ways to help their child(ren) to overcome their anxieties.

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Even in the best of situations, all children experience some anxiety in the form of worry, apprehension, dread, fear or distress. Occasional nervousness and fleeting anxieties occur when a child is first faced with an unfamiliar or especially stressful situation. It can be an important protection or signal for caution in certain situations. In fact there are specific expected fears that accompany each stage of child development.

Anxiety: Normal and Necessary
From toddlers to teens, life's challenges may be met with a temporary retreat from the situation, a greater reliance on parents for reassurance, a reluctance to take chances, and a wavering confidence. Typically these concerns will resolve when the child learns to master the situation or the situation changes. Incorporating their newfound abilities, whether it is mastering a new school, the neighborhood pool, taking tests, encountering dogs, kids move on from their fears and have no lasting ill-effects. Parents can facilitate a child's successful adjustment to a new challenge by: (1) being accepting of the child's concerns, (2) listening to the child's perceptions, and gently correcting misinformation, and (3) patiently encouraging a child to approach a feared situation one step at a time until it is becomes familiar and manageable.

Typical Childhood Fears

In response to a growing ability to differentiate familiar faces (parents) from unfamiliar, stranger anxiety (clinging and crying when a stranger approaches) develops around 7-9 months and typically resolves by end of first year.

Early Childhood
As a healthy attachment to parents grows, separation anxiety (crying, sadness, fear of desertion upon separation) emerges around one year and improves over the next 3 years, resolving in most children by the end of kindergarten. As children's worlds expand, they may fear new and unfamiliar situations, and real and imagined dangers from big dogs, to spiders, to monsters. Children from age 3-6 are trying to master what is real and what is not, and until this is resolved, they may have difficulty with costumed characters, ghosts, and supernatural beings. While trying to master fears of what could be they may struggle with the dark, the basement, closets, and under the bed. As a child learns how to manage and put aside these fears, their ability to sleep alone will be secured.

Each year, with access to new information, children begin to fear real world dangers-fire drills, burglars, storms, illness, or drugs. With experience, they learn that these risks can exist as remote, rather than imminent dangers. In middle school, the growing importance of social status leads to social comparisons and worries about social acceptance. Concerns about academic and athletic performance, and social group identification are normal. Learning about various physical and mental health diseases in school may lead to some temporary concerns about risk and safety. Teenagers continue to be focused on social acceptance, but with a greater concern for finding a group that reflects their chosen identity. Concerns about the larger world, moral issues and their future successes are common.

When You Should be Concerned

Anxiety is considered a disorder not based on what a child is worrying about, but rather how that worry is impacting a child's functioning. The content may be "normal" but help is needed when a child is experiencing too much worry or suffering immensely over what may appear to be insignificant situations, when worry and avoidance become a child's automatic response in many situations, when they feel constantly keyed up, or when coaxing or reassurance are ineffective in moving them through. For these children anxiety is not protecting them, but rather preventing them from fully participating in typical activities of daily life-school, friendships, academic performance.

Unremitting anxiety lasting for weeks or months at a time can cause physical distress in the form of headaches, stomachaches, nausea, vomiting and sleeplessness, Difficulty sleeping, reluctance to go to school or elsewhere outside of the child's comfort zone, crying jags, tantrums and clinginess are common. Anxiety can also interfere with a child's concentration and decision-making. An anxious child's thinking is typically unrealistic, catastrophic and pessimistic. They may seek excessive reassurance and yet the benefit of that reassurance is fleeting. Irritability and anger can also be red flags for anxiety when a child becomes frustrated by the stress of worry, or worn down from sleep deprivation. For some children, feeling "different" from other kids can be an additional source of concern.

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Even in the best of situations, all children experience some anxiety in the form of worry, apprehension, dread, fear or distress. Occasional nervousness and fleeting anxieties occur when a child is first faced with an unfamiliar or especially stressful situation. It can be an important protection or signal for caution in certain situations.

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The American School Counselor Association (ASCA) publishes standards or guidelines to maintain a uniform consistency of integrity and professionalism amongst school counselors nationwide (ASCA, 2016b).

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Mentally healthy kids reach developmental and emotional milestones and learn healthy social skills and how to cope with problems.

Mental disorders cause serious changes in how children learn, behave, and handle emotions, which causes distress.  If there is chronic fear, stress, or disruptive behavior, then children are not mentally healthy. (National Center on Birth Defects and Developmental Disabilities, 2022).