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Haggan, Paul » Crisis Coordinator, District

Crisis Coordinator, District

Welcome to Argyle ISD!
As district crisis coordinator I am committed to helping students with their social emotional growth and coping skills needs while moving through our schools, community and future.   -  Paul Haggan
In attempt to provide resources to support students, parents, faculty and staff, I have compiled the following information. If you have any questions about this information or you have a current need, please contact me so I can be of further support. 

Mental Health by the Numbers

Millions of people in the U.S. are affected by mental illness each year. It’s important to measure how common mental illness is, so we can understand its physical, social and financial impact — and so we can show that no one is alone. These numbers are also powerful tools for raising public awareness, stigma-busting and advocating for better health care.


The information on this page and the downloadable Infographics and Fact Sheets comes from studies conducted by organizations like Substance Abuse and Mental Health Services Administration (, Centers for Disease Control and Prevention ( and the U.S. Department of Justice ( Terminology used is reflective of what is used in the original studies. Terms like “serious mental illness,” “mental illness” or “mental health disorders” may all seem like they’re referring to the same thing, but in fact refer to specific diagnostic groups for that particular study.


If you have questions about a statistic or term that’s being used, please visit the original study by clicking the link provided.


1 in 5 U.S. adults experience mental illness each year
1 in 25 U.S. adults experience serious mental illness each year
1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
50% of all lifetime mental illness begins by age 14, and 75% by age 24
Suicide is the SECOND LEADING CAUSE OF DEATH among people aged 10-34



  • 19.1% of U.S. adults experienced mental illness in 2018 (47.6 million people). This represents 1 in 5 adults.
  • 4.6% of U.S. adults experienced serious mental illness in 2018 (11.4 million people). This represents 1 in 25 adults.
  • 16.5% of U.S. youth aged 6-17 experienced a mental health disorder in 2016 (7.7 million people)
  • 3.7% of U.S. adults experienced a co-occurring substance use disorder and mental illness in 2018 (9.2 million people)

  • Annual prevalence of mental illness among U.S. adults, by demographic group:
    • Non-Hispanic Asian: 14.7%
    • Non-Hispanic white: 20.4%
    • Non-Hispanic black or African-American: 16.2%
    • Non-Hispanic mixed/multiracial: 26.8%
    • Hispanic or Latino: 16.9%
    • Lesbian, Gay or Bisexual: 37.4%

  • Annual prevalence among U.S. adults, by condition:
    • Major Depressive Episode: 7.2% (17.7 million people)
    • Schizophrenia: <1% (estimated 1.5 million people)
    • Bipolar Disorder: 2.8% (estimated 7 million people)
    • Anxiety Disorders: 19.1% (estimated 48 million people)
    • Posttraumatic Stress Disorder: 3.6% (estimated 9 million people)
    • Obsessive Compulsive Disorder: 1.2% (estimated 3 million people)
    • Borderline Personality Disorder: 1.4% (estimated 3.5 million people)


  • Suicide is the 2nd leading cause of death among people aged 10-34 in the U.S.
  • Suicide is the 10th leading cause of death in the U.S.
  • The overall suicide rate in the U.S. has increased by 31% since 2001
  • 46% of people who die by suicide had a diagnosed mental health condition
  • 90% of people who die by suicide had shown symptoms of a mental health condition, according to interviews with family, friends and medical professionals (also known as psychological autopsy)
  • Lesbian, gay and bisexual youth are 4x more likely to attempt suicide than straight youth
  • 75% of people who die by suicide are male
  • Transgender adults are nearly 12x more likely to attempt suicide than the general population
  • Annual prevalence of serious thoughts of suicide, by U.S. demographic group:
    • 4.3% of all adults
    • 11.0% of young adults aged 18-25
    • 17.2% of high school students
    • 47.7% of lesbian, gay, and bisexual high school students


  • 43.3% of U.S. adults with mental illness received treatment in 2018  
  • 64.1% of U.S. adults with serious mental illness received treatment in 2018  
  • 50.6% of U.S. youth aged 6-17 with a mental health disorder received treatment in 2016  
  • The average delay between onset of mental illness symptoms and treatment is 11 years
  • Annual treatment rates among U.S. adults with any mental illness, by demographic group:
    • Male: 34.9%
    • Female: 48.6%
    • Lesbian, Gay or Bisexual: 48.5%
    • Non-Hispanic Asian: 24.9%
    • Non-Hispanic white: 49.1%
    • Non-Hispanic black or African-American: 30.6%
    • Non-Hispanic mixed/multiracial: 31.8%
    • Hispanic or Latino: 32.9%
  • 11.3% of U.S. adults with mental illness had no insurance coverage in 2018
  • 13.4% of U.S. adults with serious mental illness had no insurance coverage in 2018
  • 60% of U.S. counties do not have a single practicing psychiatrist




  • People with depression have a 40% higher risk of developing cardiovascular and metabolic diseases than the general population. People with serious mental illness are nearly twice as likely to develop these conditions.
  • 19.3% of U.S. adults with mental illness also experienced a substance use disorder in 2018 (9.2 million individuals)
  • The rate of unemployment is higher among U.S. adults who have mental illness (5.8%) compared to those who do not (3.6%)
  • High school students with significant symptoms of depression are more than twice as likely to drop out compared to their peers


  • At least 8.4 million people in the U.S. provide care to an adult with a mental or emotional health issue
  • Caregivers of adults with mental or emotional health issues spend an average of 32 hours per week providing unpaid care


  • Mental illness and substance use disorders are involved in 1 out of every 8 emergency department visits by a U.S. adult (estimated 12 million visits)
  • Mood disorders are the most common cause of hospitalization for all people in the U.S. under age 45 (after excluding hospitalization relating to pregnancy and birth)
  • Across the U.S. economy, serious mental illness causes $193.2 billion in lost earnings each year
  • 20.1% of people experiencing homelessness in the U.S. have a serious mental health condition
  • 37% of adults incarcerated in the state and federal prison system have a diagnosed mental illness
  • 70.4% of youth in the juvenile justice system have a diagnosed mental illness
  • 41% of Veteran’s Health Administration patients have a diagnosed mental illness or substance use disorder


  • Depression and anxiety disorders cost the global economy $1 trillion in lost productivity each year 
  • Depression is the leading cause of disability worldwide

Know the Risk Factors


Risk factors are characteristics that make it more likely that someone will consider, attempt, or die by suicide. They can't cause or predict a suicide attempt, but they're important to be aware of.


  • Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders, and certain personality disorders
  • Alcohol and other substance use disorders
  • Hopelessness
  • Impulsive and/or aggressive tendencies
  • History of trauma or abuse
  • Major physical illnesses
  • Previous suicide attempt(s)
  • Family history of suicide
  • Job or financial loss
  • Loss of relationship(s)
  • Easy access to lethal means
  • Local clusters of suicide
  • Lack of social support and sense of isolation
  • Stigma associated with asking for help
  • Lack of healthcare, especially mental health and substance abuse treatment
  • Cultural and religious beliefs, such as the belief that suicide is a noble resolution of a personal dilemma
  • Exposure to others who have died by suicide (in real life or via the media and Internet)



Know the Warning Signs


Some warning signs may help you determine if a loved one is at risk for suicide, especially if the behavior is new, has increased, or seems related to a painful event, loss, or change. If you or someone you know exhibits any of these, seek help by calling the Lifeline.


  • Talking about wanting to die or to kill themselves
  • Looking for a way to kill themselves, like searching online or buying a gun
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious or agitated; behaving recklessly
  • Sleeping too little or too much
  • Withdrawing or isolating themselves
  • Showing rage or talking about seeking revenge
  • Extreme mood swings

Self-Care During Difficult Times


Whether living through this COVID-19 pandemic or navigating the holiday season, it can be a difficult and stressful time for many. That’s why it’s so important to stop and listen to your own needs too. Here are some self-care ideas:


  • Take a walk outside
  • Write a love letter to yourself
  • Write about something you are grateful for in your life (it can be a person, place, or thing)
  • Create a happy playlist and a coping playlist
  • Treat yourself to a favorite snack
  • Watch your favorite movie
  • Forgive someone
  • Forgive yourself
  • Say thank you to someone who has helped you recently
  • Create a DIY self-care kit of things that make you feel better
  • Take your medication on time
  • Take a new fitness class at the gym (yoga, Zumba, etc.)
  • Plan a lunch date with someone you haven’t seen in a while
  • Pamper yourself with an at-home spa day
  • Take a day off from social media and the Internet
  • Reach out to your support system
  • Cuddle with your pets or a friend’s pet
  • Take the time to stop, stand and stretch for 2 minutes
  • Wake up a little earlier and enjoy a morning cup of tea or coffee before the morning rush
  • Take a hot shower or bath
  • Take yourself out to or make yourself a nice dinner
  • Volunteer
  • Start that one project you’ve been contemplating for a while
  • Sit with your emotions, and allow yourself to feel and accept them. It’s okay to laugh, cry, just feel whatever you’re feeling with no apologies!
  • Cook a favorite meal or treat from scratch
  • Take a 5-minute break in your day
  • Compliment someone (and yourself, too!)
  • Give yourself permission to say NO
  • De-clutter your mind: write down 5 things that are bothering you, and then literally throw them away
  • Donate 3 pieces of clothing that you no longer wear
  • Take the time to find 5 beautiful things during your daily routine
  • Take a mental health day from school, work, etc.
  • Take a nap
  • Reach out to a support group or hotline



Suicide Prevention Resource Center (SPRC)


Crisis Line: 1-800-273-TALK (8255)


SPRC is one of the most comprehensive resources for suicide prevention. In addition to information and training, they offer a hotline to help anyone who’s experiencing suicidal ideation: 1-800-273-TALK. Their website has links to resources in different states and a video providing advice on how to help support those considering suicide.


National Institute of Mental Health (NIMH)


This website has lots of information about mental illness and suicide prevention, including statistics, symptoms, treatment options, and risk factors. It also provides resources that can help people understand the connection between suicide and other mental health issues such as depression, bipolar disorder, and more.


Society for the Prevention of Teen Suicide (SPTS)


Teen suicide is a growing problem in America and many other countries. SPTS is a nonprofit organization created by parents whose teen children died by suicide. It’s dedicated to helping to reduce the problem of teen suicide by providing resources for teens, parents, and educators. SPTS also pushes for legislation requiring teachers to undergo training in suicide prevention.


Centers for Disease Control and Prevention (CDC)


The CDC views overall mental health and suicide as important public health issues. On this site, you’ll find statistics, resources, and more. 


Action Alliance for Suicide Prevention


This is a public and private alliance of organizations dedicated to preventing suicide. The Action Alliance works with many groups, including government agencies, religious groups, schools, and mental health organizations to help people understand and prevent suicide.


American Foundation for Suicide Prevention (AFSP)


The AFSP website has a long list of resources including crisis hotlines, advice for finding mental health care, substance misuse treatment, and resources for issues such as self-harm, borderline personality disorder, schizophrenia, and other issues that often overlap with suicide. The AFSP also provides help to people who have lost loved ones to suicide.


Crisis Text Line


Crisis Text Line: Text HOME to 741-741

Teens are often more comfortable texting than talking on the telephone, which is why Crisis Text Line provides an alternative option for those unwilling — or unable — to voice call. Specially trained crisis counselors will help de-escalate individuals who are considering suicide or dealing with severe mental health issues.




HelpGuide provides information on a wide variety of mental health issues, including suicide. Their suicide prevention page has advice for both people contemplating suicide and those who want to help someone else who’s suicidal. It also provides a list of common myths about suicide, such as the idea that people who talk about ending their own lives won’t actually do it.


Suicide Awareness Voices of Education (SAVE)


Crisis line: 1-800-273-8255

Founded by a mother who lost her daughter to suicide in 1979, SAVE’s mission is to help prevent suicide through public awareness and education, reduce the stigma of suicidal ideation, and serve as a resource to those touched by suicide. The website provides resources, training kits, ways to get involved and donate, and more.


The Trevor Project


Founded in 1998 by the creators of the Academy Award-winning short film TREVOR, The Trevor Project is the leading national organization providing crisis intervention and suicide prevention services to LGBTQ+ young people under 25.


Get immediate help in a crisis

  • Call 911
  • Disaster Distress Helplineexternal icon: 1-800-985-5990 (press 2 for Spanish), or text TalkWithUs for English or Hablanos for Spanish to 66746. Spanish speakers from Puerto Rico can text Hablanos to 1-787-339-2663.

Find a health care provider or treatment for substance use disorder and mental health



Occasional anxiety is an expected part of life. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, school work, and relationships.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and various phobia-related disorders.

Signs and Symptoms

Generalized Anxiety Disorder

People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least 6 months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work.


Generalized anxiety disorder symptoms include:

  • Feeling restless, wound-up, or on-edge
  • Being easily fatigued
  • Having difficulty concentrating; mind going blank
  • Being irritable
  • Having muscle tension
  • Difficulty controlling feelings of worry
  • Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep

Panic Disorder

People with panic disorder have recurrent unexpected panic attacks. Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation.


During a panic attack, people may experience:

  • Heart palpitations, a pounding heartbeat, or an accelerated heartrate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath, smothering, or choking
  • Feelings of impending doom
  • Feelings of being out of control


People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. Worry about panic attacks, and the effort spent trying to avoid attacks, cause significant problems in various areas of the person’s life, including the development of agoraphobia (see below).


Phobia-Related Disorders

A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object.

People with a phobia:

  • May have an irrational or excessive worry about encountering the feared object or situation
  • Take active steps to avoid the feared object or situation
  • Experience immediate intense anxiety upon encountering the feared object or situation
  • Endure unavoidable objects and situations with intense anxiety


There are several types of phobias and phobia-related disorders:


Specific Phobias (sometimes called simple phobias): As the name suggests, people who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of:

  • Flying
  • Heights
  • Specific animals, such as spiders, dogs, or snakes
  • Receiving injections
  • Blood


Social anxiety disorder (previously called social phobia): People with social anxiety disorder have a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations. Social anxiety disorder can manifest in a range of situations, such as within the workplace or the school environment.


Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:

  • Using public transportation
  • Being in open spaces
  • Being in enclosed spaces
  • Standing in line or being in a crowd
  • Being outside of the home alone

People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. In the most severe form of agoraphobia, an individual can become housebound.


Separation anxiety disorder: Separation anxiety is often thought of as something that only children deal with; however, adults can also be diagnosed with separation anxiety disorder. People who have separation anxiety disorder have fears about being parted from people to whom they are attached. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated.


Selective mutism: A somewhat rare disorder associated with anxiety is selective mutism. Selective mutism occurs when people fail to speak in specific social situations despite having normal language skills. Selective mutism usually occurs before the age of 5 and is often associated with extreme shyness, fear of social embarrassment, compulsive traits, withdrawal, clinging behavior, and temper tantrums. People diagnosed with selective mutism are often also diagnosed with other anxiety disorders.

Risk Factors

Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder. Although the risk factors for each type of anxiety disorder can vary, some general risk factors for all types of anxiety disorders include:

  • Temperamental traits of shyness or behavioral inhibition in childhood
  • Exposure to stressful and negative life or environmental events in early childhood or adulthood
  • A history of anxiety or other mental illnesses in biological relatives
  • Some physical health conditions, such as thyroid problems or heart arrhythmias, or caffeine or other substances/medications, can produce or aggravate anxiety symptoms; a physical health examination is helpful in the evaluation of a possible anxiety disorder.

Treatments and Therapies

Anxiety disorders are generally treated with psychotherapy, medication, or both. There are many ways to treat anxiety and people should work with their doctor to choose the treatment that is best for them.



Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at the person’s specific anxieties and tailored to his or her needs.


Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is an example of one type of psychotherapy that can help people with anxiety disorders. It teaches people different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects and situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.

Cognitive therapy and exposure therapy are two CBT methods that are often used, together or by themselves, to treat social anxiety disorder. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful or distorted thoughts underlying anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises and/or imagery.

CBT can be conducted individually or with a group of people who have similar difficulties. Often “homework” is assigned for participants to complete between sessions.



Medication does not cure anxiety disorders but can help relieve symptoms. Medication for anxiety is prescribed by doctors, such as a psychiatrist or primary care provider. Some states also allow psychologists who have received specialized training to prescribe psychiatric medications. The most common classes of medications used to combat anxiety disorders are anti-anxiety drugs (such as benzodiazepines), antidepressants, and beta-blockers.


Anti-Anxiety Medications

Anti-anxiety medications can help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Although benzodiazepines are sometimes used as first-line treatments for generalized anxiety disorder, they have both benefits and drawbacks.

Some benefits of benzodiazepines are that they are effective in relieving anxiety and take effect more quickly than antidepressant medications often prescribed for anxiety. Some drawbacks of benzodiazepines are that people can build up a tolerance to them if they are taken over a long period of time and they may need higher and higher doses to get the same effect. Some people may even become dependent on them.


To avoid these problems, doctors usually prescribe benzodiazepines for short periods of time, a practice that is especially helpful for older adults, people who have substance abuse problems, and people who become dependent on medication easily.


If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms, or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly. When you and your doctor have decided it is time to stop the medication, the doctor will help you slowly and safely decrease your dose.


For long-term use, benzodiazepines are often considered a second-line treatment for anxiety (with antidepressants being considered a first-line treatment) as well as an “as-needed” treatment for any distressing flare-ups of symptoms.


A different type of anti-anxiety medication is buspirone. Buspirone is a non-benzodiazepine medication specifically indicated for the treatment of chronic anxiety, although it does not help everyone.



Antidepressants are used to treat depression, but they can also be helpful for treating anxiety disorders. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.


Antidepressants can take time to work, so it’s important to give the medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. When you and your doctor have decided it is time to stop the medication, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.


Antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used as first-line treatments for anxiety. Less-commonly used — but effective — treatments for anxiety disorders are older classes of antidepressants, such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs).


Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressant medications, especially in the first few weeks after starting or when the dose is changed. Because of this, patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.



Although beta-blockers are most often used to treat high blood pressure, they can also be used to help relieve the physical symptoms of anxiety, such as rapid heartbeat, shaking, trembling, and blushing. These medications, when taken for a short period of time, can help people keep physical symptoms under control. They can also be used “as needed” to reduce acute anxiety, including as a preventive intervention for some predictable forms of performance anxieties.


Choosing the Right Medication

Some types of drugs may work better for specific types of anxiety disorders, so people should work closely with their doctor to identify which medication is best for them. Certain substances such as caffeine, some over-the-counter cold medicines, illicit drugs, and herbal supplements may aggravate the symptoms of anxiety disorders or interact with prescribed medication. Patients should talk with their doctor, so they can learn which substances are safe and which to avoid.


Choosing the right medication, medication dose, and treatment plan should be done under an expert’s care and should be based on a person’s needs and their medical situation. Your doctor may try several medicines before finding the right one.


You and your doctor should discuss:

  • How well medications are working or might work to improve your symptoms
  • Benefits and side effects of each medication
  • Risk for serious side effects based on your medical history
  • The likelihood of the medications requiring lifestyle changes
  • Costs of each medication
  • Other alternative therapies, medications, vitamins, and supplements you are taking and how these may affect your treatment; a combination of medication and psychotherapy is the best approach for many people with anxiety disorders
  • How the medication should be stopped (Some drugs can’t be stopped abruptly and must be tapered off slowly under a doctor’s supervision).

Stress Management Techniques

Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. Research suggests that aerobic exercise can help some people manage their anxiety; however, exercise should not take the place of standard care and more research is needed.

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Last Revised: July 2020


Attention-deficit/hyperactivity disorder (ADHD) is a disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

  • Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
  • Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
  • Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have a high potential for harm, or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.

Signs and Symptoms

Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD.

In preschool, the most common ADHD symptom is hyperactivity.

It is normal to have some inattention, unfocused motor activity, and impulsivity, but for people with ADHD, these behaviors:

  • Are more severe
  • Occur more often
  • Interfere with or reduce the quality of how they function socially, at school, or in a job


People with symptoms of inattention may often:

  • Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
  • Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
  • Not seem to listen when spoken to directly
  • Not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus and get easily sidetracked
  • Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines
  • Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms, or reviewing lengthy papers
  • Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
  • Be easily distracted by unrelated thoughts or stimuli
  • Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments


People with symptoms of hyperactivity-impulsivity may often:

  • Fidget and squirm in their seats
  • Leave their seats in situations when staying seated is expected, such as in the classroom or the office
  • Run or dash around or climb in situations where it is inappropriate or, in teens and adults, often feel restless
  • Be unable to play or engage in hobbies quietly
  • Be constantly in motion or “on the go,” or act as if “driven by a motor”
  • Talk nonstop
  • Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in a conversation
  • Have trouble waiting for his or her turn
  • Interrupt or intrude on others, for example in conversations, games, or activities

Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as a pediatrician, psychologist, or psychiatrist with expertise in ADHD. For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind typical development for his or her age. The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. Most children with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present before age 12.

ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood. Symptoms of ADHD can be mistaken for emotional or disciplinary problems or missed entirely in quiet, well-behaved children, leading to a delay in diagnosis. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult or failed relationships.

ADHD symptoms can change over time as a person ages. In young children with ADHD, hyperactivity-impulsivity is the most predominant symptom. As a child reaches elementary school, the symptom of inattention may become more prominent and cause the child to struggle academically. In adolescence, hyperactivity seems to lessen and may show more often as feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Many adolescents with ADHD also struggle with relationships and antisocial behaviors. Inattention, restlessness, and impulsivity tend to persist into adulthood.

Risk Factors

Researchers are not sure what causes ADHD. Like many other illnesses, several factors can contribute to ADHD, such as:

  • Genes
  • Cigarette smoking, alcohol use, or drug use during pregnancy
  • Exposure to environmental toxins during pregnancy
  • Exposure to environmental toxins, such as high levels of lead, at a young age
  • Low birth weight
  • Brain injuries

ADHD is more common in males than females, and females with ADHD are more likely to have problems primarily with inattention. Other conditions, such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance abuse, are common in people with ADHD.

Treatment and Therapies

While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments.


For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination. Sometimes several different medications or dosages must be tried before finding the right one that works for a particular person. Anyone taking medications must be monitored closely and carefully by their prescribing doctor.

Stimulants. The most common type of medication used for treating ADHD is called a “stimulant.” Although it may seem unusual to treat ADHD with a medication that is considered a stimulant, it works by increasing the brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention.

Under medical supervision, stimulant medications are considered safe. However, there are risks and side effects, especially when misused or taken in excess of the prescribed dose. For example, stimulants can raise blood pressure and heart rate and increase anxiety. Therefore, a person with other health problems, including high blood pressure, seizures, heart disease, glaucoma, liver or kidney disease, or an anxiety disorder should tell their doctor before taking a stimulant.

Talk with a doctor if you see any of these or other side effects while taking stimulants:

  • Decreased appetite
  • Sleep problems
  • Tics (sudden, repetitive movements or sounds)
  • Personality changes
  • Increased anxiety and irritability
  • Stomachaches
  • Headaches

Non-stimulants. A few other ADHD medications are non-stimulants. These medications take longer to start working than stimulants, but can also improve focus, attention, and impulsivity in a person with ADHD. Doctors may prescribe a non-stimulant: when a person has bothersome side effects from stimulants; when a stimulant was not effective; or in combination with a stimulant to increase effectiveness.

Although not approved by the U.S. Food and Drug Administration (FDA) specifically for the treatment of ADHD, some antidepressants are sometimes used alone or in combination with a stimulant to treat ADHD. Antidepressants may help all of the symptoms of ADHD and can be prescribed if a patient has bothersome side effects from stimulants. Antidepressants can be helpful in combination with stimulants if a patient also has another condition, such as an anxiety disorder, depression, or another mood disorder.

Psychotherapy and Psychosocial Interventions

Several specific psychosocial interventions have been shown to help patients and their families manage symptoms and improve everyday functioning. In addition, children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed.

For school-age children, frustration, blame, and anger may have built up within a family before a child is diagnosed. Parents and children may need specialized help to overcome negative feelings. Mental health professionals can educate parents about ADHD and how it affects a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.

Behavioral therapy is a type of psychotherapy that aims to help a person change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a person how to:

  • Monitor his or her own behavior
  • Give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting

Parents, teachers, and family members also can give positive or negative feedback for certain behaviors and help establish clear rules, chore lists, and other structured routines to help a person control his or her behavior. Therapists may also teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.

Cognitive behavioral therapy can also teach a person mindfulness techniques, or meditation. A person learns how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration. The therapist also encourages the person with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.

Family and marital therapy can help family members and spouses find better ways to handle disruptive behaviors, to encourage behavior changes, and improve interactions with the patient.

Parenting skills training (behavioral parent management training) teaches parents the skills they need to encourage and reward positive behaviors in their children. It helps parents learn how to use a system of rewards and consequences to change a child’s behavior. Parents are taught to give immediate and positive feedback for behaviors they want to encourage and ignore or redirect behaviors that they want to discourage. They may also learn to structure situations in ways that support desired behavior.

Specific behavioral classroom management interventions have been shown to be effective for managing youths’ symptoms and improving their functioning at school and with peers. These research-informed strategies typically include teacher-implemented reward programs that often utilize point systems and communication with parents via Daily Report Cards.

Many schools offer special education services to children with ADHD who qualify. Educational specialists help the child, parents, and teachers make changes to classroom and homework assignments to help the child succeed. Public schools are required to offer these services for qualified children, which may be free for families living within the school district. Learn more about the Individuals with Disabilities Education Act (IDEA), visit the U.S. Department of Education’s IDEA website.

Stress management techniques can benefit parents of children with ADHD by increasing their ability to deal with frustration so that they can respond calmly to their child’s behavior.

Tips to Help Kids and Adults with ADHD Stay Organized

For Kids:

Parents and teachers can help kids with ADHD stay organized and follow directions with tools such as:

  • Keeping a routine and a schedule. Keep the same routine every day, from wake-up time to bedtime. Include times for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.
  • Organizing everyday items. Have a place for everything, (such as clothing, backpacks, and toys), and keep everything in its place.
  • Using homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books.
  • Being clear and consistent. Children with ADHD need consistent rules they can understand and follow.
  • Giving praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior and praise it.

For Adults:

A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as:

  • Keeping routines
  • Making lists for different tasks and activities
  • Using a calendar for scheduling events
  • Using reminder notes
  • Assigning a special place for keys, bills, and paperwork
  • Breaking down large tasks into more manageable, smaller steps so that completing each part of the task provides a sense of accomplishment.

Learn More

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Last Revised: September 2019



Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behavior. Although autism can be diagnosed at any age, it is said to be a “developmental disorder” because symptoms generally appear in the first two years of life.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association used to diagnose mental disorders, people with ASD have:

  • Difficulty with communication and interaction with other people
  • Restricted interests and repetitive behaviors
  • Symptoms that hurt the person’s ability to function properly in school, work, and other areas of life

Autism is known as a “spectrum” disorder because there is wide variation in the type and severity of symptoms people experience. ASD occurs in all ethnic, racial, and economic groups. Although ASD can be a lifelong disorder, treatments and services can improve a person’s symptoms and ability to function. The American Academy of Pediatrics recommends that all children be screened for autism. All caregivers should talk to their doctor about ASD screening or evaluation.

Signs and Symptoms of ASD

People with ASD have difficulty with social communication and interaction, restricted interests, and repetitive behaviors. The list below gives some examples of the types of behaviors that are seen in people diagnosed with ASD. Not all people with ASD will show all behaviors, but most will show several.

Social communication / interaction behaviors may include:

  • Making little or inconsistent eye contact
  • Tending not to look at or listen to people
  • Rarely sharing enjoyment of objects or activities by pointing or showing things to others
  • Failing to, or being slow to, respond to someone calling their name or to other verbal attempts to gain attention
  • Having difficulties with the back and forth of conversation
  • Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond
  • Having facial expressions, movements, and gestures that do not match what is being said
  • Having an unusual tone of voice that may sound sing-song or flat and robot-like
  • Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions

Restrictive / repetitive behaviors may include:

  • Repeating certain behaviors or having unusual behaviors. For example, repeating words or phrases, a behavior called echolalia
  • Having a lasting intense interest in certain topics, such as numbers, details, or facts
  • Having overly focused interests, such as with moving objects or parts of objects
  • Getting upset by slight changes in a routine
  • Being more or less sensitive than other people to sensory input, such as light, noise, clothing, or temperature

People with ASD may also experience sleep problems and irritability. Although people with ASD experience many challenges, they may also have many strengths, including:

  • Being able to learn things in detail and remember information for long periods of time
  • Being strong visual and auditory learners
  • Excelling in math, science, music, or art

Causes and Risk Factors

While scientists don’t know the exact causes of ASD, research suggests that genes can act together with influences from the environment to affect development in ways that lead to ASD. Although scientists are still trying to understand why some people develop ASD and others don’t, some risk factors include:

  • Having a sibling with ASD
  • Having older parents
  • Having certain genetic conditions—people with conditions such as Down syndrome, fragile X syndrome, and Rett syndrome are more likely than others to have ASD
  • Very low birth weight

Diagnosing ASD

Doctors diagnose ASD by looking at a person’s behavior and development. ASD can usually be reliably diagnosed by the age of two. It is important for those with concerns to seek out assessment as soon as possible so that a diagnosis can be made, and treatment can begin.

Diagnosis in Young Children

Diagnosis in young children is often a two-stage process.

Stage 1: General Developmental Screening During Well-Child Checkups

Every child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The American Academy of Pediatrics recommends that all children be screened for developmental delays at their 9-, 18-, and 24- or 30-month well-child visits and specifically for autism at their 18- and 24-month well-child visits. Additional screening might be needed if a child is at high risk for ASD or developmental problems. Those at high risk include children who have a family member with ASD, have some ASD behaviors, have older parents, have certain genetic conditions, or who were born at a very low birth weight.

Parents’ experiences and concerns are very important in the screening process for young children. Sometimes the doctor will ask parents questions about the child’s behaviors and combine those answers with information from ASD screening tools, and with his or her observations of the child. Read more about screening instruments on the Centers for Disease Control and Prevention (CDC) website.

Children who show developmental problems during this screening process will be referred for a second stage of evaluation.

Stage 2: Additional Evaluation

This second evaluation is with a team of doctors and other health professionals who are experienced in diagnosing ASD.

This team may include:

  • A developmental pediatrician—a doctor who has special training in child development
  • A child psychologist and/or child psychiatrist—a doctor who has specialized training in brain development and behavior
  • A neuropsychologist—a doctor who focuses on evaluating, diagnosing, and treating neurological, medical, and neurodevelopmental disorders
  • A speech-language pathologist—a health professional who has special training in communication difficulties

The evaluation may assess:

  • Cognitive level or thinking skills
  • Language abilities
  • Age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting

Because ASD is a complex disorder that sometimes occurs along with other illnesses or learning disorders, the comprehensive evaluation may include:

  • Blood tests
  • Hearing test

The outcome of the evaluation will result in a formal diagnosis and recommendations for treatment.

Diagnosis in older children and adolescents

ASD symptoms in older children and adolescents who attend school are often first recognized by parents and teachers and then evaluated by the school’s special education team. The school’s team may perform an initial evaluation and then recommend these children visit their primary health care doctor or doctors who specialize in ASD for additional testing.

Parents may talk with these specialists about their child’s social difficulties including problems with subtle communication. These subtle communication issues may include problems understanding tone of voice, facial expressions, or body language. Older children and adolescents may have trouble understanding figures of speech, humor, or sarcasm. Parents may also find that their child has trouble forming friendships with peers.

Diagnosis in adults

Diagnosing ASD in adults is often more difficult than diagnosing ASD in children. In adults, some ASD symptoms can overlap with symptoms of other mental-health disorders, such as anxiety or attention-deficit/hyperactivity disorder (ADHD).

Adults who notice the signs and symptoms of ASD should talk with a doctor and ask for a referral for an ASD evaluation. While testing for ASD in adults is still being refined, adults can be referred to a neuropsychologist, psychologist, or psychiatrist who has experience with ASD. The expert will ask about concerns, such as:

  • Social interaction and communication challenges
  • Sensory issues
  • Repetitive behaviors
  • Restricted interests

Information about the adult’s developmental history will help in making an accurate diagnosis, so an ASD evaluation may include talking with parents or other family members.

Getting a correct diagnosis of ASD as an adult can help a person understand past difficulties, identify his or her strengths, and obtain the right kind of help. Studies are now underway to determine the types of services and supports that are most helpful for improving the functioning and community integration of transition-age youth and adults with ASD.

Changes to the diagnosis of ASD

In 2013, a revised version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was released. This revision changed the way autism is classified and diagnosed. Using the previous version of the DSM, people could be diagnosed with one of several separate conditions:

  • Autistic disorder
  • Asperger’s’ syndrome
  • Pervasive developmental disorder not otherwise specified (PDD-NOS)

In the current revised version of the DSM (the DSM-5), these separate conditions have been combined into one diagnosis called “autism spectrum disorder.” Using the DSM-5, for example, people who were previously diagnosed as having Asperger’s syndrome would now be diagnosed as having autism spectrum disorder. Although the “official” diagnosis of ASD has changed, there is nothing wrong with continuing to use terms such as Asperger’s syndrome to describe oneself or to identify with a peer group.

Treatments and Therapies

Treatment for ASD should begin as soon as possible after diagnosis. Early treatment for ASD is important as proper care can reduce individuals’ difficulties while helping them learn new skills and make the most of their strengths.

The wide range of issues facing people with ASD means that there is no single best treatment for ASD. Working closely with a doctor or health care professional is an important part of finding the right treatment program.


A doctor may use medication to treat some symptoms that are common with ASD. With medication, a person with ASD may have fewer problems with:

  • Irritability
  • Aggression
  • Repetitive behavior
  • Hyperactivity
  • Attention problems
  • Anxiety and depression

Read more about the latest news and information on medication warnings, patient medication guides, or newly approved medications at the Food and Drug Administration’s (FDA) website at

Behavioral, psychological, and educational therapy

People with ASD may be referred to doctors who specialize in providing behavioral, psychological, educational, or skill-building interventions. These programs are typically highly structured and intensive and may involve parents, siblings, and other family members. Programs may help people with ASD:

  • Learn life-skills necessary to live independently
  • Reduce challenging behaviors
  • Increase or build upon strengths
  • Learn social, communication, and language skills

Other Resources

There are many social services programs and other resources that can help people with ASD. Here are some tips for finding these additional services:

  • Contact your doctor, local health department, school, or autism advocacy group to learn about special programs or local resources.
  • Find an autism support group. Sharing information and experiences can help individuals with ASD and/or their caregivers learn about treatment options and ASD-related programs.
  • Record conversations and meetings with health care providers and teachers. This information helps when it’s time to make decisions about which programs might best meet an individual’s needs.
  • Keep copies of doctors' reports and evaluations. This information may help an individual qualify for special programs.

Learn More

Free Brochures and Shareable Resources

  • Autism Spectrum Disorder: This brochure provides information about the symptoms, diagnosis, and treatment of ASD.
  • Shareable Resources on ASD: Help support ASD awareness and education in your community. Use these digital resources, including graphics and messages, to spread the word about ASD.

Last Revised: March 2020




Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.

There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

  • Bipolar I Disorder— defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible.
  • Bipolar II Disorder— defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.
  • Cyclothymic Disorder (also called Cyclothymia)—defined by periods of hypomanic symptoms as well as periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, which is referred to as “other specified and unspecified bipolar and related disorders.”

Bipolar disorder is typically diagnosed during late adolescence (teen years) or early adulthood. Occasionally, bipolar symptoms can appear in children. Bipolar disorder can also first appear during a woman’s pregnancy or following childbirth. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

Signs and Symptoms

People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and uncharacteristic behaviors—often without recognizing their likely harmful or undesirable effects. These distinct periods are called “mood episodes.” Mood episodes are very different from the moods and behaviors that are typical for the person. During an episode, the symptoms last every day for most of the day. Episodes may also last for longer periods, such as several days or weeks.

People having a manic episode may:

People having a depressive episode may:

Feel very “up,” “high,” elated, or irritable or touchy

Feel very sad, “down,” empty, worried, or hopeless

Feel “jumpy” or “wired”

Feel slowed down or restless

Have a decreased need for sleep

Have trouble falling asleep, wake up too early, or sleep too much

Have a loss of appetite

Experience increased appetite and weight gain

Talk very fast about a lot of different things

Talk very slowly, feel like they have nothing to say, forget a lot

Feel like their thoughts are racing

Have trouble concentrating or making decisions

Think they can do a lot of things at once

Feel unable to do even simple things

Do risky things that show poor judgment, such as eat and drink excessively, spend or give away a lot of money, or have reckless sex

Have little interest in almost all activities, a decreased or absent sex drive, or an inability to experience pleasure (“anhedonia”)

Feel like they are unusually important, talented, or powerful

Feel hopeless or worthless, think about death or suicide

Sometimes people experience both manic and depressive symptoms in the same episode. This kind of episode is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while, at the same, time feeling extremely energized.

A person may have bipolar disorder even if their symptoms are less extreme. For example, some people with bipolar disorder (Bipolar II) experience hypomania, a less severe form of mania. During a hypomanic episode, a person may feel very good, be able to get things done, and keep up with day-to-day life. The person may not feel that anything is wrong, but family and friends may recognize the changes in mood or activity levels as possible bipolar disorder. Without proper treatment, people with hypomania can develop severe mania or depression.


Proper diagnosis and treatment can help people with bipolar disorder lead healthy and active lives. Talking with a doctor or other licensed health care provider is the first step. The health care provider can complete a physical exam and order necessary medical tests to rule out other conditions. The health care provider may then conduct a mental health evaluation or provide a referral to a trained mental health care provider, such as a psychiatrist, psychologist, or clinical social worker who has experience in diagnosing and treating bipolar disorder.

Mental health care providers usually diagnose bipolar disorder based on a person’s symptoms, lifetime history, experiences, and, in some cases, family history. Accurate diagnosis in youth is particularly important. You can find tips for talking with your health care provider in the NIMH fact sheet on Taking Control of Your Mental Health: Tips for Talking with Your Health Care Provider.

Bipolar Disorder and Other Conditions

Some bipolar disorder symptoms are similar to those of other illnesses, which can make it challenging for a health care provider to make a diagnosis. In addition, many people may have bipolar disorder along with another mental disorder or condition, such as an anxiety disorder, substance use disorder, or an eating disorder. People with bipolar disorder have an increased chance of having thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.

Psychosis: Sometimes, a person with severe episodes of mania or depression may experience psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match the person’s extreme mood. For example:

  • People having psychotic symptoms during a manic episode may have the unrealistic belief that they are famous, have a lot of money, or have special powers.
  • People having psychotic symptoms during a depressive episode may falsely believe they are financially ruined and penniless, have committed a crime, or have an unrecognized serious illness.

As a result, people with bipolar disorder who also have psychotic symptoms are sometimes incorrectly diagnosed with schizophrenia. When people have symptoms of bipolar disorder and also experience periods of psychosis that are separate from mood episodes, the appropriate diagnosis may be schizoaffective disorder.

Anxiety: It is common for people with bipolar disorder to also have an anxiety disorder.

Attention-Deficit Hyperactivity Disorder (ADHD): It is common for people with bipolar disorder to also have ADHD.

Misuse of Drugs or Alcohol: People with bipolar disorder may misuse alcohol or drugs and engage in other high-risk behaviors at times of impaired judgment during manic episodes. Although the negative effects of alcohol use or drug use may be most evident to family, friends, and health care providers, it is important to recognize the presence of an associated mental disorder.

Eating Disorders: In some cases, people with bipolar disorder also have an eating disorder, such as binge eating or bulimia.

Risk Factors

Researchers are studying the possible causes of bipolar disorder. Most agree that there is no single cause and it is likely that many factors contribute to a person’s chance of having the illness.

Brain Structure and Functioning: Some studies indicate that the brains of people with bipolar disorder may differ from the brains of people who do not have bipolar disorder or any other mental disorder. Learning more about these differences may help scientists understand bipolar disorder and determine which treatments will work best. At this time, health care providers base the diagnosis and treatment plan on a person’s symptoms and history, rather than brain imaging or other diagnostic tests.

Genetics: Some research suggests that people with certain genes are more likely to develop bipolar disorder. Research also shows that people who have a parent or sibling with bipolar disorder have an increased chance of having the disorder themselves. Many genes are involved, and no one gene can cause the disorder. Learning more about how genes play a role in bipolar disorder may help researchers develop new treatments.

Treatments and Therapies

Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of medication and psychotherapy, also called “talk therapy.”

Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help people manage these symptoms.


Certain medications can help manage symptoms of bipolar disorder. Some people may need to try several different medications and work with their health care provider before finding medications that work best.

Medications generally used to treat bipolar disorder include mood stabilizers and second-generation (“atypical”) antipsychotics. Treatment plans may also include medications that target sleep or anxiety. Health care providers often prescribe antidepressant medication to treat depressive episodes in bipolar disorder, combining the antidepressant with a mood stabilizer to prevent triggering a manic episode.

People taking medication should:

  • Talk with their health care provider to understand the risks and benefits of the medication.
  • Tell their health care provider about any prescription drugs, over-the-counter medications, or supplements they are already taking.
  • Report any concerns about side effects to a health care provider right away. The health care provider may need to change the dose or try a different medication.
  • Remember that medication for bipolar disorder must be taken consistently, as prescribed, even when one is feeling well.

Avoid stopping a medication without talking to a health care provider first. Suddenly stopping a medication may lead to a “rebound” or worsening of bipolar disorder symptoms. For basic information about medications, visit NIMH’s Mental Health Medications webpage. For the most up-to-date information on medications, side effects, and warnings, visit the U.S. Food and Drug Administration (FDA) Medication Guides website.


Psychotherapy, also called “talk therapy,” can be an effective part of the treatment plan for people with bipolar disorder. Psychotherapy is a term for a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behaviors. It can provide support, education, and guidance to people with bipolar disorder and their families. Treatment may include therapies such as cognitive-behavioral therapy (CBT) and psychoeducation, which are used to treat a variety of conditions.

Treatment may also include newer therapies designed specifically for the treatment of bipolar disorder, including interpersonal and social rhythm therapy (IPSRT) and family-focused therapy. Determining whether intensive psychotherapeutic intervention at the earliest stages of bipolar disorder can prevent or limit its full-blown onset is an important area of ongoing research.

Other Treatment Options

Some people may find other treatments helpful in managing their bipolar symptoms, including:

Electroconvulsive Therapy (ECT): ECT is a brain stimulation procedure that can help people get relief from severe symptoms of bipolar disorder. With modern ECT, a person usually goes through a series of treatment sessions over several weeks. ECT is delivered under general anesthesia and is safe. It can be effective in treating severe depressive and manic episodes, which occur most often when medication and psychotherapy are not effective or are not safe for a particular patient. ECT can also be effective when a rapid response is needed, as in the case of suicide risk or catatonia (a state of unresponsiveness).

More research is needed to determine the effects of other treatments, including:

Transcranial magnetic stimulation (TMS): TMS is a newer approach to brain stimulation that uses magnetic waves. It is delivered to an awake patient most days for 1 month. Research shows that TMS is helpful for many people with various subtypes of depression, but its role in the treatment of bipolar disorder is still under study.

Supplements: Although there are reports that some supplements and herbs may help, not enough research has been conducted to fully understand how these supplements may affect people with bipolar disorder.

It is important for a health care provider to know about all prescription drugs, over-the-counter medications, and supplements a patient is taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.

Beyond Treatment: Things You Can Do

Regular Exercise: Regular aerobic exercise, such as jogging, brisk walking, swimming, or bicycling, helps with depression and anxiety, promotes better sleep, and is healthy for your heart and brain. There is also some evidence that anaerobic exercise such as weightlifting, yoga, and Pilates can be helpful. Check with your health care provider before you start a new exercise regimen.

Keeping a Life Chart: Even with proper treatment, mood changes can occur. Treatment is more effective when a patient and health care provider work together and talk openly about concerns and choices. Keeping a life chart that records daily mood symptoms, treatments, sleep patterns, and life events can help patients and health care providers track and treat bipolar disorder over time. Patients can easily share data collected via smartphone apps – including self-reports, self- ratings, and activity data – with their health care providers and therapists.

For Immediate Help:

If you are in crisis: Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to everyone. All calls are confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency.

If you are thinking about harming yourself or thinking about suicide:

  • Tell someone who can help right away.
  • Call your licensed mental health professional if you are already working with one.
  • Call your doctor or health care provider.
  • Go to the nearest hospital emergency department or call 911.

If a loved one is considering suicide:

  • Do not leave him or her alone.
  • Try to get your loved one to seek immediate help from a doctor, health care provider, or the nearest hospital emergency room or call 911.
  • Remove access to firearms or other potential tools for suicide, including medications.

Coping with Bipolar Disorder

Living with bipolar disorder can be challenging, but there are ways to help make it easier for yourself, a friend, or a loved one.

  • Get treatment and stick with it—recovery takes time and it’s not easy. But treatment is the best way to start feeling better.
  • Keep medical and therapy appointments and talk with the provider about treatment options.
  • Take all medicines as directed.
  • Structure activities: keep a routine for eating and sleeping, and make sure to get enough sleep and exercise.
  • Learn to recognize your mood swings and warning signs, such as decreased sleep.
  • Ask for help when trying to stick with your treatment.
  • Be patient; improvement takes time. Social support helps.
  • Avoid misuse of alcohol and drugs.

Remember: Bipolar disorder is a lifelong illness, but long-term, ongoing treatment can help control symptoms and enable you to live a healthy life.

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Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

Some forms of depression are slightly different, or they may develop under unique circumstances, such as:

  • Persistent depressive disorder (also called dysthymia)is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.
  • Postpartum depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with postpartum depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.
  • Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.
  • Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
  • Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”

Examples of other types of depressive disorders newly added to the diagnostic classification of DSM-5 include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).

Signs and Symptoms

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, or pessimism
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.

Risk Factors

Depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.

Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children.

Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

Risk factors include:

  • Personal or family history of depression
  • Major life changes, trauma, or stress
  • Certain physical illnesses and medications

Treatment and Therapies

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Quick Tip: No two people are affected the same way by depression and there is no "one-size-fits-all" for treatment. It may take some trial and error to find the treatment that works best for you.


Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.

You may have heard about an herbal medicine called St. John's wort. Although it is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort before talking to your health care provider. Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use.


Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy.

Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:

  • ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.
  • Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.
  • Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.
  • ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.
  • ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.

Other more recently introduced types of brain stimulation therapies used to treat medicine-resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS).

If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary care practitioner or a health provider who specializes in diagnosing and treating mental health conditions.

Beyond Treatment: Things You Can Do

Here are other tips that may help you or a loved one during treatment for depression:

  • Try to be active and exercise.
  • Set realistic goals for yourself.
  • Try to spend time with other people and confide in a trusted friend or relative.
  • Try not to isolate yourself, and let others help you.
  • Expect your mood to improve gradually, not immediately.
  • Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
  • Continue to educate yourself about depression.

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  • Chronic Illness & Mental Health: This brochure discusses chronic illnesses and depression, including symptoms, health effects, treatment, and recovery.
  • Depression and Older Adults: Depression is not a normal part of aging. This brochure describes the signs, symptoms, and treatment options for depression in older adults.
  • Perinatal Depression: A brochure with information about perinatal depression including how it differs from the “baby blues”, causes, signs and symptoms, treatment options, and how you or a loved one can get help.
  • Teen Depression: This flier for teens describes depression and how it differs from regular sadness. It also describes symptoms, causes, and treatments, with information on getting help and coping.
  • Shareable Resources on Depression: Help support depression awareness and education in your community. Use these digital resources, including graphics and messages, to spread the word about depression.

Last Revised: February 2020



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

Signs and Symptoms

Anorexia nervosa

People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, often exercise excessively, and/or may force themselves to vomit or use laxatives to lose weight. Anorexia nervosa has the highest mortality rate of any mental disorder. While many people with this disorder die from complications associated with starvation, others die of suicide.

Symptoms include:

  • Extremely restricted eating
  • Extreme thinness (emaciation)
  • A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
  • Intense fear of gaining weight
  • Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight

Other symptoms may develop over time, including:

  • Thinning of the bones (osteopenia or osteoporosis)
  • Mild anemia and muscle wasting and weakness
  • Brittle hair and nails
  • Dry and yellowish skin
  • Growth of fine hair all over the body (lanugo)
  • Severe constipation
  • Low blood pressure slowed breathing and pulse
  • Damage to the structure and function of the heart
  • Brain damage
  • Multiorgan failure
  • Drop in internal body temperature, causing a person to feel cold all the time
  • Lethargy, sluggishness, or feeling tired all the time
  • Infertility

Bulimia nervosa

People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. People with bulimia nervosa may be slightly underweight, normal weight, or over overweight.

Symptoms include:

  • Chronically inflamed and sore throat
  • Swollen salivary glands in the neck and jaw area
  • Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid
  • Acid reflux disorder and other gastrointestinal problems
  • Intestinal distress and irritation from laxative abuse
  • Severe dehydration from purging of fluids
  • Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals) which can lead to stroke or heart attack

Binge-eating disorder

People with binge-eating disorder lose control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in the U.S.

Symptoms include:

  • Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period
  • Eating even when you're full or not hungry
  • Eating fast during binge episodes
  • Eating until you're uncomfortably full
  • Eating alone or in secret to avoid embarrassment
  • Feeling distressed, ashamed, or guilty about your eating
  • Frequently dieting, possibly without weight loss

Risk Factors

Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. Eating disorders frequently appear during the teen years or young adulthood but may also develop during childhood or later in life. These disorders affect both genders, although rates among women are higher than among men. Like women who have eating disorders, men also have a distorted sense of body image.

Researchers are finding that eating disorders are caused by a complex interaction of genetic, biological, behavioral, psychological, and social factors. Researchers are using the latest technology and science to better understand eating disorders.

One approach involves the study of human genes. Eating disorders run in families. Researchers are working to identify DNA variations that are linked to the increased risk of developing eating disorders.

Brain imaging studies are also providing a better understanding of eating disorders. For example, researchers have found differences in patterns of brain activity in women with eating disorders in comparison with healthy women. This kind of research can help guide the development of new means of diagnosis and treatment of eating disorders.

Treatments and Therapies

It is important to seek treatment early for eating disorders. People with eating disorders are at higher risk for suicide and medical complications. People with eating disorders can often have other mental disorders (such as depression or anxiety) or problems with substance use. Complete recovery is possible.

Treatment plans are tailored to individual needs and may include one or more of the following:

  • Individual, group, and/or family psychotherapy
  • Medical care and monitoring
  • Nutritional counseling
  • Medications


Psychotherapies such as a family-based therapy called the Maudsley approach, where parents of adolescents with anorexia nervosa assume responsibility for feeding their child, appear to be very effective in helping people gain weight and improve eating habits and moods.

To reduce or eliminate binge-eating and purging behaviors, people may undergo cognitive behavioral therapy (CBT), which is another type of psychotherapy that helps a person learn how to identify distorted or unhelpful thinking patterns and recognize and change inaccurate beliefs.


Evidence also suggests that medications such as antidepressants, antipsychotics, or mood stabilizers may also be helpful for treating eating disorders and other co-occurring illnesses such as anxiety or depression. Check the Food and Drug Administration’s (FDA) website: (, for the latest information on warnings, patient medication guides, or newly approved medications.

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Last Revised: February 2016




A traumatic event is a shocking, scary, or dangerous experience that can affect someone emotionally and physically. Experiences like natural disasters (such as hurricanes, earthquakes, and floods), acts of violence (such as assault, abuse, terrorist attacks, and mass shootings), as well as car crashes and other accidents can all be traumatic. Researchers are investigating the factors that help people cope or that increase their risk for other physical or mental health problems following a traumatic event.

Warning Signs

Responses to trauma can be immediate or delayed, brief or prolonged. Most people have intense responses immediately following, and often for several weeks or months after a traumatic event. These responses can include:

  • Feeling anxious, sad, or angry
  • Trouble concentrating and sleeping
  • Continually thinking about what happened

For most people, these are normal and expected responses and generally lessen with time.

In some cases, these responses continue for a longer period of time and interfere with everyday life. If they are interfering with daily life or are not getting better over time, it is important to seek professional help. Some signs that an individual may need help include:

  • Worrying a lot or feeling very anxious, sad, or fearful
  • Crying often
  • Having trouble thinking clearly
  • Having frightening thoughts or flashbacks, reliving the experience
  • Feeling angry, resentful, or irritable
  • Having nightmares or difficulty sleeping
  • Avoiding places or people that bring back disturbing memories and responses.
  • Becoming isolated from family and friends

Children and teens can have different reactions to trauma than those of adults. Symptoms sometimes seen in very young children (less than six years old) can include:

  • Wetting the bed after having learned to use the toilet
  • Forgetting how to or being unable to talk
  • Acting out the scary event during playtime
  • Being unusually clingy with a parent or other adult

Older children and teens are more likely to show symptoms similar to those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.

Physical responses to trauma may also mean that an individual needs help. Physical symptoms may include:

  • Headaches
  • Stomach pain and digestive issues
  • Feeling tired
  • Racing heart and sweating
  • Being very jumpy and easily startled

Individuals who have a mental health condition or who have had traumatic experiences in the past, who face ongoing stress, or who lack support from friends and family may be more likely to develop more severe symptoms and need additional help. Some people turn to alcohol or other drugs to cope with their symptoms. Although substance use may seem to relieve symptoms temporarily, it can also lead to new problems and get in the way of recovery.

Ways to Cope

Healthy ways of coping in this time period include:

  • Avoiding alcohol and other drugs;
  • Spending time with loved ones and trusted friends who are supportive; and
  • Trying to maintain normal routines for meals, exercise, and sleep.

In general, staying active is a good way to cope with stressful feelings.

Finding Help: If You Know Someone in Crisis

Some symptoms require immediate emergency care. If you or someone you know is thinking about harming themselves or others or attempting suicide, seek help right away:

  • Call 911 for emergency services or go to the nearest emergency room.
  • Call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741).
  • Contact social media outlets directly if you are concerned about a person’s social media updates or dial 911 in an emergency. For more information about how to contact social media outlets, visit the Lifeline’s Support on Social Media webpage.

Take any comments about suicide or wishing to die seriously—even those said by children and adolescents. Even if you do not believe your family member or friend will attempt suicide, the person is in distress and can benefit from your help in finding treatment.

Health Hotlines

    • Disaster Distress Hotline: This helpline, sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides immediate counseling for people affected by any disaster or tragedy. Call 1-800-985-5990 to connect with a trained professional from the closest crisis counseling center within the network.
    • National Suicide Prevention Lifeline: The Lifeline provides 24-hour, toll-free, and confidential support to anyone in suicidal crisis or emotional distress. Call 1-800-273-TALK (8255) to connect with a skilled, trained counselor at a crisis center in your area. Support is available in English and Spanish and via live chat.
    • Veterans Crisis Line: This helpline is a free, confidential resource for Veterans of all ages and circumstances. Call 1-800-273-8255, press "1"; text 838255; or chat online to connect with 24/7 support.
    • Crisis Text Line: Text HELLO to 741741 for free and confidential support 24 hours a day throughout the U.S.

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Last Revised: January 2020


Obsessive-Compulsive Disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and/or behaviors (compulsions) that he or she feels the urge to repeat over and over.

Signs and Symptoms

People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:

  • Fear of germs or contamination
  • Unwanted forbidden or taboo thoughts involving sex, religion, or harm
  • Aggressive thoughts towards others or self
  • Having things symmetrical or in a perfect order

Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:

  • Excessive cleaning and/or handwashing
  • Ordering and arranging things in a particular, precise way
  • Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
  • Compulsive counting

Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally:

  • Can't control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
  • Spends at least 1 hour a day on these thoughts or behaviors
  • Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
  • Experiences significant problems in their daily life due to these thoughts or behaviors

Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds.

Symptoms may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize that what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children.

If you think you have OCD, talk to your doctor about your symptoms. If left untreated, OCD can interfere in all aspects of life.

Risk Factors

OCD is a common disorder that affects adults, adolescents, and children all over the world. Most people are diagnosed by about age 19, typically with an earlier age of onset in boys than in girls, but onset after age 35 does happen. The causes of OCD are unknown, but risk factors include:


Twin and family studies have shown that people with first-degree relatives (such as a parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. The risk is higher if the first-degree relative developed OCD as a child or teen. Ongoing research continues to explore the connection between genetics and OCD and may help improve OCD diagnosis and treatment.

Brain Structure and Functioning

Imaging studies have shown differences in the frontal cortex and subcortical structures of the brain in patients with OCD. There appears to be a connection between the OCD symptoms and abnormalities in certain areas of the brain, but that connection is not clear. Research is still underway. Understanding the causes will help determine specific, personalized treatments to treat OCD.


An association between childhood trauma and obsessive-compulsive symptoms has been reported in some studies. More research is needed to understand this relationship better.

In some cases, children may develop OCD or OCD symptoms following a streptococcal infection—this is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).

Treatments and Therapies

OCD is typically treated with medication, psychotherapy, or a combination of the two. Although most patients with OCD respond to treatment, some patients continue to experience symptoms.

Sometimes people with OCD also have other mental disorders, such as anxiety, depression, and body dysmorphic disorder, a disorder in which someone mistakenly believes that a part of their body is abnormal. It is important to consider these other disorders when making decisions about treatment.


Serotonin reuptake inhibitors (SRIs), which include selective serotonin reuptake inhibitors (SSRIs) are used to help reduce OCD symptoms.

SRIs often require higher daily doses in the treatment of OCD than of depression and may take 8 to 12 weeks to start working, but some patients experience more rapid improvement.

If symptoms do not improve with these types of medications, research shows that some patients may respond well to an antipsychotic medication. Although research shows that an antipsychotic medication may help manage symptoms for people who have both OCD and a tic disorder, research on the effectiveness of antipsychotics to treat OCD is mixed.

If you are prescribed a medication, be sure you:

  • Talk with your doctor or a pharmacist to make sure you understand the risks and benefits of the medications you're taking.
  • Do not stop taking a medication without talking to your doctor first. Suddenly stopping a medication may lead to "rebound" or worsening of OCD symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.
  • Report any concerns about side effects to your doctor right away. You may need a change in the dose or a different medication.
  • Report serious side effects to the U.S. Food and Drug Administration (FDA) MedWatch Adverse Event Reporting program online or by phone at 1-800-332-1088. You or your doctor may send a report.


Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, including cognitive behavior therapy (CBT) and other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals. Research also shows that a type of CBT called Exposure and Response Prevention (EX/RP) – spending time in the very situation that triggers compulsions (e.g. touching dirty objects) but then being prevented from undertaking the usual resulting compulsion (e.g. handwashing) – is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to SRI medication.

As with most mental disorders, treatment is usually personalized and might begin with either medication or psychotherapy, or with a combination of both. For many patients, EX/RP is the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat OCD symptoms or vice versa for individuals who begin treatment with psychotherapy.

Other Treatment Options

In 2018, the FDA approved Transcranial Magnetic Stimulation (TMS) as an adjunct in the treatment of OCD in adults.

NIMH is supporting research into other new treatment approaches for people whose OCD does not respond well to the usual therapies. These new approaches include combination and add-on (augmentation) treatments, as well as novel techniques such as deep brain stimulation.

Finding Treatment

For general information on mental health and to locate treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357). SAMHSA also has a Behavioral Health Treatment Locator on its website that can be searched by location.

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Last Revised: October 2019




Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.

It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened, even when they are not in danger.

Signs and Symptoms

While most but not all traumatized people experience short term symptoms, the majority do not develop ongoing (chronic) PTSD. Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD. Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD.

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

  • At least one re-experiencing symptom
  • At least one avoidance symptom
  • At least two arousal and reactivity symptoms
  • At least two cognition and mood symptoms

Re-experiencing symptoms include:

  • Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
  • Bad dreams
  • Frightening thoughts

Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.

Avoidance symptoms include:

  • Staying away from places, events, or objects that are reminders of the traumatic experience
  • Avoiding thoughts or feelings related to the traumatic event

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

Arousal and reactivity symptoms include:

  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping
  • Having angry outbursts

Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

Cognition and mood symptoms include:

  • Trouble remembering key features of the traumatic event
  • Negative thoughts about oneself or the world
  • Distorted feelings like guilt or blame
  • Loss of interest in enjoyable activities

Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members.

It is natural to have some of these symptoms for a few weeks after a dangerous event. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

Do children react differently than adults?

Children and teens can have extreme reactions to trauma, but some of their symptoms may not be the same as adults. Symptoms sometimes seen in very young children (less than 6 years old), these symptoms can include:

  • Wetting the bed after having learned to use the toilet
  • Forgetting how to or being unable to talk
  • Acting out the scary event during playtime
  • Being unusually clingy with a parent or other adult

Older children and teens are more likely to show symptoms similar to those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.

Risk Factors

Anyone can develop PTSD at any age. This includes war veterans, children, and people who have been through a physical or sexual assault, abuse, accident, disaster, or other serious events. According to the National Center for PTSD, about 7 or 8 out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men, and genes may make some people more likely to develop PTSD than others.

Not everyone with PTSD has been through a dangerous event. Some people develop PTSD after a friend or family member experiences danger or harm. The sudden, unexpected death of a loved one can also lead to PTSD.

Why do some people develop PTSD and other people do not?

It is important to remember that not everyone who lives through a dangerous event develops PTSD. In fact, most people will not develop the disorder.

Many factors play a part in whether a person will develop PTSD. Some examples are listed below. Risk factors make a person more likely to develop PTSD. Other factors, called resilience factors, can help reduce the risk of the disorder.

Some factors that increase risk for PTSD include:

  • Living through dangerous events and traumas
  • Getting hurt
  • Seeing another person hurt, or seeing a dead body
  • Childhood trauma
  • Feeling horror, helplessness, or extreme fear
  • Having little or no social support after the event
  • Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
  • Having a history of mental illness or substance abuse

Some factors that may promote recovery after trauma include:

  • Seeking out support from other people, such as friends and family
  • Finding a support group after a traumatic event
  • Learning to feel good about one’s own actions in the face of danger
  • Having a positive coping strategy, or a way of getting through the bad event and learning from it
  • Being able to act and respond effectively despite feeling fear

Researchers are studying the importance of these and other risk and resilience factors, including genetics and neurobiology. With more research, someday it may be possible to predict who is likely to develop PTSD and to prevent it.

Treatments and Therapies

The main treatments for people with PTSD are medications, psychotherapy (“talk” therapy), or both. Everyone is different, and PTSD affects people differently, so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health provider who is experienced with PTSD. Some people with PTSD may need to try different treatments to find what works for their symptoms.

If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be addressed. Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicidal.


The most studied type of medication for treating PTSD are antidepressants, which may help control PTSD symptoms such as sadness, worry, anger, and feeling numb inside. Other medications may be helpful for treating specific PTSD symptoms, such as sleep problems and nightmares.

Doctors and patients can work together to find the best medication or medication combination, as well as the right dose. Check the U.S. Food and Drug Administration websitefor the latest information on patient medication guides, warnings, or newly approved medications.


Psychotherapy (sometimes called “talk therapy”) involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but it can last longer. Research shows that support from family and friends can be an important part of recovery.

Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person’s needs.

Effective psychotherapies tend to emphasize a few key components, including education about symptoms, teaching skills to help identify the triggers of symptoms, and skills to manage the symptoms. One helpful form of therapy is called cognitive behavioral therapy, or CBT. CBT can include:

  • Exposure therapy. This helps people face and control their fear. It gradually exposes them to the trauma they experienced in a safe way. It uses imagining, writing, or visiting the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.
  • Cognitive restructuring. This helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about something that is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.

There are other types of treatment that can help as well. People with PTSD should talk about all treatment options with a therapist. Treatment should equip individuals with the skills to manage their symptoms and help them participate in activities that they enjoyed before developing PTSD.

How Talk Therapies Help People Overcome PTSD 

Talk therapies teach people helpful ways to react to the frightening events that trigger their PTSD symptoms. Based on this general goal, different types of therapy may:

  • Teach about trauma and its effects
  • Use relaxation and anger-control skills
  • Provide tips for better sleep, diet, and exercise habits
  • Help people identify and deal with guilt, shame, and other feelings about the event
  • Focus on changing how people react to their PTSD symptoms. For example, therapy helps people face reminders of the trauma.

Beyond Treatment: How can I help myself?

It may be very hard to take that first step to help yourself. It is important to realize that although it may take some time, with treatment, you can get better. If you are unsure where to go for help, ask your family doctor. You can also search online for “mental health providers,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.

To help yourself while in treatment:

  • Talk with your doctor about treatment options
  • Engage in mild physical activity or exercise to help reduce stress
  • Set realistic goals for yourself
  • Break up large tasks into small ones, set some priorities, and do what you can as you can
  • Try to spend time with other people, and confide in a trusted friend or relative. Tell others about things that may trigger symptoms.
  • Expect your symptoms to improve gradually, not immediately
  • Identify and seek out comforting situations, places, and people

Caring for yourself and others is especially important when large numbers of people are exposed to traumatic events (such as natural disasters, accidents, and violent acts).

Last updated July 2020



Drugs and Alcohol

Did you know that addiction to drugs or alcohol is a mental illness? Substance use disorder changes normal desires and priorities. It changes normal behaviors and interferes with the ability to work, go to school, and to have good relationships with friends and family. In 2014, 20.2 million adults in the U.S. had a substance use disorder and 7.9 million had both a substance use disorder and another mental illness. More than half of the people with both a substance use disorder and another mental illness were men (4.1 million). Having two illnesses at the same time is known as “comorbidity” and it can make treating each disorder more difficult.

Tobacco and e-Cigarettes (Vaping)

E-cigarettes are exploding in popularity, and are being used by both adolescents and adults. They are not a safe alternative to cigarette smoking. E-cigarettes, personal vaporizers, vape pens, e-cigars, pod systems, e-hookah, or vaping devices, are products that produce an aerosolized mixture containing flavored liquids and nicotine that is inhaled by the user. E-cigarettes can resemble traditional tobacco products like cigarettes, cigars, pipes, or common gadgets like flashlights, flash drives, or pens.


The American Academy of Pediatrics (AAP) supports actions to prevent children and youth from using or being exposed to the vapor from e-cigarettes. Here are facts from the American Pediatric Association and tips to help parents and caregivers address e-cigarette use and exposure.


E-cigarettes, personal vaporizers, vape pens, e-cigars, pod systems, e-hookah, or vaping devices, are products that produce an aerosolized mixture containing flavored liquids and nicotine that is inhaled by the user. E-cigarettes can resemble traditional tobacco products like cigarettes, cigars, pipes, or common gadgets like flashlights, flash drives, or pens.

The American Academy of Pediatrics (AAP) supports actions to prevent children and youth from using or being exposed to the vapor from e-cigarettes.


Are They Safe?

  • The solution in e-cigarette devices and vapor contains harmful chemicals like antifreeze (made from one of two chemicals: propylene glycol or ethylene glycol), diethylene glycol, and carcinogens like nitrosamines which can cause cancer.
  • The nicotine in e-cigarettes is addictive and can harm brain development. 
  • E-cigarettes are not recommended as a way to quit smoking.
  • In some cases, e-cigarette devices have exploded, causing burns or fires.
  • Secondhand smoke/vapor from e-cigarettes is harmful to growing lungs.
  • Long-term health effects on users and bystanders are still unknown.
  • E-cigarettes can be used to smoke or "vape" marijuana, herbs, waxes, and oils.
  • E-cigarettes are not yet regulated nor approved for smoking cessation by the US Food and Drug Administration (FDA), and the long-term health effects to users and bystanders are still unknown. Due to the lack of regulation, the chemical compounds in an e-cigarette device can vary between brands. 
  • The best way to protect your children is to never smoke or vape near them. Talk with your doctor about quitting all tobacco. Never smoke indoors, in your car, or in places that children spend time.


Dangers to Youth:

  • E-cigarettes are the most commonly-used tobacco product among teens. In 2018, over 20% of high school students reported having used e-cigarettes in the last 30 days. 
  • E-cigarettes contain a liquid solution that is usually flavored. Flavors, which are appealing to children, often are things like peach schnapps, java jolt, piña colada, peppermint, bubble gum, or chocolate. 
  • Youth who use e-cigarettes are more likely to smoke traditional cigarettes in the future. 
  • Children are exposed to e-cigarette advertising in the media, and in magazines and billboards. 
  • Although it is illegal for e-cigarettes to be sold to youth under age 18, they can be ordered online.

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Risk of Poisoning:

  • E-cigarette solutions can poison children and adults through swallowing or skin contact.
  • A child can be killed by very small amounts of nicotine: less than half a teaspoon. See Liquid Nicotine Used in E-Cigarettes Can Kill Children. 
  • As of 2016, liquid nicotine is required to be sold in childproof packaging.
  • Symptoms of nicotine poisoning include sweating, dizziness, vomiting, increased heart rate lethargy, seizures, and difficulty breathing.
  • Calls to poison control centers related to e-cigarette devices have skyrocketed in the last 5 years. In 2014, poison centers in the US reported 3,783 exposures to e-cigarette devices and nicotine liquid, compared to only 1,543 exposures in 2013. In 2015, 3,073 exposures were reported. 


Recommendations for E-cigarette Users:

  • Protect your skin if handling e-cigarette products.
  • E-cigarette users should always keep e-cigarettes and liquid nicotine locked up and out of the reach of children and follow the specific disposal instructions on the label.
  • If exposure to liquid nicotine occurs, call the local poison center at 1-800-222-1222.


Additional Information & Resources:   


Some people believe vaping is safer than smoking because it doesn’t involve inhaling smoke. But the reality is, when it comes to vaping marijuana, there’s much less known about the negative health effects.


The most recent research suggests vaping THC oil could be quite harmful to lung health. The greatest concern at the moment is the severe effects of inhaling vitamin E acetate. This additive chemical has been found in many vaping products that contain THC.

Texas Considers Having Marijuana Concentrates a Felony
Even if law enforcement only finds a minuscule amount of residue inside your vaporizer pen, you could end up spending between 180 days and two years in jail and paying a fine of up to $10,000.

Dabbing is a dangerous type of marijuana use that has become more common in recent years. While the use of marijuana by teens has been a common drug issue for years, the new trend has taken marijuana use to another level. Dabbing involves using cannabis extracts with higher levels of tetrahydrocannabinol (THC), the active ingredient in marijuana that creates a high.

Because of the increased popularity of dabbing with teens, it is important to understand some of the slang terms for marijuana concentrates. By understanding or recognizing these terms, you can have a better understanding of what they mean and whether or not they indicate that teens are dabbing.


Dabbing is using dabs or marijuana concentrates. Dabbing creates a stronger high because the active ingredient of marijuana is much more concentrated than it would be in a typical joint. The strongest marijuana joint that is smoked the traditional way is about 20% THC, while dabs may contain an 80% or even higher concentration of THC. Dabbing also delivers the THC to the body much more suddenly than smoking a joint would, making it even more potent.

There are different types of dabs that have differing appearances, depending upon how they are made. The most common dab is butane hash oil, or BHO, and is made by using butane to extract the THC from marijuana leaves and then concentrate it. The THC may also be extracted mechanically or by using other chemicals.


Common Dabbing Terms

Teen drug slang includes several dab slang terms that most people may be unfamiliar with. These terms relate to the substances used while dabbing, the devices used to dab, or methods by which dab is made:

  • 710: This number spells OIL when held upside down and refers to marijuana concentrates that may appear as an oil.
  • Alcohol extraction: A method of extracting THC using alcohol.
  • Banger hanger: A popular type of device used for dabbing.
  • Butter, budder, badder: Marijuana concentrates can look like butter and have the same consistency as butter, leading to butter and similar words being used to describe it.
  • Blasting: Slang term for extracting marijuana concentrates using butane, likely originating from the risk of explosion associated with this method. 
  • Butane extraction: A method of concentrating THC using butane.
  • Butane hash oil: Also called BHO, butane hash oil is a name for concentrated marijuana.
  • Butane torch: Used to vaporize dab so that it can be inhaled.
  • Carb cap: Part of dabbing devices used to contain the vaporized marijuana concentrates within the device.
  • Crumble: A slang term for concentrated marijuana, derived from the crumbly appearance of certain types of concentrates.
  • CO2 extraction: A method of concentrating THC using carbon dioxide.
  • Concentrate: Concentrated marijuana.
  • Concentrate pipe: A pipe used to inhale marijuana concentrates.
  • Dabber: A slang name that refers to devices used to dab.
  • Dab nail: The part of most dabbing devices that the marijuana concentrates are applied to. Also just called a nail.
  • Dab oil: Also called dab or dabs; a slang term for concentrated marijuana, derived from the small amount of substance used while using marijuana concentrates.
  • Dab pen: An e-cigarette used to dab. Also called a wax pen.
  • Dab rig: The most common name for the glassware used to dab.
  • Dome: A section of the glassware used while dabbing.
  • Ear wax: A slang term for concentrated marijuana, derived from the appearance of certain types of concentrates.
  • Errl: A slang term for marijuana concentrates.
  • Glass: Slang term for the glassware used to dab.
  • Glycerin extraction: A method of concentrating THC using glycerin.
  • Ice hash: A type of marijuana concentrate made by using ice water.
  • Hash: Also called hashish; resin of the marijuana plant, used to create marijuana concentrates.
  • Hash oil: Hash that has been purified and concentrated into an oil.
  • Honey: Also called honeycomb or honey oil; a slang term for concentrated marijuana, likely originated because certain types of marijuana concentrates appear like honey.
  • Ice wax: Also called water hash; a slang term for concentrated marijuana that is made using ice water.
  • ISO oil: A slang term for concentrated marijuana that is made using isopropyl alcohol.
  • Kief: Part of the marijuana plant that produces a resin that is high in THC.
  • Knife hits: An older way to use dabs that involved heating two knives and using them to vaporize and direct the marijuana concentrates. 
  • Liquid gold: A slang term for concentrated marijuana, derived from the golden appearance of many concentrates.
  • Live resin: Marijuana concentrates that are made from plants that have not been dried or cured.
  • Nug: A term for the flower of the marijuana plant which has a high concentration of THC.
  • Nug run: Marijuana concentrates that are made from using only the flower of the marijuana plant.
  • Oil rig: Slang term for a dab rig, likely originated because dab is sometimes referred to as oil.
  • Pressed hash: A slang term for concentrated marijuana that is extracted mechanically.
  • Reclaim: Residue that is left over after dabbing, that is then reused.
  • Resin: Also called sap; refers to the resin of a marijuana plant, a part of the plant that is higher in THC.
  • Seasoning a nail: Refers to applying marijuana concentrates to a “nail,” part of the device used to dab.
  • Shatter: A common slang term for concentrated marijuana.
  • Quick wash ISO: Also called QWISO, this is a method of concentrating THC using isopropyl alcohol.
  • Vape oil: A slang term for concentrated marijuana that is used to vape.
  • Vapor rig: Slang term for a dab rig; a device used to inhale marijuana concentrates.
  • Vapor straw: Simple, one-piece glassware used to inhale marijuana concentrates.
  • Wax: A slang term for concentrated marijuana, derived from the waxy appearance certain types of concentrates have.


Dangers of Marijuana Dabs

Because of how concentrated the THC in marijuana dabs is, it creates risks that might not normally be encountered when smoking a typical joint of marijuana. Specifically, the US Drug Enforcement Administration (DEA) warns that a teen overdose may occur and that those who overdose on dabs may experience paranoia, anxiety, panic attacks and hallucinations. Additionally, marijuana concentrates may cause increased heart rate, increased blood pressure, withdrawal, and problems related to addiction.


The dangers of dabbing also include dangers introduced from the process of how dabs are made. One of the more popular methods of making marijuana concentrates involves using butane, which creates an explosive gas. The risk of explosion while making dabs using butane is comparable to that of making methamphetamine. Many of the processes used also leave behind chemicals and byproducts that can be harmful.


Drug and Alcohol Facts:

Adolescent abuse of drugs and alcohol is a preventable behavior, and the disease of drug/alcohol

addiction is a treatable disease. Parents are the most effective resource, and leverage point, in preventing and reducing adolescent and young adult drug and alcohol abuse and addiction.


  • 11 million American adolescents and young adults ages 12-29 need help with drug and alcohol problems; 9 million of these are between the ages of 12-25. (2009 National Study on Drugs and Health)

  • 90% of the nearly 2 million adolescents who need help with drug and alcohol problems are not getting the help they need. (2008 National Study on Drugs and Health)

  • The related public health, social services, public safety, and lost productivity costs of drug and alcohol abuse to society is $465 billion a year. ($280 billion drugs, $185 billion alcohol; Harwood 2004, 2000)

  • Parents consider drugs and alcohol as one of the most important issues facing teens, young adults, and parents today. (Horowitz Associates 2010)

  • Kids who learn a lot about the risks of drugs from their parents are up to 50% less likely to use drugs, yet only 37% report getting that benefit. (Partnership Attitude Tracking Study 2008)

  • Parents who intervene early with their child s drug or alcohol use can help significantly reduce the likelihood that they will become addicted, or suffer long-term negative consequences. (Dennis


  • 90% of all adults with drug or alcohol problems started using before the age of 18, and half before

    15. (Dennis 2007)

  • There is a clear association between adolescent drug and alcohol use and unhealthy, risky behavior, including: unprotected, unplanned, unwanted sexual activity; impaired motor vehicle driving/passenger; involvement with juvenile justice system; poor academic performance and dropping out. (numerous sources)

  • Some adolescents and young adults have special vulnerability to drug and alcohol problems,

    including: drug or alcohol use at an early age; family history of drug or alcohol problems; existing

    mental health problems; having friends who use drugs and alcohol. (National Institute on Drug Abuse, Substance Abuse Mental Health Services Administration)

  • African American adolescents have consistently shown lower drug and alcohol usage rates than Caucasian adolescents. (Johnson/Monitoring the Future)

  • Coerced (non voluntary) treatment for adolescent drug and alcohol problems can be just as effective as treatment after hitting bottom. (National Institute on Drug Abuse, SAMHSA)

  • The adolescent brain is not fully developed until ages 22-24, and can be more vulnerable to the effects of drugs and alcohol; the part of the brain to develop last is the prefrontal cortex, responsible for decision making and moderating social behavior. (Winters 2008)

  • Effective treatment for adolescent drug and alcohol problems has been shown to be different than treatment for adults. (National Institute on Drug Abuse)

  • On an average day, 7,540 adolescents 12-17 drank alcohol for the first time, 4,365 used an illicit drug, 2,466 abused a prescription pain medication (without a prescription) and 263 were admitted to treatment for marijuana dependence, more than any other drug. (SAMHSA)


Substance Abuse

From prescription drugs and over-the-counter medications to street drugs and alcohol, virtually any drug can be abused. While illicit drugs like cocaine and heroin are most commonly thought of as abused any time they are used, prescription drugs are abused whenever they are used in a manner other than as intended, or by someone other than to whom they were prescribed. In 2013, approximately 2.8 million people tried an illicit drug for the first time, per the Substance Abuse and Mental Health Administration (SAMHSA), illustrating that more and more people are entering into drug abuse every day. If you, a friend or family member is suffering from drug abuse or addiction, you are not alone. The Substance Abuse and Mental Health Administration reports that: 

How Substance Abuse Starts

For many people, high risk behavior that lead to drug abuse addiction start in early adolescence. Most of these children do not progress in their drug use, but the ones who do are often associated with one or more risk factors for drug abuse, including:

  • Aggressive behavior.
  • Inadequate parental supervision.
  • Easy access to drugs.
  • Living at or below the poverty level.


If a child is exposed to several of these risk factors, there is a greater likelihood that he will abuse drugs later in life.

Some people begin abusing drugs during adulthood despite the lack of risk factors. In many cases, the abuse starts with a simple prescription by a physician for a legitimate medical purpose. There are quite a few drugs, especially prescription pain relievers, that your body builds up a tolerance to. You then require more and more of the drug to achieve the same effect, which can lead to abuse as well as physical and psychological addiction


Signs and Symptoms of Drug Abuse

When someone is abusing drugs, there are often telltale signs and symptoms that are both physical and behavioral, including:

  • Sudden mood swings.
  • Changes in normal behavior.
  • Lack of hygiene and grooming.
  • Withdrawal from friends and family.
  • Loss of interest in normal social activities and hobbies.
  • Changes in sleeping patterns.
  • Bloodshot or glassy eyes.
  • Constant sniffles or runny nose.


Each drug will have its own set of specific symptoms, but these are usually found in most drug abusers. For example:

  • People who abuse methamphetamines may seem high strung or wired.
  • Cocaine abusers usually exhibit a loss of appetite.
  • Those who abuse tranquilizers or barbiturates may be lethargic and disoriented.

To get more information about a particular drug, you can search for drug articles online or reach out to your physician or counselor for more drug info and assistance. If you think you recognize any drug abuse symptoms in a friend or loved one, however, it may be time to intervene. Treatment does not have to be voluntary to be effective.


Associated Risks of Drug Abuse

Drug abuse carries a lot of potential side effects, depending on the specific drug being used:

  • Those abusing stimulants like cocaine or amphetamines may experience fatigue, depression, and lethargy as they come down from their highs.
  • Individuals who abuse opiate drugs, such as heroin or prescription painkillers, may experience intestinal issues, muscle aches, and nervousness.


Perhaps the most serious risk of drug abuse is the potential to overdose.

If you suspect that someone has overdosed, call 911 immediately. Prompt medical attention can often save a life and limit the serious damage done; however, the best way to prevent an overdose is to get help. If drug abuse is an issue, it’s only a matter of time before addiction takes hold. It’s important to get help before an overdose or substantial long-term damage occurs. 


Treatment Options

There is no magic wand when it comes to treating drug abuse and addiction. This complex disease requires a multifaceted approach to treatment for it to be effective. Most treatment programs include:

  • A thorough mental and physical assessment.
  • Detoxification.
  • Individual and or group therapy.
  • Participation in support groups.
  • A comprehensive aftercare program.
  • Likely on going counseling
  • Possible 12-step program support from organizations such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).


Last Revised: May 2020


If You Know Someone in Crisis:

Call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency. Learn more on the Lifeline’s website or the Crisis Text Line’s website.


Suicide is a major public health concern. Over 47,000 people died by suicide in the United States in 2017; it is the 10th leading cause of death overall. Suicide is complicated and tragic, but it is often preventable. Knowing the warning signs for suicide and how to get help can help save lives.

Signs and Symptoms

The behaviors listed below may be signs that someone is thinking about suicide.

  • Talking about wanting to die or wanting to kill themselves
  • Talking about feeling empty, hopeless, or having no reason to live
  • Making a plan or looking for a way to kill themselves, such as searching for lethal methods online, stockpiling pills, or buying a gun
  • Talking about great guilt or shame
  • Talking about feeling trapped or feeling that there are no solutions
  • Feeling unbearable pain (emotional pain or physical pain)
  • Talking about being a burden to others
  • Using alcohol or drugs more often
  • Acting anxious or agitated
  • Withdrawing from family and friends
  • Changing eating and/or sleeping habits
  • Showing rage or talking about seeking revenge
  • Taking great risks that could lead to death, such as driving extremely fast
  • Talking or thinking about death often
  • Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
  • Giving away important possessions
  • Saying goodbye to friends and family
  • Putting affairs in order, making a will

If these warning signs apply to you or someone you know, get help as soon as possible, particularly if the behavior is new or has increased recently.

Here are five steps you can take to #BeThe1To help someone in emotional pain:

  1. ASK: “Are you thinking about killing yourself?” It’s not an easy question, but studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts.
  2. KEEP THEM SAFE: Reducing a suicidal person’s access to highly lethal items or places is an important part of suicide prevention. While this is not always easy, asking if the at-risk person has a plan and removing or disabling the lethal means can make a difference.
  3. BE THERE: Listen carefully and learn what the individual is thinking and feeling. Research suggests acknowledging and talking about suicide may reduce rather than increase suicidal thoughts.
  4. HELP THEM CONNECT: Save the National Suicide Prevention Lifeline’s (1-800-273-TALK (8255)) and the Crisis Text Line’s number (741741) in your phone, so it’s there when you need it. You can also help make a connection with a trusted individual like a family member, friend, spiritual advisor, or mental health professional.
  5. STAY CONNECTED: Staying in touch after a crisis or after being discharged from care can make a difference. Studies have shown the number of suicide deaths goes down when someone follows up with the at-risk person.

Risk Factors

Suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk. Suicidal behavior is complex, and there is no single cause. Many different factors contribute to someone making a suicide attempt. But people most at risk tend to share specific characteristics. The main risk factors for suicide are:

  • Depression, other mental disorders, or substance abuse disorder
  • Certain medical conditions
  • Chronic pain
  • A prior suicide attempt
  • Family history of a mental disorder or substance abuse
  • Family history of suicide
  • Family violence, including physical or sexual abuse
  • Having guns or other firearms in the home
  • Having recently been released from prison or jail
  • Being exposed to others' suicidal behavior, such as that of family members, peers, or celebrities

Many people have some of these risk factors but do not attempt suicide. It is important to note that suicide is not a normal response to stress. Suicidal thoughts or actions are a sign of extreme distress, not a harmless bid for attention, and should not be ignored.

Often, family and friends are the first to recognize the warning signs of suicide and can be the first step toward helping an at-risk individual find treatment with someone who specializes in diagnosing and treating mental health conditions.

Suicide is complex. Treatments and therapies for people with suicidal thoughts or actions will vary with age, gender, physical and mental well-being, and with individual experiences.

Treatments and Therapies

Brief Interventions


Multiple types of psychosocial interventions have been found to help individuals who have attempted suicide (see below). These types of interventions may prevent someone from making another attempt.


Some individuals at risk for suicide might benefit from medication. Doctors and patients can work together to find the best medication or medication combination, as well as the right dose. Because many individuals at risk for suicide often have a mental illness and substance use problems, individuals might benefit from medication along with psychosocial intervention.

Clozapine is an antipsychotic medication used primarily to treat individuals with schizophrenia. To date, it is the only medication with a specific U.S. Food and Drug Administration (FDA) indication for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder.

If you are prescribed a medication, be sure you:

  • Talk with your doctor or a pharmacist to make sure you understand the risks and benefits of the medications you're taking.
  • Do not stop taking a medication without talking to your doctor first. Suddenly stopping a medication may lead to "rebound" or worsening of symptoms. Other uncomfortable or potentially dangerous withdrawal effects also are possible.
  • Report any concerns about side effects to your doctor right away. You may need a change in the dose or a different medication.
  • Report serious side effects to the FDA MedWatch Adverse Event Reporting program online or by phone at 1-800-332-1088. You or your doctor may send a report.

Collaborative Care

Collaborative Care has been shown to be an effective way to treat depression and reduce suicidal thoughts. A team-based Collaborative Care program adds two new types of services to usual primary care: behavioral health care management and consultations with a mental health specialist.

The behavioral health care manager becomes part of the patient’s treatment team and helps the primary care provider evaluate the patient’s mental health. If the patient receives a diagnosis of a mental health disorder and wants treatment, the care manager, primary care provider, and patient work together to develop a treatment plan. This plan may include medication, psychotherapy, or other appropriate options.

Later, the care manager reaches out to see if the patient likes the plan, is following the plan, and if the plan is working or if changes are needed to improve management of the patient’s disorders. The care manager and the primary care provider also regularly review the patient’s status and care plan with a mental health specialist, like a psychiatrist or psychiatric nurse, to be sure the patient is getting the best treatment options and improving.

Learn More

Free eBooks and Brochures

Health Hotlines

  • National Suicide Prevention Lifeline: The Lifeline provides 24-hour, toll-free, and confidential support to anyone in suicidal crisis or emotional distress. Call 1-800-273-TALK (8255) to connect with a skilled, trained counselor at a crisis center in your area. Support is available in English and Spanish and via live chat.
  • Crisis Text Line: Text HELLO to 741741 for free and confidential support 24 hours a day throughout the U.S.
  • TrevorText can be reached by texting TREVOR to 1-202-304-1200 (available M-F from 3PM to 10PM ET).

Last Revised: July 2020




Parenting - Tips

Communication Approach: Haim Ginott

  • Never deny or ignore a child’s feelings
  • Only behavior is treated as unacceptable, not the child
  • Depersonalize negative interactions by mentioning only the problem. “ I see a messy room.”
  • Attach rules to things, e.g., “Little sisters are not for hitting.”
  • Dependence breeds hostility. Let children do for themselves what they are able to do
  • Children need to learn to choose, but within the safety of limits. “Would you like to wear this blue shirt or this red one?”
  • Limit criticism to a specific event - don’t say “never”, “always”, as in: “you never listen”, or “you always manage to spill things”.
  • Refrain from using words that you would not want the child to repeat.


Quotes from Between Parent and Teenager: Haim Ginott

  • “Rebellion follows rejection”
  • “Truth for its own sake can be a deadly weapon in family relations. Truth without compassion can destroy love. Some parents try too hard to prove exactly how, where and why they have been right. This approach will bring bitterness and disappointment. When attitudes are hostil, facts are unconvincing.”
  • “I have come to the frightening conclusion that:
    • “I am the decisive element in the classroom. It is my personal approach that creates the climate. It is my daily mood that makes the weather. As a teacher I possess tremendous power to make a child’s life miserable or joyous. I can be a tool of torture or an instrument of inspiration. I can humiliate or humor, hurt or heal. In all situations, it is my response that decides whether a crisis will be escalated or de-escalated, and a child humanized or de-humanized.”
  • “If you want your children to improve, let them overhear the nice things you say about them to others.”



Eighteen Ways to Avoid Power Struggles:

Jane Nelson


Power struggles create distance and hostility instead of closeness and trust. Distance and hostility create resentment, resistance, rebellion (or compliance with lowered self-esteem). Closeness and trust create a safe learning environment. You have a positive influence only in an atmosphere of closeness and trust where there is no fear of blame, shame or pain.


It Takes Two to Create a Power Struggle:

I have never seen a power drunk child without a power drunk adult really close by. Adults need to remove themselves from the power struggle without either winning or giving in. Create a win-win environment. How? The following suggestions teach children important life skills including self-discipline, responsibility, cooperation and problem-solving skills instead of compliance or rebellion.

  1. Decide what you will do. I will read a story after your teeth are brushed. I will cook only in a clean kitchen. I will drive only when seat belts are buckled. I will pull over to the side of the road when children are fighting.
  2. Follow through. The key to this one and all of the following is kindness and firmness at the same time. Pull over to the side of the road without saying a word. Children learn more from kind and firm actions than from words. 
  3. Positive discussion time. Create a nurturing not punitive discussion area with your child.
  4. Distraction for young children and lots of supervision. Punishment decreases brain development. Children are often punished for doing what they are developmentally programmed to do… Explore.  
  5. Get children involved in the creation routines around mornings, chores and bedtimes. Then the routine chart becomes the boss. 
  6. Ask what and how questions: How will we eat if you don’t set the table? What is next on our routine chart? What was our agreement about what happens to toys that are picked up? What happened? How do you feel about what happened? What ideas do you have to solve the problem? (This does not work at the time of conflict nor does it work unless you are truly curious about what your child has to say).
  7. Put the problem on the family meeting agenda and let the kids brainstorm for a solution. 
  8. Use 10 words or less. One is best; toys. Towels. (That may have been left on the floor.) Homework. Sometimes these words need to be repeated.
  9. Get children involved in cooperation. Say, “I can’t make you, but I really need your help.“
  10. No words: use pantomime, charades, or notes. Tried to hug to create closeness and trust... then do something else.
  11. Nonverbal signals. These should be planned in advance with the child. An empty plate turned out for it at the dinner table as a reminder of chores that need to be completed before dinner; a sheet over the television as a reminder the homework needs to be done first or that things need to be picked up in common areas of the house.
  12. Use reflective listening. Stop talking and listen. Try to understand not only what your child is saying, but what she means.
  13. Limited choices: Do you want to do your homework before dinner or after dinner? Do you want to set the table or clean up after dinner?
  14. Make a wheel of choice together. Draw a big circle and divide it into wedges. Brainstorm lots of solutions to problems. Draw illustrations for each solution. During a conflict, invite the child to pick something from the wheel. 
  15. Create a game: Beat the clock or sing songs while getting chores done.
  16. Do it with them. You may even want to go to their cool down area with them.
  17. Use your sense of humor: Here comes the tickle monster to get little children who don’t pick up their toys. This creates closeness in trust and can be followed by one of the above.
  18. Hugs! Hugs! Hugs! A hug is often enough to change behavior...both theirs and yours.


Use Positive Discipline That Doesn’t Include Punishment.


Parents try to envision your future relationship with your child as a teenager. What qualities do you want the relationship to have? Parents almost always answer with the qualities of: open communication, shared feelings, thoughts, and values, fun times together, mutual respect, and being approachable when their child has problems. How you build your parenting relationship will affect your future bonds. As well, your discipline style is a key ingredient in the child parent relationship. Every child needs discipline, and the discipline style can provide connection or disconnection in the relationship.


The goals of discipline are:

  1. To teach the child lifelong skills for good character, such as responsibility and self-control
  2. To protect the child
  3. To instill values


Effective discipline is:

Effective discipline never includes punishment. Common examples of punishment are grounding, giving unrelated consequences, timed timeouts, spanking, and threats of any kind. Effective discipline uses real world cause-and-effect learning experiences. Effective discipline teaches and guides children how to think for themselves - it doesn’t just force them to obey. The world is a different place than 30 years ago. We don’t want our children to just blindly obey anyone… Especially adults that may not have their best interest in mind. We want them to think for themselves and make good decisions.


Effective discipline as proactive. Parents find underlying causes of misbehavior as well as teach future desired behavior. Discipline connects the parent and the child in their relationship. Punishment tends to be reactive and aims to just stop behaviors. Punishment disconnects them.


Effective parenting is mutually respectful: “Do unto others as you would have done to you.” Although parents have far more experience and knowledge than their children, both parents and children have the same right of having their feelings and dignity equally respected.


Effective discipline is 90% prevention and 10% correction.


Effective discipline is kind, firm and safe.


Effective discipline is fair and consistent as possible.


Power struggles are off on the result of the use of punishment. Children will often react to punishment in the forms of rebellion, retaliation, fear, resentment and/or passive resistance.


Power struggles are generally about meeting needs: the needs of the parent and the needs of the child. Both aim to get their way, but at the expense of the other person not getting their way.


When parents and children are locked in a power struggle, it is important for the parent to stay calm and let go for the moment. They have more experience in self control and can switch gears easier. Refused to participate. The time to re-examine the needs of the parents and the child causing the power struggle is later, when the emotional temperature in the relationship has gone down. Be sure to address it though. Don’t let it go unresolved forever.


Children don’t really misbehave. They act in inappropriate ways to get their needs met. The job of parents to meet those needs and teach children how to get them met in more socially appropriate ways. Children are like icebergs. We see the tip of the iceberg… Behavior… protruding out of the water. Most of the time, we don’t even look at the massive ice part under the water…which are their feelings and needs…that support the behavior. As parents, we need to jump out of the boat to look at what’s happening with the child underneath the iceberg tip. Once the underlying feelings and needs of the child are recognized and addressed the behavior often improves.


The most common discipline tools used for younger children to preschool age are redirection, substitution, supervision, offering choices, changing the environment, learning child development, ensuring enough nourishment, sleep, stimulation and attention. Most discipline at this age is prevention.


The most effective discipline tools used for older, school-age children and teens are active listening. “I“ messages, time together, changing the environment, modeling, relevant consequences and problem-solving skills. Family meetings are also especially effective.


A crucial and often overlooked discipline tool is meeting our own needs as parents. Parents who are hungry, tired, stressed and need support don’t often make the best parenting decisions.


You can’t raise a child in a dictatorship and expect them to function as an adult in a democracy.


Many parents don’t use punishment in raising caring and responsible children. It takes practice and plenty of patience…something every parent can learn. Your child will appreciate it.






Love & Logic Ideas


Dealing with Power Struggles:

Power is a major issue between children and adults. While still very young, some kids realize they don’t have much control over anything. A toddler unconsciously thinks “I’m the smallest. They tell me what to do, and I don’t get to make decisions. I need to find a way to get some control.“ Then, winning the power struggle becomes all important… More important than making good decisions. When we offer kids a choice instead of making a demand, no power struggle typically ever begins. When we make a demand we own the wise choice, leaving the child with only one way to win the power struggle… by making a foolish choice. Given a range of choices, a child has endless opportunities to choose wisely.


How to Destroy the Teaching value of a Logical Consequence:

  • Just say, “this will teach you a good lesson“
  • Display anger or disgust
  • Explain the value of the consequence
  • Moralize with or threaten them
  • Talk too much
  • Feel sorry and give in


Rules for Giving Choices;

  • Always be sure to select choices that you like. Never provide one you like, because the child seems to have a 6th sense in selecting the one you don’t like. 
  • Never give a choice unless you’re willing to allow the child to experience the consequence of that choice.
  • Never give choices when the child is in danger.

Your Delivery is Important… Try to start your sentence with:

  • You are welcome to _____ or _____.
  • Feel free to _____ or  _____.
  • Would you rather  _____ or  _____?
  • What would be best for you  _____ or  _____?


Give Consequences with Empathy:


Children learn from their mistakes, when they experience the consequences of their mistakes.

Bad choices have natural consequences...if Craig fails to wear a coat, he gets cold. If Heather misses the school bus she stays home with an unexcused absence for the day. 


Adults are tempted to scold and reprimand but may be surprised to learn that children actually learn best from consequences when adults empathize, “I’m sorry you were cold Craig” or “what a bummer that you missed an after school party on the day you were absent Heather.”


If a child is reprimanded, then the child may transform sorrow over their choice into anger with the adult shifting the focus and resulting in the lesson being lost. 


If adults expressed sorrow, children have a significant learning opportunity. Craig may think: “tomorrow I’ll wear my coat” and Heather may decide to get up 15 minutes earlier tomorrow.


Consequences discussed and given with empathy facilitate learning.


Mistakes are a critical part of a child’s development. It’s difficult but please view them as a gift to teach about life skills, love and relationships.


© Jim Fay & Charles Fay, Ph.D., Love and Logic Institute, Inc.







Adults set firm limits in loving ways without anger, lecture, threats, or repeated warnings.

  • Adults set limits using enforceable statements.
  • Adults regard mistakes as learning opportunities. 
  • Adults resist the temptation to “nag.”


When children misbehave and cause problems, adults hand these problems back in loving ways.

  • Adults provide strong doses of empathy before describing consequences.
  • Adults use very few words and consistently loving actions.
  • Adults delay consequences, when necessary, so that they can respond with wisdom and compassion.
  • Children are given the gift of owning and solving their problems.
© Jim Fay & Charles Fay, Ph.D., Love and Logic Institute, Inc. 
The Most Important Love and Logic Skills
Some Benefits of Delivering Consequences with Empathy:
  • The child’s brain stays in “thinking mode” instead of “fighting mode.”
  • The adult’s blood pressure stays lower.
  • The child must “own” his or her pain rather than blaming it on the adult.
  • The adult sees more cooperation...and less revenge.
  • The child can learn and achieve instead of resist and resent. 

Some Examples:

    • This must really hurt... 
    • This is so sad...
    • What a bummer...

Keep Your Empathy Simple and Repetitive

Most adults find it difficult to deliver empathy when a child has misbehaved. Rather than getting complicated, it’s easier to pick just one empathic response you can use each time you do discipline. When kids hear these same statements repeated, they learn two things:

  • This adult cares about me.
  • This adult is not going to back down. No use in arguing!

Try to Find a Response You Already Know and Feel Good About:

It’s always easier to use an empathic statement that you have already heard or used. The key is that it fits who you are and shows that you sincerely care about the child.

The Power of Nonverbal Communication

Studies estimate that from 70 to 90% of what we communicate, is done without words through subtle, nonverbal gestures. Research also reveals that students are experts at decoding these nonverbal cues.

When delivering empathic responses, the delivery is as important as your actual words! 



© Jim Fay & Charles Fay, Ph.D., Love and Logic Institute, Inc.




How to damage your authority and relationship with a child

The quickest way to do this is by telling a potentially resistant youngster what to do. For example:

Adult: "Get to work."

Child: "You can’t make me."

It took just one defiant child...and just a couple seconds...for this adult to lose all of their power. 

That’s why we teach:

Never tell a tough kid what to do. Describe what you will do or allow instead.

Examples of Enforceable Statements

  • Breakfast is served until seven. I’m usually happier when I eat enough to hold me until lunch.
  • I like you too much to fight with you about doing your work.
  • I’ll listen when your voice is calm.
  • I grade papers handed in on time.
  • Feel free to drive the car when you’ve made a deposit into my bank account equal to the insurance deductible.
  • I allow students to remain with the group when they aren’t causing a problem for anybody.
  • I’ll be happy to do the extra things I do for you when I feel respected and your chores are done.
  • Feel free to join us for the experiment when you’ve finished your science reading.
  • I argue at 12:00 p.m. and 3:15 p.m. daily.

© Jim Fay & Charles Fay, Ph.D., Love and Logic Institute, Inc.






A Relationship-Building Experiment

Research clearly shows that the primary element contributing to success with challenging kids is a positive relationship between the child and adults in his or her life. This research also indicates that this relationship is developed most effectively when the adults set firm limits while showing sincere interest in what is unique or special about the child. That is, this relationship blossoms when adults notice and accept the youngster as a unique human being—and adults maintain high expectations for the youth’s behavior.

  1. What are the child’s nonacademic strengths and interests? What is special about this child?
  2. List six brief statements you can use to notice these strengths and interests.
        • Example:  “I’ve noticed you really like to draw.”
        • “I’ve noticed that _____________________________________________.” 
        • “I’ve noticed that _____________________________________________.” 
        • **Do not end the statement with something like, “...and that’s great!”
  1. When and where can you make these statements without embarrassing the child?
  2. Which other adults (or other children) will help you use this technique with the child?
  3. Approach the child, smile, and use the statements identified above at least two times a week for at least three weeks.
  4. Listen to the child if he/she wants to talk about the strength or interest.
  5. Do not use this technique when the child is upset. Save it for calm times.
  6. When the child is about to do something you don’t want...or if you want him or her to do something else, experiment with saying, “Will you do this just for me?”

© Jim Fay & Charles Fay, Ph.D., Love and Logic Institute, Inc. 



Creating Self-Motivated Learners

Goal 1: End the control battle.

Have you ever known a child who refused to do anything...for an entire year...just to show his or her parents who was really in control?

Goal 2: When the child does poorly, provide strong doses of empathy and unconditional love or respect

Kids who believe they are valued only for their grades quickly learn to “punish” their parents and teachers by getting bad ones.

Goal 3: Follow some basic guidelines for helping without getting over involved.

Have you ever known a parent who did more homework than their child? Do teachers ever fall into this trap?

Goal 4: Show them that success comes from determination and perspiration.

It’s the strains not the brains.

What we model is far more important than what we preach.

Goal 5: Through contributions (chores) give the gifts of responsibility and self- respect.

Recipe for a hostile, dependent or apathetic child: Give them all they want. Never expect them to lift a finger. Show them that they are needed for nothing.

For more tips on achieving these goals, view the DVD Hope for Underachieving Kids by Jim Fay and Charles Fay, Ph.D.

© Jim Fay & Charles Fay, Ph.D., Love and Logic Institute, Inc.



Achievers Believe:

  • It’s ok if things get difficult.
  • I’m responsible for my own happiness.
  • Hard work is the key to success.
  • Hard work and learning lead to pride.
  • I’ve got what it takes to learn and solve most of the problems I face.
  • I have control over my own life.
  • “What a challenge! If I work hard, I can do it!”

Underachievers believe:

  • Life shouldn’t be hard.
  • Other people are supposed to make me happy.
  • I’m entitled to success and all of its perks.
  • Hard work and learning create misery.
  • I can’t learn and solve problems on my own.
  • What happens to me is completely beyond my control.
  • “Not fair! This is too hard!”

Three steps for creating healthy achievement beliefs:

Step 1: Write the following reasons for success on the bulletin board, refrigerator, note card, etc.

I worked hard. I kept trying. I’ve been practicing.

Step 2: Catch the child doing something well, and describe it in specific terms.

You got that problem correct. You’ve sat still for ten minutes. DO NOT SAY, “That’s great!” Praise will backfire with underachievers.

Step 3. Ask the child to provide a reason for their success.

If necessary, point at the reasons from step one, and ask, “Which one?” NOTE: It is essential that the child give the reason instead of hearing you tell them why they were successful. What  they say, they will soon come to believe.


© Jim Fay & Charles Fay, Ph.D., Love and Logic Institute, Inc.





The Foundation
The Love & Logic Process

  • Shared Control Gain control by giving away the control you don’t need (and often the control you didn’t have to begin with).

  • Shared Thinking/Decision-Making Provide opportunities for the child to do the greatest amount of thinking/decision making.

  • Equal Shares of Consequences with Empathy An absence of anger causes a child to think and learn from his/her mistakes.

  • Maintain the Child’s Self-Concept Increased self-concept leads to improved behavior and improved achievement.

The 3 Styles of Parenting

The Helicopter Parent This kind of parent hovers, rescues, and protects their child.

They send messages like:

    • “You’re fragile and can’t make it without me.”

    • “You need me to run interference.”

    • “You need me to protect you.”

    • “You can’t make it in life without me.”

The Drill Sergeant Parent This kind of parent demands that their children do it now, their way, OR ELSE!!

They send messages like:

    • “You can’t think.”

    • “I have to do your thinking for you, boss you around, and tell you what to do.”

    • “You aren’t capable of making it in life.”

The Consultant Parent This kind of parent is always around to give advice and let the child make the decision, with the idea that they will let the child make as many mistakes as possible when the price tag is affordable.
They send messages like:

 “You’d better do your own thinking because the quality of your life has a lot to do with your decisions”.


The 4 Steps to Responsibility

  • Give the child a task they can handle.

  • Hope they blow it.

  • Let equal parts of empathy and consequences do the teaching.

  • Give the same task again.


The 5 Steps to Guiding Children to Own and Solve Their Problems

  • Empathy – “How sad.” “I bet that hurts.”

  • Send the Power Message – “What do you think you’re going to do?”

  • Offer Choices – “Would you like to hear what other kids have tried?”

At this point, offer a variety of choices that range from bad to good. It’s usually best to start out with the poor choices. Each time a choice is offered, go on to step four, forcing the child to state the consequences in his/her own words. This means you will be going back and forth between steps 3 and 4.

  • Have the child state the consequence – “And how will that work?”

  • Give permission for the child to either solve the problem or not solve the problem – “Good

    luck. I hope it works out.”

  • Don’t worry. If the child is fortunate enough to make a poor choice, he/she may have a double learning opportunity.


Consequences Vs. Punishment

  • Consequences expressed with empathy will place a child in the thinking/decision-making mode and the problem will become the bad guy, not the parent.

  • Punishment usually elicits an emotional response, a desire on the part of the child to become sneaky rather than more responsible, and the parent becomes the bad guy, not the problem.

    Tips and Tricks of the Trade Enforceable Statements

  • Always say what you are going to do, not what you think the child should do

  • Only speak from your perspective because you are the only one you can control.

  • Make sure you can actually enforce the statement you are making.


Delay the Consequences

  • Delaying the consequences gives you time to think of a good one and allows you the chance to get ideas from other people and get the support you will need to carry out your plan.

  • When a problem arises and you need to delay the consequences, simply say: “Oh no. This is sad. I’m going to have to do something about this. But not now, later. Try not to worry about it.”

  • Let the child think they’ve gotten away with it, and then make a plan with help from others and carry out the plan if the child refuses to solve the problem on their own.


Give Choices

  • Give as many choices as you can while the price tag is small so you can gain control when the stakes are higher.

  • When giving choices, begin with phrases like:

    • “What would be best for you...”

    • “Would you rather...”

    • “Feel free to...”

    • “You can either...”

  • Only give choices you can be incredibly happy about. Kids need to believe (whether it’s true or

    not) that your life will go on and you’ll be happy no matter which choice they make.

  • Never give a choice only after they have argued with your original decision. This shows the child that they can manipulate you.

Love & Logic One-Liners
  • Use one-liners when an explanation is either not necessary or it will only cause an argument.

  • Don’t be afraid to be a broken record.

  • Try these one-liners. Pick one or two that work for you and try them out.

    • “Nice try.”

    • “Probably so.”

    • “I love you too much to argue.”

    • “Could be.”

    •  “It probably seems that way to you.”

    •  “Aren’t you glad I don’t believe that?”

    • “Hope you get over that feeling. Love you lots.”


Misc. Tips

  • The question we want our children to ask themselves is “How is the next decision I make going to affect me?”.

  • “Kids who have parents who make all decisions for them don’t learn how to make their own decisions. Then, when they need to make a decision, they make it not based on what is right but on who is going to find out, how that person will react, and how they can hide it from that person.” 

  • Parents have a choice in how to deal with any situation. They can rant and rave, give in and take

    away the child’s problem, or they can allow the consequences to sink in, which will in turn create

    a life-long lesson.

  • Kids need to feel they have an investment in something in order to take it seriously.

  • Kids need to understand that trust is about making and keeping agreements. The more

    agreements that are kept, the more trust is built. The more agreements that are not kept, the more trust is broken down and the child realizes just how many times a day a parent can either trust or not trust them.

  • Remember to pick your battles wisely. Not many things are worth fighting over. If you choose to fight, you better win.

  • Never argue with your kids. You won’t win.

  • Don’t nag or remind. Tell them once. They are smart enough to remember if it’s important to


  • Talk about things your child likes to do and explain exactly what you need to see from him/her

    in order to gain access to those things (this happens when a misbehavior has occurred).

  • Allow a child to have the power to gain access to the things that are important to him/her. They

    will choose the most important things to them. Don’t choose for them.

  • Preserve the relationship at all cost. Make the problem the behavior not the child.

  • When you need to talk to a child about their behavior, do it in calm waters when everything is

    going fine. You can ask them to come up with solutions of what should happen when misbehavior occurs. Have a back-up plan in case they don’t follow through with their end of the bargain when a problem arises.

  • When using the 5steps, enforceable statements, delayed consequences, and one-liners, do your part and walk away. Don’t hang around for what could turn into an argument. Go back to what you were doing to show that your life goes on and you’re not worried about it.

  • Smile!! You choose whether you are happy or sad. Consequences said with a smile are much easier to swallow.




    © Jim Fay & Charles Fay, Ph.D., Love and Logic Institute, Inc.




What is a Healthy Relationship?

A healthy relationship is when two people develop a connection based on: Mutual respect. Trust. Honesty. Healthy boundaries and communication.


Healthy Communication

Honest, open and safe communication is a fundamental part of a healthy relationship. A good first step to building a relationship is understanding each other’s needs and expectations—being on the same page is very important. That means you have to talk to each other! The following tips can help you and your partner create and maintain a healthy relationship:

  • Speak Up. In a healthy relationship, if something is bothering you, it’s best to talk about it instead of holding it in.
  • Respect Each Other. Your partner’s wishes and feelings have value, and so do yours. Let your significant other know you are making an effort to keep their ideas in mind. Mutual respect is essential in maintaining healthy relationships. Respect is acceptance. 
  • Compromise. Disagreements are a natural part of healthy relationships, but it’s important that you find a way to be flexible if you disagree on something. Try to solve conflicts in a fair and rational way. Try to avoid compromise your core values and character. 
  • Be Supportive. Offer assurance and encouragement to each other. Also, let your partner know when you need their support. Be thoughtful and caring not conditional in your give and take. Healthy relationships are about building each other up, not putting each other down.
  • Respect Each Other’s Privacy. Just because you’re in a relationship doesn’t mean you have to share everything and constantly be together. Healthy relationships allow space.


Healthy Boundaries

Establishing clear boundaries is a good way to keep your relationship healthy and secure. By setting boundaries together, you can both have a deeper understanding of the type of relationship that you and your partner want. Boundaries are not meant to make you feel trapped or like you’re “walking on eggshells.” Creating clear boundaries is not a sign of secrecy or distrust — it’s an expression of what makes you feel comfortable and what you would like or not like to happen within the relationship.


Remember, healthy boundaries shouldn’t restrict your ability to:

  • Go out with your friends without your partner.
  • Participate in activities and hobbies you like.
  • Not have to share passwords to your email, social media accounts or phone.
  • Respect each other’s individual likes and needs.


Healthy Relationship Supports

Even healthy relationships can use a boost now and then. You may need a growth spurt if you feel disconnected from your partner or like the relationship has gotten stale. If so, find a fun, simple activity you both enjoy, like going on a walk, and talk about the reasons why you want to be in the relationship. Then, keep using healthy behaviors as you continue dating.

If you’re single, don’t worry if you need a boost too! Being single can be the best and worst feeling, but remember relationships don’t just include your significant other and you. Think about all the great times you’ve had with your parents, siblings, friends, children, other family members, etc..


Try going out with the people you love and care about the most — watch movies together, go out to eat, take a day off from your busy life and just enjoy being you! If it helps, also talk about your feelings about the relationships in your life. If you just want them to listen, start by telling them that. Then ask what makes relationships good and what makes them bad? And don’t forget, you can always improve the relationship you have with yourself!


What Isn’t a Healthy Relationship?

Relationships that are based on power and control, not equality and respect are not healthy. In the early stages of an abusive relationship, you may not think the unhealthy behaviors are a big deal. However, possessiveness, insults, jealous accusations, yelling, humiliation, pulling hair, pushing or other abusive behaviors, are — at their root — expressions of power and control. Remember that abuse is always a choice and you deserve to be respected. There is no excuse for abuse of any kind.


If you think your relationship is unhealthy, it’s important to think about your safety now.  Listen and trust your intuition. We tend to override our own good sense of what is healthy and safe. 


Consider these points as you move forward:

  • Understand that a person can only change if they want to. You can’t force your partner to alter their behavior if they don’t believe they’re wrong.
  • Focus on your own needs. Are you taking care of yourself? Your wellness is always important. Watch your stress levels, take time to be with friends, get enough sleep. If you find that your relationship is draining you, consider ending it.
  • Keep and connect with your support systems. Often, abusers try to isolate their partners. Talk to your friends, family members, teachers and others to make sure you’re getting the emotional support you need. 
  • Think about breaking up. Remember that you deserve to feel safe and accepted in your relationship.
  • Even though you cannot change your partner, you can make changes in your own life to stay safe. Consider leaving your partner before the abuse gets worse. 
  • Whether you decide to leave or stay, make sure to use your safety planning tips.
  • Remember, you have many options — including obtaining a domestic violence restraining order. 
  • Laws vary from state to state, speak with a trusted authority figure to learn more.


Characteristics of Healthy & Unhealthy Relationships

Respect for both oneself and others is a key characteristic of healthy relationships. In contrast, in unhealthy relationships, one partner tries to exert control and power over the other physically, sexually, and/or emotionally.


Healthy Relationships

Healthy relationships share certain characteristics that teens should be taught to expect. They include:

  • Mutual respect. Respect means that each person values who the other is and understands the other person’s boundaries.
  • Trust. Partners should place trust in each other and give each other the benefit of the doubt.
  • Honesty. Honesty builds trust and strengthens the relationship.
  • Compromise. In a dating relationship, each partner does not always get his or her way. Each should acknowledge different points of view and be willing to give and take.
  • Individuality. Neither partner should have to compromise who he/she is, and his/her identity should not be based on a partner’s. Each should continue seeing his or her friends and doing the things he/she loves. Each should be supportive of his/her partner wanting to pursue new hobbies or make new friends.
  • Good communication. Each partner should speak honestly and openly to avoid miscommunication. If one person needs to sort out his or her feelings first, the other partner should respect those wishes and wait until he or she is ready to talk.
  • Anger control. We all get angry, but how we express it can affect our relationships with others. Anger can be handled in healthy ways such as taking a deep breath, counting to ten, or talking it out.
  • Fighting fair. Everyone argues at some point, but those who are fair, stick to the subject, and avoid insults are more likely to come up with a possible solution. Partners should take a short break away from each other if the discussion gets too heated.
  • Problem solving. Dating partners can learn to solve problems and identify new solutions by breaking a problem into small parts or by talking through the situation.
  • Understanding. Each partner should take time to understand what the other might be feeling.
  • Self-confidence. When dating partners have confidence in themselves, it can help their relationships with others. It shows that they are calm and comfortable enough to allow others to express their opinions without forcing their own opinions on them.
  • Being a role model. By embodying what respect means, partners can inspire each other, friends, and family to also behave in a respectful way.
  • Healthy sexual relationship. Dating partners engage in a sexual relationship that both are comfortable with, and neither partner feels pressured or forced to engage in sexual activity that is outside his or her comfort zone or without consent.


Unhealthy Relationships

Unhealthy relationships are marked by characteristics such as disrespect and control. It is important for youth to be able to recognize signs of unhealthy relationships before they escalate. 


Some Characteristics of Unhealthy Relationships Include:

  • Control. One dating partner makes all the decisions and tells the other what to do, what to wear, or who to spend time with. He or she is unreasonably jealous, and/or tries to isolate the other partner from his or her friends and family.
  • Hostility. One dating partner picks a fight with or antagonizes the other dating partner. This may lead to one dating partner changing his or her behavior in order to avoid upsetting the other.
  • Dishonesty. One dating partner lies to or keeps information from the other. One dating partner steals from the other.
  • Disrespect. One dating partner makes fun of the opinions and interests of the other partner or destroys something that belongs to the partner.
  • Dependence. One dating partner feels that he or she “cannot live without” the other. He or she may threaten to do something drastic if the relationship ends.
  • Intimidation. One dating partner tries to control aspects of the other's life by making the other partner fearful or timid. One dating partner may attempt to keep his or her partner from friends and family or threaten violence or a break-up.
  • Physical violence. One partner uses force to get his or her way (such as hitting, slapping, grabbing, or shoving).
  • Sexual violence. One dating partner pressures or forces the other into sexual activity against his or her will or without consent.


It is important to educate youth about the value of respect and the characteristics of healthy and unhealthy relationships before they start to date. Youth may not be equipped with the necessary skills to develop and maintain healthy relationships, and may not know how to end a relationship in an appropriate way when necessary. Maintaining open lines of communication may help them form healthy relationships and recognize the signs of unhealthy relationships, thus preventing the violence before it starts.


Categories of Verbal Abuse

  1. Withholding - refuses to listen, refuses to share oneself or participate in the relationship
  2. Countering - switching the topic of discussion away from their part; argue against another’s thoughts, perceptions, experiences
  3. Discounting - minimizing and distorting the partner’s perception of the abuse.
  4. Verbal abuse disguised as jokes - is not done in jest; the truth thinly disguised as a joke, meant to hurt
  5. Blocking and diverting - abuser refuses to communicate, establishes what can be discussed, withholds information by switching the topic, direct demand, accusations or irrelevant comments
  6. Accusing and blaming - accuses partner of some wrongdoing or breaching the basic agreement of the relationship
  7. Judging and criticizing - judges partner, expresses judgment in a critical way, expresses a lack of acceptance of partner, uses judgmental tone and word choice (“you always…, you never…”)
  8. Trivializing - what you have done or expressed is insignificant
  9. Undermining - withholds emotional support, direct squelches, sabotages - disruption and interruption
  10. Threatening - manipulates the partner by bringing up their deepest fears, usually involve the threat of loss or pain
  11. Name calling - all name calling is verbally abusive
  12. Forgetting - involves both denial and covert manipulation
  13. Ordering - denies the equality and autonomy of the partner
  14. Denial - one of the most insidious categories, denies reality of partner
  15. Abusive anger - abuser desires release of tension and power over partner

From “The Verbally Abusive Relationship,” by Patricia Evans




Emotional Intelligence (EQ)


What Is Emotional Intelligence?


Emotional intelligence (EQ), refers to the ability to identify and manage one’s own emotions, as well as the emotions of others.


Emotional intelligence is generally said to include at least three skills: 1. emotional awareness, or the ability to identify and name one’s own emotions; 2. the ability to manage those emotions and apply them to tasks like thinking and problem solving; and 3. the ability to manage emotions, which includes both regulating one’s own emotions when necessary and helping others to do the same.


There is no validated test or scale for quantifying emotional intelligence as there is for the general IQ factor—and many argue that emotional intelligence is therefore not an actual construct, but a way of describing interpersonal skills that go by other names.


Despite this criticism, the concept of emotional intelligence—sometimes referred to as emotional quotient or EQ—has gained wide acceptance. Some employers have even incorporated emotional intelligence tests into their application and interview processes, on the theory that someone high in emotional intelligence would make a better employee or leader.


What Does It Mean to Be Emotionally Intelligent?


An emotionally intelligent individual is both highly conscious of his or her own emotional states with the ability to identify and manage them. These people are tuned in to the emotions that others experience. It’s understandable that a sensitivity to emotional signals both from within oneself and from one's social environment could make one a better friend, parent, partner or leader. Interestingly, these skills can be learned and improved.


According to Daniel Goleman there are five key elements to emotional intelligence:

  • Self-awareness.
  • Self-regulation.
  • Motivation.
  • Empathy.
  • Social skills.


Emotional intelligence (EQ) is the ability to understand, use, and manage your own emotions in positive ways to relieve stress, communicate effectively, empathize with others, overcome challenges and defuse conflict. It involves social awareness and empathy. 


It helps to break it down into four main categories when trying to understand it. The four main sets of skills are self-awareness, self-management, social awareness, and relationship management.


Benefits of Emotional Intelligence (EQ):

According to the Journal of Annual Psychology, higher emotional intelligence is positively correlated with:

  1. Better social relations for children – Among children and teens, emotional intelligence positively correlates with good social interactions, relationships and negatively correlates with deviance from social norms, anti-social behavior measured both in and out of school as reported by children themselves, their own family members as well as their teachers.
  2. Better social relations for adults – High emotional intelligence among adults is correlated with better self-perception of social ability and more successful interpersonal relationships while less interpersonal aggression and problems.
  3. Highly emotionally intelligent individuals are perceived more positively by others – Other individuals perceive those with high emotional intelligence to be more pleasant, socially skilled and empathic to be around.
  4. Better family and intimate relationships – High emotional intelligence is correlated with better relationships with the family and intimate partners on many aspects.
  5. Better academic achievement – Emotional intelligence is correlated with greater achievement in academics as reported by teachers but generally not higher grades once the factor of IQ is taken into account.
  6. Better social relations during work performance and in negotiations – Higher emotional intelligence is correlated with better social dynamics at work as well as better negotiating ability.
  7. Better psychological well-being - Emotional intelligence is positively correlated with higher life-satisfaction, self-esteem and lower levels of insecurity or depression. It is also negatively correlated with poor health choices and behavior.
  8. Allows for self-compassion - Emotionally intelligent individuals are more likely to have a better understanding of themselves and to make conscious decisions based on emotion and rationale combined. Overall, it leads a person to self-actualization. 




Social Emotional Learning


Social emotional learning represents a specific realm of child development and is a primary focus in education today. It is a gradual, integrative process through which children acquire the capacity to understand, experience, express, and manage emotions and to develop meaningful emotional relationships with others. As such, social emotional development encompasses a large range of skills and constructs such as the following: self-awareness, attention to self other and environment, play, empathy, joint attention, self-esteem, emotional self-regulation, friendships, and identity development. Social emotional development sets a foundation for children to engage in other developmental tasks. 


SEL is essential to completing difficult school assignments. In such a situation, a child may need the ability to manage their sense of frustration and seek help from a peer. To maintain a romantic relationship after a fight, a teen may need to be able to articulate their feelings and take the perspective of their partner to successfully resolve the conflict. However, it is also interrelated with and dependent on other developmental domains such as communication. For example, language delays or deficits have been associated with social-emotional disturbances.


Many mental health disorders, including anxiety disorders, major depressive disorder, borderline personality disorder, eating disorder and substance use disorder can be conceptualized through the lens of social emotional development, most significantly - emotion self-regulation. Many of the core symptoms of autism spectrum disorder reflect abnormalities in social emotional developmental areas, including joint attention and theory of mind.



CASEL’s Widely Used Framework Identifies Five Core Competencies


Self-awareness: The ability to accurately recognize one’s emotions and thoughts and their influence on behavior. This includes accurately assessing one’s strengths and limitations and possessing a well-grounded sense of confidence and optimism.


Self-management: The ability to regulate one’s emotions, thoughts, and behaviors effectively in different situations. This includes managing stress, controlling impulses, motivating oneself, and setting and working toward achieving personal and academic goals.


Social awareness: The ability to take the perspective of, and empathize with, others from diverse backgrounds and cultures, to understand social and ethical norms for behavior, and to recognize family, school, and community resources and supports.


Relationship skills: The ability to establish and maintain healthy and rewarding relationships with diverse individuals and groups. This includes communicating clearly, listening actively, cooperating, resisting inappropriate social pressure, negotiating conflict constructively, and seeking and offering help when needed.


Responsible decision-making: The ability to make constructive and respectful choices about personal behavior and social interactions based on consideration of ethical standards, safety concerns, social norms, the realistic evaluation of consequences of various actions, and the well-being of self and others.


In education today, a systemic approach to SEL mindfully develops a caring, participatory, equitable and reciprocal learning environment and evidence-based practices that actively involve all students in their social, emotional, and academic growth. Social and emotional learning is embedded into every part of students’ daily lives—across all of their classrooms, during all times of the school day, and when they are in their homes and communities.


Social Emotional Learning

Personal Competence = Self-Awareness & Self-Management

My ability to maintain awareness of my emotions and manage my behavior


Do I accurately perceive and understand my emotions?

Can you identify emotions you may be feeling and quickly interpret their meaning?


Am I managing my emotions and behaviors productively?

Can you adequately harness your anger, disappointment or fear so your emotions don’t interfere with your ability to listen or problem solve? Do you know when you need help, and can you ask for it? 


Social Competence = Social Awareness & Relationship Management

My ability to understand others (including their moods, behaviors & emotions) in order to improve relationships

Social Awareness

Do I accurately perceive and understand the emotions and behaviors of others?

Can you tell when you are unintentionally making another person uncomfortable or when someone who is smiling is really upset? 

Relationship Management

How do I impact others? Do I work with others effectively?

Can you remain calm, energized and focused in the face of another’s distress or during an upsetting situation? Can you defuse conflict?






Mission Statement

To establish a collective mentoring organization for the current and future academic and social benefit of students, faculty, and members of our community. For this organization to be a catalyst to encourage and assist the Argyle Independent School District in offering our children the opportunity to reach their maximum potential through mentoring.


About Mentoring


What is a mentor?

A mentor is a person who provides young people with support, counsel, friendship, reinforcement and a constructive example on healthy living. The most critical role for a mentor is to be a person who has time for the youth, who cares about that child, who believes in that child. This relationship may provide only stability the only stability a young person knows, and the only time anyone spends quality time with the mentee


Characteristics of Mentors

  • Commitment to be involved for an extended period of time… A minimum of six months.
  • Persistence and willingness to “hang in there“ through the ups and downs of a relationship
  • Respect for individuals
  • Appreciation of individual ability and skill levels
  • Ability to empathize and understand another person struggles in a non-judge mental manner
  • Flexibility and openness
  • Desire to learn from others experiences and willingness to share one’s own personal experiences
  • Sensitivity to differences in a respect for individual perspectives
  • Interest in helping to identify and develop strengths in young people
  • Understanding that communication is a two-way street
  • Using life experiences in a variety of ways to enhance the lives of others
  • Recognizing that relationships take time to develop and that both mentors and young people can learn from each other
  • Help resolve conflict
  • She can use help when needed


What a Mentor Is:

  • A trusted friend
  • A responsible and reliable adult
  • A link to other cultures, attitudes, and behaviors
  • A guide
  • A good listener


What a Mentor Is Not:

  • A savior
  • Substitute parent
  • A cool peer
  • A parole officer
  • A therapist
  • A source of funds


Benefits of a Mentoring Program

  • Helps children in our community start school with the necessary skills for success.
  • Supports teachers and administrators in their educational efforts to develop responsible and successful future leaders.
  • Reduces the number of students at risk for dropping out of school.
  • Vastly improves the students relationships with parents guardians and adults.
  • Helps prevent substance abuse in children.
  • Improves a child’s self-esteem.
  • Office volunteers a sense of personal gratification and enjoyment.
  • Provides volunteers with a deeper understanding of the demands facing youths
  • Fulfills responsibility to the community.



Defending our Children from Sexual Perpetrators


Stranger Danger has its place in sensitizing students to dangerous people and protecting our children. However, we need to help our children additionally know the dangers of being around people that we know and trust as potential sexual predators. We train children how to cross the street safely but do we teach them the dangers of inappropriately nice people grooming them for sex?


Sexual Abuse by Adults


Adults who abuse children may manipulate, bribe, coerce, threatening, or force a child into feeling like a partner in a sexual activity. They most often use a multi step “grooming“ process that focuses on meeting the child’s needs and possibly on the parents as well. The sex offender may offer the parents free babysitting services, for example, or make friends with them to gain enough trust to be alone with a child. Once the sex offender has identified the target child, characteristically, the grooming process moves to seemingly harmless touching, such as pats on the back, hugging, massages, and exposure, and seeking opportunities to be alone with a child. The sex offender usually seeks a child who craves affection or attention and makes that child feel special by spending a lot of time with him or her and giving gifts and money. 


All children are vulnerable to sexual abuse because of their innocence, naïveté, and total trust and dependence upon adults. When the sex offender senses that the child has been sufficiently conditioned to physical contact and has an emotional bond, the physical contact becomes more intrusive. The offender may pray on the child’s emerging curiosity about sexuality and may carry on under the guise of sex education or by playing inappropriate games. 


It may involve violating rules, drinking alcohol, smoking cigarettes… all to create a “special relationship”. Most children do not know they are being groomed the inappropriate behavior until it’s too late. Many offenders are clever enough to manipulate the child into believing that he or she is equally to blame will not believe be believed if they tell.  Many children feel trapped and are afraid to tell.


Sexual Abuse by Other Youth

It is also possible for a child of the same age to abuse another through force or manipulation. About a third of sexual abuse occurs at the hands of other children, including older youth and youth and positions to manipulate through bullying behavior using their size or knowledge difference. Any peer activity, such as a club initiation, in which sexual activity is included as a form of sexual abuse. Overnight activities pose a greater risk of abuse. Personal safety awareness rules should be reviewed before these activities. Adults who learn or discover that youth on youth abuse has occurred must take immediate steps to stop it.


Signs That Your Child Might Have Been Abused

The best indicator of abuse is a disclosure by your child that someone hurt or scared him or her, or made him or her feel uncomfortable. Each child’s response to abuse is unique. Signs of stress frequently accompany maltreatment, but stress can have many causes. Other possible indicators of abuse include:

        • Sudden withdrawal from activities the child previously enjoyed
        • Reluctance to be around a particular individual, especially in the absence of others.
        • Changes in behavior or in school performance, including lower grades.
        • Inability to focus or learning problems with no known cause.
        • Hypervigilance (excessive watchfulness as if anticipating something bad happening).
        • Overly compliant behavior or an excessive desire to please.


Additionally, a child being sexually victimized may:

        • Have difficulty sitting or walking.
        • Complain of pain or itching in the genital or anal areas.
        • Use sexually explicit language or act out sexual behavior inappropriate for his or her age.


Speaking With a Child Who Discloses or Indicates Abuse

When speaking with a child who discloses or indicates abuse, your role is to become a trusted adult. 


A good approach include the following:

Get involved; be an up stander.

        • If you see something, stop it, and say something.
        • If you know or suspect something, report it.
        • If you’re not sure, seek advice from an expert.


If a child does disclose abuse, it is important that adults respond calmly and in a supportive manner. Avoid statements that might indicate shame, blame, disbelief, discussed, or fear. If the abuse started or occurred much earlier, avoid asking the child why here she did not tell anyone sooner. Tell the child it wasn’t his or her fault, and express belief in the child’s disclosure by simply stating, “I believe you”. This will further support and validate the child statement. Avoid asking children for detailed information. Ask basic open ended questions to discern the following information:

        • Name and address of the alleged victim, if known
        • Name and address of the alleged offender, if known
        • Location of the alleged abuse
        • Nature (e.g., sexual, physical, emotional) and extent of the alleged abuse
        • Approximate date of the last incident… If an older child.


Adults should recognize that talking with children about maltreatment, especially sexual abuse, is not natural or comfortable for anyone; however, a child’s first disclosure… And your response… May have lasting effects.


Five Topics to Cover With Children

  1. Network of Trusted Adults: young people should have at least five adults you have identified to whom they can talk freely about their feelings and problems and who provide healthy attention and affection. A child who has such a network of trusted adults will be more difficult for a sex offender to groom.


  1. Check First: teach your child to check with you first before agreeing to go anywhere with another person. Tell your child never go anywhere with anyone who will not let him or her check with you first. If the person refuses, your child has the right to step back from the person, make noise, runaway, or kill someone.


  1. Trust Your Gut Instinct - “The Uh-Oh” Feeling: animals and humans have a gut instinct that helps keep us safe. Teach your child to listen to that “oh“ feeling that might occur if your child is in a place that does not feel right or with a person who is making him or her feel confused or scared. Encourage your child to go to a trusted adult if the “oh“ feeling starts.
  2. Secrets and Surprises: sex offenders off and try to groom children by convincing them to keep secrets about activities they would not want their parents to know about such as drinking, smoking, pornography, etc. If the child wants to keep those activities secret, he or she might also see any abuse as something to keep secret. Your child must feel like he or she can come to you and be heard about little concerns as well as big problems. Tell your child it is not OK for people to ask him or her to keep a secret from you or another caregiver. A surprise is something that we keep quiet about for a short period of time and then everyone finds out together, like what you bought someone for his or her birthday. Give your child a simple, automatic solution. Let your child know that he or she can come to you about anything and that you will still love and support him or her. 


  1. Talk About Touches and Private Parts: Young people should be told that parts of their body covered by their swimsuit are their private parts and they have the right to say no to being touched there. Body part should be called by their appropriate names to assist in developing a healthy and positive body image. Encourage your child to say no and then tell you if someone tries to touch or look at his or her private parts or wants him or her to touch or look at their private parts. It’s important to remind children that if they get tricked into a scary or confusing touch or if they freeze and are unable to say no, it is OK and not their fault. Children should be encouraged to tell as soon as they feel comfortable doing so. Keep the lines of communication open by reminding them that they can talk to you about touches, even a long time after something happened.




Grooming is a set of behaviors to gain access, authority, and control of children. A process by which a predator will attempt to get a child alone and victimized them. The three facets of grooming focus on:

  1. Grooming the child 
  2. Grooming the parent and 
  3. Grooming the community so they will be seen as good and trustworthy thereby granting them access to children for exploitation. 


If later suspected or even accused the parent or community may refuse to believe the word of the child. An example of this process is illustrated in, The Second Mile, a nonprofit organization for underprivileged youth, providing help for at-risk children and support for their parents in Pennsylvania by Penn State football coach, Jerry Sandusky.


Often times an offending adult will make verbal or nonverbal gestures of a provocative nature to see a reaction from a child. If confronted the adult will respond with confusion and denial thereby making the child think they were wrong in assuming something of a sexual nature. Other times an offending adult will make physical contact with a child in various forms, often starting with non-sexual contact. Later the contact may take on a more affectionate tone and target more sensitive areas of the child’s body. Once again, if confronted confusion, denial, anger or even outrage are used to throw the child or suspecting adult off their intended goal. 


Compliant Victimization


This process takes place with grooming. 

  1. When an adult is nice, gives attention, respect, money or some form of generosity to get access to a child. Parents often are desensitized to the adult-child relationship even when they see hugs and pats on the back during activities or athletic events. 


  1. Next the grooming adult will get the child to do something wrong. Afterwards, they will say “it’s OK, I’ll never tell”. It becomes their secret. Now the child, out of a fear of getting in trouble, will become coerced or extorted by the adult offender.


The child, due to shame and fear of getting in trouble, is now truly cut off from parent or adult support. 


Regular Talk Time 


Talk about sensitive topics like drugs, sex, bullying to teach them about topics at age appropriate levels.


Parents should not shy away from conversations about their children’s bodies, private parts,  hygiene, locker rooms, doctors appointments, teachers, clubs, coaches, church personnel or anywhere they may be alone with adults.


It’s imperative that parents develop a working relationship with their children in which they can ask them about anything. I recommend weekly meetings that include: discussions about relationships, weird feelings, awkward interactions, or anything out of the ordinary. Also what questions they may have about their body, growth, or sex. You might ask: “What have you heard from friends? What have you read on the Internet? 


It needs to be stated and followed through with that: “You’ll never be in trouble by talking with me or us. It’s OK to share weird feelings or experiences with parents, teachers, coaches, community leaders, youth ministers etc. If anyone asks your children to keep a secret from you, teach your children that they need to tell you!


It is critical that parents develop a relationship with their children that allows for mistakes and even bad behavior to be discussed and resolved in healthy ways.


Open discussion with parents and acceptance of children who make bad decisions are protective elements to victimization from sexual predators.




The following are helpful resources in the prevention of sexual exploitation of our students and children:




 Grief, Loss and Bereavement

Children interpret the world they live in differently at various ages and differently than adults do. Our job as caretakers of our children is to companion them in the journey into grief and mourning.


Companioning bereaved children means being an active participant in their healing…allowing yourself to learn from their unique experiences. We let them teach us instead of the other way around. We make the commitment to walk with them as they journey through grief. This is their idiosyncratic process of accepting things they will never approve of in life. 


Children instinctively move towards grief and mourning in manageable doses, even when they fear the pain. They know about the need to mourn, they just need safe places in which to do it in their own way and time. Caregivers do not cure them the grieving child; instead we create conditions that allow the brief child to mourn.


No one ever totally completes the morning process. Grief is something you go through, not get through. Growth and grief is a lifelong process of exploring how death or loss challenges us to examine our assumptions about life such as the meaning and the purpose of life, and religious and spiritual values. We, as caregivers, can best help by not providing pat answers, but instead allow your children to explore their unique, appropriately childlike thoughts and feelings about life, death and loss.


Play is the child’s natural method of self-expression and communication


Bereaved children use behaviors (regressive behaviors, explosive emotions, etc.) to teach us about underlying needs for (security, trust, information, etc.). Our responsibility is to learn what those underlying needs are and help the child get those needs met. As well, we can illuminate what their process is for grieving. 


As our culture moves away from embracing the pain of grief, our children are trying to get our attention. We must listen, learn, and respond in helpful ways. When bereaved children internalize messages that encourage the repression, avoidance, denial or numbing of grief, they become powerless to help themselves heal. They may instead learn to act out their grief in destructive ways. Ultimately, not learning to mourn well results in not loving or living well. 



  1. Relationship, attachment to and personality of the deceased.
  2. Nature of death: senseless crime, drunk driver, suicide etc.
  3. Timeliness of death.
  4. Rituals, traditions, funeral experience, availability of a body to view.
  5. Personality traits of the mourner.
  6. History of previous losses.
  7. Mobility of society.
  8. Societal pressures to heal quickly.
  9. Pressure to suppress or deny emotions.
  10. Availability of support system, is it OK to mourn in the family system, can family except support.
  11. Cultural, ethnic, and/or religious backgrounds
  12. Other crises, stressors in life of the family around this time of loss.
  13. Chronological and/or developmental age
  14. Societal expectations based on gender: “I gotta be dad now.“ "I have to return to school or work Monday and perform as usual."

Potential Inhibitors of Children’s Mourning

by Wolfelt


  • Adults and others who don’t acknowledge death of a loved one… Not saying his or her name.
  • Keeping so busy they can't feel.
  • Rules that dismiss or minimize loss or take away the right to mourn.
  • Parent/adult and ability or willingness to mourn.
  • Complicated relationship with the deceased.
  • Child’s desire to protect adults: they do it instinctively to take care of parents. Parents need to do their grief work with other adults.
  • Family rules related to the expression of grief. Rules are flexible in an open family and rigid in a closed family. Crying is instinctive in the face of loss, it is simply one trying to re-create reunion. Linking objects…Keeping possessions around keeps you linked in the relationship.
  • Lack of understanding related to the nature of the death…Be honest.
  • No participation in rituals… Rituals convert grief into mourning.
  • Bereavement overload… Shut down
  • Forced “hypermaturity“… if asked grow up too fast they won’t mourn. You can only pretend for so long… eventually he or she won’t be able to pretend anymore.

COVID-19 and Grief: Mourning Our Past Lives


The COVID-19 pandemic has led to multiple losses - from our sense of safety and our social connectedness to our financial security. While the pandemic evokes anxiety, fear, crisis and sadness, keep in mind, it is also a time of collective global grief. We are all now losing something. Many people are dealing with individual losses, such as illness and death due to coronavirus, or loss of employment as a result of the economic upheaval. Even if you don’t have an identifiable loss, there is there is a communal grief and a societal regression as we watch our work, health-care, education and economic systems destabilize.


This crisis isn’t just shaking our faith in our institutions, it’s changing our understanding of the world around us, such as our sense of control, order, predictability, justice, human compassion, and the belief that we can protect our children or loved ones. Grief is natural, it helps us connect with our resilient nature, to reassess crises, and our lives in order to move on. Though grief is difficult, it is about looking within and reevaluating and rethinking ourselves, the world, our ability to adapt and create meaning in the face of adversity. Grief during crisis requires flexibility of emotion, thought, interpretation and coping that eventually results in us accepting that which we don’t approve.


The bereavement literature shows that the objects, nature and intensity of a person’s attachments has an effect on their grief reactions. Coronavirus challenges us to confront the frailty of such attachments to health, mobility, connectivity, routines, and activities. As the pandemic has evolved, we have had to confront multiple losses including the loss of a sense of safety, of social connectedness, personal freedom, employment stability and financial security. 


Looking into the future, people will experience new losses we are not yet able to predict and grieve them. With any series of losses, individuals can expect to experience confusion, anxiety, depression, loss of self-esteem or identity.


With almost the whole world confronting losses, people need to openly cope with grief. We can ask people to identify what they are losing as a result of this pandemic and more importantly what they can do to improve understanding and growth. How did you heal and recover from previous losses? How can you improve your efficiency during this pandemic?


In an era of social distancing, people are isolated in their homes away from loved ones and social support resulting in loss of meaningful physical interaction that help many to derive meaning and purpose in life. In this deficit of social connectedness, people must try to stay connected with their social support networks through phone calls, text messages, video chat and social media. Reach out, check-in, effort to communicate while experiencing this loss of physical contact. 


While many people will be resilient to the consequences wrought by COVID-19, there is a subset of people who will be chronically disrupted and need support in recovery, continuing education in areas such as disaster mental health, psychological first aid and trauma-focused therapies. An interesting thing about crisis is that it can galvanize creativity, growth and commitment. We may first be victims to loss associated with coronavirus, then learn to survive during this crisis, but ultimately mental health intervention is designed to help find a silver lining and grow people to thrive as a result of loss and trauma. This thriving process, often described as post-traumatic growth, is more or less possible for people but may require professional support. Ultimately, going through mourning and grief, we can gain clarity and skill enabling us to move forward resiliently toward a new sense of well-being.




Bullying Prevention

Bullying is defined as the calculated, ongoing abuse that is aimed at a less powerful target. A school violence specialist with the school of social work at Michigan State University, defined a bully as an individual who seeks to control, dominate and terrorize the life of another. The important parts of this definition are that bullying is repeated behavior, intended to harm another, and that involves a disparity of power. A disparity of power may be viewed from different angles: target cannot defend him or herself or the aggressor and seem to have more power than his or her target. It involves a real or perceived imbalance of power, with the more powerful child or group attacking those who are less powerful.


Educators, families and communities can increase their ability to recognize early warning signs by establishing close, caring and supportive relationships with children and youth. Certain behaviors and characteristics should alert educators to the possibility that a child is bullying others. These may include the following:


Verbal Abuse (General Name-Calling):

  • Using accusatory term such as fag, gay, lesbian, or shrew
  • Calling other people names just to be mean, i.e., Geek, for eyes, shrimp, wimp, fruitcake
  • Giving other children dirty looks
  • Making fun of the religion or nationality by calling them names like Jew boy, whop, spick, yellow, or Jap
  • Telling others they are no good: “you can’t do this, nobody likes you, get away.“
  • Calling others crazy
  • Abusing their parents or family members: “your mother is poor as dirt,“ “your brothers dumb as a doornail,“ or “your whole family is crazy.“
Verbal Abuse (Appearance):
  • Making fun of a child’s appearance by using terms like metal face, metal mouth or midget
  • Using put downs like “you’re skinny as a rail,“ “your smile looks like your teeth fell out,“ “you’re ugly,“ or “you’re fat,“ or “you’re too tall.“
  • Questioning another child’s care: “don’t you have anything else to wear?“ Or “you stink don’t you take showers?“


Verbal Abuse (Academics):

  • Assailing another child’s academic abilities by calling them retarded, teachers pet, and the like.
  • Making another child feel inadequate by saying things like, “you sure got the short end of the stick when they gave out brains,““don’t you have any common sense?“ “You’re stupid because you can’t read,“ or “you’re dumb because you can’t do that math problem.“
  • Belittling another’s successes with phrases like, “don’t you have a life after school?“ Or “he’s a geek, he knows more than the teacher.“


Verbal Abuse (Athletics):

  • “Can’t you run any faster?“
  • “You’re so weak.”
  • “What a wimp!“
  • “You kick like your mama.“
  • “You can’t do anything right.“
  • “What? You got two left feet?”
  • “You’re so slow you wouldn’t be able to catch the lice.“
  • “Our team won because we are the best. Your team stinks“


Spreading Rumors

  • Talking behind of the peoples back‘s and starting rumors.
  • Telling someone a secret that really is not the truth. Then the next person tells someone else in the entire thought is miscommunicated.
  • Passing notes which contain cruel statements about others.
  • Telling lies on others that are demeaning and hurtful.



  • Calling other names like white trash, black trash, or Mexican trash. 
  • Putting down another’s religion.


Physically Hurting

  • Beating up on smaller and or younger children
  • Punching others until they start to cry
  • Pushing and shoving others or elbowing
  • Fighting with others in front of the victims friends or girlfriend
  • Throwing things at or on them such as milk or food in the cafeteria


Pranks and Mean Games

  • Making others drop their books or papers
  • Tripping others and laughing when they fall
  • Emptying another’s persons book bag in front of other
  • Hitting others as they’re standing in line
  • Cutting in line and cutting others off when they’re talking
  • Picking smaller kids up and making them into flying airplanes
  • Stuffing others into a trashcan or dumpster


Destroying Property

  • Taking lunch money from others
  • Spitting on an individual’s clothing or possession
  • Cutting someone’s hair
  • Destroying others property such as throwing paint on someone’s jacket or cutting holes in someone’s gym shorts


Personality Characteristics

  • Mean
  • Arrogant
  • Always putting other kids down very degrading
  • Acting like they’re better than everyone else
  • Acting like they can do anything they want because they’re older or bigger than everyone else
  • Always having to be the best at the center of attention


Poor Emotional Self-Control

  • Having a lot of hatred or built-up frustration
  • Hot tempered… Very excitable
  • Rude, always in your face, and a crowdpleaser
  • Always the class clown
  • Always going with what their friends say… Not what their heart tells them


Physical Characteristics

  • Average size of the largest one in the class
  • Possibly athletic and think they’re better than others
  • Wearing baggy pants or shorts… Cool clothes, especially boys
  • Wearing very fashionable hairstyles


Poor Support System

  • Treated poorly at home… Bullies off and witnessed a violent behavior of parents or relatives; and children from violent homes are three or four times more likely to become a bully.
  • Parents lack a solid bonding or attachment with the young child
  • Poor supervision and glut of the child’s needs
  • Acceptance in modeling of aggression or bullying behaviors by parents or older siblings



  • Don’t have a lot of close friends
  • Are envious of fellow classmates
  • May not be very popular and use bullying as a way of getting attention


Behavioral Characteristics

  • Getting in trouble at school either with the principal or teacher
  • Showing a lack of respect for authority or resisting authoritative figures
  • Talking back to adults
  • Performing poorly in academic areas


Attitudes and Feelings

  • Are bossy
  • Or nice to others outside of class or when others are not around
  • Interrupt when others are speaking
  • Laugh on some thing it’s not funny but it’s demeaning


Recognizing the Signs of Victimization

  • Repeated bullying causes severe emotional harm and can eroded child’s self-esteem and mental health. Whether bullying is verbal, physical or relational, the long-term effects are equally harmful. Both boys and girls report high-level’s of emotional distress and loneliness as well as lower self-esteem, anxiety and depression. In some situations the outcome is tragic; the child may take his or her own life.
  • Here are possible warning signs that a child may be bullied and need support.
  • Unexplained physical marks, cuts, bruises and scrapes
  • Unexplained loss of toys, school supplies, clothing, lunches, or money
  • Clothes, toys, books, electronics items are damaged or missing with a child reports mysteriously “losing“ possessions
  • Doesn’t want to go to school or other activities with peers
  • Afraid of riding the school bus
  • Afraid to be left alone: want you there at dismissal, suddenly clingy
  • Suddenly Solon, withdrawn, evasive; remarks about feeling lonely
  • Marked change in typical behavior or personality
  • Appear sad, moody, angry, anxious or depressed in that mood lasts with no known cause
  • Physical complaints; headaches, stomach aches, frequent visits to the schools nurses office
  • Difficulty sleeping, nightmares, cries self to sleep, bedwetting
  • Change in eating habits
  • Begins bullying siblings are younger kids. Bully children can sometimes flip the role and become the bully.
  • Weights to get home to use the bathroom. School and park bathrooms because they’re often not adults supervised can be hotspots for bullying
  • Suddenly has fewer friends or doesn’t want to be with the “regular group.“
  • Large appetite when he comes home. Bullies can use extortion, stealing lunch money from the victim
  • Sudden and significant drop in grades. Bullying can cause a child to have difficulty focusing and concentrating
  • Blame self for problems; feels “not good enough“
  • Talks about feeling helpless or about suicide; runs away.
  • Lost or damaged property
  • Feigning illness
  • Declining grades
  • Changing social activity log
  • Mentioning or attempting self harm


If a student is being bullied at school they may:

  • Become aggressive and unreasonable
  • Start to get into fights
  • Refuse to talk about what’s wrong
  • Have an explain bruises, cuts, scratches particularly those appearing after lunch and recess
  • Have missing or damaged belongings or close
  • Have failing school grades
  • Be alone often or excluded from friendship groups at school
  • Sure changing their ability or willingness to speak up in class
  • Appear insecure or frightened
  • Be a frequent target for teasing, mimicking or ridicule


Physical Signs of Bullying:

  • Has unexplained bruises cuts and scratches
  • Comes home with missing or damaged belongings or close
  • Comes home hungry
  • Unexplained injuries

Individual Risk Factors

Individual characteristics may affect whether an individual is a bully or a victim. On the victim side, anyone may be the target of a bullying behavior. Some children are picked on for physical reasons such as being overweight or physically small, having a disability, or belonging to a different race religion or sexual orientation. These individual risk factors, are highlighted below:

  • Gender
  • Psychological traits
  • Physical traits
  • Grade level
  • Ethnicity
  • Religious orientation
  • Socioeconomic status
  • Poor social skills
  • Superior social skills
  • Low academic achievement
  • Sexual orientation
  • Disability status


Peer Group Risk Factors

  • birds of a feather flock together...bullying is a peer group phenomenon. 
  • Peer conformity, if one does it they all will likely do the same.
  • Delinquency...negative peer influence has been found to predict bullying.
  • Alcohol/drug use...both aggressive victims and non-victims are more likely to use substances.
Lesbian, gay, bisexual, transgender, & questioning (LGBTQ) Students and Bullying

Sexual minority youth, or youth who are perceived as such, or disproportionately subjected to bullying relative to their heterosexual counterparts. Over the past 20 years, progress has been made through the state laws prohibiting bullying and implementation of innovative programs within schools and classrooms to reduce harassment and improve the safety of LGBTQ youth.


The terms “LGBTQ“ and “sexual minority,“ as used here, encompass those whose identities are more accurately described as lesbian, gay, bisexual, transgender, gender variant, gender neutral, questioning, queer, to spirit, or intersex. The define terms are used for brevity and not for exclusionary purposes.


Negative Impact of Bullying on LGBTQ Students

Bullying and harassment can have negative effects on the development and mental health of LGBTQ students, such as extreme anxiety and depression, relationship problems, low self-esteem, substance abuse, and thoughts of suicide. These students are also at much greater risk of physical assault and other children and youth.


LGBTQ youth frequently deal with bullying in the form of harassment, violence, and attacks. Studies have shown that LGBTQ students receive bigoted verbal abuse such as name-calling like Homo, Fagg or sissy more than two dozen times a day. 


Negative name-calling and harassment about sexual orientation can be harmful to all students. Three out of four students who are bullied with such remarks are not identified as gay, lesbian, bisexual, transgender, or questioning. These derogatory comments are often use broadly to inflict harm in a school setting.


LGBTQ Students and Cyberbullying

LGBTQ bullying statistics show they suffer from more cyber bullying. According to Gay, Lesbian and Straight Education Network (GLSEN) and bullying(

    • 42% of LGBTQ youth have experienced cyber bullying.
    • 25% more than once.
    • 35% receive online threats.
    • 58% say something bad is said to them or about them online.
    • Cyber bullying of LGBTQ youth is three times higher than other students experience
    • 33% report sexual harassment online, which is four times higher than the experience of other students.
    • 27% of LGBTQ youth do not feel safe online.
    • 20% report receiving harassing text messages from other students.
    • 50% of all use do not understand that discriminatory language is offensive, nor do they realize the negative impact on LGBTQ youth.
GLSEN also found that LGBTQ you spend more time online and youth in general. LGBTQ youth make friends online, and use the Internet to gather information about sexuality and health information. LGBTQ youth are twice as likely to participate in political activities as other youth, making these connections online also. Because LGBTQ youth spend more time online, they are more likely the targets of cyber bullying.
Effective School-Based Bullying Prevention
Prevention involves a social-ecological, shoe-school approach that engages student, families, and all the school staff in prevention efforts and establishes consistent expirations for positive behavior across all school contexts. 

Steps that we take in preventing bullying in our schools involves the application of a wide range of evidence-based approaches. These approaches include:

1. Adopting a clear anti-bullying policy,

2. Implementing a multi tiered approach that involves students at all levels of risk,

3. Providing adequate adult supervision during unstructured time,

4. Training teachers to respond to bullying incidents effectively,

5. Promoting effective classroom management,

6. Using positive behavior support systems,

7. Providing supports two students who have been bullied,

8. Collecting data to monitor bullying and increase accountability,

9. Involving families and communities, and

10. Integrating and sustaining prevention efforts.


At Argyle ISD, we are committed to upholding our obligation to ensure that our schools are a safe place for all students. 


Learn More

Health Hotlines

  • National Suicide Prevention Lifeline: The Lifeline provides 24-hour, toll-free, and confidential support to anyone in suicidal crisis or emotional distress. Call 1-800-273-TALK (8255) to connect with a skilled, trained counselor at a crisis center in your area. Support is available in English and Spanish and via live chat.
  • LGBT National Help Center: LGBT National Hotline: 888.843.4564. LGBT National Youth Talkline 800.246.7743.
  • Crisis Text Line: Text HELLO to 741741 for free and confidential support 24 hours a day throughout the U.S.
  • TrevorText can be reached by texting TREVOR to 1-202-304-1200 (available M-F from 3PM to 10PM ET).
  • (Formerly known as Parents, Families, and Friends of Lesbians and Gays).

School Refusal


Signs of school refusal

Fussing, tantrums, running or hiding from school, and lashing out with physical force are clear-cut signs of school refusal, but many students engage in more subtle behaviors. Watch for these signs of school refusal that are sometimes difficult to see:

  • Regular trips to the school nurse for no real medical reason
  • Frequent requests to call home
  • Frequent physical complaints such as headaches, stomachaches, chest pains, muscle pains, feeling dizzy or feeling exhausted
  • Illnesses on test days or days when students need to present oral reports
  • Difficulty getting out of bed in the morning
  • Refusal to engage with peers or participate in social activities 
  • Willingness to complete work at home


How to get help for your child

The best treatment to help children struggling with school refusal includes a team approach. While children tend to focus on what they don’t like or worry about at school, the truth is that the underlying issues can include stress at home, social stress, and medical issues (a child who struggles with asthma, for example, might experience excessive worry about having an asthma attack at school). It helps to have a strong team that includes the classroom teacher, family, a school psychologist, counselor and any specialist working with the child outside of school.


1. Assess: The first step is a comprehensive medical and psychological evaluation. Given that school refusal is generally related to an underlying anxiety or depressive disorder, it’s important to get to the root of the problem and begin there. This will likely include both family and teacher questionnaires or interviews.


2. Cognitive Behavior Therapy: This highly structured form of therapy helps children identify their maladaptive thought patterns and learn adaptive replacement behaviors. Children learn to confront thoughts, feelings and work through their fears by developing coping skills.


3. Systemic desensitization: Some children struggling with school refusal need a scaffolded approach to returning to school. They might return for a small increment of time and gradually build upon it. 


4. Relaxation training: This is essential for children struggling with anxiety. Deep breathing, guided imagery, and mindfulness are all relaxation strategies that kids can practice at home and utilize in school.


5. Re-entry plan: The treatment team creates a plan to help the student return to the classroom. Younger children might benefit from arriving early and helping the teacher in the classroom, crosswalk or helping at the main office. The plan also includes contingencies to help the student during anxious moments throughout the day such as using fidget toys, taking a brain break to color or draw, or take a walk outside with a teacher’s aide, etc.


6. Structure and routine: Anxious children benefit from predictable home routines. Avoid over-scheduling, as this can increase stress for anxious kids, and put specific morning and evening routines in place.


7. Sleep: Sleep deprivation exacerbates symptoms of anxiety and depression. It also makes it difficult to get up and leave for school in the morning. Establish healthy sleep habits and keep a regular sleep cycle, even during holidays and on the weekends. 


8. Peer buddy or mentor: Consider requesting a peer buddy for school arrival, recess, lunch, and other less structured periods as anxiety can spike during these times.


9. Social skills training: Many students who struggle with making and keeping friends feel overwhelmed in the school environment. Social skills groups can help kids learn to relate to their peers and feel comfortable in larger groups.


Acknowledge your child’s difficulty, engage in open and honest communication about it, empathize with your child, and pile on the unconditional love, support and encouragement. 



The Texas Definition of Restorative Discipline


Marilyn Armour, Ph.D., defines restorative discipline as a relational approach to building school climate and addressing student behavior. The approach fosters belonging over exclusion, social engagement over control, and meaningful accountability over punishment.


An overview of Restorative Discipline Practices in Texas training is available on the Texas Gateway at  

Our Argyle ISD faculty have been trained in and uphold the philosophy and practices of Restorative Discipline. 

Best Practices in Restorative Discipline

While some schools see themselves as already engaging in restorative practices, the following guidelines serve as a means of assessing where a particular campus or administrator operates within the restorative continuum.

  • Restorative Discipline is a philosophy and system-wide intervention that places relationships at the heart of the educational experience.
  • The goal of Restorative Discipline is to change the school climate rather than merely respond to student behavior.
  • Restorative Discipline requires a top down commitment from school board members and administrators.
  • Restorative Discipline uses a whole school approach. All administrators, teachers, all staff, and students should be exposed to and/or trained in restorative processes with periodic boosters.
  • Restorative Discipline engages parents/caregivers as integral members of restorative conferences and circles.
  • Restorative Discipline uses an internal leadership response team to spearhead the implementation and help support necessary dialogue.
  • Restorative Discipline calls for an outside restorative justice coordinator to serve onsite.
  • Restorative Discipline has a data system to analyze trends and inform early interventions.
  • Restorative Discipline focuses on the harms, needs and causes of student behavior, not just the breaking of rules and dispensing of punishment.
  • Restorative Discipline places a fundamental attention on harm and the subsequent needs of the victim.
  • Restorative Discipline places an emphasis on meaningful accountability in matters involving harm and conflict.
  • Restorative Discipline takes time. It is dialogue driven and rests on the steady establishing and deepening of relationships.
  • Restorative Discipline calls for collaboration with community-based restorative justice programs, local businesses, and agencies that serve youth, including community and faith-based programs, law enforcement, and public health and mental health entities, local Community Resource Coordinating Groups, justice system representatives and other stakeholders.
  • Restorative Conferences: Facilitate a meeting between the person responsible for the harm and the harmed person. Together the group decides what is needed to be done to repair the repair the harm and puts plans in place to prevent further harm and create or maintain healthy relationships and culture.
There are two essential on-line referral systems to report a someone in need of mental health support. The first, the Threat Assessment, is designed to report significant threats to self, others or property in AISD. The second, Google Form Referral, is for lower level or non-crisis support referrals. 
1. Threat Assessment can be accessed by clicking the following sequence:
  • Eduphoria
  • Formspace
  • Submit New Form (Bottom left of page)
  • General Forms
  • Threat Assessment Report & Plan
2. Google Form Referral

Informed Consent and Confidentiality Statement

Argyle ISD

By signing the following, you are giving consent that  ________________________ may receive counseling services from our licensed staff working within Argyle ISD. These services include individual counseling. I know that the role of the counselor is to serve the best interest of my child and also understand that it is most beneficial for my child that the contents of the counseling session are kept confidential. This confidentiality is limited only by the counselor’s duty to warn the appropriate parties in the event that my child reveals intent to harm self or someone else as well as at any time disclosing knowledge of abuse or neglect to a child or elderly person. 


________________________________ _______________________________

Printed name of Parent/Guardian Printed Name of Counselor

________________________________ _______________________________

Signature of Parent/Guardian Signature of Counselor







Argyle ISD

District Form






Student Name: ______________________________________ ID#__________ Grade: ______ 


Campus: __________________________________________ Date of Birth: _______________ 




I authorize ______________________________________ to release the specified, confidential

information on the above named student to the following Argyle ISD representative: 




Person Position                                             Campus or Dept.                           Telephone Number 



RECORDS TO BE RELEASED: ___________________________    _______________________ ______________________________________________________________________________ ______________________________________________________________________________ 


PURPOSE OF RECORDS RELEASE: ____________________________    _________________ 


        ☐           I have been fully informed and understand the school’s request for my consent as 

Yes      No          described above. The records will be released upon receipt of my written consent.


☐         ☐           I understand that my consent is voluntary and may be revoked at any time. 

Yes      No         However the revocation is not retroactive.


      This request is to a school district. No parent signature required. 



Signature of Parent/Guardian/Surrogate Parent/Adult        Student       Telephone Number