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 (SAMHSA.gov), Centers for Disease Control and Prevention (CDC.gov) and the U.S. Department of Justice (justice.gov). 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
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.
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.
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:
SUICIDE PREVENTION RESOURCES
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
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.
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:
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:
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).
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:
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:
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:
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.
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:
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 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:
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.
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 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:
People with symptoms of inattention may often:
People with symptoms of hyperactivity-impulsivity may often:
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.
Researchers are not sure what causes ADHD. Like many other illnesses, several factors can contribute to ADHD, such as:
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.
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:
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.
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:
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.
Parents and teachers can help kids with ADHD stay organized and follow directions with tools such as:
A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as:
Last Revised: September 2019
AUTISM SPECTRUM DISORDER
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:
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.
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.
People with ASD may also experience sleep problems and irritability. Although people with ASD experience many challenges, they may also have many strengths, including:
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:
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 is often a two-stage process.
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.
This second evaluation is with a team of doctors and other health professionals who are experienced in diagnosing ASD.
This team may include:
The evaluation may assess:
Because ASD is a complex disorder that sometimes occurs along with other illnesses or learning disorders, the comprehensive evaluation may include:
The outcome of the evaluation will result in a formal diagnosis and recommendations for treatment.
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.
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:
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.
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:
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.
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:
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 https://www.fda.gov/.
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:
There are many social services programs and other resources that can help people with ASD. Here are some tips for finding these additional services:
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.
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.
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.
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:
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.
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.
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:
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.
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.
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:
Living with bipolar disorder can be challenging, but there are ways to help make it easier for yourself, a friend, or a loved one.
Remember: Bipolar disorder is a lifelong illness, but long-term, ongoing treatment can help control symptoms and enable you to live a healthy life.
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:
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).
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.
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:
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.
If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:
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.
Here are other tips that may help you or a loved one during treatment for 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.
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.
Other symptoms may develop over time, including:
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.
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.
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.
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:
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: (http://www.fda.gov/), for the latest information on warnings, patient medication guides, or newly approved medications.
Last Revised: February 2016
COPING WITH TRAUMATIC EVENTS
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.
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:
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:
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:
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:
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.
Healthy ways of coping in this time period include:
In general, staying active is a good way to cope with stressful feelings.
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:
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.
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.
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:
Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:
Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally:
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.
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.
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).
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:
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.
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.
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.
Last Revised: October 2019
POST-TRAUMATIC STRESS DISORDER
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.
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:
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.
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 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 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.
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:
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.
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.
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:
Some factors that may promote recovery after trauma include:
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.
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:
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:
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:
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
SUBSTANCE USE and MENTAL HEALTH
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.
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?
Dangers to Youth:
Risk of Poisoning:
Recommendations for E-cigarette Users:
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.
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.
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:
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.
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)
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:
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
When someone is abusing drugs, there are often telltale signs and symptoms that are both physical and behavioral, including:
Each drug will have its own set of specific symptoms, but these are usually found in most drug abusers. For example:
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.
Drug abuse carries a lot of potential side effects, depending on the specific drug being used:
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.
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:
Last Revised: May 2020
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.
The behaviors listed below may be signs that someone is thinking about suicide.
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.
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:
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.
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:
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.
Last Revised: July 2020
Parenting - Tips
Communication Approach: Haim Ginott
Quotes from Between Parent and Teenager: Haim Ginott
Eighteen Ways to Avoid Power Struggles:
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.
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:
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:
Rules for Giving Choices;
Your Delivery is Important… Try to start your sentence with:
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.
THE RULES OF LOVE AND LOGIC
Adults set firm limits in loving ways without anger, lecture, threats, or repeated warnings.
When children misbehave and cause problems, adults hand these problems back in loving ways.
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:
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!
AVOID SARCASM AT ALL COSTS!
© Jim Fay & Charles Fay, Ph.D., Love and Logic Institute, Inc.
TURNING YOUR WORDS INTO GOLD
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
THE ONE-SENTENCE INTERVENTION
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.
© Jim Fay & Charles Fay, Ph.D., Love and Logic Institute, Inc.
FIVE GOALS FOR SUCCESS WITH UNDERACHIEVERS
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.
BELIEFS THAT INFLUENCE ACHIEVEMENT MOTIVATION
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 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 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.”
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.”
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.
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.
“I love you too much to argue.”
“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.”
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.
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:
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:
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:
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 share certain characteristics that teens should be taught to expect. They include:
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:
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
From “The Verbally Abusive Relationship,” by Patricia Evans
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:
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:
SOCIAL EMOTIONAL LEARNING
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.
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
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?
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?
ARGYLE ISD MENTORING PROGRAM
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.
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
What a Mentor Is:
What a Mentor Is Not:
Benefits of a Mentoring Program
DEFENDING OUR CHILDREN AGAINST SEXUAL ABUSE
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:
Additionally, a child being sexually victimized may:
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 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:
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
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:
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.
This process takes place with grooming.
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 & BEREAVEMENT
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.
FACTORS INFLUENCING DIFFICULTY GRIEVING
Potential Inhibitors of Children’s Mourning
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 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):
Verbal Abuse (Academics):
Verbal Abuse (Athletics):
Pranks and Mean Games
Poor Emotional Self-Control
Poor Support System
Attitudes and Feelings
Recognizing the Signs of Victimization
If a student is being bullied at school they may:
Physical Signs of Bullying:
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:
Peer Group Risk Factors
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( statistics.org):
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.
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:
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.
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 https://www.texasgateway.org/resource/restorative-discipline-practices-texas.
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.
ARGYLE ISD: THREAT ASSESSMENT AND GOOGLE FORM REFERRALS
CONSENT FOR COUNSELING
Informed Consent and Confidentiality Statement
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
RELEASE OF CONFIDENTIAL INFORMATION FORM
NOTICE AND CONSENT TO RELEASE CONFIDENTIAL INFORMATION
Student Name: ______________________________________ ID#__________ Grade: ______
Campus: __________________________________________ Date of Birth: _______________
CONSENT TO RELEASE RECORDS
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.
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