Although fears and worries are typical in children, persistent or extreme forms of fear and sadness could be due to anxiety or depression. Because the symptoms primarily involve thoughts and feelings, they are called internalizing disorders.

Common signs include:

• Increased irritability or anger

• Declining grades

• Lasting Sadness

• Physical complaints (headache, stomachace)

• Lack of energy

• Feeling hopeless

• Difficulty concentrating/making decisions

• Sleep difficulties

• Changes in eating/self-care

• May have lack of interest in social activities/withdrawal

• Defiant attitude

• Feelings of guilt, worthlessness or despair

• May have thoughts or actions of self-harm

Although fears and worries are typical in children, persistent or extreme forms of fear and sadness could be due to anxiety or depression. Because the symptoms primarily involve thoughts and feelings, they are called internalizing disorders.

Common Signs

When a child does not outgrow the fears and worries that are typical in young children, or when there are so many fears and worries that they interfere with school, home, or play activities, the child may be diagnosed with an anxiety disorder. Examples of different types of anxiety disorders include

• Being very afraid when away from parents (separation anxiety)

• Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias)

• Being very afraid of school and other places where there are people (social anxiety)

• Being very worried about the future and about bad things happening (general anxiety)

• Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)

Anxiety may present as fear or worry, but can also make children irritable and angry. Anxiety symptoms can also include trouble sleeping, as well as physical symptoms like fatigue, headaches, or stomachaches. Some anxious children keep their worries to themselves and, thus, the symptoms can be missed. (cdc.gov)

Suicide does not have one single cause. Certain factors like substance abuse and untreated depression can lead to higher risk of suicide just as having a trusted group of friends can help protect you. (save.org)

Call 911 or the emergency service in your city, seek help from a trusted adult, and contact a mental health professional if you see or hear the following:

Someone threatening to hurt or kill him/herself or talking about wanting to die. Especially if the person has a weapon or item to hurt himself/herself.

Searching for ways to kill him/herself by seeking access to lethal means-whether that is online or physically in the moment of despair.

Someone talking, writing, or posting on social media about death and suicide when these actions are out of the ordinary for the person.

Warning Signs

The warning signs of suicide are indicators that a person may be in acute danger and may urgently need help.

• Talking about wanting to die or to kill oneself;

• Looking for a way to kill oneself;

• Talking about feeling hopeless or having no purpose;

• Talking about feeling trapped or being in unbearable pain;

• Talking about being a burden to others;

• Increasing the use of alcohol or drugs;

• Acting anxious, agitated, or reckless;

• Sleeping too little or too much;

• Withdrawing or feeling isolated;

• Showing rage or talking about seeking revenge; and

• Displaying extreme mood swings.

This list of Warning Signs for Suicide was developed by an expert review and consensus process that included SAVE’s Executive Director and was informed by a review of relevant research and literature. Additional information about the warning signs can be found in the following published article: Rudd, M. D., Berman, A. L., Joiner, T. E., Jr., Nock, M. K., Silverman, M. M., Mandrusiak, M., et al. (2006). Warning signs for suicide: Theory, research, and clinical applications. Suicide and Life-Threatening Behavior, 36(3), 255-262.

If you or someone you know is in crisis, call the Lifeline (USA) at 1-800-273-8255 OR Text SIGNS to741741 for 24/7, anonymous, free crisis counseling.

There are several types of eating disorders, especially prevalent among females 12 years and older. However, males do suffer as well and are oftentimes go un-diagnosed for a long time.

The chance for recovery increases the earlier an eating disorder is detected. Therefore, it is important to be aware of some of the warning signs of an eating disorder.

This isn’t intended as a checklist. Someone struggling with an eating disorder generally won’t have all of these signs and symptoms at once, and the warning signs vary across eating disorders and don’t always fit into neat categories. Rather, these lists are intended as a general overview of the types of behaviors that may indicate a problem.

You can find the lists at the link below as well as a short video.

https://www.nationaleatingdisorders.org/warning-signs-and-symptoms

Research:

• Combining information from several sources, Eric Stice and Cara Bohon (2012) found that

  • Between 0.9% and 2.0% of females and 0.1% to 0.3% of males will develop anorexia

  • Subthreshold anorexia occurs in 1.1% to 3.0% of adolescent females

Stice E & Bohon C. (2012). Eating Disorders. In Child and Adolescent Psychopathology, 2nd Edition, Theodore Beauchaine & Stephen Linshaw, eds. New York: Wiley.

• Young people between the ages of 15 and 24 with anorexia have 10 times the risk of dying compared to their same-aged peers.

Smink, F. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Reports, 14(4), 406-414.

Fichter, M. M., & Quadflieg, N. (2016). Mortality in eating disorders – Results of a large prospective clinical longitudinal study. International Journal of Eating Disorders, Epub ahead of print.

• Males represent 25% of individuals with anorexia nervosa, and they are at a higher risk of dying, in part because they are often diagnosed later since many people assume males don’t have eating disorders.

Mond, J.M., Mitchison, D., & Hay, P. (2014) “Prevalence and implications of eating disordered behavior in men” in Cohn, L., Lemberg, R. (2014) Current Findings on Males with Eating Disorders. Philadelphia, PA: Routledge.

** Click here to check out a wonderful guide to different types of eating disorders. https://thedermreview.com/beauty-is-skin-deep-eating-disorders-guide/

Many children occasionally have thoughts that bother them, and they might feel like they have to do something about those thoughts, even if their actions don’t actually make sense. For example, they might worry about having bad luck if they don’t wear a favorite piece of clothing. For some children, the thoughts and the urges to perform certain actions persist, even if they try to ignore them or make them go away. Children may have an obsessive-compulsive disorder (OCD) when unwanted thoughts, and the behaviors they feel they must do because of the thoughts, happen frequently, take up a lot of time (more than an hour a day), interfere with their activities, or make them very upset. The thoughts are called obsessions. The behaviors are called compulsions. (cdc.gov)

Having OCD means having obsessions, compulsions, or both.

Examples of obsessive or compulsive behaviors include:

• Having unwanted thoughts, impulses, or images that occur over and over and which cause anxiety or distress.

• Having to think about or say something over and over (for example, counting, or repeating words over and over silently or out loud)

• Having to do something over and over (for example, handwashing, placing things in a specific order, or checking the same things over and over, like whether a door is locked)

• Having to do something over and over according to certain rules that must be followed exactly in order to make an obsession go away.

Children do these behaviors because they have the feeling that the behaviors will prevent bad things from happening or will make them feel better. However, the behavior is not typically connected to actual danger of something bad happening, or the behavior is extreme, such as washing hands multiple times per hour.

Attention-deficit/hyperactivity disorder—ADHD—is a brain-based disorder that affects about one in ten school-aged children. Symptoms continue into adulthood for more than half of those who have it in childhood. People who have ADHD have higher levels of inattention, impulsivity, and/or hyperactivity than their peers.

Executive function often is generally impaired when individuals have ADHD. This affects their ability to organize, plan, and manage thoughts and actions. They may have difficulty completing tasks or forget important things and may not consider the long-term consequences of their actions.

Symptoms

Frequently, ADHD symptoms are first noticed in early childhood. They can sometimes be hard to tell apart from the impulsivity, inattentiveness, and active behavior typical for children under the age of four. For this reason, diagnosis is usually made when a child is five or older. Children need to exhibit six or more symptoms for a diagnosis; older teens and adults should have at least five of the symptoms. Symptoms can change over time. For most people, ADHD persists in some form from childhood through adolescence and into adulthood, although when present, hyperactivity tends to decrease over time.

Causes

Many genetic studies indicate that ADHD runs in families. Yet ADHD is a complex disorder, the result of many interacting genes, and most importantly, the result of genes interacting with the environment. Other risk factors for ADHD include exposure to environmental toxins during pregnancy or childhood, low birth weight or brain injury.

Treatment

ADHD is treated through combinations of medical, educational, behavioral, and psychological interventions depending on the individual’s needs. This approach to treatment is called “multimodal” and, depending on the person’s age, may include parent training, medication, skills training, counseling, behavioral therapy, and classroom interventions.

(CHADD.org)

Three Possible ADHD Presentations

Children need to exhibit six or more symptoms in two or more settings for a diagnosis; older teens and adults should have at least five of the symptoms. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists three presentations of ADHD—Predominantly Inattentive, Hyperactive-Impulsive, and Combined.

Inattentive

Often:

• Fails to give close attention to details or makes careless mistakes

• Has difficulty sustaining attention

• Does not appear to listen

• Struggles to follow instructions

• Has difficulty with organization

• Avoids or dislike tasks requiring sustained mental effort

• Loses things

• Is easily distracted

• Is forgetful in daily activities

Hyperactive-impulsive

Often:

• Fidgets with hands or feet or squirms in chair

• Has difficulty remaining seated

• Runs about or climbs excessively; extreme restlessness in adults

• Difficulty engaging in activities quietly

• Acts as if driven by a motor; adults will often feel inside as if they are driven by a motor

• Talk excessively

• Blurts out answers

• Difficulty waiting or taking turns

• Interrupts or intrudes upon others

Combined

• Meets the criteria for both inattention and hyperactive-impulsive presentations.

To receive a diagnosis, these symptoms need to start before age 12, be present in more than one setting, interfere with functioning at home, school or work, in social settings, and cannot be better explained by another disorder.

A theory developed by psychiatrist Elisabeth Kübler-Ross suggests that we go through five distinct stages of grief after the loss of a loved one: Denial, anger, bargaining, depression, and finally acceptance. Additionally, we could even take step 5 further to add "finding meaning" to acceptance. Check out the link below for a description of the 5 stages.

^{(https://www.verywellmind.com/five-stages-of-grief-4175361 )}

British psychiatrist Colin Murray Parkes developed a model of grief based on Bowlby's theory of attachment, suggesting there are four phases of mourning when experiencing the loss of a loved one:⁴

• Shock and numbness: Loss in this phase feels impossible to accept. Most closely related to Kübler-Ross's stage of denial, we are overwhelmed when trying to cope with our emotions. Parkes suggests that there is physical distress experienced in this phase as well, which can lead to somatic (physical) symptoms.

• Yearning and searching: As we process loss in this phase, we may begin to look for comfort to fill the void our loved one has left. We may try to do so by reliving memories through pictures and by looking for signs from the person to feel connected to them. In this phase, we become very preoccupied with the person we have lost.

• Despair and disorganization: We may find ourselves questioning and feeling angry in this phase. The realization that our loved one is not returning feels real, and we can have a difficult time understanding or finding hope in our future. We may feel a bit aimless in this phase and find that we retreat from others as we process our pain.

• Reorganization and recovery: In this phase, we feel more hopeful that our hearts and minds can be restored. As with Kübler-Ross's acceptance stage, sadness or longing for our loved one doesn't disappear. However, we move towards healing and reconnecting with others for support, finding small ways to reestablish some normalcy in our daily lives.

(https://www.verywellmind.com/five-stages-of-grief-4175361 )

How to Help When Others are Grieving

It can be so difficult to know what to say or do when someone who has experienced loss. We do our best to offer comfort, but sometimes our best efforts can feel inadequate and unhelpful.

Here are a few tips to keep in mind:

• Avoid rescuing or fixing. Remember, the person who is grieving does not need to be fixed. In an attempt to be helpful, we may offer uplifting, hopeful comments, or even humor, to try to ease their pain. Although the intention is good, this approach can leave people feeling as if their pain is not seen, heard, or valid.

• Don't force it. We may want so badly to help and for the person to feel better, so we believe that nudging them to talk and process their emotions before they're truly ready will help them faster. This is not necessarily true, and it can actually be an obstacle to their healing.

• Make yourself accessible. Offer space for people to grieve. This lets the person know we're available when they're ready. We can invite them to talk with us but remember to provide understanding and validation if they are not ready just yet. Remind them that you're there and not to hesitate to come to you.

All children may experience very stressful events that affect how they think and feel. Most of the time, children recover quickly and well. However, sometimes children who experience severe stress, such as from an injury, from the death or threatened death of a close family member or friend, or from violence, will be affected long-term. The child could experience this trauma directly or could witness it happening to someone else. When children develop long term symptoms (longer than one month) from such stress, which are upsetting or interfere with their relationships and activities, they may be diagnosed with post-traumatic stress disorder (PTSD).

Examples of PTSD symptoms include:

• Reliving the event over and over in thought or in play

• Nightmares and sleep problems

• Becoming very upset when something causes memories of the event

• Lack of positive emotions

• Intense ongoing fear or sadness

• Irritability and angry outbursts

• Constantly looking for possible threats, being easily startled

• Acting helpless, hopeless or withdrawn

• Denying that the event happened or feeling numb

• Avoiding places or people associated with the event

Because children who have experienced traumatic stress may seem restless, fidgety, or have trouble paying attention and staying organized, the symptoms of traumatic stress can be confused with symptoms of attention-deficit/hyperactivity disorder (ADHD).

(cdc.gov)

Unfortunately, child abuse is common and its effects can be long lasting. *An estimated 678,000 children (unique incidents) were victims of abuse and neglect in 2018¹, the most recent year for which there is national data. That’s about 1% of kids in a given year. However, this data may be incomplete, and the actual number of children abused is likely underreported. ¹ National annual child abuse statistics cited from U.S. Administration for Children & Families, Child Maltreatment 2018. This data, released annually, is the most current federal data available. https://www.acf.hhs.gov/cb/research-data-technology/statistics-research/child-maltreatment

Abuse comes in many forms: neglect, drug endangerment, physical abuse, sexual abuse, witnessing violence, psychological/emotional, and medical abuse. For most children, the abuser is someone they know and trust.

*Adult survivors of childhood abuse are more likely to experience mental health difficulties, including depression, anxiety, bipolar disorder, PTSD, eating disorders, and substance use disorders.^[10]

1. Adult survivors of childhood abuse are more likely to engage in high-risk behaviors like smoking, alcohol and drug use, and unsafe sex. They’re also more likely to report overall lower health than those who haven’t experienced childhood abuse.

(dosomething.org)*

Treatment for abuse includes, but not limited to, helping children work through their trauma, finding safe places and safe adults to connect with, and helping to change detrimental thought patterns.

Go to the link below to learn about common abuse symptoms, risk factors, and prevention tips.

https://www.mayoclinic.org/diseases-conditions/child-abuse/symptoms-causes/syc-20370864

For crisis intervention, information, referrals, and support, contact the Childhelp National Child Abuse Hotline at 1-800-422-4453. For 24/7 crisis support at your fingertips, contact the Crisis Text Line by texting DS to 741741.

ODD is a disorder that is classified under disruptive behavior disorders. Children who suffer from ODD symptoms tend to struggle with following directions, accepting authority figures, a poor response to punishment/discipline, struggle to form positive family and positive peer relationships (antisocial), angry or irritable mood and frequently defy or disobey commands. There are a variety of possible reasons this disorder may occur. Genetic factors, neurobiological, personality, family issues, and school factors can all contribute.

Students with ODD can be so uncooperative and combative that their behavior affects their ability to learn and get along with classmates and teachers. It can lead to poor school performance, anti-social behaviors, and poor impulse control.

ODD is more common in boys than girls. Signs of ODD generally develop during preschool years, and are almost always present before early teens.

Students with ODD might need:

• seating closer to the teacher to avoid disrupting other students

• breaks from classroom activities when they feel overwhelmed

• more time to complete assignments

• to consult with a school counselor or psychologist

• to visit the school nurse to take medication for coexisting conditions, such as ADHD

• an individualized education program (IEP) if a learning disability is associated with their ODD

ODD treatment involves therapy, training to help build positive interactions, and sometimes medications to treat related mental health conditions.

What Teachers Can Do

It can be difficult to recognize the differences between a strong-willed or emotional student and one with ODD.

Post classroom rules and review them regularly. Have a plan in place to handle serious behavior problems. Students with ODD often are isolated and lack friends. They may be the targets of bullies or be seen as bullies.

Be sensitive to self-esteem issues. Provide feedback to your student with ODD in private, and avoid asking the student to perform difficult tasks in front of classmates. It can be helpful to praise positive behaviors, such as staying seated, not calling out, taking turns, and being respectful.

More Information

https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/odd/odd_resource_center_odd_guide.pdf