nasp toolkit for parents

BUILDING STEPS TO

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School psychologists:Helping children achieve their best. In school. At home. In life.

www.nasponline.org

LOWERING BARRIERS TO

LEARNING

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Accommodations for Testing Students With Disabilities:Information for Parents

By Sara Bolt, MA National Center on Educational Outcomes, University of Minnesota

Todays schools are increasingly being held accountable for student achievement.Schools must demonstrate that teachers provide quality instruction that results instudents making progress toward standards.

Standards Testing for All Students

State- and district-wide assessment programs have been developed to measure theextent to which students are acquiring important skills and knowledge. Recentlegislation such as the No Child Left Behind Act of 2001 (NCLB) has createdadditional requirements for state-wide testing and demonstrating student progress.Results from these tests are used to make a variety of important decisions. In severalstates and districts, test results are used in high-stakes decision making (e.g., studentgrade promotion, high school graduation). Tests are typically administered annuallyto a whole class at a time in basic subjects such as reading, math, science, and socialstudies. Many of these tests require students to listen to or read questions and markor write out their answers, often within a specified time limit.

All students, including students with disabilities, are expected to participate in stateand district assessment programs. However, students with disabilities sometimeshave trouble showing what they know on tests because of very strict rules about howthe tests are to be given. These rules are created for a good reason: to make sure thatthe test measures the same skills for all students. Unfortunately, these rules can createproblems for students with disabilities. For example, students with print disabilities(students with visual impairments or those with reading disabilities) may not be ableto show their knowledge on a math test that is only given in standard print. Thesestudents may need to have the test read aloud or be provided with a large print orBraille edition of the test.

As a result of these and similar concerns, testing accommodations are often necessaryin order for students with disabilities to show their true knowledge on a test. Becausetests are being used more than ever before to make important decisions aboutstudents, classrooms, and schools, it is important to make sure that students withdisabilities are provided the support they need on a test so that they can show whatthey really know and can do.

Testing Accommodations

A testing accommodation is any change in typical test procedures that allowsstudents with disabilities to better show their knowledge. This might include a


change in:

How the test is presented (Braille, large print, sign language, having testdirections and items read aloud)How the student responds (using a computer, marking answers in a testbooklet rather than responding on a separate bubble answer sheet)Test scheduling (extended time for a timed test, more frequent breaks, specialtime of day)Test setting (taking the test individually or in a small group, rather than withthe entire class)

These are just some examples of accommodations that can allow individual studentsto better demonstrate their knowledge. Many other accommodations may also beneeded.

Legal Basis for Test Accommodations

Disability legislation such as the Individuals with Disabilities Education Act requiresthat appropriate accommodations be provided to students with disabilities, asnecessary, on state- and district-wide tests.

All states have a testing accommodations policy that describes whichaccommodations are typically allowed on the state- and district-wide tests as well asguidelines for making decisions about testing accommodations. An online link to anystates accommodation policy can be found at the National Center on EducationalOutcomes website. (See Websites section below.)

Almost all students with disabilities take state- and district-wide tests, either with orwithout accommodations. Proposed NCLB regulations suggest that no more than 1%of all students should take an alternate assessment, which is an assessment designedonly for students with very significant cognitive disabilities who cannot take theregular test, even with accommodations. Decisions about accommodations should bemade by the students Individualized Education Program (IEP) team, which consistsof teachers, other school support personnel, parents, and the student, and then thedecision about accommodation must be documented on the IEP.

Key Strategies for Testing Accommodations

The following strategies are recommended in order to help make good decisionsabout which accommodations a student should receive:

Consider the specific needs of your child: As a parent, you can offer a valuableperspective on what support your child may need in order to show knowledgeand skill. When making accommodation decisions, consider what test changesyou think will help your child to demonstrate that knowledge. Asking childrenwhat will help them do well on the test can also provide valuable informationand ideas about possible testing accommodations.Find out whether there are accommodations provided as a part of your childsclassroom instruction: In many cases, accommodations that are providedduring instruction can also be provided during a test. Your child may alreadybe receiving extra time to complete assignments or may use an audiotaperecording to work through math word problems. If such accommodations areprovided during instruction, these accommodations can often be providedduring a test.


When possible, choose accommodations that do not stray very far fromstandard conditions: Standard conditions are used for a reason: to make surethe same skills and knowledge are tested across all students who take the test.It is therefore usually best to provide accommodations that do not stray too farfrom standard conditions. For example, it is often necessary to provideaccommodations to students who cannot use a pencil on a writing test. Twoaccommodation options might be having students use a computer to respond orhaving students tell their responses to a teacher. If the student can write usinga computer, this will probably be a better accommodation option, because thestudent will actually be writing, and will not also have to show good dictatingskills, which might include spelling words when speaking and explainingwhere punctuation belongs. Similarly, if a student can read and understand atest, but needs more time to read, it will probably be more appropriate to havethe student read the test with extra time rather than to use a read-aloudaccommodation, in which a teacher reads the test to the student. Of course, thismust be weighed against several factors. For example, if the student is anextremely slow reader, and will likely perform better if the test were readaloud, the read-aloud accommodation might be more appropriate. Whenmaking accommodation decisions like these, always strive for a plan thatprovides an appropriate balance between meeting your childs needs andtesting under standard conditions.Check to be sure that the accommodation helps your child: Sometimesaccommodations are not helpful to students. It is always wise to have teachersverify that an accommodation does not interfere with your childs performanceand is in fact helpful.Be aware of how the accommodation decision may affect future studentopportunities: In some states, a student must take the test under standardconditions in order to receive a standard diploma. Accommodated test scoresare sometimes reported differently than those for non-accommodatedadministrations. Accommodated test scores may or may not be included inoverall school scores, and may be reported in a way that makes it difficult tocompare performance across schools and students. It is important to understandall such related consequences of providing accommodations when makingindividual decisions. It is always best to make sure that your child has theopportunity to take the test under standard conditions if this might increasefuture opportunities. It is also important to advocate for policies that will allowyour child to use appropriate accommodations on tests.Make sure that all relevant professionals are part of the decision-makingprocess: Get input from as many different professionals and family membersas possible about how your child can best show knowledge and skills. Makesure that all current teachers (both regular and special education) are part of thedecision-making process for your child. It also is important that your childcommunicates ideas and thoughts about what accommodations might behelpful.Make accommodation decisions annually: Your childs needs often changefrom year to year. It is best to annually reconsider which (if any) testingaccommodations are needed.

Key Strategies for Administering Testing Accommodations

If it is decided that your child needs accommodations:

Make sure that someone at the school is responsible for your childs testing


accommodations: Testing days can be very hectic days for schools. It is alwaysbest to make sure that there is one person at the school responsible for yourchilds accommodations. This way, your child can be sure to get theaccommodations that are needed.Make sure that your child feels comfortable with the accommodations, and hasreceived the appropriate accommodations during instruction: If students havenever received accommodations before the testing day, they may not knowhow to make the best use of them. For instance, if a child is supposed to use acomputer to respond to a test, but does not know how to use it, the child willprobably not perform very well on the test. Make sure that your child has hadexperience using the accommodations that will be used on the test. Usually thismeans providing the same accommodation during your childs instruction, suchas using a computer to complete written tasks.Those who are administering your childs accommodations should be welltrained: Some accommodations need to be provided by a test proctor. Forexample, some students have a test read aloud by a teacher or dictate theirresponses to a scribe. It is important for those who provide accommodations toknow how to best administer them. Training is sometimes necessary for thesepeople to do their job well, and to make sure that they do not confuse or biasstudent responses.Make sure your child knows why accommodations are provided, and how toadvocate for accommodations in future settings: Help your child to understandthat accommodations can help in demonstrating true abilities on tests. Manyaccommodations that your child may receive during instruction and testing canbe applied in future work settings.Help your child understand how to advocate for accommodations, as needed,in college and employment settings: Simple accommodations may be exactlywhat are needed for your child to be successful in todays world.

Resources

Council for Exceptional Children. (2000). Making assessment accommodationsvideo: A guide for families. Arlington, VA: Author. ISBN: 0-86586-963-4.

Elliott, S. N., Braden, J. P., & White, J. L. (2001). Assessing one and all:Educational accountability for students with disabilities. Arlington, VA: Council forExceptional Children. ISBN: 0-86586-375-X.

Elliott, S. N., Kratochwill, T. R., & Gilbertson, A. (1998). The assessmentaccommodations guide. Monterey, CA: CTB/McGraw-Hill. (Available for purchaseat www.ctb.com)

Thurlow, M., & Elliott, J. (2000). Improving test performance of students withdisabilities. Thousand Oaks, CA: Corwin Press. ISBN: 0-76197-550-4.

Thurlow, M., Elliott, J., & Ysseldyke, J. (2002). Testing students with disabilities:Practical strategies for complying with district and state requirements (2nd ed.).Thousand Oaks, CA: Corwin Press. ISBN: 0- 76193-809-5.

Websites

Federation for Children with Special Needs www.fcsn.org/peer/ess/esshome.html

National Center on Educational Outcomes (NCEO)


www.education.umn.edu/NCEO/ (See www.education.umn.edu/NCEO/TopicAreas/Accommodations/Accomm_topic.htm)

Sara Bolt, MA, is a doctoral candidate in the School Psychology Program at theUniversity of Minnesota and a research assistant at the National Center onEducational Outcomes.

2004 National Association of School Psychologists, 4340 East West Highway,Suite 402, Bethesda, MD 20814(301) 657-0270.

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Diagnosis and Treatment of Attention Disorders: Roles for SchoolPersonnel

The National Association of School Psychologists

One of the most controversial and frequently occurring problems confronting parentsand school personnel is the diagnosis and treatment of attention disorders, oftenlabeled Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder(ADHD). Within the medical and educational communities, there is little agreementas to the nature of the condition: Is it a medical or behavioral disorder? Is it truly a'disorder' or only a collection of symptoms reflecting many possible causes? Nor isthere consistent evidence as to how it is best treated-- with behavioral interventions,medication, or both?

The complicated nature of these questions can lead to serious disagreement betweenparents, teachers, and other professionals about the best course of action to help achild with attention problems. Much of the controversy revolves around theprescription of medication and the appropriate role of school personnel in makingrecommendations to parents. In reaction, some states have gone so far as to enactlegislation attempting to limit the role of school personnel in helping to identify andtreat attention problems, particularly when medication is considered.

Unfortunately, restrictive legislation and debates about research findings can becounterproductive to improving both behavioral and academic outcomes for a childwith ADD/ADHD. Symptoms and appropriate treatment differ from child to childbut almost always impact school performance. Effective identification and treatmentof attention problems in children requires a collaborative effort among family, schoolpersonnel and medical professionals to insure the best possible outcome. Theimportance of joint planning was emphasized recently by the American Academy ofPediatrics, in their Clinical Practice Guidelines: Treatment of the School-Aged ChildWith Attention-Deficit/Hyperactivity Disorder (October 2001).

Identification

The appropriate diagnosis of ADD/ADHD requires a collaborative effort usingmultiple sources of information, regardless of the training or credential of theprofessional(s) involved. It is essential to obtain multiple perspectives regardingsymptoms in order to assess their pervasiveness and severity. Input from family,teachers and other school personnel who have the opportunity to observe and interactwith the student over time in many different situations is therefore critical.Educational, mental health, and medical personnel with appropriate training caneffectively use systematic methods of assessing inattention, activity level, and factorsthat may contribute to attention difficulties. Such methods might include:

formal observation in multiple settingsinterviews with the student and relevant adults


rating scales completed by family, teachers, and the studentdevelopmental, school, and medical historiesformal tests to measure attention, persistence, and related characteristics

Most of these measures are not medical procedures. However, it is important that aphysician knowledgeable about attention problems participate in a comprehensiveevaluation to rule out other medical problems that can interfere with attention andactivity level and to further determine if a medical condition exists.

Eligibility for Special Education

In many states, a diagnosis of ADD or ADHD may contribute to an educationaldiagnosis or classification used to determine a student's eligibility for specialeducation. The diagnosis must be related to one of the handicapping conditionsincluded in the Individuals with Disabilities Education Act (IDEA), such as SpecificLearning Disability, Severe Emotional Disturbance, or the more frequently usedclassification of 'Other Health Impaired.' Some states require a medical doctor'sdiagnosis, while other states have regulations to insure that such diagnoses are notlimited to a physician's evaluation alone. Further, the Individuals with DisabilitiesEducation Act (IDEA) requires that the determination of special education eligibilitybe made by the IEP Team.

It is always best practice to obtain evaluation information from multiple sources,including both home and school. Parents usually know best the age at which thechild initially exhibited symptoms. This is important information that helpsprofessionals determine if the symptoms meet the criteria outlined in the Diagnosticand Statistical Manual or 'DSM-4,' a standard diagnostic classification system. Somestates may specify types of personnel to be involved in evaluating ADD for thepurpose of educational intervention. It is always best practice to include the parents,classroom teacher, and support personnel who are trained to understand and identifyattention problems, such as the school psychologist, school nurse, behavior supportteachers, etc.

Section 504 Eligibility

Sometimes students with a true disability such as ADD/ADHD require modificationsin their instructional program but do not require, or are not eligible for, specialeducation supports. Such students may be eligible for modifications such as untimedtests, quiet work spaces, etc. under Section 504 of the Rehabilitation Act of 1973(Public Law 93-112). Each school system is required to have procedures forevaluating students for Section 504 accommodations and modifications. As in thecase of determining special education needs, a team approach involving parents,teachers and support personnel should be followed in developing plans for studentswith ADD/ADHD.

Intervention

Interventions for attention problems should always include the development ofPositive Behavior Supports in the school and/or home setting, as appropriate to thechild's needs. For some children, behavioral supports can be sufficient and effectivein reducing attention problems. Medication is a common treatment for attentionproblems, but also the most controversial due to conflicting results from researchregarding side effects of both short-term and long-term use of stimulant drugs. Many


children respond quickly and positively to medication, while others may show noresponse or negative effects. Because identifying the most appropriate, safemedication and dosage for a given child can be quite difficult and time consuming, itis essential that parents and school personnel maintain ongoing collaboration with aphysician whenever medication is prescribed.

Role of School Personnel in Intervention

Only physicians and, in some states, other specifically trained personnel, canprescribe medication. In some states and school districts, school personnel may bespecifically prohibited from suggesting medication to parents. However, when amedically-based condition is suspected, it is the responsibility of all trained schoolpersonnel to provide parents with information to help them determine the need for amedical evaluation, and to provide the family and physician with relevantinformation to assist in any diagnosis or treatment plan.

Occasionally, schools inappropriately direct parents to seek evaluation andmedication for their children as a pre-requisite for readmitting the child to schoolfollowing suspension. Some states have specifically and rightly outlawed thispractice. It is never appropriate to make educational placements and programmingcontingent upon specific treatment such as medication.

Regardless of the outcome of a medical evaluation, however, children with attentionproblems require support in the school and home environments. Planning andimplementing effective behavior management strategies and modifications ininstruction and the physical environment, as well as conducting ongoing monitoringof the student's performance, are appropriate roles for school personnel. Schoolpsychologists are particularly trained to help design and implement plans to supportstudents with attention problems in the schools, and can also help parents developeffective strategies to support their child at home. Additionally, school personnel canprovide critical information about the student's performance to physicians monitoringthe effects of medication.

Conclusion

The identification and treatment of students with attention problems is bothcontroversial and complex, involving many different theories, bodies of research,legal mandates and different systems that impact the student. However, regardless ofprofessional viewpoints and legal constraints, it is essential that families, relevantschool personnel and the medical community work together to insure that symptomsare evaluated and that appropriate interventions across settings are provided. With orwithout medication, children with attention problems benefit from a positive,supportive school and home environment and the collaboration of significant adults.

Revised 3-02

2002, National Association of School Psychologists, 4340 East West Hwy #402,Bethesda, MD 20814

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Aggression in Adolescents: Strategies for Parents and Educators

By Tammy D. Barry, PhD, Texas A&M University &John E. Lochman, PhD, The University of Alabama

Childhood aggression is an important focus for educators and parents owing to itsrelative stability over time and consistent link to a variety of negative outcomes laterin adolescence, including delinquency, substance use, conduct problems, pooradjustment, and academic difficulties (poor grades, suspension, expulsion, anddropping out of school). In addition, verbal and physical aggression often are the firstsigns, as well as later defining symptoms, of several childhood psychiatric disorders.These include Oppositional Defiant Disorder and Conduct Disorder, both of whichhave prevalence rates ranging from 6 to 10% in the general population and evenhigher among males, according to the American Psychiatric Association. This furtherhighlights the need to recognize and treat aggressive behaviors early.

Characteristics

Aggressive behaviors can vary from problems with emotional regulation to severeand manipulative behaviors. There are various characteristics of aggression, whichcan include behaviors such as starting rumors; excluding others; arguing; bullying,both verbally (name-calling) and physically (pushing); threatening; striking back inanger; use of strong-arm tactics (to get something they want); and engaging inphysical fights.

Notably, aggressive behaviors do not always involve physical contact with anotherperson. Verbal aggression in elementary school years, such as starting rumors,excluding others, and arguing, can be part of a developmental trajectory leading toadolescent delinquency and Conduct Disorder.

Developmental Issues

Adolescents with a childhood onset of aggression, rather than an adolescent onset,are more likely to display the most persistent, severe, and violent antisocial behavior.Indeed, childhood aggression is often viewed as an indication of a broader syndrome,frequently involving oppositional and defiant behavior toward adults and covert rule-breaking behaviors. These behaviors could lead to more serious and recurrentviolations in adolescence, such as stealing, vandalism, assault, and substance abuse.

Family and personal factors. The development of adolescent antisocial behavior isoften considered to be the result of a set of family and personal factors, with thechilds aggressive behavior representing a substantial part of that developmentalpattern. For example, children with difficult temperaments and early behavioralproblems are at greater risk for later adolescent aggression and conduct problems.This developmental course is also set within the childs social environment. Forexample, poor parenting practices, such as poor parental monitoring and supervision


and high rates of harsh and inconsistent discipline, have been shown to contribute tochildrens aggressive behavior.

Early social interactions. In early to middle childhood, children who show highlevels of oppositional behavior and aggression may experience negative reactionsfrom teachers and peers. This may also lead to problematic ways of processing socialinformation, such as relying on aggressive solutions in problem solving whenpresented with social conflicts, expecting that aggressive solutions will work, andhaving difficulties interpreting social information accurately (such as attributingneutral behaviors by others as hostile). Aggressive children are at risk for manyacademic problems and, as their academic progress and social bond to schoolweakens (owing to problematic exchanges with teachers and peers), they becomemore vulnerable to influences from deviant peer groups.

Risks in adolescence. By adolescence, this developmental course results in aheightened risk of substance use, delinquent acts, and school failure. Likewise,certain environmental risk factors can play a role in moving an adolescent along thisdevelopmental pathway. For example, family dysfunction may be sufficient toinitiate the sequence of escalating aggressive behavior. Living in poor, crime-riddenneighborhoods also adds to the environmental risk factors leading to seriouslyaggressive, problematic behavior.

Intervention

Effective strategies. In response to recent serious school violence (includingincidents of schoolyard shootings), techniques to prevent violence and to intervenewith at-risk aggressive youth have received significant attention from educationpolicymakers. Recent research has identified effective treatments for aggressiveyouth. Group intervention programs, which are efficient in both time and cost, areoften as effective as individual therapy in treating aggressive youth. Structured groupprograms can be used not only with youth presenting with aggressive behaviors, butalso with those identified as at risk for aggressive behavior problems in an effort toprevent negative outcomes. Treatment strategies aimed at parents (such as improvingparental monitoring and consistency in discipline), as well as treatments directlytargeting children and adolescents (including cognitive behavioral treatments, such asproblem solving and anger management training), have helped reduce behavioralproblems and aggression in children and adolescents. Treatment outcome researchindicates that a combination of interventions for both parents and youth may be themost effective.

Parent involvement. Even with adolescents, parents should participate in interventionprograms when their teenager displays significant aggressive behavior. For example,the Adolescent Transitions Program is a parent training program developed by TomDishion and colleagues. It includes a parent-focused curriculum that teaches familymanagement skills, limit setting and supervision, problem solving, and improvedfamily relationships and communication patterns. The goals of the program are toprevent the development of antisocial behaviors among aggressive teenagers.

Cognitive-behavioral programs. Aggressive adolescents can also benefit greatlyfrom cognitive-behavioral programs that provide new coping techniques for angermanagement and that teach them alternative ways of dealing with social conflict. Forexample, the Anger Control Program (developed by Eva Feindler and colleagues)focuses on teaching the adolescent how to modify his or her own aggressive andimpulsive behavior when faced with aversive or stressful situations. This program


has been shown to lead to significant changes in problem-solving ability and self-control among aggressive adolescents. Problem-Solving Skills Training (PPST) wasdeveloped by Kazdin and colleagues to treat Oppositional Defiant Disorder orConduct Disorder in youth of varying ages. PPST involves 12 or more sessionsdesigned to teach problem-solving steps; introduce effective ways to apply the steps,including application to real-life situations; and provide opportunity to role-play useof the steps, including with the parent. Kazdin and colleagues have also developed aParent Management Training (PMT) program, consisting of 13 sessions focusing onobserving behavior; positive reinforcement and attending; school intervention;holding family meetings; negotiating, contracting, and compromising; and dealingwith low-rate, serious behaviors (such as fire setting). Kazdin notes that ideally boththe youth and parent would be involved in each of the respective treatment programs.Outcome research shows that combined PSST and PMT are more effective thaneither program alone.

Intensive programs: Anger Coping. Intensive, comprehensive prevention programshave been developed and evaluated with high risk youth. Results indicate thataggressive behavior and other disruptive behavior symptoms can be reduced throughearly intervention. Follow-up studies suggest that adolescents who participated inthese programs when younger have more positive outcomes. One such preventionprogram is Anger Coping, which was developed to reduce aggressive youths angerand behavior problems. This cognitive-behavioral program focuses on at-riskaggressive children and early adolescents age 913 and is designed to provide copingand problem-solving skills to deal with anger and resulting aggressive behavior.Based on promising findings for the Anger Coping Program, a more recent version,the Coping Power Program, has been developed. The Coping Power Program isdesigned to bring about change in the family system by working with both the youthand the parent separately.

The Anger Coping Program and the child component of the Coping Power Programaim to improve youths ability to regulate aggressive behavior, to function well in avariety of settings, and to better manage their anger. The programs are typicallyprovided in a school-based group format. The Anger Coping Program includes 18weekly sessions. The Coping Power Program includes 34 weekly sessions. The childcomponent sessions cover material such as goal setting, organizational skills,perspective taking, emotional awareness, use of coping statements to deal with anger,relaxation training, social problem solving, making friends and negotiating withpeers, developing positive peer relationships and avoiding deviant peer groups, andresisting peer pressure.

The Coping Power parent component is also based on cognitive-behavioralprinciples, and is designed to address caregiver and parenting risk factors for childaggression. Parents learn additional strategies that support the skills that their childrenlearn in the child component, as well as some techniques for dealing with parentingstress. Parents learn how to create a positive home environment and to end thecoercive cycle that may exist between them and their aggressive child.

Typically, parents meet during 16 meetings approximately once every 2 weeks in thelate afternoon or evening hours at their childrens school. Sessions include academicsupport in the home, tracking and attending to their childs behaviors, praise andrewards for positive behaviors, ignoring minor disruptive behaviors, giving effectiveinstructions, establishing rules and expectations, use of consequences for defiant ordisruptive behaviors, handling their childs behavior during the summer months,family cohesion building, family problem solving, and family communication.


There are many developmental implications for this treatment, and the main targetsof intervention will change with the youths age. For example, parents of youngerchildren may be taught to focus more on timeout procedures for inappropriate ordefiant behavior, whereas a focus on monitoring and supervision should be primaryfor parents of aggressive adolescents. The benefits of the Anger Coping and CopingPower programs with aggressive youth have been established in studies that includedrandom assignment to either participate in a group or to be in an untreated controlcondition (receiving care as usual).

Tips for Dealing With an Aggressive Adolescent

When dealing with an aggressive adolescent, teachers, and parents may use thefollowing guidelines:

No child is always bad. Catch the adolescent behaving well and attend to and praisethese positive behaviors. Provide additional opportunities to act appropriately andgive positive feedback. If you only notice inappropriate and aggressive behavior,these behaviors may be used as a way to get your attention.

Respect. Always let the adolescent know that you care and respect him or her.Remind the adolescent that it is the inappropriate behaviors (not the individual) thatyou do not like.

Dont ignore. Although ignoring minor disruptive behaviors (complaining) can be aneffective way to decrease those behaviors, do not ignore inappropriate aggression.

Be positive. Remain calm and model positive problem solving for the adolescent. Donot become angry in response to his or her anger.

Dont rationalize. Do not try to rationalize about the aggressive behavior or why youare invoking consequences; avoid a power struggle.

Behavior contracts. Set up a behavioral contract to help the adolescent take controlof his or her own behavior. The contract should list target positive behaviors that areexpected and a reward that can be earned for meeting a criterion number of thesetarget behaviors. Rewards can be naturally occurring consequences, such as going toa movie with friends or a homework pass. The target behaviors should be stated aspositive behaviors (the Dos rather than the Do nots). They should communicateyour expectations. Therefore, if the adolescent often argues, the target behavior mightbe to discuss things calmly.

Effective commands. Use effective instructions and commands. Commands shouldbe concise, direct, positively stated, and given one at a time. Avoid questioncommands (Would you like to help me clean out the garage?) because they providean opportunity to say, No. Avoid Lets commands, unless you actually plan tohelp with the task. Avoid commands that are vague, include multiple requestschained together, or that give too much explanation.

House rules. Set up house rules or classroom rules that must always be followed.These rules can focus on decreasing aggressive behavior. If the adolescent breaks arule, then he or she is given an immediate consequence (that is, no warnings).

Negative consequences. When the adolescent does not follow instructions or otherestablished expectations, breaks rules, or engages in aggressive behavior, provide


prompt negative consequences. These can include extra work chores or loss of aprivilege.

Communication. Increase ongoing communication and cohesion between yourselfand the adolescent. The adolescent then will be more likely to come to you when aproblem arises.

Problem solving. Model effective problem solving: identification of the problem;generating multiple potential responses, both positive and negative; evaluatingalternative responses; and planning for implementation of the response. Help theadolescent to see problem solving in action and use opportunities to assist him or herin applying these principles to his or her own problems.

Relaxation. Teach quick but effective relaxation techniques (deep breathing,counting to 10) that can be used to calm down when he or she gets very angry.

Coping statements. Help the adolescent to develop a list of coping statements to dealwith anger. Practice these statements in advance, so that he or she will be morereadily able to use these statements when in provoking social situations.

Perspective taking. Aid the adolescent in understanding others perspectives,including what others may be thinking and feeling. Again, practice perspectivetaking in advance during non-provoking situations so that he or she will be betterprepared to do so when provoked.

Negotiating. Teach the adolescent skills for negotiating needs with peers, parents,and teachers, so that the teen will be less likely to use aggression or defiance as ameans of getting what he or she wants.

Autonomy. Help the adolescent develop autonomy by valuing his or her positiveideas and encouraging positive independent thinking and decision making. Asexperience with these positive experiences develops, the adolescent is less likely torespond in negative, aggressive ways.

Monitoring. For parents of adolescents, monitoring is crucial. This monitoringshould be presented in a caring way, rather than as a violation of privacy. Whenparents take a genuine interest in their adolescent, the adolescent is less likely toengage in disruptive behavior. Ask who his or her friends are and what he or shedoes in his or her free time. Whenever your child is going out, know who is going,where he or she is going, how he or she will get there, what he or she will be doing,and when he or she will return home.

Techniques. Provide the adolescent with techniques for joining new, positive peergroups and avoiding deviant peer groups and negative peer pressure.

Evaluation. Whenever a teacher or parent is very concerned about ongoinginappropriate behavior, a comprehensive evaluation by a qualified mental healthprofessional should be arranged to determine if more intensive treatment, such astherapy, is needed.

Resources

Kazdin, A. E., & Weisz, J. R. (2003). Evidence-based psychotherapies for childrenand adolescents. New York: Guilford. ISBN: 1572306831.


Larson, J., & Lochman, J. E. (2002). Helping school children cope with anger: Acognitive-behavioral intervention. New York: Guilford. ISBN: 1572307285.

Lochman, J. E., & Wells, K. C. (2002). The Coping Power Program at the middleschool transition: Universal and indicated prevention effects. Psychology of AddictiveBehaviors, 16, S40S54.

Reid, J. B., Patterson, G. R., & Snyder, J. (2002). Antisocial behavior in children andadolescents: A developmental analysis and model for intervention. Washington DC:American Psychological Association. ISBN: 1557988978.

van de Weil, N. M. H., Matthys, W., Cohen-Kettenis, P., & van Engeland, H.(2003). Application of the Utrecht Coping Power Program and care as usual tochildren with disruptive behavior disorders in outpatient clinics: A comparative studyof cost and course of treatment. Behavior Therapy, 34, 421436.

Website

Centers for Disease Control and Prevention: Youth Violence in the United Stateswww.cdc.gov/ncipc/dvp/youth/newfacts.htm

The National Institute of Mental Health: Children and Violence (booklets, factsheets, and summaries) www.nimh.nih.gov/publicat/violencemenu.cfm

Tammy D. Barry, PhD, is an Assistant Professor at Texas A&M University. John E.Lochman, PhD, is Professor and Saxon Chair in Clinical Psychology at TheUniversity of Alabama.

2004 National Association of School Psychologists, 4340 East West Highway,Suite 402, Bethesda MD 20814 301-657-0270.

School professionals and organizations (e.g., the PTA) can print the fact sheetsindividually for hard copy distribution. However, all fact sheets must bedisseminated in the original form with the NASP logo and the information creditedto NASP, whether in print or online format.

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Anxiety and Anxiety Disorders in Children: Information forParents

By Thomas J. Huberty, PhD, NCSPIndiana University

Anxiety is a common experience to all of us on an almost daily basis. Often, we useterms like jittery, high strung, and uptight to describe anxious feelings. Feelinganxious is normal and can range from very low levels to such high levels that social,personal, and academic performance is affected. At moderate levels, anxiety can behelpful because it raises our alertness to danger or signals that we need to take someaction. Anxiety can arise from real or imagined circumstances. For example, astudent may become anxious about taking a test (real) or be overly concerned that heor she will say the wrong thing and be ridiculed (imagined). Because anxiety resultsfrom thinking about real or imagined events, almost any situation can set the stagefor it to occur.

Defining Anxiety

There are many definitions of anxiety, but a useful one is apprehension or excessivefear about real or imagined circumstances. The central characteristic of anxiety isworry, which is excessive concern about situations with uncertain outcomes.Excessive worry is unproductive, because it may interfere with the ability to takeaction to solve a problem. Symptoms of anxiety may be reflected in thinking,behavior, or physical reactions.

Anxiety and Development

Anxiety is a normal developmental pattern that is exhibited differently as childrengrow older. All of us experience anxiety at some time and cope with it well, for themost part. Some people are anxious about specific things, such as speaking in public,but are able do well in other activities, such as social interactions. Other people mayhave such high levels of anxiety that their overall ability to function is impaired. Inthese situations, counseling or other services may be needed.

Infancy and preschool. Typically, anxiety is first shown at about 79 months, wheninfants demonstrate stranger anxiety and become upset in the presence of unfamiliarpeople. Prior to that time, most babies do not show undue distress about being aroundstrangers. When stranger anxiety emerges, it signals the beginning of a period ofcognitive development when children begin to discriminate among people. A seconddevelopmental milestone occurs at about 1218 months, when toddlers demonstrateseparation anxiety. They become upset when parents leave for a short time, such asgoing out to dinner. The child may cry, plead for them not to leave, and try to preventtheir departure. Although distressing, this normal behavior is a cue that the child isable to distinguish parents from other adults and is aware of the possibility they may


not return. Ordinarily, this separation anxiety is resolved by age 2, and the childshows increasing ability to separate from parents. Both of these developmentalperiods are important and are indicators that cognitive development is progressing asexpected.

School age. At preschool and early childhood levels, children tend to be limited intheir ability to anticipate future events, but by middle childhood and adolescencethese reasoning skills are usually well developed. There tends to be a gradual changefrom global, undifferentiated, and externalized fears to more abstract and internalizedworry. Up to about age 8 children tend to become anxious about specific, identifiableevents, such as animals, the dark, imaginary figures (monsters under their beds), andof larger children and adults. Young children may be afraid of people that olderchildren find entertaining, such as clowns and Santa Claus. After about age 8,anxiety-producing events become more abstract and less specific, such as concernabout grades, peer reactions, coping with a new school, and having friends.Adolescents also may worry more about sexual, religious, and moral issues, as wellhow they compare to others and if they fit in with their peers. Sometimes, theseconcerns can raise anxiety to high levels.

Anxiety Disorders

When anxiety becomes excessive beyond what is expected for the circumstances andthe childs developmental level, problems in social, personal, and academicfunctioning may occur, resulting in an anxiety disorder. The signs of anxietydisorders are similar in children and adults, although children may show more signsof irritability and inattention. The frequency of anxiety disorders ranges from about 2to 15% of children and occurs somewhat more often in females. There are manytypes of anxiety disorders, but the most common ones are listed below.

Separation anxiety disorder. This pattern is characterized by excessive clinging toadult caretakers and reluctance to separate from them. Although this pattern is typicalin 1218-month-old toddlers, it is not expected of school-age children. This disordermay indicate some difficulties in parent-child relationships or a genuine problem,such as being bullied at school. In those cases, the child may be described as havingschool refusal, sometimes called school phobia. Occasionally, the child can talk aboutthe reasons for feeling anxious, depending on age and language skills.

Generalized anxiety disorder. This pattern is characterized by excessive worry andanxiety across a variety of situations that does not seem to be the result of identifiedcauses.

Post-Traumatic Stress Disorder. This pattern often is discussed in the popular mediaand historically has been associated with soldiers who have experienced combat. It isalso seen in people who have experienced traumatic personal events, such as loss ofa loved one, physical or sexual assault, or a disaster. Symptoms may include anxiety,flashbacks of the events, and reports of seeming to relive the experience.

Social phobia disorder. This pattern is seen in children who have excessive fear andanxiety about being in social situations, such as in groups and crowds.

Obsessive-compulsive disorder. Characteristics include repetitive thoughts that aredifficult to control (obsessions) or the uncontrollable need to repeat specific acts,such as hand washing or placing objects in the same arrangement (compulsions).


Characteristics of Anxiety

Although the signs of anxiety vary in type and intensity across people and situations,there are some symptoms that tend to be rather consistent across anxiety disordersand are shown in cognitive, behavioral, and physical responses. Not all symptoms areexhibited in all children or to the same degree. All people show some of these signsat times, and it may not mean that anxiety is present and causing problems. Most ofus are able to deal with day-to-day anxiety quite well, and significant problems arenot common. The chart at the end of the handout demonstrates behaviors that, ifpresent to a significant degree, can indicate anxiety that needs attention. As a parent,you may be the first person to suspect that your child has significant anxiety.

Relationship to Other Problems

Although less is known about how anxiety is related to other problems as comparedto adults, there are some well-established patterns.

Depression. Anxiety and depression occur together about 5060% of the time. Whenthey do occur together, anxiety most often precedes depression, rather than theopposite. When both anxiety and depression are present, there is a higher likelihoodof suicidal thoughts, although suicidal attempts are far less frequent.

Attention Deficit Hyperactivity Disorder. At times, anxiety may appear similar tobehaviors seen with Attention Deficit Hyperactivity Disorder (ADHD). For example,inattention and concentration difficulties are often seen in children with ADHD andwith children who have anxiety. Therefore, the child may have anxiety rather thanADHD. Failing to identify anxiety accurately may explain why some children do notrespond as expected to medications prescribed for ADHD. The age of the child whenthe behaviors were first observed can be a useful index for determining if anxiety orADHD is present. The signs of ADHD usually are apparent by age 4 or 5, whereasanxiety may not be seen at a high level until school entry, when children mayrespond to demands with worry and needs for perfectionism. A thoroughpsychological and educational evaluation by qualified professionals will help todetermine if the problem is ADHD or anxiety. If evaluation or consultation isneeded, developmental information about the problem will be useful to theprofessional.

School performance. Children with anxiety may have difficulties with school work,especially tasks requiring sustained concentration and organization. They may seemforgetful, inattentive, and have difficulty organizing their work. They may be toomuch of a perfectionist and not be satisfied with their work if it does not meet highpersonal standards.

Substance use. What appears to be anxiety may be manifestations of substance use,which may begin as early as the pre-teen years. Children who are abusing drugs oralcohol may show sleep problems, inattention, withdrawal, and reduced schoolperformance. Although substance abuse is less likely with younger children, thepossibility increases with age.

Interventions

Anxiety is a common experience for children, and, most often, professionalintervention is not needed. If anxiety is so severe that your child cannot do expected


tasks, however, then intervention may be indicated.

Does My Child Need Professional Help?

Answering the following questions may be helpful in deciding if your child needsprofessional help:

Is the anxiety typical for a child this age?Is the anxiety shown in specific situations or is it more pervasive?Is the problem long term or is it recent?What events may be contributing to the problems?How are personal, social, and academic development affected?

If the anxiety is atypical for the childs age, is long standing, does not seem to beimproving, and is causing significant problems, then it is advisable to talk with aprofessional, such as the school psychologist or counselor, who might recommend areferral to a community mental health professional. Individual counseling, or evengroup or family counseling, may be used to help the child deal with school, family,or personal issues that are related to the anxiety. In some cases, a physician mayrecommend medication. Although medication for childhood disorders is not wellresearched and side effects must be monitored, this treatment may be helpful whencombined with counseling approaches.

How Can I Help My Child?

Although professional intervention may be necessary, the following list may behelpful to parents in working with the child at home:

Be consistent in how you handle problems and administer discipline.Remember that anxiety is not willful misbehavior, but reflects an inability tocontrol it. Therefore, be patient and be prepared to listen. Being overly critical,disparaging, impatient, or cynical likely will only make the problem worse.Maintain realistic, attainable goals and expectations for your child. Do notcommunicate that perfection is expected or acceptable. Often, anxious childrentry to please adults, and will try to be perfect if they believe it is expected ofthem.Maintain a consistent, but flexible, routine for homework, chores, andactivities.Accept mistakes as a normal part of growing up, and that no one is expected todo everything equally well. Praise and reinforce effort, even if success is lessthan expected. There is nothing wrong with reinforcing and recognizingsuccess, as long as it does not create unrealistic expectations and result inunreasonable standards.If your child is worried about an upcoming event, such as giving a speech inclass, practice it often so that confidence increases and discomfort decreases. Itis not realistic to expect that all anxiety will be removed; rather, the goalshould be to get the anxiety to a level that is manageable.Teach your child simple strategies to help with anxiety, such as organizingmaterials and time, developing small scripts of what to do and say, eitherexternally or internally, when anxiety increases, and learning how to relaxunder stressful conditions. Practicing things such as making speeches until acomfort level is achieved can be a useful anxiety-reducing activity.Listen to and talk with your child on a regular basis and avoid being critical.Being critical may increase pressure to be perfect, which may be contributing


to the problem in the first place. Do not treat emotions, questions, andstatements about feeling anxious as silly or unimportant. They may not seemimportant to you but are real to your child. Take all discussion seriously, andavoid giving too much advice and instead be there to help and offer assistanceas requested. You may find that reasoning about the problem does not work. Attimes, children may realize that their anxiety does not make sense, but areunable to do anything about it without help.Do not assume that your child is being difficult or that the problem will goaway. Seek help if the problem persists and continues to interfere with dailyactivities.

Conclusion

Untreated anxiety can lead to depression and other problems that can persist intoadulthood. However, anxiety problems can be treated effectively, especially ifdetected early. Although it is neither realistic nor advisable to try to completelyeliminate all anxiety, the overall goal of intervention should be to return your child toa typical level of functioning.

Resources

Bourne, E. J. (1995). The anxiety and phobia workbook (2nd ed.). Oakland, CA:New Harbinger. ISBN: 1- 56224-003-2.

Dacey, J. S., & Fiore, B. (2001). Your anxious child: How parents and teachers canrelieve anxiety in children. San Francisco: Jossey-Bass. ISBN: 0-78796-040-3.

Manassis, K. (1996). Keys to parenting your anxious child. New York: Barrons.ISBN: 0-81209-605-3.

Website

Anxiety Disorders Association of Americawww.aada.org

National Mental Health Associationwww.nmha.org

Thomas J. Huberty, PhD, NCSP, is Professor and Director of the School PsychologyProgram at Indiana University, Bloomington, IN.

2004 National Association of School Psychologists, 4340 East West Highway,Suite 402, Bethesda, MD 20814(301) 657-0270.

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NASP Communiqu&ecute;, Vol. 32, #7May 2004

Attachment: Information and Strategies for Parents

Martha Farrell Erickson, PhDChildren, Youth, & Family Consortium, University of Minnesota

Attachment is a term used to describe the emotional connection between infants andtheir parents. Attachment is not the same as bonding. Bonding refers to a short-termphenomenon that occurs shortly after birth and describes the parents' experiences ofgetting to know and to feel close to their new baby. Attachment, on the other hand,is a relationship that develops over a longer period of time and depends upon bothpartners, the parent and the child. Attachment is typically well established by thetime the child is about 1 year old, the result of weeks and months of interactionsbetween parent(s) and child.

Development and Importance of Attachment

The quality of the attachment between parents and children is an important factor inhelping children develop into competent, happy, productive adults. Attachment isrelated to different patterns of behavior with long-term effects. It is through warm,caring, and trusting relationships between parents and children that children learnlife-long social, emotional, and cognitive skills. When children feel safe and securein the world, they explore the world more fully, try new things, make mistakes, buildmeaningful relationships with other children and adults, and view the world in apositive light. Research shows that a relationship with a supportive, caring adult canhelp children successfully overcome life's adversities and challenges.

Quality of Attachment

Nearly all children form attachments to their parents. The attachments are usuallywell established by the end of the first year and continue throughout the child's life. However, those attachments, or relationships, are not all the same. Attachments canbe grouped into two categories: secure and insecure. Why are some children securelyattached and others insecurely attached? The quality of the attachment is largelydetermined by how parents care for their babies:

Secure attachment. Babies become securely attached when their parents areconsistently sensitive and responsive to their needs. Their parents consistentlycomfort them when they cry or are upset, and play with them in age-appropriateways. These babies trust that they can get support and care from adults, and thinkthe world is a safe place. Children who are securely attached explore theirenvironments more thoroughly and enthusiastically, have more tolerance forchallenging situations, regulate their emotions more effectively, are better liked by


teachers and students, and are better at problem solving and showing empathy.

Insecure attachment. When parents are inconsistent or unresponsive to babies'needs, babies do not think of the world as a place of comfort, and get a message thattheir needs are unimportant. In essence, they learn that they cannot rely upon parentsfor care and support. These babies may become insecurely attached. These earliestmessages lay the foundation for children's later development. Children who areinsecure may manifest their anxiety in one of two patterns: avoidance or resistance. Avoidantly attached children often develop behavior problems (including aggressiveor socially withdrawn behavior), are unpopular with other children, lack motivationand persistence in learning, and tend to be victimizers of other children. Resistantlyattached children tend to be overly dependent upon teachers for help and attention,lack confidence and self-esteem, are less able to form friendships than other children,are socially withdrawn from peers, and are the victims of more aggressive peers.

How Parents Can Encourage Secure Attachments

Parents can do much to form secure attachments with their babies. The key is torespond sensitively and consistently, taking cues from the baby. It is similar to slowdancing, with the parent letting the baby lead. Parents can encourage secureattachment by:

Holding and caressing the babyComforting the baby when he or she criesSpeaking to the baby warmly Establishing eye contact and smiling at the babyPlaying baby games, such as "peek-a-boo" or "this little piggy"Creating and maintaining a stable environment and routine for the babyEnjoying the baby and his or her unique self

Taking care of a baby can be very difficult and challenging for parents. To be bestable to meet the needs of their babies, parents need:

Basic needs met (food, clothing, shelter, emotional support)

Knowledge about child development and understand the meaning of key behaviors(separation anxiety)

Ability to examine their own childhood experiences and how those influence theircurrent parenting behaviors and attitudes

If parents are stressed or having other personal difficulties, they may want to seekhelp or support from a family member, friend, or professional. To take care of ababy, parents also need to take care of themselves.

Where to Go for Help

There are professionals who can help if parents are concerned about the quality oftheir attachment with their baby or with their baby's development. These include:

Local school district's school psychologistLocal mental health associationCrisis hotlineParent support groups, such as Circle of Parents


Resources

Erickson, M. F., & Kurz-Reimer, K. (2002). Infants, toddlers and families: Aframework for support and intervention. New York: Guilford. ISBN: 1572307781.

Karen, R. (1998). Becoming attached: First relationships and how they shape ourcapacity to love (2nd ed.). New York: Oxford University Press. ISBN: 0195115015.

Leach, P. (1994). Your baby and child: From birth to age five. New York: Knopf.ISBN: 0375700005.

Website

Zero to Three National Center for Infants, Toddlers, andFamilies-www.zerotothree.org

Martha Farrell Erickson, PhD, is a Senior Fellow and the founding director of theChild, Youth, and Family Consortium at the Irving B. Harris Training Center forInfant and Toddler Development at the University of Minnesota. She is the developerof Project STEEP (Steps Toward Effective, Enjoyable Parenting) and has served asan advisor to a variety of policy makers, including Vice President Al Gore. Thishandout will appear in Helping Children at Home and School II: Handouts forFamilies and Educators, to be published by NASP in spring 2004.

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Bullying Prevention: What Schools and Parents Can Do

Bullying is a widespread problem in our schools and communities. The behaviorencompasses physical aggression, threats, teasing, and harassment. In any form,bullying is an unacceptable anti-social behavior that can undermine the quality of theschool environment, affect students academic and social outcomes, cause victimsemotional and psychological trauma, and, in extreme cases, lead to serious violence.

It is critical that adults create an environment in school and at home where bullyingis not tolerated under any circumstances. Bullying is not an inevitable part ofgrowing up but learned through influences at home, in school, from peer groups, andthrough the media. As such, it also can be unlearned or, better yet, prevented. Thefollowing information can help parents and teachers ensure that children understandthe appropriate way to treat others, and are not victimized by cruel or threateningbehavior.

Facts About Bullying

Bullying is the most common form of violence in our society; between 15%and 30% of students are bullies or victims.A 2001 report from the American Medical Association on a study of over15,000 6th-10th graders estimates that approximately 3.7 million youthsengage in, and more than 3.2 million are victims of, moderate or seriousbullying each year.Since 1992, there have been 250 violent deaths in schools that involvedmultiple victims. In virtually every school shooting, bullying has been afactor.Membership in either bully or victim groups is associated with school drop out,poor psychosocial adjustment, criminal activity and other negative long-termconsequences.Direct, physical bullying increases in elementary school, peaks in middleschool and declines in high school. Verbal abuse, on the other hand, remainsconstant. The U.S. Department of Justice reports that younger students aremore likely to be bullied than older students.25% of teachers see nothing wrong with bullying or putdowns andconsequently intervene in only 4% of bullying incidents.Over two-thirds of students believe that schools respond poorly tobullying, with a high percentage of students believing that adult help isinfrequent and ineffective.

Why Do Some Children and Adolescents Become Bullies?

A bully is someone who directs physical, verbal, or psychological aggression orharassment toward others, with the goal of gaining power over or dominating anotherindividual. Research indicates that bullying is more prevalent in boys than in girls,though this difference decreases when considering indirect aggression (such as verbal


threats), which is more common among girls. Bullying behavior is not caused by onefactor, but generally results from multiple influences in a childs environment,including:

Family factors. The frequency and severity of bullying is related to the amountof adult supervision that children receivebullying behavior is reinforcedwhen it has no or inconsistent consequences. Additionally, children whoobserve parents and siblings exhibiting bullying behavior, or who arethemselves victims, are likely to develop bullying behaviors. When childrenreceive negative messages or physical punishment at home, they tend todevelop negative self-concepts and expectations, and may therefore attackbefore they are attackedbullying others gives them a sense of power andimportance.School factors. Because school personnel often ignore bullying, children canbe reinforced for intimidating others. Bullying also thrives in an environmentwhere students are more likely to receive negative feedback and negativeattention than in a positive school climate that fosters respect and sets highstandards for interpersonal behavior.Peer group factors. Children may interact in a school or neighborhood peergroup that advocates, supports, or promotes bullying behavior. Some childrenmay bully peers in an effort to fit in, even though they may beuncomfortable with the behavior.

Why Do Some Children and Adolescents Become Victims?

A victim is someone who repeatedly is exposed to aggression from peers in the formof physical attacks, verbal assaults, or psychological abuse. Victims are more likelyto be boys and to be physically weaker than their peers. They generally do not havemany, if any, good friends and may display poor social skills and academicdifficulties in school.

Victims signal to others that they are insecure, primarily passive, and will notretaliate if they are attacked. Consequently, bullies often target children whocomplain, appear physically or emotionally weak, and seek attention from peers. Studies also show that victims have a higher prevalence of overprotective parents orschool personnel; as a result, they often fail to develop their own effective copingskills. Many victims long for approval and even after being rejected, some continueto make ineffective attempts to interact with the victimizer.

How Can Bullying Lead to Violence?

Bullies lack respect for others basic human rights and are more likely to resort toviolence to solve problems without worry of the potential implications. Both bulliesand victims show higher rates of fighting than their peers. And, as shown in recentschool shootings, victims frustration with bullying can turn into vengeful violence.

What Can Schools Do?

Many schools today respond to bullying, or other types of school violence, withreactive measures. However, installing metal detectors or surveillance cameras orhiring police to patrol the halls has no tangible positive results. Similarly, ZeroTolerance policies (severe consequence for any behavior defined as dangerous suchas bullying or carrying a weapon) rely on exclusionary measures (suspension,


expulsion) that have long-term negative effects.

Instead, researchers advocate school-wide prevention programs that promote apositive school and community climate. Existing programs can effectively reducethe occurrence of bullying; in fact, one program decreased peer victimization by50%. Such programs require the participation and commitment of students, parents,educators and members of the community. Effective school programs:

Provide early intervention. Researchers advocate intervening in elementary ormiddle school, or as early as preschool. Group, classroom, and building-widesocial skills training is highly recommended, as well as counseling andsystematic aggression interventions for students exhibiting bullying and victimbehaviors. School psychologists and other mental health personnel areparticularly well trained to provide such training as well as guidance inselecting and evaluating prevention programs.Balance discipline with behavioral supports. Establish clear consistentconsequences for bullying behavior that all children understand. Disciplineshould address the behavior and its underlying causes. Incorporating positivebehavioral interventions with loss of privileges or other consequences will domore to change students behavior than approaches based solely onpunishment.Support parents efforts to teach their children good social skills. Parentsmust learn to reinforce their childrens positive behavior patterns and modelappropriate interpersonal interactions. School psychologists, social workers,and counselors can help parents support children who tend to become victimsas well as recognize bullying behaviors that require intervention. Be sureparents know how to get in touch with the appropriate mental healthprofessional in the building or district.Equip teachers and school staff with prevention and intervention skills. Training can help teachers identify and respond to potentially damagingvictimization as well as to implement positive feedback and modeling to fosterappropriate social interactions. Support services personnel can helpadministrators design effective teacher training modules. All school personnel(bus drivers, playground monitors, after school program supervisors, etc.)should be trained to prevent and intervene with bullying. Supervision ofstudents is important!Change attitudes toward bullying. Researchers maintain that society muststop defending bullying behavior as part of growing up and with the attitudethat kids will be kids. School personnel should never ignore bullyingbehaviors. Consistently modeling appropriate behavior, praising children whenthey do the right thing, intervening immediately when bullying occurs, andoffering children alternatives to bullying will change attitudes and behavior. Empower students to support each other. An important factor in theprevalence of bullying behavior is the degree to which children becomeaccepting bystanders or even participants when a classmate is being bullied.Teaching children to work together to stand up to a bully, encouraging them toreach out to excluded peers, celebrating acts of kindness, and reinforcing theavailability of adult support can transform what experts call the silentmajority into a caring majority of students who become part of the anti-bullying solution.Create a positive school environment. A positive school climate will reducebullying and victimization. Schools with easily understood rules of conduct,smaller class sizes, and fair discipline practices report lower rates ofaggressive behavior and violence. Adults should be visible and vigilant in


common areas, such as hallways, cafeterias, locker rooms, and playgrounds.School personnel should be aware of behavior on the bus, and on the way toand from school for children who walk, as these can be important parts of achilds school day. Children should trust that an adult can and will help them ifthey are being bullied.

What Can Parents Do?

Be aware of changes in your childs behavior or attitudes. Children who arebullied often give signals that something is wrong. They may becomewithdrawn or be reluctant to go to school and can experience physicalsymptoms such as headaches, stomachaches, or problems sleeping. Talk toyour child about their concerns. Reassure them that you will work with theschool to stop the bullying behavior.Let the school know if your child is being bullied. Talk to your childs teacherand/or contact the schools psychologist, counselor or social worker to ask forhelp. Become involved in school programs to counteract bullying. Volunteer atthe school to get firsthand knowledge of the school environment and yourchilds peer group.Teach your child strategies to counter bullying. Useful strategies includestanding up for themselves verbally, such as saying I dont like what yousaid/or did, or You can say whatever you want but its not true; walkingaway from the bully; using humor (practice funny comebacks with your child);thinking of positive images or statements about themselves to bolster self-esteem; and getting help from an adult.Begin teaching good social skills early. The pattern of bullying can begin asyoung as age two. The earlier children learn positive alternatives, the better. Praise your child for appropriate social behaviors and model interactions thatdo not include bullying or aggression. Catch your child doing somethinggood and offer positive reinforcement. Encourage children to support theirpeers, (e.g., asking a lonely classmate to eat lunch or sticking up for a childbeing teased). Monitor television watching and video games.Foster positive social relationships and activities. Help your child identifypeers with whom they get along. Suggest things they can do together, (e.g.,study, each lunch, come home after school, go to the movies). Also, finding avariety of activities that your child enjoys and does well can help build self-esteem and confidence.Use alternatives to physical punishment. Children who are spanked tooharshly or too often learn that physical aggression is okay. Consistentalternatives, such as the removal of privileges or additional chores, serve asmore effective consequences for inappropriate or difficult behavior. Stop any bullying behavior immediately. Supervising children is important. Intervene as bullying behavior is happening and have the child practicealternative behaviors.

This handout was developed from a number of resources including Childrens Needs:Development, Problems and Alternatives and Best Practices in School CrisisPrevention and Intervention published by NASP. For a complete list of referencesand additional resources, visit www.nasponline.org.

2002, National Association of School Psychologists, 4340 East West Highway,Suite 402, Bethesda, MD 20814, (301) 657-0270, fax (301) 657-0275, TTY (301)657-4155.

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Depression in Children and Adolescents: A Primer for Parents andEducators

By Ralph E. Cash, PhD, NCSPNova Southeastern University

Depression is a serious health problem that can affect people of all ages, includingchildren and adolescents. It is generally defined as a persistent experience of a sad orirritable mood as well as anhedonia, a loss of the ability to experience pleasure innearly all activities. It also includes a range of other symptoms such as change inappetite, disrupted sleep patterns, increased or diminished activity level, impairedattention and concentration, and markedly decreased feelings of self-worth. Majordepressive disorder, often called clinical depression, is more than just feeling downor having a bad day. It is different from the normal feelings of grief that usuallyfollow an important loss, such as a death in the family. It is a form of mental illnessthat affects the entire person. It changes the way the person feels, thinks, and acts andis not a personal weakness or a character flaw. Children and youth with depressioncannot just snap out of it on their own. If left untreated, depression can lead to schoolfailure, conduct disorder and delinquency, anorexia and bulimia, school phobia, panicattacks, substance abuse, or even suicide.

Prevalence and Risk Factors

Research indicates that the onset of depression is occurring earlier in life today thanin past decades and often coexists with other mental health problems such as chronicanxiety and disruptive behavior disorders. Researchers at the University of Oregonestimate that 28% of all adolescents (ages 1319) will experience at least one episodeof major depression, with the rate estimated as 37% from ages 1315 and about 12% for children under age 13 (see Seely, Rohde, Lewinsohn, & Clarke, 2002, inResources at the end of this handout). In 2001, suicide was the third leading causeof death among those 1524 years old (see the National Institute of Mental HealthFact Sheet in Resources). Up to 7% of adolescents who develop major depressivedisorder may eventually commit suicide.

Children and teens who are under stress, who have experienced a significant loss, orwho have attention, learning, or conduct disorders are at greater risk for developingclinical depression. There is no difference between the sexes in childhood invulnerability to depression. But during adolescence girls develop depressive disorderstwice as often as boys. Children who suffer from major depression are likely to havea family history of the disorder, often a parent who also experienced depression at anearly age. Depressed adolescents are also likely to have relatives who haveexperienced depression, although the correlation is not as high as it is for youngerchildren.

Other risk factors for child and adolescent depression include previous depressiveepisodes, anxiety disorders, family conflict, uncertainty regarding sexual orientation,


poor academic performance, substance abuse disorders, loss of a parent or loved one,break up of a romantic relationship, chronic illnesses such as diabetes, abuse orneglect, and other traumas, including natural disasters.

Signs and Symptoms

Characteristics of depression that usually occur in children, adolescents, and adultsinclude:

Persistent sad and irritable moodLoss of interest or pleasure in activities once enjoyedSignificant change in appetite and body weightDifficulty sleeping or oversleepingPhysical signs of agitation or excessive lethargy and loss of energyFeelings of worthlessness or inappropriate guiltDifficulty concentratingRecurrent thoughts of death or suicide

Characteristics of childhood depression. The way symptoms are expressed varieswith the developmental level of the youngster. Symptoms associated with depressionmore commonly in children and adolescents than in adults include:

Frequent vague, non-specific physical complaints (headaches, stomachaches)Frequent absences from school or unusually poor school performanceSchool refusal or excessive separation anxietyOutbursts of shouting, complaining, unexplained irritability, or cryingChronic boredom or apathyLack of interest in playing with friendsAlcohol or drug abuseWithdrawal, social isolation, and poor communicationExcessive fear of or preoccupation with deathExtreme sensitivity to rejection or failureUnusual temper tantrums, defiance, or oppositional behaviorReckless behaviorDifficulty maintaining relationshipsRegression (acting babyish, resumption of wetting or soiling after toilettraining)Increased risk-taking behavior

The presence of one or even all of these signs and symptoms does not necessarilymean that a particular person is clinically depressed. If several of the abovecharacteristics are present, however, it could be a cause for concern and may suggestthe need for professional evaluation.

Evaluation and Treatment

Diagnostic evaluation. The good news is that depression is treatable. Virtuallyeveryone who receives proper, timely intervention can be helped. Early diagnosis andappropriate treatment are essential for depressed children and adolescents. Childrenwho exhibit signs of clinical depression should be referred to and evaluated by amental health professional who specializes in treating children and teens. A thoroughdiagnostic evaluation may include a physical examination, laboratory tests,interviews with the child and parents, behavioral observations, psychological testing,


and consultation with other professionals.

Treating depression. A comprehensive treatment plan often involves educating thechild or adolescent and the family about the illness, counseling or psychotherapy,ongoing evaluation and monitoring, and, in some cases, psychiatric medication.Optimally this plan is developed with the family, and, whenever possible, the child oradolescent participates in treatment decisions. It is important to recognize thatillnesses in general and mental disorders in particular have different overtcharacteristics and respond differently to treatment in various cultural groups.Therefore, diagnostic and treatment approaches must be culturally sensitive to beeffective.

What Adults Can Do to Help

It is important that all adults who have frequent contact with children and adolescentsknow the warning signs of depression. If you suspect a child may be depressed, makesure parents or guardians are informed. Do not hesitate to ask a child if he or she hasthought about, intends, or has plans to commit suicide. You will not give the childany new ideas, and you may save a life by asking. If a child admits to feelingsuicidal, stay with the child and get professional help immediately. School personnelcan also provide important support by linking families with information and referralto community agencies. In addition, parents, school personnel, and other adults mayplay key roles in monitoring the effectiveness of and helping to ensure compliancewith treatment plans.

What Schools Can Do

Schools can facilitate prevention, identification, and treatment for depression inchildren and adolescents. Students spend much of their time in schools where theyare constantly observed and evaluated, and come into contact with many skilled andwell-educated professionals. Effective interventions must involve collaborationbetween schools and communities to counter conditions that produce the frustration,apathy, alienation, and hopelessness experienced by many of our youth. Involvementin research-based programs such as the Surgeon Generals 1999 Call to Action toPrevent Suicide or the Yellow Ribbon Suicide Prevention Program and NationalDepression Screening Day (SOS High School Suicide Prevention Program) cangreatly enhance schools efforts to organize prevention and intervention programs tocombat depression. (See Resources for information about these programs.) Some ofthe most important steps for schools to take include:

Develop a caring, supportive school environment for children, parents, andfaculty.Ensure that every child and parent feels welcome in the school.Prevent all forms of bullying as a vigorously enforced school policy.Establish clear rules and publicizing and enforcing them fairly andconsistently.Have suicide and violence prevention plans in place and implementing them.Have specific plans for dealing with the media, parents, faculty, and studentsin the aftermath of suicide, school violence, or natural disaster.Break the conspiracy of silence (making it clear that it is the duty of everystudent to report any threat of violence or suicide to a responsible adult).Ensure that at least one responsible adult in the school takes a special interestin each student.


Emphasize and facilitate home-school collaboration.Train faculty and parents to recognize the risk factors and warning signs ofdepression.Train faculty and parents in appropriate interventions for students suspected ofbeing depressed.Utilize the expertise of mental health professionals in the school (schoolpsychologists, school social workers, and school counselors) in planningprevention and intervention, as well as in training others.

Resources

Merrell, K. W. (2001). Helping children overcome depression and anxiety: Apractical guide. New York: Guilford. ISBN: 1-57230-617-3.

National Institute of Mental Health. (2001). Depression in children and adolescents(Fact Sheet for Physicians). Bethesda, MD: Author (NIH Publication No. 00-4744).Available: www.nimh.nih.gov/publicat/depchildresfact

National Institute of Mental Health. (2001). Lets talk about depression [for teens].Bethesda, MD: Author (NIH Publication No. 01-4162). Available:www.nimh.nih.gov/publicat/letstalk.cfm

National Institute of Mental Health. (2001). Suicide facts. Bethesda, MD: Author.Available : www.nimh.nih.gov/research/suifact.cfm

Seeley, J., Rohde, P., Lewinsohn, P., & Clarke, G. (2002). Depression in youth:Epidemiology, identification, and intervention. In M. Shinn, H. Walker, &. G. Stoner(Eds.), Interventions for academic and behavior problems II: Preventive andremedial approaches (pp. 885912). Bethesda, MD: National Association of SchoolPsychologists. ISBN: 0- 932955-87-8.

U.S. Public Health Service. (1999). Mental health: A report of the Surgeon General.Washington, DC: Author. Available: www.surgeongeneral.gov

U.S. Public Health Service. (1999). The Surgeon Generals call to action to preventsuicide. Washington, DC: Author. Available: www.surgeongeneral.gov

U.S. Public Health Service. (2000). Report of the Surgeon Generals Conference onChildrens Mental Health: A national action agenda. Washington, DC: Author.Available: www.surgeongeneral.gov

World Health Organization. (2000). Preventing suicide: A resource for teachers andother school staff. Geneva: Mental and Behavioral Disorders, Department of MentalHealth (WHO). Available: http://www.who.int/entity/mental_health/media/en/ 62.pdf

Websites/Organizations

American Academy of Family Physicians, P.O. Box 11210, Shawnee Mission, KS66207; (800) 274-2237; www.aafp.org

American Psychological Association, 750 First Street, NE, Washington, DC 20002;(202) 336-5500; www.apa.org

American Psychiatric Association, 1400 K Street, NW, Washington, DC 20005;


(202) 682-6000; www.psych.org

Depression and Bipolar Support Alliance, Suite 501, 730 N. Franklin Street, Chicago,IL 60610; (800) 826- 3632; (312) 642-0049; www.dbsalliance.org

National Association of School Psychologists, Suite 402, 4340 East West Highway,Bethesda, MD 20814; (301) 657-0270; www.nasponline.org

National Institute of Mental Health, Office of Communications and Public Liaison,Information Resources and Inquiries Branch, Room 8184, 6001 Executive Boulevard,MSC 9663, Bethesda, MD 20892; (301) 443-4513; www.nimh.nih.gov

National Mental Health Association, 1021 Prince Street, Alexandria, VA 22314;(800) 969-NMHA; www.nmha.org

SOS High School Suicide Prevention Program/National Depression Screening Daywww.mentalhealthscreening.org/sos_highschool

Yellow Ribbon Suicide Prevention Program: (303) 429- 3530;www.yellowribbon.or

nasp toolkit for parents

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