Download Chapter 11: The Role of the Professional School Counselor in

Chapter Sixteen
Helping Students With Mental and
Emotional Disorders
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Helping Students

The professional school counselor’s primary
responsibility is to help students learn.


The No Child Left Behind Act of 2001 and school reform
movement has increased the pressure to focus on academic
achievement for all students.
Environment and mental health issues affect an
increasing number of children and
are affecting student achievement,
which makes it difficult for schools to
provide an appropriate education for
each child.
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Prevalence of Mental Disorders and
Mental Health Issues in Children and
Adolescents



One in five children and adolescents has a mild to
moderate mental health issue; one in twenty
has a serious mental or emotional illness.
Of the children, ages 9-17, who have a serious
emotional illness, only 20% receive mental
health services.
Children are presenting with mental health concerns
at a younger age.
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Prevalence of Mental Disorders and Mental
Health Issues in Children and Adolescents (cont.)


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Suicide is the third leading cause of death for
adolescents after accidents and homicide.
It is estimated that 7% of adolescents who develop a
Major Depressive Disorder will commit suicide and that
90% of teens who commit suicide have a mental
disorder.
High incidences of violent, aggressive and disruptive
behavior is another reflection of children’s emotional
difficulties.
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16-4
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Factors Contributing to a High Incidence
of Emotional Disturbance
Three factors are related to the prevalence of
mental disorders and mental health issues
affecting children and adolescents:
1. Environmental factors (e.g., breakdown of the
family, homelessness, poverty, violence in the
community) are rising and are likely to result in an
increase in mental health needs.
2. Low-cost mental health services are limited.
3. Special education legislation focusing attention on
children’s special needs has increased.
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16-5
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Factors Contributing to a High Incidence of
Emotional Disturbance (cont.)

Children from ethnic and cultural minority groups are at
risk for mental disorders and are overrepresented in
special education programs.

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Children and adolescents of color have been unserved or
underserved and have had their emotional difficulties overlooked
or misdiagnosed.
Estimates suggest that 48% of students with emotional
problems drop out of school and that students with
severe emotional problems miss more days of school than
those in any other disability category.
Lack of adequate community-based mental health
resources puts pressure on schools to provide those
services.
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16-6
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The Professional School Counselor’s
Role

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The role of professional school counselors is in a period of
transformation.
The focus has shifted from emphasis on a personal growth
model that promoted individual development in the 1950s and
1960s to a more recent focus on a comprehensive
developmental model with emphasis on educational goals.
There are arguments as to whether or not professional school
counselors are doing enough to meet the complex needs of atrisk children.
Dryfoos (1994) envisions full-service schools where
community mental health resources combine forces with school
and other agencies to provide adequate mental health services
for students.
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16-7
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Barriers To Providing Mental Health
Services In The Schools

The ability of professional school counselors to meet the
needs of students with mental health issues is limited
by:

Workload and non-counseling-related
responsibilities

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Duties beyond those described by professional standards,
such as lunch duty, bus duty, after-school functions, and
administrative duties.
Fragmentation and duplication of services and
programs

School- and community-based services and programs often
have been developed in isolation, without consideration of
existing services and programs.
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16-8
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Barriers To Providing Mental Health
Services In The Schools

Discrepancy between the professional school
counselors’ need to understand mental
disorders and their knowledge base

Not all professional school counselors possess the
knowledge, experience, and expertise needed to recognize
the mental health needs of students.
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16-9
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Current & Future Trends In The
Way Services Are Provided

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Some schools have increased their use of community
and private resources by hiring psychiatrists and
using outside consultants to treat students.
A current service model includes professionals from
different disciplines collaborating to promote mental
health in children and adolescents (Flaherty et al.,
1998).
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16-10
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Benefits Of The Direct Service
Model
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Students who attend schools with fully implemented
mental health programs are more academically
successful and have a greater sense of belonging and
safety.
Comprehensive community-based services to children
cut state hospital admissions and inpatient bed days by
between 39 and 79 percent and reduced average days
of detention by 40 percent.
In order to maximize effectiveness, professional school
counselors need to develop interdisciplinary and
interagency relationships and practices.
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16-11
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What Professional School Counselors
Need To Know About Mental &
Emotional Disorders



Professional school counselors must understand normal
social, emotional, cognitive, and physical development.
In addition, they should possess knowledge about mental
disorders and mental health issues affecting youth.
Professional school counselors need to be aware of the
range of mental disorders in order to identify students
experiencing emotional problems, interpret diagnostic
information, and recommend school-based interventions.
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16-12
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What Professional School Counselors Need
To Know About Mental & Emotional Disorders
(cont.)

The Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV-TR) contains the criteria for diagnosing
disorders.

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The professional school counselor generally is not expected
or trained to make diagnoses.
However, they will be expected to:

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Identify young people in need of mental health services.
Consult with other school-based mental health professionals.
Make referrals to outside community agency resources.
Communicate mental health reports to school personnel and
parents.
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16-13
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What Professional School Counselors Need
To Know About Mental & Emotional Disorders
(cont.)

With the parent’s permission, they may be asked to
provide input from the school, including
observations, behavioral checklists, and samples of
schoolwork.
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16-14
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Multiaxial System of Diagnosis

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The DSM-IV-TR uses a multiaxial approach to diagnosis
to facilitate a comprehensive and systematic evaluation
of a person.
Axis I: Clinical Disorders (e.g., conduct disorders, eating
disorders, anxiety disorders, mood disorders, etc.)
Axis II: Mental Retardation and Personality Disorders
Axis III: General Medical Conditions
Axis IV: Psychosocial and Environmental Problems (e.g.,
occupational, family, or educational stressors)
Axis V: Global Assessment of Functioning
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16-15
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Mental Disorders In Infants, Children,
& Adolescents
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
1. Mental Retardation
2. Learning, Motor, and
Communication Disorders
3. Pervasive Developmental
Disorders
4. Attention-Deficit Disorders &
Disruptive Behavior Disorders
5. Eating Disorders in Children &
Adolescents
6. Tic Disorders
7. Elimination Disorders: Encopresis
& Enuresis
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16-16
Separation Anxiety Disorder
Selective Mutism
Reactive Attachment Disorder
Mood Disorders
Substance-Related Disorders
Psychotic Disorders
Obsessive-Compulsive Disorder
Posttraumatic Stress Disorder
Generalized Anxiety Disorder
Adjustment Disorders
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Mental Retardation - Diagnosis

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Mental Retardation (MR) has an impact on cognitive, emotional, and
social development.
MR is diagnosed from results of individual intelligence tests, such as
the WISC-IV (IQ<70) and the SBIS-5 (IQ<70).
To be diagnosed as MR, onset must be prior to age 18 years, the
student must possess sub-average intellectual functioning, and have
impaired adaptive functioning in at least 2 of the following areas:
 Communication, social skills, self-care, home living, interpersonal
skills, self-direction, leisure, functional academic skills, health,
safety, or work.
MR is usually diagnosed in infancy or early childhood.
About 1-2% of the population is diagnosed as MR.
Boys are 3 times more likely than girls to be diagnosed with MR.
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16-17
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Mental Retardation - Degrees

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Borderline Intellectual Functioning- People with an IQ
that is in the 71-84 range and are not diagnosed with
mental retardation.
Four Degrees Of Mental Retardation
Mild Retardation- The IQ score is in the range of 50-55 to
70.
Moderate Retardation- IQ score is in the range of 35-40
to 50-55.
Severe Retardation- IQ score is in the range of 20-25 to
35-40.
Profound Retardation- IQ score is below 20-25.
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16-18
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Mental Retardation - Causes

Biological Causes

25-30% of people with mental retardation have
biological causes.

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Neurological Causes

Neurological causes may be associated with
more than 200 physical disorders, such as:


Down’s Syndrome is a genetic type of mild or
moderate retardation.
Cerebral Palsy, Epilepsy, and Sensory Disorders.
Environmental Causes
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16-19
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Mental Retardation –
Intervention Strategies

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Early intervention is essential.
Examples of interventions:
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Special education, home health care,
language stimulation, and social skills
training can have a positive impact.
Family, group and individual counseling can be
effective in promoting positive self-regard and
improving social, academic, and occupational skills.
Behavior modification
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16-20
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Mental Retardation - Prognosis

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Adults with a mild level of retardation often live
independently and maintain a job with minimal
supervision.
People with moderate retardation may be able to live
independently in group homes.
Those with severe and profound retardation will
probably reside in public and private institutions.
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16-21
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Mental Retardation Relevance To Professional School
Counselors
Professional school counselors:
 Are involved in the identification of children with mild
retardation.
 Help families understand and accept the diagnosis
and make the transition to an appropriate school
program.
 Provide social skills training.
 Educate other students about Mental Retardation to
promote their understanding and tolerance.
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16-22
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Learning, Motor Skills, &
Communication Disorders

Children diagnosed with these disorders function
significantly below normal expectations in a specific area,
based on their age, cognitive abilities and education, as
well as when their level of functioning is interfering with
daily achievement.
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16-23
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Learning Disabilities


Learning disabilities affect approximately 10% of the
population, but are diagnosed in about 5% of
students in U.S. public schools.
Common Learning Disorders include:

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Reading Disorder (dyslexia)
Mathematics Disorder (dyscalculia)
Disorder of Written Expression (dysgraphia)
These disorders are characterized by significant
difficulties in academic functioning in a specific area.
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Reading Disorder



Reading Disorder is diagnosed in approximately 4% of
the school-age population.
Approximately 60-80% are boys.
Children with this disorder have difficulty decoding
unknown words, memorizing sight-word vocabulary
lists, and comprehending written passages.
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Mathematics Disorder

Dyscalculia is a Mathematics Disorder in which
children have difficulty with problem-solving,
calculations, or both.
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Disorder of Written Expression
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Dysgraphia is a disability of written expression.
This disorder is rarely found in isolation. In
other words, another learning disability is often
also present.
Children with this disorder have difficulty with
handwriting, spelling, grammar and/or the
creation of prose.
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Communication Disorders
Five Communication Disorders are identified in
the DSM-IV-TR:
1. Expressive Language Disorder
2. Mixed Receptive-Expressive Language Disorder
* Children who possess characteristics of disorders 1 & 2
display language skills that are significantly below
expectations based on nonverbal ability and interfere with
academic progress.
3. Phonological Disorder
* Failure to use developmentally expected speech sounds
that are appropriate for the individual’s age and dialect.
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Communication Disorders (Cont’d)
4. Stuttering
* Speech fluency interferes with the child’s ability to
communicate or make good academic progress.
5. Communication Disorder - Not Otherwise
Specified (NOS)
* NOS is the diagnosis for disorders that belong in the
category but don’t fully meet the diagnostic criteria for any
specific disorder.
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Learning, Motor Skills, &
Communication Disorders
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Approximately 35-40% of boys with Learning Disabilities
have at least one parent who had similar learning
problems.
Learning Disorders are associated with low
socioeconomic status, poor self-esteem, depression, and
perceptual deficiencies.
Children with these disorders are often unhappy in
school, have negative self-images and social difficulties,
and show increased likelihood of dropping out of school.
Depression, AD/HD and Disruptive Behavior Disorders will
often coexist with learning disabilities.
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Learning, Motor Skills, & Communication
Disorders - Intervention Strategies
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Primary interventions occur at school.
Children who demonstrate a significant discrepancy between
intelligence and achievement may be eligible to receive
special education services.
An Individualized Education Plan (IEP) is developed.

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The IEP specifies areas of weakness, strategies for addressing
deficit areas, behavioral goals, and criteria for determining
whether goals were met.
Motor or attention on-task behaviors are also included in the
IEP.
Interventions, counseling, individualized teaching strategies
and accommodations, and social skills training are also aspects
included in some IEP objectives.
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Learning, Motor Skills, &
Communication Disorders - Prognosis


Learning Disorders (LD) continue to have an
impact throughout adolescence and adulthood.
If left undiagnosed and untreated, LD can lead to
extreme frustration, loss of self-esteem,
inadequate education, underemployment, and
more serious mental disorders
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Learning, Motor Skills, & Communication
Disorders - Relevance to Professional School
Counselors

Professional school counselors:

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Serve on child study and special education committees
tasked with screening and identifying children with LD.
Are often the first to be aware of how learning problems are
affecting the child’s performance in the classroom, home,
and with peers.
May be required by the IEP to provide individual or group
counseling, help parents and children to understand and
cope with the diagnosis, and implement accommodations.
Act as a consultant or collaborator in dealing with coexisting
issues, such as low self-esteem.
Coordinate support groups for students with Communication
Disorders.
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Pervasive Developmental Disorders
(PDD)
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PDD is diagnosed in approximately 10 to 20 cases per
10,000.
Males outnumber females by 2.5:1.
Four PDDs are described in the DSM-IV-TR, in addition to
PDD NOS:
1.
2.
3.
4.

Autistic Disorder
Rett’s Disorder
Childhood Disintegrative Disorder
Asperger’s Disorder
Children with PDD are characterized by a flat affect, poor
eye contact, language impairment, and minimal social
speech. In addition, they do not seek social attention.
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Autistic Disorder
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Present in 2 - 20 of every 10,000 people.
Causes significant deficits in socialization,
communication, and behavior.
Symptoms are evident by age three years.
Mental retardation accompanies this diagnosis 75%
of the time.
Ability to communicate varies.
Children with this disorder do not form close
relationships with others and instead engage in
repetitive interactions with inanimate objects.
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Rett’s Disorder & Childhood
Disintegrative Disorder
Both disorders are:


Less prevalent than Autistic Disorder.
Characterized by normal development in early childhood (5
months-4 years for Rett’s and 2-10 yrs. for Childhood
Disintegrative Disorder) followed by a steady deterioration.
Rett’s Disorder


Only diagnosed in females.
Results in severe or profound retardation.
Childhood Disintegrative Disorder

Results in significant regression in at least 2 of the following
areas:

Language, social skills, elimination, play and motor skills.
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Asperger’s Disorder


Characterized by impaired social skills and repetitive
or stereotypical behaviors, not characterized by the
delayed language development and impairment in
communication skills.
Boys are diagnosed with this disorder five times
more frequently than girls.
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PDD & Prognosis
Autistic Disorder - Some lead independent lives;
however, 2/3 require care throughout their lives.
 Asperger’s Disorder- Have the best prognosis. Many
succeed in becoming self-sufficient.
 Rett’s Disorder and Childhood Disintegrative Disordermost likely these individuals will be placed in residential
treatment facilities.
**EARLY INTERVENTION IS AN IMPORTANT FACTOR FOR
A POSITIVE OUTCOME**

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PDD & Intervention Strategies

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Special education services may include: language
and physical therapy, services of neurologists,
medical specialists, and behavioral therapists.
Smith (2001) suggested using Social Stories, a short
story format to inform and advise the child about a
situation.
Therapeutic goals may include: development of
social and communication skills, enhancing learning,
and helping the family cope.
Behavioral treatments have been found to be
particularly effective in helping children with Autistic
Disorders.
Social skills and social communication training are
beneficial for children with Autistic and Asperger’s
Disorder.
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PDD & Relevance To Professional
School Counselors
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Professional school counselors may help siblings cope, as
well as help parents access supportive resources (e.g.
behavioral training programs).
Professional school counselors may need to provide
educators with resources as students with PDD are
included in regular education classes.
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Attention-Deficit Disorders &
Disruptive Behavior Disorders
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These disorders have a high rate of comorbidity.
Children with AD/HD or Conduct Disorder also
often have Learning Disorders.
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Attention-Deficit/Hyperactivity Disorder
(AD/HD)
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AD/HD is found in as many as 50% of children referred
for counseling.
In 1995, public school systems spent more than 3 billion
dollars for services for children with AD/HD.
AD/HD is divided into three types:
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Predominately Hyperactive-Impulsive Type
Predominately Inattentive Type
Combined Type (both of the above simultaneously)
To be diagnosed with AD/HD:
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Onset must be prior to age seven years
Symptoms must occur in two or more settings
Must interfere with social, academic, or occupational functioning.
Symptoms need to be present for at least six months
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Attention-Deficit/Hyperactivity Disorder
(AD/HD) (cont.)
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
Symptoms may include failure to give close attention
to details, difficulty sustaining attention, poor followthrough on instructions, failure to finish work,
difficulty organizing tasks, misplacement of things,
distraction by extraneous stimuli, and forgetfulness.
Diagnosis is made through medical, cognitive, and
academic assessments, as well as through behavior
rating scales and observations.
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Attention-Deficit/Hyperactivity Disorder
(AD/HD) - Prevalance

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Prevalence rates range from 3-7% of children.
AD/HD is diagnosed in boys 2-9 times more frequently
than girls.
AD/HD is diagnosed in 44% of children receiving special
education services.
Girls with AD/HD had lower ratings on hyperactivity,
inattention, impulsivity and externalizing problems and
greater intellectual impairment and internalizing
problems than boys; however more research is needed
to clarify gender differences.
High rates of diagnosis draw particular attention to the
ways in which children are assessed. Diagnostic
assessments remain controversial.
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Attention-Deficit/Hyperactivity Disorder
(AD/HD) - Prognosis

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
The prognosis for treatment of AD/HD is good.
Behavioral interventions have been found to reduce
off-task and distractible behaviors.
In addition, psychostimulant medications are used to
help individuals with AD/HD stay on-task.
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Attention-Deficit/Hyperactivity Disorder
(AD/HD) Intervention Strategies

Behavioral strategies and the use of stimulant
medications are the most commonly used intervention
strategies.
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Behavioral strategies include developing token economy systems.
Common medications include Methylphenidate (Ritalin) and
Dextroamphetamine (Dexadrine). Other medications include
Adderall, methylphenidate (Concerta) and Strattera.
The goal of intervention includes staying on task,
completing work, and following directions.
Social skills training programs, group therapy, and skill
development are other intervention strategies.
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Disruptive Behavior Disorders

The DSM-IV-TR describes two additional Disruptive
Behavior Disorders:
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Conduct Disorder
Oppositional Defiant Disorder (ODD)
Prevalence rates for Conduct Disorder include 6-16% of
males under the age of 18 years and 2-9% of females.
Prevalence rates for ODD are 2-16%.
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Disruptive Behavior Disorders - Diagnosis


Diagnosis requires the presence of repetitive and
persistent violations of the basic rights of others or
violations of major age-appropriate societal norms.
Conduct Disorder can be diagnosed when the student
displays:




Aggression against people and animals
Destruction of property
Deceitfulness or theft
Serious violations of rules
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Disruptive Behavior Disorders Conduct Disorder

Conduct Disorder is divided into childhood-onset and
adolescent-onset types.
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
Adolescent-onset type is diagnosed when no symptoms are
present before the age of 10 years.
Many children with ODD qualify for the Conduct Disorder
(CD) diagnosis during adolescence and, by the age of 18
years, CD sometimes has evolved into Antisocial Personality
Disorder.
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Disruptive Behavior Disorders - ODD




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ODD is characterized by a pattern of negativistic, hostile, and
defiant behaviors lasting at least 6 months.
Behavioral characteristics include losing one’s temper,
arguing with adults, defying or refusing to comply with
adults’ requests, deliberately annoying people, being angry
and resentful, being easily annoyed by others, blaming others
for one’s own negative behavior, and being vindictive.
ODD is correlated with low socioeconomic status and growing
up in an urban location.
Symptoms usually first appear around the age of 8 years.
ODD is more prevalent in childhood in boys than girls, but by
puberty equal numbers are diagnosed.
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Disruptive Behavior Disorders - Prognosis


Prognosis is best when there has been late onset of
symptoms, early intervention, and long-term
intervention.
An important element of successful treatment is
parents’ support and participation.
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Disruptive Behavior Disorders –
Intervention Strategies

Four types of intervention strategies are suggested:






Individual counseling
Family interventions
School-based interventions
Community interventions
Residential or day treatment programs are recommended
when the child poses a danger to self or others.
School-based interventions may include early education,
classroom guidance units, classroom instruction, home
visits, and regular meetings with parents.
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Disruptive Behavior Disorders - Relevance
to Professional School Counselors



Of all the categories of mental disorders, professional school
counselors will have the greatest need to be knowledgeable
about AD/HD and Disruptive Behavior Disorders.
School personnel and parents may look to the counselor for
guidance.
Frequently children are not diagnosed with Disruptive Behavior
Disorders until they enter school; therefore, professional
school counselors may need to work closely with parents to
help them understand these disorders and make referrals.
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Disruptive Behavior Disorders – Research
and Early Prevention


Recent studies examining the relationship between low
reading achievement and Conduct Disorder with
perceived school culture, self-esteem, attachment to
learning, and peer approval is encouraging the
development of a range of school-based and familyfocused prevention programs targeting young children.
Two approaches to early prevention:


Provide social skills, problem-solving, and anger
management training to the entire school population
through a developmental curriculum (e.g., Second Step: A
Violence Prevention Curriculum)
Identify high-risk students and provide a small group
curriculum for them (e.g., Fast Track)
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Eating Disorders In Children &
Adolescents
There are two disorders that can interfere with a
child’s early development:
1. Pica

2.
Rumination Disorder


Characterized by the ingestion of nonfood substances.
Characterized by persistent regurgitation and re-chewing
of food.
Both Pica and Rumination Disorder are linked to children
with Mental Retardation and Pervasive Developmental
Disorder.
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Other Eating Disorders

Anorexia Nervosa






Prevalent among adolescent girls. Rates of 0.5% - 2%.
Person refuses to maintain a normal body weight. Body
weight that is 85% or less than the normal weight for the
person’s age and size.
Other symptoms may include fear of becoming fat, a
disturbed body image, and cessation of menstrual cycles.
Two types have been identified: Restricting Type (associated
with dieting, fasting, or excessive exercise), and BingeEating/Purging Type (associated with binge eating, purging,
or both).
85% of those diagnosed meet the criteria while between the
ages of 13 and 20 years.
Physiological consequences include dry skin, edema, low
blood pressure, metabolic changes, potassium loss, and
cardiac damage that can result in death.
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Other Eating Disorders

Bulimia Nervosa
 Individuals diagnosed with Bulimia Nervosa engage
in similar behavior to those with Anorexia Nervosa,
but do not meet the full criteria for that disorder,
usually because their weight is more than 85% of
normal.
 Involves an average of two episodes a week of binge
eating and compensatory behavior such as vomiting,
fasting, laxative use, or extreme exercise, for at least
3 months.
 Physiological reactions include dental cavities and
enamel loss, electrolyte imbalance, cardiac and renal
problems, and esophageal tears.
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Eating Disorders - Prognosis


44% of people with Anorexia Nervosa recover
completely through treatment, 28% are significantly
improved, 24% are not helped or deteriorate, and 5%
die.
The prognosis for Bulimia Nervosa is somewhat better:
Treatment that follows recommended guidelines can
typically reduce binge-eating and purging by a rate of at
least 75%. A positive prognosis is associated with good
pre-morbid functioning, a positive family environment,
the client’s acknowledgement of hunger, greater
maturity and self-esteem, high educational level, early
age of onset, less weight loss, shorter duration of the
disease, less denial of the disorder, and absence of
coexisting mental disorders.
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Eating Disorders –
Intervention Strategies


Medical assessment
Multi-faceted therapy



Behavior therapy to promote healthy eating and eliminate
purging and other destructive behaviors.
Cognitive therapy to help the individual gain an
understanding of the disorder, improve self-esteem and
gain a sense of control.
Group therapy and family counseling to help deal with
emotional difficulties.
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Eating Disorders - Relevance to
Professional School Counselors





Signs and symptoms of these disorders will be apparent in
school.
Prevention programs and early detection may be the best
defense.
Professional school counselors may become aware of students
who are regularly eating little or no lunch, engaging in
ritualized eating patterns, or purging.
Working with classroom teachers, the school nurse, and
parents, professional school counselors can help students and
their families become aware of dangerous eating patterns and
the long-term consequences of Eating Disorders.
Professional school counselors can also support the efforts of
mental health therapists and help parents find resources.
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Tic Disorders

The DSM-IV-TR identifies 4 Tic Disorders:





Tourette’s Disorder
Chronic Tic Disorder
Transient Tic Disorder
Tic Disorder NOS
A tic disorder is characterized by sudden, rapid repetitive
motor movements or vocalizations [i.e. clearing one’s
throat, barking, coprolalia (using obscene words), palilalia
(repetition of one’s words or sounds), and echolalia
(repetition of what is heard last)].
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Tic Disorders (Cont’d)


These symptoms are typically worse under stress, less
noticeable when the child is distracted, and diminish
entirely during sleep.
More common in boys and an elevated incidence in
children with other disorders such as AD/HD, Learning
Disorders, Pervasive Developmental Disorder, Anxiety
Disorders, and Obsessive-Compulsive Disorder.
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Tic Disorders - Tourette’s Disorder



Characterized by a combination of multiple motor
tics and one or more vocal tics that have been
present for at least one year.
These tics commonly interfere with academic
performance and social relationships.
It is diagnosed in 4-5 children per 10,000 and tends
to run in families.
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Tic Disorders - Chronic Tic Disorder &
Transient Tic Disorder


Chronic Tic Disorder - Diagnosed when one type of tic,
motor or vocal, has been present for at least one year.
Transient Tic Disorder - Symptoms include motor and/or
vocal tics that have been present for at least four
weeks, but less than a year.
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Tic Disorders - Prognosis &
Intervention Strategies

Prognosis


Habit-reversal techniques (behavioral interventions) showed a
90% reduction in tics as compared to medication that showed
only a 50-60% reduction.
Intervention Strategies




Identification of any underlying stressors, cognitive-behavioral
method for stress management, education of children and
families about the disorder, advocacy with education
professionals, and collaborative work with physicians if
pharmacological interventions are necessary.
Behavioral strategies (e.g. relaxation training).
Social skills training.
Pharmacological treatment for children who do not respond to
behavioral interventions (e.g. Haloperidol).
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Tic Disorders - Relevance To Professional
School Counselors



Professional school counselors can provide sources
of referral and information to parents and teachers
during the diagnostic period.
Suggestions concerning classroom modifications to
reduce stress, rewards for behavioral control, and
adjustment of academic expectations can be
facilitated by the professional school counselor.
Social skills training can be implemented to help
children deal with peer relationship problems.
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Elimination Disorders: Encopresis &
Enuresis




Both are characterized by inadequate bowel or bladder control in
children whose age and intellectual levels suggest they can be
expected to have adequate control of these functions.
These disorders cannot be associated with a medical condition.
Encopresis
 Voluntary or involuntary passage of feces in inappropriate places.
 Diagnosis is not made in children younger than four years.
 Sometimes there is an association between Encopresis and ODD
or Conduct Disorder. Sexual abuse and family pressure may also
be associated with this disorder.
Enuresis
 The involuntary or intentional inappropriate voiding of urine,
occurring in children over the age of five years.
 The subtype, Nocturnal Only, is the most common type.
 Behavioral interventions are the most successful.
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Elimination Disorders - Relevance To
The Professional School Counselor



Parents will need information and education about
how to deal with these disorders.
Parents should be encouraged to rule out medical
causes.
The professional school counselor can also be
available to help parents cope.
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Separation Anxiety Disorder



Separation Anxiety Disorder is the only anxiety disorder
diagnosed exclusively in childhood.
It is characterized by excessive distress upon separation
from primary attachment figures.
For diagnosis, a child needs to have 3 or more symptoms
present for at least 4 weeks and prior to 18 years of age,
e.g.:






Worry about caretakers’ safety.
Reluctance or refusal to go to school or be separated from
caregivers.
Fear of being alone.
Repeated nightmares involving separation themes.
Somatic complaints.
Adolescents exposed to domestic violence and living in
abusive homes are at particular risk for developing SAD.
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Separation Anxiety Disorder Prognosis and Intervention Strategies

Prognosis


High rate of recovery with treatment.
Intervention Strategies



Treatment can best be determined when the
underlying cause of the disorder is understood.
This disorder is considered a sort of phobia and
therefore behavioral strategies, such as systematic
desensitization, are used.
Family therapy may also be necessary.
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Separation Anxiety DisorderRelevance To The Professional School
Counselor



Counselors can help parents distinguish between mild and
transient symptoms associated with difficulty adjusting to
school and true Separation Anxiety Disorder.
Professional school counselors play an important role in
helping to plan and implement systematic desensitization.
They can also provide parents with encouragement and
support to leave their children at school, and students
with the support they need to stay in school.
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Selective Mutism




Characterized by a person consistently not
speaking in some social contexts, while speaking in
others.
Family dysfunction is often implicated in this
disorder.
97% of people diagnosed with Selective Mutism
also have symptoms of Social Phobias.
A child with this disorder is often lonely and
depressed and the mother is often over-involved or
enmeshed with the child.
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Selective Mutism (cont.)

Prognosis




Half the children treated are able to speak in public by age ten
years.
Prognosis for children over the age of 10 years who still exhibit
symptoms is less optimistic.
Older children are often teased by peers or inappropriately
managed by teachers and therefore inadvertently encouraged to
maintain the behaviors.
Intervention Strategies



Behavioral interventions are designed to teach social skills and
increase communication.
Play therapy can be used to help children overcome symptoms
and provide a nonverbal means of communication.
Family therapy is also helpful to address family roles.
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Selective Mutism (cont.)

Relevance To Professional School Counselors


Help parents and school personnel to decide whether a
referral to an outside agency is necessary.
Part of the treatment team and help provide a safe
environment.
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Reactive Attachment Disorder


Begins before the age of five years and is characterized
by children manifesting severe disturbances in social
relatedness.
RAD typically occurs in 1 of 2 extremes:




Indiscriminate and excessive attempts to receive comfort and
affection from any available adult
Extreme reluctance to initiate or accept comfort and affection,
even from familiar adults and especially when distressed
Attachments to the child’s primary caregivers have been
disrupted.
Neglect, abuse, or grossly inadequate parenting is
thought to cause this disorder.
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Reactive Attachment Disorder
(Cont’d)


Some additional symptoms of RAD include low selfesteem, lack of self-control, antisocial attitudes and
behaviors, aggression and violence, and a lack of ability
to trust, show affection, or develop intimacy.
Behaviors are generally self-destructive in nature.
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Reactive Attachment Disorder
(cont.)

Intervention Strategies



Early intervention is key.
Once the medical needs of the child are addressed, behavior
programs to improve feeding, eating, and caregiving routines
can be implemented.
Relevance To Professional School Counselors


Professional school counselors need to be aware of the criteria
because a connection has been found between insecure
attachment and both subsequent behavior and impulse control
problems and poor peer relationships in young children.
This disorder may be associated with eating problems,
developmental delays, and abuse, neglect, and other parentchild problems.
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Mood Disorders





Characteristics include irritability and somatic complaints.
An estimated 70% of children and adolescents with
serious Mood Disorders are either undiagnosed or
inadequately treated.
Major Depressive Disorder is diagnosed in 0.4% to 2.5%
of children and 0.4% to 8.3% of adolescents.
Dysthymic Disorder, a milder form of depression is
diagnosed in 0.6% to 1.7% of children and 1.6% to 8%
of adolescents.
Bipolar Disorder, characterized by episodes of depression
and episodes of mania or hypomania is rare in children.
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Mood Disorders (cont.)


Prognosis
 Psychotherapy and psychoeducational interventions
have been shown to be effective.
Intervention Strategies
 Cognitive and behavioral interventions are
emphasized.
 Psychoeducational programs focus on improving
social skills and encouraging rewarding activities.
 The effectiveness of medications has not yet been
established.
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Mood Disorders (cont.)

Relevance to the Professional School Counselor

Understanding the diagnostic criteria for Mood
Disorders is important so professional school
counselors can distinguish situational sadness from
a mental disorder.

The professional school counselor will consult with
parents, teachers and other mental health
professionals when working with a child who
appears depressed.
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Substance-Related Disorders
Children who live with parents with Substance-Related
Disorders are at a particularly high risk of developing
these disorders themselves.
Substance Use Disorders


Characterized by maladaptive patterns of using drugs and
alcohol.
Two types of Substance Use Disorders


1.
2.
Substance Abuse - Characterized by
maladaptive use of substances, leading to
significant impairment or distress.
Substance Dependence -Often includes
distress, impairment, development of tolerance,
and symptoms of withdrawal.
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Substance-Related Disorders (Cont’d)

Substance-Induced Disorders


Substance-Induced Disorders describe symptoms
such as intoxication, mood changes, and sleeprelated problems that stem directly from
maladaptive patterns of using drugs or alcohol.
Prognosis

Many factors are related to a good prognosis, such
as a stable family situation, early intervention, lack
of antisocial behavior, and no family history of
alcohol abuse.
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Substance-Related Disorders (cont.)

Ten risk factors that predict or precipitate Substancerelated Disorders (Lambie & Rokutani, 2002)










Poor parent-child relationships
Mental disorders (especially depression)
A tendency to seek novel experiences or take risks
Family members or peers who use substances
Low academic motivation
Absence of religion/religiosity
Early cigarette use
Low self-esteem
Being raised in a single-parent or blended family
Engaging in health-compromising behaviors
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Substance-Related Disorders (cont.)

Intervention Strategies





Prevention through substance abuse education,
recognition of risk factors, and early detection and
treatment are important strategies.
Accurate screening is also paramount for intervention.
Treatment may include detoxification, contracting,
behavior therapy, self-help groups, family therapy,
change in a person’s social context, and nutritional and
recreational counseling.
Specific interventions include family intervention,
remedial education, career counseling, and community
outreach.
Treatment programs for youth must target the specific
needs of adolescents, including level of cognitive
development, family situation, and educational needs.
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Substance-Related Disorders (cont.)

Relevance To The Professional School Counselor


The most dramatic increase in exposure and drug use is at
12 to 13 years of age. As a result proactive substance use
education programs are necessary.
Professional school counselors have four functions when
working with students with possible substance abuse
issues:




Identify the possible warning signs of student substance
abuse.
Work with the youth to establish a therapeutic relationship.
Support the family system to promote change.
Be a resource and liaison between the student, the family,
the school, and community agencies and treatment programs.
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Psychotic Disorders



Psychotic Disorders are rarely diagnosed in
children. For example, approximately 1 child in
10,000 develops Schizophrenia.
Some symptoms of Psychotic Disorder are
hallucinations, loose associations, and illogical
thinking.
The most common symptoms of Schizophrenia
are auditory hallucinations and delusions, and
illogical conversation and thought patterns.
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Psychotic Disorders (cont.)

Prognosis


Intervention Strategies



Prognosis is positive when Psychotic Disorders are treated with a
combination of family therapy and medication.
Treatment for children and adolescents with Psychotic Disorders
should include family therapy, medication, counseling and special
education.
Social skills training should be included as part of treatment.
Relevance to the Professional School Counselor


It is unlikely that professional school counselors will encounter
children with this disorder.
Counselors may be involved in the implementation and delivery of
special education services as part of an IEP, which may include
social and emotional goals.
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Obsessive-Compulsive Disorder
(OCD)




One in 200 children and adolescents meets the criteria
for OCD.
Children present obsessions about germs or disease
and exhibit concomitant compensatory rituals of
washing or checking.
Other compulsions include touching, counting,
hoarding and repeating.
The average age of onset is 10.2 years.
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Obsessive-Compulsive Disorder (cont.)

Intervention Strategies



Cognitive-behavioral interventions. The primary
intervention is exposure to obsessions.
Medication is also often used as part of the treatment
plan.
Relevance to Professional School Counselors


Professional school counselors can provide information
about the disorder and help parents determine
whether a referral is warranted.
When a diagnosis is made, professional
school counselors can help structure the
school modifications and interventions.
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Posttraumatic Stress Disorder


Triggered by exposure to an extreme threat of
death or serious injury, such as sexual abuse or a
car accident.
Criteria for diagnosis include:






Great fear and helplessness in response to the event.
Persistent re-experiencing of the event.
Loss of general responsiveness.
Symptoms of arousal and anxiety such as sleep disturbances,
anger or irritability.
Children may also experience nightmares.
Symptoms can be expressed both behaviorally (i.e.,
regressions, anxious attachment) or physiologically
(i.e., headaches, stomachaches).
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Posttraumatic Stress Disorder (cont.)

Prognosis


Prognosis is good with treatment.
Children who perceive that they have strong social
support are able to talk about the traumatic event and
feelings associated with the event, and who have safe
schools and cohesive family environments have a
better chance at decreasing their PTSD symptoms
more quickly.
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Posttraumatic Stress Disorder (cont.)

Intervention Strategies





Treatment should begin as soon as possible after the symptoms
emerge.
Preventive treatment, even before symptoms emerge, is
recommended.
Group intervention through critical incident stress debriefing.
The goal of treatment is to help the person access the trauma,
express feelings, increase coping and control over memories,
reduce cognitive distortions and self-blame, and restore selfconcept and previous level of functioning.
Group therapy with people who have had similar traumatic
experiences is also beneficial.
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Posttraumatic Stress Disorder (cont.)

Therapeutic interventions should be based within the school
setting only when:





Comprehensive assessment has been completed.
It is determined that school-based support is the appropriate,
least restrictive level intervention.
Parents have been informed of all treatment options.
The child is experiencing adequate adjustment and academic
success with intervention.
Consultation, supervision, and referral are readily utilized by the
professional school counselor.
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Posttraumatic Stress Disorder (cont.)

Relevance to the Professional School Counselor



Provide support to students, staff, and parents in the
event of a trauma.
Provide group and individual counseling that offer
accurate information, give people a place to ask
questions and talk about the trauma, and screen for
symptoms of PTSD.
Professional school counselors need to be aware of
the differences between unhealthy and healthy
responses to traumatic events, and be able to provide
resources to students and families.
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Posttraumatic Stress Disorder (cont.)

Professional school counselors should have a solid
working knowledge of etiological and diagnostic
implications of PTSD, the therapeutic options, and
ways to facilitate school reintegration of a child
who has suffered a traumatic event.
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Erford
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All rights reserved.
Generalized Anxiety Disorder
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Characterized by feelings of worry or anxiety about many
aspects of the person’s life and is reflected in related
physical symptoms such as shortness of breath and
muscle tension that are difficult to control.
Symptoms must persist for at least 6 months and have a
significant impact on the person’s functioning.
Prognosis
 People who receive cognitive-behavioral therapy show
significant improvement, although few will be free of
all symptoms.
Transforming the School Counseling Profession, 3e
Erford
16-96
© 2011 Pearson Education, Inc.
All rights reserved.
Generalized Anxiety Disorder


Intervention Strategies
 Strategies include teaching people to cope with
anxiety using procedures such as relaxation and
distraction, as well as rational thinking.
 Stress management techniques, such as guided
imagery, yoga, diaphragmatic breathing, meditation,
exercise, and systematic desensitization are also
used.
Relevance to the Professional School Counselor
 Suggest stress management strategies.
 Help parents understand the disorder.
 Offer guidance units and small group counseling
sessions to students coping with severe anxiety, as
well as workshops to help their parents.
Transforming the School Counseling Profession, 3e
Erford
(Con’td)
16-97
© 2011 Pearson Education, Inc.
All rights reserved.
Adjustment Disorders
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Characterized by a relatively mild maladaptive
response to a stressor which occurs within three
months of the stressor. Stressors may include
changing schools, parental separation, or illness in
the family.
Maladaptive responses may include anxiety,
depression or behavioral changes.
Prognosis
 Prognosis is good if the disorder stands alone.
Transforming the School Counseling Profession, 3e
Erford
16-98
© 2011 Pearson Education, Inc.
All rights reserved.
Adjustment Disorders (Cont’d)


Intervention Strategies
 Most improve spontaneously without treatment.
 Counseling can facilitate recovery.
 Teaching coping skills and adaptive strategies to help people
avert future crises and minimize poor choices and selfdestructive behaviors.
 A crisis-intervention model is most effective.
Relevance to the Professional School Counselor
 Provide students with supportive strategies required to cope
with the symptoms.
 Provide crisis-intervention.
 Help parents understand the effect the stressor is having on
their children.
Transforming the School Counseling Profession, 3e
Erford
16-99
© 2011 Pearson Education, Inc.
All rights reserved.