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Spring Fever + ADHD = Headaches: How School Counselors Can Help

By Julia Taylor for American School Counselor Association

Spring has sprung. For students with ADHD, this time of year may be particularly demanding. For teachers with students with ADHD, it may be even more difficult, as it's not unusual for ADHD students to have more behavior disruptions this time of year.

School counselors can help teachers by offering the following suggestions:

• Sit ADHD students close to the teacher and board, away from the window if possible.
• Make up a "look" to give the student/s with ADHD if their behavior is getting out of control, this way they are not receiving "extra" attention for disruption and still are aware of their inappropriate behavior.
• Try to stay away from long lectures and large group work during this time. Break tasks up and allow students to work in smaller groups.
• Give snack/water/restroom breaks during examinations, if allowed.
• Sit student near students who are "hard" workers.
• If student is a disruption during testing, allow him/herself to test in your office or an empty space where he or she can work alone.
• Allow students to hold an object such as a squeeze ball, rubber band, or other toy to keep them focused.
• Give rewards for writing all assignments down in planner or assignment calendar.
• Don't lose your patience with students; instead, make up a point system with student offering rewards for positive behavior, and consequences for outbursts.
• Try to communicate often with parents – a quick email, phone call, or note home will suffice.

School counselors can offer assistance by:

• Starting a group for students with ADHD!
• Allowing students to eat lunch in your office and go for a walk with you around the building when finished.
• Teaching students relaxation techniques they can use when feeling fidgety.
• Helping students clean out their locker/notebooks and organize materials that may have collected over the year.
• Checking in with students periodically so they are reminded that you are staying on top of them!

It is important for everyone involved with ADHD students to constantly praise positive behavior and keep in mind that the school year is almost over!

FEATURED RESOURCE: THE STOP, RELAX & THINK COLLECTION

If you work with children who have behavioral problems, you'll want to own this collection. It offers dozens of ways to interest and engage hard-to-reach children, with activities to help them in individual or group counseling, the classroom, or the home You'll get…

The Stop, Relax And Think Game

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The Stop, Relax, & Think Workbook

This workbook contains more than 60 paper and pencil activities that teach children such important skills as thinking about consequences, staying focused and completing a task, engaging in quiet activities without disturbing others, and more.

The Stop, Relax, & Think Card Game

In this card game, players are dealt Stop, Relax & Think cards, as well as Stressed Out, Confused, and Discouraged cards. As they acquire more cards, they must choose different self-control skills, and they learn the value of patience and cooperating with others to achieve a goal.

The Stop, Relax & Think Scriptbook

In this uniquely designed book, children can practice what to say and how to act in eight different scenarios common to children with behavioral problems.

The Stop, Relax & Think Ball

This fun and educational ball teaches children to control their impulsivity by helping them understand and control their actions

When you order the collection, you'll also get a free canvas carrying bag, regularly priced at $19.95. With this roomy, sturdy bag, you can easily store your materials or carry them to different settings.

To find out how you can purchase this collection of powerful counseling tools, click here!

ABOUT JULIA TAYLOR

Julia Taylor is an intern at the American School Counselor Association. She is completing her master's degree in school counseling at Marymount University in Arlington, Virginia.

ABOUT THE AMERICAN SCHOOL COUNSELOR ASSOCIATION

Professional school counselors everywhere share the same vision to support their schools by serving their students. School counselors know that guiding students toward personal and social development leads to improved academic achievement. Through their partnership with principals and teachers, school counselors help prepare today's students to become tomorrow's adults.

The American School Counselor Association (ASCA) responds to school counselors' unique needs, helping them grow individually as professionals and providing them with real tools to guide their students. As an international nonprofit organization founded in 1952, ASCA has the benefit of foresight and hindsight. It has grown to fit counselors' changing needs through social and educational movements from desegregation to standardized testing. Responding to the needs of counselors as voiced by counselors has enabled ASCA to remain vital and forward-thinking.

ASCA serves as the voice of school counselors on Capitol Hill and helps members ensure their voices are heard in state legislatures. ASCA has active government affairs representatives who monitor activities in Congress, the Department of Education and throughout Washington to advocate on behalf of school counselors' interests: funding, certification, student-to-counselor ratios and more.

A full-color bimonthly magazine, School Counselor provides practical information and how-to articles to help school counselors help their students and themselves. Each issue has a focus on something school counselors care about, from public relations to grief counseling, as well as departments and columns covering a range of topics. Professional School Counseling is ASCA's award-winning bimonthly academic journal, providing peer-reviewed articles on school counseling theory, research, practice and techniques. The journal and the magazine together provide counselors with the most well-rounded and up-to-date information in the field.

For more information, visit www.schoolcounselor.org or call (703) 683-ASCA.

LOOKING FOR HANDS-ON COUNSELING TOOLS?

Visit the Guidance Channel Shopping Mall! There you will find thousands of resources, many of them national and international award-winners, including reproducible handouts, therapeutic games, multimedia programs, videos, curricula, prevention-awareness items and much more. Be sure to check out our online Childswork/Childsplay catalog, as well as our At-Risk Resources and Wellness Reproductions online catalogs, for innovative tools to address the social and emotional needs of your clients.

FOR ADDITIONAL NEWSLETTERS...

If you've found The Counselor's Classroom useful and informative, you may also be interested in subscribing to some of our other newsletters. Dr. Playwell's Newsletter is a unique newsletter full of play therapy techniques to help you address the social and emotional needs of children and young adolescents. FYI From Wellness offers practical tips and suggestions for use in the clinic or classroom written by professionals from a variety of disciplines. The Guidance Channel Zine is a monthly online magazine that includes interviews, website reviews, statistics and articles by many national organizations such as the National Association of School Psychologists, the American School Counselor Association and National S.A.V.E. (Students Against Violence Everywhere).

African American Students Transitioning To High School

By Dr. Cheryl Holcomb-McCoy for American School Counselor Association

The process of transitioning from middle to high school involves a new environment and new roles and behaviors for students (Reyes et al., 2000). These include increased student body size and heterogeneity; changes in school day structure; more teachers with a variety of teaching styles, rules, and expectations; higher stakes grading; and stricter school policies. Research shows that a student’s grades, self-esteem, and sense of academic efficacy are likely to decline after the transition to high school (Fuligni, Eccles, Barber, & Clements, 2001). In addition to academic demands, beginning high school students may also become distracted by the increased complexity of social interactions that are fostered within the high school environment (Newman et al., 2000). Peers emphasize fitting in and belonging, and this can be a great source of pressure and anxiety for many students (Isakson & Jarvis, 1999). Also, due to the increase in the number of students, the high school environment can become a more anonymous setting than the middle school environment. For example, students who were top scholars and athletes in middle school may experience role loss when they arrive in high school (Newman et al.). Although a slight drop in grades and other adjustment difficulties may surface post-transition, the long-term outcomes following transition are largely determined by the ability of the student to cope with and manage change in the new environment (Isakson & Jarvis). A limited number of studies have examined the effect that the transition process has on the academic adjustment and achievement of minority students. Reyes et al. (2000) tracked eighth grade students from urban, minority, low-income backgrounds beginning in their final year of middle school through their transition to high school and up until their expected time of high school completion. They found that although the minority students who eventually graduated from high school and the minority students who dropped out of high school both showed a decrease in grade point average following the middle-to-high school transition, the students who dropped out of school showed a sharper decline in grades and attendance in the ninth grade. In a study of African American high and low performing ninth grade students, Newman et al. (2000) found that post-transition high achievers had greater notions of what was needed for them to be successful in high school and had more friends that were supportive of academics when compared with low achievers. The low performing students seemed to fall into three distinct categories: (1) students who were struggling with the fact that ninth grade was harder, (2) students who were distracted by the social aspects of the new environment, and (3) students who were showing a disconnection from school altogether (e.g., low attendance, not completing schoolwork). African Americans and Transitioning African American students face unique concerns that can impact their social development and academic lives. In addition to navigating the developmental milestones of adolescence and the transition to high school, these students may have to deal with negative academic perceptions and stereotypes based on their ethnic group that can be displayed blatantly or subtly by other peers and teachers (Kao, 2000; Ross & Jackson, 1991). In addition, these negative stereotypes may have also been internalized by these students and have undermined their ability to achieve. A developmental process that can have a major impact on transitioning to high school is the process of ethnic identity development. In middle school, many students are beginning to explore their identity by considering who they are and what makes them unique individuals. For ethnic minority students, this exploration usually involves considering who one is ethnically similar and dissimilar (Tatum, 1997). This process is important to the overall development of African American youth because it is implicated in the psychological adjustment of adolescents, including the development of a positive self-image and a sense of belonging (Phinney, 1989). McMahon and Watts (2002) report in their study that a greater sense of ethnic identity was significantly related to higher levels of cognitive decision-making, direct problem solving, seeking understanding, and positive cognitive restructuring in African American adolescent students. In turn, these attributes that are related to a higher sense of ethnic identity may also contribute to a more successful transition into high school. One factor that can impact ethnic identity development and transitioning to high school is the racial composition of the new school. French, Seidman, Allen, and Aber (2000) examined racial identity over the process of transitioning to high school as it was related to the level of racial congruence (match in race between the student and both the student body and school staff). The researchers found that a change in the racial congruence of the new environment was salient for the identity development of African American students. In other words, moving from a school in which one was part of the racial majority to a school where one is a racial minority impacted the group esteem and identity exploration process for African American students. It has also been noted that cultural attitudes towards achievement in school can impact an African American student's motivation to excel. Ogbu (1991) states that many inner city students do not associate academic achievement with being African American and therefore seek to affirm their racial identity by not putting forth maximum effort in school. Oyserman, Harrison, and Bybee (2001) investigated the relationship between racial identity and academics in a sample of African American eighth graders. It was found that students who viewed achievement as a part of being African American showed higher levels of academic efficacy. In other words, those students who included doing well in school as part of what it means to them to be African American had a greater sense that they could achieve in school. Kao (2000) also found that high academic achievement was equated with "acting White" among Black high school students. Actions that indicated a student was "acting Black" were usually seen as completely opposite to "acting White" and included images of low academic achievement. Implications for School Counselors Given the critical nature of the transition period for minority adolescents, it seems fitting that school counselors be cognizant of this process and include supports for students who are challenged by transitioning. For instance, school counselors might develop support groups for minority students who are entering high school. Likewise, middle school counselors may develop support groups for minority students before they enter high school. The goals of these groups would be to familiarize students with their new school's culture, to process feelings regarding the transition, and to discuss their identity in relationship to the new school. Also, school counselors should hold parent education sessions for minority parents of ninth grade students. These sessions would include information about the transition process and how they can support their students' achievement and development during this process. And lastly, it is critical for school counselors to share knowledge of minority students' transitioning process with other educators in the school. With increased knowledge, educators may be more able to provide not only the support that these students need but also additional programming that can enhance these students' academic and social development in high school. For instance, ninth grade students may be required to participate in peer mentoring with an older student. Or, ninth graders may be required to participate in student-teacher conferences as a means for students to have access to an understanding adult who is willing to discuss such issues as fitting in, peer pressure, and the new school culture. References French, S. E., Seidman, E., Allen, L., & Aber, L. J. (2000). Racial/ethnic identity, congruence with the social context, and the transition to high school. Journal of Adolescent Research, 15, 587-602. Fuligni, A. J., Eccles, J. S., Barber, B. L., & Clements, P. (2001). Early adolescent peer orientation and adjustment during high school. Developmental Psychology, 37, 28-36. Isakson, K. & Jarvis, P. (1999). The adjustment of adolescents during the transition into high school: A short-term longitudinal study. Journal of Youth and Adolescence, 28, 1-26. Kao, G. (2000). Group images and possible selves among adolescents: Linking stereotypes to expectations by race and ethnicity. Sociological Forum, 15, 407-430. McMahon, S. D. & Watts, R. J. (2002). Ethnic identity in urban African American youth: Exploring links with self-worth, aggression, and other psychological variables. Journal of Community Psychology, 30, 411-431. Newman, B. M., Myers, M. C., Newman, P. R., Lohman, B. J., & Smith, V. L. (2000). The transition to high school for academically promising, urban, low-income African American youth. Adolescence, 35, 45-66. Ogbu, J. (1991). Minority coping responses and school experience. Journal of Psychohistory, 18, 433-456. Oyserman, D., Harrison, K., & Bybee, D. (2001). Can racial identity be promotive of academic efficacy? International Journal of Behavioral Development, 25, 379-385. Phinney, J. S. (1989). Stages of ethnic identity development in minority group adolescents. Journal of Early Adolescence, 9, 34-49. Reyes, O., Gillock, K. L., Kobus, K., & Sanchez, B. (2000). A longitudinal examination of the transition into senior high school for adolescents from urban, low-income status, and predominantly minority backgrounds. American Journal of Community Psychology, 24, 519-544. Ross, S. I. & Jackson, J. M. (1991). Teachers’ expectations for Black males’ and Black females’ academic achievement. Personality and Social Bulletin, 17, 78-82. Tatum, B. D. (1997). “Why are all the Black kids sitting together in the cafeteria?” and other conversations about race. New York: Basic Books. FEATURED RESOURCE: SCHOOL – MAKING THE GRADE This half hour video for teens looks a unique school programs that work ot help students improve their grades, keep them from dropping out, and communicate better with teachers. Originally appearing on PBS, this video is part of the ongoing In The Mix series where teens talk about heir world, their issues, and their concerns -- in their own way. To find out how you can purchase this fast-moving video that will keep teens interested while learning about how to succeed in school, click here! ABOUT DR> CHERYL HOLCOMB-MCCOY Dr. Cheryl Holcomb-McCoy is a faculty member at the University of Maryland in the Department of Counseling and Personnel Services. She is also the chairperson of the Diversity Interest Network for ASCA. ABOUT THE AMERICAN SCHOOL COUNSELOR ASSOCIATION Professional school counselors everywhere share the same vision to support their schools by serving their students. School counselors know that guiding students toward personal and social development leads to improved academic achievement. Through their partnership with principals and teachers, school counselors help prepare today's students to become tomorrow's adults. The American School Counselor Association (ASCA) responds to school counselors' unique needs, helping them grow individually as professionals and providing them with real tools to guide their students. As an international nonprofit organization founded in 1952, ASCA has the benefit of foresight and hindsight. It has grown to fit counselors' changing needs through social and educational movements from desegregation to standardized testing. Responding to the needs of counselors as voiced by counselors has enabled ASCA to remain vital and forward-thinking. ASCA serves as the voice of school counselors on Capitol Hill and helps members ensure their voices are heard in state legislatures. ASCA has active government affairs representatives who monitor activities in Congress, the Department of Education and throughout Washington to advocate on behalf of school counselors' interests: funding, certification, student-to-counselor ratios and more. A full-color bimonthly magazine, School Counselor provides practical information and how-to articles to help school counselors help their students and themselves. Each issue has a focus on something school counselors care about, from public relations to grief counseling, as well as departments and columns covering a range of topics. Professional School Counseling is ASCA's award-winning bimonthly academic journal, providing peer-reviewed articles on school counseling theory, research, practice and techniques. The journal and the magazine together provide counselors with the most well-rounded and up-to-date information in the field. For more information, visit www.schoolcounselor.org or call (703) 683-ASCA. LOOKING FOR HANDS-ON COUNSELING TOOLS? Visit the Guidance Channel Shopping Mall! There you will find thousands of resources, many of them national and international award-winners, including reproducible handouts, therapeutic games, multimedia programs, videos, curricula, prevention-awareness items and much more. Be sure to check out our online Childswork/Childsplay catalog, as well as our At-Risk Resources and Wellness Reproductions online catalogs, for innovative tools to address the social and emotional needs of your clients. FOR ADDITIONAL NEWSLETTERS... If you've found The Counselor's Classroom useful and informative, you may also be interested in subscribing to some of our other newsletters. Dr. Playwell's Newsletter is a unique newsletter full of play therapy techniques to help you address the social and emotional needs of children and young adolescents. FYI From Wellness offers practical tips and suggestions for use in the clinic or classroom written by professionals from a variety of disciplines. The Guidance Channel Zine is a monthly online magazine that includes interviews, website reviews, statistics and articles by many national organizations such as the National Association of School Psychologists, the American School Counselor Association and National S.A.V.E. (Students Against Violence Everywhere).

Recognizing Depression (Part II)

By Dr. Sheri Bauman for American School Counselor Association

What tools are there for screening for depression?

It is important to clarify what is meant by screening. Screening is not diagnosing. Screening is a way to learn whether symptoms are present and how severe they are. Students who score above the cutoff should be referred for a more thorough evaluation by a physician and/or psychologist. The referral to a physician is important because there are some medical conditions that will produce symptoms similar to depression, and those should be ruled out and/or treated. There are several well-researched screening tools that are available and easy to use in the school setting. All are self-report measures. Each will be briefly described here, and the reader is encouraged to contact publishers or go to publishers' websites for further information. Counselors may wish to compare costs, ease of scoring, and psychometric properties in deciding which inventory would be most useful in their setting.

The Children's Depression Inventory (CDI) is appropriate for use with children and adolescents, ages 7 – 17, and is written at a first grade level. It has 27 items in the regular form, and also is available in a 10-item brief form of the most important items. This screening inventory has three statements after each stem, and the child marks the one that is most like him/her. It is quick to administer and score, and is also available in a Spanish version.

Reynolds Child Depression Scale (RCDS) can be used with children ages 8 – 12. The Reynolds Adolescent Depression Scale (RADS) is designed for use with 13 – 18-year-olds. The children's scale is written at 2nd grade reading level, and the adolescent scale is written at third grade level. Each has 30 items, with easy administration and scoring procedures. The children's scale is available in Spanish.

The Beck Depression Inventory for Youth (BDI-Y) is one of the Beck Inventories of Emotional and Social Impairment that are designed for use with children ages 7 – 14, and the 20 items are written at second grade level. Students respond to statements by indicating how frequently a statement is true for them. No Spanish version is available.

The Center for Epidemiological Studies – Depression Scale for Children (CES-DC) is appropriate for adolescents ages 12 – 18, is written at a sixth grade reading level, and has 20 items. Scoring is straightforward.

What can school counselors do about depression?

The first step for the school counselor is to educate oneself and be alert for danger signals among students. Screening all students is not a recommended practice, but screening those students who exhibit one or more symptoms or behaviors described in Part I of this article is a helpful practice. The counselor must adhere to all ethical standards, including informed consent, when administering screening measures. If the student scores above the cutoff for the particular inventory, the school counselor must inform the parent or guardian, and recommend that a full physical and psychological evaluation would be in the child's best interest.

Counselors also need to educate teachers and other staff members that these behaviors and signals, which may be disruptive to learning, may also be clues that a child has an undiagnosed depressive disorder. Teachers are in daily contact with students, and may be the first to observe changes, or see a drawing or writing that is cause for concern. Encouraging teachers to work with counselors and refer these students is an important contribution to prevention efforts.

Parents also need information and education about depression. Many pamphlets and fact sheets are available, and some can be obtained online. Include such information in newsletters, when speaking at parent information programs, and in building a library of useful books that can be loaned to parents. These are all ways to partner with parents in helping their children.

Offering to communicate with treatment providers in order to learn what strategies might be most applicable in school is a way to form important links. Finally, offering support to students who are depressed is an essential service. That support might involve monitoring progress, checking with the student regularly, and/or inviting the student to be in a support group if appropriate.

In conclusion...

There is some evidence that depression is appearing at younger ages in recent years. Because depression interferes with a student's academic, social, emotional, and behavioral functioning, school counselors must be active in identifying children who may have this disorder.

Since depression in children is linked to increased risk of suicidal thoughts and behaviors, early intervention for depression is an effective measure to prevent suicide in youth. Suicide is the third leading cause of death in adolescents, and the sixth for 5- to 14-year-olds. Treatment has been found to be effective with children and adolescents, so identifying and referring students may be a matter of life and death.

References And Resources

American Psychiatric Association. (2000). Diagnostic And Statistical Manual Of Mental Disorders (4th ed. text revision). Washington, DC.

Beck, J., Beck A. T., & Jolly, J. (2001). Beck Depression Inventory For Youth. San Antonio, TX: Harcourt Assessments, Inc.

Fendrich, M., Weissman, M. M., & Warner, V. (1990). Screening For Depressive Disorder In Children And Adolescents: Validating The Center For Epidemiologic Studies Depression Scale For Children. American Journal of Epidemiology, 131, 538-551.

Kovacs, M. (1992). Children's Depression Inventory. Tonawanda, NY: Multi-Health System.

Reynolds, W.M. (1989). Reynolds Child Depression Scale. Odessa, FL: Psychological Assessment Resources, Inc.

Reynolds, W. M. (1986). Reynolds Adolescent Depression Scale. Odessa, FL: Psychological Assessment Resources, Inc.

FEATURED RESOURCE: SOMETIMES I GET SAD (BUT NOW I KNOW WHAT MAKES ME HAPPY)

The incidence of childhood depression has increased dramatically in the last 15 years, and it is affecting younger children than ever before. This storybook helps children ages 5-10 to learn about depression and what to do about it. The main character, Sara, is depressed for a variety of reasons but she gets help from a combination of individual and group counseling. Sometimes she still gets sad, but now she knows how to make herself feel better. To find out how you can purchase this tool to help children who are depressed, click here!

ABOUT DR. SHERI BAUMAN

Dr. Sheri Bauman is an Assistant Professor in the Department of Educational Psychology at the University of Arizona, Tucson, Arizona. She can be reached by email at sherib@u.arizona.edu

ABOUT THE AMERICAN SCHOOL COUNSELOR ASSOCIATION

Professional school counselors everywhere share the same vision to support their schools by serving their students. School counselors know that guiding students toward personal and social development leads to improved academic achievement. Through their partnership with principals and teachers, school counselors help prepare today's students to become tomorrow's adults.

The American School Counselor Association (ASCA) responds to school counselors' unique needs, helping them grow individually as professionals and providing them with real tools to guide their students. As an international nonprofit organization founded in 1952, ASCA has the benefit of foresight and hindsight. It has grown to fit counselors' changing needs through social and educational movements from desegregation to standardized testing. Responding to the needs of counselors as voiced by counselors has enabled ASCA to remain vital and forward-thinking.

ASCA serves as the voice of school counselors on Capitol Hill and helps members ensure their voices are heard in state legislatures. ASCA has active government affairs representatives who monitor activities in Congress, the Department of Education and throughout Washington to advocate on behalf of school counselors' interests: funding, certification, student-to-counselor ratios and more.

A full-color bimonthly magazine, School Counselor provides practical information and how-to articles to help school counselors help their students and themselves. Each issue has a focus on something school counselors care about, from public relations to grief counseling, as well as departments and columns covering a range of topics. Professional School Counseling is ASCA's award-winning bimonthly academic journal, providing peer-reviewed articles on school counseling theory, research, practice and techniques. The journal and the magazine together provide counselors with the most well-rounded and up-to-date information in the field.

For more information, visit www.schoolcounselor.org or call (703) 683-ASCA.

LOOKING FOR HANDS-ON SCHOOL COUNSELING TOOLS?


Visit the Guidance Channel Shopping Mall! There you will find thousands of resources, many of them national and international award-winners, including reproducible handouts, therapeutic games, multimedia programs, videos, curricula, prevention-awareness items and much more. Be sure to check out our online Childswork/Childsplay catalog, as well as our At-Risk Resources and Wellness Reproductions online catalogs, for innovative tools to address the social and emotional needs of your clients.

FOR ADDITIONAL NEWSLETTERS...

If you've found The Counselor's Classroom useful and informative, you may also be interested in subscribing to some of our other newsletters. Dr. Playwell's Newsletter is a unique newsletter full of play therapy techniques to help you address the social and emotional needs of children and young adolescents. FYI From Wellness offers practical tips and suggestions for use in the clinic or classroom written by professionals from a variety of disciplines. The Guidance Channel Zine is a monthly online magazine that includes interviews, website reviews, statistics and articles by many national organizations such as the National Association of School Psychologists, the American School Counselor Association and National S.A.V.E. (Students Against Violence Everywhere).

Recognizing Depression

By Dr. Sheri Bauman for American School Counselor Association

Until the 1980s, most psychologists did not believe that children and young adolescents suffered from clinical depression. Now we realize that as many as 2 percent of elementary students and 8 percent of adolescents are depressed. In addition to decreased academic performance, untreated depression is one of the most common causes of suicide among teenagers. In pre-pubertal children, males and females have similar rates of depression, but in adolescents, females are more often depressed than males. As 60 to 80 percent of victims of suicide have depressive disorders, recognizing depression and referring students with signs of depression for a professional evaluation and possible treatment may be one of the most effective strategies for suicide prevention.

What is depression?

Perhaps one reason that it took so long for professionals to recognize that children and adolescents do suffer from depression is that symptoms of depression look different in children and adolescents than in adults. First, let's make sure we are clear about the term depression. In casual conversation, it is not unusual for people to say, "I'm depressed today," when they mean "I'm sad today," or "I'm having a bad day." The clinical definition of depression is much more specific and precise. Clinical depression, in children and adults, refers to a mental disorder that exists for at least 2 weeks and has at least 5 of the following symptoms nearly every day that cause distress and/or interfere with daily functioning. The first 2 symptoms must be among the 5.

• Depressed or irritable mood (irritability is more common in children and adolescents)
• Decreased interest in ordinarily pleasurable activities
• Significant weight loss or gain or decreased appetite
• Sleeping a great deal or not sleeping well
• Moving very slowly or very rapidly compared to usual or feeling very restless
• Loss of energy
• Inability to concentrate
• Suicidal or morbid thoughts

Note that there are cognitive, emotional, behavioral, and physical aspects of depression. Depression affects all systems, and some of those may predominate. There is also a condition called dysthymia, which is similar to depression but is longer-lasting (in children and adolescents, the symptoms must be present for at least a year) and less severe. This disorder may appear in children as young as 7, while depression may not emerge until age 10. Some children experience both depression and dysthymia at the same time.

Some children are at higher risk for depression than others. Children of depressed mothers are at higher risk than their peers, as are children with a family history of depression. Children with chronic medical problems, children with attention deficit disorders and conduct problems, sexual minority adolescents, and pregnant adolescents are also vulnerable groups. This does not mean that children and adolescents in those groups will necessarily develop depression, but they are more likely to do so than others.

What does depression look like in students?

In elementary age children, depression is often expressed as bodily complaints. Frequent stomach aches and headaches are observed. Anxiety about school (not wanting to go to school, excessive worrying about school performance) is another way depression is exhibited in children of this age. They may be extremely fearful of being separated from parents, and may develop temper tantrums and behavioral problems, and be irritable or agitated. Such symptoms may not raise a red flag to the uninformed observer, and children with these symptoms are often treated as discipline problems. Underlying sadness and hopelessness may not be easily detected, and poor self-esteem and expression of guilt may not be associated with possible depression. The counselor may be the only person who is aware of the link between such a pattern and possible depression, and as such has an opportunity to intervene and refer the child for further evaluation.

In adolescents, the sadness and hopelessness may be more obvious. Other visible signs could include withdrawal from friends and previously enjoyed activities, changes in eating and sleeping patterns, poor school performance, and low energy. The challenge with adolescents is that many teenagers experience these symptoms on occasion, and adults may dismiss them as "just being a teenager." We are more likely to find drug and alcohol abuse (which may be initiated as a kind of self-medication for unpleasant feelings) and suicidal thoughts and behavior in adolescents, so identifying untreated depression during this stage of life is particularly important.

What other clues shall we look for?

Children and adolescents may mask their feelings, and may have difficulty verbalizing what they are experiencing. The observant counselor can pay attention to other means of expression that provide clues to the inner world of the child. Play, art, and writing are activities that may reveal clues to a depressed child. Drawings that look sad and morose, or contain damaged or morbid images and gloomy colors, may signal sadness or preoccupation with fears and death. Stories and other writings, particularly in adolescence, may reveal thoughts and feelings that are not openly talked about. Adolescents may appear angry rather than sad.

Various behaviors might also lead a counselor to wonder about possible depression. When a child suddenly develops behavior problems, or seems unusually irritable, distractible, and easily frustrated, depression may be behind the behaviors. Disciplinary referrals are likely to increase, and the counselor should make note of this. In addition, unexpected changes in grades and school performance may be more than laziness or lack of interest; sleeping in class may also signal underlying mood problems.

Editor's Note: In next week's issue we will conclude this article by highlighting various tools counselors can use to screen for depression in children and adolescents.

References And Resources

American Psychiatric Association. (2000). Diagnostic And Statistical Manual Of Mental Disorders (4th ed. text revision). Washington, DC.

Beck, J., Beck A. T., & Jolly, J. (2001). Beck Depression Inventory For Youth. San Antonio, TX: Harcourt Assessments, Inc.

Fendrich, M., Weissman, M. M., & Warner, V. (1990). Screening For Depressive Disorder In Children And Adolescents: Validating The Center For Epidemiologic Studies Depression Scale For Children. American Journal of Epidemiology, 131, 538-551.

Kovacs, M. (1992). Children's Depression Inventory. Tonawanda, NY: Multi-Health System.

Reynolds, W.M. (1989). Reynolds Child Depression Scale. Odessa, FL: Psychological Assessment Resources, Inc.

Reynolds, W. M. (1986). Reynolds Adolescent Depression Scale. Odessa, FL: Psychological Assessment Resources, Inc.

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Professional school counselors everywhere share the same vision to support their schools by serving their students. School counselors know that guiding students toward personal and social development leads to improved academic achievement. Through their partnership with principals and teachers, school counselors help prepare today's students to become tomorrow's adults.

The American School Counselor Association (ASCA) responds to school counselors' unique needs, helping them grow individually as professionals and providing them with real tools to guide their students. As an international nonprofit organization founded in 1952, ASCA has the benefit of foresight and hindsight. It has grown to fit counselors' changing needs through social and educational movements from desegregation to standardized testing. Responding to the needs of counselors as voiced by counselors has enabled ASCA to remain vital and forward-thinking.

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Group Counseling Interventions For Overweight Kids

By Julia Taylor for American School Counselor Association

Some parents in Florida and Pennsylvania received an alarming letter from their child's school district a few years ago. The letter had nothing to do with their academic performance or behavior problems; it was informing them that their child had a weight problem. These particular school districts now mail home a letter when the child is overweight, underweight, or at risk for becoming overweight –- suggesting they take their child to a doctor to rule out medical conditions and/or seek advice about nutrition and exercise. While some parents were outraged and believed the letter was doing nothing more than harming their self-image; Galley (2002) reported "The biggest boost for their self-image would be to get them to a healthier weight and a more active lifestyle."

The Centers for Disease Control and Prevention (2003) refers to adolescent obesity as "a public health epidemic." The percent of overweight children has risen to approximately 15%; nearly triple the rate from the 1970's. Being overweight refers to an increase in body weight in relation to height when compared to the average standard. Obesity is defined as an excessive amount of body fat or adipose tissue in relation to lean body mass.

The Surgeon General (2003) suggests that adults be good role models to children by making healthy food choices and exercising regularly. At the same time, it was noted that 61% of the American adult population is overweight. The Surgeon General listed three major health consequences associated with childhood obesity.

• Risk factors for heart disease, such as high cholesterol and high blood pressure, occur with increased frequency in overweight children and adolescents compared to those with a healthy weight.
• Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents. Overweight and obesity are closely linked to type II diabetes.
• Overweight adolescents have a 70% chance of becoming overweight or obese adults. This increases to 80% if one or more parent is overweight or obese.

The Surgeon General also noted that the most immediate consequence of overweight, as perceived by children themselves, is social discrimination.

The average public school student spends more waking hours at school than in the home. The Action for Healthy Kids (2002) believe that the school system has a responsibility to "promote knowledge, attitudes, and behaviors among our children that help develop eating and fitness patterns that can improve health, intellectual development, and overall quality of life." Accordingly, teachers, counselors, school officials, and parents play a vital role in shaping a healthy future by providing students with a healthy school environment.

Emotional Factors

For overweight adolescents, the biggest concern of excess weight is not health problems, but emotional problems. To live in a society that values thinness often promotes feelings of guilt, depression, and anxiety in children who differ from societal norms. Leach & Morrill (1991) report that being overweight is a "nightmare" for children living in a culture purely obsessed with being thin. Strauss (2000) simply states, "Society does not tolerate excess weight."

Children are often intolerant of differences amongst one another. Barlow, et al, (2002) found that young people are taught the value of attractiveness at an early age. Children who grow up thinking they are different from other children often don't like themselves. In addition, Bartlow indicated that overweight children are at a significantly greater risk for becoming severely depressed, being bullied, developing an eating disorder, and having marked low self-esteem. Leach & Morrill added that feelings of alienation, anger, embarrassment, school avoidance, lower grades, and extreme social difficulties were also common emotional side effects of being overweight.

Successful Strategies in Group

The American School Counselor Association (2003) states that "groups and group counseling make it possible for students to achieve healthier personal adjustment in the face of rapid change and to learn to work and live with others." Overweight children face ridicule every day and are victimized because of their size. Students need to have a safe place to go to when they are feeling threatened. The collaboration, cohesiveness, and sense of belonging children experience in group counseling may help them to feel understood (Lowey, 1998).

Overweight children benefit by learning how to deal with emotional and social issues that often coincide with being viewed as different. Leach & Morrill (1991) provide many suggestions for helping overweight children cope in school. In a group setting, children can help each other identify locations where they have suffered abuse. The children can learn other routes and brainstorm ideas to reduce their vulnerability at locations that cannot be avoided. Discussions among overweight students with valuable information that can be used in many situations (Leach & Morrill).

Goal-setting is a common practice in group counseling sessions. Research shows that overweight children who have clear goals that are non-weight related have a more positive attitude and realistic outlook on life (Barlow, et al, 2002). In a group setting, children can discuss social goals and realistic strategies to obtain their goals without feeling threatened. Research by Strauss (2000) indicated that goal-setting may help children identify people whom they can trust to help carry out their goals.

Idealistic role-models help children to strive for excellence and to overcome negative feelings about themselves. Strauss (2000) believes that it is important for overweight students to have someone to admire for characteristics other than weight and appearance. In addition, children should feel comfortable talking about role models with other students to create a network of "positive people." Lowey (1998) believes that our society is filled with negative images that portray unachievable standards. Children who look up to and admire others for their non-physical achievements seem to be self-tolerant.

Perhaps the most important components of counseling groups of overweight students are the counselor's general knowledge about obesity and the level of empathy that is felt for the children. There seems to be mass confusion about the entire realm of obesity. Leach & Morrill (1991) believe that by not understanding the spectrum of obesity, school counselors often resort to using weight-loss, nutrition, and self-esteem programs to help overweight children. "These methods have been attempted by well-meaning school personnel, but evidence of success is lacking." A school counselor should be seen as someone who can provide support for children and make them feel competent about themselves both in and out of the educational environment (Hubbard & Rhyne-Winkler, 1994). In understanding the entire spectrum of obesity, Lowey (1998) assumes that counselors will come to the realization that "fat children need to be nurtured, not changed."

Unsuccessful Strategies in Group

If it were simple to lose weight perhaps obesity would not be our nation's second largest preventable health threat. School groups that focus on the physical aspects of obesity are doomed for failure. In attempts to intervene, Loewy (1998) found that overweight children are typically subjected to commercial weight-loss programs during group counseling sessions. These programs include, but are not limited to calorie restriction, weigh-ins, behavior modification, and torturous exercise programs. Some of these methods may prove short-term success, but are highly ineffective for long-term results. Lowey found these methods also result in metabolic dysfunction, which can lead to increased weight gain. "It is a vicious cycle -- weight loss, weight gain, social acceptance, social rejection -- overall, children just report increased frustration and lower self-esteem."

Self-esteem programs have not been proven effective in group counseling situations. Kaplan (1995) believes that our country is obsessed with self-esteem and that we are providing children with a disservice by focusing solely on techniques to raise it. Kaplan states that, "The media has oversold self-esteem as a national cure-all." Self-esteem is cyclic and goes through many phases, phases that cannot be taught in one particular setting. Leach & Morrill (1991) found that overweight children tend to bond with each other and show their authentic selves, leaving them isolated from other students. Many of these children do have a lot of self-esteem. By targeting obese children for self-esteem groups, school counselors are running the risk of children feeling further misunderstood.

How To Help

Nutrition and weight-loss programs need to be closely monitored by a medical doctor. Lowey (1998) feels that while dieting and weight control advice can be helpful to parents, it is often shrugged off by children because they typically do not want to feel "criticized or singled out." Leach & Morrill (1991) found that children may be going through a growth spurt and weight loss may be detrimental to future development. In addition, proper nutrition should be emphasized to everyone and should definitely not target overweight children. Group counseling that focuses on these factors has no evidence for success and long-term maintenance of weight loss. Therefore, Lowey suggests that counselor's just "steer clear" from anything not associated with the children's feelings.

School counselors have a responsibility to promote optimal mental health to help children function in the academic setting, but they should not be the one to assist in weight loss. Young people suffering from a physical or mental ailment may maintain a feeling of helplessness that needs to be addressed. A group setting is ideal for children who are overweight, children who harass overweight children, and children who may be at risk for becoming overweight to help children increase awareness and promote a positive sense of self. Such groups provide opportunities for social skill development, realistic goal-setting and providing children with the opportunity to explore their feelings in a non-judgmental, safe environment.

School counseling groups should focus on the emotional piece, school counselors have ample opportunities to provide teachers, administrators, and parent's information that can help to promote more physical success. A team approach can be used to help everyone become more aware of what is occurring in the academic setting. Before this can happen, everyone should be educated about the realm of obesity, take a look at their feelings towards obesity, and try to be empathic towards the children who are struggling. Everywhere I go (literally) I hear somebody talking about food or weight. Unfortunately, our society is obsessed with it. School counselors can help to increase the level of awareness teachers have about this sensitive subject. Parenting groups can be conducted to educate how to develop healthy lifestyles regardless of time and/or income. In addition, school counselors can provide parents with information that can lead to a more supportive environment both socially and academically. The bottom line is when school counselors learn to appreciate the value of each individual child, they may begin to truly advocate.

REFERENCES

Action for Healthy Kids (2003). Fact Sheet: The Healthy Schools Summit. Retrieved March 6th, 2003 from www.ActionForHealthyKids.org

American School Counselor Association (2003). The Role of the Professional School Counselor. Retrieved March 14th, 2003 from www.schoolcounselor.org

Bartlow, S.E., Buschbacher, V., & Jonides, L. (2002). Management of child and adolescent obesity: Psychological, emotional, and behavioral assessment. Pediatrics, 110(1), 215-222.

Galley, M. (2002). School Letters on Students' Obesity Outrage Some Parents. Education Week, 21(29), 11-12.

Hubbard, G.T., & Rhyne-Winkler, M.C. (1994). Eating attitudes and behavior: A school counseling program. School Counselor, 41(3) 195-199.

Kaplan, L.S. (1995). Self-esteem is not our national wonder drug. School Counselor, 42(5), 341-346.

Leach, J.N. & Morrill, C.M. (1991). Adolescent obesity: Rethinking traditional approaches. School Counselor, 38(5), 347-351.

Loewy, M.I. (1998). Suggestions for working with fat children in the schools. School Counselor, 1(4), 18-22.

Strauss, R.B.(2000). Self-esteem related to childhood obesity. Brown University Child & Adolescent Behavior, 16(3), 3-6.

The Center for Disease Control and Statistics (2003). Obesity Trends Among Children and Adolescents. Retrieved March 24th, 2003 from www.cdc.gov

The Office of the Surgeon General (2003). The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity. Retrieved March 6th, 2003 from www.surgeongeneral.gov

ABOUT JULIA TAYLOR

Julia Taylor works as a high school counselor for Loudoun County Public Schools in Virginia and is the Regional Conference Chairperson for the Virginia School Counselor Association (VSCA).If you've found The Counselor's Classroom useful and informative, you may also be interested in subscribing to some of our other newsletters. Dr. Playwell's Newsletter is a unique newsletter full of play therapy techniques to help you address the social and emotional needs of children and young adolescents. FYI From Wellness offers practical tips and suggestions for use in the clinic or classroom written by professionals from a variety of disciplines. The Guidance Channel Zine is a monthly online magazine that includes interviews, website reviews, statistics and articles by many national organizations such as the National Association of School Psychologists, the American School Counselor Association and National S.A.V.E. (Students Against Violence Everywhere).