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Entries for May 2015

Suicide Prevention

1-800-273-TALK (8255)

suicidepreventionlifeline.org

Suicide Warning Signs

The following signs may mean someone is at risk for suicide. The risk of suicide is greater if a behavior is new or has increased and if it seems related to a painful event, loss, or change. If you or someone you know exhibits any of these signs, seek help as soon as possible by calling the Lifeline at 1-800-273-TALK (8255).

  • Talking about wanting to die or to kill themselves.
  • Looking for a way to kill themselves, such as searching online or buying a gun
  • Talking about feeling hopeless or having no reason to live.
  • Talking about feeling trapped or in unbearable pain.
  • Talking about being a burden to others.
  • Increasing the use of alcohol or drugs.
  • Acting anxious or agitated; behaving recklessly.
  • Sleeping too little or too much.
  • Withdrawing or isolating themselves.
  • Showing rage or talking about seeking revenge.
  • Displaying extreme mood swings.

Suicide Risk Factors

Risk factors are often confused with warning signs of suicide, and frequently suicide prevention materials mix the two into lists of “what to watch out for.” It is important to note, however, that factors identified as increasing risk are not factors that cause or predict a suicide attempt. Risk factors are characteristics that make it more likely that an individual will consider, attempt, or die by suicide. Protective factors are characteristics that make it less likely that individuals will consider, attempt, or die by suicide.

Risk Factors for Suicide

  • Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders and certain personality disorders
  • Alcohol and other substance use disorders
  • Hopelessness
  • Impulsive and/or aggressive tendencies
  • History of trauma or abuse
  • Major physical illnesses
  • Previous suicide attempt
  • Family history of suicide
  • Job or financial loss
  • Loss of relationship
  • Easy access to lethal means
  • Local clusters of suicide
  • Lack of social support and sense of isolation
  • Stigma associated with asking for help
  • Lack of health care, especially mental health and substance abuse treatment
  • Cultural and religious beliefs, such as the belief that suicide is a noble resolution of a personal dilemma
  • Exposure to others who have died by suicide (in real life or via the media and Internet)

Protective Factors for Suicide

  • Effective clinical care for mental, physical and substance use disorders
  • Easy access to a variety of clinical interventions
  • Restricted access to highly lethal means of suicide
  • Strong connections to family and community support
  • Support through ongoing medical and mental health care relationships
  • Skills in problem solving, conflict resolution and handling problems in a non-violent way
  • Cultural and religious beliefs that discourage suicide and support self-preservation

(This was adapted from "Understanding Risk and Protective Factors for Suicide” and “Risk and protective factors for suicide" by the Suicide Prevention Resource Center.)

 

Glossary

This is a list of commonly used terms in information about mental health and suicide prevention.

Best practices – Activities or programs that are in keeping with the best available evidence regarding what is effective.

 

Chat service – Crisis counseling provided via instant messaging.

 

Comprehensive suicide prevention plans – Plans that use a multi-faceted approach to addressing the problem. For example, including interventions targeting biopsychosocial, social and environmental factors.

 

Confidentiality – The principle in medical ethics that the information a patient or client reveals to a health care provider is private and has limits on how and when it can be disclosed to a third party.

 

Consumer – A person who is using or has used a health service.

 

Contagion – A phenomenon whereby susceptible persons are influenced towards suicidal behavior through knowledge of another person's suicidal acts.

 

Crisis center – A facility or call center where individuals going through personal crises can obtain help or advice, either in-person or by crisis hotline.

 

Crisis counseling – Brief counseling that is focused on minimizing stress, providing emotional support and improving an individual’s coping strategies in the here and now. Like psychotherapy, crisis counseling involves assessment, planning and treatment, but the scope of service is generally much more specific.

 

Crisis hotline – A phone number individuals can call to get immediate emergency crisis counseling by telephone.

 

Crisis intervention – See Crisis counseling

 

Gatekeepers – Those individuals in a community who have face-to-face contact with large numbers of community members as part of their usual routine; they may be trained to identify persons at risk of suicide and refer them to treatment or supporting services as appropriate.

 

Health – The complete state of physical, mental, and social well-being, not merely the absence of disease or infirmity.

 

Health and safety officials – Law enforcement officers, fire fighters, emergency medical technicians (EMTs), and outreach workers in community health programs.

 

Imminent risk – A situation in which there is believed to be a close temporal connection between an individual’s current risk status and actions that could lead to his or her suicide.

 

Intentional – Injuries resulting from purposeful human action whether directed at oneself (self-directed) or others (assaultive), sometimes referred to as violent injuries.

 

Intervention – A strategy or approach that is intended to prevent an outcome or to alter the course of an existing condition (such as providing lithium for bipolar disorder or strengthening social support in a community).

 

Means – The instrument or object whereby a self-destructive act is carried out (i.e., firearm, poison, medication).

 

Means restriction – Techniques, policies, and procedures designed to reduce access or availability to means and methods of deliberate self-harm.

 

Methods – Actions or techniques which result in an individual inflicting self-harm (i.e., asphyxiation, overdose, jumping).

 

Mental disorder – A diagnosable illness characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress that significantly interferes with an individual's cognitive, emotional or social abilities; often used interchangeably with mental illness.

 

Mental health – The capacity of individuals to interact with one another and the environment in ways that promote subjective well-being, optimal development and use of mental abilities (cognitive, affective and relational).

 

Mental health problem – Diminished cognitive, social or emotional abilities but not to the extent that the criteria for a mental disorder are met.

 

Mental health services – Health services that are specially designed for the care and treatment of people with mental health problems, including mental illness. Includes hospital and other 24-hour services, intensive community services, ambulatory or outpatient services, medical management, case management, intensive psychosocial rehabilitation services, and other intensive outreach approaches to the care of individuals with severe disorders.

 

Mental illness – See Mental disorder.

 

Postvention – A strategy or approach that is implemented after a crisis or traumatic event has occurred.

 

Prevention – A strategy or approach that reduces the likelihood of risk of onset, or delays the onset of adverse health problems or reduces the harm resulting from conditions or behaviors.

 

Prevention network – Coalitions of change-oriented organizations and individuals working together to promote suicide prevention. Prevention networks might include statewide coalitions, community task forces, regional alliances, or professional groups.

 

Protective factors – Factors that make it less likely that individuals will develop a disorder. Protective factors may encompass biological, psychological or social factors in the individual, family and environment.

 

Psychiatric disorder – See Mental disorder.

 

Psychiatry – The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders.

 

Psychology – The science concerned with the individual behavior of humans, including mental and physiological processes related to behavior.

 

Public health - The science and art of promoting health, preventing disease, and prolonging life through the organized efforts of society.

 

Risk assessment – The process of quantifying the probability of an individual harming himself or others.

 

Risk factors – Those factors that make it more likely that individuals will develop a disorder; risk factors may encompass biological, psychological or social factors in the individual, family and environment.

 

Screening – Administration of an assessment tool to identify persons in need of more in-depth evaluation or treatment.

 

Screening tools – Instruments and techniques (questionnaires, check lists, self-assessment forms) used to evaluate individuals for increased risk of certain health problems.

 

Self-harm – The various methods by which individuals injure themselves, such as self-cutting, self-battering, taking overdoses or exhibiting deliberate recklessness.

 

Self-injury – See Self-harm.

 

Social services – Organized efforts to advance human welfare, such as home-delivered meal programs, support groups, and community recreation projects.

 

Social support – Assistance that may include companionship, emotional backing, cognitive guidance, material aid and special services.

 

Stakeholders – Entities, including organizations, groups and individuals, which are affected by and contribute to decisions, consultations and policies.

 

Stigma – An object, idea, or label associated with disgrace or reproach.

 

Substance abuse – A maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to repeated use. This includes maladaptive use of legal substances and illicit drugs.

 

Suicidal act (also referred to as suicide attempt) – A potentially self-injurious behavior with a nonfatal outcome, for which there is evidence that the person intended to kill himself or herself. A suicide attempt may or may not result in injuries.

 

Suicidal behavior – A spectrum of activities related to thoughts and behaviors that include suicidal thinking, suicide attempts, and completed suicide.

 

Suicidal ideation – Self-reported thoughts of engaging in suicide-related behavior.

 

Suicidality – A term that encompasses suicidal thoughts, ideation, plans, suicide attempts, and completed suicide.

 

Suicide – Death from injury, poisoning, or suffocation where there is evidence that a self-inflicted act led to the person's death.

 

Suicide attempt – See Suicidal act 

 

Suicide attempt survivors – Individuals who have survived a prior suicide attempt.

 

Suicide survivors – Family members, significant others, or acquaintances who have experienced the loss of a loved one due to suicide. Sometimes this term is also used to mean suicide attempt survivors.

 

Suicide warning signs – Indications that an individual is at risk for suicide.

 

Adapted from the National Strategy for Suicide Prevention: Goals and Objectives for action. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, 2001

Helpful Fact Sheets

Learn more about suicide prevention with information from the Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, and the Suicide Prevention Resource Center.

Suicide: Facts at a Glance (Centers for Disease Control and Prevention)

Understanding Suicide: Fact Sheet (Centers for Disease Control and Prevention)

Suicide Prevention Dialogue with Consumers and Survivors: From Pain to Promise (Substance Abuse and Mental Health Services Administration)

Suicide Prevention 101: Customized Information Series (Suicide Prevention Resource Center)

Organizations

Please visit these suicide prevention and peer support organizations for more resources and information.

Suicide Prevention Organizations

Mental Health Support Organizations

 


ANGER MANAGEMENT

Tips and Techniques for Getting Anger Under Control

Anger Management In This Article

Do you have a short fuse or find yourself getting into frequent arguments and fights? Anger is a normal, healthy emotion, but when chronic, explosive anger spirals out of control, it can have serious consequences for your relationships, your health, and your state of mind.

With insight about the real reasons for your anger and these anger management tools, you can learn to keep your temper from hijacking your life.

Understanding anger

The emotion of anger is neither good nor bad. It’s perfectly healthy and normal to feel angry when you’ve been mistreated or wronged. The feeling isn't the problem—it's what you do with it that makes a difference. Anger becomes a problem when it harms you or others.

If you have a hot temper, you may feel like it’s out of your hands and there’s little you can do to tame the beast. But you have more control over your anger than you think. You can learn to express your emotions without hurting others—and when you do, you’ll not only feel better, you’ll also be more likely to get your needs met. Mastering the art of anger management takes work, but the more you practice, the easier it will get. And the payoff can be huge. Learning to control your anger and express it appropriately can help you build better relationships, achieve your goals, and lead a healthier, more satisfying life.

Myths and Facts about Anger

Myth: I shouldn’t “hold in” my anger. It’s healthy to vent and let it out.

Fact: While it’s true that suppressing and ignoring anger is unhealthy, venting is no better. Anger is not something you have to “let out” in an aggressive way in order to avoid blowing up. In fact, outbursts and tirades only fuel the fire and reinforce your anger problem.

Myth: Anger, aggression, and intimidation help me earn respect and get what I want.

Fact: True power doesn’t come from bullying others. People may be afraid of you, but they won’t respect you if you can’t control yourself or handle opposing viewpoints. Others will be more willing to listen to you and accommodate your needs if you communicate in a respectful way.

Myth: I can’t help myself. Anger isn’t something you can control.

Fact: You can’t always control the situation you’re in or how it makes you feel, but you can control how you express your anger. And you can express your anger without being verbally or physically abusive. Even if someone is pushing your buttons, you always have a choice about how to respond.

Myth: Anger management is about learning to suppress your anger.

Fact: Never getting angry is not a good goal. Anger is normal, and it will come out regardless of how hard you try to suppress it. Anger management is all about becoming aware of your underlying feelings and needs and developing healthier ways to manage upset. Rather than trying to suppress your anger, the goal is to express it in constructive ways.

Why anger management is important

You might think that venting your anger is healthy, that the people around you are too sensitive, that your anger is justified, or that you need to show your fury to get respect. But the truth is that anger is much more likely to damage your relationships, impair your judgment, get in the way of success, and have a negative impact on the way people see you.

  • Out-of-control anger hurts your physical health. Constantly operating at high levels of stress and tension is bad for your health. Chronic anger makes you more susceptible to heart disease, diabetes, high cholesterol levels, a weakened immune system, insomnia, and high blood pressure.
  • Out-of-control anger hurts your mental health. Chronic anger consumes huge amounts of mental energy and clouds your thinking, making it harder to concentrate, see the bigger picture, and enjoy life. It can also lead to stress, depression, and other mental health problems.
  • Out-of-control anger hurts your career. Constructive criticism, creative differences, and heated debate can be healthy. But lashing out only alienates your colleagues, supervisors, or clients and erodes their respect. What’s more, a bad reputation can follow you wherever you go, making it harder and harder to get ahead.
  • Out-of-control anger hurts your relationships with others. It causes lasting scars in the people you love most and gets in the way of your friendships and work relationships. Chronic, intense anger makes it hard for others to trust you, speak honestly, or feel comfortable—they never know what is going to set you off or what you will do. Explosive anger is especially damaging to children.

Anger management tip 1: Explore what’s really behind your anger

If you’re struggling with out-of-control anger, you may be wondering why your fuse is so short. Anger problems often stem from what you’ve learned as a child. If you watched others in your family scream, hit each other, or throw things, you might think this is how anger is supposed to be expressed. Traumatic events and high levels of stress can make you more susceptible to anger as well.

Anger is often a cover-up for other feelings

In order to get your needs met and express your anger in appropriate ways, you need to be in touch with what you are really feeling. Are you truly angry? Or is your anger masking other feelings such as embarrassment, insecurity, hurt, shame, or vulnerability?

If your knee-jerk response in many situations is anger, it is very likely that your temper is covering up your true feelings and needs. This is especially likely if you grew up in a family where expressing feelings was strongly discouraged. As an adult, you may have a hard time acknowledging feelings other than anger.

Clues that there’s something more to your anger

  • You have a hard time compromising. Is it hard for you to understand other people’s points of view, and even harder to concede a point? If you grew up in a family where anger was out of control, you may remember how the angry person got his or her way by being the loudest and most demanding. Compromising might bring up scary feelings of failure and vulnerability.
  • You have trouble expressing emotions other than anger. Do you pride yourself on being tough and in control, never letting your guard down? Do you feel that emotions like fear, guilt, or shame don’t apply to you? Everyone has those emotions, and if you think you don’t, you may be using anger as a cover for them.
  • You view different opinions and viewpoints as a personal challenge to you. Do you believe that your way is always right and get angry when others disagree? If you have a strong need to be in control or a fragile ego, you may interpret other perspectives as a challenge to your authority, rather than simply a different way of looking at things.

If you are uncomfortable with many emotions, disconnected, or stuck on an angry one-note response to everything, it might do you some good to get back in touch with your feelings. Emotional awareness is the key to self-understanding and success in life. Without the ability to recognize, manage, and deal with the full range of human emotions, you’ll inevitably spin into confusion, isolation, and self-doubt.

Some Dynamics of Anger

  • We become more angry when we are stressed and body resources are down.
  • We are rarely ever angry for the reasons we think.
  • We are often angry when we didn't get what we needed as a child.
  • We often become angry when we see a trait in others we can't stand in ourselves.
  • Underneath many current angers are old disappointments, traumas, and triggers.
  • Sometimes we get angry because we were hurt as a child.
  • We get angry when a current event brings up an old unresolved situation from the past.
  • We often feel strong emotion when a situation has a similar content, words or energy that we have felt before.

Source: Get Your Angries Out

Anger management tip 2: Be aware of your anger warning signs and triggers

While you might feel that you just explode into anger without warning, in fact, there are physical warning signs in your body. Anger is a normal physical response. It fuels the “fight or flight” system of the body, and the angrier you get, the more your body goes into overdrive. Becoming aware of your own personal signs that your temper is starting to boil allows you to take steps to manage your anger before it gets out of control.

Pay attention to the way anger feels in your body

  • Knots in your stomach
  • Clenching your hands or jaw
  • Feeling clammy or flushed
  • Breathing faster
  • Headaches
  • Pacing or needing to walk around
  • “Seeing red”
  • Having trouble concentrating
  • Pounding heart
  • Tensing your shoulders

Identify the negative thought patterns that trigger your temper

You may think that external things—the insensitive actions of other people, for example, or frustrating situations—are what cause your anger. But anger problems have less to do with what happens to you than how you interpret and think about what happened. Common negative thinking patterns that trigger and fuel anger include:

  • Overgeneralizing. For example, “You always interrupt me. You NEVER consider my needs. EVERYONE disrespects me. I NEVER get the credit I deserve.”
  • Obsessing on “shoulds” and “musts.” Having a rigid view of the way things should or must be and getting angry when reality doesn’t line up with this vision.
  • Mind reading and jumping to conclusions. Assuming you “know” what someone else is thinking or feeling—that he or she intentionally upset you, ignored your wishes, or disrespected you.
  • Collecting straws. Looking for things to get upset about, usually while overlooking or blowing past anything positive. Letting these small irritations build and build until you reach the “final straw” and explode, often over something relatively minor.
  • Blaming. When anything bad happens or something goes wrong, it’s always someone else’s fault. You blame others for the things that happen to you rather than taking responsibility for your own life.

Avoid people, places, and situations that bring out your worst

Stressful events don’t excuse anger, but understanding how these events affect you can help you take control of your environment and avoid unnecessary aggravation. Look at your regular routine and try to identify activities, times of day, people, places, or situations that trigger irritable or angry feelings. Maybe you get into a fight every time you go out for drinks with a certain group of friends. Or maybe the traffic on your daily commute drives you crazy. Then think about ways to avoid these triggers or view the situation differently so it doesn’t make your blood boil.

Anger management tip 3: Learn ways to cool down

Once you know how to recognize the warning signs that your temper is rising and anticipate your triggers, you can act quickly to deal with your anger before it spins out of control. There are many techniques that can help you cool down and keep your anger in check.

Quick tips for cooling down

  • Focus on the physical sensations of anger. While it may seem counterintuitive, tuning into the way your body feels when you’re angry often lessens the emotional intensity of your anger.
  • Take some deep breaths. Deep, slow breathing helps counteract rising tension. The key is to breathe deeply from the abdomen, getting as much fresh air as possible into your lungs.
  • Exercise. A brisk walk around the block is a great idea. It releases pent-up energy so you can approach the situation with a cooler head.
  • Use your senses. Take advantage of the relaxing power of your sense of sight, smell, hearing, touch, and taste. You might try listening to music or picturing yourself in a favorite place.
  • Stretch or massage areas of tension. Roll your shoulders if you are tensing them, for example, or gently massage your neck and scalp.
  • Slowly count to ten. Focus on the counting to let your rational mind catch up with your feelings. If you still feel out of control by the time you reach ten, start counting again.

Give yourself a reality check

When you start getting upset about something, take a moment to think about the situation. Ask yourself:

  • How important is it in the grand scheme of things?
  • Is it really worth getting angry about it?
  • Is it worth ruining the rest of my day?
  • Is my response appropriate to the situation?
  • Is there anything I can do about it?
  • Is taking action worth my time?

Anger management tip 4: Find healthier ways to express your anger

If you’ve decided that the situation is worth getting angry about and there’s something you can do to make it better, the key is to express your feelings in a healthy way. When communicated respectfully and channeled effectively, anger can be a tremendous source of energy and inspiration for change.

Pinpoint what you’re really angry about

Have you ever gotten into an argument over something silly? Big fights often happen over something small, like a dish left out or being ten minutes late. But there’s usually a bigger issue behind it. If you find your irritation and anger rapidly rising, ask yourself “What am I really angry about?” Identifying the real source of frustration will help you communicate your anger better, take constructive action, and work towards a resolution.

Take five if things get too heated

If your anger seems to be spiraling out of control, remove yourself from the situation for a few minutes or for as long as it takes you to cool down. A brisk walk, a trip to the gym, or a few minutes listening to some music should allow you to calm down, release pent up emotion, and then approach the situation with a cooler head.

Always fight fair

It’s okay to be upset at someone, but if you don’t fight fair, the relationship will quickly break down. Fighting fair allows you to express your own needs while still respecting others.

  • Make the relationship your priority. Maintaining and strengthening the relationship, rather than “winning” the argument, should always be your first priority. Be respectful of the other person and his or her viewpoint.
  • Focus on the present. Once you are in the heat of arguing, it’s easy to start throwing past grievances into the mix. Rather than looking to the past and assigning blame, focus on what you can do in the present to solve the problem.
  • Choose your battles. Conflicts can be draining, so it’s important to consider whether the issue is really worthy of your time and energy. If you pick your battles rather than fighting over every little thing, others will take you more seriously when you are upset.
  • Be willing to forgive. Resolving conflict is impossible if you’re unwilling or unable to forgive. Resolution lies in releasing the urge to punish, which can never compensate for our losses and only adds to our injury by further depleting and draining our lives.
  • Know when to let something go. If you can’t come to an agreement, agree to disagree. It takes two people to keep an argument going. If a conflict is going nowhere, you can choose to disengage and move on.

When to seek help for anger management and control

controlling your anger

If your anger is still spiraling out of control, despite putting the previous anger management techniques into practice, or if you’re getting into trouble with the law or hurting others—you need more help. There are many therapists, classes, and programs for people with anger management problems. Asking for help is not a sign of weakness. You’ll often find others in the same shoes, and getting direct feedback on techniques for controlling anger can be tremendously helpful.

Consider professional help if:

  • You feel constantly frustrated and angry no matter what you try.
  • Your temper causes problems at work or in your relationships.
  • You avoid new events and people because you feel like you can’t control your temper.
  • You have gotten in trouble with the law due to your anger.
  • Your anger has ever led to physical violence.
  • Therapy for anger problems. Therapy can be a great way to explore the reasons behind your anger. If you don’t know why you are getting angry, it’s very hard to control. Therapy provides a safe environment to learn more about your reasons and identify triggers for your anger. It’s also a safe place to practice new skills in expressing your anger.
  • Anger management classes or groups. Anger management classes or groups allow you to see others coping with the same struggles. You will also learn tips and techniques for managing your anger and hear other people’s stories. For domestic violence issues, traditional anger management is usually not recommended. There are special classes that go to the issue of power and control that are at the heart of domestic violence.

If your loved one has an anger management problem

If your loved one has an anger problem, you probably feel like you’re walking on eggshells all the time. But always remember that you are not to blame for your loved one’s anger. There is never an excuse for physically or verbally abusive behavior. You have a right to be treated with respect and to live without fear of an angry outburst or a violent rage.

Tips for dealing with a loved one’s anger management problem

While you can’t control another person’s anger, you can control how you respond to it:

  • Set clear boundaries about what you will and will not tolerate.
  • Wait for a time when you are both calm to talk to your loved one about the anger problem. Don’t bring it up when either one of you is already angry.
  • Remove yourself from the situation if your loved one does not calm down.
  • Consider counseling or therapy for yourself if you are having a hard time standing up for yourself.
  • Put your safety first. Trust your instincts. If you feel unsafe or threatened in any way, get away from your loved one and go somewhere safe.

Anger isn’t the real problem in abusive relationships

Despite what many people believe, domestic violence and abuse is not due to the abuser’s loss of control over his behavior and temper. In fact, abusive behavior is a deliberate choice for the sole purpose of controlling you. If you are in an abusive relationship, know that couples counseling is not recommended—and that your partner needs specialized treatment, not regular anger management classes.

More help for anger management

Resources and references

Understanding and controlling anger

Controlling Anger Before it Controls You – An overview on the origins of excessive anger, tips on coping, and when to seek more help. (American Psychological Association)

What Your Anger May Be Hiding – Explores some of the complicated reasons behind excessive anger, including a need to self soothe, feel powerful, or avoid intimacy. (Psychology Today)

Anger Can Be a Cover Up For Guilt, Shame and Vulnerability – Learn about how anger can be an automatic, learned response for emotions such as guilt and shame and how to begin to get in touch with those feelings. (Get Your Angries Out)

The effects of out-of-control anger

The Cost of Anger – Discover the physical and mental costs of anger and why you may be unwittingly setting yourself up as a victim of your anger. (Pegasus NLP Mind-Body Health Site)

Anger management tips and techniques

Anger Management Tips: 10 Ways to Tame Your Temper– Quick reference tips for when you want to cool down your anger. (Mayo Clinic)

Dealing with the Anger Habit – New ideas on getting a handle on your anger, including a goal of addressing one trigger a week. (Pegasus NLP Mind-Body Health Site)

Professional help and treatment for anger problems

Anger management – Discusses what types of treatment are available for anger management, and when you should consider them. (Mayo Clinic)

Anger and Trauma – Learn why anger is such a common response following trauma and how it should be treated when it's a symptom of PTSD. (National Center for PTSD)

Coping with a loved one with anger problems

So You Love an Angry Person – Provides an overview of anger causes, tips on fighting fair, ways to approach a loved one, and when you need more help. (Get Your Angries Out)

Authors: Jeanne Segal, Ph.D., and Melinda Smith, M.A. Last updated: April 2015


WHT MENTAL HEALTH FIRST AID

MentalHealthFirstAid_Logo_wR_HORIZ

Mental Health First Aid is a public education program that can help individuals across the community to understand mental illnesses, support timely intervention, and save lives. 

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Log in to report your courses, order manuals, or get ongoing support and resources

Donate to Grow Mental Health First Aid
Your support makes a difference — help to grow Mental Health First Aid in the U.S.

Advocate for Mental Health First Aid
Ask your federal and state legislators to support Mental Health First Aid legislative activity

Why Mental Health First Aid?

One in five Americans has a mental illness and many are reluctant to seek help or might not know where to turn for care. The symptoms of mental illness can be difficult to detect — even when friends and family of someone who appears to be developing a mental illness can tell that something is amiss, they may not know how to intervene or direct the person to proper treatment – which means that all too often, those in need of mental health services do not get them until it is too late. As a society, we largely remain ignorant about the signs and symptoms of mental illnesses, and we ignore our role as responsible community members to help people experiencing these illnesses.

What is Mental Health First Aid?

Mental Health First Aid is an 8-hour course that introduces participants to risk factors and warning signs of mental health concerns, builds understanding of their impact, and overviews common treatments. The course uses role-playing and simulations to demonstrate how to assess a mental health crisis; select interventions and provide initial help; and connect persons to professional, peer and social supports as well as self-help resources.

Mental Health First Aid allows for early detection and intervention by teaching participants about the signs and symptoms of specific illnesses like anxiety, depression, schizophrenia, bipolar disorder, eating disorders, and addictions. The program offers concrete tools and answers key questions like “What can I do?” and “Where can someone find help?” Participants are introduced to local mental health resources, national organizations, support groups, and online tools for mental health and addictions treatment and support.

Mental Health First Aid USA is coordinated by the National Council for Behavioral Health, the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health.

Read more about the program in our special 5th Anniversary edition of National Council Magazine.

Reach and Audiences

In 2008, the National Council for Behavioral Health brought Mental Health First Aid to the U.S. To date, hundreds of thousands of people in communities across the country have been trained in Mental Health First Aid through a network of more than 5,000 certified instructors.

Mental Health First Aid has been taught to a variety of audiences, including: health, human services, and social workers; employers and business leaders; faith community leaders; college and university staff and faculty; law enforcement and public safety officials; veterans and family members; persons with mental illness-addictions and their families;  and other caring citizens.

Certified instructors teach the program in communities across the United States. To find a course or contact an instructor in your area, visit www.MentalHealthFirstAid.org.

Youth Mental Health First Aid

Youth Mental Health First Aid is designed to teach neighbors, teachers, parents, peers, and caring citizens how to help a youth or teen who is experiencing a mental health or substance
use challenge or is in crisis. The course discusses mental health challenges for youth, reviews typical adolescent development, and provides guidance through the ALGEE action plan for both crisis and non-crisis situations. Topics covered in the manual include anxiety, depression, substance use, disorders in which psychosis may occur, disruptive behavior disorders (including AD/HD), and eating disorders.

 

Advocacy and Mental Health First Aid

Mental Health First Aid can become more widespread across the country. Read more about the Mental Health First Aid Act to hear how, and how you can support the act in your community.

Advocates wishing to pursue legislation for Mental Health First Aid at the state or local level should read through our State Policy Toolkit.


Recognizing Child Abuse

Recognizing, Preventing, and Reporting Child Abuse

Child Abuse & NeglectIn This Article

Child abuse is more than bruises and broken bones. While physical abuse might be the most visible, other types of abuse, such as emotional abuse and neglect, also leave deep, lasting scars. The earlier abused children get help, the greater chance they have to heal and break the cycle—rather than perpetuate it. By learning about common signs of abuse and what you can do to intervene, you can make a huge difference in a child’s life.

Understanding child abuse and neglect

Child Abuse Hotlines:

Child abuse is more than bruises or broken bones. While physical abuse is shocking due to the scars it leaves, not all child abuse is as obvious. Ignoring children’s needs, putting them in unsupervised, dangerous situations, or making a child feel worthless or stupid are also child abuse. Regardless of the type of child abuse, the result is serious emotional harm.

Myths and facts about child abuse and neglect

MYTH #1: It's only abuse if it's violent.

Fact: Physical abuse is just one type of child abuse. Neglect and emotional abuse can be just as damaging, and since they are more subtle, others are less likely to intervene.

MYTH #2: Only bad people abuse their children.

Fact: While it's easy to say that only "bad people" abuse their children, it's not always so black and white. Not all abusers are intentionally harming their children. Many have been victims of abuse themselves, and don’t know any other way to parent. Others may be struggling with mental health issues or a substance abuse problem.

MYTH #3: Child abuse doesn't happen in “good” families.

Fact: Child abuse doesn't only happen in poor families or bad neighborhoods. It crosses all racial, economic, and cultural lines. Sometimes, families who seem to have it all from the outside are hiding a different story behind closed doors.

MYTH #4: Most child abusers are strangers.

Fact: While abuse by strangers does happen, most abusers are family members or others close to the family.

MYTH #5: Abused children always grow up to be abusers.

Fact: It is true that abused children are more likely to repeat the cycle as adults, unconsciously repeating what they experienced as children. On the other hand, many adult survivors of child abuse have a strong motivation to protect their children against what they went through and become excellent parents.

Effects of child abuse and neglect

All types of child abuse and neglect leave lasting scars. Some of these scars might be physical, but emotional scarring has long lasting effects throughout life, damaging a child’s sense of self, ability to have healthy relationships, and ability to function at home, at work and at school. Some effects include:

  • Lack of trust and relationship difficulties.If you can’t trust your parents, who can you trust? Abuse by a primary caregiver damages the most fundamental relationship as a child—that you will safely, reliably get your physical and emotional needs met by the person who is responsible for your care. Without this base, it is very difficult to learn to trust people or know who is trustworthy. This can lead to difficulty maintaining relationships due to fear of being controlled or abused. It can also lead to unhealthy relationships because the adult doesn’t know what a good relationship is.
  • Core feelings of being “worthless” or “damaged.” If you’ve been told over and over again as a child that you are stupid or no good, it is very difficult to overcome these core feelings. You may experience them as reality. Adults may not strive for more education, or settle for a job that may not pay enough, because they don’t believe they can do it or are worth more. Sexual abuse survivors, with the stigma and shame surrounding the abuse, often especially struggle with a feeling of being damaged.
  • Trouble regulating emotions. Abused children cannot express emotions safely. As a result, the emotions get stuffed down, coming out in unexpected ways. Adult survivors of child abuse can struggle with unexplained anxiety, depression, or anger. They may turn to alcohol or drugs to numb out the painful feelings.

Types of child abuse

There are several types of child abuse, but the core element that ties them together is the emotional effect on the child. Children need predictability, structure, clear boundaries, and the knowledge that their parents are looking out for their safety. Abused children cannot predict how their parents will act. Their world is an unpredictable, frightening place with no rules. Whether the abuse is a slap, a harsh comment, stony silence, or not knowing if there will be dinner on the table tonight, the end result is a child that feel unsafe, uncared for, and alone.

Emotional child abuse

Sticks and stones may break my bones but words will never hurt me? Contrary to this old saying, emotional abuse can severely damage a child’s mental health or social development, leaving lifelong psychological scars. Examples of emotional child abuse include:

  • Constant belittling, shaming, and humiliating a child.
  • Calling names and making negative comparisons to others.
  • Telling a child he or she is “no good," "worthless," "bad," or "a mistake."
  • Frequent yelling, threatening, or bullying.
  • Ignoring or rejecting a child as punishment, giving him or her the silent treatment.
  • Limited physical contact with the child—no hugs, kisses, or other signs of affection.
  • Exposing the child to violence or the abuse of others, whether it be the abuse of a parent, a sibling, or even a pet.

Child neglect

Child neglect—a very common type of child abuse—is a pattern of failing to provide for a child's basic needs, whether it be adequate food, clothing, hygiene, or supervision. Child neglect is not always easy to spot. Sometimes, a parent might become physically or mentally unable to care for a child, such as with a serious injury, untreated depression, or anxiety. Other times, alcohol or drug abuse may seriously impair judgment and the ability to keep a child safe.

Older children might not show outward signs of neglect, becoming used to presenting a competent face to the outside world, and even taking on the role of the parent. But at the end of the day, neglected children are not getting their physical and emotional needs met.

Physical child abuse

Physical abuse involves physical harm or injury to the child. It may be the result of a deliberate attempt to hurt the child, but not always. It can also result from severe discipline, such as using a belt on a child, or physical punishment that is inappropriate to the child’s age or physical condition.

Many physically abusive parents and caregivers insist that their actions are simply forms of discipline—ways to make children learn to behave. But there is a big difference between using physical punishment to discipline and physical abuse. The point of disciplining children is to teach them right from wrong, not to make them live in fear.

Physical abuse vs. Discipline

In physical abuse, unlike physical forms of discipline, the following elements are present:

  • Unpredictability. The child never knows what is going to set the parent off. There are no clear boundaries or rules. The child is constantly walking on eggshells, never sure what behavior will trigger a physical assault.
  • Lashing out in anger. Physically abusive parents act out of anger and the desire to assert control, not the motivation to lovingly teach the child. The angrier the parent, the more intense the abuse.
  • Using fear to control behavior.Parents who are physically abusive may believe that their children need to fear them in order to behave, so they use physical abuse to “keep their child in line.” However, what children are really learning is how to avoid being hit, not how to behave or grow as individuals.

Child sexual abuse: A hidden type of abuse

Help for child sexual abuse:

1-888-PREVENT (1-888-773-8368) – Stop It Now

1-800-656-HOPE – Rape, Abuse & Incest National Network (RAINN)

Or visit ChiWorld.org for a list of other international child helplines.

Child sexual abuse is an especially complicated form of abuse because of its layers of guilt and shame. It's important to recognize that sexual abuse doesn't always involve body contact. Exposing a child to sexual situations or material is sexually abusive, whether or not touching is involved.

While news stories of sexual predators are scary, what is even more frightening is that sexual abuse usually occurs at the hands of someone the child knows and should be able to trust—most often close relatives. And contrary to what many believe, it’s not just girls who are at risk. Boys and girls both suffer from sexual abuse. In fact, sexual abuse of boys may be underreported due to shame and stigma.

The problem of shame and guilt in child sexual abuse

Aside from the physical damage that sexual abuse can cause, the emotional component is powerful and far-reaching. Sexually abused children are tormented by shame and guilt. They may feel that they are responsible for the abuse or somehow brought it upon themselves. This can lead to self-loathing and sexual problems as they grow older—often either excessive promiscuity or an inability to have intimate relations.

The shame of sexual abuse makes it very difficult for children to come forward. They may worry that others won’t believe them, will be angry with them, or that it will split their family apart. Because of these difficulties, false accusations of sexual abuse are not common, so if a child confides in you, take him or her seriously. Don’t turn a blind eye!

Warning signs of child abuse and neglect

The earlier child abuse is caught, the better the chance of recovery and appropriate treatment for the child. Child abuse is not always obvious. By learning some of the common warning signs of child abuse and neglect, you can catch the problem as early as possible and get both the child and the abuser the help that they need.

Of course, just because you see a warning sign doesn’t automatically mean a child is being abused. It’s important to dig deeper, looking for a pattern of abusive behavior and warning signs, if you notice something off.

Warning signs of emotional abuse in children

  • Excessively withdrawn, fearful, or anxious about doing something wrong.
  • Shows extremes in behavior (extremely compliant or extremely demanding; extremely passive or extremely aggressive).
  • Doesn’t seem to be attached to the parent or caregiver.
  • Acts either inappropriately adult (taking care of other children) or inappropriately infantile (rocking, thumb-sucking, throwing tantrums).

Warning signs of physical abuse in children

  • Frequent injuries or unexplained bruises, welts, or cuts.
  • Is always watchful and “on alert,” as if waiting for something bad to happen.
  • Injuries appear to have a pattern such as marks from a hand or belt.
  • Shies away from touch, flinches at sudden movements, or seems afraid to go home.
  • Wears inappropriate clothing to cover up injuries, such as long-sleeved shirts on hot days.

Warning signs of neglect in children

  • Clothes are ill-fitting, filthy, or inappropriate for the weather.
  • Hygiene is consistently bad (unbathed, matted and unwashed hair, noticeable body odor).
  • Untreated illnesses and physical injuries.
  • Is frequently unsupervised or left alone or allowed to play in unsafe situations and environments.
  • Is frequently late or missing from school.

Warning signs of sexual abuse in children

  • Trouble walking or sitting.
  • Displays knowledge or interest in sexual acts inappropriate to his or her age, or even seductive behavior.
  • Makes strong efforts to avoid a specific person, without an obvious reason.
  • Doesn’t want to change clothes in front of others or participate in physical activities.
  • An STD or pregnancy, especially under the age of 14.
  • Runs away from home.

Child abuse and reactive attachment disorder

Severe abuse early in life can lead to reactive attachment disorder. Children with this disorder are so disrupted that they have extreme difficulty establishing normal relationships and attaining normal developmental milestones. They need special treatment and support. Learn more

Risk factors for child abuse and neglect

While child abuse and neglect occurs in all types of families—even in those that look happy from the outside—children are at a much greater risk in certain situations.

  • Domestic violence. Witnessing domestic violence is terrifying to children and emotionally abusive. Even if the mother does her best to protect her children and keeps them from being physically abused, the situation is still extremely damaging. If you or a loved one is in an abusive relationships, getting out is the best thing for protecting the children.
  • Alcohol and drug abuse. Living with an alcoholic or addict is very difficult for children and can easily lead to abuse and neglect. Parents who are drunk or high are unable to care for their children, make good parenting decisions, and control often-dangerous impulses. Substance abuse also commonly leads to physical abuse.
  • Untreated mental illness. Parents who suffering from depression, an anxiety disorder, bipolar disorder, or another mental illness have trouble taking care of themselves, much less their children. A mentally ill or traumatized parent may be distant and withdrawn from his or her children, or quick to anger without understanding why. Treatment for the caregiver means better care for the children.
  • Lack of parenting skills. Some caregivers never learned the skills necessary for good parenting. Teen parents, for example, might have unrealistic expectations about how much care babies and small children need. Or parents who were themselves victims of child abuse may only know how to raise their children the way they were raised. In such cases, parenting classes, therapy, and caregiver support groups are great resources for learning better parenting skills.
  • Stress and lack of support. Parenting can be a very time-intensive, difficult job, especially if you’re raising children without support from family, friends, or the community or you’re dealing with relationship problems or financial difficulties. Caring for a child with a disability, special needs, or difficult behaviors is also a challenge. It’s important to get the support you need, so you are emotionally and physically able to support your child.

Recognizing abusive behavior in yourself

If you need professional help...

Do you feel angry and frustrated and don’t know where to turn? In the U.S., call 1-800-4-A-CHILD to find support and resources in your community that can help you break the cycle of abuse. In other countries, visit Chiworld.org for helplines.

Do you see yourself in some of these descriptions, painful as it may be? Do you feel angry and frustrated and don’t know where to turn? Raising children is one of life’s greatest challenges and can trigger anger and frustration in the most even tempered. If you grew up in a household where screaming and shouting or violence was the norm, you may not know any other way to raise your kids.

Recognizing that you have a problem is the biggest step to getting help. If you yourself were raised in an abusive situation, that can be extremely difficult. Children experience their world as normal. It may have been normal in your family to be slapped or pushed for little to no reason, or that mother was too drunk to cook dinner. It may have been normal for your parents to call you stupid, clumsy, or worthless. Or it may have been normal to watch your mother get beaten up by your father.

It is only as adults that we have the perspective to step back and take a hard look at what is normal and what is abusive. Read the above sections on the types of abuse and warning signs. Do any of those ring a bell for you now? Or from when you were a child? The following is a list of warning signs that you may be crossing the line into abuse:

How do you know when you’ve crossed the line?

  • You can’t stop the anger. What starts as a swat on the backside may turn into multiple hits getting harder and harder. You may shake your child harder and harder and finally throw him or her down. You find yourself screaming louder and louder and can’t stop yourself.
  • You feel emotionally disconnected from your child. You may feel so overwhelmed that you don’t want anything to do with your child. Day after day, you just want to be left alone and for your child to be quiet.
  • Meeting the daily needs of your child seems impossible. While everyone struggles with balancing dressing, feeding, and getting kids to school or other activities, if you continually can’t manage to do it, it’s a sign that something might be wrong.
  • Other people have expressed concern. It may be easy to bristle at other people expressing concern. However, consider carefully what they have to say. Are the words coming from someone you normally respect and trust? Denial is not an uncommon reaction.

Breaking the cycle of child abuse

If you have a history of child abuse, having your own children can trigger strong memories and feelings that you may have repressed. This may happen when a child is born, or at later ages when you remember specific abuse to you. You may be shocked and overwhelmed by your anger, and feel like you can’t control it. But you can learn new ways to manage your emotions and break your old patterns.

Remember, you are the most important person in your child’s world. It’s worth the effort to make a change, and you don’t have to go it alone. Help and support are available.

Tips for changing your reactions

  • Learn what is age appropriate and what is not. Having realistic expectations of what children can handle at certain ages will help you avoid frustration and anger at normal child behavior. For example, newborns are not going to sleep through the night without a peep, and toddlers are not going to be able to sit quietly for extended periods of time.
  • Develop new parenting skills. While learning to control your emotions is critical, you also need a game plan of what you are going to do instead. Start by learning appropriate discipline techniques and how to set clear boundaries for your children. Parenting classes, books, and seminars are a way to get this information. You can also turn to other parents for tips and advice.
  • Take care of yourself. If you are not getting enough rest and support or you’re feeling overwhelmed, you are much more likely to succumb to anger. Sleep deprivation, common in parents of young children, adds to moodiness and irritability—exactly what you are trying to avoid.
  • Get professional help. Breaking the cycle of abuse can be very difficult if the patterns are strongly entrenched. If you can’t seem to stop yourself no matter how hard you try, it’s time to get help, be it therapy, parenting classes, or other interventions. Your children will thank you for it.
  • Learn how you can get your emotions under control. The first step to getting your emotions under control is realizing that they are there. If you were abused as a child, you may have an especially difficult time getting in touch with your range of emotions. You may have had to deny or repress them as a child, and now they spill out without your control.

Helping an abused or neglected child

What should you do if you suspect that a child has been abused? How do you approach him or her? Or what if a child comes to you? It’s normal to feel a little overwhelmed and confused in this situation. Child abuse is a difficult subject that can be hard to accept and even harder to talk about.

Just remember, you can make a tremendous difference in the life of an abused child, especially if you take steps to stop the abuse early. When talking with an abused child, the best thing you can provide is calm reassurance and unconditional support. Let your actions speak for you if you’re having trouble finding the words. Remember that talking about the abuse may be very difficult for the child. It’s your job to reassure the child and provide whatever help you can.

Tips for talking to an abused child

  • Avoid denial and remain calm. A common reaction to news as unpleasant and shocking as child abuse is denial. However, if you display denial to a child, or show shock or disgust at what they are saying, the child may be afraid to continue and will shut down. As hard as it may be, remain as calm and reassuring as you can.
  • Don’t interrogate. Let the child explain to you in his or her own words what happened, but don’t interrogate the child or ask leading questions. This may confuse and fluster the child and make it harder for them to continue their story.
  • Reassure the child that they did nothing wrong. It takes a lot for a child to come forward about abuse. Reassure him or her that you take what is said seriously, and that it is not the child’s fault.
  • Safety comes first. If you feel that your safety or the safety of the child would be threatened if you try to intervene, leave it to the professionals. You may be able to provide more support later after the initial professional intervention.

Reporting child abuse—anonymously

If you suspect a child is being abused, it's critical to get them the help he or she needs. Reporting child abuse seems so official. Many people are reluctant to get involved in other families' lives.

Understanding some of the myths behind reporting may help put your mind at ease if you need to report child abuse.

  • I don’t want to interfere in someone else’s family. The effects of child abuse are lifelong, affecting future relationships, self-esteem, and sadly putting even more children at risk of abuse as the cycle continues. Help break the cycle of child abuse.
  • What if I break up someone’s home? The priority in child protective services is keeping children in the home. A child abuse report does not mean a child is automatically removed from the home—unless the child is clearly in danger. Support such as parenting classes, anger management or other resources may be offered first to parents if safe for the child.
  • They will know it was me who called.Reporting is anonymous. In most places, you do not have to give your name when you report child abuse. The child abuser cannot find out who made the report of child abuse.
  • It won’t make a difference what I have to say. If you have a gut feeling that something is wrong, it is better to be safe than sorry. Even if you don’t see the whole picture, others may have noticed as well, and a pattern can help identify child abuse that might have otherwise slipped through the cracks.

When reporting child abuse

Reporting child abuse can bring up a lot of difficult emotions and uncertainty. You may ask yourself if you're doing the right thing, or question if your voice will even be heard. Here are some tips for communicating effectively in difficult situations:

  • Try to be as specific as you can. For example, instead of saying, "The parents are not dressing their children right," say something like, "I saw the child running outside three times last week in subzero weather without a jacket or hat. I saw him shivering and uncomfortable. He seemed to want to come inside." However, remember that it is not your job to "prove" abuse or neglect. If suspicions are all you have, you should report those as well.
  • Understand that you may not learn of the outcome. Due to confidentiality laws in the U.S., unless you are a mandated reporter in an official capacity, you probably won't be updated by Child Protective Services (CPS) about the results of their investigation. The family may not broadcast that they have been mandated services, either—but that doesn't mean they are not receiving them.
  • If you see future incidences, continue to call and report them. Each child abuse report is a snapshot of what is going on in the family. The more information that you can provide, the better the chance of getting the best care for the child.

Reporting abuse in your home or in child custody situations

Witnessing abuse in your own home or suspecting abuse in a custody situation brings its own set of challenges and concerns. You may be afraid of what your abuser will do to you and your children if you speak up. You may also be concerned that the abuser will be able to cover his or her tracks or even turn the abuse around onto you. Culturally, it may not be acceptable for you to separate, adding additional feelings of shame and isolation. You may also be afraid of having your children taken away from you.

Don’t go it alone

Domestic violence isn’t just about black eyes. Manipulation and emotional threats to you and your children are also a form of abuse, power, and control. Fear of losing custody of the children can be extremely stressful for both women and men in abusive relationships. Child abuse allegations in divorce or child custody issues are viewed very carefully to ensure they are not motivated by vindictiveness. However, if your abuser appears professional, well-groomed, and well-spoken to the outside world, you may feel like your concerns aren’t being taken seriously. Worse, if your allegations remain unproven, they may even result in the abuser being given custody.

Therefore, if you are planning to separate, or have already separated and are in a custody battle, it is essential to get support and legal advice. Domestic violence organizations can help you connect with legal resources in your community, and may be able to provide an advocate to assist your case and attend court hearings. Domestic violence organizations can help you work out a safety plan for both you and your children, and in the U.S. can also help you make calls to CPS if needed.

Tips on how to report child abuse in your home or in a custody situation

  1. Stay CALM. Do not let your emotions dictate your actions, and do not vent your emotions onto the people who are assigned to investigate your case (CPS, law enforcement officers, etc.).
  2. IF THIS IS AN EMERGENCY: Call 911 or your local police.
  3. DOCUMENT EVERYTHING from this point forward, including times, dates, and places. KEEP all documents from all professionals who have an opinion about the child abuse. This includes therapists, doctors, policemen, and teachers. If a professional informs you that they have an opinion or a suspicion of child abuse, have them document that suspicion, preferably in the form of an affidavit. Be sure to get a copy of any opinions from professionals regarding your child's case.
  4. HAVE YOUR CHILD EVALUATED. Talk to medical and psychology professionals. If possible, have your child evaluated at a Child Assessment Center.
  5. BEGIN INVESTIGATION. Talk to law enforcement officers to initiate an investigation into the allegation of child abuse. Any reasonable belief of abuse or neglect should be reported to the police. If you have been too afraid to voice allegations in the past, let them know. If you have previously reported abuse, communicate the fact that you are trying to protect the child from further harm
  6. TALK TO CPS. If the abuse is not criminal, talk to CPS to initiate an investigation into the allegation of child abuse.
  7. GET AN ATTORNEY. Get an attorney and start proceedings to gain full custody of your child and terminate the abuser's parental rights.
  8. CALL JUSTICE FOR CHILDREN. If you encounter a problem with completing steps 3-6, call JFC at 1-800-733-0059.Office hours are M-F 8-5 pm Central Standard Time.

More help for child abuse and neglect

Resources and references

Warning signs of child abuse

Recognizing Child Abuse: What Parents Should Know (PDF) – Lists signs and symptoms of child abuse in children and in their parents. Covering physical abuse, emotional maltreatment, neglect, and sexual abuse, this outline is useful for teachers, family friends, and relatives. (Prevent Child Abuse America)

Physical child abuse

Physical Child Abuse – Reviews the definition of physical abuse and signs of abuse, including shaken baby syndrome (Child Welfare Information Gateway)

Shaken Baby Syndrome – Clear, comprehensive description of what SBS is, how it causes brain damage and death, its signs and symptoms, and strategies for soothing a baby before the caregiver’s frustration mounts. (KidsHealth)

Sexual child abuse

Prevent Child Sexual Abuse: Facts About Those Who Might Commit It (PDF) – Offers warning signs of sexual abuse in children and in their adult abusers, along with tips on how to prevent and stop it. (Stop It Now!)

Understanding Child Sexual Abuse – A clear, objective explanation of the effects of child sexual abuse, the chances of recovery, and strategies for prevention. (American Psychological Association)

Emotional child abuse

Emotional abuse – See the “Answers to common questions” on this British site for good advice about recognizing and responding to emotional child abuse. (National Society for the Prevention of Cruelty to Children)

Fact Sheet: Emotional child abuse (Prevent Child Abuse America)

Child neglect

Child Neglect: Definition and Scope of Neglect – Article on what constitutes child neglect, how it affects children, what causes it, and how the community can intervene. (Child Welfare Information Gateway)

Neglect – Succinct lists of physical and behavioral indicators suggesting that a child is being neglected. (Coalition for Children)

Reporting and stopping child abuse

Toll-Free Crisis Hotline Numbers – (Child Welfare Information Gateway)

Talking about abuse – Discusses what to do if either a child or a caregiver approaches you about abuse. (NSPCC)

Reporting Child Abuse – Guidance on how to find out what your responsibilities are and where to get more information. (Darkness to Light)

Child Helpline International – A global portal for children with a list of crisis lines and web resources around the world. (ChiWorld.org)

How the Child Welfare System Works – Information on the services available in the U.S. to protect the well-being of children. (U.S. Department of Health and Human Services)

Preventing child abuse

Talking to a child about abuse – Helps parents teach children how to protect themselves against abuse, including learning about touch, and that they should never keep secrets. (Childhelp)

Talking to kids about child sexual abuse – Discusses concrete tips on how to protect children against abuse, including talking to family members and avoiding tricks. (Stop it Now)

Authors: Melinda Smith, M.A., and Jeanne Segal, Ph.D. Last updated: May 2015.


ADD And ADHD In Children

Signs and Symptoms of Attention Deficit Disorder in Kids

ADD / ADHD in ChildrenIn This Article

It’s normal for children to occasionally forget their homework, daydream during class, act without thinking, or get fidgety at the dinner table. But inattention, impulsivity, and hyperactivity are also signs of attention deficit disorder (ADD/ADHD), which can affect your child’s ability to learn and get along with others. The first step to addressing the problem is to recognize the signs and symptoms.

What is ADD / ADHD?

We all know kids who can’t sit still, who never seem to listen, who don’t follow instructions no matter how clearly you present them, or who blurt out inappropriate comments at inappropriate times. Sometimes these children are labeled as troublemakers, or criticized for being lazy and undisciplined. However, they may have ADD/ADHD.

Attention deficit hyperactivity disorder (ADHD) is a disorder that appears in early childhood. You may know it by the name attention deficit disorder, or ADD. ADD/ADHD makes it difficult for people to inhibit their spontaneous responses—responses that can involve everything from movement to speech to attentiveness.

Is it normal kid behavior or is it ADHD?

The signs and symptoms of ADD/ADHD typically appear before the age of seven. However, it can be difficult to distinguish between attention deficit disorder and normal “kid behavior.”

If you spot just a few signs, or the symptoms appear only in some situations, it’s probably not ADD/ADHD. On the other hand, if your child shows a number of ADD/ADHD signs and symptoms that are present across all situations—at home, at school, and at play—it’s time to take a closer look.

Once you understand the issues your child is struggling with, such as forgetfulness or difficulty paying attention in school, you can work together to find creative solutions and capitalize on strengths.

Myths about Attention Deficit Disorder
Myth #1: All kids with ADD/ADHD are hyperactive.

Fact: Some children with ADD/ADHD are hyperactive, but many others with attention problems are not. Children with ADD/ADHD who are inattentive, but not overly active, may appear to be spacey and unmotivated.

Myth #2: Kids with ADD/ADHD can never pay attention.

Fact: Children with ADD/ADHD are often able to concentrate on activities they enjoy. But no matter how hard they try, they have trouble maintaining focus when the task at hand is boring or repetitive.

Myth #3: Kids with ADD/ADHD could behave better if they wanted to.

Fact: Children with ADD/ADHD may do their best to be good, but still be unable to sit still, stay quiet, or pay attention. They may appear disobedient, but that doesn’t mean they’re acting out on purpose.

Myth #4: Kids will eventually grow out of ADD/ADHD.

Fact: ADD/ADHD often continues into adulthood, so don’t wait for your child to outgrow the problem. Treatment can help your child learn to manage and minimize the symptoms.

Myth #5: Medication is the best treatment option for ADD/ADHD.

Fact: Medication is often prescribed for attention deficit disorder, but it might not be the best option for your child. Effective treatment for ADD/ADHD also includes education, behavior therapy, support at home and school, exercise, and proper nutrition.

The primary characteristics of ADD / ADHD

When many people think of attention deficit disorder, they picture an out-of-control kid in constant motion, bouncing off the walls and disrupting everyone around. But this is not the only possible picture.

Some children with ADD/ADHD are hyperactive, while others sit quietly—with their attention miles away. Some put too much focus on a task and have trouble shifting it to something else. Others are only mildly inattentive, but overly impulsive.

The three primary characteristics of ADD / ADHD

Which one of these children may have ADD/ADHD?

  1. The hyperactive boy who talks nonstop and can’t sit still.
  2. The quiet dreamer who sits at her desk and stares off into space.
  3. Both A and B

The correct answer is “C.”

The three primary characteristics of ADD/ADHD are inattention, hyperactivity, and impulsivity. The signs and symptoms a child with attention deficit disorder has depends on which characteristics predominate.

Children with ADD/ADHD may be:

  • Inattentive, but not hyperactive or impulsive.
  • Hyperactive and impulsive, but able to pay attention.
  • Inattentive, hyperactive, and impulsive (the most common form of ADD/ADHD).

Children who only have inattentive symptoms of ADD/ADHD are often overlooked, since they’re not disruptive. However, the symptoms of inattention have consequences: getting in hot water with parents and teachers for not following directions; underperforming in school; or clashing with other kids over not playing by the rules.

Spotting ADD / ADHD at different ages

Because we expect very young children to be easily distractible and hyperactive, it’s the impulsive behaviors—the dangerous climb, the blurted insult—that often stand out in preschoolers with ADD/ADHD.

By age four or five, though, most children have learned how to pay attention to others, to sit quietly when instructed to, and not to say everything that pops into their heads. So by the time children reach school age, those with ADD/ADHD stand out in all three behaviors: inattentiveness, hyperactivity, and impulsivity.

Hyperactivity signs and symptoms of ADD/ADHD

It isn’t that children with ADD/ADHD can’t pay attention: when they’re doing things they enjoy or hearing about topics in which they’re interested, they have no trouble focusing and staying on task. But when the task is repetitive or boring, they quickly tune out.

Staying on track is another common problem. Children with ADD/ADHD often bounce from task to task without completing any of them, or skip necessary steps in procedures. Organizing their schoolwork and their time is harder for them than it is for most children.

Kids with ADD/ADHD also have trouble concentrating if there are things going on around them; they usually need a calm, quiet environment in order to stay focused.

Symptoms of inattention in children:

  • Doesn’t pay attention to details
  • Makes careless mistakes
  • Has trouble staying focused; is easily distracted
  • Appears not to listen when spoken to
  • Has difficulty remembering things and following instructions
  • Has trouble staying organized, planning ahead, and finishing projects
  • Gets bored with a task before it’s completed
  • Frequently loses or misplaces homework, books, toys, or other items

Impulsivity signs and symptoms of ADD/ADHD

The most obvious sign of ADD/ADHD is hyperactivity. While many children are naturally quite active, kids with hyperactive symptoms of attention deficit disorder are always moving.

They may try to do several things at once, bouncing around from one activity to the next. Even when forced to sit still which can be very difficult for them their foot is tapping, their leg is shaking, or their fingers are drumming.

Symptoms of hyperactivity in children:

  • Constantly fidgets and squirms
  • Often leaves his or her seat in situations where sitting quietly is expected
  • Moves around constantly, often runs or climbs inappropriately
  • Talks excessively
  • Has difficulty playing quietly or relaxing
  • Is always “on the go,” as if driven by a motor
  • May have a quick temper or a “short fuse” 

Impulsive signs and symptoms of ADD/ADHD

The impulsivity of children with ADD/ADHD can cause problems with self-control. Because they censor themselves less than other kids do, they’ll interrupt conversations, invade other people’s space, ask irrelevant questions in class, make tactless observations, and ask overly personal questions.

Instructions like “Be patient” and “Just wait a little while” are twice as hard for children with ADD/ADHD to follow as they are for other youngsters.

Children with impulsive signs and symptoms of ADD/ADHD also tend to be moody and to overreact emotionally. As a result, others may start to view the child as disrespectful, weird, or needy.

Symptoms of impulsivity in children:

  • Acts without thinking
  • Blurts out answers in class without waiting to be called on or hear the whole question
  • Can’t wait for his or her turn in line or in games
  • Says the wrong thing at the wrong time
  • Often interrupts others
  • Intrudes on other people’s conversations or games
  • Inability to keep powerful emotions in check, resulting in angry outbursts or temper tantrums
  • Guesses, rather than taking time to solve a problem

Is it really ADD / ADHD?

Just because a child has symptoms of inattention, impulsivity, or hyperactivity does not mean that he or she has ADD or ADHD. Certain medical conditions, psychological disorders, and stressful life events can cause symptoms that look like ADD / ADHD.

Before an accurate diagnosis of ADD / ADHD can be made, it is important that you see a mental health professional to explore and rule out the following possibilities:

  • Learning disabilities or problems with reading, writing, motor skills, or language.
  • Major life events or traumatic experiences (e.g. a recent move, death of a loved one, bullying, divorce).
  • Psychological disorders including anxiety, depression, and bipolar disorder.
  • Behavioral disorders such as conduct disorder and oppositional defiant disorder.
  • Medical conditions, including thyroid problems, neurological conditions, epilepsy, and sleep disorders.

To learn more about diagnosing ADD/ADHD, see ADD / ADHD Tests and Diagnosis.

A learning disability may be mistaken for ADHD

Think your child has attention deficit disorder? Sometimes, kids who are having trouble in school are incorrectly diagnosed with ADD/ADHD, when what they really have is a learning disability. Furthermore, many kids struggle with both ADD/ADHD and a learning disability.

Read: Learning Disabilities in Children

Positive effects of ADD / ADHD in children

In addition to the challenges, there are also positive traits associated with people who have attention deficit disorder:

  • Creativity – Children who have ADD/ADHD can be marvelously creative and imaginative. The child who daydreams and has ten different thoughts at once can become a master problem-solver, a fountain of ideas, or an inventive artist. Children with ADD/ADHD may be easily distracted, but sometimes they notice what others don’t see.
  • Flexibility – Because children with ADD/ADHD consider a lot of options at once, they don’t become set on one alternative early on and are more open to different ideas.
  • Enthusiasm and spontaneity – Children with ADD/ADHD are rarely boring! They’re interested in a lot of different things and have lively personalities. In short, if they’re not exasperating you (and sometimes even when they are), they’re a lot of fun to be with.
  • Energy and drive – When kids with ADD/ADHD are motivated, they work or play hard and strive to succeed. It actually may be difficult to distract them from a task that interests them, especially if the activity is interactive or hands-on.

Keep in mind, too, that ADD/ADHD has nothing to do with intelligence or talent. Many children with ADD/ADHD are intellectually or artistically gifted.

Helping a child with ADD / ADHD

Whether or not your child’s symptoms of inattention, hyperactivity, and impulsivity are due to ADD/ADHD, they can cause many problems if left untreated. Children who can’t focus and control themselves may struggle in school, get into frequent trouble, and find it hard to get along with others or make friends. These frustrations and difficulties can lead to low self-esteem as well as friction and stress for the whole family.

But treatment can make a dramatic difference in your child’s symptoms. With the right support, your child can get on track for success in all areas of life.

Don’t wait to get help for your child

If your child struggles with symptoms that look like ADD/ADHD, don’t wait to seek professional help. You can treat your child’s symptoms of hyperactivity, inattention, and impulsivity without having a diagnosis of attention deficit disorder.

Options to start with include getting your child into therapy, implementing a better diet and exercise plan, and modifying the home environment to minimize distractions.

If you do receive a diagnosis of ADD/ADHD, you can then work with your child’s doctor, therapist, and school to make a personalized treatment plan that meets his or her specific needs. Effective treatment for childhood ADD/ADHD involves behavioral therapy, parent education and training, social support, and assistance at school. Medication may also be used, however, it should never be the sole attention deficit disorder treatment.

Parenting tips for children with ADD / ADHD

If your child is hyperactive, inattentive, or impulsive, it may take a lot of energy to get him or her to listen, finish a task, or sit still. The constant monitoring can be frustrating and exhausting. Sometimes you may feel like your child is running the show. But there are steps you can take to regain control of the situation, while simultaneously helping your child make the most of his or her abilities.

While attention deficit disorder is not caused by bad parenting, there are effective parenting strategies that can go a long way to correct problem behaviors.

Children with ADD/ADHD need structure, consistency, clear communication, and rewards and consequences for their behavior. They also need lots of love, support, and encouragement.

There are many things parents can do to reduce the signs and symptoms of ADD/ADHD without sacrificing the natural energy, playfulness, and sense of wonder unique in every child.

School tips for children with ADD / ADHD

ADD/ADHD, obviously, gets in the way of learning. You can’t absorb information or get your work done if you’re running around the classroom or zoning out on what you’re supposed to be reading or listening to.

Think of what the school setting requires children to do: Sit still. Listen quietly. Pay attention. Follow instructions. Concentrate. These are the very things kids with ADD/ADHD have a hard time doing—not because they aren’t willing, but because their brains won’t let them.

But that doesn’t mean kids with ADD/ADHD can’t succeed at school. There are many things both parents and teachers can do to help children with ADD/ADHD thrive in the classroom. It starts with evaluating each child’s individual weaknesses and strengths, then coming up with creative strategies for helping the child focus, stay on task, and learn to his or her full capability.

Read ADD/ADHD and School

More help for ADD/ADHD in children

Help for ADD / ADHD at school

Resources and references

General information about ADD / ADHD in children

Attention Deficit/Hyperactivity Disorder – Guide to ADD/ADHD, including how to tell if a child has attention deficit disorder and tips for parents. Center for Parent Information & Resources)

Attention Deficit Hyperactivity Disorder (ADHD)– Learn about the signs, symptoms, causes, and treatment of attention deficit disorder. (National Institute of Mental Health)

Attention Deficit Hyperactivity Disorder: A Parent’s Guide to ADHD (PDF) – Introduction to ADD/ADHD, written for parents. Covers causes, symptoms, and treatments. (Montana State University)

Signs and symptoms of ADD / ADHD in children and teens

Symptoms and Diagnosis – Guide to the symptoms of ADD/ADHD in children, including the signs of hyperactivity, impulsivity, and inattention. (Centers for Disease Control and Prevention)

What is Hyperactivity? – Explores the signs of ADD/ADHD, including hyperactivity. Learn what to do if the doctor diagnoses your child. (Nemours Foundation)

ADHD – A clear, simple, teen-oriented article about attention deficit disorder, including information about signs and symptoms in teenagers, ADD/ADHD and driving, and treatment. (TeensHealth)

Authors: Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D. Last updated: April 2015.


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