School Problems

A Decision Tree Approach

VisionHearing

MetabolicSkin

Yes No

Academic or Behavior Problems at School

PhysicalHealth

Problem?

MentalHealth

Problem

AppropriateTreatment

MentalHealth

Problem

Trouble learning,not just missing assignments

YesPsychiatric/Psychologic

Problem

NoEducational Resources &

Psychoed Testing

Psychiatric/Psychologic

Problem

Behavioral only:Specific settings and child can

turn it off and on

No PhysiologicDisorder

Yes,School specific

Yes,All settings

OppositionalDefiant

Educational mismatch or educational issues

Reconsider learning

problems

Parent School Conference

Parent TrainingFamily Therapy

Physiologic Problem

Feels poorly:

Mad, Sad, Worried

Yes

All the time?Mood

Disoders

YesOnly when things go wrong

No

Dysregulation

Dysregulation

AttentionProblems?

All settings

AttentionDeficit

HyperactivityDisorder

Parent TrainingMedication

Sleep & NutritionADHD Coaching

504 Plan/IEP

Specific settings

No

Aggression or Property Damage

Yes

No

Reconsider mood or behavior

disorder

Dysregulation without attention problems,with aggression or property destruction

Intermittent Explosive DisorderDisruptive Mood Dysregulation

Disorder

Emotional Management TherapyMedication

Relaxation, Hypnosis, or Biofeedback

Parent Training

Obsessive Compulsive

Disorder

MedicationSpecific CBT

Repetitive thoughts orneed for sameness/perfection

Dysregulation withAttention problems only in specific

settings

Yes

Reconsider Mood

Disorder

No

Physiologic Problem

Feels poorly:

Mad, Sad, Worried

Yes

All the time?Mood

Disoders

YesOnly when things go wrong

No

Dysregulation

Mood Disorders

Mainly worries

Sad, trouble have fun

Cycles, racing thoughts

Trauma

Anxiety DepressionBipolar

DisorderPTSD

Anxiety

Can’t give presentations;Doesn’t ask for help

Missing Mondays;Visit Nurse to call parents

Social Separation

TherapyBehavior Plan for Progressive

DesensitizationMedications only if severe impairment

Depression

Reactive(Adjustment Disorder)

Endogenous

Relates to a specific stressor

Triggered or worsened by stress, but present regardless of stress

TherapyLifestyle regulation

Possible sleep medication

TherapyMedication

Lifestyle regulation

Post Traumatic Stress Disorder

TherapyMedications for Nightmares

Bipolar Disorder

Refer to a Psychiatrist

Helpful Groups and Websites

• NAMI (www.namisa.org/www.name.org) provides support, education, and advocacy

• CHADD (www.chadd.org) specific support and advocacy for ADHD

• Depression and Bipolar Support Alliance (www.dbsatucson.org/ www.dbsa.org), now merged with the Child and Adolescent Bipolar Foundation

Helpful Groups and Websites

• www.ok2talk.org

• www.depressedteens.com