Mayo Clinic Child and Adolescent Mental Health Resources.

Families and clinicians can use this website to find information about child and adolescent mental health resources within Mayo Clinic. The information is organized by the type of concerns that you have. If you are unsure which of the below categories best describes your concerns you can select the "other" option, contact your primary care provider, or directly contact the Mayo Clinic Department of Psychiatry and Psychology. Pediatric Integrated Behavioral Health (IBH) is available within Mayo Clinic primary care to provide immediate consultation for behavioral health concerns. (IBH Ordering Instructions)

Primary Recommendations

Anxiety Disorders and Obsessive Compulsive Disorder (OCD)

Summary:

Children experiencing an anxiety disorder are afraid, worried or nervous about things that do not bother other kids their age. These fears and worries are serious enough to be upsetting and/or make it hard for kids to do the things they need and want to do. There are different anxiety diagnoses based on what makes the child afraid or nervous and include: Social anxiety disorder, generalized anxiety disorder, separation anxiety disorder, specific phobia, panic disorder, agoraphobia, and obsessive compulsive disorder (OCD).

Treatment:

The treatment for anxiety disorders is called exposure therapy. Exposures are little experiments that children do to face their fears and learn that what they are afraid of is unlikely to happen. A therapist can help children and their parents learn about anxiety and how to do exposures, as well help the family complete exposures in each appointment.

Other concerns:

Anxiety disorders should be distinguished from situational stress where a child is feeling worried or nervous in response to an upsetting event that would upset most children (More differences between situational stress and anxiety disorders). Also, if children are feeling depressed or are having anger outbursts and defiance which prevent treating the anxiety disorder, these other symptoms may need to be addressed first.

Treatment Options:

1. Research Participation. The Pediatric Anxiety Disorders Clinic (PADC) is currently seeking children with anxiety disorders or OCD and their parents to participate in a treatment study described here. Interested families can contact study coordinator Deanna Hofschulte at 507-255-2972 or hofschulte.deanna@mayo.edu.

2. Identification and Assessment. Assessment of Anxiety and OCD can include completion of questionnaires completed by parents (download here), and kids (download here).

3. Self-help. Families that would like to explore self-help treatment can access https://anxietycoach.mayoclinic.org/anxiety/ to learn about exposure therapy.

4. Pediatric Anxiety Disorders Clinic (PADC). Treatment in the PADC consists of parent-coached exposure therapy, where youth and their parent(s) learn how to gradually build confidence through facing their fears. Treatment is primarily delivered in groups, with individual sessions as needed. Families interested in receiving evaluation and/or treatment through the PADC can talk to their primary care provider for a referral or call (507) 266-5100 directly to schedule an appointment.

5. Intensive Treatment. Children experiencing more severe symptoms or who do not live close to Mayo Clinic Rochester can participate in the 5-day intensive treatment program (more information here). An evaluation to determine if the 5-day intensive treatment program would be appropriate for a child’s symptoms can be requested by primary care providers, other mental health professionals, or families directly by calling (507) 266-5100.

6. Specialty Evaluation-Medication Only. Families only interested in medication without behavioral therapy, can receive a general psychiatric evaluation, not within the Pediatric Anxiety Disorders Clinic. Families can talk with primary care providers or call (507) 266-5100 directly to schedule an appointment.

7. External Resources. General mental health resources are available outside of Mayo Clinic. List of providers are organized by region. As individual providers’ practices change between updates, the current lists may be incomplete and contain outdated information.

• Providers in the Rochester area can be found here.

• Providers in the Austin, Albert Lea, Owatonna area can be found here.

• A global list of local, regional, national, and international providers can be accessed within the Mayo Clinic electronic environment here.

(Ordering Instructions)

Disruptive Behavior

Summary:

Disruptive behaviors refer to when children are refusing to do what is asked of them, are frequently argumentative, and have anger outbursts. When these behaviors occur frequently, across different types of parental requests, and generally when children do not get their way, they might lead to a diagnosis of oppositional defiant disorder (ODD). Children with attention deficit/hyperactivity disorder (ADHD) may also behave in this way. For other children, the resistance and emotional outbursts may result from anxiety, depression, or life stressors.

Treatment:

The treatment for disruptive behavior is called Behavior Management Training (BMT). In BMT parents learn how to use firm expectations, rewards, and consequences to increase cooperation and emotion management, and decrease arguing, refusal, and anger outbursts. Although many parents are familiar with standard parenting strategies, most of the time parents do not need to use these strategies precisely. The goal of BMT is for parents to learn how behavior management strategies work, so they can get the most out of these techniques.

Other concerns:

Behavior Management Training is appropriate whenever parents or other caregivers need a child to be more cooperative with requests. When resistance and emotional outbursts occur because of anxiety, depression, or other disorder, BMT likely should be used in combination with another treatment. If a child’s behavior leads to significant safety concerns, these issues should be assessed careful and addressed directly.

Treatment Options:

1. Self-help. Families that would like to explore self-help treatment can explore https://anxietycoach.mayoclinic.org/cooperation-coach/ to learn about Behavior Management Training.

2. Brief therapy within primary care. Brief therapy and further evaluation is available within Primary Care through Integrated Behavior Health (IBH). Families interested in meeting with a social worker through IBH should contact their primary care provider.

3. Specialty Care-Evaluation. For families seeking further evaluation of disruptive behavior to determine the accurate diagnosis and appropriate treatment, specialty consultation are available in the Mayo Clinic Department of Psychiatry and Psychology. Interested families should talk with their primary care provider or call (507) 266-5100 directly to schedule an appointment.

4. Specialty Care-Treatment Program. Families that have been assessed and found to be a good fit by primary care, integrated behavior health, or psychiatry/psychology can participate in the Behavior Management Orientation Session (flyer). This single session covers all behavior strategies, helps parents make a plan to address their concerns, and arranges follow-up appointments. Interested families should talk with their primary care provider, therapist, or call (507) 266-5100 directly to schedule an evaluation to determine if this treatment is appropriate.

5. External Resources. General mental health resources are available outside of Mayo Clinic. List of providers are organized by region. As individual providers’ practices change between updates, the current lists may be incomplete and contain outdated information.

• Providers in the Rochester area can be found here.

• Providers in the Austin, Albert Lea, Owatonna area can be found here.

• A global list of local, regional, national, and international providers can be accessed within the Mayo Clinic electronic environment here.

(Ordering Instructions)

Depression

Summary:

Children experiencing depression feel sad and down most of the day nearly every day. They might also be irritable or lose interest in doing activities that they used to enjoy. These symptoms are a change from how they usually feel and behave, must be present for at least two consecutive weeks, and are serious enough to be upsetting and/or make it hard for kids to do the things they need and want to do. A diagnosis of major depression requires the presence depressed and/or irritable mood along with somatic symptoms (e.g., sleep and appetite difficulties, changes in interests and activity levels, reduction in their self-esteem and concentration).

Treatment:

The treatment for depression should begin with psychotherapy. Behavioral activation is a treatment that helps children and their families increase the positive experiences in a child’s life to gradually improve their mood. Medication management should be considered when a child is struggling to remain safe or is consistently unable to meaningfully engage in daily expectations. Additionally, medication can be a second line treatment if a child meets criteria for less impairing elements of major depression and has not responded to psychotherapy.

Other concerns:

Major depression should be distinguished from situational stress where a child is feeling sad or down in response to an upsetting event that would upset most children (e.g., the loss of a friendship or loss of a pet). Depression may result from untreated anxiety disorders or other conditions. As long as the depression is not severe enough to prevent other forms of treatment or impairing the child’s functioning, other disorders that are contributing to the depression should be treated first.

Treatment Options:

1. Screening and Assessment. Administration of the PHQ-9 (download here) can assist identification and assessment of depression in adolescents age 12 to 17.

2. Self-help. Families that would like to explore self-help treatment can explore https://anxietycoach.mayoclinic.org/depression/ to learn about behavioral activation and other therapies.

3. Brief therapy and assessment within primary care. Brief therapy and further evaluation is available within Primary Care through Integrated Behavior Health (IBH).

4. Care Coordination (IBH PEDS: formally EMERALD). Adolescents age 12 to 17 (18 if still in high school) that receive primary care through Mayo Clinic Rochester or Kasson may be able to receive care coordination through the IBH PEDS program, if appropriate for their level of symptoms. Interested families should talk with their primary care provider at Mayo Clinic Rochester or Kasson.

5. Specialty Care. Families interested in having a specialty evaluation for mood disorders can be seen in the Pediatric Mood Clinic. Interested families should talk with their primary care provider or call (507) 266-5100 directly to schedule an appointment.

6. External Resources. General mental health resources are available outside of Mayo Clinic. List of providers are organized by region. As individual providers’ practices change between updates, the current lists may be incomplete and contain outdated information.

• Providers in the Rochester area can be found here.

• Providers in the Austin, Albert Lea, Owatonna area can be found here.

• A global list of local, regional, national, and international providers can be accessed within the Mayo Clinic electronic environment here.

(Ordering Instructions)

Attention Deficit/Hyperactivity Disorder (ADHD)

Summary:

Attention Deficit/Hyperactivity Disorder (ADHD) includes three different conditions: 1) ADHD-predominately hyperactive type describing children who are over active and impulsive, 2) ADHD-predominately Inattentive type describing children who have difficulty concentrating, focusing, and avoiding distractions, but are not hyperactive, and 3) ADHD- combined type describing children that have both inattention and hyperactivity/impulsivity. To meet the diagnostic criteria the symptoms must be present before age 12, be impairing and occur in two settings, usually home and school.

Assessment and Treatment:

Diagnosing ADHD typically requires three components: 1) A thorough clinical interview in which a clinician determines that sufficient symptoms of hyperactivity/impulsivity and/or inattention are present, 2) Questionnaires completed by the child’s parents suggesting that the symptoms meet the clinical severity level, and 3) Questionnaires completed by an adult in another situation (typically the child’s teacher) suggesting that the symptoms meet the clinical severity level in a second setting. Treatment typically includes medication and may also include Behavior Management Training (BMT). In BMT parents learn how to use firm expectations, rewards, and consequences to increase cooperation.

Other concerns:

Children may exhibit symptoms that appear to be ADHD for other reasons, including: undiagnosed learning problems, situational stress, severe anxiety, or weight loss.

Treatment Options:

1. Identification and Assessment. Diagnosis of ADHD is often completed through primary care with assistance of Vanderbilt questionnaires completed by parents (download here), and teachers (download here).

2. Integrated Community Specialties-Rochester and Kasson. Within Rochester and Kasson primary care clinics, more specialized assessment is available by primary care providers with additional knowledge and training in the area of ADHD/child mental health through Integrated Community Specialties. Interested families should talk to their primary care provider.

3. Self-help. Families that would like to begin with self-help behavior management can explore https://anxietycoach.mayoclinic.org/ cooperation-coach/.

4. Subspecialty Evaluation. When a potential diagnosis of ADHD is complicated or initial treatment options have not been successful, subspecialty evaluations are available through the ADHD Clinic within the Department of Psychiatry and Psychology. Interested families should talk to their primary care physician or can call (507) 266-5100 directly to schedule an appointment.

5. Behavior Management Treatment. Families that have been assessed by primary care, integrated behavior health, or psychiatry/psychology and found to be a good fit can participate in the Behavior Management Orientation Session. This single session covers all behavior strategies, helps parents make a plan to address their concerns, and arranges follow-up appointments. Interested families should talk to their primary care physician or can call (507) 266-5100 directly to schedule an appointment.

6. External Resources. General mental health resources are available outside of Mayo Clinic. List of providers are organized by region. As individual providers’ practices change between updates, the current lists may be incomplete and contain outdated information.

• Providers in the Rochester area can be found here.

• Providers in the Austin, Albert Lea, Owatonna area can be found here.

• A global list of local, regional, national, and international providers can be accessed within the Mayo Clinic electronic environment here.

(Ordering Instructions)

Eating Disorders

Summary:

Children and adolescents with eating disorders present with a pattern of skewed thoughts, feelings, and behaviors around food and their bodies. An eating disorder should be considered in any case where an individual has fallen off their personal growth curve- either through weight loss or failure to make expected gains in weight or BMI. Eating disorders should also be considered when a child or adolescent is restricting their eating, eating in secret, binge eating, compensating for eating by doing things such as inducing vomiting, compulsively exercising, or using diet pills or laxatives, even if there is no accompanying weight loss. Eating disorders are often marked by a desire to “get healthy”, get in shape, or lose weight, however, it is also possible for patients to “back into” an eating disorder, if their appetite or weight get disrupted for other reasons, such as anxiety or depression, a medical illness, or a change in medication. It is important to also remember that eating disorders affect children and adolescents of all races and ethnicities, genders, and at all BMIs. Regardless of the presentation, disordered eating can have serious medical and/or psychological consequences and should be addressed right away.

Treatment:

The gold standard treatment for restrictive eating disorders (e.g. anorexia nervosa) is called Family-Based Treatment (FBT; sometimes this is also called the Maudsley approach). This treatment can only be delivered by specially trained therapists, and involves empowering parents to take charge of meal monitoring, with weight restoration and normalization of eating habits as the first priority. For patients who are not restricting, but who have a pattern of binge eating and/or purging (e.g. bulimia nervosa or binge eating disorder), FBT can be helpful, as can individual therapies such as CBT. For patients who are unable to engage in or make gains in outpatient treatment, inpatient treatment or a day treatment program may be necessary.

Other concerns:

Outpatient treatment for eating disorders is only possible if the patient is medically stable. In many cases children and adolescents should be screened for medical stability before initiating FBT, including labs, an ECG, and orthostatic vitals
(guidelines). Children and adolescents may need an immediate referral for medical hospitalization.

Treatment Options:

1. Additional Information for Families. For parents interested in learning more about child and adolescent eating disorder, Help Your Teenager Beat an Eating Disorder by James Lock and Daniel Le Grange is an excellent book. In addition, families can visit the following websites: https://www.feast-ed.org/, http://maudsleyparents.org/, https://www.aedweb.org/home, https://www.nationaleatingdisorders.org/.

2. Treatment within Primary Care. Families who receive primary care through Mayo Clinic Rochester can receive an eating disorder evaluation through Integrated Behavioral Health (IBH). Limited outpatient treatment is available through IBH for lower severity/early eating disorders. Interested families should talk with their primary care provider.

3. Treatment outside of Mayo Clinic for Severe Symptoms. For children and adolescents with more severe symptoms or who do not meet criteria for outpatient eating disorder treatment, Mayo Clinic does not have a higher level of care option. The closest evidence-based inpatient and/or day treatment program is Melrose Center 952-993-6200 in the Twin Cities. For patients who need an even higher level of care (longer term residential care) and/or for whom out of state care is a possibility, the Eating Recovery Center in Denver is recommended 720-677-9985.

4. Medical Stabilization. Children and adolescents who need medical hospitalization should be referred immediately to the Emergency Department or, if possible, Children’s Hospital in Minneapolis in the Twin Cities.

5. External Resources. General mental health resources are available outside of Mayo Clinic. List of providers are organized by region. As individual providers’ practices change between updates, the current lists may be incomplete and contain outdated information.

• Providers in the Rochester area can be found here.

• Providers in the Austin, Albert Lea, Owatonna area can be found here.

• A global list of local, regional, national, and international providers can be accessed within the Mayo Clinic electronic environment here.

(Ordering Instructions)

Adjusting to Stress

Summary:

When children adjust to situational stress they may experience increased anxiety, sadness, anger or irritability. These feelings may occur after upsetting events or changes in life such as illness, divorce, teasing, moves, or losses.

Treatment:

The treatment for situational stress usually involves providing warm support, a safe place to discuss one’s feelings, and assistance with skills to handle challenges in life.

Other concerns:

Situational stress should be distinguished from anxiety disorders. When adjusting to situational stress, a child is feeling worried or nervous in response to an upsetting event that would upset most children. In contrast, children experiencing an anxiety disorder are afraid, worried or nervous about things that do not bother other kids their age (More differences between situational stress and anxiety disorders). Situational stress should also be distinguished from major depression which may require more intensive treatment.

Treatment Options:

1. Self-help. Families that would like to explore self-help treatment can explore https://anxietycoach.mayoclinic.org/family-stress/ to learn strategies for dealing with stress and the emotions that accompany stressful situations

2. Treatment in Primary Care. Brief therapy and further evaluation is available within Primary Care through Integrated Behavior Health (IBH).

3. Specialty Care. For families whose child requires specialty evaluation to determine whether additional symptoms are present, consultation through the Department of Psychiatry and Psychology. Families can talk with their primary care provider or call (507) 266-5100 directly to schedule an appointment.

4. External Resources. General mental health resources are available outside of Mayo Clinic. List of providers are organized by region. As individual providers’ practices change between updates, the current lists may be incomplete and contain outdated information.

• Providers in the Rochester area can be found here.

• Providers in the Austin, Albert Lea, Owatonna area can be found here.

• A global list of local, regional, national, and international providers can be accessed within the Mayo Clinic electronic environment here.

5. Grief Counseling. Resources, including support groups, for families experiencing the loss of a loved one can be found here.

(Ordering Instructions)

Crisis Assessment

Summary:

Mental health crises can include concerns about suicidality and self-harm, inability to handle an immediate stressor, interpersonal conflict, lack of necessary resources, among other factors. These situations require immediate evaluation, steps to ensure safety, and a plan for follow-up care.

Resources:

1. At home. When families are concerned for immediate safety they are encouraged to contact their primary care provider, therapist, emergency resources listed within in the Family Stress Resource Center (https://anxietycoach.mayoclinic.org/family-stress/crisis-managment/), or call 911.

2. Within Primary Care. Crisis assessment is available within Primary Care through Integrated Behavior Health (IBH).

3. Southeastern MN Crisis Team. Immediate face-to-face crisis assessment is available through Crisis Response For Southeast Minnesotat. Phone number: 1-844-274-7472, website: https://crisis2southeastmn.com/mental-health-services/. Covers counties: Dodge, Steele, Waseca, Mower, Olmsted, Fillmore, Goodhue, Wabasha, Winona, Houston.

4. South Central Mobile Crisis Team. Support for children, teens, and adults living in south central Minnesota who are experiencing a mental health crisis is available through Horizon Homes Inc. Phone number: 877-399-3040, website: https://www.horizonhomes.org/south-central-mobile-crisis-team/. Covers counties: Blue Earth, Brown, Faribault, Freeborn, Le Sueur, Martin, Nicollet, Rice, Sibley, and Watonwan.

5. Self-help. Additional strategies and resources for handling stressful situations can be found within the Family Stress Resource Center website to learn strategies for dealing with stress and the emotions that accompany stressful situations

6. External Resources. General mental health resources are available outside of Mayo Clinic. List of providers are organized by region. As individual providers’ practices change between updates, the current lists may be incomplete and contain outdated information.

• Providers in the Rochester area can be found here.

• Providers in the Austin, Albert Lea, Owatonna area can be found here.

• A global list of local, regional, national, and international providers can be accessed within the Mayo Clinic electronic environment here.

(Ordering Instructions)

Substance Use

Summary:

Use of drugs and/or alcohol can interfere with a youth’s emotional well-being, relationships with friends and family, as well as performance in school. Help is available for families concerned about youth substance use. Families should talk with their primary care provider for information about available treatment resources.

Treatment:

The treatment for substance use disorders can include peer lead self-help groups, individual therapy, group therapy, and medication assisted treatment. Treatment options range along a spectrum from least restrictive care to most restrictive care, including outpatient treatment and residential treatment. A clinical assessment with a Licensed Alcohol and Drug Counselor (LADC) determines appropriate level of care to recommend.

Treatment Options:

1. Within Primary Care. Initial assessment to assist with determining whether a substance abuse assessment is appropriate is available within Primary Care through Integrated Behavior Health (IBH). Interested families should talk with their primary care provider.

2. Fountain Centers. Evaluation and treatment of adolescent substance use is available through Fountain Centers in the Mayo Clinic Health System at a variety of locations across Southern Minnesota. Interested families can call (507) 252-0818 for further information. Website: https://www.mayoclinichealthsystem.org/locations/albert-lea/fountain-centers.

3. Prairie Care. Evaluation and treatment of adolescent substance use is available through Prairie Care. Website: https://www.prairie-care.com/.

4. Independent Management Services. Chemical Health evaluations are available through Independent Management Services located in Austin, MN. Phone: (507) 437-6389. Website: https://www.imsofmn.com/blank-9.

5. External Resources. General mental health resources are available outside of Mayo Clinic. List of providers are organized by region. As individual providers’ practices change between updates, the current lists may be incomplete and contain outdated information.

• Providers in the Rochester area can be found here.

• Providers in the Austin, Albert Lea, Owatonna area can be found here.

• A global list of local, regional, national, and international providers can be accessed within the Mayo Clinic electronic environment here.

(Ordering Instructions)

Other Behavioral and Emotional Concerns

Summary:

The are a wide variety of behavioral and emotional symptoms that children may experience. If the presenting concerns do not fit into one of the specific categories, the family can be referred for evaluation through

1. Treatment in Primary Care. Brief therapy and further evaluation is available within Primary Care through Integrated Behavior Health (IBH).

2. Specialty Care. For families whose child requires specialty evaluation, evaluations are available through the Department of Psychiatry and Psychology. Interested families should talk with their primary care provider or call (507) 266-5100 directly to schedule an appointment.

3. External Resources. General mental health resources are available outside of Mayo Clinic. List of providers are organized by region. As individual providers’ practices change between updates, the current lists may be incomplete and contain outdated information.

• Providers in the Rochester area can be found here.

• Providers in the Austin, Albert Lea, Owatonna area can be found here.

• A global list of local, regional, national, and international providers can be accessed within the Mayo Clinic electronic environment here.

(Ordering Instructions)

Secondary Recommendations

Anxiety Disorders and Obsessive Compulsive Disorder (OCD)

Summary:

Children experiencing an anxiety disorder are afraid, worried or nervous about things that do not bother other kids their age. These fears and worries are serious enough to be upsetting and/or make it hard for kids to do the things they need and want to do. There are different anxiety diagnoses based on what makes the child afraid or nervous and include: Social anxiety disorder, generalized anxiety disorder, separation anxiety disorder, specific phobia, panic disorder, agoraphobia, and obsessive compulsive disorder (OCD).

Treatment:

The treatment for anxiety disorders is called exposure therapy. Exposures are little experiments that children do to face their fears and learn that what they are afraid of is unlikely to happen. A therapist can help children and their parents learn about anxiety and how to do exposures, as well help the family complete exposures in each appointment.

Other concerns:

Anxiety disorders should be distinguished from situational stress where a child is feeling worried or nervous in response to an upsetting event that would upset most children (More differences between situational stress and anxiety disorders). Also, if children are feeling depressed or are having anger outbursts and defiance which prevent treating the anxiety disorder, these other symptoms may need to be addressed first.

Treatment Options:

1. Research Participation. The Pediatric Anxiety Disorders Clinic (PADC) is currently seeking children with anxiety disorders or OCD and their parents to participate in a treatment study described here. Interested families can contact study coordinator Deanna Hofschulte at 507-255-2972 or hofschulte.deanna@mayo.edu.

2. Identification and Assessment. Assessment of Anxiety and OCD can include completion of questionnaires completed by parents (download here), and kids (download here).

3. Self-help. Families that would like to explore self-help treatment can access https://anxietycoach.mayoclinic.org/anxiety/ to learn about exposure therapy.

4. Pediatric Anxiety Disorders Clinic (PADC). Treatment in the PADC consists of parent-coached exposure therapy, where youth and their parent(s) learn how to gradually build confidence through facing their fears. Treatment is primarily delivered in groups, with individual sessions as needed. Families interested in receiving evaluation and/or treatment through the PADC can talk to their primary care provider for a referral or call (507) 266-5100 directly to schedule an appointment.

5. Intensive Treatment. Children experiencing more severe symptoms or who do not live close to Mayo Clinic Rochester can participate in the 5-day intensive treatment program (more information here). An evaluation to determine if the 5-day intensive treatment program would be appropriate for a child’s symptoms can be requested by primary care providers, other mental health professionals, or families directly by calling (507) 266-5100.

6. Specialty Evaluation-Medication Only. Families only interested in medication without behavioral therapy, can receive a general psychiatric evaluation, not within the Pediatric Anxiety Disorders Clinic. Families can talk with primary care providers or call (507) 266-5100 directly to schedule an appointment.

(Ordering Instructions)

Disruptive Behavior

Summary:

Disruptive behaviors refer to when children are refusing to do what is asked of them, are frequently argumentative, and have anger outbursts. When these behaviors occur frequently, across different types of parental requests, and generally when children do not get their way, they might lead to a diagnosis of oppositional defiant disorder (ODD). Children with attention deficit/hyperactivity disorder (ADHD) may also behave in this way. For other children, the resistance and emotional outbursts may result from anxiety, depression, or life stressors.

Treatment:

The treatment for disruptive behavior is called Behavior Management Training (BMT). In BMT parents learn how to use firm expectations, rewards, and consequences to increase cooperation and emotion management, and decrease arguing, refusal, and anger outbursts. Although many parents are familiar with standard parenting strategies, most of the time parents do not need to use these strategies precisely. The goal of BMT is for parents to learn how behavior management strategies work, so they can get the most out of these techniques.

Other concerns:

Behavior Management Training is appropriate whenever parents or other caregivers need a child to be more cooperative with requests. When resistance and emotional outbursts occur because of anxiety, depression, or other disorder, BMT likely should be used in combination with another treatment. If a child’s behavior leads to significant safety concerns, these issues should be assessed careful and addressed directly.

Treatment Options:

1. Self-help. Families that would like to explore self-help treatment can explore https://anxietycoach.mayoclinic.org/cooperation-coach/ to learn about Behavior Management Training.

2. Brief therapy within primary care. Brief therapy and further evaluation is available within Primary Care through Integrated Behavior Health (IBH). Families interested in meeting with a social worker through IBH should contact their primary care provider.

3. Specialty Care-Evaluation. For families seeking further evaluation of disruptive behavior to determine the accurate diagnosis and appropriate treatment, specialty consultation are available in the Mayo Clinic Department of Psychiatry and Psychology. Interested families should talk with their primary care provider or call (507) 266-5100 directly to schedule an appointment.

4. Specialty Care-Treatment Program. Families that have been assessed and found to be a good fit by primary care, integrated behavior health, or psychiatry/psychology can participate in the Behavior Management Orientation Session. This single session covers all behavior strategies, helps parents make a plan to address their concerns, and arranges follow-up appointments. Interested families should talk with their primary care provider, therapist, or call (507) 266-5100 directly to schedule an evaluation to determine if this treatment is appropriate.

5. External Resources. General mental health resources are available outside of Mayo Clinic. Providers in the Austin, Albert Lea, Owatonna area can be found here.

(Ordering Instructions)

Depression

Summary:

Children experiencing depression feel sad and down most of the day nearly every day. They might also be irritable or lose interest in doing activities that they used to enjoy. These symptoms are a change from how they usually feel and behave, must be present for at least two consecutive weeks, and are serious enough to be upsetting and/or make it hard for kids to do the things they need and want to do. A diagnosis of major depression requires the presence depressed and/or irritable mood along with somatic symptoms (e.g., sleep and appetite difficulties, changes in interests and activity levels, reduction in their self-esteem and concentration).

Treatment:

The treatment for depression should begin with psychotherapy. Behavioral activation is a treatment that helps children and their families increase the positive experiences in a child’s life to gradually improve their mood. Medication management should be considered when a child is struggling to remain safe or is consistently unable to meaningfully engage in daily expectations. Additionally, medication can be a second line treatment if a child meets criteria for less impairing elements of major depression and has not responded to psychotherapy.

Other concerns:

Major depression should be distinguished from situational stress where a child is feeling sad or down in response to an upsetting event that would upset most children (e.g., the loss of a friendship or loss of a pet). Depression may result from untreated anxiety disorders or other conditions. As long as the depression is not severe enough to prevent other forms of treatment or impairing the child’s functioning, other disorders that are contributing to the depression should be treated first.

Treatment Options:

1. Screening and Assessment. Administration of the PHQ-9 (download here) can assist identification and assessment of depression in adolescents age 12 to 17.

2. Self-help. Families that would like to explore self-help treatment can explore https://anxietycoach.mayoclinic.org/depression/ to learn about behavioral activation and other therapies.

3. Brief therapy and assessment within primary care. Brief therapy and further evaluation is available within Primary Care through Integrated Behavior Health (IBH).

4. Care Coordination (IBH PEDS: formally EMERALD). Adolescents age 12 to 17 (18 if still in high school) that receive primary care through Mayo Clinic Rochester or Kasson may be able to receive care coordination through the IBH PEDS program, if appropriate for their level of symptoms. Interested families should talk with their primary care provider at Mayo Clinic Rochester or Kasson.

5. Specialty Care. Families interested in having a specialty evaluation for mood disorders can be seen in the Pediatric Mood Clinic. Interested families should talk with their primary care provider or call (507) 266-5100 directly to schedule an appointment.

6. External Resources. General mental health resources are available outside of Mayo Clinic. List of providers are organized by region. As individual providers’ practices change between updates, the current lists may contain outdated information.

• Providers in the Rochester area can be found here.

• Providers in the Austin, Albert Lea, Owatonna area can be found here.

• A global list of local, regional, national, and international providers can be accessed within the Mayo Clinic electronic environment here.

(Ordering Instructions)

Attention Deficit/Hyperactivity Disorder (ADHD)

Summary:

Attention Deficit/Hyperactivity Disorder (ADHD) includes three different conditions: 1) ADHD-predominately hyperactive type describing children who are over active and impulsive, 2) ADHD-predominately Inattentive type describing children who have difficulty concentrating, focusing, and avoiding distractions, but are not hyperactive, and 3) ADHD- combined type describing children that have both inattention and hyperactivity/impulsivity. To meet the diagnostic criteria the symptoms must be present before age 12, be impairing and occur in two settings, usually home and school.

Assessment and Treatment:

Diagnosing ADHD typically requires three components: 1) A thorough clinical interview in which a clinician determines that sufficient symptoms of hyperactivity/impulsivity and/or inattention are present, 2) Questionnaires completed by the child’s parents suggesting that the symptoms meet the clinical severity level, and 3) Questionnaires completed by an adult in another situation (typically the child’s teacher) suggesting that the symptoms meet the clinical severity level in a second setting. Treatment typically includes medication and may also include Behavior Management Training (BMT). In BMT parents learn how to use firm expectations, rewards, and consequences to increase cooperation.

Other concerns:

Children may exhibit symptoms that appear to be ADHD for other reasons, including: undiagnosed learning problems, situational stress, severe anxiety, or weight loss.

Treatment Options:

1. Identification and Assessment. Diagnosis of ADHD is often completed through primary care with assistance of Vanderbilt questionnaires completed by parents (download here), and teachers (download here).

2. Integrated Community Specialties-Rochester and Kasson. Within Rochester and Kasson primary care clinics, more specialized assessment is available by primary care providers with additional knowledge and training in the area of ADHD/child mental health through Integrated Community Specialties. Interested families should talk to their primary care provider.

3. Self-help. Families that would like to begin with self-help behavior management can explore https://anxietycoach.mayoclinic.org/ cooperation-coach/.

4. Subspecialty Evaluation. When a potential diagnosis of ADHD is complicated or initial treatment options have not been successful, subspecialty evaluations are available through the ADHD Clinic within the Department of Psychiatry and Psychology. Interested families should talk to their primary care physician or can call (507) 266-5100 directly to schedule an appointment.

5. Behavior Management Treatment. Families that have been assessed by primary care, integrated behavior health, or psychiatry/psychology and found to be a good fit can participate in the Behavior Management Orientation Session. This single session covers all behavior strategies, helps parents make a plan to address their concerns, and arranges follow-up appointments. Interested families should talk to their primary care physician or can call (507) 266-5100 directly to schedule an appointment.

6. External Resources. General mental health resources are available outside of Mayo Clinic. Providers in the Austin, Albert Lea, Owatonna area can be found here.

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Eating Disorders

Summary:

Children and adolescents with eating disorders present with a pattern of skewed thoughts, feelings, and behaviors around food and their bodies. An eating disorder should be considered in any case where an individual has fallen off their personal growth curve- either through weight loss or failure to make expected gains in weight or BMI. Eating disorders should also be considered when a child or adolescent is restricting their eating, eating in secret, binge eating, compensating for eating by doing things such as inducing vomiting, compulsively exercising, or using diet pills or laxatives, even if there is no accompanying weight loss. Eating disorders are often marked by a desire to “get healthy”, get in shape, or lose weight, however, it is also possible for patients to “back into” an eating disorder, if their appetite or weight get disrupted for other reasons, such as anxiety or depression, a medical illness, or a change in medication. It is important to also remember that eating disorders affect children and adolescents of all races and ethnicities, genders, and at all BMIs. Regardless of the presentation, disordered eating can have serious medical and/or psychological consequences and should be addressed right away.

Treatment:

The gold standard treatment for restrictive eating disorders (e.g. anorexia nervosa) is called Family-Based Treatment (FBT; sometimes this is also called the Maudsley approach). This treatment can only be delivered by specially trained therapists, and involves empowering parents to take charge of meal monitoring, with weight restoration and normalization of eating habits as the first priority. For patients who are not restricting, but who have a pattern of binge eating and/or purging (e.g. bulimia nervosa or binge eating disorder), FBT can be helpful, as can individual therapies such as CBT. For patients who are unable to engage in or make gains in outpatient treatment, inpatient treatment or a day treatment program may be necessary.

Other concerns:

Outpatient treatment for eating disorders is only possible if the patient is medically stable. In many cases children and adolescents should be screened for medical stability before initiating FBT, including labs, an ECG, and orthostatic vitals
(guidelines). Children and adolescents may need an immediate referral for medical hospitalization.

Treatment Options:

1. Additional Information for Families. For parents interested in learning more about child and adolescent eating disorder, Help Your Teenager Beat an Eating Disorder by James Lock and Daniel Le Grange is an excellent book. In addition, families can visit the following websites: https://www.feast-ed.org/, http://maudsleyparents.org/, https://www.aedweb.org/home, https://www.nationaleatingdisorders.org/.

2. Treatment within Primary Care. Families who receive primary care through Mayo Clinic Rochester can receive an eating disorder evaluation through Integrated Behavioral Health (IBH). Limited outpatient treatment is available through IBH for lower severity/early eating disorders. Interested families should talk with their primary care provider.

3. Treatment outside of Mayo Clinic for Severe Symptoms. For children and adolescents with more severe symptoms or who do not meet criteria for outpatient eating disorder treatment, Mayo Clinic does not have a higher level of care option. The closest evidence-based inpatient and/or day treatment program is Melrose Center 952-993-6200 in the Twin Cities. For patients who need an even higher level of care (longer term residential care) and/or for whom out of state care is a possibility, the Eating Recovery Center in Denver is recommended 720-677-9985.

4. Medical Stabilization. Children and adolescents who need medical hospitalization should be referred immediately to the Emergency Department or, if possible, Children’s Hospital in Minneapolis in the Twin Cities.

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Adjusting to Stress

Summary:

When children adjust to situational stress they may experience increased anxiety, sadness, anger or irritability. These feelings may occur after upsetting events or changes in life such as illness, divorce, teasing, moves, or losses.

Treatment:

The treatment for situational stress usually involves providing warm support, a safe place to discuss one’s feelings, and assistance with skills to handle challenges in life.

Other concerns:

Situational stress should be distinguished from anxiety disorders. When adjusting to situational stress, a child is feeling worried or nervous in response to an upsetting event that would upset most children. In contrast, children experiencing an anxiety disorder are afraid, worried or nervous about things that do not bother other kids their age (More differences between situational stress and anxiety disorders). Situational stress should also be distinguished from major depression which may require more intensive treatment.

Treatment Options:

1. Self-help. Families that would like to explore self-help treatment can explore https://anxietycoach.mayoclinic.org/family-stress/ to learn strategies for dealing with stress and the emotions that accompany stressful situations

2. Treatment in Primary Care. Brief therapy and further evaluation is available within Primary Care through Integrated Behavior Health (IBH).

3. Specialty Care. For families whose child requires specialty evaluation to determine whether additional symptoms are present, consultation through the Department of Psychiatry and Psychology. Families can talk with their primary care provider or call (507) 266-5100 directly to schedule an appointment.

4. External Resources. General mental health resources are available outside of Mayo Clinic. Providers in the Austin, Albert Lea, Owatonna area can be found here.

5. Grief Counseling. Resources, including support groups, for families experiencing the loss of a loved one can be found here.

5. External Resources. General mental health resources are available outside of Mayo Clinic. List of providers are organized by region. As individual providers’ practices change between updates, the current lists may contain outdated information.

• Providers in the Rochester area can be found here.

• Providers in the Austin, Albert Lea, Owatonna area can be found here.

• A global list of local, regional, national, and international providers can be accessed within the Mayo Clinic electronic environment here.

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Crisis Assessment

Summary:

Mental health crises can include concerns about suicidality and self-harm, inability to handle an immediate stressor, interpersonal conflict, lack of necessary resources, among other factors. These situations require immediate evaluation, steps to ensure safety, and a plan for follow-up care.

Resources:

1. At home. When families are concerned for immediate safety they are encouraged to contact their primary care provider, therapist, emergency resources listed within in the Family Stress Resource Center (https://anxietycoach.mayoclinic.org/family-stress/crisis-managment/), or call 911.

2. Within Primary Care. Crisis assessment is available within Primary Care through Integrated Behavior Health (IBH).

3. Southeastern MN Crisis Team. Immediate face-to-face crisis assessment is available through Crisis Response For Southeast Minnesotat. Phone number: 1-844-274-7472, website: https://crisis2southeastmn.com/mental-health-services/. Covers counties: Dodge, Steele, Waseca, Mower, Olmsted, Fillmore, Goodhue, Wabasha, Winona, Houston.

4. South Central Mobile Crisis Team. Support for children, teens, and adults living in south central Minnesota who are experiencing a mental health crisis is available through Horizon Homes Inc. Phone number: 877-399-3040, website: https://www.horizonhomes.org/south-central-mobile-crisis-team/. Covers counties: Blue Earth, Brown, Faribault, Freeborn, Le Sueur, Martin, Nicollet, Rice, Sibley, and Watonwan.

5. Self-help. Additional strategies and resources for handling stressful situations can be found within the Family Stress Resource Center website to learn strategies for dealing with stress and the emotions that accompany stressful situations

6. External Resources. General mental health resources are available outside of Mayo Clinic. List of providers are organized by region. As individual providers’ practices change between updates, the current lists may contain outdated information.

• Providers in the Rochester area can be found here.

• Providers in the Austin, Albert Lea, Owatonna area can be found here.

• A global list of local, regional, national, and international providers can be accessed within the Mayo Clinic electronic environment here.

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Substance Use

Summary:

Use of drugs and/or alcohol can interfere with a youth’s emotional well-being, relationships with friends and family, as well as performance in school. Help is available for families concerned about youth substance use. Families should talk with their primary care provider for information about available treatment resources.

Treatment:

The treatment for substance use disorders can include peer lead self-help groups, individual therapy, group therapy, and medication assisted treatment. Treatment options range along a spectrum from least restrictive care to most restrictive care, including outpatient treatment and residential treatment. A clinical assessment with a Licensed Alcohol and Drug Counselor (LADC) determines appropriate level of care to recommend.

Treatment Options:

1. Within Primary Care. Initial assessment to assist with determining whether a substance abuse assessment is appropriate is available within Primary Care through Integrated Behavior Health (IBH). Interested families should talk with their primary care provider.

2. Fountain Centers. Evaluation and treatment of adolescent substance use is available through Fountain Centers in the Mayo Clinic Health System at a variety of locations across Southern Minnesota. Interested families can call (507) 252-0818 for further information. Website: https://www.mayoclinichealthsystem.org/locations/albert-lea/fountain-centers.

3. Prairie Care. Evaluation and treatment of adolescent substance use is available through Prairie Care. Website: https://www.prairie-care.com/.

4. Independent Management Services. Chemical Health evaluations are available through Independent Management Services located in Austin, MN. Phone: (507) 437-6389. Website: https://www.imsofmn.com/blank-9.

5. External Resources. General mental health resources are available outside of Mayo Clinic. List of providers are organized by region. As individual providers’ practices change between updates, the current lists may contain outdated information.

• Providers in the Rochester area can be found here.

• Providers in the Austin, Albert Lea, Owatonna area can be found here.

• A global list of local, regional, national, and international providers can be accessed within the Mayo Clinic electronic environment here.

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Other Behavioral and Emotional Concerns

Summary:

The are a wide variety of behavioral and emotional symptoms that children may experience. If the presenting concerns do not fit into one of the specific categories, the family can be referred for evaluation through

1. Treatment in Primary Care. Brief therapy and further evaluation is available within Primary Care through Integrated Behavior Health (IBH).

2. Specialty Care. For families whose child requires specialty evaluation, evaluations are available through the Department of Psychiatry and Psychology. Interested families should talk with their primary care provider or call (507) 266-5100 directly to schedule an appointment.

3. External Resources. General mental health resources are available outside of Mayo Clinic. Providers in the Austin, Albert Lea, Owatonna area can be found here.

4. External Resources. General mental health resources are available outside of Mayo Clinic. List of providers are organized by region. As individual providers’ practices change between updates, the current lists may contain outdated information.

• Providers in the Rochester area can be found here.

• Providers in the Austin, Albert Lea, Owatonna area can be found here.

• A global list of local, regional, national, and international providers can be accessed within the Mayo Clinic electronic environment here.

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