Children and adolescents: bullying, abuse, school problems and self-harm

AI-narrated overview made with Google NotebookLM. The written lesson below is by Dr. Andrew Wichterman.

The blueprint names bullying, and child and adolescent presentations appear throughout the clinical focus items. This lesson covers what the exam asks about young clients: the common problems, the mandated-report line, and the counselor's role with parents and schools.

Working with minors

A minor client comes with a legal guardian who consents to treatment and has a right to information; the minor gives assent, and the counselor negotiates at the start what will and will not be shared with parents, typically general themes and any safety concern, not session content. State law sets exceptions where minors can consent alone: substance use treatment, reproductive health, and in some states outpatient mental health at a set age. Developmental level shapes the work: play therapy and expressive methods for young children, activity and skill-based approaches for school age, and a more collaborative talk-based approach for adolescents, who are acutely sensitive to autonomy and confidentiality. Parents are part of the treatment, not an obstacle to it, and behavioral parent training is the evidence base for most childhood behavior problems.

Bullying

Bullying is repeated aggressive behavior with an imbalance of power; it can be physical, verbal, relational, spreading rumors and exclusion, or electronic. Cyberbullying follows the child home and has no bystanders to intervene. Victims show anxiety, somatic complaints, school avoidance, declining grades and depression; a subset become bully-victims, who fare worst. Bullies are more likely to have conduct problems and later legal involvement. The evidence favors whole-school programs that change the climate, Olweus is the model, over programs that treat bullying as a conflict between two individuals; peer mediation is not recommended for bullying because of the power imbalance. The counselor assesses safety, works with the school, builds the victim's support network and coping, and addresses the bully's behavior and its causes without labeling the child.

Abuse, neglect and mandated reporting

Every state requires counselors to report reasonable suspicion of child abuse or neglect; suspicion, not proof, is the threshold, and the report goes to child protective services or law enforcement, usually within twenty-four to seventy-two hours. Physical abuse signs include injuries inconsistent with the explanation, injuries in various stages of healing, and fear of going home. Sexual abuse signs include sexual knowledge or behavior beyond the child's age, regression, and physical symptoms; disclosure is often delayed and partial and is believed. Neglect, the most common form, shows as poor hygiene, hunger, unmet medical needs and lack of supervision. Emotional abuse is harder to see and is reported when it meets the state definition. The counselor does not investigate, does not confront the suspected abuser, and does not promise the child secrecy. Reporting in good faith is immune from liability; failing to report is a crime and an ethics violation. Adverse childhood experiences, the ACE study, link abuse and household dysfunction to adult health outcomes in a dose-response pattern.

School problems and disruptive behavior

School refusal is anxiety-based avoidance, distinct from truancy, which is concealed from parents and not anxious; treatment is graded return, not extended homebound instruction. Oppositional defiant disorder is a six-month pattern of angry mood, argumentative and defiant behavior, or vindictiveness. Conduct disorder is a repetitive pattern violating others' rights or major norms, aggression to people and animals, destruction, deceit or theft, serious rule violations, with childhood-onset and adolescent-onset types and a limited-prosocial-emotions specifier; childhood onset carries the worse prognosis. Intermittent explosive disorder is impulsive aggression out of proportion to provocation. Multisystemic therapy, functional family therapy and parent management training are the evidence-based treatments for serious conduct problems. Section 504 plans and IEPs under IDEA are the school accommodations the counselor should know, and the school counselor's role is consultation and advocacy, not long-term therapy.

Self-harm and adolescent suicide

Nonsuicidal self-injury, cutting, burning and hitting oneself without suicidal intent, is common in adolescence and functions to regulate emotion, punish the self or communicate distress; it is assessed directly, without alarm, and distinguished from suicidal behavior, though it raises suicide risk. Suicide is a leading cause of death for ages ten to twenty-four, and risk factors include a prior attempt, depression, substance use, LGBTQ identity in a rejecting environment, bullying, family conflict, access to firearms and contagion after a peer's death. Warning signs are talking about death, giving away possessions, withdrawal, sudden calm after despair, and researching means. The counselor asks directly, involves parents in means restriction and safety planning, and coordinates with the school after a death to prevent contagion, following postvention guidelines that avoid glamorizing the death. Dialectical behavior therapy for adolescents has the best evidence for repeated self-harm.