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Hair Pulling / Trichotillomania

While it is common for children, adolescents and even adults to play with their hair, frequent or obsessive hair pulling can lead to serious problems.  When hair pulling becomes severe, the medical term for this is trichotillomania.

People with trichotillomania pull hair on various parts of their bodies, including the scalp, face, arms, legs and pubic areas.  They may not notice the hair pulling until they need to cover up bald patches.  They may try to do this with hair clips, a hat, wig or scarf.  Those with trichotillomania are not able stop pulling their hair.

The most common symptoms of trichotillomania are:

  • Constant hair pulling causing noticeable hair loss that is unrelated to baldness.
  • Pleasure, excitement, or relief when pulling out hair
  • Embarrassment or shame resulting from hair loss
  • Problems at home, school or work

The cause of trichotillomania is unknown and in some individuals it can be damaging and very difficult to control. Hair pulling can occur anytime, but is often worse in stressful situations.

Most children with trichotillomania feel shame, embarrassment or guilt about their hair loss.  In order to avoid these feelings, or even parental punishment, they may try to hide or deny they are pulling their hair.  However, younger children may not notice or be bothered by hair loss. Older children and adolescents may be teased, have low self-esteem, anxiety or depression.

Parents of children with trichotillomania can become frustrated, since it is very difficult to understand that children with this condition can’t simply stop pulling their hair.  Neither parents nor children are to blame for the hair pulling behavior.  Punishing children for pulling their hair is not advised, because it is unlikely to decrease the behavior and can lead to problems with self-esteem.

Frequently used treatments for trichotillomania include:

  • A specialized form of behavior therapy: Cognitive behavioral therapy (CBT).  It involves helping the person recognize thoughts, feelings and behaviors associated with hair pulling.  The goal of this therapy is to increase the awareness of hair pulling and replace it with alternative behaviors
  • Medication therapy is also used to decrease the anxiety, depression and obsessive compulsive symptoms that accompany trichotillomania
  • Family therapies and support groups are also available.

Those with trichotillomania should be evaluated by a trained and qualified mental health professional. Treatment is most effective when it is comprehensive and individualized to the needs of the individual and family.

Learning Disorders

There are many reasons for school failure, but a common one is a specific learning disability. Children with learning disabilities may have normal intelligence, but the specific learning disability can make teachers and parents concerned about the general intelligence of the child. These children often try very hard to follow instructions, concentrate, and “be good” at home and in school.  Yet, despite this effort, he or she is not mastering school tasks and falls behind.  This can lead the child to perceive they are “dumb” and this negative self perception can begin to affect their self esteem.  Since learning disabilities affect at least 1 in 10 schoolchildren it is important that it be detected as soon as possible so that corrections can be made.

Learning Disorders occur when the child or adolescent’s reading, math, or writing skills are much below what is expected for his or her age, schooling, and level of intelligence. About 5% of students in public schools in the United States are identified as having a learning disorder. As previously mentioned, students with learning disorders can become so frustrated with their performance in school that by adolescence they may feel like failures and want to drop out of school.  They can even develop behavioral problems.  To make the diagnosis of a learning disorder and to develop appropriate remedial interventions special testing is always required. Learning disorders should be identified as early as possible during school years.

Learning disabilities are caused by a difficulty with the nervous system that affects the receiving, processing, or communication of information. They can also run in families. Some children with learning disabilities can also be hyperactive; unable to sit still, easily distracted, and have a short attention span.

Child and adolescent psychiatrists are keenly aware that some of the long-range consequence of learning disabilities can be decrease with early intervention.  However, if not detected and treated early, they can have a “snowballing” effect.  For instance, a child who does not learn addition in elementary school cannot understand algebra in high school.  Trying very hard to learn in the face of repeated failure, the child becomes more and more frustrated, and can develop emotional problems such as low self-esteem.  In fact, some learning disabled children misbehave in school because they would rather be seen as “the class clown” than “stupid.”

Frequent signals of learning disabilities that parents should watch for in their child include the following:

  • Difficulty understanding and following instructions.
  • Trouble remembering what someone just told him or her.
  • Fails to master reading, spelling, writing, and/or math skills.
  • Easily loses or misplaces homework, schoolbooks, or other items.
  • Lacks coordination in walking, sports, or small activities such as holding a pencil or tying a shoelace.
  • Difficulty understanding the concept of time; is confused by “yesterday, today, tomorrow.”
  • Difficulty distinguishing right from left; difficulty identifying words or a tendency to reverse letters, words, or numbers; (for example, confusing 25 with 52, “b” with “d,” or “on” with “no”).

An important first step is a comprehensive evaluation by an expert who can assess all of the different issues affecting the child.  This will allow a greater understanding of the child’s learning difficulties and consideration of how they will affect the child’s communication, self help skill, willingness to accept discipline, impact on play, and capacity for independence.

A child and adolescent psychiatrist can help coordinate the evaluation.  This will involve working with school professionals and others to have the evaluation and educational testing done and clarify if a learning disability exists. It will also include talking with the child and family, evaluating their situation, reviewing the educational testing, and consulting with the school. The child and adolescent psychiatrist can then make recommendations on appropriate school placement.  This may include the need for special help such as special educational services, speech-language therapy and helping parents assist their child in maximizing his or her learning potential.

Since parents need to be aware of the delicate balance between providing too much or too little assistance to their child, sometimes individual or family psychotherapy will be recommended. If other problems are present, medication may be prescribed, such as for hyperactivity or distractibility.  The final goal is to strengthen the child’s self-confidence and help parents and other family members better understand and cope with the realities of living with a child with learning disabilities.

Bed-Wetting / Enuresis

Parents often become concerned when their child continues to wet their bed at night past the age of three years old. Since most children begin to stay dry through the night around three years of age their concerns are valid.  However, enuresis (bed-wetting) is a fairly common symptom and not a disease.  Keep in mind that occasional accidents may occur, often when the child is ill.  It is important that parents be understanding, particularly if the child has been able to have a majority of dry nights. These are some facts parents should know about bedwetting:

  • Bedwetting runs in families
  • Usually bedwetting stops by puberty
  • Boys wet their beds more often than girls
  • Most bedwetters do not have emotional problems
  • Approximately 15 percent of children wet the bed after the age of three

In most cases, bedwetting it is due to the development of the child’s bladder control being slower than normal.  Bedwetting may be related to a sleep disorder.  In addition, it can also be the result of the child’s tensions and emotions that require attention.  There are a variety of emotional reasons for bedwetting.  For example, when a young child begins bedwetting after several months or years of dryness during the night (secondary enuresis), this may reflect new fears or insecurities the child is having.  Often, this may follow changes or events which make the child feel insecure.  Such things as:  moving to a new home, parental divorce, losing a family member or loved one, or the arrival of a new baby or child in the home, all can trigger new onset bedwetting.

It is important for parents to remember that children rarely wet on purpose, and usually feel ashamed about the incident.  Rather than make the child feel ashamed, parents need to encourage the child and express confidence that he or she will soon be able to stay dry at night. Parents may help children who wet the bed by:

  • Avoiding punishments
  • Limiting liquids before bedtime
  • Praising the child on dry mornings
  • Waking the child during the night to empty their bladder
  • Encouraging the child to go to the bathroom before bedtime

Treatment for bedwetting in children usually includes behavioral conditioning devices (bell & pad/buzzer) and even medications, if behavioral interventions are unsuccessful.   Sometimes the child may also show symptoms of emotional problems.  When persistent sadness, irritability, or a change in eating or sleeping habits becomes evident, parents may want to talk with a child and adolescent psychiatrist.  He/she will evaluate physical and emotional problems that may be causing the bedwetting, and will work with the child and parents to resolve these problems. Bare in mind that early supportive intervention will help minimize the potential emotional impact of persistent bedwetting on the child.

Reactive Attachment Disorder

What is Reactive Attachment Disorder?

Reactive attachment disorder is a problem with social interaction that occurs when a child’s basic physical and emotional needs are neglected, particularly when the child is an infant.

What Causes Reactive Attachment Disorder?

Reactive Attachment Disorder is caused by the abuse or neglect of an infant’s needs for:  food, physical safety, touching and most importantly the ability to develop an emotional bond with an individual who is entrusted with the emotional care and support of the child (i.e. the Caregiver).  The risk of neglect to the infant or child increases when the:  Caregiver is mentally retarded, Caregiver lacks parenting skills, Parents are isolated, Parents are teenagers.  In addition to this, a frequent change in caregivers (for example, in orphanages or foster care) is another cause of reactive attachment disorder, because the child never gets used to any one individual.  A consistent caregiver is imperative for the formation of a predictable attachment that contributes to a personal sense of security and trust.  Children who are adopted from foreign orphanages are commonly affected, particularly if they were removed from their birth parents during the first weeks of life, or worse at a few months, when bonding with the original caregiver is established and suddenly broken.

What are Symptoms of Reactive Attachment Disorder in a Child?

The symptoms of Reactive Attachment Disorder in a child include:  an avoidance of the caregiver; avoidance of physical contact; difficulty in being physically comforted; does not make distinctions when socializing with strangers; resists social interaction; a desire to be alone.

What are Symptoms of Reactive Attachment Disorder in a Caregiver?

The symptoms of Reactive Attachment Disorder in a caregiver include a disregard for the child’s basic emotional needs for comfort, stimulation, and affection; a disregard for child’s basic physical needs like food, toileting, and play

How is Reactive Attachment Disorder Diagnosed?

The diagnosis of Reactive Attachment Disorder includes a complete history, physical examination and a psychiatric evaluation.  This evaluation will be helpful in developing a treatment plan.

How is Reactive Attachment Disorder Treated?

Reactive Attachment Disorder treatment has two parts.  The first priority is to make sure the child is currently in a safe environment where emotional and physical needs are met.  Once that has been established, the next step is to change the relationship between the caregiver and the child, if the caregiver has caused or contributed to the problem. Parenting skills classes can help with this.  These skills give the caregiver the ability to meet the child’s needs and help them bond with the child.  The caregiver should also have counseling to work on any current problems, such as drug abuse or family violence.  Parents who adopt babies or young children from foreign orphanages should be aware that this condition might occur and be sensitive to the child’s need for consistency, physical affection, and love.  These children may be frightened of people and find physical affection overwhelming at first, and parents should try not to see this as rejection. It is a normal response in someone who has been abused to avoid contact. Hugs should be offered frequently, but not forced.

What Can be Expected from Reactive Attachment Disorder Treatment?

The right intervention can improve the outcome for a child with this condition.  If not treated, this can permanently affect the child’s social interactions.  It can eventually lead to Anxiety, Depression, Post-traumatic Stress Disorder and other psychological problems

How can Reactive Attachment Disorder be Identified?

This disorder is usually identified when a parent (or prospective parent) is at high risk for neglect or when an adoptive parent has difficulty coping with a newly adopted child.  Additionally, if you have recently adopted a child from a foreign orphanage or another situation where neglect may have occurred and your child shows these symptoms, see your health care provider.

How can Reactive Attachment Disorder be Prevented?

Early identification is very important for the child. Parents who are at high risk for neglect should be taught parenting skills.  Either a social worker or doctor should follow the family to make sure the child’s needs are being met.

Obsessive-Compulsive Disorder

What is OCD? 

Obsessive-Compulsive Disorder (OCD), a type of anxiety disorder, is a potentially disabling illness that traps people in endless cycles of repetitive thoughts and behaviors. Obsessive-Compulsive Disorder is characterized by recurrent intense obsessions and/or compulsions that cause severe discomfort and interfere with day-to-day functioning. Obsessions are recurrent and persistent thoughts, impulses, or images that are unwanted and cause marked anxiety or distress. Compulsions are repetitive behaviors or rituals (like hand washing, hoarding, keeping things in order, checking things over and over, asking questions over and over again, etc.) or mental acts (like counting, or repeating words silently). Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts. Most people who have Obsessive-Compulsive Disorder are aware that their obsessions and compulsions are irrational, yet they feel powerless to stop them. These can interfere with a person’s normal routine, schoolwork, job, family, or social activities. Several hours every day may be spent focusing on obsessive thoughts and performing seemingly senseless rituals. Children can suffer from Obsessive-Compulsive Disorder as well. Unlike adults, however, children with Obsessive-Compulsive Disorder do not realize that their obsessions and compulsions are excessive.

What are some of the symptoms of OCD? 

Obsessive symptoms may include:

• Fear of dirt or contamination by germs

• Fear of causing harm to another

• Fear of making a mistake

• Excessive doubt and the need for constant reassurance

• Fear of being embarrassed or behaving in a socially unacceptable manner

• Fear of thinking evil or sinful thoughts

• The need for order, symmetry or exactness.

Compulsive symptoms may include:

• Repeatedly bathing, showering or washing hands

• Refusing to shake hands or touch doorknobs

• Repeatedly checking things, such as locks or stoves

• Constantly counting, mentally or aloud

• Constantly arranging things in a certain way

• Eating foods in a specific order

• Repeating specific words, phrases, or prayers

• Needing to perform tasks a certain number of times

• Collecting or hoarding items with no apparent value.

If people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed (children may insist on sleeping with their parents, even between them for extra protection). People with Obsessive-Compulsive Disorder may also be preoccupied with order and symmetry, have difficulty throwing things out, so they accumulate, or hoard, unneeded items. Healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house. The difference is that people with Obsessive-Compulsive Disorder perform their rituals even though doing so interferes with daily life and they find the repetition distressing. Symptoms may come and go, ease over time, or get worse. If Obsessive-Compulsive Disorder becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with Obsessive-Compulsive Disorder may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. If Obsessive-Compulsive Disorder is left untreated, it may start to interfere with all aspects of life.

What Causes OCD? 

Studies have shown that a combination of biological and environmental factors may be involved. The brain is a very complex structure. It contains billions of nerve cells, called neurons, that must communicate and work together for the body to function normally. The neurons communicate via electrical signals. Special chemicals, called neurotransmitters, help move these electrical messages from neuron to neuron. Research has found a link between low levels of one neurotransmitter, called serotonin, and the development of Obsessive-Compulsive Disorder.  In addition, there is evidence that a serotonin imbalance may be passed on from parents to children. This means the tendency to develop Obsessive-Compulsive Disorder may be inherited, although this doesn’t mean the child will definitely develop symptoms if a parent has the disorder. A child may also develop Obsessive-Compulsive Disorder with no previous family history. There are environmental stressors that can trigger Obsessive-Compulsive Disorder in people such as: abuse, changes in living situation, illness, death of a loved one, work- or school-related changes or problems, and also relationship concerns.  Additionally, some studies also have found a link between a certain type of infection caused by the Streptococcus bacteria and Obsessive-Compulsive Disorder. This infection, if recurrent and untreated, may lead to the development of Obsessive-Compulsive Disorder and other disorders in children or adults.

How Common Is OCD? 

Obsessive-Compulsive Disorder affects about 2.2 million American adults and about 1 million American children. This problem can be accompanied by eating disorders, other anxiety disorders, or depression. It strikes men and women in roughly equal numbers and usually appears in childhood, adolescence, or early adulthood. One-third of adults with Obsessive-Compulsive Disorder developed symptoms as children.

How Is OCD Treated? 

Seeking help from a psychiatrist (or in children a child and adolescent psychiatrist) is important both to better understand the complex issues created by Obsessive-Compulsive Disorder as well as to get help. Most individuals with Obsessive-Compulsive Disorder can be treated effectively with a combination of psychotherapy (cognitive behavior therapy) and certain medications.  These include: Tricyclic antidepressants (i.e. Anafranil), and selective serotonin reuptake inhibitor (SSRI) antidepressants, such as Celexa, Lexapro, Paxil, Prozac and Zoloft. Obsessive-Compulsive Disorder usually responds well to treatment with medications and/or exposure- based psychotherapy.

Exposure-based psychotherapy is when people are faced with situations that cause fear or anxiety and causes them to become less sensitive (desensitized) to them. The goal of these cognitive behavior therapies are to teach people with OCD to confront their fears and reduce anxiety without performing the ritual behaviors. Therapy also focuses on reducing the exaggerated or catastrophic thinking that often occurs in people with Obsessive-Compulsive Disorder. Family support and education are also central to the success of treatment. Antibiotic therapy may be useful in cases where Obsessive-Compulsive Disorder is linked to streptococcal infection.  In very severe cases of Obsessive-Compulsive Disorder and in people who do not respond to medical and behavioral therapy, electroconvulsive therapy (ECT) or psychosurgery may be used to treat Obsessive-Compulsive Disorder.  During ECT, electrodes are attached to the patient’s head, and a series of electric shocks are delivered to the brain, which induce seizures. The seizures then cause the release of neurotransmitters in the brain. Obsessive-Compulsive Disorder will not go away by itself, so it is important to seek some kind of treatment.


What is Depression?

Everyone has moments in their lives where they may feel down, sad or blue.  However, these feelings typically don’t last long and pass within a few days.   When you have depression, these feelings last much longer (at least 2 weeks) and can interfere with sleep, appetite, energy and concentration and thereby affect daily life.  Depression is a common and serious illness, but too often people never seek treatment for it.  They believe it will go away on its own or are ashamed and convinced that it is some sort of personal weakness or defect.  The reality is that most people with depression can get better with treatment, even in cases of severe depression.

What are the Signs and Symptoms of Depression?

Since each person is a unique individual, depression affects people in different ways, but there are some commonly known symptoms that usually indicate a person might be depressed.  These include: persistently feeling sad, numb or empty; loss of interest in previously pleasurable hobbies or activities (including sex); irritability, restlessness; feelings of guilt, worthlessness, or helplessness; feelings of hopelessness or pessimism; insomnia (such as waking up in the middle of the night or the early-morning) or excessive sleeping; overeating, or loss of appetite; decreased energy or fatigue; difficulty concentrating, remembering details, and making decisions; thoughts of suicide, or even suicide attempts.

What Causes Depression?

There are a number of things that can lead to depression, but it is often a combination of biological, environmental, and genetic factors.  Biologically speaking, there are a number of real changes that occur in a depressed human brain.  As a result, brain-imaging technologies, like magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression.  Despite this fact, these images do not reveal why the depression has occurred, nor can they be used to diagnose depression.  However, there are longstanding theories about depression that suggest that on a microscopic level chemical neurotransmitters (what brain cells use to communicate) are out of balance in a depressed brain, which over time leads real structural changes on a macroscopic level.  Environmentally, the loss of a loved one, a difficult relationship, trauma, or any stressful situation can trigger a depressive episode.   Sometimes, though, depressive episodes may occur without an obvious trigger.  As for genetics, some types of depression tend to run in families, who may carry one or more genes for it that have not yet been identified.  Lastly, they can also occur in people without any family history at all.

What are the Different Types of Depression?

Major Depression or Major Depressive Disorder is characterized by a combination of symptoms that interfere with a person’s sleep, appetite, energy and concentration and loss enjoyment for previously pleasurable activities.  There are times when we may feel sad, lonely, or hopeless for a few days and we talk about feeling “depressed.” But Major Depression or clinical depression is disabling and can prevent us from functioning normally. An episode of clinical depression may occur only once in a person’s lifetime, but if left untreated can recur throughout a person’s life.  The reason for this is that each episode of depression is damaging to the brain and increases the likelihood of further episodes.  For a depression to be considered a Major Depression, one of the symptoms must be either a depressed mood or loss of interest in previously pleasurable activities. The symptoms should be present daily or for most of the day or nearly daily for at least two weeks. Also, the depressive symptoms must cause clinically significant distress or impairment in functioning.  They cannot be due to the direct effects of a substance, such as in drug abuse or the result of medications.   They cannot be the result of a medical condition, such as hypothyroidism, nor occur within two months of the loss of a loved one.  However, while Major Depression can be a serious and disabling condition, it can get better with treatment.  This may involve the use of therapy and/or medications.

Persistent Depressive Disorder (previously known as Dysthymic Disorder)Chronic Depression, or Dysthymia are different terms for the same condition.  This is characterized by long-term symptoms that while not severe enough to disable a person, can prevent normal functioning or feeling well.  It results in low, dark moods that invade your life nearly every day for two years or more.  It is a less severe form of depression in that those who suffer from Dysthymia are usually able to function adequately, but might seem consistently unhappy.  People with Dysthymia may also experience one or more episodes of major depression during their lifetimes.

Double Depression is when a Major Depression occurs over an existing Chronic Depression.  Between 3% and 6% of the population is at risk for this, yet many people avoid getting treatment that could save their lives.  What is important to know is that if an episode of depression is treated early enough sometimes brief psychotherapy or medication alone can help.  However, a chronic depression such as a double depression erodes and changes a person’s personality from its original state thereby leading to the need for longer psychotherapeutic treatment in order to restore a person’s personality back to its original state or an improved state.

Depressive Disorder NOS is a term used to describe any kind of depression that doesn’t neatly fit into one of the two categories above, or basically every other kind of depression.  These include: Minor Depression, Psychotic Depression, Postpartum Depression, Seasonal Affective Disorder and Atypical Depression.  Some also consider Manic-Depression to be a kind of depression, but this is another name for Bipolar Disorder, which while also a mood disorder, is more than just a depression.

Minor Depression is characterized by having symptoms for 2 weeks or longer that do not meet full criteria for major depression.  However, people with Minor Depression are at high risk for developing major depressive disorder without treatment.

Psychotic Depression occurs when a person has severe depression to the point that they lose touch with reality and can begin to have hallucinations, delusions or both.   A person with Psychotic Depression may have unusual and disturbing false beliefs (delusions).  Those with Psychotic Depression may hear or see things that others don’t see or hear (hallucinations).

Postpartum Depression is form of depression which is much more serious than the “baby blues”.  As many as 75% of new moms experience the “baby blues” after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming.  However, in some women this can develop into a postpartum depression.  It is estimated that about 10 percent of women experience postpartum depression after giving birth.  This is diagnosed when a new mother develops a major depressive episode within one month after delivery.

Seasonal Affective Disorder (SAD) is characterized by the onset of depression each year at the same time during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer.  Seasonal Affective Disorder (SAD) may be effectively treated with light therapy, but nearly half of those with Seasonal Affective Disorder (SAD) do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce Seasonal Affective Disorder (SAD) symptoms, either alone or in combination with light therapy.

Atypical Depression is a depression that unlike regular depression is not marked by pervasive sadness.  Instead those that suffer from Atypical Depression have overeating, oversleeping, fatigue, extreme sensitivity to rejection and moods that worsen or improve in direct response to events.

Manic-Depression is also known as Bipolar Disorder.  It is not as common as major depression or Dysthymia and characterized by cycling mood changes that go from extreme highs (e.g., mania) to extreme lows (e.g., depression).

How Do Women Experience Depression?

Depression is more common among women than among men.  One reason may be due to the cyclical rise and fall of estrogen and other hormones that affect a woman’s brain chemistry.  This is evident in the fact that some women may develop depressive symptoms associated with the hormonal changes that typically occur around ovulation and before menstruation begins.  This is a severe form of premenstrual syndrome (PMS) called premenstrual dysphoric disorder (PMDD).  Women are also especially vulnerable to developing depression (postpartum depression) after giving birth, when there is a sudden drop in their hormone levels.  Lastly, some women experience an increased risk for depression during the transition into menopause.   There are also life cycle, psychosocial factors and societal expectations that women experience differently and they may be linked to women’s higher depression rate.   Many women face additional stresses of balancing work and home responsibilities, caring for children and aging parents and relationship strains.

How Do Men Experience Depression?

Men and women experience depression differently.   Unlike women who are more likely to have feelings of sadness, worthlessness, and excessive guilt, men are more likely to be very tired, irritable, lose interest in once-pleasurable activities, and have difficulty sleeping. They can also become irritable, angry, frustrated, discouraged, and sometimes abusive.  They are more likely than women to turn to alcohol or drugs when depressed.  Some will spend more time at work to avoid talking about their depression with family or friends, or behave recklessly.

How Do Children Experience Depression?

– Courtesy of the American Academy of Child & Adolescent Psychiatry: Facts for Families

Not only adults become depressed. Children and teenagers also may have depression, as well. The good news is that depression is a treatable illness. Depression is defined as an illness when the feelings of depression persist and interfere with a child or adolescent’s ability to function.  About 5 percent of children and adolescents in the general population suffer from depression at any given point in time. Children under stress, who experience loss, or who have attention, learning, conduct or anxiety disorders are at a higher risk for depression. Depression also tends to run in families. The behavior of depressed children and teenagers may differ from the behavior of depressed adults. Child and adolescent psychiatrists advise parents to be aware of signs of depression in their youngsters.

If one or more of these signs of depression persist, parents should seek help:

  • Frequent sadness, tearfulness, crying
  • Decreased interest in activities; or inability to enjoy previously favorite activities
  • Hopelessness
  • Persistent boredom; low energy
  • Social isolation, poor communication
  • Low self esteem and guilt
  • Extreme sensitivity to rejection or failure
  • Increased irritability, anger, or hostility
  • Difficulty with relationships
  • Frequent complaints of physical illnesses such as headaches and stomachaches
  • Frequent absences from school or poor performance in school
  • Poor concentration
  • A major change in eating and/or sleeping patterns
  • Talk of or efforts to run away from home
  • Thoughts or expressions of suicide or self-destructive behavior

A child who used to play often with friends may now spend most of the time alone and without interests. Things that were once fun, now bring little joy to the depressed child. Children and adolescents who are depressed may say they want to be dead or may talk about suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed adolescents may abuse alcohol or other drugs as a way of trying to feel better.  Children and adolescents who cause trouble at home or at school may also be suffering from depression. Because the youngster may not always seem sad, parents and teachers may not realize that troublesome behavior is a sign of depression. When asked directly, these children can sometimes state they are unhappy or sad. Early diagnosis and treatment are essential for depressed children. Depression is a real illness that requires professional help. Comprehensive treatment often includes both individual and family therapy. For example, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of individual therapy shown to be effective in treating depression. Treatment may also include the use of antidepressant medication. For help, parents should ask their physician to refer them to a qualified mental health professional, who can diagnose and treat depression in children and teenagers.

What are Some Coexisting Conditions that Occur in Depression?

There are a number of things that can cause depression, result from depression or amplify depression.  When this occur the identification and treatment of these other conditions is important because the coexistence of depression with other illnesses compounds them all.  This leads to more severe symptoms, more suffering, greater duration of all coexisting conditions and greater medical costs.  Regardless, co-occurring illnesses need to be diagnosed and treated, in order to improve the overall outcome for the individual.

Depression can occur with many serious medical conditions such as heart disease, stroke, cancer, seizures, HIV/AIDS, diabetes, and Parkinson’s disease.  Sometimes hormone or thyroid problems can lead to depression.  Lack of vitamins and poor nutrition can lead to it as well.  Additionally, many psychiatric conditions that are not adequately treated can lead to depression as the afflicted individual gets more and more worn down.  These include ADHD, Anxiety Disorders (post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, panic disorder, social phobia, and generalized anxiety disorder), movement Disorders, and the list goes on.  Furthermore, people who are suffering may try to self-medicate and end up with a substance abuse problem, though the reverse is also true in that many substance of abuse or dependence (such as alcohol) can in excess lead to depression.

Bipolar Disorder / (Manic-Depression)

What is Bipolar Disorder?

Bipolar Disorder (Manic-Depression) is a brain disorder that causes unusual changes in mood, energy, behavior, and the ability to accomplish daily responsibilities. These symptoms can eventually cause relationships to fall apart, poor performance at school and work, and can even cause suicide. These severe symptoms of bipolar disorder are different than the normal ups and downs that one goes through every now and then. Although bipolar disorder symptoms are severe, it can be treated, and people with this condition can live normal productive lives. Bipolar disorder (Manic-Depression) is a condition that is usually found in adolescence and adults, but the symptoms can begin in young children.  Bipolar disorder is a long-term illness that requires careful treatment through out one’s life.

What are the Symptoms of Bipolar Disorder?

Symptoms for bipolar disorder are a combination of both manic and depressive symptoms. These symptoms will include, severe mood swings (from extreme happiness, silliness, aggressiveness, and anger to frequent crying, sadness, irritability, and depression). Symptoms also include, suicidal thoughts or extreme highs in self-esteem, an unusual increase or decrease in energy, a change in eating or sleeping patterns, and an increase in risky behavior (such as, abusing drugs and alcohol, and participating in reckless driving or sexual promiscuity). Symptoms may also include, being easily distractible, talking very fast, jumping from one idea or thought to the next, and frequent complaining of physical illness. Some people may experience symptoms of both mania and depression at the same time, and this is called a mixed state. At first, these symptoms may not seem abnormal to the affected individual.   However, if not treated, these symptoms can worsen over time and have an effect on their everyday life.

Occasionally, a person with severe symptoms of mania or depression will also have psychotic symptoms. These symptoms will include hallucinations and delusions, and can be misdiagnosed as Schizophrenia. These episodes often reflect the person’s extreme mood. If they are having manic symptoms then they will believe that they are famous, wealthy, and powerful. If they are having depressive symptoms then they will believe they are worthless, ruined, and have committed a crime. In addition to mania and depression, bipolar disorder can also cause a range of moods. These moods include: severe depression, moderate depression, mild low mood, normal or balanced mood, hypomania and severe mania.

How Does Bipolar Disorder Affect Someone Over Time?

Bipolar disorder is a lifetime disorder. Manic and depressive episodes are treatable but the symptoms can always come back. There are 4 basic types of bipolar disorder specified in the Diagnostic and Statistical manual of mental disorders (DSM). The first type is the Bipolar I Disorder, which the person will show manic and mixed state symptoms. Sometimes the manic episodes are so severe the person may need immediate supervision in a hospital or a medical care facility. People with Bipolar I Disorder can also have symptoms of depression. The second type of bipolar disorder is the Bipolar II Disorder. This is a shift between the depressive episodes and symptoms of hypomania, with no symptoms of severe mania or mixed state episodes. The third bipolar disorder from the DSM is called Bipolar Disorder Not Otherwise Specified (BP-NOS), which does not meet the criteria of symptoms for the bipolar I or II disorder, but still shows an abnormal range of behavior. The final bipolar disorder is called Cyclothymic Disorder, or Cyclothymia. This disorder is a shift between hypomania and mild depression, with no other symptoms of the other types of bipolar disorder.

Some people may also be diagnosed with rapid-cycling bipolar disorder, which is when four or more episodes of each symptom occur within a year. This disorder usually occurs more in women, and in people with severe bipolar disorder. With out treatment, this disorder can worsen and can increase the frequency and severity of episodes. With proper treatment, people can live a healthy full life.

What Illnesses Often Co-Exist with Bipolar Disorder?

A number of other illnesses can occur with Bipolar Disorder and having these can make it difficult to diagnose and treat bipolar disorder.   ADHD can occur with Bipolar Disorder and given that several symptoms of ADHD, are also common to Bipolar Disorder the likelihood of a misdiagnosis or the wrong diagnosis is high.  So while increase energy, distractibility, and pressured speech commonly occur in ADHD and Bipolar Disorder, irritability, grandiosity, racing thoughts, decrease need for sleep, euphoria/elation, poor judgment, flight of ideas and hyper sexuality generally occur only with bipolar disorder.  This is important to know, because some of the treatments for ADHD can worsen or bring out symptoms of Bipolar Disorder.  In children, a condition called Oppositional Defiant Disorder can occur along with Bipolar Disorder and lead to problems with authority figures, verbal hostility, defiance, temper tantrums and non-compliance.  Sleep problems can occur in Bipolar Disorder, where people often have a decreased need for sleep or go without it completely.  Certain seizures in an area of the brain called the temporal lobe can produce symptoms that can be confused with Bipolar Disorder, but can occur independently of Bipolar Disorder.   Fortunately many of the same medicine used to treat seizures also treat Bipolar Disorder.  Bipolar Disorder can occur with Obsessive Compulsive Disorder (OCD) and other Anxiety Disorders (Generalized Anxiety, Separation Anxiety, Panic Disorder, PTSD, etc).  This is important to find out for several reasons.  Many of the medications used to treat OCD and anxiety, such as the antidepressants, can worsen symptoms of Bipolar Disorder.  Substance abuse or dependence can be a common problem as well.  Often, people treat their symptoms with alcohol or drugs without realizing that this can trigger their symptoms, and cause them to worsen. People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.

Is Bipolar Disorder Genetic?

Advances in technology are helping genetic research on bipolar disorder. Studies do show that bipolar disorder tends to run in families, but that is not always the case. Children that have bipolar disorder in their family are 4 to 6 times more likely to develop the disorder, then children who do not. So far the advances in technology help launch the Bipolar Disorder Phenome Database, funded in part by NIMH. With this database, scientists will be able to link visible signs of the disorder with the genes that may influence them. Genes are contained inside people’s cells that are passed down from parents to children. They help control how the body and brain work and grow.   However, not everyone who carries the gene for Bipolar Disorder will develop it.  In fact, studies on identical twins (who share identical genes) have found one affected and one non-affected twin.  The reason for this is environment.  Many of us carry identical copies of genes, but these remain in a default “off” position.  However, under the right environmental stress they can “turn on” and then the individual develops Bipolar Disorder.  Once on they cannot be shut off again, but treatment can often result in such success with the individual’s symptoms that it is like fully “dimming” a light, rather than shutting it “off”.

How Is Bipolar Disorder Diagnosed and Treated?

The most important thing is to get help from a medical doctor, such as a psychiatrist.  He or she may conduct an interview, physical examination, and lab tests. Bipolar disorder cannot be detected through a blood test or brain scan, but this can eliminate other causes of unusual mood changes,  such as a stroke or brain tumor. The doctor may conduct a mental health evaluation or refer the person to a mental health professional, such as a psychiatrist.  A psychiatrist is trained and experienced with diagnosing and treating mood disorders, such as bipolar disorder. The psychiatrist will begin by asking questions about any family history of mental illnesses. Then he or she will continue by getting a complete history of symptoms. Input from family and friends should also be included in the medical history. People with bipolar disorder tend to seek help when they are experiencing depressive symptoms. As a result, this can be mistaken to be major depressive disorder also known as unipolar disorder, which is bipolar with out the manic symptoms. That is why family members are asked to give a brief description of the person’s symptoms. To treat this disorder, medication is given to gain better control of their mood swings and related symptoms. There is no actual cure for bipolar disorder, since it is a lifelong illness, but an effective maintenance treatment plan including medication and psychotherapy can help control symptoms. Several different medications may need to be tried before the best course of treatment is found, since not everyone responds to medications in the same way.

Autism Spectrum Disorders

The autism spectrum disorders can often be reliably detected by the age of 3 years, and in some cases as early as 18 months. Studies suggest that many children eventually may be accurately identified by the age of 1 year or even younger. The appearance of any of the warning signs of ASD is reason to have a child evaluated by a professional specializing in these disorders. The autism spectrum disorders, or pervasive developmental disorders, range from a severe form, called autistic disorder, to a milder form, Asperger’s syndrome.

What is autism? 

Most infants and young children are very social creatures who need and want contact with others to thrive and grow. They smile, cuddle, laugh, and respond eagerly to games like “peek-a-boo” or hide-and-seek. Occasionally, however, a child does not interact in this expected manner. Instead, the child seems to exist in his or her own world, a place characterized by repetitive routines, odd and peculiar behaviors, problems in communication, and a total lack of social awareness or interest in others. These are characteristics of a developmental disorder called autism.

The severity of autism varies widely, from mild to severe. Some children are very bright and do well in school, although they have problems with school adjustment. They may be able to live independently when they grow up. Other children with autism function at a much lower level. Mental retardation is commonly associated with autism. Occasionally, a child with autism may display an extraordinary talent in art, music, or another specific area.

What are the symptoms of autism?

Some of the early signs and symptoms, which suggest a young child may need further evaluation for autism, include:

  • No smiling by six months of age
  • No back and forth sharing of sounds, smiles or facial expressions by nine months
  • No babbling, pointing, reaching or waving by 12 months
  • No single words by 16 months
  • No two word phrases by 24 months
  • Regression in development
  • Any loss of speech, babbling or social skills

Symptoms almost always start before a child is 3 years old. Usually, parents first notice that their toddler has not started talking yet and is not acting like other children the same age. But it is not unusual for a child to start to talk at the same time as other children the same age, then lose his or her language skills. Symptoms of autism include:

  • A delay in learning to talk, or not talking at all. A child may seem to be deaf, even though hearing tests are normal.
  • Repeated and overused types of behavior, interests, and play. Examples include repeated body rocking, unusual attachments to objects, and getting very upset when routines change.

How is autism diagnosed?

There are guidelines your doctor will use to see if your child has symptoms of autism. The guidelines put symptoms into three categories:

  • Social interactions and relationships. For example, a child may have trouble making eye contact. People with autism may have a hard time understanding someone else’s feelings, such as pain or sadness.
  • Verbal and nonverbal communication. For example, a child may never speak. Or he or she may often repeat a certain phrase over and over.
  • Limited interests in activities or play. For example, younger children often focus on parts of toys rather than playing with the whole toy. Older children and adults may be fascinated by certain topics, like trading cards or license plates.

How is autism treated?

Treatment for autism involves special behavioral training. Behavioral training rewards good behavior (positive reinforcement) to teach children social skills and to teach them how to communicate and how to help themselves, as they grow older. With early treatment, most children with autism learn to relate better to others. They learn to communicate and to help themselves, as they grow older. Depending on the child, treatment may also include such things as speech therapy or physical therapy. Medicine is sometimes used to treat problems such as depression or obsessive-compulsive behaviors.

Take advantage of every kind of help you can find. Talk to your doctor about what help is available where you live. Family, friends, public agencies, and autism organizations are all possible resources.

Remember these tips:

  • Plan breaks. Daily demands of caring for a child with autism can take their toll. Planned breaks will help the whole family.
  • Get extra help when your child gets older. The teen years can be a very hard time for children with autism.
  • Get in touch with other families who have children with autism. You can talk about your problems and share advice with people who will understand.

Raising a child with autism is hard work. But with support and training, your family can learn how to cope.

Attention-Deficit Hyperactivity Disorder (ADHD) & ADD

What is Attention-Deficit Hyperactivity Disorder (ADHD)?

Attention-Deficit Hyperactivity Disorder (ADHD) is an often-misunderstood condition, which is not only over diagnosed, but under diagnosed as well.  While Attention deficit hyperactivity disorder (ADHD) is one of the most common mental health disorders of childhood, ADHD is not just a childhood disorder.  The symptoms affect children, teens, and adults.  Recent national surveys have documented an increase in the prevalence of Attention-Deficit Hyperactivity Disorder (ADHD) during the past decade.  In fact, according to the Centers for Disease Control and Prevention (more simply known as the CDC), it is estimated that in the United States alone approximately 8 percent of children ages 3-17 years have ever been diagnosed with ADHD.  This includes 11 percent of boys’ ages 3-17 years old and nearly 6 percent of girls’ ages 3-17 years old.  This stunning fact means that around 5 million children from the ages of 3-17 years old have been diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD) in the United States.  In childhood, ADHD is more common in boys than girls by a ratio of 3 to 1, but by adulthood this ratio seems to even out.  The symptoms of Attention-Deficit Hyperactivity Disorder (ADHD) include inattention, impulsivity and hyperactivity.  Nearly everyone shows some of these behaviors at times, but ADHD lasts more than 6 months and in affected individuals these symptoms frequently lead to problems in several areas of a person’s life.  These include academic, school, occupation, family, home, relationships and social settings.  They begin in childhood and often persist into adulthood. The specific causes and risk factors for Attention-Deficit Hyperactivity Disorder (ADHD) are unknown, but genetic factors do play a large role.  The appropriate diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD) should involve several steps, including a medical exam; a checklist for rating Attention-Deficit Hyperactivity Disorder (ADHD) symptoms based on reports from parents, teachers, and sometimes the child; and an evaluation for coexisting conditions.

Why is Attention-Deficit Hyperactivity Disorder (ADHD) Over Diagnosed?

There are a number of conditions or problems that can mimic the distractibility, impulsivity and hyperactivity usually associated with ADHD.  For instance, while a lack of focus (distractibility) is considered by many to be suggestive of ADHD there are actually two things that must be present for one to focus:  Attention and Concentration.  Attention problems may certainly be the result of ADHD, but certain kinds of Seizures can affect this as well.  The second is concentration.  There are a number of things that if present can cause problems with concentration and lead someone to be diagnosed with ADHD, when the real problem is something else.  Depression, Anxiety, OCD, Tourette’s Disorder, Poor Nutrition, High Levels of Lead in the Blood and Poor Sleep can all lead to a decrease in concentration, which would then cause focusing problems.  Impulsivity and hyperactivity can also occur with Anxiety, Tourette’s Disorder, Poor Sleep, Poor Nutrition (such as Foods with Sugar, Food Additives, and Dyes) and Bipolar Disorder.  Additionally, the level of acceptable hyperactivity varies depending on ones age.  So while one could expect a 5 year old to be running around a fountain at a public park, we wouldn’t expect it from a 15 year old.

Why is Attention-Deficit Hyperactivity Disorder (ADHD) Under Diagnosed?

Some critics of ADHD allege that children with problematic behavior are often diagnosed with ADHD when the behavior may result from other causes.  These critics are correct and this underscores the need to have individuals evaluated correctly.  Other critics state that some children diagnosed with ADHD, or labeled ADHD by parents or teachers, are normal but do not behave in the way that responsible adults want them to behave.  This too is important, given that parents often see kids as a reflection of themselves or are afraid of how others may view them.  As a result, they can be overly critical of normal childhood behavior due to fear of embarrassment or being wrongly judged.

Does Attention-Deficit Hyperactivity Disorder (ADHD) Occur in Adults ?

It is now known that in 60% of children ADHD symptoms can continue into adulthood.   That amounts to 4% of the US adult population, or roughly 8 – 10 million adults. However, few adults are identified or treated for adult ADHD.   Additionally, while ADHD affects males at a higher rate than females in childhood, this ratio seems to even out by adulthood.  Adults with ADHD may have trouble in a number of areas that can cause associated behavioral, emotional, social, occupational and academic problems.  These include chronic lateness, forgetfulness, problems concentrating and following directions.  They also include problems organizing tasks and completing work within time limits.   Furthermore, they can result in impulsiveness, low frustration tolerance, and chronic feelings of boredom, difficulty controlling anger and more.  These behaviors can be mild to severe and can vary with the situation or be present all of the time.   For instance, some adults with ADHD can be withdrawn and antisocial, or they can be overly social and unable to be alone.  Some are able to concentrate if they are interested in or excited about what they are doing (such as something that gives their brain a “Wow”). Others may have difficulty focusing under any circumstances.  Some will look for stimulation, but others avoid it.  Adults with ADHD are more likely to have had a history of poor educational performance, been underachievers in school, had more frequent school disciplinary actions, repeated a grade or dropped out of school.  As a result of all these challenges, they can end up with anxiety, mood swings, depression, substance abuse or addiction, low self-esteem and relationship problems.  Adults with ADHD are more likely to smoke cigarettes, have driving violations such as: be cited for speeding; have their licenses suspended; be involved in more crashes; rate themselves and others as using poorer driving habits.  They may have a lower socioeconomic status, and use illegal substances more frequently.

How Does Attention-Deficit Hyperactivity Disorder (ADHD) Affect Teenagers?

Incredibly, ADHD teens can have about four times the amount of traffic citations, four times as many car wrecks and are seven times more likely to be involved in a second car accident as non-ADHD teens.  In school they can have problems with authority figures, exhibit verbal hostility, defiance and non-compliance.   As teenagers 21% repeatedly skip school, 30% fail subjects and repeat a year of school, 35% get suspended and 35% drop out of school. It is important to diagnose and treat ADHD in teens with some form of child psychiatry.

Is Attention-Deficit Hyperactivity Disorder (ADHD) Genetic?

There is strong evidence that genetics plays a role in the risk of getting ADHD. In fact, a study conducted in 2009 concluded that genetics account for about 75 percent of the risk.  Additionally, it runs in families, to the point that 40% of ADHD children have at least one parent with ADHD.   Specific studies have found that kids with ADHD were more likely to have small parts of their DNA that were duplicates or missing.  These deletion or duplication of genetic material is called copy number variants or CNVs.  However, this research did not conclude that ADHD is entirely genetically based.  In fact, human development includes both genetic origins of behavior and the direct influence that environmental forces have on the expression of those genes (nature vs. nurture).  Simply put, how our genes express themselves is greatly impacted by our environment.  This is important because increased environmental stress can, in effect, turn ON genes that were previously in the OFF position.  Presently, once these genes are turned ON and ADHD is expressed (present in the individual) the genes cannot be turned OFF.  However, while there is no cure for it, treatments can in effect “dim the lights” to the point that someone can appear as if they don’t have ADHD, provided they continue with treatment.

How Does Attention-Deficit Hyperactivity Disorder (ADHD) Lead to Academic or School Impairment?

It is estimated that in a classroom of 30 students there are about 1 to 3 children with ADHD.  65% of ADHD children have problems with authority figures, exhibit verbal hostility, defiance, temper tantrums and non-compliance. About 25% of ADHD students have additional learning problems that can be serious. These include problems with listening skills, oral expression, reading comprehension and mathematics.  50% of ADHD students have problems with listening comprehension.  33% of ADHD students have language deficits, poor organizational skills, poor fine motor skills and poor memory.  ADHD children are three times more likely to have problems with expressive language.  As teenagers 21% repeatedly skip school, 30% fail subjects and repeat a year of school, 35% get suspended and 35% drop out of school.  Adults with ADHD are more likely to have had a history of poor educational performance, been underachievers in school, had more frequent school disciplinary actions, repeated a grade or dropped out of school.   Some people have misconceptions about ADHD, such as that those with ADHD are lazy or dumb.  The truth is that anyone of any level of intelligence can have ADHD and the higher one’s intelligence the longer they can go without being detected.  The reason for this is that when someone has the distractibility that comes with ADHD, but is highly intelligent, they can afford to miss information and still get by.  However, as the difficulty of subjects increases with advancing years, this becomes more difficult and people can no longer simply “wing it” by not fully listening in class or preparing for exams.  This is why many adults escape detection until college, graduate school, law or medical school.  Another misconception is that medicine for ADHD can make you smart.  The reality is that it just gives you back your own brain so you can use it.  People with the distractibility of ADHD are often unable to read something in spite of deciding they NEED to read it.  They find themselves thinking or daydreaming of other things as they are reading, to the point that they get to the end of a page and realize they don’t know what they just read.  Medicines do help with this tremendously and dramatically to the point people often feel as if someone turned on a light in their brain.

How Does Attention-Deficit Hyperactivity Disorder (ADHD) Lead to Occupational Impairment?

Adults with ADHD are more likely to have problems organizing tasks, completing work within time limits, forgetfulness, and problems concentrating and following directions.  This leads to fewer occupational achievements, promotions, etc.  Due to impulsiveness, low frustration tolerance, and difficulty controlling anger, they have a difficult time interacting with their peers and managing others.  They may also be chronically late and procrastinate a lot.  As a result they change employers frequently and perform poorly.

How Does Attention-Deficit Hyperactivity Disorder (ADHD) Lead to Family, Home or Relationship Impairment?

Due to impulsiveness, low frustration tolerance, and difficulty controlling anger, parents with an ADHD child are three times as likely to separate or divorce as parents who don’t have an ADHD child.   Adults with ADHD are more likely to have more marital problems and multiple marriages.  They also have a higher incidence of separation and divorce.  However, most of these problems that are related to ADHD can improve with appropriate treatment.

How Does Attention-Deficit Hyperactivity Disorder (ADHD) Lead to Social Impairment?

In childhood the rate of emotional development for a person with ADHD can be 30% slower than the emotional development of a similar person without ADHD.  Therefore, a 10-year-old child with ADHD operates at a 7-year-old maturity level.  Also ADHD children are three times more likely to have problems with expressive language, making communication with peers a challenge.  The impulsiveness, low frustration tolerance, and difficulty controlling anger that can be present in ADHD, make establishing and maintaining friendships more difficult.  Children often want to at least take turns and get tired of someone who always has to play their way.  Adults too cannot deal well with people who get angry and easily upset all the time.

Does Medicine for Attention-Deficit Hyperactivity Disorder (ADHD) Make You Smart?

Some people have misconceptions about ADHD, such as that those with ADHD are lazy or dumb.  The truth is that anyone of any level of intelligence can have ADHD and the higher one’s intelligence the longer they can go without being detected, despite being distractible.  The reason for this is that when someone has the distractibility that comes with ADHD, but is highly intelligent, they can afford to miss information and still get by.  However, as the difficulty of the subject increases with advancing years, this becomes more difficult and people can no longer simply “wing it” by not fully listening in class or preparing for exams.  This is why many adults escape detection until college, graduate school, law or medical school.  Another misconception is that medicine for ADHD can make you smart.  The reality is that it just gives you back your own brain so you can use it.  People with the distractibility of ADHD are often unable to read something in spite of deciding they need to read it.  They find themselves thinking or daydreaming of other things as they are reading, to the point that they get to the end of a page and realize they don’t know what they just read.  Medicines do help with this tremendously and dramatically to the point people often feel as if someone turned on a light in their brain.

How Do You Diagnose Attention-Deficit Hyperactivity Disorder (ADHD)?

The appropriate diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD) should involve several steps, including a medical exam; a checklist for rating Attention-Deficit Hyperactivity Disorder (ADHD) symptoms based on reports from parents, teachers, and sometimes the child; and an evaluation for coexisting conditions.

What Are There Different Types of Attention-Deficit Hyperactivity Disorder (ADHD)?

Attention-Deficit Hyperactivity Disorder, Primarily Inattentive Type – ADD

The general public tends to refer to this as simply ADD, because of the lack of the hyperactivity (the H), but in reality it is also a form of ADHD.  The reason for this is that while the majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, hyperactivity-impulsivity may still be present to some degree.  Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.  Children who have symptoms of inattention may:  be easily distracted, miss details, forget things, start but not finish things and frequently switch from one activity to another.  They may have difficulty focusing on one thing; become bored with a task after only a few minutes, unless they are doing something enjoyable; have difficulty focusing attention on organizing and completing a task or learning something new; have trouble completing or turning in homework assignments; often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities; seem not to listen when spoken to directly; daydream, become easily confused, and move slowly; have difficulty processing information as quickly and accurately as others; struggle to follow instructions.

Attention-Deficit Hyperactivity Disorder, primarily Hyperactive-Impulsive Type

In this subtype, most symptoms (six or more) are in the hyperactivity-impulsivity categories.  Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.  Children who have symptoms of hyperactivity may:  fidget and squirm in their seats, talk nonstop, run around, touch or play with anything and everything in sight, have trouble sitting still (such as during dinner, school, and story time), be constantly in motion, have difficulty doing quiet tasks or activities.  Children who have symptoms of impulsivity may: be very impatient, blurt out inappropriate comments, often interrupt conversations or others’ activities, show their emotions without restraint, act without regard for consequences, have difficulty waiting for things they want or waiting their turns in games, etc.

Attention-Deficit Hyperactivity Disorder (ADHD), Combined Type

Most children have the combined type of ADHD.  It includes the presence of six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity.

What Does a MEDICAL Exam for Attention-Deficit Hyperactivity Disorder (ADHD) Involve?

Unfortunately, no single test can diagnose a person as having ADHD.  Instead, a licensed medical health professional (such as a Medical Doctor who completed a 4 year medical school and a further 3-6 years of Residency Training) needs to gather information about the person, and his or her behavior and environment.  This is important because there are a number of MEDICAL causes and conditions that can appear like ADHD.  A mother’s pregnancy history can increase the risk for ADHD, such as the use of cigarettes, alcohol, or other drugs during pregnancy.  In addition, preschoolers who are exposed to high levels of lead may have a higher risk of developing ADHD.  Lead is a danger for them because it can sometimes be found in plumbing fixtures, well water, and old building paints and in some older Chinese made toys.  Individuals who have suffered a traumatic brain injury may show some behaviors similar to those of ADHD.  Those with undetected seizures could appear hyperactive, impulsive and/or inattentive.  A middle ear infection or any undetected hearing or vision problems can cause someone to “miss” things and appear inattentive.  Learning disabilities can do this as well.   Anxiety or depression, or other psychiatric problems can lead to ADHD-like symptoms, because they affect a person’s concentration and subsequently will decrease their focus.  Environmental changes and stressors can cause this too.  Things such as a significant or sudden change in the individual’s life (death of a family member or friend, a divorce, a parent’s job loss, school stress/bullying, new school, new home, new town, new country) can seriously impact a person’s ability to concentrate and focus.  This is why a specialist will often review school and medical records for clues, to see if the child’s home or school settings appear unusually stressful or disrupted, and gather information from the child’s parents and teachers.  Babysitters, coaches, and other adults who know the child well also may be consulted.  Some families may want to first talk with the child’s pediatrician. Some pediatricians can assess the child themselves, but many will refer the family to a Child Psychiatrist with experience in childhood mental health challenges such as ADHD. The pediatrician, or preferably a medical health professional that specializes in mental health challenges (Child Psychiatrist or Psychiatrist) will first try to rule out other possibilities for the symptoms.  A specialist will investigate whether the behaviors are excessive and long-term, and do they affect all aspects of the person’s life?  Do they happen more often in this person or child compared with the person or child’s peers?  Are the behaviors a continuous problem or a response to a temporary situation?  Do the behaviors occur in several settings or only in one place, such as the playground, classroom, home or work?  The specialist will pay close attention to the individual’s behavior during different situations.  Some situations are highly structured, but some have less structure. Others would require the person to keep paying attention. Most children with ADHD are better able to control their behaviors in situations where they are getting individual attention and when they are free to focus on enjoyable activities. The same is true of adults. These types of situations are less important in the assessment.  A child also may be evaluated to see how he or she acts in social situations, and may be given tests of intellectual ability and academic achievement to see if he or she has a learning disability.  Finally, if after gathering all this information the child meets the criteria for ADHD, he or she will be diagnosed with the disorder.

Attention-Deficit Hyperactivity Disorder (ADHD) Checklists for Rating ADHD Symptoms – new content coming soon

What are Some Coexisting Conditions that Occur in Attention-Deficit Hyperactivity Disorder (ADHD)?

65% of ADHD children have problems with authority figures, and exhibit verbal hostility, defiance, temper tantrums and non-compliance and many are diagnosed with Oppositional Defiant Disorder.  50% of ADHD children also have sleep problems.   These can range from poor sleep habits, restlessness in bed, sleep apnea, sleepwalking and Enuresis (bedwetting).   Many parents believe that foods with sugar, food additives, and dyes make their children more hyperactive.  However, while this may be true, these foods have not been shown to cause ADHD.  There is also a relationship between high levels of lead in the blood and distractibility.  But again, this doesn’t cause ADHD and the treatment involves getting rid of the extra lead in the body.  Sometimes individuals with certain types of seizures (i.e. Absence Seizures) can appear to have the distractibility of ADHD as they are seen to be “starring into space”.  While this is easily treated with medication once identified, its identification is imperative, as many of the medications used to treat ADHD can make this problem worse.  ADHD can also occur with and or lead to a Depression if it remains untreated for a long time.  The reason for this may not just be genetics, but an environment of failure across several areas of an individual’s life that eventually erode their self-esteem and lead to depression.  ADHD can occur with Obsessive Compulsive Disorder (OCD) and other Anxiety Disorders (Generalized Anxiety, Separation Anxiety, Panic Disorder, PTSD, etc).  This is important to find out for several reasons.  Some of the medications used to treat ADHD can make OCD and or Anxiety worse.  Additionally, having OCD or Anxiety affect concentration and focus and lead some to mistake them for the inattentive features of ADHD.  Tourette’s Disorder, is also common and can co-occur with ADHD.  It can cause repetitive involuntary movements of the eyes, nose, mouth, face, neck, head, arms, hands, etc. and vocal sounds such as throat clearing, coughing, clicking, grunting or sneezing sounds.  Often many of the symptoms of Tourette’s Disorder can be confused for those of ADHD and are only identified by the characteristic movements these individuals have, that only those trained to identify them can detect.  Additionally, these symptoms can be made worse by many of the very same medications used to treat ADHD and require special planning and management when treating with medications.  ADHD can also occur with Bipolar Disorder and given that several symptoms of ADHD, in childhood are also common to Bipolar Disorder the likelihood of a misdiagnosis or the wrong diagnosis is high.  So while increase energy, distractibility, and pressured speech commonly occur in ADHD and Bipolar Disorder, irritability, grandiosity, racing thoughts, decrease need for sleep, euphoria/elation, poor judgment, flight of ideas and hyper sexuality generally occur only with bipolar disorder.  This too is important to know, because some of the treatments for ADHD can worsen or bring out symptoms of Bipolar Disorder.

Attention-Deficit Hyperactivity Disorder (ADHD) Treatment

Attention-Deficit Hyperactivity Disorder (ADHD) Treatment often includes medicines to control symptoms. But some form of child psychiatry is imperative for children and teens who are dealing with ADHD. For example, structure at home and at school is also important. Parenting classes or behavioral therapy may also help.  – new content coming soon

Asperger’s Disorder – a milder form of an Autism Spectrum Disorder

What is Asperger’s syndrome?

Asperger’s syndrome is a former term for what is now considered a milder form of an Autism Spectrum Disorder.  Those affected individuals may not have any intellectual impairment, nor any language impairment.  This disorder makes it very hard to interact with other people. Your child may find it hard to make friends because he or she is socially awkward. People with Asperger’s Disorder – a milder form of an Autism Spectrum Disorder have some traits of autism. For example, they may have poor social skills, prefer routine, and not like change. But unlike those who have more severe autism, children with Asperger’s Disorder – a milder form of an Autism Spectrum Disorder usually start to talk before 2 years of age, when speech normally starts to develop. Asperger’s Disorder – a milder form of an Autism Spectrum Disorder is a lifelong condition, but symptoms tend to improve over time. Adults with this condition can learn to understand their own strengths and weaknesses. And they can improve their social skills.

What are the symptoms of Asperger’s Disorder – a milder form of an Autism Spectrum Disorder?

Asperger’s Disorder – a milder form of an Autism Spectrum Disorder is usually noticed at age 3 or later. Symptoms vary, so no two children are the same. Children with Asperger’s Disorder – a milder form of an Autism Spectrum Disorder:

  • Have a very hard time relating to others. It doesn’t mean that they avoid social contact. But they lack instincts and skills to help them express their thoughts and feelings and notice others’ feelings.
  • Like fixed routines. Change is hard for them.
  • May not recognize verbal and nonverbal cues or understand social norms. For example, they may stare at others, not make eye contact, or not know what personal space means.
  • May have speech that’s flat and hard to understand because it lacks tone, pitch, and accent. Or they may have a formal style of speaking that’s advanced for their age.
  • May lack coordination; have unusual facial expressions, body postures, and
  • May have poor handwriting or have trouble with other motor skills, such as riding a bike.
  • May have only one or a few interests, or they may focus intensely on a few things. For instance, they may show an unusual interest in snakes or star names or may draw very detailed pictures.
  • May be bothered by loud noises, lights, or strong tastes or textures.

How is Asperger’s Disorder – a milder form of an Autism Spectrum Disorder diagnosed and treated?

The doctor may refer you to a specialist to confirm or rule out Asperger’s Disorder – a milder form of an Autism Spectrum Disorder. The specialist may test your child’s learning style, speech and language, IQ, social and motor skills, and more.

Treatment is based on your child’s unique symptoms. It may change often so that it’s most useful for your child. Doctors, teachers, and mental health counselors can help your child improve his or her behavior and build social and learning skills. School programs, job training, and counseling can help too. Many children with Asperger’s Disorder – a milder form of an Autism Spectrum Disorder also have other conditions, such as ADHD or obsessive-compulsive disorder. So they may need other treatments, such as medicine. 

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