The Importance of Correct Diagnosis: ADHD

Correctly diagnosing psychological disorders is of course of paramount importance for any Clinical Psychologist who hopes to be effective. This statement may be no more true than in the case of ADHD.

ADHD is one of the most OVERDIAGNOSED disorders in the field of mental health and medicine in general. In the past 15 years, much publicity has been given to this disorder creating a situation where kids, parents, teachers, and doctors not trained to diagnose psychiatric disorders have begun to throw the title of ADHD around liberally. I’ve even heard kids use the term as an adjective i.e. “I’m so ADD”. The media’s coverage of this serious mental health disorder has created an explanation for parents who have kids who are underperforming at school creating high demand for special educational intervention and medications like Ritalin. There is a great danger however to misdiagnosing a child with ADHD, and if you as a parent suspect that your child might have ADHD, it is best to have him or her evaluated by a psychologist who specializes in recognizing the disorder. Below are just some of the dangers of misdiagnosing a child (or an adult for that matter) with ADHD.

1. ADHD is a biologically based disorder, but there are many other physiological ailments that can produce ADHD-like behavior such as: allergies, hyperthyroidism, manic depression, anxiety disorders, auditory processing deficits, and specific Learning Disabilities.

2. Medication can be an extremely effective intervention for ADHD, but if a child is misdiagnosed, and does not have ADHD negative consequences can ensue. For instance, if a child with an anxiety disorder is diagnosed with ADHD and given a stimulant like Ritalin, the child’s behavior will become increasingly erratic he/she will become restless, and his/her anxiety will only worsen.

3. If a child or adult is Bipolar, but incorrectly diagnosed with ADHD, medical intervention will intensify the manic episodes of a Bipolar disorder to a potentially physically dangerous degree that can lead to hospitalization.

4. If ADHD is mistaken for a Learning Disorder, your child’s school will initiate academic support plans that will miss the mark, and not address the true problem. The student will receive tutoring and remediation yet will fall farther and farther behind due to the lack of focus on the child’s attention deficit.

ADHD is a treatable disorder through the use of behavioral interventions and medication. Proper diagnosis is the first step toward effective treatment.

**If you feel that you or your child may have ADHD, don’t hesitate to contact me to schedule a consultation at (310) 712-5480.

Risk Factors of Teenage Drinking

Some parents breathe a sign of relief when they find their child is “just” drinking alcohol and not using drugs, but it is a myth that alcohol is a “better” drug. Alcohol abuse, drunk driving, and alcohol-related diseases take a major toll on our society, and children who begin drinking at a young age are at much higher risk of developing problems.

Alcohol is by far the drug of choice among adolescents. It is the most used and abused mood-altering substance among pre-teens and teenaged children. Although some teens report it is easier to get illegal drugs than buy alcohol, the overall social acceptability of alcohol and the pervasive advertising that suggests alcohol creates a positive and rewarding experience often leads both teens and their parents to think drinking is simply a rite of passage with little danger over the long run. Some studies suggest that there could be as many as four million alcoholics under the age of 18, three years younger than the legal drinking age. The age when children begin drinking alcohol has decreased over the last few decades. Many children are already experimenting with alcohol in the fifth grade, many more than were just 10 years ago when teens were more likely to start drinking in eighth or ninth grade. According to the Centers for Disease Control, 40% of ninth-graders report that they tried alcohol before the age of 13 and had used alcohol within the past month.

One of the more dire consequences of this increase in drinking among children still in elementary school is the that it has a greater effect on cognitive development at this young age. Students who use alcohol remember much less of their academic work than those who do not use alcohol. Also, statistics clearly show that the younger a child is when he or she begins drinking, the more likely they are to develop problems with alcohol as adults. According to a report in the Journal of Substance Abuse, more than 40% of individuals who start drinking before the age of 13 will develop alcohol abuse problems later in life (Grant, BF, & Dawson, DA. 9:103-110, 1997).

Some major factors that influence a child’s decision to begin drinking are: the number of peers within their immediate environment who have started to drink, the number of adults they have regular contact with who have an alcohol problem, and the amount of the time the child is alone in the home (limited supervision). Exposure to alcohol advertising also influences children by creating a positive attitude toward alcohol use. If children view alcohol in a positive light, they are more likely to drink at a younger age. Children who start drinking at a young age are more likely to experiment later with illegal drugs. Yet, many children report that although they learn early on about the dangers of drugs, many do not learn about the dangers of drinking alcohol (The Weekly Reader National Survey on Drugs and Alcohol. Middleton, CT: Field Publications, 1995)

What keeps children alcohol-free? Children who have strong communication with their parents are less likely to drink. Children whose parents set clear rules and expectations are less likely to use alcohol. Children whose parents discipline them when they break the rules are also less likely to use alcohol.

Early Indicators of Learning Disabilities

In dealing with a child who has a Learning Disability, the most important parental intervention is EARLY DETECTION followed by consultation with a psychologist who is experienced in psychoeducational testing.  Below is a list of behavioral symptoms to help parents begin to identify signs that their child may have a Learning Disability.  These symptoms listed below are intended to indicate the possibility for learning problems amongst preschool aged children:

1. language: problems with pronunciation, slow vocabulary growth, lack of interest in story telling

2. memory:trouble learning numbers, alphabet, days of the week, poor memory for routines

3. attention: trouble sitting still, extreme restlessness, lack of persistence in completing tasks

4. fine motor skills: trouble dressing him/herself i.e. buttoning buttons, tying laces, overall clumsiness, reluctance to draw freely or trace pictures.

5. other: trouble interacting with peers, trouble learning left from right; spacial confusion

*****For more information about learning disabilities visit www.wrightslaw.com

Ten Tips for Parents of Learning Disabled Kids

This list of 10 parenting tips is a guideline for successful parenting of a child with learning disabilities.  In addition to the incorporation of these tips into your parenting skills, understand that often, therapy for children with learning disabilities and their parents can increase feelings of success and self acceptance, and decrease feelings of isolation.

1.  Do not underestimate your child’s potential.  Encourage him or her to develop to the best of their ability while pursuing their own interests.

2.  Consult a professional specializing in working with Learning Disabled children to begin to pool the public resources available to children with Learning Disabilities.

3.  Help your child to not feel alone with their disability.  Find positive role models such as an adult living productively and successfully with a Learning Disorder.

4.  After securing appropriate educational services for your child, (IEP’s, Resource Classes, Special Education Aides etc…) STAY INVOLVED with your child’s educational support team and ask for recommendations of how to create a positive learning environment for your child at home. 

5.  Keep in mind the feelings of your spouse and other children.  Remind them that just because your Learning Disabled child gets more of your time does not mean that he or she gets more of your love. 

6.  Be honest with yourself and be aware of your own limitations.  You cannot be a perfect parent, nor do you have an unlimited reservoir of energy.  Do not foget self care.

7.  Keep a sense of humor.

8.  Do not get caught up in comparing your child to his or her other classmates.  Judge your child’s progress by comparing your child only against themselves. 

9.  Slow down, allow time to reflect on you and your child’s accomplishments, not just his/her, or your own shortcomings. 

10.  Seek out support groups for parents of children with Learning Disabilities. 

What is PTSD?

Post Traumatic Stress Disorder is an anxiety disorder that impacts 7.7 million American adults. The disorder can also develop in children as well and is more common in women than men. It is a disorder that commonly develops in response to a trauma or repeated traumas in which a person may have felt their life was threatened. PTSD was first documented among veterans of war who were exposed to combat firsthand, but this disorder can also impact those who have merely witnessed a violent crime or assault. Not every traumatized person develops full-blown or even minor PTSD. Symptoms usually begin within 3 months of the incident but occasionally emerge years afterward. They must last more than a month to be considered PTSD. The symptoms of PTSD can be particularly insidious and can drastically and negatively impact a person’s life. Below are symptoms of PTSD:

The traumatic event is persistently reexperienced in (or more) of the following ways:

  1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
  2. Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
  3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
  4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
  5. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

  1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma.
  2. Efforts to avoid activities, places, or people that arouse recollections of the trauma
  3. Inability to recall an important aspect of the trauma
  4. Markedly diminished interest or participation in significant activities
  5. Feeling of detachment or estrangement from others
  6. Restricted range of affect (e.g., unable to have loving feelings)
  7. Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

  1. Difficulty falling or staying asleep
  2. Irritability or outbursts of anger
  3. Difficulty concentrating
  4. Hypervigilance
  5. Exaggerated startle response

*******NOTE*******

PTSD is a serious and life altering condition that in most cases will NOT abate on its own. If you believe that you or a loved one has PTSD, contact a mental health professional as soon as possible to initiate treatment. (Some information obtained from www.healthyplace.com)

Is Your Child Ready for Kindergarten?

Children mature in very different ways on different timelines. Not all kids who are 5 years old are ready to begin Kindergarten, and some children are Kindergarten ready by age 4. Judging if your child is ready for Kindergarten is a difficult task for parents because most schools do not adequately assess each child on the basis of their verbal skills, social and emotional functioning or their self care skills. Below is a listing of the important criteria to consider in deciding whether YOUR child is ready to begin Kindergarten:

1. Verbal Skills: Can your child use words rather than physical suggestion to express their needs? Does your child speak clearly enough to be understood by those who do not know him/her well? Can your child communicate with peers?

2. Social Skills: Does your child initiate play with other children? Can he/she wait his/her turn? Can your child follow simple directions? Can your child verbalize simple requests?

3. Self-Care Skills: Can your child ask to go to the bathroom without prompting? Is your child consistently dry during naps? Can your child eat lunch and snack foods without assistance?

4. Maturation: Does your child demonstrate an understanding of the concept of time? Can your child clean up his/her own toys? Can your child sit still for over 10 minutes? Can your child understand consequences of behavior (good and bad)? Can your child separate from parents without tantruming?

5. Academic Skills: Can your child have the ability to sustain attention? Can your child memorize things that have been stated to him/her repeatedly? Can your child count to ten? Can your child string together complete sentences?

If more than 1 of these skills is NOT met in each category, your child may not be ready to begin Kindergarten. This does NOT necessarily indicate any type any type of psychological or cognitive disorder, children develop and mature at different paces, and if as a parent you are not sure that your child meets the vast majority of these criteria listed above, it would be wise to consult with an expert in child development such as a psychologist or psychiatrist well versed in child assessment, and possibly wait to enroll your child in Kindergarten during the next academic year.

What is a Panic Attack? (definition and treatment)

Panic attacks, though not a threat to one’s physical health often are experienced as a feeling of impending doom combined with quick, shallow breathing, accelerated heart rate, excessive perspiration and even feelings of depersonalization(similar to an ‘out of body experience’). Often those experiencing panic attacks for the first time are caught by surprise and fear that they are dying. Some end up in doctor’s offices, even emergency rooms, convinced that they are experiencing a life threatening physical condition. Of course, once all physical disorders are ruled out, the E.R. doctor usually refers the patient to a therapist to treat this emotional anxiety disorder.

The most difficult aspect of experiencing a panic attack is that usually they seem to “come from nowhere”. Generally people experience panic attacks during situations that do not inherently feel threatening, or anxiety provoking. Rather, they often seem “free floating” in nature, not triggered by anything in one’s conscious awareness.

Panic attacks arise from one’s unconscious, where repressed anxieties can seem to “pop up” into consciousness in the form of this intense feeling of fear and dread. Due to the fact that one cannot predict when a panic attack will occur, the style of therapy that is most effective for long-term treatment of panic attacks is one that exposes one’s inner conflicts and repressed material. In this manner, insight and understanding of one’s self can eventually replace the internal fear and angst that originally caused the panic to occur. This treatment modality is the hallmark of insight oriented, psychodynamic therapy. By making the unconscious conscious, the power of one’s negative mood states such as depression, anxiety and anger, can be deflated, thus making these emotional experiences easier to cope with.

The early indicators of Autism:

Autism is a diagnosis that inexplicably, psychologists are seeing more and more both in clinical and school settings. Autism is a spectrum disorder, and children can be diagnosed with Autism, but may present with varying degrees of severity and intensity. Symptoms of Autism are first noted very early in life, normally prior to age 2. Autism is a serious disorder that can be managed, but unfortunately a child with Autism will grow up to be an adult with Autism. People with Autism can learn appropriate social skills, and some high functioning kids and adults with Autism can live productive lives in mainstream society. More severe cases of Autism can render a person dependent upon others for the rest of their lives. There is often such great disparity in the severity of Autistic cases from person to person. Below is a listing of symptoms that parents can observe in infant children with Autism:

  • Does not babble, point, or make meaningful gestures by 1 year of age
  • Does not speak one word by 16 months
  • Does not combine two words by 2 years
  • Does not respond to name
  • Loses language or social skills
  • Poor eye contact
  • Doesn’t seem to know how to play with toys
  • Excessively lines up toys or other objects
  • Is attached to one particular toy or object
  • Doesn’t smile
  • At times seems to be hearing impaired
  • If your child has several of these symptoms, they may need to be evaluated by a psychologist with experience in diagnosing Autism. Autism can be difficult to diagnose, and sometimes other, less severe disorders can masquerade as Autism due to the overlapping of certain symptoms from other psychological disorders. Treating Autism from an early age is crucial in assisting your child to live life in the social world in which we live, and obtaining certain community based services can be of great benefit to children with Autism and their families.

    For more information about Autism, check out these websites!

    www.firstsigns.org

    www.nimh.nih.gov/events/interagencyautism.cfm

    www.ddhealthinfo.org

    www.lifestages.com/health/autism.html

    www.wrightslaw.com

    Does your child have ADHD? They might have these symptoms.

    ADHD is a biological and psychological disorder that impacts a child or adult negatively in several different settings such as: at school, at home, in relationships,  at work etc..

    The following characteristics are associated with ADHD in children and adolescents:  Hyperactive, prone to restlessness, often leaves tasks incomplete, easily frustrated, impulsive-acts without thinking, has trouble following directions, talks excessively, difficulty concentrating, difficulty sharing, difficulty taking turns.

    If several of these characteristics apply to your child, further evaluation is recommended to determine if ADHD is present.  There are many treatment options associated with ADHD including help to thrive in school academically, and help to thrive emotionally.

    Below is a link to access more information about ADHD and Learning Disabilities:

    <a href=”http://www.ldworldwide.org”>Learning Disabilities Worldwide</a>

    Childhood Depression

    Clinical Depression is becoming more and more common amongst children and teens. This is a phenomenon that I notice both in my office as well as in more casual situations in daily life. Currently 1 out of 8 teens is Clinically Depressed, and that number seems to be rising from year to year. Often children and teens do not get the mental health services that they need, not because their parents are not paying attention, but because parents often have difficulty identifying depression in kids and teens. Children and adolescents are notoriously reticent in describing their feelings of sadness often associated with depression. Instead kids and teens experience depression through a different set of symptoms commonly seen in adults. The following are symptoms that parents should look-out for in their children: frequent headaches , frequent stomachaches, changes in appetite, changes in sleep patterns, inattention, lack of energy, and social isolation. Teenagers who present with several of these symptoms may be suffering from depression, and may need to be evaluated by a mental health professional in order to obtain relief from their symptoms, and avoid further psychological complications resulting from untreated depression.