Month: May 2012

Abnormal Psychology, Uncategorized

Pervasive Developmental Disorders

by Torey C. Richards, LMHCLeave a Comment on Pervasive Developmental Disorders

Pervasive Developmental Disorders (PDD) are also known as Autistic Spectrum Disorders. They include a group of five neurological disorders characterized by developmental delays of basic functions such as the ability to communicate, understand language, and socialize with others including peers and family. The five developmental disorders are:

  • Autistic Disorder
  • Rett’s Disorder
  • Childhood Disintegrative Disorder
  • Asperger’s Disorder
  • Pervasive Developmental Disorders Not Otherwise Specified

Many parents are often confused by the term Pervasive Developmental Disorders when their child is diagnosed. Often this is because a lot of doctors are hesitant to diagnose very young children with a specific PDD, but PDD is not a true diagnosis, but a category that includes all five of the disorders listed above. The official diagnosis in this case should be Pervasive Developmental Disorders Not Otherwise Specified (PDDNOS) which simple means that there is a pervasive developmental disorder present, but the doctor has yet to narrow down which exact disorder it is.

I could write a very long post that tried to cover all of the PDDs, but that would be very long and perhaps confusing, so what I am going to do is post one at a time over the next few days. To understand each PDD it is good to have a definition of the overall disorder and so we will start with PDDNOS.

Pervasive Developmental Disorders Not Otherwise Specified

All PDDs are neurological disorders that are usually evident by the time the child is three years old. They generally have trouble playing with their peers, socializing and relating to others. They also often have stereotyped behavior, interest and activities, inappropriate fascination with objects and often don’t like changes, even small ones. One parent vented her frustration to me saying that it felt like her child was always rejecting her.

Children with PDDNOS either do not fully meet the criteria of the other PDDs or do not have the degree of impairment usually considered suitable to fulfill the diagnosis of the other four disorders. According to the Diagnosis and Statistical Manual of Mental Disorders IV (DSM-IV), this diagnosis should be used “when there is a severe and pervasive impairment in the development of social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder” (American Psychiatric Association).

In general, children are usually diagnosed with PDDNOS when they have behaviors that are seen in Autism, but doesn’t meet the full diagnostic criteria.

Part of the confusion with PDDs is that the DSM-IV should be used as a guideline for diagnosing PDDS. Many doctors use it as a checklist. There are no clear guidelines for measure severity of symptoms which cause the lines between Autism and PDDNOS to become blurred. Confusion is also added in the fact that some doctors feel that Autistic Disorder only covers those who show extreme symptoms that meet every single criteria for it, while other doctors are comfortable using Autistic Disorder to define those with a broad range of symptoms related to language and social skills. Therefore, it is not uncommon for an individual to be diagnosed by one doctor as having Autistic Disorder and by another as having PDDNOS. There is growing evidence that PDDNOS and Autistic Disorder aren’t actually separate disorders, but are on a continuum which is why the term Autistic Spectrum Disorders is now frequently used to refer to PDDs. Multisystem Developmental Disorders is another term thrown around seldomly, but it is the same as PDDNOS and Autistic Spectrum Disorder.

Causes of PDDNOS

Studies that include behavioral and biological studies all suggest that PDDNOS is caused by neurological abnormalities (problems with the nervous system). However, no specific cause is known. There’s been controversy about childhood vaccinations being responsible for PDDNOS, but no clear evidence or studies have been able to show consistent evidence supporting that.

Symptoms/Signs of PDDNOS

These are some of the symptoms and signs of PDDNOS. Since it is a spectrum disorder, not all children will show the same symptoms, all of the symptoms or have the same intensity of symptoms as other children with PDDNOS.

  • Impairment in Nonverbal Communication
  • Impairment in Understanding Speech
  • Impairment in Speech Development
  • Abnormal Attachments and Behaviors
  • Unusual Responses to Sensory Experiences
  • Disturbance of Movement
  • Resistance to Change
  • Intellectual and Cognitive Deficits

They may also have associated features such as emotional expressions that are flat, excessive or inappropriate to the situation. They may scream, cry or laugh at any time for no apparent reason. They may not be afraid of real dangers such as falling or getting hit by a car, yet be terrified by a specific doll or stuffed animal.

Diagnosis

The DSM-IV is only one tool used to help diagnose PDDNOS. Medical assessments, occupational assessments (used to determine how the child’s different senses work together), interviews with the child’s parents, teachers, behavioral rating scales, psychological assessments, educational assessments and direct behavioral observations are some of the many other tools used to help diagnose PDDNOS. There are no specific test such as blood tests, or x-ray exams that can determine if a child has PDDNOS or not.

Treatments

Treatments for PDDNOS are usually the same used to treat all PDDs, but no one treatment will help all children and often they need to be individualized. Common treatments include:

  • behavior modification
  • structured educational approaches
  • medications
  • speech therapy
  • occupational therapy
  • counseling
  • family counseling
  • psychological treatment
  • facilitated communication
  • Auditory Integrative Therapy
  • Sensory Integrative Therapy
  • Dietary Therapies
The aim is typically to promote more acceptable and appropriate social and communication behavior as well as to minimize negative behaviors such as repetitive behaviors, self-injury, hyperactivity and aggression.

It is also important for parents of children with PDDNOS or any PDD (just like parents of children with any other disorder) to seek out help in the form of parent support groups in order to educate, remember that they are not alone and also to replenish themselves.

I hope that this post on PDDNOS was helpful. I realized halfway through writing this how tough it was going to be to try to cover PDDNOS in one post, partway through I was like, “What was I thinking” but hopefully I’ve laid out a decent basis to start discussing the other four disorders starting with Autistic Disorder tomorrow.

For those of you who want more information I’ve included the names, contact information and web addresses of some organizations below.

Resources

Autism Coalition
http://www.autismcoalition.com

Autism Patient Center
http://www.patientcenters.com/autism


Autism-PDD Resources Network
http://www.autism-pdd.net


Division TEACCH: http://www.teacch.com


Indiana Resource Center for Autism
http://www.iidc.indiana.edu/irca


National Institute of Child Health and
Human Development
http://www.nichd.nih.gov/publications/
pubskey.cfm

Asperger Syndrome Coalition of the United States, Inc. (ASCU.S.)
2020 Pennsylvania Ave., NW, Box 771, Washington, DC 20006
Telephone: 1-866-427-7747
Web: http://www.asperger.org
 
Autism Society of America
7910 Woodmont Avenue, Suite 300
Bethesda, MD 20814
Telephone: 1-800-328-8476
Web: http://www.autismsociety.org

International Rett Syndrome
Association, 9121 Piscataway Road,
Clinton, MD 20735. Telephone:
1-800-818-RETT; (301) 856-3334.
Web: http://www.rettsyndrome.org

Uncategorized
by Torey C. Richards, LMHC1 Comment on

Another great post I will be passing along and sharing with parents!

help4yourfamily's avatarhelp4yourfamily

It’s Monday, May 14th- Parent Affirmation day at Help 4 Your Family! Today’s affirmation is one I use a lot:

I give my children age appropriate time and space to solve their own problems.

This affirmation is good for many kinds of situations.  One is watching our children struggle with something.  This affirmation helps us to remember that there are some struggles that are age appropriate and that our children will benefit from resolving on their own because they want to learn it.  Rebecca from Mom Meets Blog writes about this in her sweet post about her son that you can read here.

Another situation where this affirmation is helpful is when our children are struggling with something and do not want to learn it- but we know it is age appropriate for them to do so.  A child who works really hard to get to you to give him the answers…

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The Perplexed Minds of Teenagers

Is Pretending to be Pregnant a Mental Illness?

by Torey C. Richards, LMHC166 Comments on Is Pretending to be Pregnant a Mental Illness?

In The Pregnancy Project: A Memoir, Gaby Rodriguez faked her own pregnancy as a social experiment, but teenage girls pretending to be pregnant is not a new phenomenon.

Over the past three years I’ve grown more and more concerned about teenage girls pretending to be pregnant, the reasons they do this and the mental and social rewards and consequences of it. I have to wonder if part of this is because of shows like 16 and Pregnant and Teen Mom, but I also think that the alarming number of their peers who actually are pregnant or have kids has an effect on them. Why would a teenage girl want to put up with the scrutiny and criticism that comes along with being pregnant in high school? This is what I think:

1. Attention

  • Some of these young girls are starving for attention no matter if it’s positive or negative. Perhaps they see all the attention their peers or siblings got when they were pregnant and crave some of that same attention. I often see that their friends, while at times judgmental, often start bonding with the young girl in a nurturing way, something that she doesn’t get normally from them.

2. To Keep a Boy Interested

  • I think this may be the most common reason young girls pretend to be pregnant. I see it played out over and over again each year in the high school I work at. A relationship ends or is on the break of ending and all of a sudden the young girl blurts out she’s pregnant or thinks she’s pregnant. This usually sends the young man into a panic and even if he’s skeptical, he tends to at least try to stay on her good side until the pregnancy is confirmed or denied. Like a lot of young teens who pretend to be pregnant, these ladies may go through great lengths to convince their boyfriends (ex-boyfriend) that they are pregnant and often times in the process, continue to try to really get pregnant. These drastic attempts to keep a boy are seldom successful.

3. Biology

  • Evolutional psychology may say that it is normal for young teens to pretend to be pregnant since it’s in their biology to want to conceive children. During my research it appears that pretending to be pregnant is to some extend normal, but I think what is abnormal is the way that some young adults go about pretending to be pregnant. Perhaps pretending to be pregnant to yourself is normal, while pretending to be pregnant and in effect lying to your friends/boyfriend is more on the abnormal end of the scale. However, if it is to some extend normal to pretend to be pregnant, can it ever go so far that it can be classified as a mental illness. To what extent does a young girl have to go to inorder convince people she is pregnant, before she moves into the realm of psychopathology?

More recently, Annette Morales Rodriguez was arrested and suspected of stalking, beating and choking to death a pregnant woman and using an xacto knife to remove her unborn child because she had had four miscarriages and had been faking her pregnancy.

One source said that she panicked as her fake due date approached and she had to produce a baby. She was willing to kill in order to “have” a child.

Pretending to be Pregnant as a Mental Illness

I have a client I’ve known for three years and each year she “gets pregnant”. I was originally referred to her when she “gave birth” to a premature baby and was back at school the next day showing pictures of “this baby” in neo-intensive care. One of her teachers was concerned about her physical and mental health and referred her to me. When I met with her she told me that the baby had died and I spend several weeks helping her get through the grieving process and even helped her with a memorial ceremony. A few months later I found out that this was all a lie. She was never pregnant. The pictures of the baby in NIC-U had come from Google Images, and this wasn’t the first time she had pretended to be pregnant. The extend to which this young girl went through to convince people she was pregnant and had given birth to a premature baby that died concerned me. I thought surely she was mentally ill, but I let it go as the next year her problems turned to the more normal problems teenage girls come and see me about (boys, family, school, friends, drugs).

And then this year she said she was pregnant again. This time I believed her (call me gullible, but I tend to believe people until I have evidence not to) because from her pretending to be pregnant last year, I felt like she wanted to get pregnant, and from my experience, young girls that talk a lot about being pregnant, pretend to be pregnant, and are sexually active, they usually end up pregnant within twelve months. Well this young girl started to gain weight, starting looking pregnant (even wore too small clothing to enhance the effect) up to a certain extend when she suddenly stopped “growing”. She claimed to feel the baby moving and said she went to doctor appointments, but would never let her friends go with her. She told her boyfriend she was pregnant and all of her friends, but not her family. She even went as far as to have her friends plan a baby shower. I offered over and over to help her break the news to her mom, but she refused and then one day her best friend came to my office in tears, telling me that she thinks the young girl is “crazy” because she really isn’t pregnant and keeps pretending to be pregnant. Her best friend told me that all of her friends and even her boyfriend are concerned for her, but they haven’t confronted her out of fear that she really is mentally ill.

After an intense session with the young girl she admitted to me that she really wasn’t pregnant, but couldn’t tell me why she kept pretending to be pregnant and was still planning on letting her friends and boyfriend think she was pregnant. As of Friday she was still planning her baby shower. That lead me to truly believe that this girl has a mental illness, but if so, what?

Factitious Disorders

The first thing that came to my mind was that she had a factitious disorder. Factitious disorders occur when a person acts like they have an illness and purposely produces symptoms of that illness. They may go as far as contaminating urine samples, manipulating documents and taking substances to make themselves ill. The benefits they seek usually are attention, sympathy, nurturance and mercy. The old term for factitious disorder is Munchausen Syndrome, and many of you have probably heard of Munchausen by proxy, which is when the person uses someone else, usually a child or elderly person, to produce the sick symptoms of an illness unto, often times with alarming and deadly results. But does a young girl who continues to pretend to be pregnant and goes to great lengths to convince people she is pregnant suffering from a factitious disorder? Through all my research I couldn’t find a definite answer, but this as of right now is my number one guess.

Personality Disorders

Borderline Personality Disorder

I also have to wonder if this girl and others like her may have some type of personality disorder. Borderline personality disorder is very popular these days, but I have only known about three people I would diagnose with borderline personality disorder and only  one of them have pretended to be pregnant in a very similar manner to the young girl I’ve been talking about. I also don’t think this young girl qualifies to be diagnosed with borderline personality disorder, but it is possible.

Histrionic Personality Disorder

People with histrionic personality disorder are always seeking attention and can be very inappropriately seductive, have exaggerated emotions and feel shallow. I’m not sure if this describes the young lady I’m talking about either.

Dependent Personality Disorder

People who have dependent personality disorder are dependent psychologically on other people. Pretending to be pregnant would increase the likelihood that the people this person is dependent on will be more nurturing and present, but from knowing this girl I highly doubt she has dependent personality disorder, but it may explain why some other young ladies pretend to be pregnant.

Psychopathy

Some people are just psychopaths as defined by:

  • lack of remorse or empathy
  • shallow emotions
  • manipulativeness
  • lying
  • egocentricity
  • glibness
  • low frustration tolerance
  • episodic relationships
  • parasitic lifestyle
  • persistent violation of social norms

Is it necessary that I diagnose this young lady and those like her? Probably not. I prefer not to diagnose clients unless I have to or it is a diagnoses that is literally screaming in my face. I don’t like labeling clients, but there are many reasons to give a diagnosis. Most insurance companies require a diagnosis and a diagnosis does help give a framework for developing a treatment plan. It is however, in my opinion, essential that I figure out what is driving this young girl and others like her to go through such great extents to pretend to be pregnant in hopes of helping them deal with whatever it is they are trying to get externally, and be able to give it to themselves so that they can develop into emotionally and mentally healthy adults.

If you have any opinions or if you’ve been through this or even pretended to be pregnant before, please comment. I would love to hear your story.

Abnormal Psychology, Popular Psychology

Bipolar Disorder in Children and Adolescents

by Torey C. Richards, LMHC3 Comments on Bipolar Disorder in Children and Adolescents

Often times bipolar disorder is thought of as an illness that effects mostly young adults, and while the average age of bipolar disorder is around the age of 21, younger children and teens can also be effected with the disorder, sometimes referred to as pediatric bipolar disorder.

Working in a high school with students who mostly have anger problems, I hear a lot of them talking about their “mood swings” and some of them even call themselves “bipolar” although they have never been officially diagnosed. But almost everyone has mood swings from time to time, so what exactly is bipolar disorder?

Bipolar Disorder

Bipolar disorder (sometimes called manic-depressive disorder) is a brain illness characterized by episodes of intense mood swings and behaviors known as mania (high energy, elated, impulsive, etc.) and depression that are usually high or low and shift, generally over days or weeks, and sometimes even blend (mixed episodes). It is not the same as the normal ups and down adolescents and teens go through, it is much more severe.

Early onset bipolar disorder happens in adolescence and the early teenage years and may be more severe than bipolar that develops later in life. There was a time in the past when most experts did not believe that bipolar disorder could happen in childhood, but research shows that at least half of bipolar disorder cases start before the age of 25. Children with bipolar disorder often have co-occurring disorders such as attention deficit-hyperactivity disorder and anxiety disorders.

Symptoms

Adolescents and teens exhibiting a manic episode of bipolar disorder may:

  • Feel very happy and act silly in a way that is unusal
  • Talk really fast about a lot of different things
  • Have a short temper
  • Do risky things (i.e. jumping off of things, dashing in front of cars)
  • Have trouble sleeping, yet not feel tired
  • Have trouble staying focused
  • Talk and think about sex more often (if they are sexually active they may actively seek out sexual encounters)
Adolescents and teens exhibiting a depressive episode of bipolar disorder may:
  • Sleep too little or too much
  • Be very sad/depressed
  • Complain about various pains such as stomach and headaches
  • Eat too little or too much
  • Feel very guilty
  • Be overly emotional and/or sensitive
  • Have little energy or interest in doing anything
  • Think/talk about suicide and/or death

Treatments

Treatments for bipolar disorder include medications and psychotherapies including family therapy (it is important that parents taking care of a child with bipolar disorder, just like any other illness, take the time for self-care in order to be healthy and effective caregivers themselves). There is a concern that many children are being over diagnosed with bipolar disorder since in children, bipolar disorder can also look like other disorders such as severe mood dysregulation or temper dysregulation disorder, and some children may not have a disorder at all but be expressing another, normal biopsychological response to life stressors. While there is no way to prevent bipolar disorder, there is ongoing research trying to find a way to delay the onset of symptoms in children with a family history of the disorder.

I currently see 69 adolescents and adults for various reasons and only about three or four I would seriously evaluate for bipoloar disorder and two I have diagnosed with it. One of them is a 15 year old female and her parents are currently in denial of the seriousness of her illness, yet don’t understand why she isn’t getting better although I’ve had to Baker Act (Florida’s statue for involuntary examination of an individual where they are kept up to 72hrs in a hospital for their saftey) due to suicidal thoughts and self-injury. I’ve also referred them repeatedly for medication evaluations, but again, her parents are in denial and think her issue is all behavioral and not a real illness like bipolar disorder. I have another 15 year old girl I diagnosed with bipolar disorder and she is now on medication (Trilecta) and seeing me for cognitive behavioral therapy and is doing a lot better.

Where to go for Help?

As always, your family doctor or mental health professional should be able to direct you to the proper source of help for your child. If not, look up a doctor or mental health facility in your area to have your child evaluated and treated if necessary. If you know someone who is in crisis do not leave them alone, instead get them help, go to an emergency room or call 911 if it is necessary to keep them safe from themselves. If you are in need of help, the same applies and you can also call a free suicide hotline at 1-800-273-TALK (8225). Also, www.thebalancedmind.org . Their “Library” section has terrific information on pediatric bipolar disorder as well as an excellent checklist to help you monitor your child’s behavior.

Uncategorized

Looking at the Five Stages of Grief in Our Daily Lives

by Torey C. Richards, LMHC1 Comment on Looking at the Five Stages of Grief in Our Daily Lives

Elizabeth Kubler-Ross developed the five stages of grief theory after her work with terminally ill patients. It is a widely used theory used to explain what happens when people are coping with dying and now is even used outside of death to include any experience of loss including divorce, separation and bereavement.  The five stages are:

  1. Denial- “I am fine”
  2. Anger- “Why me! It’s not fair!”
  3. Bargaining- “I’ll do anything for a few more years!” “I promise to go to church everyday!”
  4. Depression- “I’m dying, what’s the point of trying to be happy?”
  5. Acceptance- “I can’t fight it. It’s happening. I might as well be prepared for it the best way I can.”

People often go through these stages in different orders and sometimes from one to the other and back again. For example, someone can be in acceptance and go back to bargaining, or go from denial to depression while skipping anger and bargaining. While this theory has most widely been studied and accepted in dealing with the dying and grieving, in my experience, I’ve notice that it seems to apply outside of these populations.

The Five Stages of Grief Outside of The Grieving Population

  • Substance Abuse

In working with substance abuse users, they often times also experience the five stages of grief. There is a period of denial that there is a problem, anger that there may be a problem, pleading with themselves or a higher power to take away the problem, a period of depression as the reality of the problem starts to set in and then acceptance eventually sets in, more so in those seeking treatment compared to those who do not seek help and seem to remain in the denial stage. Even family members of substance abusers tend to go through the stages of grief in dealing with the family member who is abusing substances.

  • Loss of a Relationship/Affair
Often times the unseen or unwanted end of a relationship sends someone through the five stages of grief. The same sometimes happens when an affair is discovered or sensed. The person first is in denial and then as further evidence is discovered, the person becomes angry and then bargains with themselves, the other person, the universe or whoever for this not to be happening, and then they usually fall into a depression and then eventually acceptance which allows them to try to deal with the reality of the situation in a healthy way.
  • Sexual Abuse
 In cases of sexual abuse, families often go through the five stages of grief. Sometimes it’s a mother who goes through the stages when confronted with evidence or suspicion that one of her kids is being molested by a new boyfriend. Recently I started working with a young girl who was sexually abused by her uncle, who had recently gotten out of prison for sexually assaulting a minor,  but still no one in her family believed her until a year later when her younger sister became pregnant with her uncle’s baby. That tragedy could have been avoided if the family would have not stayed in the denial stage for so long in realizing that her uncle was a sexual predator.
  • Mental Illness
I wrote in a previous post about parents denial of their child’s mental illness. From my experience, parents often go through the five stages of grief when it comes to facing the fact that their child has certain challenges such as ADHD, anxiety or mood disorders or even more severe issues. Mentally ill individuals also sometimes go through the fives stages of grief, not wanting to admit or accept that they may have a depressive disorder, an anger problem, or whatever it may be. This is what usually keeps them from seeking help for years until they finally reach the acceptance stage.
  • Everyday Life
I know there are many other times and situations in which the five stages of grief can be applied, but the ones I named above are the ones I seem to deal with the most. How have the five stages of grief showed up in your life? Have you been diagnosed with an illness and went through a period of denial, anger, bargaining, depression and finally acceptance? I know when I was diagnosed with type II diabetes I went through the five stages of grief and it was only when I reached the acceptance stage that I was able to actively take control of my life.
Uncategorized

Can Tanning and UV Rays be Addictive?

by Torey C. Richards, LMHCLeave a Comment on Can Tanning and UV Rays be Addictive?

To be honest, before “Tan Mom” I had never ever heard of tanorexia. I assumed that she was a sick woman in need of mental help. I wasn’t judging her, or maybe I was. It just didn’t make sense to me why someone would do that to themselves, but maybe she really has a problem.

Tanorexia is a physical or psychological addiction to tanning. According to a study done by dermatologists, really frequent tanners tend to lose control of their tanning schedules and become a lot like smokers and other substance abusers, wanting more and more. Research says that tanning releases an opioid that tanners can become addicted to and even have withdrawal symptoms from.

Negative side effects of tanorexia include all of the negative things that come along with prolonged exposure to UV rays including cancer. In some cases  of tanorexia, it may even be a form of body dysmorphic disorder (which I originally thought “Tan Mom” had) where the person sees themselves as always too pale no matter how dark their skin gets, and/or finds their pale skin to be disgusting, unattractive and unacceptable. It’s this way it is a lot like anorexia where the person sees themselves as overweight no matter how thin they get.

Currently tanorexia is not an official diagnosis in the Diagnosis and Statistical Manual of Mental Disorders IV (DSM IV), but an updated version of this manual (the DSM V) is scheduled to come out soon and it will be interesting to see if tanorexia will be an official diagnosis. Further more, The Archives of Dermatology appear to make a case for diagnosing the addiction to UV rays as a type of substance abuse disorder so along with alcoholics we may soon have tanaholics.

I’ve always heard that you can become addicted to anything and everything should be done in moderation. Tanorexia seems to prove that statement.

Uncategorized
by Torey C. Richards, LMHC1 Comment on

I really like this. Especially as I sit here in my office with students and parents coming for help. I will pass this along and I know it will make a difference to someone today.

help4yourfamily's avatarhelp4yourfamily

From now on, Monday is going to be parent affirmation day at Help 4 Your Family.  Sometimes I  will share affirmations I have created and used, other times I will quote affirmations from teachers I have come to trust.

For this Monday, May 7, 2012 your parenting affirmation is:

My children give me constant opportunities to learn and grow.

Now, you know this one makes you smile, even when you are tired. I would suggest that, to make this part of your self-talk, you repeat it many times throughout the day.  Say it to yourself in the mirror, and mention it to your friends in conversations.

If you have a parenting affirmation that you would like to share, please feel free to let me know.  Maybe you will see it some other Monday 🙂

All the best to your family,

Kate

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Abnormal Psychology, Popular Psychology

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

by Torey C. Richards, LMHCLeave a Comment on Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

There is a growing hypothesis that there exist in a small subset of children, a form of rapidly forming obsessive-compulsive disorder (OCD) and/or tic disorder known as PANDAS.

PANDAS is an acronym for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. According to research, these children literally go from “normal” to “abnormal” in the matter of hours. Parents are usually able to pinpoint the exact time and day their child’s behavior changed in the forms of tics (erratic movements or vocalizations), emotional irritability, bed wetting and lose of previous learned motor skills. This is thought to follow exposure to the strep virus (i.e. a strep throat) and appears to be some type of autoimmune reaction.

PANDAS was first proposed during observations and clinical trials by the US National Institute of Health and was verified by further clinical trials, where children, after having been exposed to the streptococcal virus, developed rapid, sudden and dramatic OCD and tic disorder symptoms. There isn’t a 100% cause and effect between streptococcal and PANDAS, or even clear evidence that PANDAS is a separate disorder from Tourettes/OCD, so research is ongoing. Because of this, PANDAS is not yet, or may never be considered a complete disease on it’s on, and there is some discussion that it should be called PANS, an acronym for Pediatric acute-onset neuropsychiatric syndrome to further include not just the sudden onset of tics and OCD symptoms following exposure to a previous infection, but the sudden onset in children regardless of a previous infection or not.

What if I Think My Child Has PANDAS and is There a Cure?

Your family doctor or psychiatrist will be able to access and diagnosis whether your child has PANDAS or not. Treatment for PANDAS right now are the same as the treatment for Tourettes and OCD which include cognitive behavioral therapy and medications such as selective serotonin reuptake inhibitors (SSRIs). As research grows and the PANDAS hypothesis is either further confirmed or denied, other therapies and medication options will become available, but as of right now, there is no cure other than to try to reduce and control the disturbing and undesirable symptoms of PANDAS.

There seems to be a link between previous childhood exposure to infections such as strep throat, to the development of PANDAS, but there isn’t a 100% certain link and you shouldn’t worry too much that exposure to infection in childhood will lead to life long, neuropsychiatric problems. However, there seems to be growing evidence that in some children, this is the case and like with every child, if you notice sudden changes in your child, such as decrease in previous learned motor skills, increased irritability, tics (vocal and/or physical), difficulty sleeping, difficulty eating or any other unusual behaviors, it is very important to have your child seen by a doctor or specialist to not only rule out PANDAS, but also other diseases and pervasive developmental disorders such as Autism, Aspergers and childhood disintergrative disorder.

For more information on PANDAS visit http://intramural.nimh.nih.gov/pdn/web.htm

Abnormal Psychology, Popular Psychology

Is Your Child’s Oppositional Behavior ‘Normal’?

by Torey C. Richards, LMHCLeave a Comment on Is Your Child’s Oppositional Behavior ‘Normal’?

Oppositional behavior is often a normal part of childhood, especially around the ages of two to three years of age and early adolescence. Often oppositional behavior occurs when the child is hungry, tired, stressed or irritated. During these periods they may defy their parents, teachers, other caregivers, argue, talk back and be disobedient. These behaviors may be upsetting to parents, but they usually aren’t too upsetting because they fall into the “normal” realm of oppositional behavior expected in childhood. But when does openly defiant, uncooperative and hostile behavior become abnormal and a need for serious concern? When it stands out when compared to other children of the same age and developmental level and when it is so consistent, frequent and disruptive that it affects the child’s personal, school and family life. That’s when normal oppositional behavior becomes Oppositional Defiant Disorder (ODD).

Oppositional Defiant Disorder

Children with Oppositional Defiant Disorder (ODD) present with an ongoing pattern of defiant, hostile and uncooperative behavior towards authority figures that seriously interferes with the child’s daily life in the form of getting in trouble at school frequently or having to be disciplined regularly. Some symptoms of ODD are:

  • Spiteful attitude and revenge seeking
  • Often being touchy or easily annoyed by others
  • Excessive arguing with adults
  • Frequent temper tantrums
  • Often questioning rules
  • Deliberate attempts to annoy or upset people
  • Active defiance and refusal to comply with adult requests and rules
  • Mean and hateful talking when upset

Usually these symptoms are exhibited in multiple settings such as at school or at home, although they may be more present in one or the other. While the causes of ODD are unknown, one to sixteen percent of school-aged children/adolescents have it. Parents with children who have ODD often say that their child was more rigid and demanding from an early age compared to their other children who didn’t have ODD. It is widely expected that a combination of psychological, biological and social factors contribute to the development of ODD.

What To Do If You Think Your Child Has ODD

If you think your child has ODD, they will need a comprehensive evaluation that will include checking for other disorders such as attention-deficit hyperactivity disorder (ADHD), mood disorders (such as depression or bipolar disorder), learning disabilities and anxiety disorders. If these disorders are also present in your child, they will have to be treated as well because it is nearly impossible to treat ODD without also treating any other coexisting disorders. Some children with ODD can go on to develop conduct disorder, which is a much more pathological and destructive disorder.

Treatments for ODD

They are many treatments for ODD that include Parent Management Training Programs which help parents manage the child’s behavior. Individual therapy where the child can learn anger management skills. Family therapy to help the overall family communicate and work more effectively together. Cognitive Problem-Solving Skills Training and Therapies to assist with problem solving and negativity. Social Skills Training to increase flexibility and improve social skills, increase tolerance and decrease frustration with peers. 

Medication in some cases is helpful when ODD symptoms are extreme or very distressing or if they coexist with other disorders such as ADHD.

Since ODD children can be very difficult, parents of children with ODD need help, support and understanding. They need self care in the forms of:

  • Take a time out if you are being extremely stressed by your child and support your child if they decide to take a time out to prevent from getting more upset
  • Maintain interest in other things besides your child
  • Pick your battles with your child
  • Build on the positives, reinforce desired behaviors
  • Manage your own stress
  • Set up age appropriate rules and consequences for your child
  • Don’t be afraid/embarrassed to ask for help

Most children at different stages in their development will exhibit oppositional behavior, that is normal, but when it becomes abnormal, it’s important to know when and who to turn to for help. The Oppositional Defiant Disorder Resource Center (www.aacap.org) is a great resource and a great place to start if  you want to know more about ODD.

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Parents Denial of Their Child’s Mental Health Issues Doesn’t Make It Go Away

by Torey C. Richards, LMHC31 Comments on Parents Denial of Their Child’s Mental Health Issues Doesn’t Make It Go Away

ImageThe more family sessions I do, the more concerned I become at the astonishing number of parents who are in denial of their child’s mental health issues.

Recently I was dealing with a teenage girl referred to me by her mother because she was scared to be by herself, “acting weird”, talking and laughing to herself.

After meeting with the girl twice I got her to tell me some information she had ever told anyone else. She was hearing voices and having extreme paranoid delusions of someone putting “voodoo” on her and making her do things against her will.

After further sessions and gathering more collateral information from her mom and sister, I diagnosed the girl with a psychotic disorder, with a rule out of paranoid schizophrenia.  I referred the mom to a local psychiatrist so the young lady could be evaluated further and the mom was extremely hesitant. She questioned my every judgment, and while she was very concerned for her daughter, she hoped that it was “all in her head”. I tried to convince her mother that it wasn’t “all in her head”, but an illness, that according to her records, seemed to run in the family.

Their family history was peppered with undiagnosed mental illnesses.

Needless to say, the mother didn’t follow up on my referral until a few weeks later when her daughter had a psychotic episode that truly scared the mother. It was then she came back and thanked me for recognizing this when I did.

And then last week, I had a girl come to me extremely tearful. She had old and new self-inflicted cuts up and down her arm. She told me that she was suicidal, tried to walk out into traffic the day before but a friend stopped her. She had thoughts that day of hanging herself or jumping off the third floor of the school building.

I called her dad to have a conference and recommend that she be taking to the nearby psychiatric hospital for her safety. I didn’t need his permission to do that, but I thought it would be better for her.

When her dad showed up he was extremely annoyed, yelled at her for not being able to communicate with him, and said that she wasn’t suffering from depression, she was just “lazy”. He said she was failing school because she slept all the time, didn’t do her homework, didn’t want to be involved with her family and seemed aloof.

The more he described her “laziness” to me, the more he re-affirmed my diagnosis of his daughter being depressed. He argued with me that she was depressed because of her failing grades and being behind in her school work, even though she and I both tried to explain to him that the depression is what caused her to start failing school and get behind in her work in the first place.

He didn’t want to hear or believe that his daughter was depressed and suicidal. He said that it was a cry for attention, and it very well may be, but as a mental health professional, my job is the evaluate the situation and keep my client from hurting themselves or other people. I had her involuntarily hospitalized to a mental health facility for her safety. Her dad left with angry, probably thinking we were wasting his time, but I’d prefer him to be angry with me for being overly concerned than to be mad at me for not trying hard enough to prevent her suicide.

Even just recently I have been working with a girl suffering from severe depression and suicidal thoughts. She confessed to me that she had attempted suicide last weekend by taking 18 sleeping pills and was disappointed that it didn’t work. I convinced her to allow me to call her father so that I could recommend psychiatric help, possibly hospitalization. The first thing her father said to me over the phone was, “No, I don’t believe it. We are Christians, we don’t do things like that.”

It took me while to convince her father to actually come into my office so him and I can sit down and talk with his daughter, and even then it took nearly the whole session before he started to accept that his daughter was indeed depressed although he was still in denial about her suicidal thoughts or previous attempt.

Parents can be my biggest allies or worst enemies when it comes to dealing with children and adolescent clients, and their denial of their child’s mental health issues only complicates everything. I see so many kids who can benefit from intense therapy and maybe even medication, but their parents ignore the seriousness of the situation and write it off as defiant behavior, active imagination or they just hope their child will grow out of things such as torturing animals and setting fires. Denial is a defense mechanism and while it’s okay to be skeptical, being in denial is almost always unhealthy in the long run.