Abnormal Psychology – Page 2 – Licensed Mental Health Counselor

Childhood PTSD AND Trauma: Part 1

22 Feb 2013by Torey C. Richards, LMHC2 Comments

Imagine a four-year-old child found covered in blood, lying over her mother’s naked, dead body, whimpering incoherently. She’s witnessed her mother being raped and murdered, and her own throat had been cut, twice in an attempt to leave behind no witnesses. She’s alone with her mother for approximately eleven hours before she is discovered.

After being hospitalized she is released as a ward of the state and put into foster care with no follow up treatment for the trauma she experienced.

How will she go on through life with those images etched in her mind? How will she survive psychologically? How will her mind protect her from such traumatic experiences?

This story is unfortunately a very true story, one of several stories of childhood trauma that can be found in the book, The Boy Who Was Raised As A Dog by Bruce Perry and Maia Szalavaitz.

Tragedies like this occur across our nation and the world everyday, leaving behind sometimes physical, but always emotional and psychological scars.

Post Traumatic Stress Disorder is a condition that 30 or so years ago was reserved only for soldiers who had experienced traumatic events at war. It was later recognized that rape survivors, people who had been through terrible accidents or natural disaster, also exhibited symptoms of PTSD including flashback, hyper-vigilance and avoidance behaviors.

When it came to children however, the mental health and medical fields were slow to realize the impact of trauma on their lives.

Children were thought to be naturally resilient and would “bounce back” without the aid of any type of support or treatment. Those same children who had experienced trauma would often later develop psychiatric problems, depression and attention issues that would sometimes led to medication.

We know now that children who have live through tragedies, are just as affected as adults, perhaps even more so. This is evident in the great way the mental health community around the nation responded to the Sandy Hook Elementary School tragedy.

What Causes PTSD?

PTSD can occur in anyone who has lived through an event in which they could have been killed or severely hurt or where they witnessed someone else getting killed or severely hurt. These can include violent crimes, physical or sexual abuse, someone close to them committing suicide, car crashes, shootings, war and natural disasters just to name a few.

Approximately 40% of children by the age of 18 will experience a traumatic event, which includes the loss of a parent or sibling and domestic violence. In the United States, child protective services receives an estimated 3 million reports of abuse and neglect yearly, involving approximately 5.5 million kids. About 30% of all those cases show proof of abuse:

65% neglect
18% physical abuse
10% sexual abuse
7% psychological (mental) abuse

This of course doesn’t include the estimate 66% of child abuse cases that are never reported.

The Likely Hood Of PTSD Developing

Girls are more likely than boys to develop PTSD symptoms. Approximately 3-15% of girls and 1-6% of boys who experience a trauma will develop PTSD. The chances of developing PTSD are higher depending on the type of trauma experienced. Some of the risk factors for PTSD include:

How severe the trauma was
How the parents react to the trauma
How close or far away that child is from the trauma

Of course children who go through the most severe traumas have the highest level and severity of PTSD symptoms. Incidents where people are hurting other people such as assault and rape, tend to result in PTSD more frequently. Children who have healthy support systems tend to have less severe symptoms.

The age of the child during the traumatic experience doesn’t seem to effect rather PTSD symptoms will develop, however PTSD looks different in children of different ages.

What Does PTSD Look Like In Children Ages 5-12?

children may not have flashbacks or problems remembering parts of the trauma like adults with PTSD often do.
Children might, however put the events of the trauma in the wrong order.
They might also think there were signs that the trauma was going to happen and thus they think that they will see these signs again before another trauma happens.
They think that if they pay attention, they can avoid future traumas which can lead to hyper-vigilance.

Children around this age may also show signs of PTSD during their play. They may keep reenacting part of the trauma. For instance, a child who has seen a shooting may want to play video games involving shootings or carry a gun to school.

Teens (ages 12-18)

In teens, some of the PTSD symptoms may be similar to those of adults including flashbacks, reoccurring nightmares about the event, hyper-vigilance and exaggerated startle responses. Teens are more likely than children or adults to show aggressive and impulsive behavior.

What are the other effects of trauma on children?

Other effects of trauma on children from PTSD comes from research done with children who have been through sexual abuse. They include:

fear
worry
sadness
anger
feeling alone and apart from others
feeling as if people are looking down on them
low self-worth
not being able to trust others
undesired behaviors such as aggression, out-of-place sexual behavior, self-harm, and abuse of drugs or alcohol

For many children, PTSD symptoms go away on their own after a few months. Yet some children show symptoms for years and possibly a lifetime if they do not get treatment.

How Is PTSD Treated In Children?

For some children, the symptoms of PTSD will go away on their own with healthy supports and when they aren’t being re-traumatized by anxious parents or the media. For others, they may need professional help including:

Cognitive-Behavioral Therapy such as Trauma-Focused Cognitive Behavioral Therapy
Psychological first aid/crisis management
Eye movement desensitization and reprocessing (EMDR)
Play therapy
Special treatments may be necessary for children who show out-of-place sexual behaviors, extreme behavior problems, or problems with drugs or alcohol.

What Can You Do To Help?

Educated yourself on PTSD and pay attention to your child for signs such as anger, avoidance of certain places and people, problems with friends, academic changes and sleep problems. If you need professional help, find a therapist in your area that treats PTSD and that your child feels comfortable with. Where to Get Help .

Sources: The National Center for PTSD

Abnormal Psychology, Popular Psychology

Combating Depression: 10 Tips

29 Jan 201329 Jan 2013by Torey C. Richards, LMHCLeave a Comment

Depression affects about 17. 5 million Americans and out of those, an estimated 9.2 million will have what is considered major or clinical depression.

What’s the difference between depression and major depression?

Major depression is categorized as:

a depressed mood, most of the day, nearly everyday for at least two weeks. In children, adolescence and some adults, depression may present as irritation or anger.
Marked diminished interest in or pleasure in all, or nearly all activities most of the day, nearly everyday.
Significant weight loss (when not dieting), decrease in appetite, or significant weight gain or appetite nearly everyday.
Insomnia or hypersomnia nearly everyday.
Psychomotor agitation or retardation (i.e. moving extremely slow or faster than normal) nearly everyday.
Fatigue or loss of energy nearly everyday.
Feelings or worthlessness or excessive or inappropriate guilt nearly everyday.
Decreased ability to think or concentrate, or indecisiveness nearly everyday.
Recurrent thoughts of death, suicidal thoughts with or without a plan or a suicide attempt.

A person doesn’t have to have all of these symptoms to be diagnosed as having major depression, but they have to have the majority of these symptoms for at least two weeks and they can’t be accounted for something else, such as bereavement (i.e., losing someone close to them recently).

Depression has been given a bad name and so many people who feel depressed don’t like to admit to it and may not seek help or even the comfort of a friend when they are feeling depressed. The thing about depression in general is that it is not always a bad thing.As a matter of fact, very often, depression is your minds way of telling you that something in your life is not going the way you want it to go.

Instead of ignoring that feeling or trying to make it go away immediately, it may be a good time to sit with it and evaluate your life and see what is it that is not going the way you want it to go, and if you can change it, then change it, if you can’t, then try to change the way you think about it.

More often then not, this is what depression is and it is possible for a person who is in tune with themselves, to take this self-evaluation, correct the problem(s) and eliminate their symptoms. Other times, a depressed person may need the help of a professional to help them analyze what’s going wrong in their lives and help them learn how to deal with it. And yet, still there are times when medication is needed due to chemical imbalances or if a person gets to the point where they are so depressed that they don’t have the capacity to be introspective.

While most of us have or will experience depression at least once in our lifetimes, major depression can be a very dark and dangerous place. The Center for Disease Control has intentional suicide as the number ten cause of death in the United States last year, killing an estimated 38, 364 people.

10 Tips To Fighting Depression

**First off… if you or someone you know is suicidal, don’t be afraid to call 911 or 1-800-suicide for immediate help**

Opposite Actions is a technique from Dialectical Behavior Therapy that basically says, do the opposite of what the depression is telling you to do. If you feel like staying in bed all day, get up and do something. If you feel like blowing off your friends, don’t, call them and force yourself to be out with them. One of the things about depression is that it is a self-feeding disease. It zaps a persons motivation, makes them want to isolate themselves and stop doing things like going to the gym, all of which end up making the person feel more depressed.
Set an alarm that will help you wake up, that will remind you to eat, or to do whatever it is you need to do.
Take care of yourself by getting out of your bed, making it, and taking a shower. Letting yourself go is one of the hallmarks of being depressed and will make it easier for you to start avoiding other people.
Go outside for at least ten minutes a day. It doesn’t matter where you go, or if you don’t go anywhere. Going outside, getting some fresh air, some sun even, can do natural miracles when battling depression.
Exercise. You won’t feel like it, but it will be good for you and will get your blood flowing and your endorphin and dopamine (natural feel good hormones) going.
Make a list of activities to do, hopefully some will involve other people.
Keep a schedule, that way you can stay on track during the days you don’t feel like doing anything.
Make a daily necessity schedule if needed that reminds you when to eat, take a bath, brush your teeth, etc. Yes, in the middle of severe depression, it’s easy to neglect all these things.
Visit people like healthy family and friends. Once again, you will feel like isolating yourself, but having good family and friends around will help pull you out of the fog.
Last, but not least, if all self-help fails, do not be afraid to see your doctor or a psychotherapist. 80% of people with major depression who received treatment had significant improvements.

Depression will affect us or someone we know to some degree, and it’s always good to have some idea of what you’re dealing with and how to begin fighting it.

Abnormal Psychology, Popular Psychology

The Most Commonly Diagnosed Mental Disorders

17 Oct 201217 Oct 2012by Torey C. Richards, LMHC1 Comment

We are bombarded all the time with the depressing number of people diagnosed with illnesses such as cancer and heart disease, but did you know that mental illness is even more prevalent?

Like cancer and heart disease, mental illness is a medical condition that does not discriminate by age, sex, race/ethnicity or socioeconomic status.

Mental disorders often strike people when they less expect it, when they are in the prime of their lives and are often associated with other high risk behaviors such as gambling and substance abuse.

Like any other illness, they also vary in degree from mild, moderate and severe. In developed countries, these are the top 10 diagnosed mental disorders:

10. Autism Spectrum Disorders (Pervasive Developmental Disorders)

I’ve written a previous post on pervasive developmental disorders. They start when children are very young and are often difficult to diagnose. As a matter of fact, I know a parent who has just acknowledged (after much denial) that her 17 year old son has Asperger’s, something he should have been tested for and began treatment for years ago.

9. Schizophrenia

To me, schizophrenia is one of the most interesting mental illnesses. I used to enjoy working with schizophrenic patients when I worked in the mental hospital, although I did feel very bad for them.

Imagine being tormented by voices telling you bad things about yourself, thoughts that someone is trying to poison you, or seeing visions of dead bodies everywhere. That’s just some of the things people with schizophrenia I’ve worked with were tortured by.

To be diagnosed with schizophrenia, a person has to have two or more of the following:

Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behavior
Emotional flatness

Contrary to popular believes, most people with schizophrenia are harmless.

8. Bipolar Disorder

Most people with bipolar disorder are diagnosed by age 25, although different things can bring out underlying bipolar symptoms, such as pregnancy.

“Bipolar” is a term loosely used these days, usually to describe someone who seems to have mood swings, although in most cases, people with bipolar disorder don’t change their moods from moment to moment, and if you ever get to meet someone with severe bipolar disorder and they are not on their medication, you will know it and probably never forget it.

I’ve seen grown men swinging from trees and women drop from exhaustion after running ragged for four days straight, partying, sleeping with half a dozen men and charging thousands of dollars on credit cards they can’t afford.

7. Panic Disorder

Sweating, rapid heart beat, nausea, shortness of breath, dizziness, fear, loss of control, chest pains, tingling, smothering sensation, these are all symptoms of panic disorder.

Panic disorder and panic attacks are common, and can be triggered by certain events such as riding in an elevator, being in a crowd, having to give a speech or being in a place where there is no easy escape (agoraphobia).

1 out of 3 people with agoraphobia become housebound and are basically held hostage in their own homes by their illness.

6. Anxiety Disorders

Anxiety disorders include obsessive compulsive disorder (OCD), post traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD).

OCD is a combination of reoccurring thoughts (obsessions) and actions (compulsions) that a person performs because they believe it gives them control. For instance, a person may believe they have to take 50 baths a day or they aren’t clean and they may lose their job, friends and family to this behavior.

PTSD occurs after a person experiences a terrifying even in which they face great bodily harm, death, fear or helplessness. They may then have reoccurring thoughts, nightmares, heighten fear and avoidance behaviors. Many rape victims and soldiers coming back from war experience PTSD, but so do people who have been robbed, beaten or in a car accident.

GAD is basically when someone has anxiety, stress and worry for at least 6 months period for no specific reason. Some of these people are considered “worry worts” in layman terms, but their anxiety can cause them to have a host of physical systems and a decreased quality of life.

5. Phobias

Phobias are related to anxiety disorders and there is almost a phobia for everything although social phobia is one of the more common phobias.

In social phobia, everyday situations causes the person to become self-conscious and nervous, often leading to physical responses such as sweating which then causes the person to become even more self-conscious and nervous.

Children with social phobia often go through great lengths to avoid going to school and once at school may either be super anti-social or go to extremes to avoid other students by skipping, or staying in the clinic and feigning and illness.

A person can pretty much have a phobia of anything. Check out http://www.phobalist.com

4. Attention Deficit/Hyper Activity Disorder

This is another one I’ve written about previously. ADHD is very common and most children learn to manage their illness or outgrow it altogether, but some will have ADHD throughout their adult life.

3. Eating Disorders

Anorexia nervosa, bulimia nervosa and binge-eating are common illnesses, usually affecting females.

People suffering from anorexia, when a person looks in the mirror, no matter how thin they are, all they see is a fat person. They then go through great lengths to restrict their food and burn calories until often they are on the verge of starving themselves to death, and sadly many do just that.

People suffering from bulimia are often of normal body weight, but binge on large quantities of food, then feel guilty about it and then may try to vomit it back up, exercise obsessively, or use laxatives to try to get rid of the food and calories.

People who suffer from binge-eating are caught in a vicious cycle of over-eating, feeling guilty about the over-eating, and then over-eating to try to self-soothe themselves, which all of course leads to weight gain and shame.

2. Personality Disorders

All humans have personality traits, most which are relatively fluid, based on our culture, upbringing and experiences. Many of us even have some traits of personality disorders, but people with true personality disorders have traits that are so rigid that they impair their ability to function and get along with people in their everyday life.

Some of the most common personality disorders diagnosed include:

Antisocial personality disorder– these people don’t follow rules of society, often care little about other people unless they can use them for their own gain, they can’t empathize or feel sorry for people, they generally show no remorse. They often have criminal behavior.
Avoidant personality disorder– these people are anxious, usually over-controlled and fear criticism, making them hesitant to become involved with other people. There for, they tend to avoid people as much as possible.
Borderline personality disorder– these people are generally impulsive, unstable, suicidal at times, fear abandonment while at the same time they tend to push people away from them, resulting in tense, unstable relationships.

1. Mood Disorders

Mood disorders are the number one most diagnosed mental illness in developing countries and something that nearly everyone can relate to in one form or another.

Mood disorders are sustained emotions that go beyond the usual, normal feelings of sadness, to deeper feelings such as dysthymic disorder and major depression.

Abnormal Psychology, Popular Psychology

One Mother’s Experience with Bipolar Disorder and the Importance of Support Groups for Caregivers

18 Sep 201217 Sep 2012by Torey C. Richards, LMHC2 Comments

The other day I was fortunate to have the opportunity to speak with a former client’s mother about her experiences dealing with her now 19 year old daughter, who was diagnosed with bipolar disorder at the age of 8.

This girl from what I knew of her was extremely unstable, as could be expected from a teenager suffering from bipolar disorder.

Unlike other people suffering from bipolar disorder, teenage girls tend to be even more fickle when you factor in the normal hormones of teenagers as well as social pressures that make even some non-bipolar teens act and feel erratic.

This girl was prone to bouts of depression, mania, impulsivity and explosive anger.

At home her mom had done everything she was supposed to do to support her child including psychotherapy, family therapy and medication, but her daughter was still a hand-full.

When she was in her manic states she tended to have anger directed towards her mother and would at times try to get physical with her and had to be hospitalized several times for suicidal/homicidal ideations.

Her mother tried all she could to pacify her daughter, including painting her room the pretty purple she wanted, only to come home one day and find nearlyevery inch of that wall covered in permanent marker with words directed towards her mother such as “bitch”, “whore” and “I hope you die”.

On top of that she was extremely needy, wanting to be up under her mom 24/7 to the point that she got angry whenever her mom left her and would tear up the house or refuse to go to school.

When she was depressed she would self-mutilate and attempt to kill herself. Her mother would be afraid to leave her alone.

“My biggest fear, even today, is that I will come home and find her dead”, the mother told me.

The biggest thing this mother did that made the most difference was getting educating herself on her daughter’s illness and counseling for herself and joining a support group.

Support groups are invaluable resources that often aren’t utilized enough by those living with or taking care of people with mental illnesses or substance issues.

Through counseling and the support group she learned that she was not alone, that many other parents were on the same roller coaster ride she was on.

She also learned how to change the way she had been dealing with her daughter.

If what you are doing isn’t getting you the results you desire, you have to try something different.

She started accepting that her daughter was going to have good days and bad days, and sometimes within the same day. She also had to understand her role and limitations as the mother of a child with bipolar disorder.

She had to accept that some days she might feel like giving up, or not care when her daughter threatens to hang herself, and that doesn’t make her a bad mother, but it is a sign that she needs to take a break, regroup and seek support herself.

At the end of our reunion I was happy to see that a mother, who just a couple of years ago who was so flustered, angry and exhausted, had turned into a woman not only surviving, but thriving with a daughter suffering from bipolar disorder.

Her and her daughter are doing better, but they are still taking it one day at a time.

Abnormal Psychology

On Childhood Disintegrative Disorder

23 May 201223 May 2012by Torey C. Richards, LMHCLeave a Comment

We conclude our discussion on the Pervasive Developmental Disorders with a brief overview of Childhood Disintegrative Disorder.

Introduction

Childhood Disintegrative Disorder (CDD), is also known as Heller’s Syndrome and Disintegrative Pschosis. It is a rare Pervasive Developmental Disorder that affects about 1 in 100,000 children. CDD resembles many of the other disorders on the Autism spectrum in the fact that it involves developmental delays, impairment in communication and social functioning, but most closely resembles Rett syndrome in that it almost exclusively affects boys whereas Rett syndrome almost exclusively affects girls. New research suggest that while CDD affects boys more than girls at a rate of 4 to 1, it is thought that girls diagnosed with CDD most likely should have been diagnosed with Rett. There is also further talk that in the future Rett and possibly even CDD won’t be separate diagnosis, but that they will both be collapsed into the Autistic category as low functioning forms of Autism.

Symptoms

Children with CDD develop normally up until about ages 2 to 4 years of age (rarely there are cases of delayed onset up to 10 years of age), and then start regressing, losing previously acquired developmental skills with in a few months to years, including language, non-verbal communication skills, motor skills and social skills.

Symptoms include:

Delay or lack of spoken language
Impairment in nonverbal behaviors
Inability to start or maintain a conversation
Lack of play
Loss of bowel and bladder control
Loss of language or communication skills
Loss of motor skills
Loss of social skills
Problems forming relationships with other children and family members

Causes

There are no known causes of CDD although abnormal electroencephalograms (EEG), epilepsy, Lipid storage diseases (excess build up of toxic fats in the brain and nervous system), Tuberous sclerosis (benign tumors that may grow in the brain and other vital organs) and Subacute sclerosing panencephalitis (chronic infection of the brain due to a form of the measles that damage the brain) all appear to be associated with CDD.

Treatment

There is no cure for Childhood Disintegrative Disorder and the treatment for it is similar to the treatment for all of the Pervasive Developmental Disorders with the addition of trials with steroid medications to try to slow down the progress of the disorder.

Diagnosis

Physicians will use some of the same assessment tools used to diagnose the other Pervasive Developmental disorders with the inclusion of all the symptoms listed above and impairment in normal function or impairment in at least two of the following three areas:

Social interaction
Communication
Repetitive behavior & interest patterns

The main symptoms to look for in diagnosing CDD is the loss of previous learned skills in at least two of these areas:

Expressive language skills (being able to produce speech and communicate a message)
Receptive language skills (comprehension of language – listening and understanding what is communicated)
Social skills & self-care skills
Control over bowel and bladder
Play skills
Motor skills

If your child has any developmental delays or starts to lose developmental functions previously learned, it is vital to talk with your physician in order to rule out CDD or any of the Pervasive Developmental Disorders or mental retardation. The faster any illness is discovered and treatment begins, even if there is no cure, the better the prognosis or at least the slowing of the progress of the disorder. Some children with similar, yet less severe symptoms may have a learning disability or something much less serious than a Pervasive Developmental Disorder, but it is important to have everything ruled out for the best care of your child.

Abnormal Psychology, Uncategorized

On Rett Syndrome

21 May 201221 May 2012by Torey C. Richards, LMHCLeave a Comment

An Introduction to Rett Syndrome

What separates Rett syndrome from the other Pervasive Developmental Disorders is that it almost exclusively affects girls, whereas Autistic Disorder affects boys at a much higher rate than girls.

Worldwide Rett Syndrome affects 1 in every 10,000 to 15,000 females of all races and ethnicity. Prenatal testing is possible for families who have had a child born with Rett, but since the chances of developing Rett is so low, the chances of a family having two children born with Rett is less than 1%. Most boys born with the genes thought to be responsible for Rett often die shortly after birth. Because Rett syndrome is thought to be caused by a mutation to the X chromosome, girls are thought to be more able to compensate for the mutation because they have two X chromosomes where boys only have one and aren’t able to compensate.

In Rett Syndrome, similar to Asperger’s, there is normal early development and then a slowing of development, distinctive hand movements, lack of purposeful use of hands, and slowed head and brain growth. Problems walking, seizures and intellectual disability are usually also present. This disorder was first described by Dr. Andreas Rett, an Austrian physician in 1966, but it wasn’t until later in 1983 that it was recognized as a disorder after an article about it was written by Swedish researcher Dr. Bengt Hagbeg.

Like all of the Pervasive Developmental Disorders, the severity of symptoms in Rett varies from child to child, but they all start with relatively normal development, although loss of muscle tone (hypotonia), jerkiness in limb movements and difficulty feeding are often noticeable even in infancy. Gradually more apparent physical and mental symptoms become apparent such as the inability to talk and loss of purposefully movement of hands which is followed by compulsive hand movements such as wringing and washing. Other symptoms such as problems walking, crawling and lack of eye contact may also be early signs. This period of regression is often sudden. The inability to perform motor functions (Apraxia) is one of the most severe disabilities of Rett syndrome, it effects body movement, eye gaze and speech.

Early stages of Rett syndrome often resemble Autistic disorder or one of the other Pervasive Developmental Disorders. Some symptoms may also include walking on toes, awkward gait, difficulty chewing, teeth grinding, slowed growth, sleep problems, breathing problems, air swallowing, cognitive disabilities and apnea (holding breath)..

Diagnosis

Rett is typically diagnosed by a developmental pediatrician, pediatric neurologist or clinical neurologist using many of the same neurological, physical and psychological assessments used to diagnose the other Pervasive Developmental Disorders with the inclusion of genetic testing to look for the MECP2 mutation on the child’s X chromosome.

The Diagnostic and Statistical Manual of Mental Disorders also has these criteria for diagnosing Rett Disorder.

All of the following:
- apparently normal prenatal and perinatal development
- apparently normal psychomotor development through the first 5 months after birth
- normal head circumference at birth
Onset of all of the following after the period of normal development:
- deceleration of head growth between ages 5 and 48 months
- loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (i.e., hand-wringing or hand washing)
- loss of social engagement early in the course (although often social interaction develops later)
- appearance of poorly coordinated gait or trunk movements
- severely impaired expressive and receptive language development with severe psychomotor retardation

Causes

According to research, nearly all cases of Rett syndrome are due to a mutation in the metyl CpG binding protein 2 (MECP2) gene. The gene was discovered in 1999 and controls many other genes. It may also be responsible for some of the other Pervasive Developmental Disorders. This gene is needed for brain development and helps other genes increase or decrease their own unique expressions and proteins. This genes malfunction causes other genes to become abnormal. The puzzling thing is, not everyone with MECP2 mutation has Rett syndrome, so other genetic mutations are also thought to be responsible and research is ongoing. Rett syndrome is not thought to be genetic. Only about 1% of Rett syndrome cases are thought to be inherited, which means that in the overwhelming majority of cases, the gene mutations are random.

Treatment

Just like all the other Pervasive Developmental Disorders, there is no cure for Rett Syndrome and treatment is pretty similar including medication and therapy to help control and minimize many of the disabling features of Rett syndrome.

Although Rett syndrome can be very disabling, many people with Rett live to be in their 40’s and 50’s and perhaps even longer .

Resources

International Rett Syndrome Foundation: www.rettsyndrome.org

National Institute of Child Health and Human Development (NICHD): www.nichd.nih.gov

Office of Rare Diseases: www.rarediseases.info.nih.gov

Rett Syndrome Research Trust: www.rsrt.org

Abnormal Psychology, Popular Psychology

On Asperger’s Disorder

17 May 201217 May 2012by Torey C. Richards, LMHCLeave a Comment

In the 1940s, a pediatrician working in a clinic in Vienna named Hans Asperger treated several patients who displayed similar symptoms. However, because his work was conducted during World War II, none of it was seen amongst the English-speaking world so it wasn’t until the 1980s that his work was discovered by the English-speaking community and was translated in 1991 by Uta Frith. The characteristic first described by Hans Asperger became known as Asperger’s Disorder.

What Is Asperger’s Disorder?

Just like all of the Pervasive Developmental Disorders, children with Asperger’s have trouble relating to others. In some children this means that they do not like interacting with others, or that they do enjoy interacting with others but lack the non-verbal skills (i.e. eye contact, smiling, facial expression, touching) necessary to have full interaction. Having a two way conversation with a child with Asperger’s is often very difficult because they have trouble understanding figures of speech, sarcasm, subtle suggestions and often take speech very literally. These children are also often unaware of their own behavior and can’t relate to other children at their developmental level.

Children with Asperger’s also often have unusual behaviors and interests. Some children become almost obsessed with an object or ideal to the point that they exclude everything else. For example, a young man I worked with was very interested in sports and would talk you to death about sports, but only sports and if you tried to talk to him about anything unrelated to sports he would just go back to talking about sports. In other children, they may have extreme reactions to simple changes to their environment (i.e. movement of furniture or objects) or routine.

While all children with Asperger’s have impairment in social and behavior functions, the degree of impairment differs in each child. To be diagnosed with Asperger’s the symptoms have to be severe enough that it impacts their life (i.e. school functioning, family function, or social life).

How Does Asperger’s Differ from Autistic Disorder?

Asperger’s differs from Autistic Disorder in that there are no significant delays in cognition or language development. Many children with Asperger’s have difficulty with non-verbal communication, hand eye-coordination and may appear clumsy. Some children with Asperger’s have an exceptional vocabulary and may speak earlier than expected. Because children with Asperger’s appear to develop normally, they usually aren’t diagnosed before the age of five while children with Autistic Disorder are generally diagnosed earlier. Some people reach all the way to adulthood without being diagnosed with Asperger’s, whereas children with Autistic Disorder generally aren’t expected to live independently.

Risk for Other Issues

Children with Asperger’s Disorder are often also diagnosed with Attention Deficit/Hyperactivity Disorder. They are also at a higher risk for Obsessive-Compulsive disorder. Undiagnosed children with Asperger’s often experience depression and social isolation, especially in their adolescent years when peer interactions and relationships become more important.

Diagnostic Criteria (Diagnostic and Statistical Manual of Mental Disorders IV)

I) Qualitative impairment in social interaction, as manifested by at least two of the following:

(A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
(B) failure to develop peer relationships appropriate to developmental level
(C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people)
(D) lack of social or emotional reciprocity

(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:

(A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(B) apparently inflexible adherence to specific, nonfunctional routines or rituals
(C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
(D) persistent preoccupation with parts of objects
(III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.

(IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years, communicative phrases used by age 3 years)

(V) There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.

(VI) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.”

I Think My Child May Have Asperger’s Disorder, What Do I Do?

If you think your child has symptoms of Asperger’s Disorder, contact your physician, school psychologist or a licensed psychologist to initiate an evaluation. Thorough medical, family and developmental histories will be taken, as well as interviews with the family and child as well as behavioral observations to help determine if a diagnosis of Asperger’s Disorder is correct.

All of the interventions and prognosis for Asperger’s Disorder are basically the same for all the other Pervasive Developmental Disorders and you can find those on my post about Pervasive Developmental Disorders.

Resources

Attwood, Tony. (2006) The Complete Guide to Asperger’s Syndrome. Jessica Kingsley Publishers.

Online Asperger Syndrome Information and Support

(OASIS) http://udel.edu/bkirby/asperger/

Center for Autism and Related Disabilities (CARD): http://card.ufl.edu/

Abnormal Psychology, Popular Psychology, Uncategorized

On Autistic Disorder

16 May 201216 May 2012by Torey C. Richards, LMHCLeave a Comment

In my years in the field of mental health, I’ve had the privilege to work briefly with children who had Autistic Disorder. That brief time gave me a tremendous amount of respect for these children, those who work with them regularly as well as the parents who care for them around the clock. The degree of impairment in each child was sometimes drastically different. Some didn’t move from the same spot all day, staring out into space and rocking back and forth while others were very mobile and verbal (even if I couldn’t understand a word they were saying). Most of them were very rigid however in appearance, behavior and psychomotor activity.

If you haven’t done so already, you may want to read the post I wrote on Pervasive Developmental Disorders in order to get a better understanding of Autistic Disorder and all of the other Pervasive Developmental Disorders under the Autism Spectrum.

Autistic Disorder shares a lot in common with all the previously discussed Pervasive Developmental Disorders and is sometimes referred to as early infantile autism or childhood autism. To add to the confusion of labeling, some professionals use Autistic Disorder to describe all five of the pervasive developmental disorders (Autistic Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s disorder, Pervasive Developmental Disorder Not Otherwise Specified) under the Autistic spectrum.

Brief Introduction to Autistic Disorder

Autistic Disorder is four times more common in boys than in girls. Children with Autistic Disorder have a moderate to severe range of communication, behavior problems and socialization abilities. Many of them also have mental retardation. It is also thought to be high genetic.

Like all of the other Pervasive Developmental Disorders, parents of children with Autistic Disorder normally notice signs within the first two to three years of life. They usually develop gradually, but sometimes the child will develop normally at first and then regress.

Early behavioral and cognitive interventions are essential in helping children with Autistic Disorder learn to improve their skills of self-care, communication and socialization. Most children with the disorder will never live independently as adults and while there is no cure, they have been reported cases of children who have appeared to recover from it.

Diagnostic Criteria for Autistic Disorder

The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) uses these criteria to aid in the diagnosis of Autistic Disorder.

Six or more items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):
1. 1. qualitative impairment in social interaction, as manifested by at least two of the following:
    1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
    2. failure to develop peer relationships appropriate to developmental level
    3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
    4. lack of social or emotional reciprocity
1. qualitative impairments in communication as manifested by at least one of the following:
  1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
  2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
  3. stereotyped and repetitive use of language or idiosyncratic language
  4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
1. restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
  1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
  2. apparently inflexible adherence to specific, nonfunctional routines or rituals
  3. stereotyped and repetitive motor manners (e.g., hand or finger flapping or twisting, or complex whole-body movements)
  4. persistent preoccupation with parts of objects
Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.
The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

For more information visit http://www.autismspeaks.org

Abnormal Psychology, Uncategorized

Pervasive Developmental Disorders

15 May 201215 May 2012by Torey C. Richards, LMHCLeave a Comment

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

Abnormal Psychology, Popular Psychology

Bipolar Disorder in Children and Adolescents

10 May 201210 May 2012by Torey C. Richards, LMHC3 Comments

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.