Category: Abnormal Psychology

The darker side of psychology isn’t always as dark as it seems.

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.