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, 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.

Abnormal Psychology, Popular Psychology

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

7 May 20128 May 2012by Torey C. Richards, LMHCLeave a Comment

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’?

4 May 2012by Torey C. Richards, LMHCLeave a Comment

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.

Popular Psychology

Letting the Dead Die this Easter Sunday

7 Apr 20127 Apr 2012by Torey C. Richards, LMHC3 Comments

Holding on to Dead Stuff

One of the reasons we get cheated out of the most our lives can be is because we hold on to too much dead stuff. Dead relationships, dead jobs and dead dreams.

This Easter, the resurrection, no matter what religion (or no religion) you believe in, can have significant meaning for all of us. Perhaps you are married to something that is dead or holding on to a dream that is dead. Too many of us are holding on to death.

Many of us have dreams that need to die. It’s not the most pleasant thought, but holding on to a dream that will never come to fruition holds us back from realizing the dreams that can and have already come true. It can’t happen until you let that dream die.

A new great relationship can’t happen until you let your old relationship die. You’re tied to something dead.

Your dream job might be right around the corner, but it’s hard if not impossible to get to it if you are holding on to your dead job.

What’s in Your Life that Needs to Die?

This Easter, and periodically afterwards, I want you to examine what is it in your life that needs to die. Maybe it’s a fantasy. Maybe you’re holding out for the perfect person and you’re missing so many other terrific people because you won’t let that fantasy die. This Easter is all about resurrection. Let what is dead go so that you can make room in your life for everything that is waiting to be raised.

Easter represents the the new life we all can find by living in the truth. Let what needs to die die so that this Easter Sunday, and everyday forward, you can be free to be all you were meant and born to be.

Popular Psychology

Attention Deficit and Hyperactivity Disorder: A Quick Primer

31 Mar 201231 Mar 2012by Torey C. Richards, LMHCLeave a Comment

Taking a Closer Look at ADHD

Attention Deficit/Hyper Activity Disorder (ADHD) is defined in the Diagnostic and Statistical Manual IV (DSM IV) as a composite disorder including two major syndromes which are inattentive and hyperactivity-impulsivity which may occur independently, starting before the age of 7 and cause some impairment in two or more settings (i.e. home and school).

Types of ADHD

The DSM goes on to break the diagnosis down to four types:

Attention-Deficit/Hyperactivity Disorder; Predominately Inattentive Type
Attention-Deficit/Hyperactivity Disorder: Predominately Hyperactive-Impulsive Type
Attention-Deficit/Hyperactivity Disorder; Combined Type
Attention-Deficit/Hyperactivity Disorder Not Otherwise Specified

The diagnostic criteria for ADHD is fairly broad. Most of us at some point and time could theoretically meet the criteria for ADHD which brings me to the reason for this post. Is ADHD a real disorder?

Controversy

ADHD has been a controversial disorder since the 1970s. Most of the controversy surrounds the questions of over diagnosing the disorder, using stimulants such as Ritlan, Adderal and Tenex (which are chemically similar to illegal drugs such as Speed and Cocaine) to treat the disorder, especially in children and even over diagnosing the disorder in minorities and poor people for financial gain (we’ll explore this in another post). Common side effects we know from using stimulants include:

Psychosis
Addiction
Nervousness including agitation, anxiety and irritability
Trouble Sleeping
Decreased appetite
Headache
Stomach ache
Nausea
Dizziness
Heart Palpitations
Slowing growth in children
Seizures
eyesight changes or blurred vision

These are all serious side effects that need to be taken into consideration when prescribing stimulants to anyone, especially children, but often these things are ignored in the medicalization of deviant behavior.

Most healthcare providers in America recognize ADHD as a legitimate disorder, although in the United Kingdom the disorder isn’t as quickly diagnosed or treated with stimulants due to no one really knowing the long-term effects of using these stimulants due to there not having been any long-term studies on them.

I personally believe that ADHD is a real diagnosis. I’ve diagnosis children as well as adults with ADHD and feel confident in my diagnosis. I currently work with three teenagers who I have diagnosed with ADHD and none of them are on medication although they are prescribed medication. In there cases, I personally believe that medication would benefit because when they aren’t on their medication they don’t seem to be in control of themselves and their grades and behavior suffer. However, I have evaluated nearly one hundred students this year for ADHD and I’ve only diagnosed three. The others have some signs of ADHD, but I truly believed that most of their “deviant behavior” stems from a poor educational system and poor parenting. I do feel like it is over-diagnosed and over-medicated.

A lot of the signs and symptoms of ADHD are just children being children, products of their environment, poor parenting and poor educational systems. Not everyone who meets criteria for the disorder should actually be diagnosed and then subsequently medicated with stimulants which can cause undesirable side effects.

If you have a child you think may have ADHD then get them evaluated by a school psychologist or another qualified healthcare/mental health provider. If your child is diagnosed with ADHD, see about natural remedies such as changes in diet, vitamins, supplements and cognitive behavioral treatments. WebMD has a good page on some Home Remedies to help with ADHD. Always question your healthcare provider before just taking the prescription for stimulants and getting it filled. Ask about non-stimulant medication such as Strattera and other alternative medications if medication is recommended. Always educate yourself, your child and your family and be active members of you and your child’s mental and physical health.