Defending Fatherhood: The Impact Of Fathers And Father Figures On Children

Defending Fatherhood: The Impact Of Fathers And Father Figures On Children

bi-fathers-day-istockThe other day I came across a clip of actor Terry Crews as a guest on the show The View. In the clip, Terry Crews was basically defending fatherhood and I was somewhat amazed at how at times it seemed like one or more of the hosts of The View kept trying to attack fatherhood (the clip is at the end of the page). I realized that fatherhood in general is greatly under valued in today’s society.

So many of us have grown up without reliable fathers or father figures in our lives that we diminish the importance of fathers. So many women have been forced to raise children without a decent man in their children’s lives that they start to believe that a child having a father or father figure is an option that they’d prefer to do without.

As men we have to take some blame in this. Many of us have let or children and women down so much that we are considered elective pieces of the family dynamic and are often made to feel that way. Some women will try so hard to prove that they don’t need a man that they will also imply that their children don’t need a father either.

I’m not just talking about single mothers either. Even in marriages the father is often relegated to a relatively small role in raising the children. Sometimes fathers withdraw nearly completely from the task of helping raise the children, believing that child-rearing is a woman’s job and all they have to do is provide.

And while many single mothers do awesome jobs raising well-rounded children, especially the ones that have to, more often than not, those children struggle from the absence of a strong, positive male role model in their lives.

I am not saying that any man will do. Some men are bad fathers, bad role models or just bad people in general. They will do more harm to a child’s development than good. However, there are many good men who want and try to be good fathers, but are limited or not allowed to because of their child’s mother.

When I worked as a children’s therapist I ran into many women who moved multiple states away just to punish their child’s father. They were mad at him for whatever reason and decided to not only distance themselves from him, but to distance him from his children as punishment.

Many single mothers push their child’s father away either by making it extremely hard on him to see his children, or by turning the children against him. They want to make the father feel unwanted and unneeded and if the man isn’t strong enough, he may give up and walk away or greatly diminish his involvement in his child’s life.

Most of the times these children not only suffered from behavioral problems like stress, depression and anxiety, but many of them, especially the young boys ended up acting out in ways that the mother couldn’t handle, especially as they got bigger.

Many of the boys became disrespectful to the mother and women in general. They did poorly in school, got in trouble with the law and basically became unruly and why wouldn’t they? They were trying to figure out how to grow into a man without any decent examples and so they come up with their own, either modeling other young men, poor examples from their neighborhoods, or rappers, athletes or other celebrities.

Some of these same women often sent their boys back to live with their fathers once they got too out of hand, but by then the father-child bond has usually been so disrupted that the father doesn’t know how to effectively parent that child and the child has little understanding or respect for a parent who has been absent from their lives over a period of time.

While I feel that it is extra important that boys have a good male role model, no matter if it’s their biological father, stepfather, uncle, coach, teacher or any other reliable, nurturing, male, it is important that girls have a father figure as well as I wrote in my post absent fathers can lead to depression in teenage girls.

Healthy and respectful male role models can teach young girls how they should expect men to treat them. While at the same time, even fathers who are in the house that are angry and disrespectful to the mother are more likely to have children that develop anxiety, are withdrawn and are more likely to have unhealthy relationships.

So you see, it’s not just about having a man around, it has to be someone who is giving positively to the child’s social-emotional well-being.

Dr. David Popenoe, one of the pioneers of the young field of research into fathers and fatherhood says, “Involved fathers bring positive benefits to their children that no other person is as likely to bring.”

Involved fathers have an impact on a child’s emotional health, cognitive ability and educational outcomes.

Children with involved and nurturing fathers are more likely to be emotionally secure, confident, willing to explore their surroundings and end up with better social relationships. They are less likely to get in trouble at school, have disruptive behaviors or develop anxiety and depression.

Studies suggest that fathers who are nurturing, involved and playful with their infants end up having children with better linguistic skills, cognitive skills and higher IQs.

Toddlers with involved fathers tend to start school more academically ready, more patient and less likely to get frustrated or stressed when compared to toddlers with absent fathers or fathers who aren’t involved.

Adolescents and teenagers with involved, active and nurturing fathers tend to have better intellectual functioning, better verbal skills and higher academic achievement.

All of these benefits are amplified if that involved, nurturing male is the biological father, but it doesn’t have to be in order to still see positive benefits.

I’m not saying that any man will do, or even any biological father because any idiot can become a dad, it doesn’t mean that they will be the best role model for a child. What I am saying is that having a father figure is just as important as having a mother figure for every child. Fathers have a powerful and important impact on the development and health of a child.

Is Pretending to be Pregnant a Mental Illness: Part 2

In my original  post, Is Pretending to be Pregnant a Mental Illness, I discussed a high school teenager I have known for three, now going on four years, who has been “pregnant” every year and has had a “miscarriage” every year as well.

Last year was no different, but for some reason I believed she was pregnant, even when her closes friends did not. Still I remained skeptical, especially as the “pregnancy” went along and she didn’t get any bigger and refused to tell her mom about it.

Then summer came and I waited anxiously to see her when school started, knowing she should be close to her due time. Yet, when I saw her last week, she was no bigger than she was almost three months ago.

She told me that she had also “lost” that baby (big surprise), but now she is pregnant again and this time she isn’t making it up… and I believe her!

Why would I believe she is pregnant this time when she has lied about being pregnant four previous times?

Well this time she told me she told her mom, something she never did in her previous “pregnancies” even when I offered to talk to her mom with her.

Also, I know she has wanted to get pregnant for the past four years and so it was bound to eventually happen for real. I knew she was having unprotected sex with different guys.

And then today she showed me a picture of her getting a sonogram… a real picture this time and so yes, the girl who pretended to be pregnant for four years is finally pregnant.

It’s so sad because at 18 she is lost, she’s barely passing school, is extremely immature, admitted that her baby’s father is no good, that she doesn’t like him and her family doesn’t either, but yet they are bringing a child into this world.

There is no way she is ready to be a mother and yet, if everything goes right, she will be soon enough.

I’m concerned because this is a young lady with obvious mental issues and if she doesn’t get the help she needs she will raise a child who will potential have further issues because of being raised by an ill-prepared mother.

On top of everything, I really think this girl wanted to get pregnant to fulfill something missing in her life, maybe attention, unconditional love, purpose, who knows, and if having this baby doesn’t meet her conscious or unconscious expectations then where will that leave her and the child?

I see many mothers who had children for the wrong reasons (to keep a man, to fulfill a void, to prove that they can accomplish something, etc.) abandon their children physically, mentally or both when those expectations weren’t met.

Many of those parents end up abusing their kids, resenting them or being negligent in the way they raise their kids.

I’m not saying that this is definitely the case with this young lady, who knows? For a very few, having a baby serves as a catalyst to get them to step up and change their lives for the better so that they can be the best parent they can be for their child.

Unfortunately, that is rarely the case. Many impoverished, poorly educated, single, teenage moms end up dropping out of school and remaining in poverty.


The psychological issues that made this young girl persistently pursue to be pregnant for years will probably remain after she gives birth so I won’t be surprised if she isn’t pregnant or “pregnant” again and again even after she gives birth for real.

Stress During Pregnancy and it’s Affects on the Unborn Child

I have two close friends who are both first time mothers to be and although both are in healthy relationships and are overall healthy individuals, both of them are incredibly stressed, so much to the point that they both at times get very dysthymic, have trouble eating, sleeping, being intimate, feeling attractive and are easily irritable. 

When asked what exactly they are stressed about, they both answered that they are worried about being good mothers, about being financially secure enough to properly take care of their child, how their child will change their lives and mostly, if their child will be healthy despite all the signs that they are having a normal, healthy pregnancy. 

I found that last part to be very interesting. Their biggest concern was that their child is developing normally and that they will have a healthy child, yet the stress that they are experiencing may play a vital role in the health of their baby. 

Stress is a Part of Life

We all experience stress and pregnant women often experience stress more than any of us. Often times women who are pregnant are busy trying to run house holds, hold down jobs and balance a busy schedule. While stress is normal, how much stress is too much and does it affect the fetus?

It used to be considered a myth that too much stress affects the unborn child, but researchers, including Dr. Calvin Hobel, a perinatologist (an obstetrician who practices maternal-fetus medicine) in Los Angeles who studies the affects of stress on pregnancy, are providing more and more evidence that stress is bad for pregnant women and their unborn child. Stress not only increases the risk of pre-term labor, but also a number of problems after the child is born. 

Women who are stressed release hormones and those hormones “wash” over the fetus. Genetically the fetus is forced to react to environmental cues about how to best construct and respond within the capabilities of that specific gene to what is going on. According to Dr. Pathik Wadhwa, assistant professor of behavioral science, obstetrics and gynecology at University of Kentucky College of Medicine, “The fetus builds itself permanently to deal with this kind of high-stress environment, and once it’s born may be at greater risk for a whole bunch of stress-related pathologies.” 

Some of the most recognizable effects of maternal stress on pregnancy: pre-term births and low birth weight.

Baby’s who are born premature (before 37 weeks) are at risk of many complications later such as developmental delays, learning disabilities, chronic lung disease, pervasive developmental disorders, and even death. There is even research suggesting that babies who express stress in utero are more likely to suffer from heart disease, diabetes and high blood pressure as adults. More recent evidence is pointing to stress in utero affecting the baby’s temperament and possibly IQ. Baby’s who experience a lot of stress in utero are more likely to show signs of depression and irritability and are less likely to tune out repeated, unimportant stimuli, a predictor of IQ. 

Who the Mother is and What She is Like During Pregnancy Affects Who the Baby Will Turn Out To Be

According the the biopsychosocial model, we are who we are determine in part by biological, psychological and environmental influences. Mother’s who experience a lot of stress and anxiety during pregnancy are bathing their unborn child in those chemicals that affect the baby. Stress causes the mother’s nervous system to stimulate the release of epinephrine and norepinephrine which are stress hormones that restrict blood flow and oxygen to the fetus. Research also shows that the placenta in pregnant women who are stressed, releases more corticotropin-releasing hormone (CRH) which tells the body how long a pregnancy should last and helps the fetus reach maturation. This is probably largely responsible for the increase in pre-term birth and low birth weight. 

How much stress is too much stress?

It’s hard to say, it really comes down to the woman, her personality and how she copes with stress. One woman can work two or three jobs and be fine, while one woman may find herself in trouble just trying to hold down one job. The woman needs to listen to her body, her doctor and even her family member’s if they are worried that she is too stressed or anxious. Studies show that extra help for the mother to relive some of the psycho-social stress as well as work leaves as early as 24 weeks cut down on the risk of premature birth by about 21%

Ways to Relieve Stress

Somethings pregnant women can do to relieve stress include yoga (not strenuous yoga of course), biofeedback, guided imagery and deep breathing techniques. Also, having a great support network is crucial. It is important for the pregnant woman to slow down when she starts feeling stressed, even if that means cutting back on certain things and delegating tasks to others. 

Pregnant Women Should Take this Questionnaire! 

One way to measure your stress is to take this questionnaire developed by Dr. Hobel. For every question answer “yes”, “no” or “sometimes”. If you answer “yes” or “sometimes” to three or more questions, Dr. Hobel believes you may be stressed enough to warrant talking to a counselor or your physician to help put together an intervention to help protect you and your unborn child from stress.   

  1. I feel tense
  2. I feel nervous
  3. I feel worried
  4. I feel frightened
  5. I have trouble dealing with problems
  6. Things are not going well 
  7. I cannot control things in my life
  8. I am worried that my baby is abnormal
  9. I am concerned that I may lose my baby
  10. I am concerned that I will have a difficult delivery
  11. I am concerned that I will be unable to pay my bills
  12. I live apart from my partner or spouse
  13. I have extra-heavy homework
  14. I have problems at work
  15. Have you and your partner or spouse had any problems?
  16. Have you been threatened with physical harm?

Teen Mom Wants to Have Another Baby ASAP

What if your 18 year old daughter who is in the 11th grade of high school, already has a two year old child, told you she was planning on having another child by her new boyfriend in order to not be selfish?

Working with teenagers it’s rarely anything I see or hear these days that shock me, however, there are plenty of things I see and hear that leave me dumbfounded, including when one of my favorite teenage clients, who already has a child, told me that she plans to stop taking her birth control so she can get pregnant by her new boyfriend of only about three months. What?!?!

She told me that she thought it was UNFAIR to her son that he didn’t have a sibling and unfair to her new boyfriend that she didn’t have a child by him and that she felt like she was being selfish to everyone by WAITING until the right time (oh, let’s say after she finished high school, started a career, got married) to have another child. I sat listening to her, almost hoping that I had falling off into a daydream and that this was just all part of my imagination, but it wasn’t. This high school junior, soon to be senior, with one child at home already was telling me that she was planning on getting pregnant again as soon as possible! She is already raising this child without the father’s involvement and I shouldn’t say she is raising her child because her parents are actually the ones taking care of her and her current child, yet she wants to go and get pregnant again!

I know part of the psychology of why she wants to get pregnant again is to keep her current boyfriend around. She is thinking that if she gets pregnant by her current beau, they will stay together forever. I am sure she had that same delusional fantasy with her current child’s father who she hasn’t seen in over two years. You would think she would have learned, but the delusional, fantasy world and mind of a teenager is a hard shell to crack, no matter how many times the world gets dropped on it.

As I listened to her, I actually felt a great deal of heartache for her because she was about to go and do something dumb… at least in my professional opinion. The chances of her being 18 with two kids, barely a high school degree, and being successful aren’t in her favor, especially coupled with her history of alcohol and drug use and her impulsive behavior that often leads her to be in dangerous situations.

I tried and hope I spoke some sense into her. I told her that she isn’t being selfish by waiting for the right time (and person) to have another child. I told her that it is OKAY for her to be selfish when it comes to her life. A lot of times we are told so many times about not being selfish that we forget that sometimes being selfish is a form of self-care and self-preservation. I also told her that it wouldn’t be fair to her, her current child or her future children if she once again got pregnant by a man who wouldn’t be around to help her raise the child(ren) they produced together. I definitely tried to convince her that waiting until after high school, after college (which she plans to attend), and hopefully after getting married, would be the time for her to have more children if she so chose to do that. Being a high school senior next year with two kids her and her parents are raising together is not the situation she wants to be in.

I really hope I convinced her that having a child right now, with a guy she’s only known for three months, is not a rational decision, but a large majority of the teenage mind functions irrationally. Their brains are just wired differently at this age and we’ll explore that in a future post. The bottom line is, every high school girl I’ve worked with that got pregnant to keep a boy NEVER ends up with that boy more than a year or so later. Does it happen? I’m sure it does, but I haven’t seen it. Still, it doesn’t stop them from thinking otherwise and even if they already had a child and that child’s father disappeared shortly after the birth of the child, some of them will still be convinced, as this young lady is, that it won’t happen again.

This isn’t the first time I had to deal with something similar to this. Not too long ago one of my high school clients who had a baby less than a year ago, wanted to have another baby right away because that is what her boyfriend (the babys’ father) wanted. A month or so later they broke up because he wasn’t helping her take care of the baby they already had. Imagine if she would have gotten pregnant with a second child like she wanted.

On Childhood Disintegrative Disorder


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.

On Rett Syndrome

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

On Asperger’s Disorder

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/

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.