Tag: children

Abnormal Psychology, Uncategorized

Pervasive Developmental Disorders

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

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

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

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

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

Pervasive Developmental Disorders Not Otherwise Specified

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

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

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

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

Causes of PDDNOS

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

Symptoms/Signs of PDDNOS

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

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

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

Diagnosis

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

Treatments

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

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

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

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

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

Resources

Autism Coalition
http://www.autismcoalition.com

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


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


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


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


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

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

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

Abnormal Psychology, Popular Psychology

Bipolar Disorder in Children and Adolescents

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

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

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

Bipolar Disorder

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

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

Symptoms

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

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

Treatments

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

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

Where to go for Help?

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

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.