Category: depression

Your child’s ADHD diagnosis could be wrong, leaving other issues untreated

Your child’s ADHD diagnosis could be wrong, leaving other issues untreated

Inattention and distractibility are caused by many medical conditions and life situations.  You child may not have ADHD or ADD if they didn’t show signs when they were young.

Children don’t just catch ADHD or ADD

If your child has a behavioral change you haven’t seen before, there may be an underlying medical or co-occurring mental disorder that’s causing ADHD symptoms… especially if they’re on ADHD-ADD medications which are not working well.

“It is vital not to mistake another medical or psychiatric condition as ADHD.”
Richa Bhatia, MD, Fellow of the American Psychiatric Association

The medical conditions listed below produce ADHD and/or ADD symptoms such as slow processing speed, impulsive behavior, and limited attention and focus.

  • Epileptic seizures: some types cause a brief freeze in thinking–the child’s brain goes blank for a few moments (“absence seizures”)
  • Diseases of the brain: Lyme disease, HIV infection, parasitic and viral infections, brain tumors
  • Brain damage from head injury or toxins (e.g. narcotics)
  • Chemotherapy side-effects, “stupor”
  • Hypothyroidism.  Too little thyroid hormone results in memory, attention, and concentration problems. It decreases blood flow in brain regions that mediate attention and executive functioning (the hippocampus and cerebral cortexes).
  • Hyperthyroidism. At the other extreme, too much thyroid hormone causes anxiety and tension, irritability and impatience, and hyperactivity and distraction.
  • Sleep apnea. A condition where a child stops breathing during sleep, for a few seconds to a few minutes several times per night.  The following day, the child can’t pay attention, remember, or follow a sequence of steps.  It also causes hyperactivity and belligerence.


Mental health disorders with ADHD-like symptoms:

Anxiety disorders are common to most other mental health conditions, and create problems with concentration.  The chronic stress from anxiety affects the brain regions responsible for memory and cognitive functions.   If a child does not have a history of ADHD symptoms, than significant and pervasive anxiety may be the cause of inattention and distraction.

Abuse or trauma. Difficulty concentrating is one of the core symptoms of post-traumatic stress disorder (PTSD), and recent abuse or trauma can cause agitation, restlessness, and behavioral disturbance—symptoms that mimic ADHD.

Depression – Difficulty concentrating also is a criterion for major depressive disorder.

Bipolar disorder – ADHD symptoms are apparent in children with suspected bipolar disorder. Both disorders can cause distractibility, increased energy, and instant mood swings. (Some children are eventually diagnosed with both disorders.)

Drug abuse using marijuana, cocaine, ecstasy, produce similar symptoms of ADHD because they affect the same brain regions affected by anxiety.  MRI scans of the brain were taken of young children who were exposed to cocaine in the womb. The scans revealed frontal lobe malformations which predicted long-term problems with attention and impulse control.

Common stimulant foods and beverages with excess caffeine or sugar

Insomnia from medical conditions. Sleep plays a huge role in memory and attention. Sleep disorders (e.g., sleep apnea, restless legs syndrome) can produce chronic tiredness and significantly reduce attention, concentration, and cognitive functioning in children, adolescents, and adults.

Plain old lack of sleep in healthy children can cause inattention and reduce academic achievement.  There are many causes of sleep loss:  early school hours; screen time at least an hour before bed (because the blue light suppresses sleepiness); or allowing the use of technology in the bedroom at nighttime.  What helps getting to sleep and staying asleep:

  • A cool, dark room
  • Thirty minutes of reading or drawing on paper before lights out.
  • Removing phones, laptops, or desktops from the bedroom at night.


Learning disorders:
Children with an undiagnosed learning disorder often present with ADHD symptoms. An undiagnosed reading or mathematics disorder (dyslexia), or an autism spectrum disorder that’s not yet diagnosed, can have a significant impact on classroom behavior.  The child might not be paying attention because of his (her) restricted ability to grasp the subject matter, or because they are frustrated and irritated with the struggle to keep up.

Caution:  Teachers often report a student’s inattention and confused thinking to parents, and suggest a diagnosis of ADHD when the real problem may be lack of sleep or something else.  It’s useful to hear classroom observations of your child, but teachers are not trained in mental health diagnosis—get a second opinion from a professional!

More on the consequences of untreated ADHD or another underlying disorder is in this article:  “ADHD kids become troubled adults.”

–Margaret


Subject matter was drawn from this article by psychiatrist Dr. Richa Bhatia.

“Rule out these causes of inattention before diagnosing ADHD”
Richa Bhatia, MD, FAPA, Current Psychiatry. 2016 October; 15(10):32-C3

Marijuana is uniquely dangerous for troubled teens

Marijuana is uniquely dangerous for troubled teens

Marijuana’s effect on adolescents is more serious than many realize, especially for those with behavioral disorders.  This is no exaggeration; marijuana can lead to psychosis and long-term cognitive impairment for your troubled child.  Numerous recent research studies show that marijuana has a more damaging effect on the young brain than is generally understood. The THC in marijuana is psychoactive, which means it can affect your child’s unbalanced brain chemistry more than the general population. Serious depression, anxiety, paranoia, and psychosis can be triggered in children with latent psychiatric vulnerabilities. (Additional marijuana research going back to 2004 is at the end of this article).

Just because marijuana is plant-based does not mean it is safe.  It has dangerous side-effects like any other psychoactive drug.

Marijuana legalization has deeply concerned pediatric psychiatrists and other specialists in child, adolescent, and young adult mental health treatment.  Up until the their early 20’s, young people’s brains undergo radical changes as part of normal development.  Neurons are “pruned” to reduce their number (yes indeed, one can have too much gray matter to function as an adult). Pruning occurs rapidly in teenagers–think about it, in addition to puberty, a lot of nonsensical teenage behavior can be explained by this.  The THC in marijuana, the part responsible for the high, interferes with the normal pruning process.

When marijuana is ‘medicinal,’ a doctor determines a safe dose.  When it is ‘recreational,’ there is no such limit… teen users don’t realize there should be.

Let’s talk about a safe “dose,” which is different for each person.

THC is known to relieve anxiety in smaller doses and increase it in larger; this is due to its bi-phasic effects, meaning it can have two opposite effects in high doses. Furthermore, some people are genetically predisposed to experience anxiety with cannabis as a result of brain chemistry.”
–What are the Side-Effects of High THC Cannabis. Bailey Rahn, 2016

Recent evidence that marijuana leads teenagers to harder drugs

“The study of the lives of more than 5,000 teenagers produced the first resounding evidence that cannabis is a gate way to cocaine, amphetamines, hallucinogens and heroin.” Read the full story

“Teenagers who regularly smoke cannabis are 26 times more likely to turn to other drugs by the age of 21.  It also discovered that teenage cannabis smokers are 37 times more likely to be hooked on nicotine and three times more likely to be problem drinkers than non-users of the drug.”
–Steve Doughty and Ben Spencer, Daily Mail, London UK, June 7, 2017

Now let’s talk about long-term.  Our troubled children are already slipping behind their peers in important ways, which can include school; emotional maturity (certainly); and physical health (such as gut and digestive problems).   Marijuana will add to your teen’s problems by causing lethargy, impaired memory, and cognitive delays.

We can’t pretend or assume marijuana is safe anymore, regardless of its legality or medicinal uses.

I found this research result extremely worrisome:

“Increasing levels of cannabis use at ages 14-21 resulted in lower levels of  degree attainment by age 25, lower-income at age 25, higher levels of welfare dependence, higher unemployment, lower levels of relationship satisfaction, and lower levels of life satisfaction.”
–Cannabis use and later life outcomes.  Fergusson DM, Boden JM, Addiction;  Pp: 969-76;  Vol: 103(6), June 2008

I worked with adolescents in residential care and in the juvenile justice system who regularly used marijuana when they could.  A young man on my caseload grew noticeably depressed after he started smoking regularly, and his anxiety, irritability, and paranoia increased.  He said that smoking helped him feel better, but he couldn’t observe what I and other social workers observed over time. Smoking marijuana, ironically, was temporarily relieving him of its own side-effects.

A clarification about the two substances in marijuana – The plant Cannabis sativa has two chemicals of interest:

  1. Cannabidiol (CBD) = Medical marijuana:  the molecule is safe for a variety of treatments, such as relief of pain and nausea, and it is approved by the American Medical Association;
  2. Tetrahydrocannabinol (THC) = psychoactive “high”:  in those who are vulnerable it, triggers psychotic symptoms, paranoia, depression, anxiety, and memory loss.

Your troubled child’s future is already at-risk, why worsen it with marijuana use?

All children need the same warnings that we give about alcohol and street drugs to include marijuana.  Whether you live in a jurisdiction where marijuana is legal or not, teens can and will find it.  It may not be possible to completely prevent your troubled child from using, but your caring persistence can reduce or end its use.

marijuana infographic

Please share this information with other parents.  

–Margaret

12 Ways Dogs Reduce Depression & Anxiety

12 Ways Dogs Reduce Depression & Anxiety

Most people know that dogs are good for one’s wellbeing, but these creatures literally improve one’s physical and mental health.

Dogs are medicine.

1. They lower our blood pressure

Research has proven time and time again that dogs significantly lower heart rates and blood pressure, before and after performing strenuous tasks. Blood pressure drops when one pets a dog. Petting dogs have also been known to ease pain and improve one’s immune system. It is like a dog’s mere presence is beneficial for pet owners.

2. They offer a soothing presence

Pets, particularly dogs, offer a soothing presence when one is performing tasks that take up a lot of mental energy. This goes a long way in helping speed up recovery of mental conditions.  It is well-known that some children will only respond to animals due to trauma or autism or intense anxiety.

3. They offer unconditional love and acceptance

Dogs are incapable of criticizing, judging or voicing their opinions. They snuggle up next to you even if you smell like poop.  Two reports describe the medical benefits of pets.  According to a 2013 white paper from the American Heart Association “…owning a pet, particularly a dog or a cat, is associated with decreased cardiovascular risk factors.”  The November 2015 Current Gerontology and Geriatrics Research published research showing “pet therapy programs have been shown to be effective in helping improve socialization abilities, lower blood pressure, and combat loneliness.”

There are other great therapy pets : “Benefits have been seen in owners of pets ranging from dogs, cats, birds, and fish to goats, chimps, and snakes.”  Be sure the right animal is matched to the owner.

4. Dogs alter our behavior

You or your child could come home annoyed at a million little problems that happened during the day, and maybe even taking anger out on someone. But imagine that before this happens, a smiling, tail-wagging dog walks up for attention.

Imagine, you or your child kneels and pets her, she licks your face and you smile. Just like that, your behavior is altered and chances that someone will become a casualty of frustration are now much better. People calm down in the presence of a dog, and don’t anger easily or use curse words.  Dogs make us slow our minds and our speech.

5. Dogs promote touch

There is no disputing the healing power of touch. An article published on Huffington Post cites that a 45-minute massage can reduce the levels of cortisol, a stress hormone, and build white blood cells which optimize one’s immune system. Hugging floods human bodies with oxytocin, a hormone that lowers heart rates, blood pressure and stress levels.

A study conducted at the University of Virginia showed that holding hands reduces stress-related activity in the hypothalamus region of the brain, which makes up part of the emotional center. It shouldn’t come as a surprise that stroking a dog can boost dopamine and serotonin levels while lowering heart rate and blood pressure.

6. Dogs distract us

It’s not a problem but a benefit! Dogs take us out of our heads and plunge us into another reality – one that involves affection, food, water… and scratching doggie butt for as long as we allow it. Distraction is sometimes the only thing you or your child needs when you have lost mental or emotional control. It is tough to ponder feeling awful when your dog is breathing in your face.

7. Dogs make us responsible

Owning a dog comes with responsibility and research has shown that responsibility promotes mental health. Psychologists assert that applying our skills to a job and taking ownership of a task helps build our self-esteem, which is why dogs are the most common therapy animals. When your child nurtures a happy healthy dog, it reinforces confidence and a sense of competence. This is especially important for troubled children who are often overtaken by their own thoughts and emotions.  Finally, pet care helps kids and teenagers learn independence and brings structure to their day.

Dogs pull a depressed or anxious child (or parent) out of their troubled head.

8. Dogs increase social interaction

Staying connected to other people or creatures is good for our depression. Starting a conversation is particularly scary for people suffering from depression. That isn’t true with dogs. They are natural social magnets that help pet owners connect with other people and maintain positive social contact.  Walk a dog, and people come up to meet the dog.

9. Dogs help one get into physical shape

Other than grooming, dogs need physical stimulation. This means taking walks and going out to a park to play. In the process of tossing a Frisbee or hiking with your pup, you get to exercise and enjoy nature simultaneously.

The energy boost consequently boosts your mood or blow off some steam.  Blood flow and oxygen to the brain is good for depression. When outside with a dog, your skin synthesizes vitamin D from the sun, which helps fight symptoms of depression.

10. Dogs are great listeners

The most effective way to release stress is to talk about it with someone. But what if you don’t have the courage to approach a friend? What if the idea of talking about your innermost worries makes you anxious?  Pet owners, particularly those who own a dog, will share their wishes and thoughts with a caring partner, with the guarantee that they won’t be disclosed to someone else. Even better, you can talk about your worries knowing that you won’t be judged

11. Dogs provide sensory stress relief

Movement and touch are some of the most effective ways to manage stress. Dogs offer the need for touch such as in grooming, petting and exercising them. Such tasks also help with sensory stress relief, which is particularly important for people suffering from depression.

12. Dogs help you find meaning and joy in life

Taking care of a dog can help lift morale and increase a sense of self-worth, optimism, and fulfillment.  If you’ve adopted a shelter dog, it’s also fulfilling to know you (and your child) provided a home to a dog that may have otherwise been euthanized.

Take care of your dog and your dog will take care of you.

Conclusion

The physical and mental health benefits of owning a dog for children, teenagers, and even the elderly are proven by research.

Note: Owning a dog is not a miracle cure for a family and child coping with anxiety and depression. Dogs are for those who appreciate and love domestic animals, and those who invest money and time to keep their dog healthy and happy.

By Andy McNaby

Founded by animal lovers, we provide honest reviews of pet products. We review products hands-on and we test products side-by-side, so you know you’re getting good honest reviews.

Use the “S” word: talk openly with your child about suicide

Use the “S” word: talk openly with your child about suicide

Don’t be silent on the subject of suicide, even if there’s no evidence your child has considered it.  Bring it in the open, especially if you have a hunch something is wrong and they may have suicidal thoughts.  This article addresses:

  1. Why you should talk about suicide with your child
  2. How to respond if there’s been a threat
  3. How to respond if there’s been an attempt

Parents talk about many uncomfortable subjects with their child; and suicide must be one of them.

Don’t let suicide become a ‘sensitive’ subject.  Your child needs to hear about it from you.  They should feel safe talking about it.  Don’t expect them to bring this subject up.  They may fear you will overreact, and worsen their depression, or you could under-react or dismiss it because you’re uncomfortable.  Neither response helps.

Won’t this give my child ideas and encourage suicidal thoughts?

No.  Children usually know what suicide is and will have wondered about it—even young children. Ask what your child thinks. Children as young as 7 and 8 have asked about suicide or communicated they had suicidal thoughts.  Children as young as 10 and 11 have attempted or completed suicide.  The ages of highest suicide risk are between 10 to 24.

Talk with your child. Don’t leave him or her alone with thoughts or questions about suicide.

An 11-year-old boy died of suicide a couple of weeks before this article was written. There had been no prior signs.  He killed himself after receiving a prank text saying his girlfriend had committed suicide. He told no one beforehand.  His parents had no idea he was even at risk.

Why might my child become suicidal?

Mental health professionals assess risk by using the Biopsychosocial Model.  The more negatives in the biological, social, and psychological aspects of one’s life, the higher the risk of suicide or other mental health problems.

The major risks of suicide are in the central part of this diagram: drug effects, temperament, IQ, family relationships, trauma.

From Pinterest and the blog, Social Workers Scrapbook

What can you control and change at home?
What do you and family members need to reduce these risks?
Communicate about these with everyone. (Can be hard to do, but try.)

What can trigger suicidal thoughts?

Examples from two states that did the research:

Oregon: Survey results for an exceptionally high suicide rate among 10-24 year olds by population, 180 individuals in one year (“Suicide circumstances by life stage, 2013-2014”).

  • 62% – Current depressed mood
  • 53% – Relationship problems
  • 47% – Current mental health problems
  • 43% – Current/past mental health treatment
  • 42% – History of suicidal thoughts/plans
  • 31% – Recent/imminent crisis
  • 22% – Family relationship problems
  • 21% – Non-alcohol substance abuse problems
  • 8% – School problem

New York: Life situations of children completing suicide, 88 individuals; (“Suicide Prevention, Children Ages 10 to 19 Years”, 2016)

  • Feeling hopeless and worthless (often because of bullying at school, home, or online)
  • Previous suicide attempt(s)
  • Physical illness
  • Feeling detached and isolated from friends, peers, and family
  • Family history of suicide, mental illness, or depression
  • Family violence, including physical or sexual abuse
  • Access to a weapon in the home
  • Knowing someone with suicidal behavior or who committed suicide, such as a family member, friend, or celebrity
  • Coping with homosexuality in an unsupported family, community, or hostile school environmental
  • Incarceration (time in juvenile detention or youth prison)

What if my child has threatened suicide?

A threat opens a door for a discussion.  A good approach is to interview your child about their feelings, plans, needs, and reasons.  Listen earnestly without input.*  You might be surprised to find their problem is solvable, but their depressed mood paints it as hopeless.  Listening helps them get clarity and feel heard and respected.  Once you understand their problems, you assist them in identifying options and provide emotional support.

* I have a friend who worked for a suicide hotline, and he said the job wasn’t difficult at all.  He said, “All I did was listen and show understanding of their feelings and just let them talk. “

After a frustrating discussion about my teenage daughter’s suicidal threats, I gave up and said “No.  I’m telling you not to commit suicide.”  She was incredulous; “You can’t tell me what to do!  You can’t stop me!”  I responded, “Don’t commit suicide. You’re important to us.  You have important things to do in life.”  She made a few attempts in the following years (they were always public… as if she wanted to be discovered and prevented), and she always reached out to her family afterwards for support.  Did my words make a difference?

What if a threat is just for attention?

It’s hard to tell. It could be genuine  or manipulative.  Some children use threats to prevent parents from asserting rules.  Angry children, especially teens, use threats to blame and hurt parents emotionally.  If you think a threat is not genuine, open up the suicide discussion.  “Talk to me about this”, “It seems like an extreme reaction to something we can fix.” “What needs to change?”  “How can I help?”  Focusing on the threat will either expose the ruse or draw out important information for addressing an underlying problem.

What else can I do if my child threatens suicide?

  1. Observe and investigate.
  • Do they have access to unsafe objects or substances?  You can legally search their room.
  • Do they frequent unsafe places or spend time with people who encourage drug use?
  • Do they have extreme mood swings (up or down), or a chronic dark mood?
  • Do they take dangerous risks and seek dangerous activities?
  • Are there any other danger signs?
  1. Build a network of eyes–choose people who will observe your child and keep you advised of risk, e.g. a mature sibling, a teacher, your child’s friend or the friend’s parents, your child’s boyfriend or girlfriend, a relative, or a trusted person who knows your child.
  1. Make changes you have control over, and solidly commit to these changes. Bring the whole family along on the plan.  FOLLOW THROUGH.
  • In family life – reduce chaos, fighting, blaming, or bullying; express appreciation; neglect no one including yourself; create 2 – 3  house rules that are easy to enforce and everyone follows, even you.
  • In social and online life – learn as much as you can about the nature of your child’s relationships, whether romantic or social. Support them if they distress your child. Can they remove themselves from a toxic relationship? or cope effectively with anxiety? Can you help them address bullying at school or online?
  • Biological health – Sleep, Exercise, Diet.  Limit screen time at night because blue light inhibits sleep.  Pay attention to digestive health, which affects mental health. These are some natural approaches.
  • Psychological health – Ask a school counselor about your child.  Seek a working diagnosis and mental health treatment.  Help your child find outlets for personal self-expression:  journaling, music, art, poetry, or a website such as this one, where teens help teens.  Mind Your Mind is an excellent example.

What if my child attempted suicide?

He or she is still very fragile, even if in treatment!  They have taken the action, they’ve been there, and have the option for taking it again—a high percentage try againSuicide attempts are long-term emergencies. You need to be on alert in the following days, weeks, months, and possibly years.  In addition to intensive mental and physical health treatment, ensure your child gets regular deep sleep, exercise, and a good diet.  Ask them if they’ve had suicidal thoughts if you sense something is wrong.  Don’t be shy about checking in.

Pay attention to events that trigger suicide.

Check-in with your child when something traumatic happens or might happen, especially if someone he or she knows attempted or committed suicide, or a suicide was in a TV drama or covered in the news.  Triggers are an emergency, act immediately.

You have the power to prevent a child’s suicide.
Be strong. You can do this. 

Take care of yourself.

–Margaret

What to know about psychiatric residential treatment

What to know about psychiatric residential treatment

residential centerHave you been searching for psychiatric residential treatment for your child?  Do all the programs sound wonderful?  Ads include quotes from happy parents, and lovely photos and fabulous-sounding activities.  But what’s behind the ads?  Residential treatment programs are diverse, but there are important elements they should all have.  Here’s how to avoid low quality residential treatment.

Psychiatric residential treatment is serious stuff–it’s difficult to do–especially when troubled children and teens are put together in one facility.

Should you ask other parents for their opinion of a program?  In my experience with a child in psychiatric residential care, and as a former employee of one, word-of-mouth is not a reliable way to assess quality or success rate.  There are too many variables: children’s disorders are different; acuity is different; parents’ attitudes and expectations are different; length of time in the facility is different; what happens once a child returns home is different…  It’s most helpful to ask questions of intake staff and doctors or psychologists on staff.  Quality psychiatric residential care facilities have important things in common.

What to ask about the staff:

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  • What is the training and licensure of staff?  Are there therapists with MSW degrees, registered nurses, psychiatrists and psychiatric nurse practitioners, and is a medical professional available on site 24/7?
  • There should be a high staff to patient ratio, and a physically comfortable environment with lots of emotional support.
  • Do the staff seem mature to you?  Do they support each other, are they a team? There is often heavy staff turnover at residential treatment centers because the work is emotionally draining, so staff cohesion is as important as the qualities of each individual.
  • Safety is paramount.  What are the safety and security plans in the facility?  Staff must be able to safely manage anything that can go wrong with troubled kids.  They should be trained in NCI (Nonviolent Crisis Intervention), “training that focuses on prevention and offers proven strategies for safely defusing anxious, hostile, or violent behavior at the earliest possible stage.”

What to ask about programs:

  • Does the program specifically identify parent/family involvement as part of treatment?  Does it emphasize parent partnership with staff?  Ask.  Whether you live close or far from the center, even out-of-state, you should be regularly included in conversations with staff about your child’s treatment.  You should also be included in a therapy session with your child periodically; some facilities can connect with you over Skype.  Your child’s success in psychiatric care depends on their family’s direct involvement.
  • The program should coach you in specific parenting approaches that work for child’s behavioral needs.  While your child is learning new things and working on their own changes, you must know what to establish back home when they return.
  • You should be informed why your child is getting the treatment or behavioral modifications he/she is receiving.
  • Last and most important: when your child leaves, there should be a discharge meeting and a discharge plan.  What this means:  all staff who worked with your child get together with you and discuss what treatment should continue once they go home.  Medication management and therapy is identified in advance, appropriate school accommodations are discussed, changes in the home environment are discussed if needed…  You should never leave without knowing what comes next in the months following care.

Body health is brain health, and vice versa.

  • residential programsMental health treatment will include medication and therapy, but must also include positive activities and an educational program.  The whole body needs care:  exercise, social activities, therapeutic activities (art, music, gardening), healthy food, restful sleep, etc.

Is your child emotionally safe as well as physically safe?

  • You should be able to visit the unit or cottage where your child will live, see their bedroom, and see how the other children interact with staff and how staff interact with each other.

What to ask about the business itself:

  • Can you take a tour ahead of time?  Can your child or teen visit too if appropriate?
  • Are emergency services nearby (hospital, law enforcement) that can arrive quickly?
  • Does the facility have a business license in their state?  Do they have grievance procedures?  Is the center accredited as a treatment facility, and by whom?  In the U.S., the main accreditation authority for healthcare facilities is The Joint Commission.

Psychiatric residential treatment works miracles, but it doesn’t work for all children.  Some need to go into treatment more than once to benefit. Some fall apart a few weeks or months after discharge.  These are common.  What’s important is that staff observations and advice help you and your child with insight and skills for managing his or her unique symptoms, and for communicating effectively.

Good luck.

 

What was your experience when your child was in residential care?  Please share your comment so others can learn.