ADHD/ADD

Attention-deficit hyperactivity disorder (ADHD) is one of the most common reasons children are referred for mental health services. It affects as many as one in every 20 children. Although boys are three to four times more likely than girls to experience ADHD, the disorder affects both boys and girls.

While the condition is most often associated with children, there has been a more recent understanding that Attention Deficit Disorders (ADD, ADHD) continue into adulthood for many individuals. Symptoms such as inattention, impulsivity and over activity are now known to continue into adulthood for a significant percentage of children with ADD. Unfortunately, relatively few adults are diagnosed or treated for ADD.

The prevalence of ADD in adults is unknown; very few have been studied. In the few treatment studies of adults, there does not appear to be a significant sex difference. About two-thirds of the children who are diagnosed in or before elementary school with ADD continue to have behavioral symptoms in adolescence. During this time period, associated behavioral, learning, and emotional problems also manifest themselves. Approximately one-third to one-half of these adolescents continue to have symptoms of ADD during their adult years.

Causes

ADHD is nobody’s fault. Researchers believe that biology and genes play a large role in the development of ADHD. In fact, 30 to 40 percent of children diagnosed with ADHD have relatives with the same disorder. Brain scans reveal that the brains of children with ADHD differ from those of children without the disorder. Children with ADHD are thought to have problems with the part of the brain that controls the organization and direction of thought and behavior.

The exact cause or causes of ADD are not conclusively known. Scientific evidence suggests that in many cases the disorder is genetically transmitted and is caused by an imbalance or deficiency in certain chemicals that regulate the efficiency with which the brain controls behavior. A 1990 study at the National Institute of Mental Health correlated ADD with a series of metabolic abnormalities in the brain, providing further evidence that ADD is a neurobiological disorder.

There is little scientific evidence to suggest that environmental factors, dietary factors such as food dyes or sugar, inner-ear problems or “visual motor” difficulties are the underlying cause of ADD.

SYMPTOMS

ADHD

There are three main types of ADHD. One type is characterized by inattentiveness, one type is characterized by hyperactive or impulsive behavior, and the third type is combined—when children exhibit signs of both types. Symptoms are often unnoticed until a child enters school. To be diagnosed with ADHD, a child must show symptoms in at least two settings, such as home and school, and the symptoms must interfere with the child’s ability to function at home or school for at least six months. Specialists have agreed that at least six symptoms from the following lists must be present for an accurate diagnosis, and symptoms must begin by age 7.

Signs of inattentive behavior:

• Has difficulty following instructions
• Has difficulty focusing on tasks
• Loses things at school and at home
• Forgets things often
• Becomes easily distracted or has difficulty listening
• Lacks attention to detail, makes careless mistakes or is disorganized
• Fails to complete homework or tasks

Signs of hyperactive behavior:

• Is fidgety
• Leaves seat when they shouldn’t
• Runs or climbs inappropriately
• Talks excessively
• Has difficulty playing quietly
• Always on the go
• Blurts out answers
• Has trouble waiting their turn
• Interrupts

The presence of some symptoms, however, does not confirm a diagnosis of ADHD. Just because a child has a lot of energy or difficulty paying attention in school does not mean the child has ADHD. An accurate diagnosis relies on the presence of a range of symptoms and difficulties that prevent the child from performing at an appropriate level for his or her age and intelligence level. Teachers often first observe these issues, and their input should be considered seriously.

ADD

Adults who are living with the condition, and especially those who are undiagnosed and untreated, may be experiencing a number of problems, some of which stem directly from the disorder and others that are the result of associated adjustment patterns.

Current symptoms of an adult with ADD may include:

• Distractibility
• Disorganization
• Forgetfulness
• Procrastination
• Chronic lateness
• Chronic boredom
• Anxiety
• Depression
• Low self-esteem
• Mood swing
• Employment problems
• Restlessness
• Substance abuse or addictions
• Relationship problems

The symptoms of ADD can be variable and situational, or constant. Some people with ADD can concentrate if they are interested or excited, while others have difficulty concentrating under any circumstances. Some avidly seek stimulation, while others avoid it. Some become oppositional, ill-behaved and, later, antisocial; others may become ardent people-pleasers. Some are outgoing, and others, withdrawn.

Autism

Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. Some people with ASD have a known difference, such as a genetic condition. Other causes are not yet known. Scientists believe there are multiple causes of ASD that act together to change the most common ways people develop. We still have much to learn about these causes and how they impact people with ASD.

There is often nothing about how people with ASD look that sets them apart from other people. They may behave, communicate, interact, and learn in ways that are different from most other people. The abilities of people with ASD can vary significantly. For example, some people with ASD may have advanced conversation skills whereas others may be nonverbal. Some people with ASD need a lot of help in their daily lives; others can work and live with little to no support.

ASD begins before the age of 3 years and can last throughout a person’s life, although symptoms may improve over time. Some children show ASD symptoms within the first 12 months of life. In others, symptoms may not show up until 24 months or later. Some children with ASD gain new skills and meet developmental milestones until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had.

A diagnosis of ASD now includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. These conditions are now all called autism spectrum disorder. Updated criteria for diagnosing ASD include problems with social communication and interaction, and restricted or repetitive behaviors or interests. It is important to note that some people without ASD might also have some of these symptoms. But for people with ASD, these characteristics can make life very challenging.

Social Communication and Interaction Skills

Social communication and interaction skills can be challenging for people with ASD.

Examples of social communication and social interaction characteristics related to ASD can include:

• Avoids or does not keep eye contact
• Does not respond to name by 9 months of age
• Does not show facial expressions like happy, sad, angry, and surprised by 9 months of age
• Does not play simple interactive games like pat-a-cake by 12 months of age
• Uses few or no gestures by 12 months of age (e.g., does not wave goodbye)
• Does not share interests with others (e.g., shows you an object that he or she likes by 15 months of age)
• Does not point or look at what you point to by 18 months of age
• Does not notice when others are hurt or sad by 24 months of age
• Does not pretend in play (e.g., does not pretend to “feed” a doll by 30 months of age)
• Shows little interest in peers
• Has trouble understanding other people’s feelings or talking about own feelings at 36 months of age or older
• Does not play games with turn taking by 60 months of age
• Restricted or Repetitive Behaviors or Interests

People with ASD have behaviors or interests that can seem unusual. These behaviors or interests set ASD apart from conditions defined by only problems with social communication and interaction.

Examples of restricted or repetitive interests and behaviors related to ASD can include:

• Lines up toys or other objects and gets upset when order is changed
• Repeats words or phrases over and over (i.e., echolalia)
• Plays with toys the same way every time
• Is focused on parts of objects (e.g., wheels)
• Gets upset by minor changes
• Has obsessive interests
• Must follow certain routines
• Flaps hands, rocks body, or spins self in circles
• Has unusual reactions to the way things sound, smell, taste, look, or feel

Other Characteristics

Most people with ASD have other characteristics. These might include:

• Delayed language skills
• Delayed movement skills
• Delayed cognitive or learning skills
• Hyperactive, impulsive, and/or inattentive behavior
• Epilepsy or seizure disorder
• Unusual eating and sleeping habits
• Gastrointestinal issues (e.g., constipation)
• Unusual mood or emotional reactions
• Anxiety, stress, or excessive worry
• Lack of fear or more fear than expected

It is important to note that children with ASD may not have all or any of the behaviors listed as examples here.

Anxiety Disorder

Most people experience feelings of anxiety before an important event such as a big exam, business presentation or first date. Anxiety disorders, however, are illnesses that cause people to feel frightened, distressed and uneasy for no apparent reason. Left untreated, these disorders can dramatically reduce productivity and significantly diminish an individual’s quality of life.

Anxiety disorders are among the most common mental illnesses in America; over 21% of adults (42.5 million) are affected by these debilitating illnesses each year.

Causes

Stress is a normal, proportional reaction to a stressful situation or external pressures. It’s normal to feel stressed about a final exam or job interview. Anxiety in anxiety disorders is characterized by feelings of apprehension or unexplained thoughts of impending doom.

While most individuals will experience some form of anxiety in their lives, there is still research being done on the causes of anxiety disorders. New research shows that anxiety disorders run in families, and that they have a biological basis, much like allergies or diabetes and other disorders. Anxiety disorders may develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.

For people who experience trauma, anxiety is a way that the brain and body has reacted to the traumatic experience – sometimes as a protective measure. When we’re feeling attacked it makes sense to be on guard and not trust others. For people who have been through trauma, those thoughts and protective behaviors can continue even when danger is gone. Finding ways to feel safe, re-teach your body and mind to readjust to feelings of safety, and working through bad experiences can help.

Symptoms

• Feeling restless
• Feeling tired
• Difficulty concentrating or losing their train of thought
• Irritability
• Muscle pain, tightness, or soreness
• Difficulty sleeping – both falling asleep or staying asleep

Depression

Basic Facts About Depression

• Major depression is one of the most common mental illnesses, affecting 6.7% (more than 16 million) of American adults each year and 3.2% of children aged 3-17 years (approximately 1.9 million).
• Depression causes people to lose pleasure from daily life, can complicate other medical conditions, and can even be serious enough to lead to suicide.
• Depression can occur to anyone, at any age, and to people of any race or ethnic group. Depression is never a “normal” part of life, no matter what your age, gender or health situation.
• While the majority of individuals with depression have a full remission of the disorder with effective treatment,only about a third (35.3%) of those suffering from severe depression seek treatment from a mental health professional. Too many people resist treatment because they believe depression isn’t serious, that they can treat it themselves or that it is a personal weakness rather than a serious medical illness.

Causes

Many things can contribute to clinical depression. For some people, a number of factors seem to be involved, while for others a single factor can cause the illness. Oftentimes, people become depressed for no apparent reason.

Biological – People with depression may have too little or too much of certain brain chemicals, called “neurotransmitters.” Changes in these brain chemicals may cause or contribute to depression.

Cognitive – People with negative thinking patterns and low self-esteem are more likely to develop clinical depression.

Gender – More women experience depression than men. While the reasons for this are still unclear, they may include the hormonal changes women go through during menstruation, pregnancy, childbirth and menopause. Other reasons may include the stress caused by the multiple responsibilities that women have.

Co-occurrence – Depression is more likely to occur along with certain illnesses, such as heart disease, cancer, Parkinson’s disease, diabetes, Alzheimer’s disease, Multiple Sclerosis and hormonal disorders.

Medications – Side effects of some medications can bring about depression.

Genetic – A family history of depression increases the risk for developing the illness. Some studies also suggest that a combination of genes and environmental factors work together to increase risk for depression.

Situational – Difficult life events, including divorce, financial problems or the death of a loved one can contribute to depression.

Symptoms

• Persistent sad, anxious or “empty” mood
• Sleeping too much or too little, middle of the night or early morning waking
• Reduced appetite and weight loss, or increased appetite and weight gain
• Loss of pleasure and interest in activities once enjoyed
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment (such as chronic pain or digestive disorders)
• Difficulty concentrating, remembering or making decisions
• Fatigue or loss of energy
• Feeling guilty, hopeless or worthless
• Thoughts of suicide or death

Reactive Attachment Disorder (RAD)

Reactive attachment disorder (RAD) is a condition in which an infant or young child does not form a secure, healthy emotional bond with his or her primary caretakers (parental figures).

Children with RAD often have trouble managing their emotions. They struggle to form meaningful connections with other people. Children with RAD rarely seek or show signs of comfort and may seem almost fearful of their caretakers, even in situations where the current parent figures seem quite loving and caring. These children are often irritable or sad, and may report feeling unsafe and/or alone.

Symptoms

Symptoms of reactive attachment disorder vary from child to child. Infants and young children who may have RAD show common signs such as:

• Failure to show an expected range of emotions when interacting with others; failure to show “emotions of conscience” such as remorse, guilt, or regret
• Avoiding eye contact and physical touch, especially with caregivers
• Expressing anger; having tantrums; being irritable, unhappy and sad; disobedience and arguing (beyond what would be “usual” for the child’s age and situation)
• Displaying inappropriate affection toward strangers while demonstrating a lack of affection for and/or fear of their primary caretakers.

When children with RAD grow older, their symptoms usually fall into one of two general patterns:

• Inhibited RAD symptoms. Children are aware of what happens around them, but they do not respond typically to outside stimuli. Children showing inhibited RAD symptoms are withdrawn and emotionally unresponsive. They may not show or seek affection from caregivers or others, keeping largely to themselves.
• Disinhibited RAD symptoms. Children may be overly friendly toward strangers. Children with disinhibited RAD symptoms do not prefer their primary caretakers over other people. In most cases, these children act younger than their age and may seek out affection from others in an unsafe way.

Speech Disorder

Some children struggle with understanding and speaking and they need help. They may not master the language milestones at the same time as other children, and it may be a sign of a language or speech delay or disorder.

Language development has different parts, and children might have problems with one or more of the following:

• Understanding what others say (receptive language). This could be due to
  • Not hearing the words (hearing loss).
  • Not understanding the meaning of the words.
• Communicating thoughts using language (expressive language). This could be due to
  • Not knowing the words to use.
  • Not knowing how to put words together.
  • Knowing the words to use but not being able to express them.

Language and speech disorders can exist together or by themselves. Examples of problems with language and speech development include the following:

• Speech disorders
  • Difficulty with forming specific words or sounds correctly.
  • Difficulty with making words or sentences flow smoothly, like stuttering or stammering.
• Language delay – the ability to understand and speak develops more slowly than is typical
• Language disorders
  • Aphasia (difficulty understanding or speaking parts of language due to a brain injury or how the brain works).
  • Auditory processing disorder (difficulty understanding the meaning of the sounds that the ear sends to the brain).

Language or speech disorders can occur with other learning disorders that affect reading and writing. Children with language disorders may feel frustrated that they cannot understand others or make themselves understood, and they may act out, act helpless, or withdraw. Language or speech disorders can also be present with emotional or behavioral disorders, such as attention-deficit/hyperactivity disorder (ADHD) or anxiety. Children with developmental disabilities including autism spectrum disorder may also have difficulties with speech and language. The combination of challenges can make it particularly hard for a child to succeed in school. Properly diagnosing a child’s disorder is crucial so that each child can get the right kind of help.

Detecting problems with language or speech

If a child has a problem with language or speech development, talk to a healthcare provider about an evaluation. An important first step is to find out if the child may have a hearing loss. Hearing loss may be difficult to notice particularly if a child has hearing loss only in one ear or has partial hearing loss, which means they can hear some sounds but not others.

A language development specialist like a speech-language pathologist will conduct a careful assessment to determine what type of problem with language or speech the child may have.

Overall, learning more than one language does not cause language disorders, but children may not follow exactly the same developmental milestones as those who learn only one language. Developing the ability to understand and speak in two languages depends on how much practice the child has using both languages, and the kind of practice. If a child who is learning more than one language has difficulty with language development, careful assessment by a specialist who understands development of skills in more than one language may be needed.

Treatment for language or speech disorders and delays

Children with language problems often need extra help and special instruction. Speech-language pathologists can work directly with children and their parents, caregivers, and teachers.

Having a language or speech delay or disorder can qualify a child for early intervention (for children up to 3 years of age) and special education services (for children aged 3 years and older). Schools can do their own testing for language or speech disorders to see if a child needs intervention. An evaluation by a healthcare professional is needed if there are other concerns about the child’s hearing, behavior, or emotions. Parents, healthcare providers, and the school can work together to find the right referrals and treatment.

What every parent should know:

Children with specific learning disabilities, including language or speech disorders, are eligible for special education services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA).

Get help from your state’s Parent Training and Information Center

The role of healthcare providers

Healthcare providers can play an important part in collaborating with schools to help a child with speech or language disorders and delay or other disabilities get the special services they need. The American Academy of Pediatrics has created a report that describes the roles that healthcare providers can have in helping children with disabilities, including language or speech disorders.

Occupational Therapy

Occupational therapy, which treats the social, mental, emotional, environmental and physiological effects of disabilities, disorders, illnesses, and injuries, can help patients become or remain independent. Occupational therapists give patients the “skills for the job of living,” such as caring for themselves, cooking, homemaking and working. They work with people of all ages to obtain productive, independent and satisfying lives.

The process is different for every patient. Sometimes it requires highly specialized types of therapy or different combinations of therapy. Occupational Therapy works closely with Physical Therapy, as well as Speech and Language Therapy.

Those who benefit from occupational therapy vary widely in age, profession and health status, and include those with:

• Limitations following a stroke or heart attack
• Mental health or behavioral problems
• Birth injuries
• Learning or developmental disabilities
• Substance abuse
• Eating disorders
• Broken bones or other injuries from falls, sports injuries or accidents
• Arthritis, Multiple Sclerosis and other chronic conditions
• Burns
• Amputations
• Spinal cord injuries
• Vision or cognitive problems that compromise the ability to function safely