Mental Health

DISSOCIATIVE IDENTITY DISORDER (DID)

2009-06-03T07:49:00.000-07:00

Definition of DISSOCIATIVE IDENTITY DISORDER (DID)

DISSOCIATIVE IDENTITY DISORDER (DID) is a severe condition in which two or more distinct identities, or personality states, are present in—and alternately take control of—an individual. The person also experiences memory loss that is too extensive to be explained by ordinary forgetfulness. It is a disorder characterized by identity fragmentation rather than a proliferation of separate personalities. The disturbance is not due to the direct psychological effects of a substance or of a general medical condition, yet as this once rarely reported disorder has become more common, the diagnosis has become controversial. Some believe that because DISSOCIATIVE IDENTITY DISORDER (DID) patients are easily hypnotized, their symptoms are iatrogenic, that is, they have arisen in response to therapists' suggestions. Brain imaging studies, however, have corroborated identity transitions in some patients. DISSOCIATIVE IDENTITY DISORDER (DID) was called Multiple Personality Disorder until 1994, when the name was changed to reflect a better understanding of the condition—namely, that it is characterized by a fragmentation, or splintering, of identity rather than by a proliferation, or growth, of separate identities.

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DISSOCIATIVE IDENTITY DISORDER (DID) reflects a failure to integrate various aspects of identity, memory and consciousness in a single multidimensional self. Usually, a primary identity carries the individual's given name and is passive, dependent, guilty and depressed. When in control, each personality state, or alter, may be experienced as if it has a distinct history, self-image and identity. The alters' characteristics—including name, reported age and gender, vocabulary, general knowledge, and predominant mood—contrast with those of the primary identity. Certain circumstances or stressors can cause a particular alter to emerge. The various identities may deny knowledge of one another, be critical of one another or appear to be in open conflict.

Symptoms of DISSOCIATIVE IDENTITY DISORDER (DID)

The individual experiences two or more distinct identities or personality states (each with its own enduring pattern of perceiving, relating to, and thinking about the environment and self).
The reported range of identities is from 2 to more than 100. Half of the reported cases of DISSOCIATIVE IDENTITY DISORDER (DID) include individuals with 10 or fewer.
At least two of these identities or personality states recurrently take control of the person's behavior. Each may exhibit its own distinct history, self-image, behaviors, and, physical characteristics, as well as possess a separate name.
Particular identities may emerge in specific circumstances. Alternative identities are experienced as taking control in sequence, one at the expense of the other, and may deny knowledge of one another, be critical of one another or appear to be in open conflict. Transitions from one identity to another are often triggered by psychosocial stress.
Frequent gaps are found in memories of personal history, including people, places, and events, for both the distant and recent past. Different alters may remember different events, but passive identities tend to have more limited memories whereas hostile, controlling or protective identities have more complete memories.
Symptoms of depression, anxiety, passivity, dependence and guilt may be present.
In childhood, problem behavior and an inability to focus in school are common.
Self-destructive and/or aggressive behavior may take place.
Visual or auditory hallucinations may occur.
The average time that elapses from the first symptom to diagnosis is six to seven years.
The disturbance is not due to the direct psychological effects of a substance or of a general medical condition.

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Causes of DISSOCIATIVE IDENTITY DISORDER (DID)

Why some people develop DISSOCIATIVE IDENTITY DISORDER (DID) is not entirely understood, but they frequently report having experienced severe physical and sexual abuse, especially during childhood. Though the accuracy of such accounts is disputed, they are often confirmed by objective evidence. Individuals with DISSOCIATIVE IDENTITY DISORDER (DID) may also have post-traumatic symptoms (nightmares, flashbacks, and startle responses) or Post-Traumatic Stress Disorder. Several studies suggest that DISSOCIATIVE IDENTITY DISORDER (DID) is more common among close biological relatives of persons who also have the disorder than in the general population. As this once rarely reported disorder has grown more common, the diagnosis has become controversial. Some believe that because DID patients are highly suggestible, their symptoms are at least partly iatrogenic— that is, prompted by their therapists' probing. Brain imaging studies, however, have corroborated identity transitions.

Treatment for DISSOCIATIVE IDENTITY DISORDER (DID)

The primary treatment for DISSOCIATIVE IDENTITY DISORDER (DID) is long-term psychotherapy with the goal of deconstructing the different personalities and uniting them into one. Other treatments include cognitive and creative therapies. Although there are no medications that specifically treat DISSOCIATIVE IDENTITY DISORDER (DID), antidepressants, anti-anxiety drugs or tranquilizers may be prescribed to help control the mental health symptoms associated with it.

An intense interest in spiritualism, parapsychology, and hypnosis continued throughout the 19th and early 20th centuries, running in parallel with John Locke's views that there was an association of ideas requiring the coexistence of feelings with awareness of the feelings. Hypnosis, which was pioneered in the late 1700s by Franz Mesmer and Armand-Marie Jacques de Chastenet, Marques de Puységur, challenged Locke's association of ideas. Hypnotists observed second personalities emerging during hypnosis and wondered how two minds could coexist.

The 19th century saw a number of reported cases of multiple personalities which Rieber estimated would be close to 100. Epilepsy was seen as a factor in some cases and discussion of this connection continues into the present era.

By the late 19th century there was a general realization that emotionally traumatic experiences could cause long-term disorders which may manifest with a variety of symptoms. Between 1880 and 1920, many great international medical conferences devoted a lot of time to sessions on dissociation. It was in this climate that Jean-Martin Charcot introduced his ideas of the impact of nervous shocks as a cause for a variety of neurological conditions. One of Charcot's students, Pierre Janet, took these ideas and went on to develop his own theories of dissociation. One of the first individuals with DID to be scientifically studied was Clara Norton Fowler, under the pseudonym Christine Beauchamp; American neurologist Morton Prince studied Fowler between 1898 and 1904, describing her case study in his 1906 monograph, Dissociation of a Personality. Fowler went on to marry one of her analyst's colleagues.

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In the early 20th century interest in dissociation and DISSOCIATIVE IDENTITY DISORDER (DID) waned for a number of reasons. After Charcot's death in 1893, many of his "hysterical" patients were exposed as frauds and Janet's association with Charcot tarnished his theories of dissociation. Sigmund Freud recanted his earlier emphasis on dissociation and childhood trauma. Freud, a man who actively promoted his ideas and enlisted the help of others, won out over the "lone wolf" Janet who did not train students in a teaching hospital.

In 1910, Eugen Bleuler introduced the term "schizophrenia" to replace "dementia praecox" and a review of the Index medicus from 1903 through 1978 showed a dramatic decline in the number of reports of multiple personality after the diagnosis of schizophrenia "caught on," especially in the United States. A number of factors helped create a large climate of skepticism and disbelief; paralleling the increased suspicion of DISSOCIATIVE IDENTITY DISORDER (DID) was the decline of interest in dissociation as a laboratory and clinical phenomenon.

Starting in about 1927, there was a large increase in the number of reported cases of schizophrenia, which was matched by an equally large decrease in the number of multiple personality reports. Bleuler also included multiple personality in his category of schizophrenia. It was found in the 1980s that DID patients are often misdiagnosed as suffering from schizophrenia.

The public, however, was exposed to psychological ideas which took their interest. Mary Shelley's Frankenstein, Robert Louis Stevenson's Strange Case of Dr Jekyll and Mr Hyde, and many short stories by Edgar Allan Poe, had a formidable impact. In 1957, with the publication of the book The Three Faces of Eve, and the popular movie which followed it, the American public's interest in multiple personality was revived. DISSOCIATIVE IDENTITY DISORDER (DID) began to emerge as a separate disorder in the 1970s when an initially small number of clinicians worked to re-establish it as a legitimate diagnosis.

In 1974, the highly influential book Sybil was published, and six years later the diagnosis of multiple personality disorder was included in the DSM. There has since been additional controversy over Sybil as a research case study with allegations over the legitimacy of the data. As media coverage spiked, diagnoses climbed. There were 200 reported cases of DISSOCIATIVE IDENTITY DISORDER (DID) as of 1980, and 20,000 from 1980 to 1990. Joan Acocella reports that 40,000 cases were diagnosed from 1985 to 1995. The majority of diagnoses are made in North America, particularly the United States, and in English-speaking countries more generally with reports recently emerging from other countries.

Controversy

DISSOCIATIVE IDENTITY DISORDER (DID) is a controversial diagnosis and condition, with much of the literature on DISSOCIATIVE IDENTITY DISORDER (DID) being generated and published in North America, to the extent that it was regarded as a phenomenon confined to that continent. Even within North American psychiatrists there is a lack of consensus regarding the validity of DISSOCIATIVE IDENTITY DISORDER (DID). Practitioners who do accept DISSOCIATIVE IDENTITY DISORDER (DID) as a valid disorder have produced an extensive literature with some of the more recent papers originating outside North America. Criticism of the diagnosis continues, with Piper and Merskey describing it as a culture-bound and often iatrogenic condition which they believe is in decline.There is considerable controversy over the validity of the multiple personality profile as a diagnosis. Unlike the more empirically verifiable mood and personality disorders, dissociation is primarily subjective for both the patient and the treatment provider. The relationship between dissociation and multiple personality creates conflict regarding the DISSOCIATIVE IDENTITY DISORDER (DID) diagnosis. While other disorders require a certain amount of subjective interpretation, those disorders more readily present generally accepted, objective symptoms. The controversial nature of the dissociation hypothesis is shown quite clearly by the manner in which the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) has addressed, and re-addressed, the categorization over the years.

The second edition of the DSM referred to this diagnostic profile as multiple personality disorder. The third edition grouped MPD in with the other four major dissociative disorders. The current edition, the DSM-IV-TR, categorizes the disorder as DISSOCIATIVE IDENTITY DISORDER (DID). The ICD-10 (International Statistical Classification of Diseases and Related Health Problems) continues to list the condition as multiple personality disorder.

Sources:

American Psychiatric Association
National Institute of Mental Health
Handbook of Psychology, Vol. 8 (John Wiley)
psychologytoday

CEREBRAL PALSY

2009-02-25T07:26:00.000-08:00

CEREBRAL PALSY EXPLAINED

What is CEREBRAL PALSY ?

The term CEREBRAL PALSY refers to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination but don’t worsen over time. Even though CEREBRAL PALSY affects muscle movement, it isn’t caused by problems in the muscles or nerves. It is caused by abnormalities in parts of the brain that control muscle movements. The majority of children with CEREBRAL PALSY are born with it, although it may not be detected until months or years later. The early signs of CEREBRAL PALSY usually appear before a child reaches 3 years of age. The most common are a lack of muscle coordination when performing voluntary movements (ataxia); stiff or tight muscles and exaggerated reflexes (spasticity); walking with one foot or leg dragging; walking on the toes, a crouched gait, or a “scissored” gait; and muscle tone that is either too stiff or too floppy. A small number of children have CEREBRAL PALSY as the result of brain damage in the first few months or years of life, brain infections such as bacterial meningitis or viral encephalitis, or head injury from a motor vehicle accident, a fall, or child abuse.

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Is there any treatment for CEREBRAL PALSY ?

CEREBRAL PALSY can’t be cured, but treatment will often improve a child's capabilities. Many children go on to enjoy near-normal adult lives if their disabilities are properly managed. In general, the earlier treatment for CEREBRAL PALSY begins the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them. Treatment may include physical and occupational therapy, speech therapy, drugs to control seizures, relax muscle spasms, and alleviate pain; surgery to correct anatomical abnormalities or release tight muscles; braces and other orthotic devices; wheelchairs and rolling walkers; and communication aids such as computers with attached voice synthesizers.

What is the prognosis?

CEREBRAL PALSY doesn’t always cause profound disabilities. While one child with severe cerebral palsy might be unable to walk and need extensive, lifelong care, another with mild cerebral palsy might be only slightly awkward and require no special assistance. Supportive treatments, medications, and surgery can help many individuals improve their motor skills and ability to communicate with the world.

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What CEREBRAL PALSY research is being done?

Researchers are investigating the roles of mishaps early in brain development, including genetic defects, which are sometimes responsible for the brain malformations and abnormalities that result in CEREBRAL PALSY. Scientists are also looking at traumatic events in newborn babies’ brains, such as bleeding, epileptic seizures, and breathing and circulation problems, which can cause the abnormal release of chemicals that trigger the kind of damage that causes CEREBRAL PALSY. To make sure children are getting the right kinds of therapies, studies are also being done that evaluate both experimental treatments and treatments already in use so that physicians and parents have valid information to help them choose the best therapy.

NIH Patient Recruitment for CEREBRAL PALSY Clinical Trials
At NIH Clinical Center
Throughout the U.S. and Worldwide
Organizations

United CEREBRAL PALSY (UCP)
1660 L Street, NW
Suite 700
Washington, DC 20036
national@ucp.org
http://www.ucp.org
Tel: 202-776-0406 800-USA-5UCP (872-5827)
Fax: 202-776-0414

Pathways Awareness Foundation [For Children With Movement Difficulties]
150 N. Michigan Avenue
Suite 2100
Chicago, IL 60601
friends@pathwaysawareness.org
http://www.pathwaysawareness.org
Tel: 312-893-6620 800-955-CHILD (2445)
Fax: 312-893-6621

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March of Dimes Foundation
1275 Mamaroneck Avenue
White Plains, NY 10605
askus@marchofdimes.com
http://www.marchofdimes.com
Tel: 914-428-7100 888-MODIMES (663-4637)
Fax: 914-428-8203

Easter Seals
233 South Wacker Drive
Suite 2400
Chicago, IL 60606
info@easterseals.com
http://www.easterseals.com
Tel: 312-726-6200 800-221-6827
Fax: 312-726-1494

Children's Neurobiological Solutions (CNS) Foundation
1726 Franceschi Road
Santa Barbara, CA 93101
info@cnsfoundation.org
http://www.cnsfoundation.org
Tel: 866-CNS-5580 (267-5580) 805-898-4442

Children's Hemiplegia and Stroke Assocn. (CHASA)
4101 West Green Oaks Blvd., Ste. 305
PMB 149
Arlington, TX 76016
info437@chasa.org
http://www.hemi-kids.org
Tel: 817-492-4325

CEREBRAL PALSY International Research Foundation
1025 Connecticut Avenue
Suite 701
Washington, DC 20036
nmaher@cpirf.org
http://www.cpirf.org
Tel: 202-496-5060

Pedal with Pete [For Research on CEREBRAL PALSY ]
P.O. Box 274
Kent, OH 44240
petezeid@aol.com
http://www.pedalwithpete.com
Tel: 800-304-PETE (7383)
Fax: 330-673-1240

PROPRANOLOL - Promising cure for Fear

2009-02-16T08:34:00.000-08:00

Imagine being able to decouple bad memories from the fear and anxiety they produce with just a pill.

As more effective brain-boosting pills are developed, demand for them is likely to grow among...
As more effective brain-boosting pills are developed, demand for them is likely to grow among middle-aged people who want youthful memory powers and multitasking workers who need to keep track of multiple demands, said one commentary author, brain scientist Martha Farah of the University of Pennsylvania.
That's the promise of a new report from Dutch researchers published in the Feb. 15 advance online issue of Nature Neuroscience.

HTBWMedia

Merel Kindt and colleagues used a beta blocker called propranolol (Inderal) to erase, at least in the short-term, the fear response induced by a laboratory-induced painful memory in humans.

Such findings could one day help individuals suffering from pathological anxiety disorders from the debilitating physiological effects of their fears. Yet many questions remain, experts note, such as how permanent the effect is, and whether it can affect traumatic memories that may be decades old.

"I think it's a very interesting and exciting study," said Jane Taylor, a professor of psychiatry at Yale University, who studies memory reconsolidation in rats. "It will be interesting to know how long-lasting this effect is, and whether it only works on recently consolidated memories."

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Mark Bouton, a professor of psychology at the University of Vermont, echoed that sentiment. "This study is a solid step forward in our understanding of how to reduce fear," he said. "The big question is whether this treatment will reduce all forms of relapse, including the return of fear that can occur with the passage of time."

Human memory often is compared to computer storage. Some memories exist in a sort of neurological flash RAM, whereas others are stored for the long term, on the brain's hard disk. The analogy works to a point, but it isn't perfect, as it turns out to be quite difficult to permanently erase files in the brain's memory banks.

"Fear memories can be surprisingly resilient," Bouton explained.

To try to break at least the physiological hold these fears have over individuals, Kindt induced a kind of Pavlovian fear response in 60 undergraduate students at the University of Amsterdam.

The study lasted three days. On the first day, the subjects learned to associate images of spiders with a mild electrical shock. Fear was measured by assessing each individual's startle response -- how much their eyes blinked in response to the stimulus. That fear memory was then consolidated -- written to the hard disk, if you will.

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According to Treffert, about half of persons with SAVANT SYNDROME have autistic disorder, while the other half have another developmental disability, mental retardation, brain injury or disease. He says, "... not all savants are autistic, and not all autistic persons are savants." Other researchers state that autistic traits and savant skills may be linked, or have challenged some earlier conclusions about SAVANT SYNDROME as "hearsay, uncorroborated by independent scrutiny".

What is SAVANT SYNDROME?

People with SAVANT SYNDROME are people who despite serious mental or physical disability have quite remarkable, and sometimes spectacular, talents. This is an exceedingly rare phenomena, although there are several well documented cases (see Sacks, 1986; 1995; Treffert, 1989), and recently the Academy Award winning movie Rain Man has led to the term SAVANT SYNDROME being much more widely known. SAVANT SYNDROME is perhaps one of the most fascinating phenomena in the study of human differences and cognitive psychology. It is often claimed that, because of the extraordinary abilities involved, we will never truly understand human memory and cognition until we understand the savant.

SAVANT SYNDROME was first properly recognised by Dr. J. Langdon Down, (n.b. he also originated the term Down’s syndrome). In 1887, he coined the term "idiot savant" - meaning low intelligence, and from the French, savoir, knowing or wise, to describe someone who had "extraordinary memory but with a great defect in reasoning power." This term is now little used because of its inappropriate connotations, and the term SAVANT SYNDROME has now been more or less adopted. Another term, AUTISTIC SAVANT, is also widely used, but this can be somewhat misleading. Although there is a strong association with autism, it is certainly not the case that all savants are autistic. It is estimated that about 50% of the cases of SAVANT SYNDROME are from the autistic population, and the other 50% from the population of developmental disabilities and CNS injuries. The estimated incidence of savant abilities in the autistic population is about 10%, whereas the incidence in the learning disability population (which is very much larger) is probably less than 1%. Nevertheless, in order to understand SAVANT SYNDROME, it is helpful to know something about autism, also it is important to realize that there is some confusion over these estimates of the incidence of the syndrome which stems from the different ways in which it is defined and described.

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What is Autism?

Autism is a moderately rare condition resulting from a complex developmental disability that typically appears during the first three years of life. It is a neurological disorder that affects the functioning of the developing brain, resulting in sometimes profound communicative, social and cognitive deficits. Autism is estimated to occur in as many as 1 in 500 individuals, and is four times more prevalent in boys than girls and does not seem to be associated with any demographic features, such as economic, class, racial, ethnic, etc. Autistic traits are also sometimes observed in connection with other developmental disabilities, and CNS injuries.

The term autistic was first used by Eugen Bleuler in 1908, but the condition of autism was first named and described by the psychiatrist, Leo Kanner, in a landmark paper published in 1943. It is a condition in which children and adults typically have a lowered level of intelligence, together with difficulties in verbal and non-verbal communication, in the skills of social interaction, and in play activities. The disorder makes it hard for them to relate to the outside world, and there is a marked tendency to withdraw from human interactions and become preoccupied with attachment to objects. There is a failure in human intersubjectivity, characterized by difficulties in joint action, turn taking, and shared activities. Aggressive and/or self-injurious behaviour may well be present. Often there will be continuous repetition of body movements (hand flapping, rocking), a rigidity of actions, resistance to changes in routine, and a "desire" for sameness. Independently of Kanner, in 1944 Hans Asperger, an Austrian physician, described a very similar condition, although there were some subtle differences. In 1981, Lorna Wing adopted the term Asperger’s syndrome in referring to a group of people who did not fit the strict criteria for autism, and were relatively high functioning (see Happé, 1994 for a fuller account).

It is probably best to think of autism as a spectrum disorder. For example, DSM-IV includes autism, grouped together with several related disorders, under the broad heading "Pervasive Developmental Disorder (PDD)." This is a general category of disorders which is characterized by severe and pervasive impairment in several areas of development. There are no medical criteria for diagnosing autism, a specific diagnosis is made when a specified number of characteristics are noted as present, based on the presence of specific behaviours indicated by observation and through parent consultation. Individuals who fall under the PDD category in DSM-IV exhibit commonalties in communication and social deficits, but may differ in terms of severity. Defining autism as a spectrum disorder, recognizes that the symptoms and characteristics of autism can present themselves in a wide variety of combinations, which may also range from mild to severe. Clearly, there is no standard "type" or "typical" person with autism, and the terminology in use includes: autistic traits, autistic tendencies, autism spectrum disorder, high-functioning or low-functioning autism. However, this lecture is not concerned directly with autism, its definition or diagnosis.

Characteristics of SAVANT SYNDROME

SAVANT SYNDROME is exceedingly rare, but a remarkable condition in which persons with autism, or other serious mental handicaps, or major mental illness, have astonishing islands of ability or brilliance that stand out in stark contrast to their overall disability. The condition can be congenital or be acquired by an otherwise normal individual following CNS injury or disease. It occurs in males more frequently than in females in an approximate ratio of 6 to 1. The skills can appear suddenly, without explanation, and have been reported as sometimes disappearing just as suddenly. It is useful to put these special skills into the following three categories: Splinter Skills where the individual possesses specific skills that stand in contrast to their overall level of functioning, Talented Savants where the individual displays a high level of ability that is in contrast to their disability, and Prodigious Savants which involves a much rarer form of the condition, where the ability or brilliance is not only spectacular in contrast to the disability, but would be spectacular even if viewed in a non-disabled person. It is very likely that many savants do go unnoticed, and depending upon whether the three categories above are recognized, estimates of the incidence of savant syndrome can vary widely. In the case of prodigious savants it has been estimated that there may be fewer than 100 cases reported in the world literature in the past 100 years.

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#Categories of SAVANT SYNDROME Skill

SAVANT SYNDROME skills occur within a narrow but fairly constant range of human mental functions. If they have anything in common it is that they all more or less involve considerable feats of memory. In some cases a specific skill might exist, while in others there may be several skills that co-exist simultaneously. An important observation is that the skills tend to be right hemisphere oriented: i.e. non-symbolic, artistic, concrete, directly perceived. Table 1 describes some of the striking abilities that have been found in savants.

Table 1: SAVANT SYNDROME Skills
(n.b. the focus here is on examples of prodigious savants)

Memorization - superior memory is a common feature of SAVANT SYNDROME, but it also can be a special skill in its own right. There are cases of savants who have memorized population statistics, telephone books, bus scheduals, and in one remarkable case the 9 volume edition of Grove’s Dictionary of Music and Musicians (The Walking Grove, Sacks, 1986).

Lightening calculation - this is exhibited in the instantaneous calculation of multiplications, square roots, etc, the determination of prime numbers, or subitizing (The Twins, Sacks, 1986).

Calender calculating - often involving the ability to identify the day of the week upon which a particular date falls, in one case any time in the last, or next, forty thousand years!! (The Twins, Sacks, 1986).

Musical ability - this is a relatively common savant skill, the co-occurrence of musical genius, blindness and learning disability is a striking feature here. Savants will have perfect pitch, and can play a complete piece of music after hearing it only once (see Hermelin, 2001).

Artistic ability - not as common as musical abilities, but there are savants with exceptional painting, sculpture and especially drawing skills. e.g. Nadia (Selfe, 1977) and Stephen Wiltshire (1987; 1991; see also Sacks, 1995; Hermelin, 2001). See also The Autistic Artist in Sacks (1986).

Language ability - this is fairly rare, but there is one well documented case of a savant with CNS damage since birth who could read write and translate 15 to 20 languages (Smith & Tsimpli, 1995; Hermelin, 2001). Hermelin also includes a case of a savant poet.

#Theories of SAVANT SYNDROME

The reason why some autistic and disabled individuals have savant abilities is not understood, however, the strong link with autism does offer a good starting point. There have been many theories, but it is clear that no one theory is sufficient. Theories include: Biological-Developmental - such as genetic, neurochemical, left hemisphere dysfunction, frontal and temporal lobe damage, and the DSM IV diagnostic category is Pervasive Developmental Disorder (PDD); Cognitive - such as deficits in executive function and abstract thinking; weak coherence theory; highly developed procedural memory and eidetic imagery (Happé, 1994; Schopler & Mesibov, 1995). Other theories include a deficit in theory of mind (Frith, 1989), compensation for sensory disabilities (especially blindness) and social isolation, and the modularity of mind hypothesis which proposes that particularly when executive cognitive functions are disrupted the mind exhibits a striking modular organization (see Smith & Tsimpli, 1995). However, any theory would need to explain the link with autism, the islands of exceptional ability, the bias towards male savants, and recent research that includes a finding of the emergence of savant abilities in fronto-temporal dementia patients, and the suggestion of a neurotoxic effect of circulating testosterone on the left hemisphere in the male fetus possibly related to autism.

#Some Management Issues

There are two necessary components of the SAVANT SYNDROME: (i) a remarkable ability to memorize, to record detail, or repeat an operation endlessly and efficiently, and (ii) a means of giving expression to this ability. The importance of (ii) should not be underestimated. Not only are savants noticed by this expression of their special abilities, but also savants like doing something, and doing it again, again and again. No one has any idea how many savants go unnoticed. In the case of prodigious savants it is possible that early recognition and careful encouragement are important contributory factors to how the talent develops. It has been proposed that helping the savant to achieve a higher level of general functioning may result in a loss of the special savant skills. However, there is little evidence for this, and it may well be that "training the talent" could be a valuable approach towards improving socialization, communication and self-esteem.

#A illustrative case example: Tim, age 40+

Tim has profound sensory and communicative disabilities (his identity has been concealed). He lives in a residential home with day care facilities for adults with learning difficulties, and has been in residential or institutional care since the age of 15. He has no hearing and consequently no speech. He has moderate physical difficulties and sometimes he requires a wheelchair. Tim has probably been disabled since very early childhood, and it is believed that he has been diagnosed as having "autistic traits." But, as far as it is known, his medical records have been destroyed. He has a previous history of challenging behaviour and mood swings, which has in the past been controlled with powerful anti-psychotic drugs. These have been greatly reduced over the 5 years that he has been living at his current residential home, during which time there have been striking changes in his behaviour, including a particularly marked reduction in his challenging behviour. The most likely reason for this is due mainly to communication barriers being greatly decreased. Despite Tim’s profound disabilities, he is relatively outgoing and is not withdrawn, and he shows a remarkable intelligence (although this would be very difficult to measure formally). He is strong willed, and will only do things that he wants to do. He is helpful, he values affection, and he is considerate to other residents, especially in being tolerant of younger residents. Tim has probably received very little education, he cannot read or write (although he can recognize his name and a few words, and copy any shape that he wishes), but he has been taught a system of alternative communication called Makaton. This is a visual and signing process, usually used alongside speech, which is widely used in the UK by people with learning disabilities. The Makaton Vocabulary was designed in 1972 by Margaret Walker, a UK Speech and language Therapist. She developed Makaton in response to the needs of deaf adults with severe learning disabilities, particularly who were residents in an institution, because other sign communication systems were not very satisfactory. Without Makaton, Tim would only be able to make himself understood with a few crude gestures, and his life could and would be very confusing and frustrating. Tim uses Makaton to initiate conversations, to ask questions, and clarify any situation.

Table 2: Some observations of Tim

Tim draws from memory, and from life
He draws with accurate perspective
He draws with attention to detail
He can draw a good likeness, and can draw a self-portrait
He can draw a "building plan" with a ruler
He finds "hair" very difficult

Tim’s drawing involves deliberate use of lines - "as if tracing an image"
He has a high level of concentration
He is reflective, pausing to think
He chooses his pencils, colours carefully (he knows which pencil/crayon he needs, which box it is in, and he will make a very special effort to match "eye colour")
When drawing from life he takes brief infrequent glimpses

Tim draws what he wants to draw
He likes to draw batteries, light bulbs and lifts
In the past, he did not share his drawings with others, he folded them up very small and put them in his pocket, but kept them all in his room
He has developed his own narrative style of drawing
In addition, he has excellent assembly skills (e.g. IKEA furniture)
His rigidity has relaxed with improved communication

When placed within the context of all these disabilities, Tim possesses extraordinary abilities which primarily are illustrated by his drawing and his photographic memory. As far as it is known, these extraordinary abilities have gone unnoticed, or unrecognized, for most of his life. It was my wife, Elaine, who was the first to recognize Tim’s special abilities. It seems very clear that Tim falls into the category of a savant. What is particularly interesting is that very few cases of savants who are profoundly deaf have ever been documented (the one exception seems to be the case of James Henry Pullen, see Treffert, 1989). I will demonstrate what I am talking about by showing you a selection of his drawings. I will point out a number of features that show how his abilities fit well with those usually attributed to savant syndrome (see Table 2). His drawings are deceptively simple, and it is easy to underestimate the level of his achievements. I will draw especially upon the work of David Hockney (2001) who has recently uncovered some of the techniques used by the old masters in their paintings. Tim has very little difficulty drawing images in accurate perspective that the old masters could only do with sophisticated technical aids. What most people, including skilled artists, would find very difficult to do "by eye", Tim can do with little effort, from memory, sometimes months later, and without any formal instruction or training.

At this time, Tim is clearly a talented savant, he may even be prodigious. His special skills and abilities are highly specialized, and are obviously conspicuous when viewed over against his over-all handicap, he can draw in ways that most professional artists would find impossible. Tim seems to fit with one view of savant syndrome as resulting from a compensation for a sensory deficit, i.e. his deafness, and the possession of a remarkable photographic memory. My wife has adopted the position that Tim’s drawing ability would not have become so apparent if the communication barriers had not been bridged. Tim has a need to be sure of, and trust, what is happening around him. Without this need being met, Tim’s exceptional abilities would not have had the chance to develop in the way that they have. Indeed, it is highly unlikely that they would ever have been noticed at all.

For More information on AUTISM

AUTISM and SEIZURES

2009-01-03T08:52:00.000-08:00

Definition and Frequency of Epilepsy in Autistic Population.

Epilepsy is a chronic disorder of the brain characterized by recurrent seizures, as opposed to seizures occurring in association with high fever, drug effects, chemical imbalance (e.g., low blood sugar). Epilepsy can occur without other evidence of neurologic dysfunction, but it is often associated with more global neurologic abnormalities, such as autism, cerebral palsy, or mental retardation.

The majority of autistic persons do not have seizures. However, they are at higher risk for seizures if they have certain specific neurologic conditions, such as tuberous sclerosis, neurofibromatosis, untreated phenylketonuria.

Infantile spasms (sudden generalized muscle contractions, usually beginning between ages 3 and 8 months) do occur in association with autism, often in young children who have tuberous sclerosis or other significant neurologic problems. Other forms of epilepsy--complex partial epilepsy, generalized tonic-clonic epilepsy and, more rarely, absence seizures--also may occur in autistic children. The frequency of epilepsy in autistic children is below 15% (my estimate) and, if seizures do occur, they are more likely to occur in the autistic child who is also mentally retarded.

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There is an increased incidence of seizures in otherwise seizure-free autistic persons when they become adolescents. Roughly 25-30% of autistic adolescents have been reported to develop seizures, although such a high incidence has not been noted by me. It is of note that the seizures are usually not serious, are usually controlled by anticonvulsants, and are inclined to diminish in adulthood. The reason for this significant increased frequency of seizures in autistic adolescents is unknown and may represent, at least in part, the general tendency for seizure disorders to become more problematic at puberty.

There are many autistic persons who have behavior and mannerisms, e.g., swaying, sudden repetitive movements, which may raise questions about a seizure disorder. This is a valid concern because seizures can reduce one's awareness of the environment and/or create anxiety and thus enhance autistic behavior and communication problems. How can seizures be distinguished from unusual behaviors?

1. Seizures are sudden and without provoking events. If an autistic person's suspected "seizures" are clearly the consequence of anger, frustration, fear, these episodes are probably not seizures. (On occasion, seizures are provoked by certain light frequencies or sounds. Seizures can also be brought on by prolonged hyperventilation in a person susceptible to seizures.)

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2. Seizures generally follow a similar -pattern each time, although some seizures might be more intense and prolonged than others. If the autistic person's "seizures" are varied in movements and mannerisms, these events are probably not seizures.

3. Generalized seizures are often associated with an aura (perhaps a sense of fear or odd sensations) and may be followed by a headache, weakness or exhaustion. If the autistic person has had a major "seizure," it is unlikely he would immediately resume his regular activity.

4. Absence attacks, often suggested by the autistic person's staring mannerisms, involve brief (less than 10 seconds unless frequent episodes) loss of consciousness, often with some eyeblinking or mild facial movements. Complex partial seizures, which can also involve staring, are also often associated with some associated movements, lip-smacking, shuddering. If an autistic person has frequent staring episodes, it is important to determine if there is any response to environmental stimuli and whether there are any associated movements.

If there is any question about repeated, unpredictable and similar episodes of unusual behavior and/or movements, an electroencephalogram (EEG) should be done. A sleep EEG is usually the most productive. Obtaining an EEG in the autistic population can require patience, creative scheduling, and sedation. An EEG is done to help localize the origin of the abnormal electrical activity in the brain and can help determine the most appropriate therapy. Other diagnostic studies might be necessary. An MRI or CT would be done to rule out a brain tumor or malformation. Blood studies would be done to rule out metabolic disturbances. In very puzzling cases, EEG telemetry might be used.

Seizure Treatment

If the EEG supports the clinical diagnosis of a seizure disorder or if the clinical history is strongly suggestive but an EEG is unobtainable, anticonvulsant therapy should be considered. Carbamazepine (Tegretol) and valproic acid (Depakene) are the most commonly used anticonvulsants. They have relatively few significant side effects, and often have positive behavioral effects--the improved behaviors may not relate to seizure control. There are a variety of other traditional anticonvulsants, including phenobarbital, diphenylhydantoin (Dilantin), and ethosuximide (Zarontin). Barbiturates often make children more hyperactive and irritable, and diphenylhydantoin has a range of subtle metabolic, endocrinologic, and neurologic side effects. There are also a variety of newer anticonvulsants (vigabatrin, lamotrigine, gabapentin) which hold promise.

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It is important to note that all anticonvulsants may have behavioral and cognitive side effects. Therefore, anticonvulsant therapy needs to be carefully monitored and probably not considered in a person with rare, brief and/or questionable seizures.

Adult ADHD ADD

2008-10-17T11:12:00.000-07:00

Most children with ADD / ADHD don’t outgrow their disorders; rather, they become disorganized, inattentive adults. If you’re an adult with ADD / ADHD, your symptoms may be holding you back at work, impacting your relationships, and keeping you from accomplishing your goals. Happily, once you recognize the signs and symptoms of adult ADD / ADHD, you can begin to address your areas of weakness and make your strengths work for you.

ADD / ADHD in adults
Many people have a stereotypical picture in their head of what someone with attention deficit disorder looks like: hyperactive, loud, a whirlwind of energy and unchecked impulses. And let’s face it: it’s probably a kid they’re picturing in their mind’s eye. However, ADD / ADHD is not just a childhood disorder. Kids don’t simply grow out of ADHD, as if it’s a phase. In fact, the symptoms of ADD / ADHD typically get worse as children grow into adulthood and face life’s increasing pressures and demands.

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Adults with ADD / ADHD struggle daily with self-regulation: regulating their attention, regulating their impulses in talking and action, and regulating their emotions. If you have trouble staying focused, getting organized, starting and completing your work, managing your time and money, and remembering all the little things in your daily life, you may very well be one of these people.

The chaos of living with unrecognized and untreated ADD / ADHD can take its toll: never-ending to-do lists, the stress of missed deadlines and forgotten appointments, aggravated friends and family members who just don’t understand why you can’t pull it together and self-recrimination over your lack of accomplishments.

The good news: life doesn’t have to be this way. Treatment can go a long way toward getting ADD / ADHD in check. But before you can manage the problem, you have to be able to identify it, starting with a thorough understanding of what ADD / ADHD looks like in adults.

Adult ADD Myths: Fact or Fiction
MYTH: ADD is just a lack of willpower. Persons with ADD focus well on things that interest them; they could focus on any other tasks if they really wanted to.

FACT: ADD looks very much like a willpower problem, but it isn’t. It’s essentially a chemical problem in the management systems of the brain.

MYTH: Everybody has the symptoms of ADD, and anyone with adequate intelligence can overcome these difficulties.

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FACT: ADD affects persons of all levels of intelligence. And although everyone sometimes has symptoms of ADD, only those with chronic impairments from these symptoms warrant an ADD diagnosis.

MYTH: Someone can’t have ADD and also have depression, anxiety, or other psychiatric problems.

FACT: A person with ADD is six times more likely to have another psychiatric or learning disorder than most other people. ADD usually overlaps with other disorders.

MYTH: ADD doesn’t really cause much damage to a person’s life.

FACT: Untreated or inadequately treated ADD syndrome often severely impairs learning, family life, education, work life, social interactions, and driving safely.

MYTH: Unless you have been diagnosed with ADD as a child, you can’t have it as an adult.

FACT: Many adults have struggled all their lives with unrecognized ADD impairments. They haven’t received help because they assumed that their chronic difficulties, like depression or anxiety, were caused by other impairments that did not respond to the usual treatments.

Source: Dr. Thomas E. Brown, Attention Deficit Disorder: The Unfocused Mind in Children and Adults

Adult vs. childhood ADD / ADHD
The symptoms of ADD / ADHD change as someone with ADD / ADHD develops from a child into a teenager and then into an adult. While the core problems of hyperactivity, impulsiveness, and inattentiveness remain the same, the specific symptoms manifest differently. Typically, the symptoms of hyperactivity decrease and become more subtle, while problems related to concentration and organization become more dominant.

Hyperactivity in adults:

inability to relax
restlessness, nervous energy
talking excessively
Impulsiveness in adults:

volatile moods
blurting out rude or insulting remarks
interrupting others
Inattentiveness in adults:

“tuning out” unintentionally
inability to focus on mundane tasks
constantly losing and forgetting things

Signs and symptoms of adult ADD / ADHD
According to Dr. Thomas E. Brown of the Yale University School of Medicine, "ADHD is essentially a name for developmental impairment of executive function." Executive functions are the skills involved in planning, selective attention, motivation, and impulse control. Adults with ADHD have problems in six major areas of executive functioning:

Activation – Problems with organization, prioritizing, and starting tasks.
Focus – Problems with sustaining focus and resisting distraction, especially with reading.
Effort – Problems with motivation, sustained effort, and persistence.
Emotion – Difficulty regulating emotions and managing stress.
Memory – Problems with short-term memory and memory retrieval.
Action – Problems with self-control and self-regulation.
Signs and Symptoms of ADD / ADHD
Activation Focus Effort
Procrastination; difficulty getting started on projects
Excessive disorganization and messiness
Inability to prioritize tasks
Underestimating the time needed to finish a task
Inability to screen out distractions
"Zoning out" when others are talking
Randomly skipping from topic to topic in conversation
Reading words over and over in order to grasp the meaning

Difficulty sustaining effort over long periods of time
Starting multiple tasks, but never completing any of them
Missing deadlines
Trouble going to sleep at night and staying alert during the day.

Emotion Memory Action
Easily bored
Low tolerance for frustration and stress
Unstable, unpredictable moods
Quick temper
Constant worrying

Trouble remembering things, even for a short time
Doesn’t recall conversations, things others said
Forgetting appointments
Constantly losing or misplacing things

Inability to delay gratification
Speaking without thinking
Acting impulsively (e.g. impulsive spending, sudden change of plans) without regard for consequences
Jumping to conclusions

Effects of adult ADD / ADHD
Left untreated, ADD can wreak havoc in your life, disrupting everything from your career to your social life, love life, and financial stability.

Work
ADD / ADHD can be a big stumbling block on the road to career success. The symptoms of disorganization and inattention, in particular, pose problems in the workplace. If you have ADD / ADHD, you may:

be chronically late to work,
miss or forget deadlines and meetings,
have a hard time organizing projects and delegating work,
have difficulty completing projects on time,
spend hours at work, but get very little done,
get distracted by trivial tasks, while neglecting the most important ones, and
have trouble paying attention in meetings or in conversations with your boss and colleagues.
Relationships
ADD / ADHD can put a strain on your relationships. The chaos that surrounds the disorder is particularly hard on romantic relationships. The spouse or partner without ADD may feel resentful if he or she is the one who has to take care of all the planning, organizing, cleaning, bill paying, and other household responsibilities. And you may resent your partner’s constant nagging to tidy up, get organized, and take care of business.

Friends and family members may also take it personally when you tune them out, forget conversations or commitments, speak a little too bluntly, or keep them waiting.

Finance
The ADD / ADHD symptoms of procrastination, disorganization, and impulsivity can interfere with good money management. If you have ADD / ADHD, you may find that you:

forget to pay bills,
run up huge balances on your credit cards,
cannot save money,
are unable to follow through on long-term financial goals,
shop impulsively,
have difficulty keeping financial paperwork in order, and
fail at budgeting and recordkeeping.
Eating behaviors
The impulsivity of ADD / ADHD can extend to eating, and many adults with the condition also suffer from overeating, obesity, or disordered eating. talks about the connection between ADHD (ADD) and disordered eating:
If you have ADD / ADHD, you may:

eat snacks throughout the day, rather than eating at planned meals,
be unable to stick with a diet,
have intense cravings for carbohydrates and caffeine (in coffee and chocolate),
eat a lot of fast food and “junk food” (cookies, chips, soda, fries, ice cream),
ignore hunger signs, waiting until you’re too hungry to plan a healthy meal and then eating whatever you can find.
The Connection between ADD and Disordered Eating

Healthy dietary regulation requires organization and planning—two areas of cognitive functioning that are typically difficult for those with ADD. Good eating habits also require self-awareness: awareness of when one is hungry, awareness of when one is full. Many individuals with ADD report that they skip meals because they were busy and distracted; these same individuals often report that later their hunger becomes so intense that they swing in the opposite direction, overeating well beyond the point of reasonable intake because they don't know when to stop until they feel "stuffed."

Source: Diet and Weight Management Strategies for Adults with ADD (ADHD)

Positive characteristics of adults with ADD / ADHD
The symptoms of ADD / ADHD are not all negative. People with ADD / ADHD also have many positive traits that are directly tied to their active, impulsive minds:

Creativity – People with ADD excel at thinking outside of the box, brainstorming, and finding creative solutions to problems. Because of their flexible way of thinking about things, they tend to be more open-minded, independent, and ready to improvise.
Enthusiasm and spontaneity – People with ADD are free spirits with lively minds—qualities that makes for good company and engrossing conversation. Their enthusiasm and spontaneous approach to life can be infectious.
A quick mind - People with ADD have the ability to think on their feet, quickly absorb new information (as long as it’s interesting), and multitask with ease. Their rapid-fire minds thrive on stimulation. They adapt well to change and are great in a crisis.
High energy level – People with ADD have loads of energy. When their attention is captured by something that interests them, they can have virtually unlimited stamina and drive.
Hyperfocus: A Positive Symptom of ADD / ADHD

While adults with ADHD have great difficulty maintaining attention, those same individuals often are able to “hyperfocus” for long periods of time on tasks or projects that they find interesting. This is particularly true of interactive or hands-on activities. They may even be compulsive about it, spending hours immersed in the activity without a thought to anything or anyone else.

When they’re “in the zone,” people with ADD often lose all concept of time. Hours pass as if they are minutes. This single-minded ability to hyperfocus can lead to significant accomplishments, discoveries, and creative breakthroughs.

Coulrophobia

2008-09-25T09:44:00.000-07:00

Coulrophobia or fear of clowns is quite an interesting subject. What makes you suffer from fear of clowns is quite confusing, as in most cases clowns are meant for amusement and entertainment.

Everyone experiences a fear of something at some time in their lives. Fear is natural, but sometimes it becomes irrational and develops into a phobia. A phobia is a strong, persistent fear of situations, objects, activities or persons. The main symptom is an excessive and unreasonable desire to avoid the feared subject. One particular phobia affects as many as one in seven people. Coulrophobia, the fear of clowns, is clinically known.

Coulrophobia is the official name for the fear of clowns. This condition is one of the most remarked-upon phobias on the Internet. Coulrophobia was coined during the 1990's and is based on the Greek word Koulon or limb. Related derivatives are suggestive of stilts and stilt walking. For example the Greek work Kolobathristes means one who goes on stilts. Clowns are often known to walk on stilts and so this how the relationship developed and the word Coulrophobia was made.

Those who suffer from Coulrophobia, do so, for many reasons. The most fear-inducing aspects of clowns is the heavy make-up that is accompanied by the big red nose and different color hair. These things completely conceal the identity of the wearer. It is also possible that the costume conceals a darker personality. Although clowns are known for being happy and creating a fun atmosphere, Coulrophobes tend to fear who the clown is as a real person.

Another reason for fearing clowns, is the clowns ability to act outside social boundaries. Clowns have been around for thousands of years and they serve an unique role in many societies. In Egypt and China as early as 1800 B.C. Court Jesters were allowed to mock and criticize Kings when no one else was allowed to. They can get in your face and squirt you with water and generally make fun of you without suffering any consequences. It is because of this that some people feel uncomfortable in the presence of a clown.

Asperger's Disorder

2008-08-28T07:49:00.000-07:00

Asperger's Disorder is a milder variant of Autistic Disorder. Both Asperger's Disorder and Autistic Disorder are in fact subgroups of a larger diagnostic category. This larger category is called either Autistic Spectrum Disorders, mostly in European countries, or Pervasive Developmental Disorders ("PDD"), in the United States. In Asperger's Disorder, affected individuals are characterized by social isolation and eccentric behavior in childhood. There are impairments in two-sided social interaction and non-verbal communication. Though grammatical, their speech may sound peculiar due to abnormalities of inflection and a repetitive pattern. Clumsiness may be prominent both in their articulation and gross motor behavior. They usually have a circumscribed area of interest which usually leaves no space for more age appropriate, common interests. Some examples are cars, trains, French Literature, door knobs, hinges, cappucino, meteorology, astronomy or history. The name "Asperger" comes from Hans Asperger, an Austrian physician who first described the syndrome in 1944.

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epidemiology of Asperger's Disorder

In a total population study of children between ages 7-16 in Goteborg, Sweden, minimum prevalence of Asperger's Disorder was 36/10,000 (55/10,000 of all boys, and 15/10,000 of all girls), and the male/female ratio was 4:1.
The prevalence of autism has traditionally been estimated around 4-5/10,000. A recent study from United Kingdom found the prevalence of autism at 17/10,000, and the prevalence of all Autistic Spectrum Disorders (including autism) at 63/10,000.

differences between Asperger's Disorder and 'High Functioning' (i.e. IQ > 70) Autism

It is believed that in Asperger's Disorder

onset is usually later
outcome is usually more positive
social and communication deficits are less severe
circumscribed interests are more prominent
verbal IQ is usually higher than performance IQ (in autism, the case is usually the reverse)
clumsiness is more frequently seen
family history is more frequently positive
neurological disorders are less common

biology of Asperger's Disorder

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Despite the now widely accepted fact that biological factors are of crucial importance in the etiology of autism, so far the brain imaging studies have shown no consistent pattern, no consistent evidence of any type of lesion, and no single location of any lesion in subjects with autistic symptoms. This inconsistency in the results of various brain imaging studies has been attributed to the fact that people with autism represent a highly heterogeneous group in terms of underlying pathology. Therefore there is an ongoing effort to specify more homogenous subgroups among autistic individuals to enhance the accuracy of etiologic inquiry. This approach has been supported with the inclusion of the diagnosis 'Asperger's Disorder' in the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association.

Associated medical conditions such as fragile-X syndrome, tuberous sclerosis, neurofibromatosis, and hypothyroidism are less common in Asperger's Disorder than in classical autism. Therefore it may be expected that there are fewer major structural brain abnormalities associated with Asperger's Disorder than with autism. To our knowledge, a very small number of structural brain abnormalities have been so far associated with Asperger's Disorder, which include left frontal macrogyria, bilateral opercular polymicrogyria, and left temporal lobe damage. On the other hand brain imaging techniques like positron emission tomography (PET), and single photon emission tomography (SPECT) which provide information about the functional status of brain may be more helpful in determining the brain dysfunction in individuals with Asperger's Disorder. Detailed neuropsychological testing may support these findings providing information about the performances of individual right or left hemispheric brain regions. The first SPECT study in a patient with Asperger's Disorder was published by the host of this page and his colleagues, and found left parietooccipital hypoperfusion. Continuation of research in Asperger's Disorder with various brain imaging techniques in coordination with neuropsychological evaluation in larger samples is clearly needed in this area.

diagnostic criteria of Asperger's Disorder

DSM-IV DIAGNOSTIC CRITERIA FOR ASPERGER'S DISORDER

A.Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
(2) failure to develop peer relationships appropriate to developmental level
(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
(4) lack of social or emotional reciprocity

B.Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines or rituals
(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
(4) persistent preoccupation with parts of objects

C.The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D.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).

E.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.

F.Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

--------------------------------------------------------------------------------

GILLBERG'S CRITERIA FOR ASPERGER'S DISORDER

1.Severe impairment in reciprocal social interaction
(at least two of the following)
(a) inability to interact with peers
(b) lack of desire to interact with peers
(c) lack of appreciation of social cues
(d) socially and emotionally inappropriate behavior

2.All-absorbing narrow interest
(at least one of the following)
(a) exclusion of other activities
(b) repetitive adherence
(c) more rote than meaning

3.Imposition of routines and interests
(at least one of the following)
(a) on self, in aspects of life
(b) on others

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4.Speech and language problems
(at least three of the following)
(a) delayed development
(b) superficially perfect expressive language
(c) formal, pedantic language
(d) odd prosody, peculiar voice characteristics
(e) impairment of comprehension including misinterpretations of literal/implied meanings

5.Non-verbal communication problems
(at least one of the following)
(a) limited use of gestures
(b) clumsy/gauche body language
(c) limited facial expression
(d) inappropriate expression
(e) peculiar, stiff gaze

6.Motor clumsiness: poor performance on neurodevelopmental examination

(All six criteria must be met for confirmation of diagnosis.)

other psychological problems that can co-exist with Asperger's Disorder

Asperger's Disorder may not be the only psychological condition affecting a certain individual. In fact, it is frequently together with other problems such as:

Attention Deficit Hyperactivity Disorder (ADHD)
Oppositional Defiant Disorder (ODD)
Depression (Major Depressive Disorder or Adjustment Disorder with Depressed Mood)
Bipolar Disorder
Generalized Anxiety Disorder
Obsessive Compulsive Disorder

treatment of Asperger's Disorder

There is no specific treatment or "cure" for Asperger's Disorder. All the interventions outlined below are mainly symptomatic and/or rehabilitational.

Psychosocial Interventions

Individual psychotherapy to help the individual to process the feelings aroused by being socially handicapped
Parent education and training
Behavioral modification
Social skills training
Educational interventions
Psychopharmacological Interventions

For hyperactivity, inattention and impulsivity: Psychostimulants (methyphenidate, dextroamphetamine, metamphetamine), clonidine, Tricyclic Antidepressants (desipramine, nortriptyline), Strattera (atomoxetine)
For irritability and aggression: Mood Stabilizers (valproate, carbamazepine, lithium), Beta Blockers (nadolol, propranolol), clonidine, naltrexone, Neuroleptics (risperidone, olanzapine, quetiapine, ziprasidone, haloperidol)
For preoccupations, rituals and compulsions: SSRIs (fluvoxamine, fluoxetine, paroxetine), Tricyclic Antidepressants (clomipramine)
For anxiety: SSRIs (sertraline, fluoxetine), Tricyclic Antidepressants (imipramine, clomipramine, nortriptyline)

Alzheimer's Disease

2008-08-17T19:35:00.000-07:00

Introduction
Alzheimer's disease is a progressive, degenerative disease of the brain, which causes thinking and memory to become seriously impaired. It is the most common form of dementia. (Dementia is a syndrome consisting of a number of symptoms that include loss of memory, judgment and reasoning, and changes in mood, behaviour and communication abilities. Related diseases include: Vascular Dementia, Frontotemporal Dementia, Creutzfeldt-Jakob Disease and Lewy body Dementia.)

The disease was first identified by Dr. Alois Alzheimer in 1906. He described the two hallmarks of the disease: "plaques" - numerous tiny dense deposits scattered throughout the brain which become toxic to brain cells at excessive levels and "tangles" which interfere with vital processes eventually "choking" off the living cells. As well, when brain cells degenerate and die, the brain markedly shrinks in some regions.

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The image below shows, a person with Alzheimer's disease has less brain tissue (right) than a person who does not have the disease (left). This shrinkage will continue over time, affecting how the brain functions.

As Alzheimer’s disease progresses and affects different areas of the brain, various abilities become impaired. The result is changes in abilities and/or behaviour. At present, once an ability is lost, it is not known to return. However, research is now suggesting that some relearning may be possible.

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Alzheimer's disease is a progressive, degenerative disease. Symptoms
include loss of memory, difficulty with day-to-day tasks,
and changes in mood and behaviour. People may think
these symptoms are part of normal aging but they aren't.
It is important to see a doctor when you notice any
of these symptoms as they may be due to other conditions
such as depression, drug interactions or an infection.
If the diagnosis is Alzheimer's disease, your local
Alzheimer Society
can help.

To
help you know what warning signs to look for, the Alzheimer
Society has developed the following list:

Memory loss that affects day-to-day function

It's normal to occasionally forget appointments, colleagues'
names or a friend's phone number and remember them later.
A person with Alzheimer's disease may forget things more
often and not remember them later, especially things that
have happened more recently.

Difficulty performing familiar tasks

Busy people can be so distracted from time to time that
they may leave the carrots on the stove and only remember
to serve them at the end of a meal. A person with Alzheimer's disease may have trouble with tasks that have been familiar
to them all their lives, such as preparing a meal.

Problems
with language

Everyone has trouble finding the right word sometimes,
but a person with Alzheimer's disease may forget simple
words or substitute words, making her sentences difficult
to understand.

Disorientation
of time and place

It's normal to forget the day of the week or your destination
-- for a moment. But a person with Alzheimer's disease can
become lost on their own street, not knowing how they
got there or how to get home.

Poor
or decreased judgment

People may sometimes put off going to a doctor if they
have an infection, but eventually seek medical attention.
A person with Alzheimer's disease may have decreased judgment,
for example not recognizing a medical problem that needs
attention or wearing heavy clothing on a hot day.

Problems
with abstract thinking

From time to time, people may have difficulty with tasks
that require abstract thinking, such as balancing a cheque
book. Someone with Alzheimer's disease may have significant
difficulties with such tasks, for example not recognizing
what the numbers in the cheque book mean.

Misplacing
things

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Anyone can temporarily misplace a wallet or keys. A person
with Alzheimer's disease may put things in inappropriate
places: an iron in the freezer or a wristwatch in the
sugar bowl.

Changes
in mood and behaviour

Everyone becomes sad or moody from time to time. Someone
with Alzheimer's disease can exhibit varied mood swings
-- from calm to tears to anger -- for no apparent reason.

Changes
in personality

People's personalities can change somewhat with age. But
a person with Alzheimer's disease can become confused, suspicious
or withdrawn. Changes may also include apathy, fearfulness
or acting out of character.

Loss
of initiative

It's normal to tire of housework, business activities
or social obligations, but most people regain their initiative.
A person with Alzheimer's disease may become very passive,
and require cues and prompting to become involved.

Oppositional Defiant Disorder

2008-08-17T14:44:00.000-07:00

What is oppositional defiant disorder (ODD)?
Oppositional defiant disorder (ODD) is a behavior disorder, usually diagnosed in childhood, that is characterized by uncooperative, defiant, negativistic, irritable, and annoying behaviors toward parents, peers, teachers, and other authority figures. Children and adolescents with ODD are more distressing or troubling to others than they are distressed or troubled themselves.

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What causes oppositional defiant disorder?
While the cause of ODD is not known, there are two primary theories offered to explain the development of ODD. A developmental theory suggests that the problems begin when children are toddlers. Children and adolescents who develop ODD may have had a difficult time learning to separate from their primary attachment figure and developing autonomous skills. The bad attitudes characteristic of ODD are viewed as a continuation of the normal developmental issues that were not adequately resolved during the toddler years.

Learning theory suggests, however, that the negativistic characteristics of ODD are learned attitudes reflecting the effects of negative reinforcement techniques used by parents and authority figures. The use of negative reinforcers by parents is viewed as increasing the rate and intensity of oppositional behaviors in the child as it achieves the desired attention, time, concern, and interaction with parents or authority figures.

Who is affected by oppositional defiant disorder?
Behavior disorders, as a category, are, by far, the most common reason for referrals to mental health services for children and adolescents. Oppositional defiant disorder is reported to affect 20 percent of the school-age population. ODD is more common in boys than in girls.

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What are the symptoms of oppositional defiant disorder?
Most symptoms seen in children and adolescents with oppositional defiant disorder also occur at times in children without this disorder, especially around the ages or 2 or 3, or during the teenage years. Many children, especially when they are tired, hungry, or upset, tend to disobey, argue with parents, or defy authority. However, in children and adolescents with oppositional defiant disorder, these symptoms occur more frequently and interfere with learning, school adjustment, and, sometimes, with the child's (adolescent's) relationships with others.

Symptoms of oppositional defiant disorder may include:

frequent temper tantrums
excessive arguments with adults
refusal to comply with adult requests
always questioning rules; refusal to follow rules
behavior intended to annoy or upset others, including adults
blaming others for his/her misbehaviors or mistakes
easily annoyed by others
frequently has an angry attitude
speaking harshly, or unkind
deliberately behaving in ways that seek revenge
The symptoms of ODD may resemble other medical conditions or behavior problems. Always consult your child's (adolescent's) physician for a diagnosis.

How is oppositional defiant disorder diagnosed?
Parents, teachers, and other authority figures in child and adolescent settings often identify the child or adolescent with ODD. However, a child psychiatrist or a qualified mental health professional usually diagnoses ODD in children and adolescents. A detailed history of the child's behavior from parents and teachers, clinical observations of the child's behavior, and, sometimes, psychological testing contribute to the diagnosis. Parents who note symptoms of ODD in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

Further, oppositional defiant disorder often coexists with other mental health disorders, including mood disorders, anxiety disorders, conduct disorder, and attention-deficit/hyperactivity disorder, increasing the need for early diagnosis and treatment. Always consult your child's (adolescent's) physician for more information.

Treatment for oppositional defiant disorder:
Specific treatment for children with oppositional defiant disorder will be determined by your child's (adolescent's) physician based on:

your child's (adolescent's) age, overall health, and medical history
extent of your child's (adolescent's) symptoms
your child's (adolescent's) tolerance for specific medications, procedures, or therapies
expectations for the course of the condition
your opinion or preference
Treatment may include:

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individual psychotherapy
Individual psychotherapy for ODD often uses cognitive-behavioral approaches to improve problem solving skills, communication skills, impulse control, and anger management skills.
family therapy
Family therapy is often focused on making changes within the family system, such as improving communication skills and family interactions. Parenting children with ODD can be very difficult and trying for parents. Parents need support and understanding as well as developing more effective parenting approaches.
peer group therapy
Peer group therapy is often focused on developing social skills and interpersonal skills.
medication
While not considered effective in treating ODD, medication may be used if other symptoms or disorders are present and responsive to medication.
Prevention of oppositional defiant disorder in childhood:
Some experts believe that a developmental sequence of experiences occurs in the development of oppositional defiant disorder. This sequence may start with ineffective parenting practices, followed by difficulty with other authority figures and poor peer interactions. As these experiences compound and continue, oppositional and defiant behaviors develop into a pattern of behavior. Early detection and intervention into negative family and social experiences may be helpful in disrupting the sequence of experiences leading to more oppositional and defiant behaviors. Early detection and intervention with more effective communication skills, parenting skills, conflict resolution skills, and anger management skills can disrupt the pattern of negative behaviors and decrease the interference of oppositional and defiant behaviors in interpersonal relationships with adults and peers, and school and social adjustment. The goal of early intervention is to enhance the child's normal growth and developmental process, and improve the quality of life experienced by children or adolescents with oppositional defiant disorder.

ADD ADHD and Addictions

2008-08-17T14:40:00.000-07:00

Living in families, and raising children can be difficult under the best of circumstances. Many of us had a hard time living in the families that we grew up in. It may be difficult today, living together in the families that we have created. We may feel guilty for not giving our children or partner what we feel they deserve. We may feel painfully aware of how we are not taking care of our own needs. This is especially true if a member, or several members of our family have Attention Deficit Disorder.

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As our knowledge of Attention Deficit Disorder grows, we are learning that ADD is not simply a disorder of childhood. ADD is life long condition. Children with ADD grow up to be adults with ADD. People with ADD do not live and grow in a vacuum. They have relationships, children, and create families with people who may or may not have ADD. Therefore, it is essential to help not only the person directly affected by ADD, but the entire family. Attention Deficit Disorder, similar to addictions affects every member in the family. Families do not cause ADD, and yet families need help to live and thrive in spite of the impact of ADD.

We now know that ADD runs in families. It has been estimated that there is a 30% chance that a child with ADD has at least one parent who has ADD. It has also been estimate that there is a 30% chance that that same child will have a sibling with ADD. I frequently work with families where one or both parents have ADD, and one or two of their children also have the condition. Living in a family with ADD can be like living in a five ring circus. There is always someone or something that demands attention.

As parents we want the best for our children, and are often willing to sacrifice our needs for theirs. But what is the impact on the family if one of the parents has untreated Attention Deficit Disorder? Too many times, I hear caring parents say, "Please help my son or daughter. I've dealt with this all my life and can continue to." The problem with this is that it can be incredibly difficult to provide consistent parenting for any child, let alone a child with ADD, if you as the parent have untreated ADD. There is a reason why the airlines request that adults put their oxygen mask on first, so that they are then able to help the children.

Families with ADD have higher incidents of physical, and verbal abuse. Substances such as alcohol, food and drugs are often used to self-medicate the pain and frustration of family ADD. Some parents of children with ADD suffer from Post-traumatic Stress Disorder (PTSD). PTSD is a condition that occurs when people are subjected to extreme, ongoing stress that is beyond the realm of normal experience. PTSD symptoms include depression, anxiety, sleep disturbances, hyper-vigilance, and re-experiencing of the trauma.

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For the for mention reasons, it is imperative that ADD is viewed in the context of the family, or persons environment. Relationship therapy that is specific to addressing the impact of ADD is essential. Family therapy which includes parents and siblings with and without ADD is critical. So often the non-ADD siblings are left out, or feel that they have to somehow make up for the difficulties that their ADD sibling(s) are causing. Educating and treating all members of the family system promotes family wellness.

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We have learned from the evolution of the chemical dependency field over that past two decades that treating alcoholics and addicts outside of the context of their relationships is less than helpful. We have also learned that family members of the chemically dependent person also need treatment, so that they too can recover. The same is true with Attention Deficit Disorder. Let us continue to be quick learners as our knowledge of ADD expands. ADD is not caused by poor parenting, or dysfunctional families, and yet the entire family deserves treatment. No one in the family is immune from the impact of Attention Deficit Disorder.

Wendy Richardson M.A., LMFCC specializes in the treatment of ADD and co-related substance abuse. She provides education and therapy for couples and families where ADD is present. She is a writer who speaks nationally ,and provides workshops and trainings on Attention Deficit Disorder.

THE LINK BETWEEN ADD/HD AND EATING DISORDERS

SELF-MEDICATING WITH FOOD

As human beings we find creative ways to decrease our emotional, physical, and spiritual pain. Some people use alcohol and other drugs to ease the pain and frustration of their ADD symptoms. Others use compulsive behaviors such as gambling, spending, or sexual addictions. Eating in ways that are not good for us, but temporarily make us feel better is also a form of self-medicating. Self-medicating is when we use substances and behaviors to change how we feel. The problem with self-medicating is that it initially works, but soon leads to a host of new problems.

Eating can temporarily calm ADD physical and mental restlessness. Eating can be grounding for some people with ADD, helping them focus better while reading, studying, watching television or movies. If your brain is not quick to contain your impulses, you may eat without thinking. Some compulsive overeaters are shocked to realize they have finished a carton of ice cream or a king-size tub of theater popcorn. They were not consciously aware of how much they were eating. Eating puts them into a pleasant trance like state that is a respite from their often active and chaotic ADD brain.

Although we don't think of food as a drug, it can be used as one. We have to eat, but eating too much or too little of certain types of food has consequences. Since there is no way to totally abstain from food, eating disorders are extremely hard to recover from. You may have to abstain from certain foods, perhaps those containing sugar, because they trigger a compulsion for more, yet everywhere you look you see and smell these foods.

WHY FOOD?

Food is legal. It is a culturally acceptable way to comfort ourselves. For some people with ADD food is the first substance that helped them feel calm. Children with ADD will often seek out foods rich with sugar and refined carbohydrates such as candy, cookies, cakes, and pasta. People who compulsively over eat, binge, or binge and purge also eat these types of foods.

It is no accident that binge food is usually high in sugars and carbohydrates, especially when you take into consideration how the ADD brain is slow to absorb glucose. One of the Zametkin PET scan studies, results indicated that "Global cerebral glucose metabolism was 8.1 percent lower in the adults with hyperactivity than in the normal controls..."1 Other research has also confirmed slower glucose metabolism in ADD adults with and without hyperactivity. This suggests that the binge eater is using these foods to change his or her neurochemistry.

SUGAR CRAVING AND HYPERACTIVITY

Researchers have searched for the connection between sugar and hyperactivity. Some studies have reported that sugar causes hyperactivity in children. When these studies have been duplicated, however, the results were not always consistent. The idea that sugar causes hyperactivity is relatively new in our culture, and has not been passed on from previous generations. This is why grandparents are often miffed when they are told not to give their grandchild any sugar. They haven't had the experience of sugar causing hyperactivity.

What if we have been looking at the question backward? What if ADD hyperactivity actually causes people to crave sweets? If the ADD brain is slower to absorb glucose, it would make sense the body would find a way to increase the supply of glucose to the brain as quickly as possible.

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I have worked with many ADD adults who are addicted to sugar, especially chocolate which also contains caffeine. They find that eating sugar helps them stay alert, calm, and focused. Prior to ADD treatment many report drinking 6-12 sugar sodas, several cups of coffee with sugar, and constantly nibbling on candy and sweets throughout the day. It is impossible to sort out what is pure sugar craving when it is mixed with the stimulating effects of caffeine on the ADD brain.

THE SEROTONIN CONNECTION

Serotonin is a neurotransmitter that has been associated with symptoms of depression. Serotonin helps regulate sleep, sexual energy, mood, impulses and appetite. Low levels of serotonin can cause us to feel irritable, anxious, and depressed. One way to temporarily increase our serotonin level is to eat foods that are high in sugar and carbohydrates. Our attempts to change our neurochemistry are short lived, however, and we have to eat more and more to maintain feeling of well being. Medications such as Prozac, Paxil and Zoloft work to regulate serotonin. These medications are frequently helpful when used in combination with ADD and eating disorder treatment. Proper levels of serotonin can also help improve impulse control giving the person time to think before they eat.

COMPULSIVE OVER EATING

Most of us overeat at times. We may eat for sheer enjoyment even if we're not hungry, or we may eat more than we intend at a dinner party or celebration. But for some, overeating becomes a compulsion they cannot stop. Compulsive overeaters lose control of their ability to stop eating. They use food to alter their feelings rather than satisfy hunger. Compulsive overeaters tend to crave foods high in carbohydrates, sugars, and salt.

BINGE EATING

Binge eating differs from compulsive overeating in that the binge eater enjoys the rush and stimulation of planning the binge. Buying the food and finding the time and place to binge in secret creates a level of risk and excitement that the ADD brain craves. Large amounts of foods high in carbohydrates and sugars are rapidly consumed in a short period of time. The binge itself may only last fifteen to twenty minutes. Proper levels of serotonin and dopamine aid in impulse control problems that contribute to binge eating and Bulimia.

BULIMIA

Bulimia is binge eating accompanied by purging. The bulimic experiences the rush of planning the binge, which can be very stimulating for the person with ADD. In addition, the bulimic may be stimulated by the satiation binging provides; then, he or she adds an additional dimension to the process: the relief of purging. Many bulimics report entering an altered state of consciousness, experiencing feelings of calmness and euphoria after they vomit. This cleansing provides relief which is short lived, and so the bulimic is soon binging again.

ANOREXIA

Our culture is obsessed with thinness. "Food is OK, but, don't gain weight." No wonder so many adolescent boys and girls, as well as women and men, become imprisoned in binge and purge cycles, chronic dieting, and anorexia nervosa. Anorexia can be deadly. Anorectics have lost their ability to eat in a healthy way. Self-starvation is characterized by loss of control. They are obsessed with thoughts of food, body image, and diet. Anorectics can also use laxatives, diuretics, enemas, and compulsive exercise to maintain their distorted image of thinness.

As we learn more about ADD, we discover that people manifest ADD traits differently. Obsessing on food, exercise, and thinness gives the anorectic a way to focus their chaotic ADD brains. They become over focused on thoughts and behaviors that related to food.

Frequently these people will only become aware of their high level of activity, distractibility, and impulsiveness after they have been in recovery for anorexia. Self starvation curtails hyperactivity.

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Distractibility and spaceyness are characteristics of both anorexia and bulimia, whether or not they're accompanied by ADD. In each case the inability to concentrate or focus results because the brain is not being properly nourished. For people with ADD, however, there is a history of attention difficulties that predates the eating disorder. Their concentration, impulse problems, and activity level may not improve when their eating disorder is treated. As a matter of fact, their ADD traits can get worse once they are no longer self-medicating with food, or organizing their lives around food and exercise. If you are someone who has struggled with eating disorders, and suspect you may have ADD, it is important to get an evaluation. Both your eating disorders and your ADD must be treated.

COMPREHENSIVE TREATMENT

It is essential that both ADD and eating disorders are treated. Too many people are struggling with their eating disorders because they have undiagnosed or untreated ADD. When ADD is properly treated the individual is better able to focus and follow through with treatment for their eating disorders. They also have greater control of their impulses, and less of a need to self-medicate their ADD symptoms.

Stimulant medications such as Dexedrine, Ritalin, Desoxyn, and Adderall that work with the neurotransmitter dopamine can be helpful in treating ADD restlessness, impulsiveness, attentional problems, and problems with obsessive thoughts. Medications such as Paxil, Prozac, and Zoloft are useful because they increase serotonin levels, thus helping with impulse control, obsessive thoughts, and decrease agitation.

The key to successful treatment lies in a comprehensive treatment program that address the medical, emotional, social, and physical aspects of both ADD and eating disorders. Recovering from eating disorders takes time, hard work and commitment. Recovering from eating disorders when you have ADD is even tougher. I encourage you to be patient. Put away the whip of contempt, and have compassion for yourself. You've been through a lot. Over the years I have seen many people who were once hopeless and despondent because they could not recover from their eating disorders chart solid courses of recovery once their ADD was treated.

1. Zametkin, Nordahl, Gross, King, Semple, Rumsey, Hamburger, and Cohen, "Cerebral Glucose Metabolism in Adults with Hyperactivity of Childhood Onset," {The New England Journal of Medicine}, 30 (1990).

Wendy Richardson, MA., LMFT, the author of The Link Between ADD And Addiction: Getting The Help You Deserve, is a licensed marriage, family, child therapist and Certified Addiction Specialist in private practice. She is also a consultant, trainer, and speaks at national and international ADD, chemical dependency, and learning disability conferences.

The Link Between ADHD & Addiction

It is common for people with ADHD to turn to addictive substances such as alcohol, marijuana, heroin, prescription tranquilizers, pain medication, nicotine, caffeine, sugar, cocaine and street amphetamines in attempts to soothe their restless brains and bodies. Using substances to improve our abilities, help us feel better, or decrease and numb our feelings is called self-medicating.

Putting Out Fires With Gasoline

The problem is that self-medicating works at first. It provides the person with ADHD relief from their restless bodies and brains. For some, drugs such as nicotine, caffeine, cocaine, diet pills and "speed" enable them to focus, think clearly, and follow through with ideas and tasks. Others chose to soothe their ADHD symptoms with alcohol and marijuana. People who abuse substances, or have a history of substance abuse are not "bad" people. They are people who desperately attempt to self-medicate their feelings, and ADHD symptoms. Self-medicating can feel comforting. The problem is, that self-medicating brings on a host of addiction related problem which over time make people's lives much more difficult. What starts out as a "solution", can cause problems including addiction, impulsive crimes, domestic violence, increased high risk behaviors, lost jobs, relationships, families, and death. Too many people with untreated ADHD, learning, and perceptual disabilities are incarcerated, or dying from co-occurring addiction.

Self-medicating ADD with alcohol and other drugs is like putting out fires with gasoline. You have pain and problems that are burning out of control, and what you use to put out the fires is gasoline. Your life may explode as you attempt to douse the flames of ADD.

A 1996 article in American Scientists states that "In the United States alone there are 18 million alcoholics, 28 million children of alcoholics, 6 million cocaine addicts, 14.9 million who abuse other substances, 25 million addicted to nicotine."1

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Who Will Become Addicted?

Everyone is vulnerable to abusing any mind altering substance to diminish the gut wrenching feelings that accompany ADHD. There are a variety of reasons why one person becomes addicted and another does not. No single cause for addictions exists; rather, a combination of factors is usually involved. Genetic predisposition, neurochemistry, family history, trauma, life stress, and other physical and emotional problems contribute. Part of what determines who becomes addicted and who does not is the combination and timing of these factors. People may have genetic predispositions for alcoholism, but if they choose not to drink they will not become alcoholic. The same is true for drug addictions. If an individual never smokes pot, snorts cocaine, shoots or smokes heroin, he or she will never become a pot, coke, or heroin addict.

The bottom line is that people with ADHD as a whole are more likely to medicate themselves with substances than those who do not have ADHD. Dr.s Hallowell and Ratey estimate that 8 to 15 million Americans suffer from ADD, other researchers estimated that as many as 30-50% of them use drugs and alcohol to self-medicate their ADHD symptoms.2 This does not include those who use food, and compulsive behaviors to self-medicate their ADD brains and the many painful feelings associated with ADHD. When we see ADD it is important to look for substance abuse and addictions. And when we see substance abuse and addictions, it is equally important to look for ADHD.

Prevention and Early Intervention

"Just Say No!" may sound simple, but if it was that simple we would not have millions of children, adolescents, and adults using drugs every day. For some their biological and emotional attraction to drugs is so powerful, that they cannot conceptualize the risks of self-medication. This is especially true for the person with ADHD who may have an affinity for risky, stimulating experiences. This also applies to the person with ADHD who is physically and emotionally suffering from untreated ADHD restlessness, impulsiveness, low energy, shame, attention and organization problems, and a wide range of social pain.3 It is very difficult to say no to drugs when you have difficulties controlling your impulses, concentrating, and are tormented by a restless brain or body.

The sooner we treat children, adolescents, and adults with ADHD the more likely we are to help them to minimize or eliminate self-medicating. Many well meaning parents, therapists and medical doctors are fearful that treating ADHD with medication will lead to addiction. Not all people with ADHD need to take medication. For those who do, however, prescribed medication that is closely monitored can actually prevent and minimize the need to self-medicate. When medication helps people to concentrate, control their impulses, and regulate their energy level, they are less likely to self-medicate.

Untreated ADHD and Addiction Relapse

Untreated ADHD contributes to addictive relapse, and at best can be a huge factor in recovering people feeling miserable, depressed, unfulfilled, and suicidal. Many individuals in recovery have spent countless hours in therapy working through childhood issues, getting to know their inner child, and analyzing why they abuse substances and engage in addictive behaviors. Much of this soul searching, insight, and release of feelings is absolutely necessary to maintain recovery. But what if after years of group and individual therapy, and continued involvement in addiction programs your client still impulsively quit jobs and relationships, can't follow through with their goals, and has a fast chaotic, or slow energy level. What if, along with addiction your client also has ADHD?

Treating Both ADHD and Addictions

It is not enough to treat addictions and not treat ADHD, nor is it enough to treat ADHD and not treat co-occurring addiction. Both need to be diagnosed, and treated for the individual to have a chance at ongoing recovery. Now is the time to share information so that addiction specialists, and those treating ADHD can work together. It is critical that chemical dependency practitioners understand that ADHD is based in one's biology and responds well to a comprehensive treatment program that sometimes includes medications. It is also important for practitioners to support the recovering persons involvement in Twelve Step programs and help them to work with their fear about taking medication.

A COMPREHENSIVE TREATMENT PROGRAM CONSISTS OF:

A professional evaluation for ADHD and co-occurring addiction.
Continued involvement in addiction recovery groups or Twelve Step programs.
Education on how ADHD impacts each individual's life, and the lives of those who love them.
Building social, organization, communication, and work or school skills.
ADHD coaching and support groups.
Closely monitored medication when medication is indicated.
Supporting individuals decisions to take medication or not ( in time they may realize on their own that medication is an essential part of their recovery).
Stages of Recovery
It is important to treat people with ADHD and addiction according to their stage of recovery. Recovery is a process that can be divided into four stages, pre-recovery, early recovery, middle recovery, and long term recovery.

PRE-RECOVERY: Is the period before a person enters treatment for their addictions. It can be difficult to sort out ADHD symptoms from addictive behavior and intoxication. The focus at this point is to get the person into treatment for their chemical and/or behavioral addiction. This is NOT the time to treat ADHD with psycho stimulant medication.

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EARLY RECOVERY: During this period it is also difficult, but not impossible to sort out ADHD from the symptoms of abstinence which include, distractibility, restlessness, mood swings, confusions, and impulsivity. Much of what looks like ADHD can disappear with time in recovery. The key is in the life long history of ADHD symptoms dating back to childhood. In most cases early recovery is NOT the time to use psycho stimulant medication, unless the individual's ADHD is impacting his or her ability to attain sobriety.

MIDDLE RECOVERY: By now addicts, and alcoholics, are settling into recovery. This is usually the time when they seek therapy for problems that did not disappear with recovery. It is much easier to diagnose ADHD at this stage; and medication can be very effective when indicated.

LONG TERM RECOVERY: This is an excellent time to treat ADHD with medications when warranted. By now most people in recovery have lives that have expanded beyond intense focus on staying clean and sober. Their recovery is an important part of their life, and they also have the flexibility to deal with other problems such as ADHD.

Medication and Addiction

Psychostimulant medication when properly prescribed and monitored is effective for approximately 75-80% of people with ADHD. These medications include Ritalin, Dexedrine, Adderall, and Desoxyn. It is important to note that when these medications are used to treat ADHD the dosage is much less that what addicts use to get high. When people are properly medicated they should not feel high or "speedy, instead they will report increases in their abilities to concentrate, control their impulses, and moderate their activity level. The route of delivery is also quite different. Medication to treat ADHD is taken orally, where street amphetamines are frequently injected and smoked.

Non stimulant medications such as Wellbutrin, Prozac, Nortriptyline, Effexor and Zoloft can also be effective in relieving ADHD symptoms for some people. These medications are frequently used in combination with a small dose of a psychostimulant. Recovering alcoholics and addicts are not flocking to doctors to get psychostimulant medication to treat their ADHD. The problem is that many are hesitant for good reasons to use medication, especially psycho stimulants. It has been my experience that once a recovering person becomes willing to try medication the chance of abuse is very rare. Again the key is a comprehensive treatment program that involves close monitoring of medication, behavioral interventions, ADHD coaching and support groups, and continued participation in addiction recovery programs.

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There is Hope

For the last few years I have witnessed the transformation of lives that were once ravaged by untreated ADHD and addiction. I have worked with people who had relapsed in and out of treatment programs for ten to twenty years attain ongoing and fulfilling sobriety once their ADHD was treated. I have Witnessed people with ADHD achieve recovery once their addictions were treated.

"Each day I understand more about how pervasive ADHD is in my life. My clients, friends, family and colleagues are my teachers. I wouldn't wish ADHD and addictions on anyone, but if these are the genetic cards that you have been dealt, your life can still be fascinating and fulfilling."

TOURETTE SYNDROME (TS)

2008-08-17T14:36:00.000-07:00

Tourette Syndrome (TS) is a neurological or "neurochemical" disorder characterized by tics -- involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way.

The cause has not been established, although current research presents considerable evidence that the disorder stems from the abnormal metabolism of at least one brain chemical (neurotransmitter) called dopamine. Very likely other neurotransmitters, such as serotonin, are also involved.

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In 1825 the first case of TS was reported in medical literature by Dr. Itard. It was a description of the Marquise de Dampierre, a noblewoman whose symptoms included involuntary tics of many parts of her body and various vocalizations including echolalia [repetition or echoing of verbal utterances] and coprolalia [involuntary swearing or the involuntary utterance of obscene words or socially inappropriate & derogatory remarks]. She lived to the age of 86 and was again described in 1883 by Dr. Georges Gilles de la Tourette, the French neurologist for whom the disorder was named. Samuel Johnson, the lexicographer and André Malraux, the French author, are among the famous people who are thought to have had TS.

SYMPTOMS OF TOURETTES

The most common first symptom is a facial tic, such as rapidly blinking eyes or twitches of the mouth. However, involuntary sounds, such as throat clearing and sniffing, or tics of the limbs may be the initial signs. For some, the disorder begins abruptly with multiple symptoms of movements and sounds.

The symptoms include;
Both multiple motor and one or more vocal tics present at some time during the illness although not necessarily in the same way;
The occurrence of ticks many times a day (usually in bouts) nearly every day or intermittently throughout a span of more than one year;
The periodic change in the number, frequency, type and location of the tics, disappear for weeks or months at a time; and
Onset before the age of 18.

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The term "involuntary" used to describe TS tics is a source of confusion since it is known that most people with TS do have some control over the symptoms. What is recognized is that the control which can be exerted from seconds to hours at a time, may merely postpone more severe outbursts of symptoms. Tics are experienced as irresistible as the urge to sneeze and must eventually be expressed. People with TS often seek a secluded spot to release their symptoms after delaying them in school or at work. Typically, tics increase as a result of tension or stress (but are not caused by stress) and decrease with relaxation or concentration on an absorbing task.

Individuals not only struggle with the condition itself, they must bear the double burden of the stigma attached.

TREATMENT of TOURETTES

The majority of people with TS are not significantly disabled by their tics or behavioural symptoms and therefore do not require medication. However, there are medications to help control symptoms when they interfere with functioning. The drugs include haloperidol (Haldol®), pimozide (Orap®), clonidine (Catapres®), clonazepam (Rivotril®) and nitrazepam (Mogadon®). Stimulants such as methylphenidate (Ritalin®) and dextroamphetamine (Dexedrine®), that are prescribed for hyperactivity may temporarily increase tics and should be used cautiously. Obsessive compulsive symptoms may be controlled with fluoxetine (Prozax®), clomipramine (Anafranil®) and other similar medications.

The dosage necessary to achieve maximum control of symptoms varies for each patient and must be gauged carefully by a doctor. The medicine is administered in small doses with gradual increases to the point where there is a maximum alleviation of symptoms with minimal side effects. Some of the undesirable reactions to medications are fatigue, motor restlessness, weight gain and social withdrawal, most of which can be reduced with specific medications. Side effects such as depression and cognitive impairment can sometimes be alleviated with dosage reduction or a change of medication.

Other types of therapy may also be helpful. Sometimes psychotherapy can assist a person with TS and help his/her family cope with the psycho-social problems associated with TS. Some behavioural therapies can teach the substitution of one tic with another that is more acceptable. The use of relaxation techniques and/or biofeedback may help during prolonged periods of high stress.

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GENES and TOURETTES

The majority of people with TS are not significantly disabled by their tics or behavioural symptoms and therefore do not require medication. However, there are medications to help control symptoms when they interfere with functioning. The drugs include haloperidol (Haldol®), pimozide (Orap®), clonidine (Catapres®), clonazepam (Rivotril®) and nitrazepam (Mogadon®). Stimulants such as methylphenidate (Ritalin®) and dextroamphetamine (Dexedrine®), that are prescribed for hyperactivity may temporarily increase tics and should be used cautiously. Obsessive compulsive symptoms may be controlled with fluoxetine (Prozax®), clomipramine (Anafranil®) and other similar medications.

The dosage necessary to achieve maximum control of symptoms varies for each patient and must be gauged carefully by a doctor. The medicine is administered in small doses with gradual increases to the point where there is a maximum alleviation of symptoms with minimal side effects. Some of the undesirable reactions to medications are fatigue, motor restlessness, weight gain and social withdrawal, most of which can be reduced with specific medications. Side effects such as depression and cognitive impairment can sometimes be alleviated with dosage reduction or a change of medication.

Other types of therapy may also be helpful. Sometimes psychotherapy can assist a person with TS and help his/her family cope with the psycho-social problems associated with TS. Some behavioural therapies can teach the substitution of one tic with another that is more acceptable. The use of relaxation techniques and/or biofeedback may help during prolonged periods of high stress.

Some of the Mental Health Disorders explained

2008-08-17T14:15:00.000-07:00

There are many different conditions that are recognized as mental illnesses. The more common types include:

Anxiety disorders: People with anxiety disorders respond to certain objects or situations with fear and dread, as well as with physical signs of anxiety or nervousness, such as a rapid heartbeat and sweating. An anxiety disorder is diagnosed if the person's response is not appropriate for the situation, if the person cannot control the response or if the anxiety interferes with normal functioning. Anxiety disorders include generalized anxiety disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder and specific phobias.

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Mood disorders: These disorders, also called affective disorders, involve persistent feelings of sadness or periods of feeling overly happy, or fluctuations from extreme happiness to extreme sadness. The most common mood disorders are depression, mania and bipolar disorder.
Psychotic disorders: Psychotic disorders involve distorted awareness and thinking. Two of the most common symptoms of psychotic disorders are hallucinations -- the experience of images or sounds that are not real, such as hearing voices -- and delusions -- false beliefs that the ill person accepts as true, despite evidence to the contrary. Schizophrenia is an example of a psychotic disorder.
Eating disorders: Eating disorders involve extreme emotions, attitudes and behaviors involving weight and food. Anorexia nervosa, bulimia nervosa and binge eating disorder are the most common eating disorders.

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Impulse control and addiction disorders: People with impulse control disorders are unable to resist urges, or impulses, to perform acts that could be harmful to themselves or others. Pyromania (starting fires), kleptomania (stealing) and compulsive gambling are examples of impulse control disorders. Alcohol and drugs are common objects of addictions. Often, people with these disorders become so involved with the objects of their addiction that they begin to ignore responsibilities and relationships.
Personality disorders: People with personality disorders have extreme and inflexible personality traits that are distressing to the person and/or cause problems in work, school or social relationships. In addition, the person's patterns of thinking and behavior significantly differ from the expectations of society and are so rigid that they interfere with the person's normal functioning. Examples include antisocial personality disorder, obsessive-compulsive personality disorder and paranoid personality disorder.
Other, less common types of mental illnesses include:

Adjustment disorder: Adjustment disorder occurs when a person develops emotional or behavioral symptoms in response to a stressful event or situation. The stressors may include natural disasters, such as an earthquake or tornado; events or crises, such as a car accident or the diagnosis of a major illness; or interpersonal problems, such as a divorce, death of a loved one, loss of a job or a problem with substance abuse. Adjustment disorder usually begins within three months of the event or situation and ends within six months after the stressor stops or is eliminated.
Dissociative disorders: People with these disorders suffer severe disturbances or changes in memory, consciousness, identity, and general awareness of themselves and their surroundings. These disorders usually are associated with overwhelming stress, which may be the result of traumatic events, accidents or disasters that may be experienced or witnessed by the individual. Dissociative identity disorder, formerly called multiple personality disorder, or "split personality", and depersonalization disorder are examples of dissociative disorders.
Factitious disorders: Factitious disorders are conditions in which physical and/or emotional symptoms are experienced in order to place the individual in the role of a patient or a person in need of help.

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Sexual and gender disorders: These include disorders that affect sexual desire, performance and behavior. Sexual dysfunction, gender identity disorder and the paraphilias are examples of sexual and gender disorders.
Somatoform disorders: A person with a somatoform disorder, formerly known as psychosomatic disorder, experiences physical symptoms of an illness even though a doctor can find no medical cause for the symptoms.
Tic disorders: People with tic disorders make sounds or display body movements that are repeated, quick, sudden and/or uncontrollable. (Sounds that are made involuntarily are called vocal tics.) Tourette syndrome is an example of a tic disorder.
Other diseases or conditions, including various sleep-related problems and many forms of dementia, including Alzheimer's disease, are sometimes classified as mental illnesses because they involve the brain.

Mental Disorders are often misunderstood

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While all people with mental disorders suffer discrimination, children and adolescentsare the least capable of advocating for themselves. Also, developmentally, childrenthink more dichotomously than adults about categories such as “good” and “bad,” or“healthy” and “sick”. They are thus less likely to temper a negative remark with othermore positive feedback, and may therefore more easily accept negative, misappliedlabels. Stigma and discrimination include: bias, stereotyping, fear, embarrassment,anger and rejection or avoidance; violations of basic human rights and freedoms; denialof opportunities for education and training; and denial of civil, political, economic, socialand cultural rights. Additionally, in contrast to physical illnesses where parents mayreceive community support, stigma often results in parents being blamed for the mentalhealth problems of their

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children.Behaviours associated with mental disorders are often misunderstood, or areconsidered to be intentional or deliberately wilful. For example, a depressed child whois acting badly may be punished for being naughty or may be told to “snap out of it.”An anxious adolescent may consume increasing amounts of alcohol in order to cope,but is told to “just say no!”. When a problem is misunderstood by others, it is morelikely that the solutions applied will be inappropriate and ineffective, or possibly harmfulto the health of the individual who is suffering. Social exclusion, punitive action andcriticism leading to lowered self-esteem may result. A mistaken and inappropriateunderstanding of mental disorders can result in children and adolescents beingdeprived of the assistance they need. Stigmatization may result, with a range ofnegative impacts, including a reduction in the resources needed for treatment. In certain countries, mental disorders may be attributed to spiritual causes, or topossession by the devil due to alleged evil acts or the neglect of spiritual duties.Epilepsy, for example, has a wide range of such putative causes worldwide, and issometimes even considered contagious. Children or adolescents with epilepsy may beexcluded from school for fear that others will contract their illness. Families may beashamed of their children who suffer from a mental disorder or fearful that they may bephysically abused. They may keep them locked up or isolated from the community.Such severe measures can have devastating effects on the physical and emotionaldevelopment of these children and adolescents. Unless children and adolescents with mental disorders receive appropriate treatment,their difficulties are likely to persist, and their social, educational and vocationalprospects diminished. This results in direct costs to the family and lost productivity forsociety. It is also now known that individuals with untreated mental disorders representa disproportionately large segment of the populations in the juvenile justice and adultcriminal justice systems. For example, a study among youth in detention centres inMassachusetts, United States of America (USA), found that

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approximately 70% of themales and 81% of the females scored above the clinical cut-off on at least one of thescales of a screening instrument: alcohol/drug use, angry-irritable, depressed-anxious,somatic complaints and suicide ideation (Cauffman, 2004). These sequelae areparticularly tragic because some mental illnesses are preventable, many are treatable,and children with psychiatric disorders could be living normal or near-normal lives ifgiven appropriate treatment

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Overview

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Children and adolescents are thinking and feeling beings with a degree of mentalcomplexity that is only now being recognized. While it has long been accepted thatphysical health can be affected by traumas, genetic disturbances, toxins and illness, ithas only recently been understood that these same stressors can affect mental health,and have long-lasting repercussions. When risk factors and vulnerabilities outweigh orovercome factors that are protective or that increase resilience, mental disorder canresult. Child and adolescent mental disorders manifest themselves in many domainsand in different ways. It is now understood that mental disturbances at a young agecan lead to continuing impairment in adult life.

Child and adolescent mental health includes a sense of identity and self-worth; soundfamily and peer relationships; an ability to be productive and to learn; and a capacity touse developmental challenges and cultural resources to maximize development (Daweset al., 1997). Good mental health in childhood is a prerequisite for optimal psychologicaldevelopment, productive social relationships, effective learning, an ability to care forself, good physical health and effective economic participation as adults.

However, a proportion of children and adolescents suffer from overt mental healthdisorders. A mental illness or disorder is diagnosed when a pattern of signs andsymptoms is identified that is associated with impairment of psychological and socialfunctioning, and that meets criteria for disorder under an accepted system ofclassification such as the International Classification of Disease, version 10 (ICD-10,WHO, 1992) or the Diagnostic and Statistical Manual IV (DSM-IV, American PsychiatricAssociation, 1994).3Examples include: mood disorders, stress-related and somatoformdisorders, and mental and behavioural disorders due to psychoactive substance use.Community-based studies have revealed an overall prevalence rate for such disordersof about 20% in several national and cultural contexts (Bird, 1996; Verhulst, 1995).

Some children and adolescents are in difficult circumstances; for example, they mightexperience physical, emotional and/or sexual abuse, experience or witness violence orwarfare, suffer from intellectual disability, slavery or homelessness, migrate from rural tourban areas, live in poverty, engage in sex work, be addicted to substances such asalcohol and cannabis, or be infected or affected by HIV/AIDS. Difficult circumstancesand mental health problems can be interrelated in a number of ways. They could, forexample, serve as risk factors for mental health problems, such as post-traumaticstress disorder in a child who has been sexually abused. Alternatively, mental healthproblems could serve as risk factors in difficult circumstances; for example, when anadolescent uses alcohol or drugs to deal with depressive feelings. Whatever the natureof the relationship between mental health problems and difficult circumstances, specificintervention strategies are necessary to address children’s and adolescents’ needs.