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.
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
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.
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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
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)
Thursday, August 28, 2008
Sunday, August 17, 2008
Alzheimer's Disease
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.
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.
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.
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
To
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Oppositional Defiant Disorder
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.
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.
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:
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.
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.
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.
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:
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
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.
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.
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.
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.
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.
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
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.
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.
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."
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.
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.
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.
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.
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
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.
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.
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)
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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
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
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
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
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
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
Overview
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.
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.
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