Blog Articles and Resources
This video was obtained from YouTube on 5/16/16. It was published on 5/26/15 as part of a series: How to Treat Various Child Ailments.
Is it ADHD or Immaturity?
The following article was found on the Child Mind Institute website. This website does a good job of providing factual, research based information for parents to help in raising kids struggling with various mental health concerns. This particular article was written by Caroline Miller, the editorial director for the Child Mind Institute.
Is It ADHD or Immaturity?
How to avoid a misdiagnosis when a child is young for his class
Several studies in recent years have found that children who are among the youngest in their class are diagnosed with ADHD at a much higher rate than their older classmates.
This suggests that a significant percentage of kids with ADHD are being misdiagnosed just because they are less mature. It raises important questions about how kids are being diagnosed, and how to avoid misinterpreting the behavior of children who might be having trouble meeting expectations just because they are younger.
The findings in these studies of large populations of kids — in Michigan, British Columbia and (most recently) Taiwan — are consistent. The youngest children are significantly more likely to be diagnosed than the oldest in the same class: boys as much as 60 percent and girls as much as 70 percent. The Taiwan study even showed the prevalence of kids diagnosed with ADHD decreased month by month from the youngest to the oldest in the class.
What can we do to address this problem while still making sure kids get the help they need?
How to avoid misdiagnosis
Most ADHD diagnoses are the result of children struggling to meet expectations for behavior and performance in school. All young children find it challenging to sit still, pay attention, wait their turn, finish tasks and keep from interrupting. By school age most have developed skills to manage these things as expected. Those who don’t are often flagged by teachers who have a lot of experience with typical behavior and child development.
But the age range of students in a given classroom can span a whole year, which means that the developmental differences between the youngest and the oldest can be substantial. That’s why it’s important that if children are being evaluated for ADHD, their behavior should be compared with that of other children their age, not all the other children in their class.
“If a child is behaving poorly, if he’s inattentive, if he can’t sit still, it may simply be because he’s 5 and the other kids are 6,” explained Todd Elder, lead author of the Michigan study. “There’s a big difference between a 5-year-old and a 6-year-old, and teachers and medical practitioners need to take that into account when evaluating whether children have ADHD.”
Here are other “best practices” that should be followed to avoid misdiagnosis:
A variety of sources: A child shouldn’t get a diagnosis of ADHD based on a teacher’s observations alone. A clinician evaluating a child should collect information from several adults, including teachers, parents and others who spend time with him.
Not just at school: For a child to be properly diagnosed with ADHD, the symptoms that are associated with the disorder — inattention, impulsivity and hyperactivity — have to be present in more than one setting. Are they noticeable at home and in social situations, as well as school? Do his parents worry that he’s so impulsive he’s a danger to himself? Does she have trouble keeping friends because she can’t follow rules, can’t wait her turn or has tantrums when she doesn’t get her way?
Rating scales: Scales that are filled out by teachers and parents should be used to collect specific information about the frequency of behaviors we associate with ADHD, and compare them with other children the same age, rather than relying on general impressions.
A thorough history: To get a good, nuanced understanding of a child’s behavior, a clinician needs to know how it’s developed over time, notes Dr. Matthew Rouse, a clinical psychologist at the Child Mind Institute. “What was she like at two or three or four? Is kindergarten the first time these issues have come up, or was she kicked out of preschool because she couldn’t behave?”
Level of impairment: The biggest difference between kids with ADHD and those who are just immature is likely to be how much their behavior impacts their lives. Are they in a negative spiral at home because they can’t seem to do what they’re asked to do, and parents are very frustrated? Are they unable to participate in sports because they can’t follow rules? Do they get excluded from play dates?
A wait and see approach
If a child is struggling because he’s immature, things could get better over time, as he adjusts to the expectations of a new classroom.
“Some children starting kindergarten might have a difficult time fitting into a new setting, adjusting to new rules,” notes Dr. Rouse. “It might be the first time the child has been in a setting with so many other kids around, and the first time taking direction from people not his parents.”
Giving kids time to adjust is one reason Dr. Rouse says that when a child presents symptoms that look like ADHD in kindergarten, when it’s his first year in school, he’ll make a provisional or “rule out” diagnosis, and reevaluate when the child is 6.
While medication has been shown repeatedly to be the most effective at reducing symptoms of ADHD, it isn’t necessarily the go-to treatment for the youngest kids. The potential for misdiagnosis is one reason why Dr. Rouse recommends behavioral therapy for younger children with ADHD, rather than starting with stimulant medication.
Similarly, the American Association of Pediatricians recommends behavioral therapy administered by parents and teachers as the first line of treatment for children 4 to 5 years old. Stimulant medication is recommended only if the behavioral therapy doesn’t produce results, and the child continues to have moderate to severe symptoms.
Delay in brain development
One reason immaturity might be confused with ADHD is that ADHD itself has been linked to a delay in brain maturation. An older child with ADHD might present behaviors that are typical in a younger child — and the opposite could be true if your frame of reference is older children. Several important neuroimaging studies have shown delays in brain development in kids with ADHD.
In a 2006 study at the National Institutes of Mental Health, the brains of several hundred children were scanned over a 10-year period. As the brain matures, the cortex thickens and then thins again following puberty, when connections are pruned to increase the efficiency of the brain. Researchers found that what they call “cortical maturation” — the point in which the cortex reaches peak thickness — was three years later in kids with ADHD than kids in a control group: 10.5 years old, compared to 7.5. The kids with ADHD also lag behind other kids in the subsequent cortical thinning.
The researchers noted that the most delayed areas of the brain are those that “support the ability to suppress inappropriate actions and thoughts, focus attention, remember things from moment to moment, work for reward and control movement – functions often disturbed in people with ADHD.”
They also added, tantalizingly, that the only area that matured faster than usual in kids with ADHD was the motor cortex. Combine that with the late-maturing frontal cortex areas that direct it, and the mismatch, they suggested, could account for the restlessness associated with the disorder.
Then in 2013, a study using scans of brain functioning, rather than structure, also found a lag in maturity in kids with ADHD. That study, at the University of Michigan, found that children and teens with ADHD are behind others of the same age in how quickly their brains form connections within, and between, key brain networks.
Specifically, they found less-mature connections between what’s called the “default mode network,” which controls internally directed thought, and networks that focus on externally directed tasks. Researchers propose that this lag in connectivity could help explain why children with ADHD find their thoughts wandering and struggle to complete tasks and stay focused.
Maturing out of ADHD symptoms
Finally, we know that some children grow out of ADHD symptoms as they become teenagers and young adults. Hyperactive and impulsive symptoms often wane through adolescence, while inattentive symptoms may continue to be a problem into adulthood.
Regardless of whether or not a child has ADHD, if his behaviors interfere with learning, making friends and being a part of the family, then he needs help. But the behavioral therapies and medications that can work wonders for kids with ADHD aren’t appropriate for children who are struggling to meet expectations just because they are less mature than those they are being compared to.
There are also other problems that can be misread as ADHD. Anxiety and trauma, for instance, can also cause inattention and what looks like impulsivity. That’s why it’s important that kids with behavior issues be evaluated thoroughly; careful and effective diagnosis benefits everyone.
Miller, Caroline. "Is It ADHD or Immaturity?" Child Mind Institute. Child Mind Institute, 2016. Web. 13 Apr. 2016.
Managing Problem Behavior At Home
The following article comes from the Child Mind Institute website. This site has numerous sources on issues parents face raising children with a variety of concerns. The site does an excellent job of providing factual information as well as interventions and ideas to try as parents.
Managing Problem Behavior at Home
A guide to more confident, consistent and effective parenting
One of the biggest challenges parents face is managing difficult or defiant behavior on the part of children. Whether they’re refusing to put on their shoes, or throwing full-blown tantrums, you can find yourself at a loss for an effective way to respond.
For parents at their wits end, behavioral therapy techniques can provide a roadmap to calmer, more consistent ways to manage problem behaviors and offers a chance to help children develop the skills they need to regulate their own behaviors:
ABC’s of behavior management
To understand and respond effectively to problematic behavior, you have to think about what came before it, as well as what comes after it. There are three important aspects to any given behavior:
The first step in a good behavior management plan is to identify target behaviors. These behaviors should be specific (so everyone is clear on what is expected), observable, and measurable (so everyone can agree whether or not the behavior happened).
An example of poorly defined behavior is “acting up,” or “being good.” A well-defined behavior would be running around the room (bad) or or starting homework on time (good).
Antecedents, the good and the bad
Antecedents come in many forms. Some prop up bad behavior, others are helpful tools that help parents manage potentially problematic behaviors before they begin and bolster good behavior.
Antecedents to AVOID:
Here are some antecedents that can bolster good behavior:
Not all consequences are created equal. Some are an excellent way to create structure and help kids understand the difference between acceptable behaviors and unacceptable behaviors while others have the potential to do more harm than good. As a parent having a strong understanding of how to intelligently and consistently use consequences can make all the difference.
Consequences to AVOID
Consequences that are more effective begin with generous attention to the behaviors you want to encourage.
"Managing Problem Behavior at Home | Child Mind Institute." Child Mind Institute. Child Mind Institute, 2016. Web. 13 Apr. 2016.
The above video was found on YouTube on 5/16/16 and was originally published on October 28, 2015. It is a clip from Psychologist Kristine Turner addressing how parents can learn to effectively co-parent following divorce.
This article comes from the website PsychCentral.com which has several great articles about stress and managing stress. Many of the articles are written by mental health professionals who specialize in helping clients deal effectively with stress and the resulting complications.
How To Help A Stressed Or Depressed Loved One
By Chris Green
I receive many emails from concerned relatives, partners and friends who are trying to help a loved one suffering the torment of a stressful or depressive episode. Sometimes, it’s easy to forget that people who love us are also affected by these illnesses and may find it difficult to understand what’s happening. They want to help, but just don’t know what to do for the best.
Having lived with a depressed partner for 3 years and suffered anxiety and depression for 5 years, I’ve experienced both sides. In this article, I’ll show you exactly what you can do – and, what you shouldn’t do – to help your loved one.
1. Please, however frustrated you feel, please never say to a depressed or stressed person: “Come on, snap out of it. What have you got to be worried or sad about anyway. People have it much worse than you.” Please understand that these illnesses cannot be “snapped out of.” You wouldn’t say this to someone with high blood pressure or pneumonia because you know it isn’t that simple. Stress, depression and anxiety are real illnesses that have specific causes. Asking someone to snap out of it makes that person feel inadequate or that they’re doing something wrong. Absolutely not so. Comparing their circumstances to people who are suffering greater hardship is no use either. I couldn’t have given two hoots about other people when I was ill because their circumstances meant nothing to me. I was struggling to solve my own problems and couldn’t see anything else. Knowing that others are starving, are terminally ill, or suffer in squalor didn’t matter a jot because they didn’t make my problems go away. One more thing about such statements: they confront the sufferer with their illness and they put pressure on them. This will cause sufferers to retreat further and further into their own world. Better is to offer love and support: “I’m always here if you need me or want to talk.” And 3 little words can mean so much: “I love you.” I didn’t hear them for 3 years and believe me, I missed them so very much.
2. As a loved one, it is totally natural to want to understand what is happening. Many loved ones conduct research into these illnesses to develop understanding. Nothing wrong with that whatsoever. However, a problem can arise if you start to impose your knowledge on the sufferer. This happens when you observe certain behaviors and habits performed by sufferers and comment on why they are behaving in such a way. For example, you hear a sufferer put themselves down, so you say “That’s a part of your illness. I’ve been reading about it and self-deprecation is one of the reasons why people become depressed. You need to stop putting yourself down.” Again, this is confrontational and puts the sufferer under pressure. All they’ll do is dismiss your comments and clam up whenever you’re around as they’ll feel they’re being scrutinised. A better way is to challenge them very gently by reminding them of a time when they did something good. For example, you hear a sufferer say: “I’m useless, I never get anything right.” You can say “Sure you do, hey, remember the time when you…”. Do you see the difference in approach? The first is more like a doctor assessing a patient, the second is just a normal, natural conversation and doesn’t mention stress, depression or anxiety. This is very, very helpful as it shifts focus from a bad event: “I’m useless…” to a good one: “remember when.” without exerting pressure.
3. Finally, you may find a resource – a book, a video, a supplement etc. – that you think will help someone to beat their illness. Perfectly natural. But there’s a problem. It confronts the sufferer with their illness and puts them under pressure to do something about it. The result of this will be resentment followed by retreat into their own world. Isolation is a part of these illnesses. Sometimes, you just can’t bear to be around people. My ex-partner used to sleep in a dark room for an entire weekend because she just couldn’t handle anyone being around her. “I bore people, I’ve nothing to say of interest and I don’t want anyone asking me how I’m feeling. I just want to be on my own.” I know, it cuts you to ribbons when you hear such words from someone you care deeply about. But please, you must resist the urge to DIRECTLY give them a resource you think will help them. For someone to emerge from these illnesses, they have to make the decision themselves. A direct offer will more often than not be refused. So, if you find something you think will help, leave it lying around somewhere your loved one will find it. The idea here is for them to CHOOSE by themselves to investigate further. Such an INDIRECT approach is more effective because once again, there is no pressure, no reminder, no confrontation. It is the sufferer who takes a willing first step towards recovery.
It is so hard to understand and reach loved ones when they’re caught up in these illnesses but please believe me, these ideas are very effective and they will help.
Green, Chris. "How To Help A Stressed Or Depressed Loved One." Psych Central. Chris Green by Psych Central, 2015. Web. 13 Apr. 2016.
This video was found on youTube and features Dr. Collins Hodges, a child and adolescent psychologist. This video was published by the Best Docs network on May 28th, 2015.
Depression in Teens
The following article comes from the Mental Health America website. This site has numerous articles on numerous mental health related subjects and provides resources for helping these issues across the country.
Depression In Teens
It’s not unusual for young people to experience "the blues" or feel "down in the dumps" occasionally. Adolescence is always an unsettling time, with the many physical, emotional, psychological and social changes that accompany this stage of life.
Unrealistic academic, social, or family expectations can create a strong sense of rejection and can lead to deep disappointment. When things go wrong at school or at home, teens often overreact. Many young people feel that life is not fair or that things "never go their way." They feel "stressed out" and confused. To make matters worse, teens are bombarded by conflicting messages from parents, friends and society. Today’s teens see more of what life has to offer — both good and bad — on television, at school, in magazines and on the Internet. They are also forced to learn about the threat of AIDS, even if they are not sexually active or using drugs.
Teens need adult guidance more than ever to understand all the emotional and physical changes they are experiencing. When teens’ moods disrupt their ability to function on a day-to-day basis, it may indicate a serious emotional or mental disorder that needs attention — adolescent depression. Parents or caregivers must take action.
Dealing With Adolescent Pressures
When teens feel down, there are ways they can cope with these feelings to avoid serious depression. All of these suggestions help develop a sense of acceptance and belonging that is so important to adolescents.
I write articles based on my experience as a therapist or a training or conference attendee. Many of these articles are written by others who are experts in their field and I share their information as resources for others.