Category: Mental Health

How to help teens, as a parent, with mental health issues such as depression, suicide, ADD/ADHD, bipolar disorder, oppositional defiant disorder, and more.

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Mental Health

Eating Disorders

What are teen eating disorders?
Teen eating disorders often are long-term illnesses that may require long-term treatment. In addition, teen eating disorders frequently occur with other mental disorders such as teen depression,substance abuse, and anxiety disorders (NIMH, 2002). The earlier these eating disorders are diagnosed and treated, the better the chances are for full recovery. This fact sheet identifies the common signs, symptoms, and treatment for three of the most common teen eating disorders: anorexia nervosa, bulimia nervosa, and binge-eating disorder (NIMH, 2002).

Who has teen eating disorders?
Research shows that more than 90 percent of those who have eating disorders are women between the ages of 12 and 25 (National Alliance for the Mentally Ill, 2003). However, increasing numbers of older women and men have these eating disorders. In addition, hundreds of thousands of boys are affected by these disorders (U.S. DHHS Office on Women’s Health, 2000).

What are the symptoms of teen eating disorders?
Teen anorexia nervosa – People who have teen anorexia develop unusual eating habits such as avoiding food and meals, picking out a few foods and eating them in small amounts, weighing their food, and counting the calories of everything they eat. Also, they may exercise excessively.

Teen bulimia – People who have teen bulimia eat an excessive amount of food in a single episode and almost immediately make themselves vomit or use laxatives or diuretics (water pills) to get rid of the food in their bodies. This behavior often is referred to as the “binge/purge” cycle. Like people with teen anorexia, people with teen bulimia have an intense fear of gaining weight.

Teen binge-eating disorder – People with this recently recognized eating disorder have frequent episodes of compulsive overeating, but unlike those with teen bulimia, they do not purge their bodies of food (NIMH, 2002). During these food binges, they often eat alone and very quickly, regardless of whether they feel hungry or full. They often feel shame or guilt over their actions. Unlike anorexia and bulimia, binge-eating disorder occurs almost as often in men as in women (National Eating Disorders Association, 2002).

How are teen eating disorders treated?
Teen anorexia nervosa – The first goal for the treatment of anorexia is to ensure the person’s physical health, which involves restoring a healthy weight (NIMH, 2002). Reaching this goal may require hospitalization. Once a person’s physical condition is stable, treatment usually involves individual psychotherapy and family therapy during which parents help their child learn to eat again and maintain healthy eating habits on his or her own. Behavioral therapy also has been effective for helping a person return to healthy eating habits. Supportive group therapy may follow, and self-help groups within communities may provide ongoing support.

Teen bulimia – Unless malnutrition is severe, any substance abuse problems that may be present at the time the eating disorder is diagnosed are usually treated first. The next goal of bulimia treatment is to reduce or eliminate the person’s binge eating and purging behavior (NIMH, 2002). Behavioral therapy has proven effective in achieving this goal. Psychotherapy has proven effective in helping to prevent the eating disorder from recurring and in addressing issues that led to the disorder. Studies have also found that Prozac, an antidepressant, may help people who do not respond to psychotherapy (APA, 2002). As with anorexia, family therapy is also recommended.

Teen Binge-eating disorder – The goals and strategies for treating teen binge-eating disorder are similar to those for teen bulimia. Binge-eating disorder was recognized only recently as an eating disorder, and research is under way to study the effectiveness of different interventions (NIMH, 2002).

Eating Disorder Information obtained from SAMHSA

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Mental Health

Learning Disability

A learning disability is a disorder that affects one’s ability to effectively learn or use basic skills such as reading, writing and mathematics. Knowing how the brain works, will help you to understand what can go wrong. Basically, there are four steps our brain goes through when processing information; input, integration, memory/storage and output.

Input – the brain receives information through either auditory or visual channels
Integration – the brain integrates or organizes the information
Memory/Storage – the brain retains the information so that it can be used appropriately
Output – the information is presented either verbally or visually (writing, visual expression)

When your teen is suffering with a learning problem, one or more of these steps are being affected.

Learning disabilities are quite prevalent in our schools. According to LDA (Learning Disability Association of America), about 1 in 7 people suffer from a learning disability and “among school-age children, more than 6% are currently receiving special education services because of learning disabilities”. 1

Learning disabilities are not indicative of intelligence. Your teen can have normal to above normal intelligence and still suffer from a learning problem. Knowing the signs and getting help immediately is the best way to deal with the situation.

Signs of a Learning Disability

Although the various types of learning disabilities can display different warning signs, there are common signs to all of them.

* Short attention span/easily distracted
* Frustration
* Disorganization
* Hard time remembering things
* Difficulty understanding directions
* Falling grades

Types of Learning Disabilities

Some teens may suffer one particular type of learning problem, while others may have difficulty in a combination of areas. While ADD/ADDH is not a learning disability, it does have an impact on learning. A lot of teens who are diagnosed with ADD/ADDH also suffer from another type of learning disability as well. The most common types are listed below.

Dyslexia
* Involves mixing up words/letters while reading and/or writing language
* Genetic – most teens will have a relative with this disorder as well
* Signs include reading slowly, trouble with spelling, substituting words with one another

Dyscalculia
* Difficulty understanding and applying mathematical concepts
* Signs include having problems with time, value, simple math, sequencing and money to name a few.

Dysgraphia
* Difficulty in writing
* Signs include ineligible writing, mixing small/upper case together, mixing print/cursive together, spaces words incorrectly, misses words and/or letters while writing. Usually the teens writing will be slow and they might hold a pen/pencil awkwardly.

Dyspraxia
* A disability that involves problems with motor coordination and Sensory Integration Disorder (a neurological disorder in which the brain has difficulty integrating sensory information)
* Signs include stumbling, breaking things, trouble with fine motor skills, sensitivity to touch and/or sounds

Treatment for a Learning Disability

Learning disabilities are a life-long battle. Although they cannot be “cured”, with the proper support and treatment teens can learn to effectively cope with them and improve their daily lives. First and foremost, check with your teens medical doctor to rule out any physical causes such as problems with their sight and/or hearing.

If you suspect your teen is showing some of the symptoms, talk with your teen’s school. All schools have special education programs that are there to help with these types of disorders. You will be able to sit down with your teen’s teachers and other staff to set up an IEP (Individualized Education Program). This is a program designed specifically for your teen to address their particular needs. When appropriate, your teen will be involved in this process as well.

It’s also important to know that there are laws set up to help protect your teen. Section 504 is a federal law which was created to prevent discrimination for people with disabilities. Schools are required to show what accommodations they will be providing for children with such disabilities.

Categories
Mental Health

Oppositional Defiant Disorder

Many parents have been shocked at least once by a formerly cooperative teen resisting the house rules, talking back, or otherwise acting defiantly, but this type of behavior may just be part of normal growing up. More is required for a diagnosis of Oppositional Defiant Disorder.

Why Oppositional Defiant Disorder Is Difficult to Understand

There are two main guides to health issues and disorders that are used to guide the diagnosis of Oppositional Defiant Disorder (ODD). Whereas in many cases, these two resources present a similar view of disorders, in the case of Oppositional Defiant Disorder, the categorization is at odds, and this, in addition to a complicated definition, makes it difficult to understand what Oppositional Defiant Disorder is.

The DSM-IV-TR View of Oppositional Defiant Disorder

The Diagnostic and Statistics Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) includes Oppositional Defiant Disorder as a subcategory of Attention-deficit and disruptive behavior disorders, along with Attention-Deficit Hyperactivity Disorder, Conduct Disorder, and Disruptive Behavior Disorder NOS (Not Otherwise Specified).

Diagnosing ODD using the DSM-IV-TR criteria, which can only be done by mental health professionals who are qualified to do so,is only after determination that the criteria for Conduct Disorder are not met and, if the person is 18 or older, that criteria for Antisocial Personality Disorder are not met.

In that case, the individual must demonstrate a pattern of behavior that has lasted at least 6 months and shown at least four of the following signs or symptoms:

• frequently losing temper

• frequently argues with adults

• frequently defying or refusing to cooperate with the requests or rules of adults

• frequently annoying others on purpose

• frequently scapegoating others for his or her own mistakes or misbehavior

• frequently showing a high degree of sensitivity and touchiness with others

• frequently acting angry and resentful

• frequently acting spiteful or vindictive.

In addition, the behavior disturbance must:

• be more frequently that is normal for other individuals of similar age and development;

• cause “clinically significant impairment” in at least one area of life, whether academic, social, or occupational;

• not occur solely as the result of a psychotic disorder or mood disorder.

According to the Surgeon General’s website, Oppositional Defiant Disorder is sometimes considered a “precursor of conduct disorder.”

ICD-10 View of Oppositional Defiant Disorder

The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) takes a different approach to Oppositional Defiant Disorder than the DSM-IV-TR. It includes it under the category “Behavioral and emotional disorders with onset usually occurring in childhood and adolescence” within the subcategory “Conduct disorders.” The other members of the category are:

• Conduct disorder confined to the family context

• Unsocialized conduct disorder

• Socialized conduct disorder

• Other conduct disorders

• Conduct disorder unspecified.

As you can see, it is the only member of the category that does not have conduct disorder in its name. The subcategory “Conduct disorders” is separate from the following category, called “Mixed disorders of conduct and emotions,” which addresses the limitation in the DSM-IV-TR diagnostic criteria that rules out behavior that is only present in connection with a mood disorder or psychotic disorder.

The ICD-10 diagnosis, which specifically says that it usually occurs in “younger children,” begins with a child meeting the criteria for Conducts disorders generally. This requires that the pattern of behavior–whether dissocial, aggressive, or defiant—be both repetitive and persistent, as well as well outside age-appropriate expectations, and last six months or longer. If the behavior can be explained by a different psychiatric diagnosis, that explanation should be preferred.

Given that those criteria are met, one goes on to the specific Oppositional Defiant Disorder criteria, which limits the characterization of the behaviors to acts that are “defiant, disobedient, disruptive,” but not delinquent, extremely aggressive, or extremely dissocial, nor merely extremely mischievous or naughty.

The Upshot of Differing Understandings

A research study published in 2005 found that some children who were diagnosed with Oppositional Defiant Disorder using the criteria of ICD-10 as described above received no DSM-IV diagnosis, and this is a problem. The study suggested ways of addressing the situation.

If this comparison does nothing else, it will hopefully equip parents whose child is being considered for an ODD diagnosis, has been ruled out from having such a diagnosis, or has already received such a diagnosis to be able to discuss the criteria whereby the child’s behavior was analyzed and ask knowledgeable questions.

Sources

http://www.surgeongeneral.gov/library/mentalhealth/
chapter3/sec6.html#disruptive

http://apps.who.int/classifications/apps/icd/icd10online/?gf90.htm+f913

http://www.ncbi.nlm.nih.gov/pubmed/16313431

Categories
Mental Health

Conduct Disorders

Why Conduct Disorder Is Difficult to Understand

The two primary guides to diagnosing disorders, both of which are used in the diagnosis of Conduct Disorder are the Diagnostic and Statistics Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10).

In some cases, the two guides have a similar analysis of disorders and how they relate to each other. In the case of conduct disorder, however, the two views are different, complicating understanding.

The DSM-IV-TR View of Conduct Disorder

The DSM-IV-TR lists Conduct Disorder as a subcategory of “Attention-deficit and disruptive behavior disorders,” along with Oppositional Defiant Disorder, Attention-Deficit Hyperactivity Disorder, and Disruptive Behavior Disorder NOS (Not Otherwise Specified). There are three specific subcategories of Conduct Disorder, distinguished by the time of onset: in childhood, during adolescence, or unspecified.

Diagnosing Conduct Disorder using the DSM-IV-TR criteria, which should only be done by qualified mental health professionals. If the person is 18 or older, a diagnosis of Conduct Disorder cannot be given unless the criteria for Antisocial Personality Disorder are not met.

The descriptions make it clear that this is a more serious disorder than Oppositional Defiant Disorder. For a diagnosis, the person must demonstrate a pattern of behavior that has included three or more symptoms of those listed below for at least the past 12 months and shown at least one in the past 6 months:

• Aggression towards people and animals

  • frequently bullies, threatens, or intimidates
  • frequently initiates physical altercations
  • has employed a weapon capable of causing serious physical harm
  • has shown physical cruelty to people
  • has shown physical cruelty to animals
  • has confronted and stolen something from a victim
  • has forced sexual activity on someone

• Property destruction

  • has set at least one fire meaning to cause notable damage
  • has purposely destroyed property in some other way

• Deceit or theft

  • has forcibly entered someone else’s house or car without permission
  • frequently lies, conning others
  • has stolen items without a confrontation

• Serious rule violations

  • has frequently broken the house rules and stayed out at night, since before age 13
  • at least twice has stayed away from home overnight without permission or once for an extended period
  • has frequently been truant from school, since before age 13. 

In addition, these behavior disturbances must:

• result in “clinically significant impairment” in either academic, social, or occupational functioning;

If Childhood-Onset type is diagnosed, at least one characteristic must have manifested prior to age 10, whereas is Adolescent-Onset is diagnosed, there must be an absence of manifestation of any of the behaviors prior to age 10. The severity can be designated as mild, moderate, or severe.

ICD-10 View of Conduct Disorder

ICD-10 takes a different approach to Conduct Disorder than the DSM-IV-TR. It includes Conduct Disorder under the category “Behavioral and emotional disorders with onset usually occurring in childhood and adolescence” and designates six subcategories, which are:

• Conduct disorder confined to the family context

• Unsocialized conduct disorder

• Socialized conduct disorder

• Oppositional Defiant Disorder (ODD)

• Other conduct disorders

• Conduct disorder unspecified.

So ODD is a subset of Conduct disorder in the ICD-10 analysis, but not in the DMS-IV-TR analysis, and the category of Conduct Disorder is subdivided in a completely different way, based not on age of onset, but on other specifics of how it manifests.

Diagnosis of any of the ICD-10 subgroups requires that a child first meet the criteria for Conduct disorders generally. This means that the pattern of disruptive behavior–which may be dissocial, aggressive, or defiant—must both be repetitive and persistent, notably beyond outside age-appropriate expectations, and last for six months or longer. If a different psychiatric diagnosis explains the symptoms, that diagnosis should be used.

The further criteria that separate the subcategories are:

• Conduct disorder confined to the family context occurs only or almost only in the home and with members of the family or household.

• Unsocialized conduct disorder is marked by serious abnormalities in relationships between the child and other children.

• Socialized conduct disorder is diagnosed when a person gets along well with peers, and is generally characterized by delinquent activities as a group, or gang, as well as truancy.

• Oppositional Defiant Disorder is usually diagnosed in younger children and the behaviors demonstrated are better characterized as disobedient, defiant, and disruptive rather than delinquent, dissocial, or aggressive.

Understanding a Diagnosis of Conduct Disorder

If you or someone you know has a child who has received a diagnosis of conduct this order, you can use the information in this article to ask questions and find out more. Which type of conduct disorder has been diagnosed and according to which definition? Which criteria were met to support the diagnosis?

Sources

http://www.surgeongeneral.gov/library/mentalhealth/
chapter3/sec6.html#disruptive

http://apps.who.int/classifications/apps/icd/icd10online/?gf90.htm+f913

http://www.surgeongeneral.gov/library/mentalhealth/
chapter3/sec6.html

Categories
Mental Health

Bipolar Disorder

Teen Bipolar Disorder

Bipolar disorder is an illness that can have serious impacts on teens and their families. Teen bipolar disorder, also known as manic-depressive disorder, causes teens to experience extreme moods, known as mania and depression. Mania causes a teen to feel overly energetic and irritable, while teens suffering from depression feel sad, tired, and unable to do anything. Scientists do not yet fully understand teen bipolar disorder, but it seems to be caused by chemical imbalances in the teen’s brain. Teen bipolar disorder cannot be cured, but it can be treated with therapy, and sometimes medications.

Teens with bipolar disorder experience intense moods, often without a clear cause. They may change rapidly from mania to depression, or experience one extreme or the other with long periods of normal or less extreme moods in between. These mood changes are more severe and extreme than the normal ups and downs that every teen experiences. Sometimes stress, medications, or environmental factors can trigger a manic or depressive episode, but the exact causes of bipolar disorder are not yet known. Bipolar disorder seems to have a genetic component, and teens whose close family members have bipolar disorder are more likely to develop bipolar disorder.

Commons signs of mania include:

  • High energy
  • Irritability
  • Violent outbursts
  • Excessive, rapid talking, often jumping from one topic to another
  • Inability to concentrate
  • Little need for sleep
  • Poor judgement, sometimes leading to spending sprees, drug use, or sexual promiscuity
  • Obsession with sexuality
  • Grandiosity, which is an unrealistic sense of one’s abilities, such as thinking one has special powers. Many young people like to imagine having special abilities, have trouble evaluating risk, or exaggerate their own unique talents and skills; this generally only becomes a symptom if the teen tries to act on the ability, like trying to fly. 

Episodes of depression can cause:

  • Prolonged sadness or boredom
  • A feeling of emptiness
  • Loss of interest or energy
  • Headaches and body aches
  • Changes in sleeping or eating habits
  • Fatigue
  • Feeling worried, hopeless, guilty, or anxious
  • Suicidal thoughts or behavior 

Some teens with bipolar disorder show signs of mania and depression in the same day, sometimes even at the same time, such as feeling depressed, but engaging in manic activities. Other teens with bipolar disorder never have severe manic episodes, only minor episodes known as hypomania. Teens who suffer from bipolar disorder may deny that they have a problem, especially while experiencing mania. Some other signs of teen bipolar disorder can include:

  • Poor performance in school
  • Talking or thinking about running away
  • Using drugs or alcohol
  • Engaging in self-destructive behaviors, such as fighting
  • Becoming isolated
  • Being overly sensitive
  • Delusions or hallucinations
  • Thinking about or attempting suicide 

Because doctors are just beginning to understand teen bipolar disorder, they are not yet sure of the number of teens who suffer from it, but about 10 million Americans have bipolar disorder. Many adults who develop bipolar disorder begin to show symptoms in their late teens, but researchers believe that bipolar disorder may begin much younger in some individuals.

A teen who may have bipolar disorder should visit a doctor, who can make sure the teen does not have another medical condition such as attention deficit hyperactivity disorder (ADHD), conduct disorder, or substance abuse problems. A doctor or therapist can recommend and provide treatments for teen bipolar disorder. Treatment may consist of counseling, often combined with a mood stabilizing medication. The use of medication by teens should be monitored carefully; while it helps many people, it may cause suicidal thoughts and behavior in teens.

Families can help teens with bipolar disorder by:

  • Understanding, and helping the teen to understand, that he or she has an illness, and that this illness is not the teen’s fault, but that he or she can do things to feel better.
  • Enrolling in family therapy.
  • Seeking help for any other untreated mental illnesses in family members, such as depression or anxiety; this sets a good example and reduces stress in the family.
  • Providing a quiet environment for the teen, with a regular schedule, especially for sleep.
  • Being patient; avoid telling your teen to “snap out of it” or “get over it.”
  • Always taking talk of suicide seriously and seeking immediate medical help for suicidal teens; be especially alert after a traumatic event like moving, divorce, death in the family, or loss of a friendship or boyfriend or girlfriend. 

Some things teens with bipolar disorder can do to reduce symptoms include:

  • Follow any treatments prescribed by your therapist or doctor
  • Consider keeping a daily journal of your thoughts and feelings
  • Learn ways to manage stress, such as yoga, deep breathing exercises, going for walks, or listening to soothing music
  • Exercise, eat a balanced diet, and get enough sleep
  • Avoid drugs, alcohol, and caffeine, which is found in coffee, tea, energy drinks, chocolate, and many sodas
  • Ask for help when you feel you need it 

Teens with bipolar disorder are at increased risk for suicide. A teen who is having suicidal thoughts or actions should get medical help immediately, or call 911 or a suicide prevention hotline, such as 1-800-SUICIDE (1-800-784-2433); check your phone book for local suicide prevention hotlines or mental health centers.

Sources:
National Institute of Mental Health, “Bipolar Disorder” [online]
WebMD.com and Healthwise, “Bipolar Disorder in Childhood” [online]
National Alliance on Mental Illness, “Bipolar Disorder” [online]
Nemours Foundation, TeensHealth, “Bipolar Disorder” [online]
Kowatch, et. al., “Treatment Guidelines for Children and Adolescents With Bipolar Disorder,” Journal of the American Academy of Child and Adolescent Psychiatry, 44:3, March 2005 [online]

Categories
Mental Health

Teen Depression

What is Teen Depression?

Most of us feel sad or unhappy at various times in our life, but teenage depression that extends for a longer lengths of time (usually more than 2 weeks) and that interferes with our daily life is considered to be major depression. This type of teen depression is one that isn’t to be taken lightly and should be treated as early as possible to prevent further problems.

Studies and statistics show that approximately 1 in 8 adolescents may be suffering from depression, a very scary statistic. Even more frightening is that only about 30% of these children who are suffering emotional/mental turmoil are receiving any treatment for it.(1)

Many teens have mood swings or are quick to express anger, but how do you distinguish between normal teenage angst and a more serious problem?

Teenage Depression Warning Signs

Although at times teens will normally go through some of these following signs, when they occur alone for extended periods of time and/or occur in conjunction with each other it’s important to look at what may be causing them.

  • Sadness or hopelessness
  • Low self-esteem
  • Sluggishness (less active)
  • Substance abuse
  • Spending more time alone (this includes time alone from you as parents and time away from their regular friends)
  • Decrease in desire to do things they used to like to do (sports, activities, hobbies)
  • Physical ailments (headaches, appetite problems, sleeping problems)
  • Problems in school (falling grades, getting into trouble, not paying attention in class)
  • Talking about death or suicide (never to be taken lightly)
  • Not caring about appearance
  • Running away from home
  • Blaming self for things that are not their fault
  • Unable to concentrate and/or make decisions

Who’s At Risk for Teen Depression? 

Every teen is at risk in developing major teen depression, but there are certain groups of individuals that are more prone to this type of disorder.

  • Females are more likely to develop adolescent depression than males (about 2x more often)
  • Abused/neglected individuals
  • Children that have or have had long-term/chronic illnesses
  • Teens that have a family history of depression or other mood disorders
  • Teens with family disruptions at home (divorce, death in family, etc)
  • Teens with low self-esteem

Adolescent Depression Treatment Options

Depending on the degree of depression your teen is determined to have, there are several forms of treatment that are available. Only a mental health professional is qualified to determine what would be the best course of treatment for your child. All types of treatment can take place either at home and/or in a residential setting.

  • Medicine (anti-depressants – usually used in addition to other forms of therapy)
  • Individual Therapy -Cognitive Behavioral Therapy – helps to teach healthy ways of thinking
  • Interpersonal Psychotherapy – helps to determine interpersonal issues/situations that may be the cause of the depression
  • Group Therapy – individuals with the same affliction meet together to discuss their problems and in turn help each other through their situations

Major adolescent depression, if left untreated, will rarely go away on it’s own. Relapses are extremely common and should always be prevented. Other forms of mental health illnesses are more common as well in depressed teens. If teens are left without help, they may decide to take things into their own hands. They can turn to alcohol and/or drug abuse to help make their pain go away. At it’s worst, teen depression can lead to suicide. According to www.teendepression.org, teen suicide is the 3rd leading cause of death among young people ages 15-24. We must all do our part in preventing these outcomes as best we can. Early intervention is key. Watch for those warning signs and if observed, seek the necessary help right away.

Teen Depression Sources:
www.nih.gov
www.teendepression.org
www.aacap.org