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The following articles are written by BHI clinicians and others to provide education and information about various topics. Check back with us frequently for more articles.

We also invite you to read our BHI BLOG for timely and informative posts: www.HealthyBehavior.blogspot.com.

Disclaimer:
The information in these articles is for informational purposes only. It is not intended to be psychological advice and should not be considered a substitute for consultation with a licensed mental health professional.

ADD: Evaluation, Treatment and Prognosis
By Frederick M. Kravitz, Ph. D., Licensed Psychologist
Behavioral Health Institute

While there has been a lot of publicity in the past few years about children being diagnosed and treated for Attention Deficit Disorder, there still seems to be much confusion over the nature of the disorder, how we evaluate and treat it and the long-term prognosis for ADD kids.

ADD is a neurological disorder that negatively affects many aspects of a child's life. The disorder causes problems in a child's ability to control his behavior, leading to difficulties attending to tasks, completing work and organizing as well as others his age. These children are impulsive, easily distracted and quite disorganized. While there is no one cause, heredity, perinatal factors and head injuries have been cited. Some theories postulate an insufficiency of neurotransmitters, chemicals in the brain that regulate the flow of messages between brain cells. Regardless of cause, ADD is a group of behaviors including difficulty paying attention, focusing, staying on task and regulating one's own behavior. Some ADD children are hyperactive; some are inattentive. The latter are often times harder to recognize since they may appear attentive and focused while they are in fact daydreaming and not with the program. When called upon in class they may have no idea what's being asked of them. Whether a child is hyperactive or inattentive, these kids bore easily and often engage in self-stimulative behaviors.

Evaluating a child for ADD requires the input of parents, teachers and other caregivers. While it is normal for children to become restless and inattentive at one time or another, ADD should be considered only if these symptoms interfere with functioning at home and at school. The ADD evaluation typically includes a developmental history, teacher ratings of classroom behaviors, parent ratings of behavior at home, and psychological testing and observations. While there is no single test for ADD, psychologists typically administer a continuous performance test to see how a child's ability to sustain his attention on a tedious task compares with their same-age peers. Often times an intelligence test and/or an achievement test are administered to assess the child's ability to stay on task and to rule out other learning difficulties that may be contributing to the child's misbehavior and poor academic performance.

Once a diagnosis is made, treatment options may include the following:

The physician's decision to recommend medication is typically based on the data presented by the treating psychologist. Specific stimulant medications are estimated to each have a 75% positive response rate. Overall, more than 90% of children respond well to one of the available stimulants. These medications control the ADD; they do not cure it. These medications are considered safe. Side effects are usually manageable: decreased appetite at lunchtime and a small delay in falling asleep at night.

As far as prognosis goes, we used to think that ADD children outgrew the disorder in adolescence. We now know that many of the symptoms persist throughout the life-cycle. However we also find that many children learn to compensate as they get older; they acquire new skills and may no longer need medication to function adequately in their later schooling or in their adult life. The career choices made by ADD adults may also reduce the need for treatment by providing stimulation with a minimum of tedium. ADD's effects are most apparent when an individual is in a classroom with the passive role of listening and learning. Once these individuals are out in the world working the effects are very different.

While some people have questioned whether we are over diagnosing ADD, scholars remind us that the world we live in is increasingly complex and requires that we stop and focus and try to keep up. The demands of modern life are clearly beyond the demands made on previous generations. The complexities of modern life have not caused ADD, but have revealed it.

10 (Low Cost) Ways to Maintain Your Psychological Health
By Todd D. Giardina, Ph. D., Licensed Psychologist
Behavioral Health Institute

Sometimes life can feel overwhelming. Whether it’s due to the loss of a job, family problems, or ”too much to do with too little time,” stress can build and problems can appear insurmountable. It’s easy to lose perspective. Here are some simple, low-cost ways to maintain your psychological health in these times of trouble

  1. Prioritize. Ask yourself, “What is essential and what can I take off my list?” When stress mounts, you’ll find yourself with less time and energy. To avoid unnecessary frustration and conflict, decide on your priorities and make decisions accordingly. For instance, maybe until the big project at work is finished you could make career and family your focus, and the bowling league will have to make do without you for now.
  2. Exercise. While physical limitations may be an issue for some, being physically active in whatever way you can has several psychological benefits. Not only does physical activity produce a feeling of accomplishment, but it also causes chemical reactions in your body, which can have natural antidepressant and anti-anxiety effects. And, you recognize that you can escape your thoughts and feelings and just BE for a while.
  3. Keep talking. Don’t keep your feelings pent up. When you find yourself worrying, it’s better to talk with someone you trust – close friend, family member, or clergy. This can help you define the problem and develop ideas for possible solutions.
  4. Seek happiness. It is important to utilize the resources that are already within your grasp but that you may have failed to recognize or forgotten about. Schedule hobbies, social activities, and activities you enjoy into your routine. Why wait for happiness to come to you if you can seek it out?
  5. Set Goals. Consider reasonable and achievable goals, steps to attain them, and then work consistently in that direction. Whether you are working on saving money by packing lunches and eating out less, or controlling your anger by increasing your physical exercise and taking time outs when your tension starts to build, it is possible to change your behavior.
  6. Draw on past successes. Think back to difficult times you have experienced in the past – how did you get through? What did you do to cope? These answers may help you formulate a plan for weathering the current storm. If your faith helped you survive a rough divorce, then maybe meditation and prayer will help you manage your work-related anxiety now.
  7. Work on changing one thing at a time. If you are already stretched thin in other areas, adding the stress of major lifestyle change may not be a good idea. This is why Alcoholics Anonymous advises participants to wait until they have achieved sobriety before starting a new relationship. You end up adding to your burden and setting yourself up for failure if you lack the psychological energy to commit to such a task. Sometimes you need to give yourself a pass on some bad habits and focus on changing just one thing at a time.
  8. Avoid unhealthy comparisons. Just because your friends or co-workers seem to be handling life stress better than you doesn’t mean they are; they might just be better at hiding it (and that can be a stressor in itself). Stress is very relative, and how you manage it all depends on your personality, life history, coping resources, belief system, and so on. Life is not an apples to apples comparison, and you’ll only make yourself more upset by trying to keep up with the Joneses.
  9. Take a breath and count to 10. Long, slow breathing into your diaphragm (stomach) has a relaxing effect on the body and mind. Combine this with counting slowly to ten and you have tools that help manage anxiety, stress, anger, pain, insomnia, and even depression. You end up calming yourself instead of dwelling on your thoughts/emotions, allowing you to regain a feeling of self-control and greatly reduce reacting impulsively.
  10. Be realistic. Don’t expect too much of yourself or other people. Give in occasionally when something is just not that important, and use your sense of humor whenever possible. Sometimes it’s best to try to accept what you cannot change and just keep working toward changing what you can.

Depression: A Patient Guide to Treatment
By E. Nelson-Wernick, Ph. D., Licensed Psychologist
Behavioral Health Institute

Everyone feels “down” or “blue” once in a while, and these moods are often a normal reaction to stress or some disappointment or loss in life. But when this mood lingers on for weeks, it begins to impact different aspects of day-to-day functioning. It is impossible to “just snap out of it.”

Clinical depression is a common medical illness, affecting 1 in 10 adults in any given year. Also, depression is known to weaken the immune system, making the individual more vulnerable to other health problems.

Signs of depression include:

Some people believe that depression is a sign of personal weakness, and that the best thing to do is just “pull yourself up by the bootstraps and get over it.” This is not true. In fact, this type of thinking leads people to feel ashamed of seeking treatment.

Depression is very treatable. 80 % of people respond well to treatment, and nearly all experience some level of improvement.

It is important to see a health professional in order to evaluate the possible causes of depression, including certain illnesses and the side effects of prescription medications. If these factors are found to be causing your symptoms, your physician will address them. Depression can also occur along with other medical illnesses, and if this is the case, both conditions may require treatment.

How is depression treated?

Treatments for depression include psychological interventions and antidepressant medications. Often a combination of the two treatments is most effective.

Cognitive and behavioral therapies are the most effective psychological treatments for depression. These therapies can help change negative styles of thinking and behaving that may contribute to depression. It can help you to develop good decision-making skills, learn to deal more effectively with others, and improve your relationships. A licensed mental health professional can help you set realistic goals for yourself and work with you toward achieving them. Sometimes family members are involved in treatment in order to learn effective ways to provide support.

Today there is a wide range of antidepressant medications used to treat depression. These medications help to alleviate symptoms of depression. It is important to be aware that regular physical exercise can also help manage symptoms.

Not everyone with depression requires medication. The decision to start antidepressant medication often depends upon the nature and severity of symptoms. Your physician and/or a licensed mental health professional can help you make that decision, and if you do start medication, they will work together to treat your depression.

If you are being treated with antidepressant medication, it is important to remember the following:

  1. Take the medication just as it is prescribed. Ask questions if you are unsure of the instructions, and write them down.
  2. If you experience any side effects, they will usually be mild and pass within a few days. If this is not the case, notify your physician.
  3. Because it takes a while for these medications to build up in your bloodstream, it may take several weeks before you can expect to feel positive effects.
  4. Do not stop taking your medication without first discussing this with your physician.

Conclusion:
Depression is a common medical illness that results in changes in one’s thoughts, emotions, behaviors and physical functioning. It is impossible to “just snap out of it.” Cognitive and behavioral therapies as well as antidepressant medication have been shown to be effective treatments for depression. By being an active participant in your treatment you can help yourself move through the depression more quickly, and return to a healthier life.

For more information about depression and its treatment, please contact Behavioral Health Institute at 954-340-0888.

Dollars and Sense:
Talking to your Children about the Economy

In this time of extreme economic stress, it is difficult to leave the problems of the economy off the kitchen table. Fears about mortgages, college tuition, retirement, and day-to-day expenses haunt the halls of many family homes. Children are no doubt noticing the increased stress of their parents during the financial crisis and may be experiencing their own stress as a result.

“Children are extremely resilient,” says psychologist Dr. David Palmiter, “However, they are keenly aware of tension in the household, whether it is from the financial situation or from other familial problems. It is important to be honest with your children, yet only share information that you think they can handle.”

While open communication between parents and their children is the foundation of a healthy relationship, parents should not overburden their children. Instead, address problems at age-appropriate levels. For example, what a parent might tell a younger child about the family’s financial situation is different then what they might tell an adolescent; young children may interpret the situation as more dire than it actually is. Older children and teens will be more exposed to the news--discussing their understanding of the economy and its implication on the family can be reassuring.

How parents phrase their worries about the financial situation influences a child’s interpretation. Younger children may take overheard statements such as “we’re going to the poor house” literally and thus internalize fears about losing their home. Talking to your children and asking them their thoughts and ideas will help clear up any misunderstandings, ease their anxieties, and reduce their stress.

Families can also use their financial situation as an opportunity to manage their children’s expectations for material goods. Teaching your children about budgeting, perhaps by setting up a “savings account” for their pocket money, or by allocating a certain amount for charity, will help them better understand that an Xbox or an iPod might not be feasible for the holidays this year. Furthermore, these times offer an opportunity to focus on the positive aspects, and prioritizing what’s important—relationships with loved ones and friends, the family’s health—can lessen children’s fears and reinforce family values.

Pay attention to signals that your child may experience: sleep and appetite changes, nightmares or avoidance of situations or people. Parents who use healthy stress-relieving behaviors set a good example for children. Taking a family walk after dinner or playing a board game in the evening are not only positive alternatives to distract oneself from the news, but also inexpensive activities that foster bonding time.

Being proactive about managing your family’s stress and continuing life as usual, despite what’s happening on Wall Street or Main Street, will help make a psychologically healthy home even in a time of economic unrest.

Special thanks to APA members Dr. David Palmiter, Dr. Mary Alvord, and Dr. Nabil Hassan El Ghoroury for their help with this article.

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