Clinical Psychology, School Counseling

Kleptomania

Kleptomania is a condition in which an individual experiences a consistent impulse to steal items not needed for personal use or monetary value. The objects are stolen despite typically being of little value to the individual and are often given away or discarded after being taken.

Kleptomania involves experiencing tension before the theft and feelings of pleasure, gratification, or relief when committing the theft. The stealing is not done to express anger or vengeance or in response to a delusion or hallucination and is not attributable to conduct disorder, a manic episode, or antisocial personality disorder.

Occasionally the individual may hoard the stolen objects or surreptitiously return them. Although someone with this disorder will generally avoid stealing when immediate arrest is probable (such as in full view of a police officer), they usually do not plan the thefts or fully take into account the chances of apprehension. People with kleptomania commonly feel depressed or guilty about the thefts after they occur.

Kleptomania is relatively rare in the general population, with about 0.3 to 0.6 percent of people experiencing this condition.

Symptoms

People with kleptomania have an irresistible impulse to steal. These episodes of stealing occur unexpectedly, without planning. Often they throw away the stolen goods, as they are mostly interested in the act of stealing itself. Kleptomania is distinguished from shoplifting because shoplifters plan the stealing of objects and usually steal because they do not have money to purchase the items. Signs of kleptomania include:

  • Recurrent failure to resist stealing impulses unrelated to personal use or financial need
  • Feeling increased tension right before the theft
  • Feeling pleasure, gratification, or relief at the time of the theft
  • Thefts are not committed in response to delusions, hallucinations or as expressions of revenge or anger
  • Thefts cannot be better explained by Antisocial Personality Disorder, Conduct Disorder or a Manic Episode

The age of onset for kleptomania is variable. It can begin in childhood, adolescence, or adulthood and in rare cases, late adulthood.

Features

People with kleptomania typically exhibit these features or characteristics:

  • Unlike typical shoplifters, people with kleptomania don’t compulsively steal for personal gain, on a dare, for revenge or out of rebellion. They steal simply because the urge is so powerful that they can’t resist it.
  • Episodes of kleptomania generally occur spontaneously, usually without planning and without help or collaboration from another person.
  • Most people with kleptomania steal from public places, such as stores and supermarkets. Some may steal from friends or acquaintances, such as at a party.
  • Often, the stolen items have no value to the person with kleptomania, and the person can afford to buy them.
  • The stolen items are usually stashed away, never to be used. Items may also be donated, given away to family or friends, or even secretly returned to the place from which they were stolen.
  • Urges to steal may come and go or may occur with greater or lesser intensity over the course of time.

Causes

The cause of kleptomania is not known. Several theories suggest that changes in the brain may be at the root of kleptomania. More research is needed to better understand these possible causes, but kleptomania may be linked to:

  • Problems with a naturally occurring brain chemical (neurotransmitter) called serotonin. Serotonin helps regulate moods and emotions. Low levels of serotonin are common in people prone to impulsive behaviors.
  • Addictive disorders. Stealing may cause the release of dopamine (another neurotransmitter). Dopamine causes pleasurable feelings, and some people seek this rewarding feeling again and again.
  • The brain’s opioid system. Urges are regulated by the brain’s opioid system. An imbalance in this system could make it harder to resist urges.

Kleptomania is rare overall, but more common in females than in males. People with kleptomania often have another psychiatric disorder, such as depressive and bipolar disorders, anxiety disorders, eating disorders, personality disorders, substance abuse disorders, and other impulse-control disorders. There is evidence linking kleptomania with the neurotransmitter pathways in the brain associated with behavioral addictions, including those associated with the serotonin, dopamine, and opioid systems.

Some clinicians view kleptomania as part of the obsessive-compulsive spectrum of disorders, reasoning that many individuals experience the impulse to steal as an alien, unwanted intrusion into their mental state. Also, other evidence indicates that kleptomania may be related to, or a variant of, mood disorders such as depression.

Treatments

The treatment for kleptomania may include a combination of psychopharmacology and psychotherapy.

Psychological counseling or therapy

Counseling or therapy may be in a group or one-on-one setting. It is usually aimed at dealing with underlying psychological problems that may be contributing to kleptomania. Possible treatments include:

  • Behavior modification therapy
  • Family therapy
  • Cognitive behavioral therapy
  • Psychodynamic therapy
Clinical Psychology, School Counseling

Somnambulism ( Sleepwalking)

What Is Sleepwalking?

Sleepwalking is very common in kids. Most kids who walk in their sleep only do so occasionally and outgrow it by the teen years.

Kids tend to sleepwalk within an hour or two of falling asleep and may walk around for anywhere from a few seconds to 30 minutes. It’s difficult to wake someone up while they’re sleepwalking. When awakened, a person may feel groggy and disoriented for a few minutes.

Despite its name, sleepwalking (also called somnambulism) involves more than just walking. Sleepwalking behaviors can be:

  • harmless — like sitting up
  • potentially dangerous — such as wandering outside
  • inappropriate — like opening a closet door and peeing inside

No matter what kids do during sleepwalking episodes, though, it’s unlikely that they’ll remember ever having done it!

Still, some simple steps can keep your young sleepwalker safe while traipsing about.

What Causes Sleepwalking?

Sleepwalking is far more common in kids than in adults. It may run in families, so if you or your partner are or were sleepwalkers, your child may be too.

Things that may bring on a sleepwalking episode include:

  • lack of sleep or fatigue
  • irregular sleep schedules
  • illness or fever
  • some medicines
  • stress

What Happens During Sleepwalking?

Getting out of bed and walking around while still sleeping is the most obvious sleepwalking symptom. But young sleepwalkers may also:

  • sleeptalk
  • be hard to wake up
  • seem dazed
  • be clumsy
  • not respond when spoken to
  • sit up in bed and go through repeated motions, such as rubbing their eyes or fussing with their pajamas

Also, sleepwalkers’ eyes are open, but they don’t see the same way they do when they’re awake. Often, they think they’re in different rooms of the house or different places altogether.

Sometimes, these other conditions may happen with sleepwalking:

  • sleep apnea (brief pauses in breathing while sleeping)
  • bedwetting (enuresis)
  • night terrors

Is Sleepwalking Harmful?

Sleepwalking itself is not harmful. But sleepwalking can be hazardous because sleepwalking kids aren’t awake and may not realize what they’re doing, such as walking down stairs or opening windows.

Sleepwalking is not usually a sign that something is emotionally or psychologically wrong with a child. And it doesn’t cause any emotional harm. Sleepwalkers probably won’t even remember the nighttime stroll.

How to Keep a Sleepwalker Safe

Sleepwalking isn’t dangerous by itself. But it’s important to take precautions so that your sleepwalking child is less likely to fall down, run into something, walk out the front door, or drive (if your teen is a sleepwalker).

To help keep your sleepwalker out of harm’s way:

  • Try not to wake a sleepwalker because this might scare your child. Instead, gently guide him or her back to bed.
  • Lock the windows and doors, in your child’s bedroom and throughout your home, in case your young sleepwalker decides to wander. You may consider extra locks or child safety locks on doors. Keep keys out of reach for kids who are old enough to drive.
  • To prevent falls, don’t let your sleepwalker sleep in a bunk bed.
  • Remove sharp or breakable things from around your child’s bed.
  • Keep dangerous objects out of reach.
  • Remove obstacles from your child’s room and throughout your home to prevent a stumble. Get rid of clutter on the floor (in your child’s bedroom or playroom).
  • Install safety gates outside your child’s room and/or at the top of any stairs.

When Should I Call the Doctor?

There’s usually no need to treat sleepwalking unless the episodes are:

  • very regular
  • cause your child to be sleepy during the day
  • involve dangerous behaviors

If the sleepwalking happens often, causes problems, or your child hasn’t outgrown it by the early teen years, talk to your doctor.

For kids who sleepwalk often, doctors may recommend a treatment called scheduled awakening. This means you will gently wake your child up a little before the usual sleepwalking time, which can help stop sleepwalking. In rare cases, a doctor may prescribe medicine to aid sleep.

What Else Should I Know?

To help prevent sleepwalking episodes:

  • Have your child relax at bedtime by listening to soft music or relaxation tapes.
  • Establish a regular sleep and nap schedule and stick to it — both nighttime and wake-up time.
  • Make your child’s bedtime earlier. This can improve excessive sleepiness.
  • Don’t let kids drink a lot in the evening and be sure they go to the bathroom before going to bed. (A full bladder can contribute to sleepwalking.)
  • Avoid caffeine near bedtime.
  • Make sure your child’s bedroom is quiet, cozy, and comfortable for sleeping. Keep the noise down while kids are trying to sleep (at bedtime and naptime).

The next time you see your nighttime wanderer, don’t panic. Just steer your child back to the safety and comfort of his or her bed.

Clinical Psychology, School Counseling

Exam Phobia

Many people experience stress or anxiety before an exam. In fact, a little nervousness can actually help you perform your best. However, when this distress becomes so excessive that it actually interferes with performance on an exam, it is known as Exam Phobia.

Symptoms of Exam Phobia

The symptoms of Exam Phobia can vary considerably and range from mild to severe. Some students experience only mild symptoms of test anxiety and are still able to do fairly well on exams. Other students are nearly incapacitated by their anxiety, performing dismally on tests or even experiencing panic attacks before or during exams.​

  • Physical symptoms of test anxiety include sweating, shaking, rapid heartbeat, dry mouth, fainting, and nausea. Milder cases of test anxiety can cause a sense of “butterflies” in the stomach, while more severe cases can actually cause students to become physically ill.
  • Cognitive and behavioral symptoms can include fidgeting or outright avoidance of testing situations. In some cases, test anxiety can become so severe that students will drop out of school in order to avoid the source of their fear. Substance abuse can also occur since many students attempt to self-treat their anxiety by taking downers such as prescription medications and alcohol. Many people with test anxiety report blanking out on answers to the test, even though they thoroughly studied the information and were sure that they knew the answers to the questions. Negative self-talk, trouble concentrating on the test and racing thoughts are also common cognitive symptoms of test anxiety.
  • Emotional symptoms of test anxiety can include depression, low self-esteem, anger and a feeling of hopelessness. Students often feel helpless to change their situation or belittle and berate themselves for their symptoms and poor test performance.

Causes of Exam Phobia

There are several potential causes of Exam Phobia, including:

  • A history of poor testing outcomes. If you’ve done poorly on tests before, either because you didn’t study well enough or because you were so anxious, you couldn’t remember the answers, this can cause even more anxiety and a negative attitude every time you have to take another test.
  • Being unprepared. If you didn’t study or didn’t study well enough, this can add to your feeling of anxiety.
  • Being afraid of failure. If you connect your sense of self-worth to your test scores, the pressure you put on yourself can cause severe test anxiety.

Ways to Help Overcome Exam Phobia

Fortunately, there are steps that students can take to alleviate these unpleasant and oftentimes harmful symptoms. Some ways to help overcome test anxiety include:

  • Relaxation techniques like deep breathing can help you to relax before and during a test.
  • Make sure you get enough sleep and eat healthy meals.
  • Work on developing good study habits and make sure you are well-prepared for tests. One good way to do this is to reward yourself for goals you set as you study.
  • Don’t connect your self-worth to the test’s outcome. It’s one test and your worthwhileness as a person is not dependent on grades.
  • Focus on the test and try not to get distracted.
  • Stay positive.
  • If you need extra support, make an appointment with your school counselor.
Clinical Psychology, School Counseling

Treatment For Learning Disability

People with learning disabilities and disorders can learn strategies for coping with their disabilities. Getting help earlier increases the likelihood for success in school and later in life. If learning disabilities remain untreated, a child may begin to feel frustrated with schoolwork, which can lead to low self-esteem, depression, and other problems.

Usually, experts work to help a child learn skills by building on the child’s strengths and developing ways to compensate for the child’s weaknesses. Interventions vary depending on the nature and extent of the disability.

Special Education Services

Children diagnosed with learning and other disabilities in most states, territories and provinces can generally qualify for special educational services. Educational laws typically require that children with specific learning disorder be given the same opportunities that children without the disorder have.

In most locations, children become eligible for such services in preschool or in the first years of formal schooling since research has shown that the early intervention can be key.

Interventions for Specific Learning Disabilities

A learning disability cannot be cured. However with timely intervention and support, children with learning disabilities can be successful in school. Parents and teachers are the first persons to notice that the child is finding it difficult to read, write or learn. If you think that your child may have a learning disability, seek help from a mental health expert or other trained specialists for the required intervention program or therapy.

Note: Early detection can help the child benefit from treatment or therapy. Neglecting the condition may affect the child’s ability to cope with the condition.

If your child has a learning disorder, your child’s doctor or school might recommend:

  • Extra help: A reading specialist or other trained professional can teach your child techniques to improve his or her academic skills. Tutors can also teach children organizational and study skills.
  • Individualized Education Program (IEP): Your child’s school or a special educator might develop an IEP that will describe how a child can best learn in school.
  • Therapy: Depending on the learning disorder, some children might benefit from therapy. For example, speech therapy can help children who have language disabilities. Occupational therapy might help improve the motor skills of a child who has writing problems.
  • Complimentary/alternative therapy: Research shows that alternative therapies like music, art, dance can benefit children with learning disabilities.

Parents and experts need to set goals and assess if the child is improving with the selected mode of intervention and support. If not, alternative methods can be chosen to help the child.

Below are just a few examples of ways educators help children with specific learning disabilities.

For children that have specific language disorder with impairment in reading:

  • Special teaching techniques. These can include helping a child learn through multisensory experiences and by providing immediate feedback to strengthen a child’s ability to recognize words.
  • Classroom modifications. For example, teachers can give students that need it, extra time to finish tasks and provide recorded tests that allow the child to hear the questions instead of reading them.
  • Use of technology. Children with impairment in reading may benefit from listening to books on tape or using word-processing programs with spell-check features.

For children that have specific language disorder with impairment in written expression:

  • Special tools. Teachers can offer oral exams, provide a note-taker, and/or allow the child to videotape reports instead of writing them.
  • Use of technology. A child can be taught to use word-processing programs or an audio recorder instead of writing by hand.
  • Other ways of reducing the need for writing. Teachers can provide notes, outlines, and preprinted study sheets.

For children that have specific language disorder with impairment in mathematics:

  • Visual techniques. For example, teachers can draw pictures of word problems and show the student how to use colored pencils to differentiate parts of problems.
  • Use of memory aids. Rhymes and music are among the techniques that can be used to help a child remember math concepts.
  • Use of computers. A child can use a computer for math drills and practice.

Other Treatments

A child with specific learning disorder may struggle with low self-esteem, frustration, and other problems. Mental health professionals, including school counselors or psychologists, can help the child understand these feelings, develop coping tools, and build healthy relationships. Children with specific learning disorder sometimes have other conditions such as ADHD or Anxiety Disorders. These conditions require their own treatments, which may include psychotherapy and medications.

Clinical Psychology, School Counseling

Types of learning disabilities

Dyslexia

“Dys” means difficulty with and “lexia” means words – thus “difficulty with words”. Originally the term “Dyslexia” referred to a specific learning deficit that hindered a person’s ability to read. More recently, however, it has been used as a general term referring to the broad category of language deficits that often includes the ability to hear and manipulate sounds in words as well as the ability to read and spell words accurately and fluently. When breakdowns occur in these foundational reading skills, dyslexic students often struggle to understand what they read as well as develop vocabulary at a slower rate.

There are two types of learning disabilities in reading. Basic reading problems occur when there is difficulty understanding the relationship between sounds, letters and words. Reading comprehension problems occur when there is an inability to grasp the meaning of words, phrases, and paragraphs.

Signs of reading difficulty include problems with:

  • letter and word recognition
  • understanding words and ideas
  • reading speed and fluency
  • general vocabulary skills

Dysgraphia

“Dys” means difficulty with and “graphia” means writing – thus “difficulty with writing”.  The term dysgraphia refers to more than simply having poor handwriting. This term refers to those who struggle with the motor skills necessary to write thoughts on paper, spelling, and the thinking skills needed for vocabulary retrieval, clarity of thought, grammar, and memory.

Learning disabilities in writing can involve the physical act of writing or the mental activity of comprehending and synthesizing information. Basic writing disorder refers to physical difficulty forming words and letters. Expressive writing disability indicates a struggle to organize thoughts on paper.

Symptoms of a written language learning disability revolve around the act of writing. They include problems with:

  • neatness and consistency of writing
  • accurately copying letters and words
  • spelling consistency
  • writing organization and coherence

Dyscalculia

“Dys” means difficulty with and “calculia” means calculations and mathematics – thus “difficulty with calculations and mathematics”. This term refers to those who struggle with basic number sense and early number concepts as well as have difficulties with math calculations and math reasoning.

Learning disabilities in math vary greatly depending on the child’s other strengths and weaknesses. A child’s ability to do math will be affected differently by a language learning disability, or a visual disorder or a difficulty with sequencing, memory or organization.

A child with a math-based learning disorder may struggle with memorization and organization of numbers, operation signs, and number “facts” (like 5+5=10 or 5×5=25). Children with math learning disorders might also have trouble with counting principles (such as counting by twos or counting by fives) or have difficulty telling time.

specific learning disability types Beautiful Lindsey Lipsky M Ed on

Other types of learning disabilities and disorders

Reading, writing, and math aren’t the only skills impacted by learning disorders. Other types of learning disabilities involve difficulties with motor skills (movement and coordination), understanding spoken language, distinguishing between sounds, and interpreting visual information.

Learning disabilities in motor skills (dyspraxia)

Motor difficulty refers to problems with movement and coordination whether it is with fine motor skills (cutting, writing) or gross motor skills (running, jumping). A motor disability is sometimes referred to as an “output” activity meaning that it relates to the output of information from the brain. In order to run, jump, write or cut something, the brain must be able to communicate with the necessary limbs to complete the action.

Signs that your child might have a motor coordination disability include problems with physical abilities that require hand-eye coordination, like holding a pencil or buttoning a shirt.

Learning disabilities in language (aphasia/dysphasia)

Language and communication learning disabilities involve the ability to understand or produce spoken language. Language is also considered an output activity because it requires organizing thoughts in the brain and calling upon the right words to verbally explain something or communicate with someone else.

Signs of a language-based learning disorder involve problems with verbal language skills, such as the ability to retell a story and the fluency of speech, as well as the ability to understand the meaning of words, parts of speech, directions, etc.

Auditory and visual processing problems: the importance of the ears and eyes

The eyes and the ears are the primary means of delivering information to the brain, a process sometimes called “input.” If either the eyes or the ears aren’t working properly, learning can suffer.

Auditory processing disorder – Professionals may refer to the ability to hear well as “auditory processing skills” or “receptive language.” The ability to hear things correctly greatly impacts the ability to read, write and spell. An inability to distinguish subtle differences in sound, or hearing sounds at the wrong speed make it difficult to sound out words and understand the basic concepts of reading and writing.

Visual processing disorder – Problems in visual perception include missing subtle differences in shapes, reversing letters or numbers, skipping words, skipping lines, misperceiving depth or distance, or having problems with eye–hand coordination. Professionals may refer to the work of the eyes as “visual processing.” Visual perception can affect gross and fine motor skills, reading comprehension, and math.

Common types of learning disabilities

Dyslexia – Difficulty with reading

  • Problems reading, writing, spelling, speaking

Dyscalculia – Difficulty with math

  • Problems doing math problems, understanding time, using money

Dysgraphia – Difficulty with writing

  • Problems with handwriting, spelling, organizing ideas

Dyspraxia (Sensory Integration Disorder) – Difficulty with fine motor skills

  • Problems with hand-eye coordination, balance, manual dexterity

Dysphasia/Aphasia – Difficulty with language

  • Problems understanding spoken language, poor reading comprehension

Auditory Processing Disorder – Difficulty hearing differences between sounds

  • Problems with reading, comprehension, language

Visual Processing Disorder – Difficulty interpreting visual information

  • Problems with reading, math, maps, charts, symbols, pictures
Clinical Psychology, School Counseling

Learning Disability (LD)

What are learning disabilities?

Learning disabilities, or learning disorders, are an umbrella term for a wide variety of learning problems. A learning disability is not a problem with intelligence or motivation. Kids with learning disabilities aren’t lazy or dumb. In fact, most are just as smart as everyone else. Their brains are simply wired differently. This difference affects how they receive and process information.

Simply put, children and adults with learning disabilities see, hear, and understand things differently. This can lead to trouble with learning new information and skills, and putting them to use. The most common types of learning disabilities involve problems with reading, writing, math, reasoning, listening, and speaking.

Children with learning disabilities can, and do, succeed

It can be tough to face the possibility that your child has a learning disorder. No parents want to see their children suffer. You may wonder what it could mean for your child’s future, or worry about how your kid will make it through school. Perhaps you’re concerned that by calling attention to your child’s learning problems they might be labeled “slow” or assigned to a less challenging class.

But the important thing to remember is that most kids with learning disabilities are just as smart as everyone else. They just need to be taught in ways that are tailored to their unique learning styles. By learning more about learning disabilities in general, and your child’s learning difficulties in particular, you can help pave the way for success at school and beyond.

CAUSES

Experts say that there is no single, specific cause for learning disabilities. However, there are some factors that could cause a learning disability:

  • Heredity: It is observed that a child, whose parents have had a learning disability, is likely to develop the same disorder.
  • Illness during and after birth: An illness or injury during or after birth may cause learnign disabilities. Other possible factors could be drug or alcohol consumption during pregnancy, physical trauma, poor growth in the uterus, low birth weight, and premature or prolonged labor.
  • Stress during infancy: A stressful incident after birth such as high fever, head injury, or poor nutrition.
  • Environment: Increased exposure to toxins such as lead (in paint, ceramics, toys, etc.)
  • Comorbidity: Children with learning disabilities are at a higher-than-average risk for attentional problems or disruptive behavior disorders. Up to 25 percent of children with reading disorder also have ADHD. Conversely, it is estimated that between 15 and 30 percent of children diagnosed with ADHD have a learning disorder.

Signs and symptoms of learning disabilities and disorders

Learning disabilities look very different from one child to another. One child may struggle with reading and spelling, while another loves books but can’t understand math. Still another child may have difficulty understanding what others are saying or communicating out loud. The problems are very different, but they are all learning disorders.

It’s not always easy to identify learning disabilities. Because of the wide variations, there is no single symptom or profile that you can look to as proof of a problem. However, some warning signs are more common than others at different ages. If you’re aware of what they are, you’ll be able to catch a learning disorder early and quickly take steps to get your child help.

The following checklist lists some common red flags for learning disorders. Remember that children who don’t have learning disabilities may still experience some of these difficulties at various times. The time for concern is when there is a consistent unevenness in your child’s ability to master certain skills.

Signs and symptoms of learning disabilities: Preschool age

  • Problems pronouncing words
  • Trouble finding the right word
  • Difficulty rhyming
  • Trouble learning the alphabet, numbers, colors, shapes, days of the week
  • Difficulty following directions or learning routines
  • Difficulty controlling crayons, pencils, and scissors, or coloring within the lines
  • Trouble with buttons, zippers, snaps, learning to tie shoes

Signs and symptoms of learning disabilities: Ages 5-9

  • Trouble learning the connection between letters and sounds
  • Unable to blend sounds to make words
  • Confuses basic words when reading
  • Slow to learn new skills
  • Consistently misspells words and makes frequent errors
  • Trouble learning basic math concepts
  • Difficulty telling time and remembering sequences

Signs and symptoms of learning disabilities: Ages 10-13

  • Difficulty with reading comprehension or math skills
  • Trouble with open-ended test questions and word problems
  • Dislikes reading and writing; avoids reading aloud
  • Poor handwriting
  • Poor organizational skills (bedroom, homework, desk is messy and disorganized)
  • Trouble following classroom discussions and expressing thoughts aloud
  • Spells the same word differently in a single document

Identifying a learning disability 

Identifying a learning disability is a complex process. The first step is to rule out vision, hearing, and developmental issues that can overshadow the underlying learning disability. Once these tests are completed, a learning disability is identified using psychoeducational assessment, which includes academic achievement testing along with a measure of intellectual capability. This test helps determine if there is any significant discrepancy between a child’s potential and performance capability (IQ) and the child’s academic achievement (school performance). 

Paying attention to developmental milestones can help you identify learning disorders

Paying attention to normal developmental milestones for toddlers and preschoolers is very important. Early detection of developmental differences may be an early signal of a learning disability and problems that are spotted early can be easier to correct.

A developmental lag might not be considered a symptom of a learning disability until your child is older, but if you recognize it when your child is young, you can intervene early. You know your child better than anyone else does, so if you think there is a problem, it doesn’t hurt to get an evaluation. You can also ask your pediatrician for a developmental milestones chart.

Clinical Psychology, School Counseling

ADHD Turns Onto …

Cantwell (1988) discusses the relationship of ADHD to conduct, affective disorders and later substance abuse disorders.  Dykman (1993) found that children with ADHD who were also hyperactive and aggressive were at increased risk to have oppositional and conduct disorders.  Lilienfeld, (1990) reviewed the literature on ADHD and antisocial behavior. 

The ADHD and Oppositional defiant disorder (ODD) Link

ODD is related to a child’s conduct and how they interact with their family, friends, and teachers. ADHD is a neurodevelopmental disorder.These conditions are different, but can occur together. Some seemingly defiant symptoms may be related to impulsivity in ADHD. In fact, it’s believed that about 40 percent of children with a diagnosis of ADHD also have ODD. Though, just like ADHD, not all children diagnosed with ODD have ADHD.

A child who only has ADHD may be full of energy or get overly excited when playing with classmates. This can sometimes lead to roughhousing and causing unintended harm to others.Children with ADHD may also throw tantrums. But this isn’t a typical symptom of the disorder. Instead, the tantrum can be an impulse outburst due to frustration or boredom.If the same child has ODD, not only do they have issues with impulse control, but also with an angry or irritable mood which can lead to physical aggression.

These children may have tantrums due to an inability to control their temper. They may be spiteful, upset others on purpose, and blame others for their own mistakes. In addition to getting overly excited and hurting a classmate while playing, they might lash out and blame the classmate and then refuse to apologize.It’s important to note that traits of ODD and ADHD can also occur with learning disabilities and other conduct disorders. Care should be taken by a provider to get a clear picture of the overall symptoms before making a diagnosis.

The ADHD and Conduct disorder (CD) Link

Among individuals with ADHD, conduct disorder (CD) may also be present, occurring in 27 percent of children, 45–50 percent of adolescents and 20–25 percent of adults with ADHD. Children with conduct disorder may be aggressive to people or animals, destroy property, lie or steal things from others, run away, skip school or break curfews. Adults with CD often exhibit behaviors that get them into trouble with the law.

Children with coexisting conduct disorder are at much higher risk for getting into trouble with the law or having substance abuse problems than children who have only ADHD. Studies show that this type of coexisting condition is more common among children with the primarily hyperactive/impulsive and combination types of ADHD.

The ADHD and Antisocial Personality Disorder Link

Antisocial Personality Disorder is one of the most researched disorders in connection with ADHD and is the adult version of Conduct disorder. Lilienfeld, (1990) reviewed the literature on ADHD and antisocial behavior.  Findings from longitudinal, family and adoption, neuropsychological, psychophysiological, and other laboratory studies reviewed indicate that childhood ADHD is associated with adult disorders characterized by antisocial behavior

 Antisocial Personality Disorder most closely resembles the hyperactive-impulsive type of ADHD.  Both ADHD and Antisocial personality have difficulties with impulse control.  There is a risk taking, thrillseeker component to both, but the individual with Antisocial Personality disorder will typically have less regard for their own safety and the safety of others than the person with ADHD.  In contrast, the adult with ADHD is often times overly sensitive to the reactions and feelings of others and may feel remorseful to the point of becoming depressed over his/her impulsive actions. 

Unlike some of the other disorders we have been discussing in the differential diagnosis section, Antisocial Personality disorder is not easily and quickly treated.  The personality disorders in general are long standing patterns of behavior and personality that have developed over a life time.  Individuals with personality disorders are so familiar with the symptoms and behaviors that they are not distressed by them.  Many times it is a significant other who will request that the personality disordered individual seek treatment, or in the case of Antisocial Personality, it is often times due to legal difficulties.  Relatively long term therapy can alter the patterns of behavior, and if the individual has ADHD and Antisocial Personality disorder, medications may help control the level of impulsive behavior. 

Clinical Psychology, School Counseling

Treatments For ADHD

Whether or not your child’s symptoms of inattention, hyperactivity, and impulsivity are due to ADHD, they can cause many problems if left untreated. Children who can’t focus and control themselves may struggle in school, get into frequent trouble, and find it hard to get along with others or make friends. These frustrations and difficulties can lead to low self-esteem as well as friction and stress for the whole family.

But treatment can make a dramatic difference in your child’s symptoms. With the right support, your child can get on track for success in all areas of life. If your child struggles with symptoms that look like ADHD, don’t wait to seek professional help. You can treat your child’s symptoms of hyperactivity, inattention, and impulsivity without having a diagnosis of attention deficit disorder. Options to start with include getting your child into therapy, implementing a better diet and exercise plan, and modifying the home environment to minimize distractions.

If you do receive a diagnosis of ADHD, you can then work with your child’s doctor, therapist, and school to make a personalized treatment plan that meets his or her specific needs. Effective treatment for childhood ADHD involves behavioral therapy, parent education and training, social support, and assistance at school. Medication may also be used; however, it should never be the sole attention deficit disorder treatment.

Professional treatment for ADHD

Although there are many ways you can help a child with ADHD at home, you may want to seek professional help along the way. ADHD specialists can help you develop an effective treatment plan for your child. Since ADHD responds best to a combination of treatments and strategies, consulting several specialists is advisable.

To find ADHD treatment providers, you may want to contact your primary care physician, your child’s pediatrician, local hospitals, or clinics. Other sources for provider references include your insurance company, officials at your child’s school, or a local parent support group.

Child and adolescent psychiatrists:

  • Diagnose ADHD and prescribe medications

Psychologists:

  • Diagnose ADHD and provide talk therapy
  • Help people with ADHD explore their feelings

Cognitive-behavioral therapists:

  • Set up behavioral modification programs at school, work, and home
  • Establish concrete goals for behavior and achievement
  • Help families and teachers maintain rewards and consequences

Educational specialists:

  • Teach techniques for succeeding in school
  • Help children obtain accomodations from school
  • Advise families about assistive technology

Behavioral therapy for ADHD

Behavioral therapy, also known as behavior modification, has been shown to be a very successful treatment for children with ADHD. It is especially beneficial as a co-treatment for children who take stimulant medications and may even allow you to reduce the dosage of the medication.

Behavior therapy involves reinforcing desired behaviors through rewards and praise and decreasing problem behaviors by setting limits and consequences. For example, one intervention might be that a teacher rewards a child who has ADHD for taking small steps toward raising a hand before talking in class, even if the child still blurts out a comment. The theory is that rewarding the struggle toward change encourages the full new behavior.

Behavior Therapy for ADHD in Children

According to the American Academy of Pediatrics, there are three basic principles to any behavior therapy approach:

  1. Set specific goals. Set clear goals for your child such as staying focused on homework for a certain time or sharing toys with friends.
  2. Provide rewards and consequences. Give your child a specified reward (positive reinforcement) when he or she shows the desired behavior. Give your child a consequence (unwanted result or punishment) when he or she fails to meet a goal.
  3. Keep using the rewards and consequences. Using the rewards and consequences consistently for a long time will shape your child’s behavior in a positive way.

As parents, you can set up a customized behavioral modification program for your child who has ADHD with the help of a behavioral specialist such as a cognitive-behavioral therapist. A cognitive-behavioral therapist focuses on practical solutions to everyday issues. This kind of therapist can set up a behavioral modification program of rewards and consequences for your child at home and at school and support you in shaping your child’s behavior.

Patience is key with behavioral therapy, since people with ADHD are notoriously variable in their symptoms. One day, your child may behave beautifully, and the next, fall back into old patterns. Sometimes it may seem as if the training is not working. However, over time, behavioral treatment does improve the symptoms of ADHD.

Social skills training

Because kids with attention deficit disorder often have difficulty with simple social interactions and struggle with low self-esteem, another type of treatment that can help is social skills training. Normally conducted in a group setting, social skills training is led by a therapist who demonstrates appropriate behaviors and then has the children practice repeating them. A social skills group teaches children how to “read” others’ reactions and how to behave more acceptably. The social skills group should also work on transferring these new skills to the real world.

For a social skills group near you, ask for a referral from your school psychologist or a local mental health clinic.

Parenting tips for children with ADHD

If your child is hyperactive, inattentive, or impulsive, it may take a lot of energy to get him or her to listen, finish a task, or sit still. The constant monitoring can be frustrating and exhausting. Sometimes you may feel like your child is running the show. But there are steps you can take to regain control of the situation, while simultaneously helping your child make the most of his or her abilities.

While attention deficit disorder is not caused by bad parenting, there are effective parenting strategies that can go a long way to correct problem behaviors. Children with ADHD need structure, consistency, clear communication, and rewards and consequences for their behavior. They also need lots of love, support, and encouragement.

There are many things parents can do to reduce the signs and symptoms of ADHD without sacrificing the natural energy, playfulness, and sense of wonder unique in every child.

Take care of yourself so you’re better able to care for your child. Eat right, exercise, get enough sleep, find ways to reduce stress, and seek face-to-face support from family and friends as well as your child’s doctor and teachers.

Establish structure and stick to it. Help your child stay focused and organized by following daily routines, simplifying your child’s schedule, and keeping your child busy with healthy activities.

Set clear expectations. Make the rules of behavior simple and explain what will happen when they are obeyed or broken—and follow through each time with a reward or a consequence.

Encourage exercise and sleep. Physical activity improves concentration and promotes brain growth. Importantly for children with ADHD, it also leads to better sleep, which in turn can reduce the symptoms of ADHD.

Help your child eat right. To manage symptoms of ADHD, schedule regular healthy meals or snacks every three hours and cut back on junk and sugary food.

Teach your child how to make friends. Help him or her become a better listener, learn to read people’s faces and body language, and interact more smoothly with others.

School tips for children with ADHD

ADHD, obviously, gets in the way of learning. You can’t absorb information or get your work done if you’re running around the classroom or zoning out on what you’re supposed to be reading or listening to. Think of what the school setting requires children to do: Sit still. Listen quietly. Pay attention. Follow instructions. Concentrate. These are the very things kids with ADHD have a hard time doing—not because they aren’t willing, but because their brains won’t let them.

But that doesn’t mean kids with ADHD can’t succeed at school. There are many things both parents and teachers can do to help children with ADHD thrive in the classroom. It starts with evaluating each child’s individual weaknesses and strengths, then coming up with creative strategies for helping the child focus, stay on task, and learn to his or her full capability.

Clinical Psychology, School Counseling

Attention Deficit Hyperactivity Disorder (ADHD)

What is ADHD ?

We all know kids who can’t sit still, who never seem to listen, who don’t follow instructions no matter how clearly you present them, or who blurt out inappropriate comments at inappropriate times. Sometimes these children are labeled as troublemakers, or criticized for being lazy and undisciplined. However, they may have attention deficit hyperactivity disorder (ADHD), formerly known as attention deficit disorder, or ADD. ADHD makes it difficult for people to inhibit their spontaneous responses—responses that can involve everything from movement to speech to attentiveness.

The signs and symptoms of ADHD typically appear before the age of seven. However, it can be difficult to distinguish between attention deficit disorder and normal “kid behavior.” If you spot just a few signs, or the symptoms appear only in some situations, it’s probably not ADHD. On the other hand, if your child shows a number of ADHD signs and symptoms that are present across all situations—at home, at school, and at play—it’s time to take a closer look.

The primary characteristics of ADHD

When many people think of attention deficit disorder, they picture an out-of-control kid in constant motion, bouncing off the walls and disrupting everyone around. But this is not the only possible picture. Some children with ADHD are hyperactive, while others sit quietly—with their attention miles away. Some put too much focus on a task and have trouble shifting it to something else. Others are only mildly inattentive, but overly impulsive.

The three primary characteristics of ADHD are inattention, hyperactivity, and impulsivity. The signs and symptoms a child with attention deficit disorder has depend on which characteristics predominate.

Children with ADHD may be:

  • Inattentive, but not hyperactive or impulsive.
  • Hyperactive and impulsive, but able to pay attention.
  • Inattentive, hyperactive, and impulsive (the most common form of ADHD).

Children who only have inattentive symptoms of ADHD are often overlooked, since they’re not disruptive. However, the symptoms of inattention have consequences: getting in hot water with parents and teachers for not following directions; underperforming in school; or clashing with other kids over not playing by the rules.

Because we expect very young children to be easily distractible and hyperactive, it’s the impulsive behaviors—the dangerous climb, the blurted insult—that often stand out in preschoolers with ADHD. By age four or five, though, most children have learned how to pay attention to others, to sit quietly when instructed to, and not to say everything that pops into their heads. So by the time children reach school age, those with ADHD stand out in all three behaviors: inattentiveness, hyperactivity, and impulsivity.

Inattentiveness signs and symptoms of ADHD

It isn’t that children with ADHD can’t pay attention: when they’re doing things they enjoy or hearing about topics in which they’re interested, they have no trouble focusing and staying on task. But when the task is repetitive or boring, they quickly tune out.

Staying on track is another common problem. Children with ADHD often bounce from task to task without completing any of them, or skip necessary steps in procedures. Organizing their schoolwork and their time is harder for them than it is for most children. Kids with ADHD also have trouble concentrating if there are things going on around them; they usually need a calm, quiet environment in order to stay focused.

Symptoms of inattention in children:

  1. Has trouble staying focused; is easily distracted or gets bored with a task before it’s completed
  2. Appears not to listen when spoken to
  3. Has difficulty remembering things and following instructions; doesn’t pay attention to details or makes careless mistakes
  4. Has trouble staying organized, planning ahead, and finishing projects
  5. Frequently loses or misplaces homework, books, toys, or other items

Hyperactivity signs and symptoms of ADHD

The most obvious sign of ADHD is hyperactivity. While many children are naturally quite active, kids with hyperactive symptoms of attention deficit disorder are always moving. They may try to do several things at once, bouncing around from one activity to the next. Even when forced to sit still, which can be very difficult for them, their foot is tapping, their leg is shaking, or their fingers are drumming.

Symptoms of hyperactivity in children:

  1. Constantly fidgets and squirms
  2. Has difficulty sitting still, playing quietly, or relaxing
  3. Moves around constantly, often runs or climbs inappropriately
  4. Talks excessively
  5. May have a quick temper or “short fuse”

Impulsive signs and symptoms of ADHD

The impulsivity of children with ADHD can cause problems with self-control. Because they censor themselves less than other kids do, they’ll interrupt conversations, invade other people’s space, ask irrelevant questions in class, make tactless observations, and ask overly personal questions. Instructions like, “Be patient” and “Just wait a little while” are twice as hard for children with ADHD to follow as they are for other youngsters.

Children with impulsive signs and symptoms of ADHD also tend to be moody and to overreact emotionally. As a result, others may start to view the child as disrespectful, weird, or needy.

Symptoms of impulsivity in children:

  1. Acts without thinking
  2. Guesses, rather than taking time to solve a problem or blurts out answers in class without waiting to be called on or hear the whole question
  3. Intrudes on other people’s conversations or games
  4. Often interrupts others; says the wrong thing at the wrong time
  5. Inability to keep powerful emotions in check, resulting in angry outbursts or temper tantrums

Is it really ADHD?

Just because a child has symptoms of inattention, impulsivity, or hyperactivity does not mean that he or she has ADHD. Certain medical conditions, psychological disorders, and stressful life events can cause symptoms that look like ADHD. Before an accurate diagnosis of ADHD can be made, it is important that you see a mental health professional to explore and rule out the following possibilities:

Learning disabilities or problems with reading, writing, motor skills, or language.

Major life events or traumatic experiences (e.g. a recent move, death of a loved one, bullying, divorce).

Psychological disorders including anxiety, depression, and bipolar disorder.

Behavioral disorders such as conduct disorder and oppositional defiant disorder.

Medical conditions, including thyroid problems, neurological conditions, epilepsy, and sleep disorders.

Positive effects of ADHD in children

In addition to the challenges, there are also positive traits associated with people who have attention deficit disorder:

Creativity – Children who have ADHD can be marvelously creative and imaginative. The child who daydreams and has ten different thoughts at once can become a master problem-solver, a fountain of ideas, or an inventive artist. Children with ADHD may be easily distracted, but sometimes they notice what others don’t see.

Flexibility – Because children with ADHD consider a lot of options at once, they don’t become set on one alternative early on and are more open to different ideas.

Enthusiasm and spontaneity – Children with ADHD are rarely boring! They’re interested in a lot of different things and have lively personalities. In short, if they’re not exasperating you (and sometimes even when they are), they’re a lot of fun to be with.

Energy and drive – When kids with ADHD are motivated, they work or play hard and strive to succeed. It actually may be difficult to distract them from a task that interests them, especially if the activity is interactive or hands-on.

Keep in mind, too, that ADHD has nothing to do with intelligence or talent. Many children with ADHD are intellectually or artistically gifted.

Clinical Psychology, School Counseling

SCHOOL COUNSELING

Health Care to Children & Adolescents with Psychosocial Disorders

According to the recent estimates, 17% to 22 % of the children under age of 18 years meet the diagnostic criteria for one or more mental disorders. Of these, 11 to 14 million children, that is, at least, half of them may be severely handicapped by this order, and half may have trouble coping with the demands of community, family and school.

The most commonly known developmental problem faced by the children is LD (Learning Disability), Attention Deficit Hyperactivity Disorder (ADHD), Anxiety Disorder (AD), Disorders such as Enuresis, Encopresis, Sleep Walking, Tics, Autism, etc

To participate in the management of these disorders, psychologists have developed a broad range of treatments

Primary prevention addresses risk and protective factors that may influence the onset of a disease. The goals of primary prevention are to prevent specific disorders and diseases and to foster general health enhancement through education

Secondary prevention is aimed at reducing the prevalence or severity of a disorder through early identification and treatment

Tertiary prevention refers to efforts to minimize the sequelae of established disorders or diseases through rehabilitation

Interdisciplinary Collaborative Activities in School Settings

collaboration between paediatric psychologists, health care providers, teachers, and other school personnel

Relevant factors that can affect collaboration include the goal or content of collaboration.

Pediatric psychologists and at times pediatric health care providers will work with school staff and parents concerning planning for the educational and classroom support needs of an individual child.

School counselors and health care providers may have information concerning the needs of children with various health conditions, medication management, and/or neuropsychological status of individual children who have been seen for medical and/or psychological evaluation and/or treatment, all of which may be very useful to teachers

Teachers also have valuable information about how the child is responding to the social and educational demands of the school setting that can help to inform the psychologist’s or pediatrician’s recommendations and to develop an effective educational and psychological management plan for the child.

  • characteristics of collaborators,
  • outcomes of collaboration,
  • relationship characteristics,
  • stages of collaborative relationships.

Models of Collaboration/Consultation

Pediatric psychologists have described a range of collaborative models that have focused on clinical consultation in patient care or teaching and that are applicable to school settings.

Four basic models of psychological consultation in pediatric settings are:-

(1) Independent functions

In this model, the psychologist or behaviouralpaediatrician functions as a specialist who provides diagnostic information and, in some instances, recommendations for management in the classroom setting of a patient referred by a teacher or paediatrician.

(2) Indirect consultation

An alternative approach is the indirect psychological consultation or process-educative model. The hallmark of this model is that the psychologist or paediatrician assumes the role of informed colleague who provides advice, teaching, or protocols for ongoing management.

(3) Collaborative team models

A third general model of consultation, the collaborative team model, is characterized by shared responsibility and joint decision making among the paediatric psychologist and teacher concerning the child’s management

(4) Systems-based approach

The models of consultation described thus far emphasize interactions and relationships among the individual pediatric psychologist, paediatrician, teacher, and/or educator.

Systems-based approach, is characterized by a proactive approach that may also develop a novel service designed to address the ongoing problem in systems of care

Collaborative Challenges

teachers spend a considerable amount of time with children and are often skeptical about taking suggestions from a consultant.

Moreover, teachers may believe that the test data the neuropsychological consultant provides will not result in meaningful, concrete intervention techniques that can be employed in the classroom

In fact, these are difficult to accomplish, and they require a high level of expertise and the time to develop and implement specific recommendations based on classroom observation on the part of the psychologist consultant.

Another challenge faced is that the effective consultation and collaboration with school staff concerning the complex, highly individual needs of children with Autism is inevitably time consuming as it requires observation of the child in a classroom context, phone and face-to-face contact with teachers, and ongoing reviews of the child’s progress.

Another challenge posed by this work involves the need to coordinate neuropsychological consultation with input from pediatric neurologists and pediatricians concerning medication management

Psychosocial Challenges and Clinical Interventions for Children and Adolescents

Children with chronic illnesses are faced with a number of ongoing stressors that affect many dimensions of their lives. They often encounter changes in their physical, social, and emotional functioning, and must cope with the added burden of clinic visits and daily medical treatments

Parents also experience increased demands on their time, energy, and resources, as well as shifts in the enactment of their primary social roles (e.g., parental, marital)

Non-identification of psychosocial problems of school children.

It is a serious concern when children and adolescents go without needed mental health services

There are a number of factors that causes such problems

  • 1Training programs that do not provide school counselors with specific education, knowledge, training, and skills to address psychosocial disturbances in their patients.
  • School counselors may be undertrained in recognizing the complex problems associated with mental health issues and also may lack the necessary expertise to care for children who evidence psychopathology
  • Even in the case where a child is identified by the primary care school counselor families may be reluctant for a number of reasons to follow through with recommended services.
  • Reasons may include the stigma associated with labeling and receiving psychological services at a school.
  •  A general unfamiliarity with the nature and benefits of psychological services by children and their caregivers and health care providers hinders use of services.
  • So do environmental barriers like limited office space and lack of cooperation from teaching faculties.
  • Beliefs of parents and teachers about the inability of school counselors to manage psychosocial problems of students