Diagnoses, Medication, & Psychological Testing

DIAGNOSES DESCRIPTIONS ON THIS SITE

ADJUSTMENT DISORDER

Adjustment Disorder is a severe emotional reaction to a difficult event in your life. It may affect your feelings, thoughts and behavior. Unlike anxiety disorders there is a clear presence of a stressor that leads to significant emotional or behavioral symptoms. Stressors can be anything from going to school abroad to marital problems, or business crises. Emotional signs of an adjustment disorder include: sadness, hopelessness, nervousness, anxiety, worry, difficulty concentrating, and trouble sleeping. Behavioral symptoms of adjustment disorders are: fighting, reckless driving, avoiding family or friends, poor school or work performance, and vandalism. There are six subtypes of Adjustment Disorder that characterizes predominant symptoms.

  • Adjustment disorder with depressed mood is characterized by predominant symptoms of tearfulness, depression or feelings of hopelessness
  • Adjustment disorder with anxiety is characterized by predominant symptoms of nervousness, worry, or jitteriness.
  • Adjustment disorder with mixed anxiety and depressed mood is characterized by symptoms that are a combination of depression and anxiety
  • Adjustment disorder with disturbance of conduct is characterized by predominant symptoms of vandalism, reckless driving, fighting, and defaulting on legal responsibilities.
  • Adjustment disorder with mixed disturbance of emotions and conduct is characterized by a combination of emotional and conduct symptoms.
  • Adjustment disorder unspecified is characterized by maladaptive reactions to stressors that are cannot be classified to one specific subtype.

DEPRESSION

Depression is often called the “common cold” of mental health disorders, in that most people experience depression at some point in their life. However, to meet diagnostic criteria for clinical depression, symptoms must persist steadily for at least two weeks. Thus while most people experience depression in their lives, a smaller number are ever clinically depressed. Seeking treatment early when signs of depression are first evident can greatly reduce the likelihood the depression will worsen or persist.

Depression can be characterized by either a depressed mood or the loss of interest or pleasure in nearly all activities. Depression goes beyond occasional feelings of sadness and interrupts a person’s daily life and functioning. In children and adolescents the mood may be irritable rather than sad. Individuals with depression also commonly experience changes in appetite or weight, sleep, psychomotor agitation (pacing, wringing hands, pulling clothing), psychomotor retardation (slowing of speech, coordination, and impaired articulation), decreased energy, feelings of worthlessness or guilt, difficulty thinking, concentration, and making decisions. One may also experience recurrent thoughts of death or suicide as well as make suicidal plans or attempts. A person experiencing depression may self-describe as depressed, sad, hopeless, or discouraged. Individuals may also complain about having no feelings or feeling “blah.” Others exhibit bodily aches and pains rather than feelings of sadness. Loss of interest or pleasure in hobbies, or not feeling enjoyment in activities that were previously considered pleasurable, is also common. Family members often notice social withdrawal.

With the exception of suicidal thoughts or attempts, symptoms must last for at least two weeks before being considered a potential sign of depression.

Diagnosis of clinical depression in children is more difficult than in adults. While some children still function reasonably well, most who are suffering depression will experience a noticeable change in their social activities and life, a loss of interest in school and poor academic performance, and possibly drastic changes in appearance. They may also begin abusing drugs and/or alcohol, particularly past the age of 12. Although much rarer than in adults, children with major depression may attempt suicide or have suicidal thoughts even before the age of twelve.

There is no known single cause for depression. Research indicates that it is the result of genetic, environmental, biochemical, and psychological factors. Depression is a highly treatable disorder; like most disorders, the earlier the treatment the more effective it can be.

BI-POLAR DISORDER

Bipolar Disorder is also known as manic-depressive disorder, and is characterized by mood instability. Bipolar disorder causes unusual shifts in a person’s mood, energy, and ability to function. However, unlike typical ups and downs, the mood shifts in bipolar disorder are severe. If left untreated, the symptoms of bipolar disorder can interrupt everyday functioning, relationships, and school/work performance.

Bipolar disorder is characterized by drastic mood swings, from a “high” euphoric or irritable feeling (manic) to sadness and hopeless (depression), and then back again. Many people experience periods of “normal” mood in between these shifts. These shifts in mood are called episodes of mania and depression and accompany severe changes in energy and behavior.

Signs and symptoms of mania (or a manic episode) include:

  • Increased energy, activity, and restlessness
  • Excessively “high,” euphoric mood
  • Extreme irritability
  • Racing thoughts and talking very fast, jumping from one idea to another
  • Distractibility, difficulty with concentration
  • Little sleep needed
  • Unrealistic beliefs in one’s abilities and powers
  • Poor judgment
  • Spending sprees
  • A lasting period of unusual behavior
  • Increased sexual drive
  • Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
  • Provocative, intrusive, or aggressive behavior
  • Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for one week or longer. If the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include:

  • Lasting sad, anxious, or empty mood
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in activities once enjoyed, including sex
  • Decreased energy, a feeling of fatigue or of being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Restlessness or irritability
  • Sleeping too much or inability to sleep
  • Change in appetite and/or unintended weight loss or gain
  • Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
  • Thoughts of death or suicide or suicide attempts

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of two weeks or longer.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus, even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of psychosis. Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person’s usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity such as believing one is the President or has special powers or wealth, may occur during mania. Delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania, many times within a day. Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.

Bipolar disorder in children and adolescents can be hard to tell apart from other problems that may occur in these age groups. While irritability and aggressiveness can indicate bipolar disorder, they also can be symptoms of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder. Manic and depressive symptoms may also indicate other types of mental disorders more common among adults such as major depression or schizophrenia. Drug abuse also may lead to manic and/or depressive symptoms.

For any illness, however, effective treatment depends on appropriate diagnosis. Children or adolescents with emotional and behavioral symptoms should be carefully evaluated by a mental health professional.

ANXIETY

Anxiety is a naturally and normally occurring reaction to stress. Anxiety can become a serious disorder when it turns into irrational fear and dread of every day situations. Individuals with anxiety find it difficult to control their worry. The anxiety and worry accompany restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and disturbed sleep. Although individuals with anxiety may not identify the worries as excessive, they report distress due to constant worry, have difficulty controlling the worry, or experience related impairment in social, occupational, or other important areas of functioning. The intensity, duration, or frequency of the anxiety and worry is far out of proportion to the actual likelihood or impact of the feared event. People with anxiety find it difficult to keep worrisome thought from interfering with their attention to the task at hand and have difficulty stopping the worry. Anxiety in adults may be demonstrated about everyday, routine life circumstances such as possible job responsibilities, finances, the health of family members, misfortune to their children, or minor matters such as household chores. In children, anxiety might be demonstrated by excessive worry about competence or quality of performance. Physical symptoms of anxiety include muscle tension, trembling, twitching, feeling shaky, and muscle aches or soreness. Individuals may also experience sweating, nausea, diarrhea, an exaggerated startle response, accelerated heart rate, shortness of breath, and dizziness. Depressive symptoms are also common. The anxiety disorders encompass six different disorders. While each disorder is different, and symptoms may be exhibited differently in each person, they all provoke extreme fear or worry that interferes with normal life.

Generalized Anxiety Disorder (GAD): Excessive uncontrollable worry about everyday issues, including school, work, money, friends and health.

Social Anxiety Disorder (also called Social Phobia): Avoidance of everyday social situations due to extreme anxiety about being judged by others or behaving in a way that might cause embarrassment or ridicule.

Panic Disorder: Severe attacks of terror, which may make people feel like they are having a heart attack or going crazy, for no apparent reason.

Specific Phobias: Intense fear of an object, place or situation, such as riding in elevators, driving on highways or heights, that leads to an avoidance of the object or situation. A person with a specific phobia will typically recognize that the fear is irrational and inappropriate for the circumstance.

Obsessive-Compulsive Disorder (OCD): Persistent, recurring thoughts (obsessions) that reflect exaggerated anxiety or fears and manifest as repetitive behaviors or rituals (compulsions). For example, the uncontrollable need to scrub your hands repeatedly or the insistence on absolute neatness and order.

Obsessive-Compulsive Disorder (OCD) is characterized by recurrent obsessions or compulsions that are severe enough to be time consuming or cause marked distress or significant impairment. At some point the person has recognized that the obsessions or compulsions are a product of her or her own mind and are not based in reality. Obsessions are persistent ideas, thought, impulses, or images that are experienced as intrusive and inappropriate and cause marked anxiety or distress. The most common obsessions are thoughts about contamination, repeated doubts, a need to have things in a particular order, aggressive or horrific impulses, and sexual imagery. The thoughts, impulses, or images are not simply excessive worries about real-life problems. Individuals with obsessions usually attempt to ignore or suppress such thoughts or impulses or to neutralize them with some other thought or action.

Compulsions are repetitive behaviors or mental acts in which the goal is to prevent or reduce anxiety or duress, not to provide pleasure or gratification. Individuals feel driven to perform these actions in order to prevent a dreaded event or situation. Compulsions are either clearly excessive or are not connected in a realistic way with what they are designed to neutralize or prevent. Common compulsions include washing, cleaning, counting, checking, requesting or demanding assurance, repeating actions, and ordering.

Posttraumatic Stress Disorder (PTSD): Several months or years after a traumatic life experience symptoms appear such as avoidance, detachment, difficulty sleeping and concentrating, and re- experiencing or reliving the traumatic event. People may also experience nightmares, paranoia, or have exaggerated startle responses. People with PTSD may startle easily, become emotionally numb (especially in relation to people with whom they used to be close), lose interest in things they used to enjoy, have trouble feeling affectionate, be irritable, become more aggressive, or even become violent. They avoid situations that remind them of the original incident, and anniversaries of the incident are often very difficult. Most people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings, and are often triggered by ordinary occurrences, such as a door slamming or a car backfiring on the street. A person having a flashback may lose touch with reality and believe that the traumatic incident is happening all over again. Not every traumatized person develops full-blown or even minor PTSD. Symptoms usually begin within 3 months of the incident but occasionally emerge years afterward. They must last more than a month to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

SUBSTANCE ABUSE & DEPENDENCE

Individuals with Substance Dependence continue to use substances despite significant substance-related problems. People often go through a pattern of repeated self-administration that results in tolerance, withdrawal, and compulsive drug-taking behavior. Individuals will experience tolerance when they feel the need for greatly increased amounts of the substance to achieve intoxication, or a diminished effect with continued use of the same amount of the substance. This can often occur to a dosage that would be lethal to a non user. Withdrawal is a physical state and occurs when blood or tissue concentrations of a substance declines. Withdrawal symptoms vary by substance, but they are generally the opposite of the acute effects of the drug. However, Substance Dependence can occur with or without physiological dependence. Individuals may suffer from Substance Dependence when there is no evidence of tolerance or withdrawal, but there is a pattern of compulsive use. People who are dependent on substances will go through unsuccessful attempts to cut down or control substance use. People who are dependence on a substance are generally aware that they have a problem, yet will go through great lengths to obtain the substance. Often important social, occupational or recreational activities are given up because of substance abuse.

Unlike Substance Dependence, Substance Abuse does not include the presence of tolerance or withdrawal symptoms, or a pattern of compulsive use. People with substance abuse often fail to meet major obligations, legal problems, social problems, and interpersonal problems. Often people will use substances in situations where it is particularly hazardous such as driving an automobile. Substance is more likely to occur in individuals who have recently started taking a substance. Despite interpersonal, social or legal problems created by substance use, those suffering from substance abuse will continue to use.

EATING DISORDERS

Anorexia Nervosa:

Anorexia nervosa is characterized by refusal to maintain a minimally normal body weight, an intense fear of weight gain, and a disturbance in the perception of the shape or size of their body. Lack of menstruation among girls and women, and extremely disturbed eating behavior. Some people with anorexia lose weight by dieting and exercising excessively; others lose weight by self-induced vomiting, or misusing laxatives, diuretics or enemas.
Many people with anorexia see themselves as overweight, even when they are starved or are clearly malnourished. Concern about weight often increases as actual weight continues to decrease. Eating, food and weight control become obsessions. A person with anorexia typically weighs themselves repeatedly, portions food carefully, and eats only very small quantities of only certain foods. Weight loss is viewed as an impressive achievement and a sign of extraordinary self-discipline, whereas weight gain is perceived as an unacceptable failure of self-control. Some individuals with Anorexia Nervosa may admit to being thin, they typically deny the medical implications.

Other symptoms may develop over time, including:

  • thinning of the bones
  • brittle hair and nails
  • dry and yellowish skin
  • growth of fine hair over body
  • mild anemia, and muscle weakness and loss
  • severe constipation
  • low blood pressure, slowed breathing and pulse
  • drop in internal body temperature, causing a person to feel cold all the time
  • lethargy

There are 2 subtypes of Anorexia Nervosa. The Restricting Type describes weight loss that is accomplished though dieting, fasting, or excessive exercise. The Binge-Eating/Purging Type uses binge-eating and/or purging behavior. Some individuals do not binge eat, but will purge after small meals. This can be done with vomiting, laxatives, diuretics, or enemas.

Bulimia Nervosa:

Bulimia nervosa is characterized by binge eating and inappropriate compensatory methods to prevent weight gain. Unlike people with Anorexia, people with Bulimia can fall within the normal weight range for the age and weight. Like people with Anorexia they fear gaining weight, want to loose weight, and are very unhappy with their body size and shape. A binge is defined as eating in a discrete period of time an amount of food that is larger than most individuals would eat under similar circumstances. The binge is done within a limited period, usually less than 2 hours. Individuals with Bulimia are typically ashamed of their eating problems and attempt to conceal their symptoms. The Binge/ Purge behavior is often accompanied by feelings of disgust or shame.

An episode of binge eating is accompanied by a sense of lack of control. A person may be in a frenzied state while binge eating, and some even describe a dissociate quality during or following binge episodes.

Other symptoms include:

  • chronically inflamed and sore throat
  • swollen glands in the neck and below the jaw
  • worn tooth enamel and increasingly sensitive and decaying teethe as result of exposure to stomach acids
  • gastroesophageal reflux disorder
  • intestinal distress and irritation from laxative abuse
  • kidney problems from diuretic abuse
  • severe dehydration from purging of fluids

Binge-Eating Disorder:

Binge-eating disorder is characterized by recurrent binge-eating episodes during which a person feels a loss of control over his or her eating. Unlike bulimia, binge-eating episodes are not followed by purging, excessive exercise or fasting. As a result, people with binge-eating disorder often are overweight or obese. They also experience guilt, shame and/or distress about the binge-eating, which can lead to more binge-eating. Obese people with binge-eating disorder often have coexisting psychological illnesses including anxiety, depression, and personality disorders. In addition, links between obesity and cardiovascular disease and hypertension are well documented.

Eating Disorders in Men

Although eating disorders primarily affect women and girls, boys and men are also vulnerable. One in four preadolescent cases of anorexia occurs in boys, and binge-eating disorder affects females and males about equally.
Like females who have eating disorders, males with the illness have a warped sense of body image and often have muscle dysmorphia, a type of disorder that is characterized by an extreme concern with becoming more muscular. Some boys with the disorder want to lose weight, while others want to gain weight or “bulk up.” Boys who think they are too small are at a greater risk for using steroids or other dangerous drugs to increase muscle mass.
Boys with eating disorders exhibit the same types of emotional, physical and behavioral signs and symptoms as girls, but for a variety of reasons, boys are less likely to be diagnosed with what is often considered a stereotypically “female” disorder.

INSOMNIA

Insomnia is described as difficulty initiating or maintaining sleep, or the complaint of nonrestorative sleep that lasts for at least 1 month. Most commonly people with insomnia report difficulty falling asleep and wakefulness during sleep. The type of sleep troubles can vary in people with insomnia. One week they might have trouble getting to sleep, and the following week they may have difficulty staying asleep. Some individuals will be able to sleep, but will wake up not feeling rested. Insomnia differs from everyday sleeping troubles, in that it causes distress or impairment in social, occupational, or other areas of functioning. People with insomnia may find it easier to sleep when they are not trying to do so. Often people with insomnia will develop maladaptive sleeping behaviors such as daytime napping, spending excessive time in bed, and following an erratic sleep schedule. Chronic insomnia may lead to decreased feelings of well-being during the day, deterioration of mood, and motivations, decreased attention, decreased energy, and decreased concentration. While individuals with insomnia will feel daytime fatigue they often do not have the physical signs of sleepiness.

BORDERLINE PERSONALITY DISORDER

Borderline Personality Disorder (BPD) can be described as a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood. Individuals with BPD make frantic efforts to avoid real or imagined abandonment. Individuals are very sensitive to environmental circumstances, and experience intense abandonment fears and inappropriate anger, even when faced with realistic time-limited separation, or where there are unavoidable changes in plans. Even with family members, individuals with BPD are high sensitive to rejections, reacting with anger and distress. People with BPD have distorted images of themselves, often feeling worthless and fundamentally bad or damaged. While they long for loving relationships, people with BPD find that their anger, impulsivity, stormy attachments and frequent mood swings push others away. There is a high rate of self-injury without suicide intents, as well as a significant rate of suicide attempts. People with BPD can have frequent changes in long-term goals, career plans, jobs, friendships, gender identity and values. They may feel unfairly misunderstood or mistreated, bored, empty and have little idea of who they are. People with BPD exhibit impulsive behaviors, such as excessive spending, binge eating, and risky sex. (Personality disorders cannot be diagnosed until a person is an adult. Such patterns in teens may not suggest the emergence of a personality disorder, though you may want to seek therapy for the teen as a preventative measure.)

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

Attention-Deficit/Hyperactivity Disorder is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed than is typically observed in an individual of comparable development. Hyperactive-impulsive or inattentive symptoms are present in at least two different settings (i.e. school/home or home/work). Individuals with this disorder may fail to give close attention to detail or may make careless mistakes in schoolwork or other tasks. Work is often messy and performed carelessly without much thought. Individuals with AD/HD often appear as if their mind is elsewhere, or as if they are not listening or did not hear what was just said. Individuals will often shift from one uncompleted activity to another. People with AD/HD are often unable to follow through on requests or instructions and fail to complete schoolwork, chores or other duties. In social situations, inattention may be expressed as frequent shifts in conversations, not listening to others, not keeping one’s mind on conversations, and not following details or rules of games or activities.

Hyperactivity is often manifested by fidgetiness or squirming in one’s seat, by not remaining seated when expected to do so, and by excessive running or climbing where it is inappropriate. Individuals commonly feel as if they are on the go or driven by a motor. In adolescents and adults hyperactivity take the form of feelings of restlessness and difficulty engaging in quiet sedentary activities. Impulsivity is often described as impatience, difficulty in delaying responses, blurting out answers, and difficulty awaiting ones turn.

  • The most common symptoms of AD/HD are distractibility, difficulty with concentration and focus, short term memory slippage, procrastination, problems organizing ideas and belongings, tardiness, impulsivity, and difficulty with planning and execution of tasks. Not all people with AD/HD have all the symptoms. Most people exhibit some of these behaviors, but not to the level where they seriously interfere with the person’s work, relationships or studies, or cause anxiety or depression. Children do not often have to deal with deadlines, organization issues, and long term planning to the extent teens and adults do, therefore these types of symptoms often become evident only during adolescence or adulthood when life demands become greater. Hyperactivity is common among children with AD/HD but tends to disappear during adulthood. However, over half of children with AD/HD continue to have symptoms of inattention throughout their lives.

LEARNING DISORDERS

Learning Disorders are diagnosed when the individual’s achievement on standardized tests in reading, mathematics, or written expression is substantially below that expected for age, schooling and level of intelligence. These problems significantly interfere with academic achievement or activities of daily living that require reading, mathematical, or writing skills. Approximately 5% of students in U.S public schools are identified as having a learning disorder.

  • Reading Disorder is identified by reading achievement (reading accuracy, speed, or comprehension) that falls substantially below that expected given the individual’s age, measured intelligence, and education. In individuals with Reading Disorder oral and silent reading are characterized by slowness and errors in comprehension. Signs associated with Reading Disorder include poor recognition of the written word, slow oral reading, mistakes in oral reading, poor comprehension.
  • Mathematics Disorder is identified by mathematical ability (tests of mathematical calculation or reasoning) that falls substantially below that expected for the individual’s age, measured intelligence, and education. Mathematical disorder significantly interferes with academic achievement or with activities of daily living that require mathematical skills. Mathematics Disorder can be identified by impairment in writing or printing numbers, counting, adding/subtracting, working with mathematical signs (+,-, /,*), and learning names that include numbers.
  • Disorder of Written Expression is identified by writing skills that fall substantially below those expected given the individual’s age, intelligence, and education. Disorder of Written Expression may significantly interfere with a person’s academic achievement, as well as daily living activities that require writing skills. Signs of Disorder of Written Expression include written sentences and paragraphs that are poorly formed, excessive spelling errors, excessive punctuation errors, excessive grammatical errors, and extremely poor handwriting.
  • Learning Disorder Not Otherwise Specified includes disorders that do not meet the criteria for any specific Learning Disorder. This might include problems in all three areas (reading, mathematics, written expression) that when combined may significantly interfere with academic achievement. Individual testing on these areas may not be substantially below that expected given the person’s age, intelligence or education.

COMMUNICATION DISORDERS

Communication Disorders impair clear and efficient human communication. They may include impairments in speech, language, and auditory processing. Some causes of communication disorders include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate, vocal abuse or misuse, emotional or psychiatric disorders, and developmental disorders. Frequently, however, the cause is unknown. It is estimated one in every 10 Americans of all ages, races and genders have experienced or lived with some type of communication disorder (including speech, language and hearing disorders). Nearly 6 million children under the age of 18 have a speech or language disorder.

  • Expressive Language Disorder occurs when a person understands language better than they are able to communicate it. This disorder can result from delayed language development or it can be acquired after brain injury. Delayed language development is typically seen in children, while acquired expressive language disorder is more commonly seen in the elderly after trauma such as a stroke. Children with this disorder often do not talk much or often, although they have a normal understanding of language. Some children may be able to use simple expression, but have trouble organizing words and sentences to relay complicated thoughts and ideas. Expressive Language disorder can manifest in writing as well. Difficulties in spelling, composing sentences, and completing written composition may exist.
  • Mixed Receptive-Expressive Language Disorder is impairment in both receptive and expressive language development. This is typically a developmental disorder and therefore seen mostly in children, however it can be acquired as result of a neurological condition. Difficultly may occur in communication involving both verbal and sign language. This disorder is similar to Expressive Language Disorder in that individuals have trouble organizing words and sentences, errors in tense, limited vocabulary, and difficulty expressing ideas. Along with that individuals have difficulty understanding words, sentences and specific types of words.
  • Phonological Disorder is a failure to develop and produce some or all of the sounds that are appropriate for an individual’s age. Phonological Disorder can range from speech that is completely incomprehensible, to speech that is understood but some sounds are slightly mispronounced. Difficulties in speech sound production interfere with academic or occupational achievement and social communication. The symptoms of Phonological Disorder depend on the age of a person. Normal speech for a 4-year old may be a sign of phonological disorder in a 6-year old and so diagnosis must be done on an age appropriate level.
  • Stuttering is described as disturbance in the normal fluency and time patterning of speech and is characterized by one or more of the following:
    • Sound and syllable repetitions
    • Sound prolongations
    • Interjections
    • Broken words
    • Audible or silent blocking
    • Word substitutions to avoid problematic words
    • Words produced with an excess of physical tension
    • Monosyllabic whole-word repetitions (I-I-I-I see him)

At the onset of stuttering, the speaker may not be aware of the problem. Awareness may develop later which may lead to stress or anxiety which can sometimes make the problem worse. Impairment of social functioning may result from associated anxiety, frustration or low self-esteem.

  • Communication Disorder Not Otherwise Specified is a category for disorders in communication that do not meet criteria for any specific communication disorder, but impair normal communication.

AUTISM

Autism is a complex developmental disability that is characterized by the presence of markedly abnormal or impaired development in social interaction and communication. Autism typically appears during the first three years of life and is the result of a neurological disorder that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills. Both children and adults with autism typically show difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities. Autism is a spectrum disorder and therefore no two individuals experience it the same. Some individuals way have mild language delays while others may have greater challenges with social interactions.

Persons with autism may also exhibit some of the following traits:

  • Insistence on sameness; resistance to change
  • Difficulty in expressing needs, using gestures or pointing instead of words
  • Repeating words or phrases in place of normal, responsive language
  • Laughing (and/or crying) for no apparent reason; showing distress for reasons not apparent to others
  • Preference to being alone; aloof manner
  • Tantrums
  • Difficulty in mixing with others
  • Not wanting to cuddle or be cuddled
  • Little or no eye contact
  • Unresponsive to normal teaching methods
  • Sustained odd play
  • Spinning objects
  • Obsessive attachment to objects
  • Apparent over-sensitivity or under-sensitivity to pain
  • No real fears of danger
  • Noticeable physical over-activity or extreme under-activity
  • Uneven gross/fine motor skills
  • Non-responsive to verbal cues; acts as if deaf, although hearing tests in normal range).

Autistic behaviors may not be apparent in the first 18 to 24 months of life, but usually become more obvious during early childhood. As part of a check-up, your child’s doctor should do a “developmental screening,” asking specific questions about your baby’s progress. Parents are usually the first to notice symptoms of autism in their child. As early as infancy, a baby with autism may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. The National Institute of Child Health and Human Development (NICHD) lists five behaviors that signal further evaluation is warranted:

  • Does not babble or coo by 12 months
  • Does not gesture (point, wave, grasp) by 12 months
  • Does not say single words by 16 months
  • Does not say two-word phrases on his or her own by 24 months
  • Has any loss of any language or social skill at any age

Having any of these five behaviors does not mean your child has autism. But because the characteristics of the disorder vary so much, a child showing these behaviors should have further evaluations.

An accurate diagnosis of Autism must be based on observation of the individual’s communication, behavior and developmental levels. There is no one test that can diagnosis Autism. However, because many of the behaviors associated with autism are shared by other disorders, various medical tests may be ordered to rule out or identify other possible causes of the symptoms being exhibited. At first glance, some persons with autism may appear to have mental retardation, a behavior disorder, problems with hearing, or even odd and eccentric behavior. To complicate matters further, these conditions can co-occur with autism. However, it is important to distinguish autism from other conditions, since an accurate diagnosis and early identification can provide the basis for building an appropriate and effective educational and treatment program.

ASPERGER’S DISORDER

Asperger’s Disorder is often characterized as “high-functioning autism.” What distinguishes Asperger’s Disorder from Autism is the severity of the symptoms and the absence of language delays. People with Asperger’s Disorder may be only mildly affected and frequently have good language and cognitive skills. To the untrained observer someone with Asperger’s Disorder may just seem like a normal person behaving differently. While people with Autism are frequently seen as aloof and uninterested in others, individuals with Asperger’s Disorder usually want to fit in and have interaction with others; they simply don’t know how to do it. They may be socially awkward, not understanding of conventional social rules, or show a lack of empathy. They may have limited eye contact, seem to be unengaged in a conversation, and not understand the use of gestures.

Interests in a particular subject may border on the obsessive. People with Asperger’s Disorder frequently like to collect categories of things, such as rocks or bottle caps. They may be proficient in knowing categories of information, such as baseball statistics or Latin names of flowers.

Unlike Autism, individuals with Asperger’s Disorder have no speech delay. Individuals frequently have good language skills; they simply use language in different ways. Speech patterns may be unusual, lack inflection or have a rhythmic nature, or it may be formal, but too loud or high pitched. Children with Asperger’s Disorder may not understand the subtleties of language, such as irony and humor, or they may not understand the give-and- take nature of a conversation.

Another distinction between Asperger’s Disorder and autism concerns cognitive ability. While some individuals with autism experience mental retardation, by definition a person with Asperger’s Disorder cannot possess a “clinically significant” cognitive delay and most possess average to above average intelligence.

While motor difficulties are not a specific criteria for Asperger’s, children with Asperger’s Disorder frequently have motor skill delays and may appear clumsy or awkward.

People with Asperger’s Disorder particularly need assistance in developing their social and communication skills. Children and young adults who receive social and communications skills training are better able to express themselves, understand language and become more skillful at communicating with others, increasing their likelihood of successful social interactions. Early intervention means a better chance for independent living and further education.

SEPARATION ANXIETY DISORDER

Separation Anxiety Disorder can be characterized by excessive anxiety concerning separation from the home or from those to whom the person is attached. The anxiety is beyond what would be expected for the individual’s developmental level. Individuals with Separation Anxiety Disorder commonly experience distress in social, academic, occupational or other important areas of functioning. Individuals may need to constantly know the whereabouts of attachment figures, and will want to constantly stay in touch with them. During separation they may be constantly preoccupied with thoughts of reunion, and constantly worry about possible harm befalling major attachment figures. Individuals may have persistent, excessive worrying about losing the subject of attachment, and about some event that will lead to separation from a major attachment. People with Separation Anxiety Disorder may also suffer from a reluctance or refusal to go to sleep without being near attachment figure, and recurrent nightmares about separation. Individuals with Separation Anxiety Disorder may complain of physical symptoms such as headaches, stomachaches, palpitations, or dizziness when separation from attachment figure occurs or is anticipated. Typically the disturbance lasts at least four weeks, and occurs before age 18.

OPPOSITIONAL DEFIANT DISORDER

Oppositional Defiant Disorder (ODD) is a mental disorder that occurs in 2-16% of children and adolescents. It often leads to conduct disorder, a more serious disorder that can result in delinquency and substance abuse. Both disorders are categorized as disruptive behavior disorders (DBD).

The Diagnostic and Statistical Manual of the American Psychiatric Association, fourth edition (DSM-IV) defines ODD as a pattern of negativistic, hostile and defiant behavior, lasting at least six months, during which four or more of the following symptoms are present:

  • Often loses temper
  • Often argues with adults
  • Often actively defies or refuses to comply with adult’s requests or rules
  • Often deliberately annoys people
  • Often blames others for his or her mistakes or misbehaviors
  • Is often touchy or easily annoyed by others
  • Is often angry or resentful
  • Is often spiteful or vindictive

The symptoms listed must cause significant impairment in social, academic or occupational functioning. ODD is not the diagnosis if the therapist believes these behaviors are directly related to another psychotic or mood disorder.

ODD is often hard to diagnose because a lot of the symptoms are similar to normal behavior characteristic of child development, such as acting in opposition to adults’ requests. Counselors or therapists should not diagnose a child or teen with ODD unless the behavior occurs more frequently than is normal for others of the same age or stage of development. Some conflict between children and their parents is expected, but if the problem becomes more severe a professional should be consulted.

Children and teens should not be diagnosed with ODD unless these behaviors are consistent over a long period of time. It is also often confused with or is comorbid with other psychological disorders, including: mental retardation, autistic spectrum disorder, mood disorders, and anxiety disorders. Attention-Deficit Hyperactivity Disorder (ADHD) is the most common diagnosis that co-occurs with ODD.

Treatments for ODD include cognitive-behavioral therapy (CBT), individual psychotherapy, family therapy and social skills training.

CONDUCT DISORDER

If not treated properly, about 52% of children with ODD will progress to Conduct Disorder, a more serious disorder that is characterized by aggression, destruction of property, criminal activity and/or serious violation of rules. Conduct Disorder is a repetitive and persistent pattern of behavior that violates the basic rights of others or major rules and values of society. According to DSM-IV, three or more of the following symptoms must be present in the past 12 months, with at least one present in the past six months:

Aggression to people and animals:

  • Often bullies, threatens or intimidates others
  • Often initiates physical fights
  • Has used a weapon that can cause serious physical harm to others (for example, a bat, brick, broken bottle, knife, gun)
  • Has been physically cruel to people
  • Has been physically cruel to animals
  • Has stolen while confronting a victim (for example, mugging, purse snatching, extortion, armed robbery)
  • Has forced someone into sexual activity

Destruction of property:

  • Has deliberately engaged in fire setting with the intention of causing serious damage
  • Has deliberately destroyed others’ property (other than fire setting)

Deceitfulness or theft:

  • Has broken into someone else’s house, building or car
  • Often lies to obtain goods or favors or to avoid obligations (in other words, “cons” others)
  • Has stolen items of nontrivial value without confronting a victim (for example, shoplifting, but without breaking and entering; forgery)

Serious violations of rules:

  • Often stays out at night despite parental prohibitions, beginning before age 13 years
  • Has run away from home overnight at least twice while living in a parental or parental surrogate home (or once without returning for a lengthy period)
  • Is often truant from school, beginning before age 13 years

In order to diagnose a teen with conduct disorder, these disturbances in behavior must be causing significant problems in the person’s life, including school, with friends and family and at work. If a teen gets into serious trouble on one occasion and never repeats it, he or she probably does not have conduct disorder. Conduct disorder may be diagnosed in people 18 years or older if some of these behaviors are present but they do not meet the criteria for Antisocial Personality Disorder.

The problem usually begins in late childhood or early adolescence and is more common in boys than in girls. Boys with conduct disorder are more likely to engage in physical aggression, such as fighting, stealing, and vandalism, while girls are more likely to lie, run away, or engage in dangerous sexual behavior (such as prostitution). Both boys and girls are at high risk for substance abuse and make frequent threats of suicide, which should be taken seriously.

About 50% of teenagers with conduct disorder stop these behaviors by adulthood, but the younger the child is when symptoms begin, the more likely the behavior is to continue. Adults in whom the disorder persists often meet the criteria for Antisocial Personality Disorder.

Children and teens with conduct disorder tend to misinterpret the actions and intentions of others, many times believing they are being threatened or picked on. They react with aggression and generally show little or no remorse for their actions. They act recklessly with no regard for their own or others’ safety.

According to DSM-IV criteria, conduct disorder may be diagnosed when a child seriously misbehaves with aggressive or nonaggressive behaviors against people, animals or property that may be characterized as belligerent, destructive, threatening, physically cruel, deceitful, disobedient, or dishonest. This may include stealing, intentional injury, and forced sexual activity. Keep in mind that this behavior disorder consists of a pattern of severe, repetitive acting-out behavior and not of an isolated incident here and there.

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