There is a very interesting study out of the journal of Child Psychiatry and Human Development out this month. It was a study of children with Autism Spectrum Disorders who suffered from anxiety. The purpose of the study was to try out Cognitive Behavioral Therapy (CBT) for 16 weeks with these children to see if anxiety could be reduced. This therapy was also compared with a Social Recreational program.
Results were significant. Children in both groups showed lessened anxiety levels at 6 month follow-up.
This study also made suggestions to make programs successful. Factors such as regular sessions in a structured setting, social exposuire, the use of autism-friendly stategies and consistent therapists were mentioned as components of effective management of anxiety in children and adolescents with ASD.
In my practice, I’m amazed about how many people come to me and have taken some test online and have self-diagnosed themselves with ADHD or ADD and want me to give them stimulants. It happens every week. I also don’t know how many times I’ve had to tell these same people that stimulants may not be the answer to their problems and can even make their mental health symptoms worse! Let me give you a case in point of when stimulants may have done more harm than good.
Larry, (not his real name) is a 53 year old male who reports that he has taken Adderall or the equivalent for 30 years. He reports it makes him organized. It makes him be able to focus and concentrate and complete tasks. I take careful note but also observe that this same guy is very rigid, angry and irritable during our visit. He has a history of attempted suicide and has been hospitalized several times. He also tries to hide the fact that he lived in a reclusive situation away from civilization for years and has been unable to work for authority figures. He also reports he is estranged from friends and family.
Yes, it is true that stimulants help many people with focus and concentration. It is also the fact that ADHD is not the only condition that makes a person disorganized, unfocused and unable to complete tasks. For instance the guy above ended up being diagnosed with Schizophrenia. Other conditions like Bipolar Disorder, Depression, anxiety disorders and Thyroid Disorders can look like ADHD. Giving the above patient stimulants can bring out his rigidness, his anger and irritability and even psychotic symptoms. If one has tendencies toward obsessive compulsive disorder it would be especially important to avoid taking stimulants. Stimulants can make the OCD worse. A better way to go might be to effectively treat the OCD symptoms and the patient may find that their ADHD like symptoms greatly improve.
Sadly, years of stimulant misuse for the above patient made him so rigid in his expectations that he was psychologically unable to consider other possibilities for his problems. This is why it is so important that when suffering from ADHD like symptoms that a specialist who works regularly with the various mental illnesses be called upon to do the initial evaluation. It can potentially prevent years of problems and help a person become quickly more functional to reach his goals. I wish this guy could have been spared all the pain he went through! Can you imagine the implications for posterity and other family members?
I have some patients who come to me for Depression who wonder whether St. John’s Wort is adequate in the treatment of Depression. My answer is it depends on the severity of the Depression.
In mild to moderate cases where the Depression has been experienced for 3-6 months or less I would suggest the possibility of St. John’s Wort as a chemical remedy. There has been some recent promising research showing the effectiveness of St. John’s Wort in these cases. The advantage of using St. John’s Wort is not only in its effectiveness but it has fewer side effects than antidepressants. Antidepressants can have side effects such as weight gain, sexual dysfunction, fatigue and insomnia for some. Usually I see these side effects in the higher doses of antidepressants. There are some antidepressants that are worse than others as far as side effects are concerned.
If the Depression has been going on for greater than 3 months and especially for recurrent types of Depression I would suggest trying an antidepressant. Both St. John’s Wort and antidepressants increase Serotonin and other neurotransmitters.
This article is not meant to say that other forms of help should not be tried. I am a strong believer of Cognitive Behavioral Therapy (CBT) which seems to have the most promising research out as far as effectiveness. However, in the more severe types of depression the best combination appears to be a therapy like CBT combined with an antidepressant. That appears to be the quickest route to the remission of moderate to severe Depression.
If you are not sure what type of treatment is best for you I would suggest you confer with a mental health specialist who prescribes, either a Psychiatric Mental Health Practitioner (Sometimes called an Advanced Practice Nurse) or a Medical Doctor. In some states Clinical Nurse Specialists (CNS) in mental health can also do the evaluations and prescribe medication.
According to the Surgeon General, anxiety disorders affect approximately 13% of children. Some diagnoses that reflect a problem with anxiety are: Generally Anxiety Disorder, Social Phobia, Avoidant Personality Disorder, and Panic Disorder. All of these show similar symptoms of anxious feelings, sweaty palms, pounding heart, increased respiratory out put, sick or sore stomach, and other symptoms.
What is the cause of anxiety disorders? It’s not fully understood, but we do know that anxiety disorders tend to run in families—probably a mixture of environmental upbringing and heredity.
There is also a correlation between anxiety disorders and children that have trouble sleeping. Sometimes it is hard to know what came first, the chicken or the egg. But children that have trouble sleeping tend to have higher levels of stress during the day, which increases stress hormones like Cortisol. Cortisol tends to deplete Serotonin, a feel-good neurotransmitter, which sets them up for problems like anxiety or depression.
When I see a child for anxiety, I test the parents as well. More than not, I find at least one parent that will also be experiencing anxiety. I will also note that the parent tends to have an “anxious parent” type of parenting style. This is shown by a tendency of over-protectiveness and a tendency towards elevated expressed emotion when stressed. Unfortunately, too often a child learns from this parent how to experience and deal with the world. If the parent has a highly reactive style towards spiders, for example, the child often will also.
I also would like to note the correlation between anxiety and frequent illness. If you see your child getting sick a lot and missing school you might want to go get your child checked for an anxiety disorder with your Psychiatric Mental Health Nurse Practitioner or Psychiatrist. They are often missed. Thousands of dollars later you may find that your child has an anxiety disorder and not an ulcer!