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Part 5 Autism spectrum disorders
Autism Spectrum Disorders (ASD) result in difficulty blocking out stimuli. Imagine living every day in the middle of a marching band and a laser light show. The only way to survive would be to give all of your focus to a few things. Accordingly, learning subtle things, like social cues, which most of us just pick up and have a hard time even describing, can be a major problem. For example, what are the rules on flirting? How long do you maintain a hand shake with a person?
Many people with ASD go through life like a person who cannot hear music trying to fit in at a dance. They watch, they mimic the movements of the people they see, but you can tell that they just don't feel the rhythm.
The Spectrum part of ASD means that impairment falls on a continuum. Like problems with vision or hearing. Some people just need reading glasses, some people are totally blind, and yet these are all problems of the visual spectrum.
In ASD the degree of impairment can make it so a child never learns to differentiate words from background noise, and may never learn to talk. Other highly functional individuals like Temple Grandin (author of the excellent book Thinking in Pictures) may go years without being able to speak due to their reaction to too much stimuli at that time.
While a number of people with ASD are mentally retarded others are geniuses and bring a laser like intensity to their topics of interest, which might lead to innovations that the average person could never create.
It is hard to determine who has a related disorder like asperger's, in which there can be pronounced social impairment and an inability to read social cues, along with some rigidity, and topics of intense interest (stims), but rarely the kind of communication impairment seen in ASD. It is often stated that Bill Gates seems like he may have a mild form of asperger's.
In my experience I have never met a student who had a diagnosis of ASD or asperger's that I did not feel was accurate. I have met a great number of kids whose parents were resistant to one of these diagnoses despite the presence of symptoms. No parent wants to think their child might have a disorder that cannot be fixed. They want to imagine their children growing up to be “normal” and while many people with ASD may be extremely successful, they will never be “normal”. They just need to learn that this isn't a bad thing.
There has been an exponential increase in diagnosis of ASD in the last few years but I do not think this is a media creation. When you work with these students you can feel the distress they get from too much stimuli and there is often a quality in the body language and voice tone, a flatness of verbal emotional range that no one could or would fake.
Why the increase? I don't know. I know some parents blame it on vaccinations. From my experience it seems to be more prevalent in more affluent communities, and I do not think that is a factor of better diagnosis as much as I think there may be a missing environmental factor. There does seem to be some genetic relationship as well.
Regardless of the cause the result is that in the future people with ASD will be in every work place and in every community. Public education must be increased so we can benefit from the unique tools people with ASD can bring to us all.
Showing posts with label diagnosis. Show all posts
Showing posts with label diagnosis. Show all posts
Monday, August 3, 2009
Friday, July 24, 2009
Part 2 increase in ADHD dx
(If you like the blog please spread the word and sign up to follow it on this site or on facebook. If you would like a question answered or to set up a counseling appointment send me an e-mail)
Part 2 Increased diagnosis and ADHD
“Blindness is not a disability in the dark.” I do not know whose quote this is but it isn't mine so I won't claim it. In order to begin to understand ADHD we must know the difference between a symptom and a disorder. Just because someone has a symptom it is not a disorder unless it impairs their functioning in some way. In addition, a person cannot be diagnosed with a disorder if their symptoms are better explained by behavior, something in the environment, or another disorder.
Attention deficit disorder (ADHD) is the most over and under diagnosed disorder in our society today. How can this be? The over and under is all about the presence or absence of the H in ADHD: Hyperactivity. Not every child who is hyperactive has ADHD, but most of them get diagnosed with it because the treatment for ADHD (counseling to improve organization and stimulant medication) tends to improve performance in almost anyone.
A child might be hyperactive for many reasons, and if this reason is related to environment (trauma, family instability, poor diet...) it would be unethical to medicate them for a disorder they don't have. So why is that the first choices of parents and doctors? Because it often works, and it is easier to blame a problem on the internal biology of a child than change the dynamics of a family. Also there is very little to lose by trying an ADHD medication. They are in and out of the system in 24 hours and are not physically addictive. Is it any wonder that so many people say why not, rather than why when it comes to medicating hyperactive kids?
But what about the other part? What if you are just inattentive? How can you tell the difference between someone who is inattentive and someone who is just lazy? It is really really hard. Especially when you consider how likely it would be to give up and become lazy if you had a much more difficult time paying attention than your class chums and everyone was calling you dumb.
But don't we all have difficulty paying attention sometimes? Yes. Every person in the world meets some of the criteria for ADHD some of the time. In fact there are many people who meet most of the criteria almost all of the time and yet they would not qualify for a diagnosis? Why? Because no matter how hyper or inattentive you are if it does not cause a problem in your functioning then it is not a disorder.
Highly intelligent people often don't get diagnosed with things like ADHD or even dyslexia until late high school or college because up to that point they have found strategies that allow them to succeed in their own way.
People with ADHD are often resistant to doing things any way but their own, they don't know why, but when we slow them down in counseling and explore it they have usually determined that the “typical” way of doing things won't work for them.
Contrary to popular belief people do not out grow ADHD. They just find strategies that work for them in helping them negotiate their environment. Often once people leave the academic world they no longer need medication, just as some people only need glasses for reading.
ADHD is real. It is as genetically linked as height but up until the 1970's we called it things like “minimal brain dysfunction.” and so parents often do not realize that they had it themselves until they go to the doctor to get their child diagnosed.
Today about 1 in 25 children are diagnosed with ADHD, but if the diagnostic trend continues at its current pace I believe that number will go to 1 in 10. My experience suggests that this will be close to the actual rate but 50% of people diagnosed with ADHD will not actually have it, and 50% of people who have it will not be diagnosed.
ADHD is more prevelant now because we live in a society of near constant stimuli so when the demand for extended concentration is placed upon a mind that is pre-disposed toward ADHD they are going to be more likely to struggle.
People with ADHD CAN focus on certain things, like video games, or other things they like. This does not mean they do not have the disorder. In fact, people with ADHD tend to have hypo (not enough) and hyper (too much) focus, when confronted with different stimuli.
The good news is ADHD is extremely treatable and there are very few side effects from treatment. If you think you or your child is suffering from ADHD go to a qualified professional and begin the process of diagnosis. Beware any one who does not at least give you a checklist to be filled out by parents, teachers, and the student. If a person suffers from bi-polar disorder the stimulant medication usually used for ADHD can lead to highly agitated behavior and that is why all medications need to be prescribed and reviewed by a doctor.
A final warning. Many people with ADHD try to self medicate using marijuana. This is the WORST thing you could do. A brain with ADHD is like a heavily loaded truck trying to drive up a hill. It doesn't have quite the energy so the engine is whining and straining. A stimulant medication is like a burst of turbo boost to get it over the hill. Marijuana is like suddenly throwing the truck in reverse. Sure the engine stops straining, but we never get over the hill and that shift of gears will make it harder to get over the hill the next time.
Part 2 Increased diagnosis and ADHD
“Blindness is not a disability in the dark.” I do not know whose quote this is but it isn't mine so I won't claim it. In order to begin to understand ADHD we must know the difference between a symptom and a disorder. Just because someone has a symptom it is not a disorder unless it impairs their functioning in some way. In addition, a person cannot be diagnosed with a disorder if their symptoms are better explained by behavior, something in the environment, or another disorder.
Attention deficit disorder (ADHD) is the most over and under diagnosed disorder in our society today. How can this be? The over and under is all about the presence or absence of the H in ADHD: Hyperactivity. Not every child who is hyperactive has ADHD, but most of them get diagnosed with it because the treatment for ADHD (counseling to improve organization and stimulant medication) tends to improve performance in almost anyone.
A child might be hyperactive for many reasons, and if this reason is related to environment (trauma, family instability, poor diet...) it would be unethical to medicate them for a disorder they don't have. So why is that the first choices of parents and doctors? Because it often works, and it is easier to blame a problem on the internal biology of a child than change the dynamics of a family. Also there is very little to lose by trying an ADHD medication. They are in and out of the system in 24 hours and are not physically addictive. Is it any wonder that so many people say why not, rather than why when it comes to medicating hyperactive kids?
But what about the other part? What if you are just inattentive? How can you tell the difference between someone who is inattentive and someone who is just lazy? It is really really hard. Especially when you consider how likely it would be to give up and become lazy if you had a much more difficult time paying attention than your class chums and everyone was calling you dumb.
But don't we all have difficulty paying attention sometimes? Yes. Every person in the world meets some of the criteria for ADHD some of the time. In fact there are many people who meet most of the criteria almost all of the time and yet they would not qualify for a diagnosis? Why? Because no matter how hyper or inattentive you are if it does not cause a problem in your functioning then it is not a disorder.
Highly intelligent people often don't get diagnosed with things like ADHD or even dyslexia until late high school or college because up to that point they have found strategies that allow them to succeed in their own way.
People with ADHD are often resistant to doing things any way but their own, they don't know why, but when we slow them down in counseling and explore it they have usually determined that the “typical” way of doing things won't work for them.
Contrary to popular belief people do not out grow ADHD. They just find strategies that work for them in helping them negotiate their environment. Often once people leave the academic world they no longer need medication, just as some people only need glasses for reading.
ADHD is real. It is as genetically linked as height but up until the 1970's we called it things like “minimal brain dysfunction.” and so parents often do not realize that they had it themselves until they go to the doctor to get their child diagnosed.
Today about 1 in 25 children are diagnosed with ADHD, but if the diagnostic trend continues at its current pace I believe that number will go to 1 in 10. My experience suggests that this will be close to the actual rate but 50% of people diagnosed with ADHD will not actually have it, and 50% of people who have it will not be diagnosed.
ADHD is more prevelant now because we live in a society of near constant stimuli so when the demand for extended concentration is placed upon a mind that is pre-disposed toward ADHD they are going to be more likely to struggle.
People with ADHD CAN focus on certain things, like video games, or other things they like. This does not mean they do not have the disorder. In fact, people with ADHD tend to have hypo (not enough) and hyper (too much) focus, when confronted with different stimuli.
The good news is ADHD is extremely treatable and there are very few side effects from treatment. If you think you or your child is suffering from ADHD go to a qualified professional and begin the process of diagnosis. Beware any one who does not at least give you a checklist to be filled out by parents, teachers, and the student. If a person suffers from bi-polar disorder the stimulant medication usually used for ADHD can lead to highly agitated behavior and that is why all medications need to be prescribed and reviewed by a doctor.
A final warning. Many people with ADHD try to self medicate using marijuana. This is the WORST thing you could do. A brain with ADHD is like a heavily loaded truck trying to drive up a hill. It doesn't have quite the energy so the engine is whining and straining. A stimulant medication is like a burst of turbo boost to get it over the hill. Marijuana is like suddenly throwing the truck in reverse. Sure the engine stops straining, but we never get over the hill and that shift of gears will make it harder to get over the hill the next time.
Wednesday, July 22, 2009
Is America going crazy?
Question: Is it just me or does it seem like everyone is diagnosed with ADHD, Depression, Bi-Polar, or Autism? Do you think it is because professionals are better at recognizing the symptoms or have we turned into a society that needs an excuse for everything? Or is there something in the environment that is making us crazy?
This is such a good question that I think I will have to do a separate post for each disorder, and a general one to start on diagnosis.
Part 1: General increase in mental health disorder diagnosis in our society.
The short answer to your question is...yes. I think professionals are far better at recognizing symptoms and since the introduction of better diagnostic tools (like the DSM III, IV, and IV tr) more professionals are speaking the same language and using the same objective criteria to make a diagnosis.
A diagnosis is not a label that you stick on someone and say, “Ok we're done.” It is a suggestion for a course of treatment. The DSM (big book of disorders) is not a menu. Any person looking through it would find at least 10 disorders they thought they had by going through the check lists. That is not how it is supposed to work.
The way it is supposed to work is a licensed professional meets with a client/patient and they get the feeling, based on their experience and the symptoms they observe, that this person may have a particular disorder. Then they check the DSM to make sure there is nothing that they missed, so they don't try a form of treatment that might be more harmful than helpful.
Assessment and Diagnosis are never complete, they are a statement of the best course of treatment so far based on the information we have. If the symptoms go away there is a pretty good chance the diagnosis was correct.
Does our society just need an excuse for everything? I think our society needs a reason for everything, and wants a cure for everything. We are taught that if we feel discomfort something has gone wrong and we ought to diagnose and cure the problem. Diagnosis is not an excuse, it is a reason, and suggests a course of treatment, but there are many people who use a diagnosis as an excuse.
Also I think that while every disorder in the book has been around for centuries (just read Shakespeare or Greek mythology) our environment lends itself to mental illness in a way it never has before.
Why? Kids today have everything right? I mean it is so easy for them, they don't have to work for anything what do they have to be stressed about?
Every mental health disorder is made worse by (and some are caused by) stress. Stress comes from having to make choices and decisions. Freedom and choices are wonderful things that we value, but when you have the freedom to choose there is a possibility that you might choose wrong and that knowledge grinds people down.
Our society has changed more in the last 150 years than it had in the 10,000 years prior to that. I am glad to live in our world today, but with each passing year as we give our children more leisure, freedom, and choices we pile the stress on. It is hard to have a nervous break down when you are a peasant who doesn't have time to worry about anything more than whether or not you are going to have enough to eat.
Finally there is something biological occurring in our present environment which cannot be denied. The increase in peanut allergies in the last generation requires a physical explanation. As does the increase in Aspergers and ASDs (autism spectrum disorders), these disorders exist. We do not know why yet but it is certainly not a failure of parenting, or over protective mommies making up excuses for the children.
The end result is we have a lot of people who are struggling. The good news is we can help and we are getting better at it all the time. I believe we are in the infancy of our understanding and treatment of metal health disorders. In 50 years as our understanding of the brain matures they will look back at our techniques as we do the blood letting of George Washington's generation.
This is such a good question that I think I will have to do a separate post for each disorder, and a general one to start on diagnosis.
Part 1: General increase in mental health disorder diagnosis in our society.
The short answer to your question is...yes. I think professionals are far better at recognizing symptoms and since the introduction of better diagnostic tools (like the DSM III, IV, and IV tr) more professionals are speaking the same language and using the same objective criteria to make a diagnosis.
A diagnosis is not a label that you stick on someone and say, “Ok we're done.” It is a suggestion for a course of treatment. The DSM (big book of disorders) is not a menu. Any person looking through it would find at least 10 disorders they thought they had by going through the check lists. That is not how it is supposed to work.
The way it is supposed to work is a licensed professional meets with a client/patient and they get the feeling, based on their experience and the symptoms they observe, that this person may have a particular disorder. Then they check the DSM to make sure there is nothing that they missed, so they don't try a form of treatment that might be more harmful than helpful.
Assessment and Diagnosis are never complete, they are a statement of the best course of treatment so far based on the information we have. If the symptoms go away there is a pretty good chance the diagnosis was correct.
Does our society just need an excuse for everything? I think our society needs a reason for everything, and wants a cure for everything. We are taught that if we feel discomfort something has gone wrong and we ought to diagnose and cure the problem. Diagnosis is not an excuse, it is a reason, and suggests a course of treatment, but there are many people who use a diagnosis as an excuse.
Also I think that while every disorder in the book has been around for centuries (just read Shakespeare or Greek mythology) our environment lends itself to mental illness in a way it never has before.
Why? Kids today have everything right? I mean it is so easy for them, they don't have to work for anything what do they have to be stressed about?
Every mental health disorder is made worse by (and some are caused by) stress. Stress comes from having to make choices and decisions. Freedom and choices are wonderful things that we value, but when you have the freedom to choose there is a possibility that you might choose wrong and that knowledge grinds people down.
Our society has changed more in the last 150 years than it had in the 10,000 years prior to that. I am glad to live in our world today, but with each passing year as we give our children more leisure, freedom, and choices we pile the stress on. It is hard to have a nervous break down when you are a peasant who doesn't have time to worry about anything more than whether or not you are going to have enough to eat.
Finally there is something biological occurring in our present environment which cannot be denied. The increase in peanut allergies in the last generation requires a physical explanation. As does the increase in Aspergers and ASDs (autism spectrum disorders), these disorders exist. We do not know why yet but it is certainly not a failure of parenting, or over protective mommies making up excuses for the children.
The end result is we have a lot of people who are struggling. The good news is we can help and we are getting better at it all the time. I believe we are in the infancy of our understanding and treatment of metal health disorders. In 50 years as our understanding of the brain matures they will look back at our techniques as we do the blood letting of George Washington's generation.
Friday, June 12, 2009
Cold psychiatrist
Dear Maigler: After years of thinking about it I finally got up the courage to go and see a psychiatrist to see if I should go on medication for depression. The whole experience was so cold. I felt like he was not really listening to me and that he had made up his mind in the first 5 minutes he knew me. He gave me a prescription and told me to come back in two weeks. I don’t know if I will. How can a psychiatrist make a decision about something this important without really knowing me?
Disappointed WithDoctors
Dear Disappointed,
I’m sorry to hear you had a negative experience with your psychiatrist. Unfortunately many doctors have poor people skills. You would think that psychiatrists, who are supposed to be experts in people, would be more warm and outgoing. Some are, many are not, but that does not mean that their clinical judgment is poor.
Most psychiatrists have worked with literally thousands of patients. While each patient is different the psychiatrist has relatively few treatment options. Within seconds of meeting you a good psychiatrist has picked up hundreds of things about you and your treatment needs before you have even opened your mouth.
If you show up to the office and you are clean, groomed, and have decent posture there is a good chance that you are not psychotic. Body language and the intensity with which a person makes or avoids eye contact tells the psychiatrist a great deal.
When you made your appointment and filled out the forms in the office the doctor was informed that you thought you might be dealing with depression. Once the doctor has met you, heard how you are functioning in many basic ways, and even heard the tone and rate of your speech all he or she has to determine is if depression is an accurate diagnosis or if there is a better explanation for the way you are feeling, if medication might help, and which medication to try first.
For a person who has done this thousands of times they could probably make an accurate diagnosis in 10 minutes 90% of the time. Most of them will take 40 minutes to an hour so that they don’t miss anything. The really good ones take 90 minutes or more to explore the person in depth, but even they probably had a pretty good idea of what they were going prescribe in that 10 minute window.
Always remember, however, that you don’t work for the doctor she /he works for you!
If you would like them to slow down and explain to you how they made their decision, most will do so happily, they might just forget from time to time how new this is for you.
I would highly recommend you go back to your doctor. Tell her/him that you are looking for more of a personal touch and if that is not her/his style ask them for a referral to a psychiatrist who will be a better fit. Please don’t stop here, you’ve already taken the hardest step.
Disappointed WithDoctors
Dear Disappointed,
I’m sorry to hear you had a negative experience with your psychiatrist. Unfortunately many doctors have poor people skills. You would think that psychiatrists, who are supposed to be experts in people, would be more warm and outgoing. Some are, many are not, but that does not mean that their clinical judgment is poor.
Most psychiatrists have worked with literally thousands of patients. While each patient is different the psychiatrist has relatively few treatment options. Within seconds of meeting you a good psychiatrist has picked up hundreds of things about you and your treatment needs before you have even opened your mouth.
If you show up to the office and you are clean, groomed, and have decent posture there is a good chance that you are not psychotic. Body language and the intensity with which a person makes or avoids eye contact tells the psychiatrist a great deal.
When you made your appointment and filled out the forms in the office the doctor was informed that you thought you might be dealing with depression. Once the doctor has met you, heard how you are functioning in many basic ways, and even heard the tone and rate of your speech all he or she has to determine is if depression is an accurate diagnosis or if there is a better explanation for the way you are feeling, if medication might help, and which medication to try first.
For a person who has done this thousands of times they could probably make an accurate diagnosis in 10 minutes 90% of the time. Most of them will take 40 minutes to an hour so that they don’t miss anything. The really good ones take 90 minutes or more to explore the person in depth, but even they probably had a pretty good idea of what they were going prescribe in that 10 minute window.
Always remember, however, that you don’t work for the doctor she /he works for you!
If you would like them to slow down and explain to you how they made their decision, most will do so happily, they might just forget from time to time how new this is for you.
I would highly recommend you go back to your doctor. Tell her/him that you are looking for more of a personal touch and if that is not her/his style ask them for a referral to a psychiatrist who will be a better fit. Please don’t stop here, you’ve already taken the hardest step.
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