Kids and Mental Disorders – ADHD

Children and mental disorders – when is too soon for diagnosis?

I spend a decent chunk of my time cruising chat boards and reading journals, news, social media posts and such about mental disorders.  My own “specialties” are Bipolar Disorder, Adult ADHD, Autism Spectrum DisorderBorderline Personality Disorder, Anxiety Disorder, Depression, Abuse Disorders, OCD… nevermind – I really “specialize” in them all, because I know most Attention Deficit Hyperactivity Disorderof these disorders within my social circle, and I know them on a professional level.

Anyway, I was on a Facebook page the other day for ADHD. (attention deficit hyperactivity disorder)  A woman posted a question about how to manage a kid with ADHD who wakes up and wreaks havoc within the house while everyone is trying to get ready for school and work.  Naturally he was disagreeable, confrontational, oppositional, had “meltdowns” – and it was all exhausting.  (pretty typical behavior for a truly ADHD kid)  A therapist once told me that the ADHD brain doesn’t “wake up” right away and cause all this trouble partly because their brain is not actually engaged yet.  The mom was asking for advice.

Comments on the page gave some really good answers. Some of them are common. Like plan your morning before you go to bed (get out clothes, get backpack ready, make lunch), let the kid make some choices – blah blah blah, stuff we have all heard.

Others were less common, but possibly better advice. Advices like; give the kid an extra 30 minutes to “wake up” in silence, give the child an incentive to get dressed NOW – like playing Minecraft after he is dressed.  I handle mine with the “don’t talk to him yet” option – waiting about 20-30 minutes before making him get busy.  His siblings aren’t allowed to bug him during this time either.  He can wrap himself in a blanket, stare at the wall or whatever – just don’t go back to sleep.

One lady suggested that the kid should be woken to take his meds an hour before he has to be out of bed. Then let him go back to sleep so that his medicines are working by the time he actually gets up.  I found that last piece of advice to be very helpful. My husband with adult ADHD takes his meds about 4 am and gets up at 6, ready to go rather than rude, obnoxious and unhelpful.

Mental Disorders - ADHDWhat troubled me was a comment from a woman who didn’t actually give advice, but chimed in to complain about how hard her four-year-old was to manage.  She said that he had been diagnosed with ADHD and was on meds, but also said that he had bipolar disorder, and still was a screaming banshee in the morning.  This gives me pause for concern.

I certainly can’t do anything about this particular kid, and I don’t really know the exact circumstances but I find the dual diagnosis with bipolar disorder very troubling for a four-year-old child.  Certainly, kids can exhibit ADHD symptoms at 4, and some will benefit from treatment.  But the medications weren’t working, and I am not so sure about the bipolar disorder.

Traditionally, until a few years ago, no one was willing to consider bipolar disorder as a pediatric concern.  Still today, though bipolar disorder obviously exists in childhood – most of the major issues don’t come out until adolescence.

The Diagnostic and Statistical Manual of Mental Disorders does not recognize the bipolar disorder in children under the age of 13

The National Institutes of Mental Health does acknowledge that bipolar disorder in children MAY exist but also warns that many children are misdiagnosed when the main problem is ADHDNIMH recommends that these children be labeled with Mood Dysregulation Syndrome until such time as a diagnosis can be relied upon.

The main problem in diagnosing young children with any mental disorder is that symptoms in children are vastly different from those in adults.  To complicate matters, symptoms of various Cerebrum Lobesdisorders in children are similar to one another.

Symptoms such as irritability, excessive mood swings, meltdowns, oppositional behavior, trouble in school, social inadequacies, explosive behavior, frequent frustration, and hyperactivity, etc. can point to a number of disorders.  Frankly the child may be ADHD, Bipolar, Depressed, Autism Spectrum… or even have food intolerance.

Because of our family history (not just mine), I watch my children very carefully.  I do analyze everything that happens, and I know that all of them probably have a disorder of one type or another.  Two may have ADHD, one is likely bipolar and one has Asperger’s or mild ASD.  I have sought treatment for some issues – but with others, I hesitate to run to a physician – likely a pediatrician who just doesn’t really know.

Our understanding of mental disorders is still evolving

I was personally diagnosed with the wrong disorder for over 15 years – and I was an adult.  How damaging would it have been if I had been labeled with a disorder that I did not have when I was only four years old?
The particular woman I described with the dual diagnosis child was beside herself.  Despite the fact that the four-year-old was receiving medical treatment for both disorders – it wasn’t working.  To me, this means that the treatment was with the wrong meds and for the wrong disorder(s).  In addition, her management skills weren’t the best.

As I said, I know that my children are likely to have disorders of their own but I don’t want to treat them for just any disorder.  I will want them to be treated for the right disease.  My advice to this parent, or any parent whose child had been put on medication that wasn’t working would be to seek a second opinion.

I am more emphatic about that advice if the doctor was willing to “add” a diagnosis to provide more medication; she should definitely seek another opinion.  Preferably the opinion of a pediatric Ritalin - ADHD Medicinepsychiatrist – or even a pediatric behavioral neurologist.  These specialists are few and far between, but it isn’t worth doing anything, but suffering through all the misery because the treatment isn’t working.

Medications are beneficial in the treatment of some types of mental disorders, but they do “change the brain”.  That is how they work – changing the brain can be harmful if you are changing it in the “wrong” directions.  Just seems like common sense.

Melissa Lind

New Online Tools for Anxiety Disorders

What can online tools for Anxiety Disorders do for free?

There has been a dramatic upsurge in websites, smartphone apps and hi-tech gadgets to monitor health conditions such as blood pressure, heart rate, and calorie output – all physical measurementsMental health doesn’t easily lend itself to computer monitoring.  Most people who need intervention go to a therapist or other mental health professional.  When that isn’t affordable, people usually “go it alone” which can have disastrous results.

Online Tools for Anxiety DisordersA new company “Joyable”, is developing an online web platform for people with anxiety disorders.  The company is a start-up venture that aims to create online tools for a variety of mental health conditions.  So far, they have raised over $2 million from Venture Capitalists – and “Angel Investors” which may bode well for additional funding.  Joyable will be starting with Social Anxiety Disorder but plans expansion into other conditions such as generalized anxiety, OCD, PTSD and others.  The big problem with this development is that it isn’t cheap.

The company plans to offer their online tools for a significant cost of $99 / month. Though hi-tech has entered the medical field in other areas, costs are usually low, if not free and available on a smartphone.  The developers state that their program is usable on a smartphone or tablet through the internet. They also have plans to develop a native app for smartphones and tablets as well, but they will probably still charge for the service.

The NIH reports that 15 million Americans may suffer from Social Anxiety Disorder but only about 15 percent of those are adequately treated – leaving 12 million or so, with unattended issues.  The good news is that there are online tools for people with a variety of mental health conditions, and some of those are free.

Not to disparage therapy – but a lot of it is talk and even with insurance, it can be expensive.  You talk, the therapist talks, you talk, the therapist listens.  If you are in group therapy – you also have to listen while others talk.  Sometimes the problems match your own; sometimes they don’t.  In a lot of cases, you may be able to get some insight from hearing others talk about the same thing – but the best information is stuff that you learn about yourself.

The best place to start looking for help online is through forums – nearly always free.  You can find plenty of people with nearly any mental disorder that you can chat with and take or leave the advice as you want.  There is also no shortage of educational – and even entertaining websites (like this one) that offer information, quizzes, daily planning – all for free.

Smartphone for Anxiety DisorderIf you are willing to pay a bit, there are online therapists who are cheaper than going to an office.  Therapists who will attend you privately on the computer – or even by phone.  Joyable is planning on offering three categories of activities – education, cognitive exercises, and behavioral activities.  They plan to have “coaches” who are “empathetic” and “good listeners” – trained by the company.

Psychologists oversee the program, but it is not very likely that you will get personal attention from a licensed professional.   With a little bit of work, you can probably get much of the same service at a low cost – or even without spending a dime. But for the future, the attention that the service may bring might provide promise and signal hope for people with mental disorders.

One development often leads to another. An App, even at a cost may provide assistance for those who won’t otherwise receive adequate care – particularly with disorder such as PTSD that don’t often get enough or the right kind of attention.  For now, you can probably skip the cost – and gather up the services yourself.

Melissa Lind

“Mania Days” – Movie about Bipolar Disorder

“Mania Days,” Debuts at South by Southwest Film Festival in Austin

Mania Days” is a movie by Paul Dalio, features Katie Holmes and Luke Kirby as two New Yorkers suffering in the various stages of Bipolar DisorderMovie About Bipolar DisorderDalio, who in actual bipolar mode, wrote, directed, produced, edited and unbelievably – “scored” his own movie which is based on his own discovery of his bipolar disorder.

In an interview with the Huffington Post, Dalio describes the Holmes character as what he was like when he had his first episode “really scared and ashamed of it”.  The other character, played by Luke Kirby is based on a period of when he “started to romanticize bipolar disorder” and “embraced lunacy”.

Dalio himself endured three years of bipolar misery but eventually adhered to treatment when he recognized the pain he was causing his family.  Now he credits much of his inner peace to meditation (in addition to medication) and adherence to a routine schedule – including sleep.

The film debuts at the 2015 South by Southwest (SXSW) Music, Film, and Interactive Festival in Austin, Texas which runs a number of independent films.  The film festival coincides with the world famous music festival and an “interactive” conference which includes “gaming” and interactive media.

Katie HolmesKatie Holmes’ presence in the film shows potential for commercial success, but whether it achieves stardom – it is a good thing for bipolar disorder.  Basically, any attention for bipolar disorder is good – even the “bad” of bipolar disorder – as awareness can only reduce bipolar stigma.

I know that in my own journey over 20 plus years, I have gone through many stages.  I don’t much remember being “scared” of the diagnosis – or even of my behavior.  I have chosen to steel myself with “it is what it is”.

I did, however, maintain a long romance with the idea of “crazy” is good.  I spent many years believing (and many hours arguing with my therapist) that being “normal” was boring.  The last thing I wanted to be was “normal”.

I would like to say I was young and stupid – which I was but maybe part of the truth was that I had been crazy for so long that it was “normal”.  Eventually, crazy is exhausting – and you can’t do it anymore.

In most cases – you are eventually stopped from being crazy – up against a wall, sometimes caught by family members but sometimes a lot worse.  You get normal – only to get bored and do it all again.

As much as I would like to say that there is a real way to stop this cycle – in many cases there is not.  Even with medication, the cycle will continue – for a while.  Eventually, hopefully, you just get too tired of doing crazy.  Lost relationships, lost jobs… lost stuff.  It is exhausting.

Today – I am stable on medication.  Like an alcoholic – I say today.  Tomorrow and likely next week I will be stable on medication.  I would like to say forever – but I remember (at least what I do remember) that someday I may not.  The best I can do is to be open and forthright about my disorder so that those around me may know the signs if I decide to do “crazy” again.

Even though, I live near the festival and have many friends who are attendees, musicians, event planners, and sponsors – I won’t be seeing the film in Austin… crowds, excitement, and all that are no longer my thing – but I will see it, and I hope it is good.  Even if it isn’t great, it is another step in the right direction for the disease.

The Movie about Bipolar Disorder, “Mania Days”, Debuts at Film Festival in Austin

Melissa Lind

Face of Borderline Personality Disorder

Pro Football Player Brandon Marshall Wants to be the “face” of Borderline Personality Disorder

Brandon Marshall - The Face of Borderline Personality DisorderIf you don’t follow professional sports in the U.S., you may not know who Brandon Marshall is. He is an NFL Wide Receiver, recently acquired by the New York Jets. His long history of violent outbursts, brushes with law enforcement and behavioral issues that have affected both his personal and professional life.

Marshall had played professional football since 2006 when the Denver Broncos drafted him. He has since played for the Miami Dolphins, the Chicago Bears and was recently acquired by the New York Jets. The Wide Receiver played in five Pro-Bowls, receiving an MVP award in 2011 and has set several receiving records during his NFL career.

Brandon Marshall - BPDThough he has played for four different teams in only nine years, most of the trades have come after a series of injuries. Not all of those injuries, however, have come from football and Marshall has a long history of legal trouble, and those issues have affected various team’s willingness to put up with his erratic behavior.

One notable injury was sustained in 2008 when he slipped on an empty bag in McDonalds. While this seems like a complete accident, the incident occurred during a physical scuffle with “family members”. Shortly after the event, he fell through a television set at his home, causing a severe arm injury.

Marshall has faced multiple fines with the NFL including two penalties for violating the team’s dress code by wearing brightly colored cleats during a game. The list of legal troubles he has had include drunk driving charges, domestic violence, assault, battery and disorderly conduct. Marshall was diagnosed with Borderline Personality Disorder in 2011.

Borderline Personality Disorder is not a well-known disorder and is highly stigmatized, with many people unwilling to disclose the condition. It is characterized by severe abandonment issues, risky behavior, personal identity issues, rapid changes in an Borderline Personality Disorder - Brandon Marshallemotional level, and high potential for self-harm. Treatment is largely comprised of behavioral therapy. However, some patients receive medication for other psychiatric disorders that may improve BPD symptoms. There is also some thought that medication treatment may be useful in Borderline Personality Disorder. However, no drugs are approved to treat the condition.

Marshall’s diagnosis of BPD likely comes as no surprise to those who understand the disorder. His willingness to come forward and publicly announce his condition may help others to understand BPD. He has been and is currently undergoing treatment and is in the process of filming a documentary about his battle with BPD. Marshall has stated that his goal is to be the “face” of Borderline Personality Disorder to bring public awareness for those who struggle with the condition.

Though he has been forthright, many in the sports world had stated that the New York Jets will have their hands full when he joins the team as his troubles have decreased only slightly since he began treatment.

Melissa Lind

Woman with Bipolar Disorder Wins Court Case

Future discrimination of people with Bipolar Disorder may be more difficult

Score one (kind of) for Bipolar Disorder.  A federal jury awarded a woman who was fired because she requested time off from work to deal with a manic episode $32.5 thousand.

Bipolar Disorder StigmatizationBipolar disorder (and many other psychiatric illnesses) carries a relatively big stigma in the workplace.  Unless you are in the creative arts, likely, you will not want anyone at your job to know that you have bipolar disorder.

Three years ago, a nursing assistant who worked in an assisted living facility, named Charlotte Massey realized she was in the middle of a manic episode.  Charlotte had been diagnosed with Bipolar Disorder – and kudos to her for recognizing that she needed to do something about it before it spiraled out of control.

When she called her boss, the owner of the facility, her boss not only didn’t give her “kudos”, he gave her a pink slip.  She got fired because she asked to take a leave of absence to deal with her medical issue.

Unlike most people who have been fired for Bipolar Disorder – Charlotte didn’t lose her job because she went wacko.  Instead, she maintained enough mental clarity to notify her employer of her Bipolar Disorder Discriminationdisability and was rewarded with… firing.

It is certain that the owner of the facility was aware of the American with Disabilities Act.  It is likely that he or she was aware that he could not randomly fire employees with physical or obvious mental disabilities. But, it may be that he was unaware that “mental disabilities” includes illnesses such as bipolar disorder.

The ADA bars discrimination against persons with physical or mental disabilities who can perform the essential functions of their job with “reasonable accommodation” and without imposing an “undue hardship” on the employer.

From the outside, some may say… well she wanted to take time off.  In fact, she took a whole five days off, with herself or a family member reporting in each day with the supervisor.  When she returned to work after only a week of absence, she was fired.

Part of the law includes an evaluation of whether the employer would be subjected to “undue hardship”.  Is giving an employee time off to deal with a medical issue, an employee whose shifts could be made up by another person – an undue hardship?

Workplace StigmaThe court thought it was not.  The jury awarded Massey $25,000 in damages for lost wages and benefits and $7,500 in punitive damages.

The employer and his lawyer attempted to have the lawsuit dismissed by claiming that:

•    Charlotte Massey wasn’t fired; she resigned
•    She had a faulty memory of the events due to her disability
•    She never reported her disability to her employer

In fact, none of those were true.  Though the employer’s attorney repeatedly referred to the case as “frivolous”, the jury found otherwise.
This award may be the first of its kind, and it may be small, but it is a groundbreaking case.  With the ability to claim protections of the ADA, future discrimination may be more difficult.

Melissa Lind

More difficult for Bipolar Disorder stigma in the future!

Asperger’s Syndrome

Asperger’s – A parent’s journey to being grateful

As the parent of a child with Asperger’s, I have gone through a series of emotional stages, and though I never thought I would be grateful, I am.

Aspergers SyndromeWhen I first realized my kid had Asperger’s, I was relieved.  I was relieved because there was suddenly an explanation.  I had thought that there was something “wrong” with him, but I couldn’t figure out what it was.

Finding out that he has Asperger’s let me know that he is “different” but not “bad.”  He isn’t just a kid who chooses not to behave.  He isn’t a kid with a mom who doesn’t make him behave.  He has Asperger’s.

Then, I was sad.  I was sad for all the times that I didn’t understand.  I was sad for the fact that others have taught him he is a “bad” kid.  I was sad for all the times I got frustrated and lost my temper.

I was also angry.  I was angry because even the health care “professionals” did not see.  They focused on his “bad” behavior.  They focused on what I wasn’t doing to make him better. They did not truly understand that he is “different” and they certainly did not see how great he is.

Today (several years later) I am in acceptance. I accept that my child (now 10) is different.  I accept that he will have difficulties.  I accept that his school will call about once a week to describe some heinous event.

I am also grateful.  I am grateful that I know.  I am grateful that I can appreciate the terrific kid that he is and mostly know how to help him through. I do still get frustrated and lose my temper but at least I know what I am doing wrong.  I no longer have to feel like I am doing everything wrong – or that I just don’t know what to do at all.

Autism Spectrum DisorderI am grateful that at least right now, he is fortunate enough to have a teacher that gets Autism Spectrum Disorder.  A principal that gets it – and both of these wonderful ladies see how lovable he is, how smart he is, and even though they may get frustrated and angry, they still get it.   I am grateful that I have enough information to know that there are just some things that we cannot do, and that really we shouldn’t bother.

I was thinking about this because I heard about a convention that I could go to.  The convention organizers have a “kid camp.”   The children are put on a bus and taken to some activity – a museum, a park, a walking tour…and even though he is 10 and even though he is “high-functioning” – he could not do this.  He could not be calm and collected and manage.

He has difficulty with scheduling, he has difficulty with noise, he has difficulty with crowds, he has difficulty with spontaneous activities, he has difficulty with new food… I would not even consider sending him to “kid camp” or any other activity that I could not be at.

This is not because I won’t “allow” it.  It is because the well-meaning organizers will not be able to predict and compensate for his Aspergers Children“different-ness”.  He would not have a good time; I would not have a good time – it would not be best for him.  I cannot go to that convention, but that is OK.

Not every kid who has Asperger’s has the same “different-ness”, and not every parent feels the same way. But I am grateful that I have gone through the relief, the anger and the sadness, to be accepting of my life and his life.

I am thankful that I can compensate for his differences and see how terrific he is.

Children with Asperger’s Syndrome have different different-nesses!

Melissa Lind