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Common Disorders

Attention Deficit Hyperactivity Disorder (ADHD)

What is Attention Deficit Hyperactivity Disorder?

Attention Deficit Hyperactivity Disorder, ADHD, is one of the most common mental disorders that develop in children. Children with ADHD have impaired functioning in multiple settings, including home, school, and in relationships with peers. If untreated, the disorder can have long-term adverse effects into adolescence and adulthood.

Signs and Symptoms

Symptoms of ADHD will appear over the course of many months, and include:

  • Impulsiveness: a child who acts quickly without thinking first
  • Hyperactivity: a child who can’t sit still, walks, runs, or climbs around when others are seated, talks when others are talking.
  • Inattention: a child who daydreams or seems to be in another world, is sidetracked by what is going on around him or her.

How is it diagnosed?

If ADHD is suspected, the diagnosis should be made by a professional with training in ADHD. After ruling out other possible reasons for the child’s behavior, the specialist checks the child’s school and medical records and talks to teachers and parents who have filled out a behavior rating scale for the child. A diagnosis is made only after all this information has been considered.

Treatment

Effective treatments for ADHD are available, and include behavioral therapy and medications.

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Adult ADHD

What is Adult ADHD?

Adults with attention-deficit/hyperactivity disorder (ADHD) increasingly present to primary care physicians, psychiatrists, and other practitioners for diagnosis and treatment of this disorder. The prevalence of ADHD in adults is 4% to 5%, which equals ~8 million people. Less than 20% of these cases are diagnosed and even fewer are treated. High rates of ADHD are present in other psychiatric and substance use disorders as well. The diagnosis of ADHD in adults is established by clinical history applying the core symptom criteria for ADHD. In order to understand the presentation of ADHD in adults, it is imperative to view the disorder as a lifelong condition which begins in childhood and continues with adult manifestations related to the core symptoms.

Signs and Symptoms

Although ADHD symptoms are usually evident in early childhood, the symptoms may not cause significant problems until later in life. Serious problems may surface in high school, in college, or at work. In some cases, parents may be able to minimize the impact of ADHD symptoms on the lives of their children by providing a highly protective, structured, and supportive environment. However, their child’s ADHD symptoms may resurface or increase when he or she begins to live life independently as a young adult. Some individuals are able to develop coping mechanisms that let them �work around� their symptoms during childhood. But these methods of compensation may break down later as the person enters adulthood and faces new challenges.

Treatment

Without treatment, many adults with ADHD experience significant difficulties in social, vocational, or academic settings. These difficulties are caused by the common symptoms of ADHD listed below.

  • Poor attention; excessive distractibility
  • Physical restlessness or hyperactivity
  • Excessive impulsivity; saying or doing things without thinking
  • Excessive and chronic procrastination
  • Difficulty getting started on tasks
  • Frequently losing things
  • Poor organization, planning, and time management skills
  • Excessive forgetfulness

There are several medication choices available for ADHD-some are highly effective (depending on individual response) and can make a significant difference in controlling symptoms. Medication is usually the cornerstone of any ADHD management program. However, treatment may require a wide-ranging, multifaceted approach that also involves psychological and behavioral counseling.

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Autism Spectrum Disorders

What is Autism?

Most infants and young children are very social creatures who need and want contact with others to thrive and grow. They smile, cuddle, laugh, and respond eagerly to games like "peek-a-boo" or hide-and-seek. Occasionally, however, a child does not interact in this expected manner. Instead, the child seems to exist in his or her own world, a place characterized by repetitive routines, odd and peculiar behaviors, problems in communication, and a lack of social awareness or interest in others. These are characteristics of a developmental disorder called autism.

Signs and Symptoms

Autism is usually identified by the time a child is three years of age. It is often discovered when parents become concerned that their child may be deaf, is not yet talking, resists cuddling, and avoids interactions with others.

A preschool age child with "classic" autism is generally withdrawn, aloof, and fails to respond to other people. Many of these children will not even make eye contact. They may also engage in odd or ritualistic behaviors like rocking, hand flapping, or an obsessive need to maintain order.

Many children with autism do not speak at all. Those who do may speak in rhyme, have echolalia (repeating a person’s words like an echo), refer to themselves as "he" or "she", or use peculiar language.

The severity of autism varies widely, from mild to severe. With proper supports, many of these children are able to perform well in a school setting and may be able to live independently when they grow up. Other children with autism function at a much lower level. Mental retardation is commonly associated with autism. Occasionally, a child with autism may display an extraordinary talent in art, music, or another specific area.

What is the Cause?

The cause of autism remains unknown, although current theories indicate a problem with function or structure of the central nervous system. What we do know, however, is that parents or "inadequate parenting" do not cause autism.

Treatment

Children with autism need a comprehensive evaluation and specialized behavioral and educational programs. Some children with autism may also benefit from treatment with medication. Child and adolescent psychiatrists are trained to diagnose autism, and to help families design and implement an appropriate treatment plan. They can also help families cope with the stress which may be associated with having a child with autism.

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Asperger Syndrome (DSM IV - no longer a formal diagnosis in DSM 5)

What is Asperger’s Syndrome?

Asperger’s Syndrome is the term for a specific type of pervasive developmental disorder which is characterized by problems in development of social skills and behavior. In the past, many children with Asperger’s Disorder were diagnosed as having autism, another of the pervasive developmental disorders, or other disorders. While autism and Asperger’s have certain similarities, there are also important differences. For this reason, children suspected of having these conditions require careful evaluation.

Signs and Symptoms

In general, a child with Asperger’s Disorder functions at a higher level than the typical child with autism. For example, many children with Asperger’s Disorder have normal intelligence. While many children with autism fail to develop appropriate language or have language delays, children with Asperger’s Disorder are usually using words by the age of two, although their speech patterns may be somewhat odd.

Most children with Asperger’s Disorder have difficulty interacting with their peers. They tend to be loners and may display eccentric behaviors. A child with Asperger’s, for example, may spend hours each day preoccupied with counting cars passing on the street or watching only the weather channel on television. Coordination difficulties are also common with this disorder. These children often have special educational needs.

What is The Cause?

Although the cause of Asperger’s Disorder is not yet known, current research suggests that a tendency toward the condition may run in families. Children with Asperger’s Disorder are also at risk for other psychiatric problems including depression, attention deficit disorder, schizophrenia, and obsessive �compulsive disorder.

Treatment

Child and adolescent psychiatrists have the training and expertise to evaluate pervasive developmental disorders like autism and Asperger’s Disorder. They can also work with families to design appropriate and effective treatment programs. Currently, the most effective treatment involves a combination of psychotherapy, special education, behavior modification, and support for families. Some children with Asperger’s Disorder will also benefit from medication.

The outcome for children with Asperger’s Disorder is generally more promising than for those with autism. Due to their higher level intellectual functioning, many of these children successfully finish high school and attend college. Although problems with social interaction and awareness persist, they can develop lasting relationships with family and friends.

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Depression

What is Depression?

Depression is a serious medical illness. It’s more than just feeling "down in the dumps" or "blue" for a few days. It is feeling "down" and "low" and "hopeless" for weeks at a time.

Signs and Symptoms

  • Persistent sad, anxious, or "empty" mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed.

In addition to feelings of sadness and/or irritability, a depressive illness includes several of the following:

  • Change of appetite with either significant weight loss (when not dieting) or weight
  • Change in sleeping patterns (such as trouble falling asleep, waking up in the middle of the night, early morning awakening, or sleeping too much)
  • Loss of interest in activities formerly enjoyed
  • Loss of energy, fatigue, feeling slowed down for no reason, "burned out"
  • Feelings of guilt and self blame for things that are not one’s fault
  • Inability to concentrate and indecisiveness
  • Feelings of hopelessness and helplessness
  • Recurring thought of death and suicide , wishing to die, or attempting suicide

Depression in Children and Adolescents

Children and adolescents with depression may also have symptoms of irritability, grumpiness, and boredom. They may have vague, non-specific physical complaints (stomachaches, headaches, etc.) There is an increased incidence of depressive illness the children of parents with significant depression.

Treatment

A variety of treatments including medications and short-term psychotherapies have proven effective for depression.

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Childhood Anxiety

All children experience anxiety. Anxiety in children is expected and normal at specific times in development. For example, from appropriately age 8 months through the preschool years, healthy youngsters may show intense distress (anxiety) at times of separation from their parents or other persons with whom they are close. Young children may have short-lived fears (such as fear of the dark, storms, animals or strangers). If anxieties become severe and begin to interfere with the daily activities of childhood, such as separating from parents, attending school and making friends, parents should consider seeking the evaluation and advice of a child and adolescent psychiatrist.

One type of anxiety that may need treatment is called separation anxiety. This includes:

  • constant thoughts and fears about safety of self and parents
  • refusing to go to school
  • frequent stomachaches and other physical complaints
  • extreme worries about sleeping away from home
  • overly clingy
  • panic or tantrums at times of separation from parents
  • trouble sleeping or nightmares

Another type of anxiety (phobia) is when a child is afraid of specific things such as dogs, insects, or needles and these fears cause significant distress. Some anxious children are afraid to meet or talk to new people. Children with this difficulty may have few friends outside the family.

Other children with severe anxiety may have:

  • many worries about things before they happen
  • constant worries or concern about school performance, friends, or sports
  • repetitive thoughts or actions (obsessions)
  • fear of embarrassment or making mistakes
  • low self-esteem

Anxious children are often overly tense or uptight. Some may seek a lot of reassurance, and their worries may interfere with activities. Because anxious children may also be quiet, compliant and eager to please, their difficulties may be missed. Parents should also be alert to the signs of severe anxiety so they can intervene early to prevent complications. It is important not to discount a child’s fears.

If you are concerned that your child has difficulty with anxiety you should consult a child and adolescent psychiatrist or other qualified mental health professional. Severe anxiety problems in children can be treated. Early treatment can prevent future difficulties, such as, loss of friendships, failure to reach social and academic potential, and feelings of low self-esteem. Treatments may include a combination of the following: individual psychotherapy, family therapy, medications, behavioral treatments, and consultation to the school.

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Generalized Anxiety Disorder (GAD)

What is Generalized Anxiety Disorder?

Generalized Anxiety Disorder, GAD, is an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it.

Signs and Symptoms

People with generalized anxiety disorder can’t seem to shake their concerns. Their worries are accompanied by physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating and hot flashes.

Treatment

A variety of effective treatments, including medications, are available for anxiety disorders. Research is yielding new and improved therapies that can help most people with anxiety disorders lead productive, fulfilling lives.

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Social Phobia

What is Social Phobia?

Social Phobia, or Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive, self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation- such as a fear of speaking in formal or informal situations, or eating or drinking in front of others- or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people.

Signs and Symptoms

People with social phobia have a persistent, intense, and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions. Their fear may be so severe that it interferes with work or school, and other ordinary activities. Physical symptoms often accompany the intense anxiety of social phobia and include blushing, profuse sweating, trembling, nausea, and difficulty talking.

Treatment

A variety of effective treatments, including medications, are available for social phobia. Research is yielding new, improved therapies that can help most people with social phobia and other anxiety disorders lead productive, fulfilling lives.

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Obsessive-Compulsive Disorder (OCD)

What is Obsessive-Compulsive Disorder?

Obsessive Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as hand washing, counting, checking, or cleaning are obsessive thoughts or making them go away. Performing these so-called "rituals", however, provides only temporary relief, and not performing them markedly increases anxiety.

Signs and Symptoms

People with OCD may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals. They may be obsessed with germs or dirt, and wash their hands over and over. They may be filled with doubt and feel the need to check things repeatedly.

Teenagers with OCD have obsessions and/or compulsions. An obsession refers to recur and persistent thoughts, impulses, or images that are intrusive and cause severe anxiety distress. Compulsions refer to repetitive behaviors and rituals (like hand washing, hoarding�..) or mental acts (like counting, repeating words silently, avoiding). The obsessions and compulsions also significantly interfere with the normal routine.

Treatment

A variety of effective treatments, including medications, are available for obsessive-compulsive disorder. Research is yielding new, improved therapies that can help most people with OCD and other anxiety disorders lead productive, fulfilling lives.

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Selective Mutism

Selective Mutism refers to selective silence in a child who speaks freely in very familiar situations. Children with selective mutism appear comfortable and talkative with close family members, but become quiet and shy whenever people other than the closest family members are present. Some children avoid eye contact and do not communicate in any form with others. Some refrain from the use of gestures or changes in facial expressions. Although rare, selective mutism deserves careful attention because of its persistence and debilitating impact on young children. Obviously, the condition can have dramatic effects on social and educational functioning. It is important to establish that the silence is not due to lack of knowledge of the language used in the situation, and not due to other conditions such as Communication Disorder, Psychotic Disorder or Pervasive Developmental Disorder.

What is the Cause?

At this time, researchers believe that most cases of selective mutism are due to social phobia, an anxiety disorder characterized by inhibited social actions due to fear or embarrassment or concerns that others will judge them negatively.

Treatment

Behavioral therapy with family intervention and the use of medications, alone or in combination, have shown positive results.

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Tourette’s Syndrome and Tic Disorder

Signs and Symptoms

Tourette’s Syndrome is characterized by multiple motor tics and at least one vocal tic. People with Tourette’s have sudden, rapid movements of some of the muscles in the body that occurs over and over and do not serve any purpose. The location, frequency, and complexity of tics changes over time. Motor tics frequently involve the head, central body, legs, and arms. They may result in simple movements such as eye blinking, or more complex movements such as touching or squatting. Vocal tics can include sounds such as grunts, barks, sniffs, snorts, coughs and shouting obscenities.

Tourette’s Syndrome is usually diagnosed before the age of eighteen- most commonly appearing around seven years of age. It occurs more often in males than females. The severity of Tourette’s varies a great deal over time, but improvement can occur during late adolescence and in adulthood. Teens with Tourette’s Syndrome often have additional problems with obsessions, compulsions, hyperactivity, distractibility, and impulsiveness.

Treatment

There is no cure for Tourette’s Syndrome but the disorder can be controlled with relaxation techniques and certain medications.

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*Information was compiled using resource materials from National Institute Mental Health, American Academy of Psychiatry and American Academy of Child and Adolescent Psychiatry. Updates and corrections may be available. Please check each organization’s websites for original reference materials and updates. Links are provided under our Resource Links tab.


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