Child and Adolescent Psychiatry Consulting, LLC Jenna Saul, M.D. F.A.A.C.A.P.  (715) 318-0047 

Attachment refers to the intimate bond formed between an infant or very young child and the primary caregiver. Research suggests that this bond, or attachment, is vital to the child's emotional development. This relationship is important in  developing the child's ability to establish other healthy social relationships. 

When infants and children under the age of five show disturbed and developmentally inappropriate social relatedness and do not initiate or respond to most social interactions, a diagnosis of Reactive Attachment Disorder is considered.

The difficulties of children who develop this disorder are due primarily to a grossly deprived environment. There may be repeated changes of caregivers, or caregivers who persistently disregard the child's physical needs or emotional needs for comfort, stimulation and affection. (more) 

Adjustment disorders are quite common in children and adolescents.

An adjustment disorder is defined as a maladaptive or unhealthy emotional or behavioral reaction to an identifiable stressful event or change in a person’s life. This reaction occurs within three months of the occurrence of the identified stressful event or change. A family move, parental divorce or separation, the loss of a pet, birth of a brother or sister, are some events that can cause children and adolescents to develop an adjustment disorder.

In all adjustment disorders, the reaction to the stressor seems to be in excess of a normal reaction, or the reaction significantly interferes with social or occupational (educational) functioning. (more) 

ADHD, or Attention Deficit Hyperactivity Disorder, used to be divided into two separate diagnoses, ADD and ADHD depending on whether a person exhibited inattention without hyperactivty, or exhibited inattention and hyperactivity. Currently, only the diagnosis of ADHD exists, with various subtypes.

All people are restless and inattentive occasionally. These qualities are more severe, persistent, and impairing in children with Attention-Deficit/Hyperactivity Disorder (ADHD).  A diagnosis of ADHD, requires that trouble with restlessness and inattention  must cause difficulty in multiple areas such as at home, in school, or with friends. (more)

Overview:

Anxiety is a normal human emotion, that can be adaptive and can be imortant to our success and our survival. Anxiety can help us to be aware of our surroundings when we are not safe, and can motivate us to focus and concentrate when preparing to speak publicly, or studying for a test.

Children have anxieties that can be developmentally normal, such as a preschooler who is fearful of the dark, or a 5-6 year old who is afraid of insects.

Sometimes, a person’s anxiety can be more severe. They may spend a great deal of time worrying, they may feel exhausted due to the energy spent worrying, or they may be unable to function to do the things that are necessary to function. Anxiety is a disorder when a person worries excessively to a degree that interferes with his or her life.

Anxiety disorders are among the most common mental health issues in children and adolescents. They are also among the most effectively treated mental health issues. (more)

The autism spectrum disorders (ASD) affect an estimated  3.4 children of every 1,000 children 3-10 years old had autism.

All children with ASD demonstrate deficits in

1. social interaction
2. verbal and nonverbal communication
3. repetitive behaviors

They will often have unusual responses to sensory experiences, such as certain sounds or the way objects look.

Each of these symptoms can range from mild to severe, so that  two individuals with an autism spectrum disorder  diagnosis can seem very very different from each other.Each child will display communication, social, and behavioral patterns that are individual but fit into the overall diagnosis of ASD.

Children with ASD do not follow the typical patterns of child development. Some may show early signs of being different from birth. Some other children will appear to have very few signs, and then start to appear to react to people more differently than other children their age. Sometimes, parents are the first to notic that their children’s communication and social skills seem to be delay compared to their peers, and it may be difficult to get others to appreciate the differences. Eventually, as the child with an ASD lags farther and farther behind their peers in social and communication skills, their differences become more apparent.

It is important to remain proactive if you have concerns about your child’s development, ask questions, gather data. The earlier the diagnosis is made, the sooner treatment interventions can be started. (more) 

Eating disorders include extreme emotions, attitudes, and behaviors surrounding weight and food issues. Eating disorders are serious emotional and physical problems that can have life-threatening consequences for females and males. (more) 

Intermittent explosive disorder is characterized by repeated episodes of aggressive, violent behavior in which you react grossly out of proportion to the situation.

• Road rage, domestic abuse, and angry outbursts or temper tantrums that involve throwing or breaking objects may be signs of intermittent explosive disorder (IED).
• People with intermittent explosive disorder may attack others and their possessions, causing bodily injury and property damage.
• Later, people with intermittent explosive disorder may feel remorse, regret or embarrassment.
• Treatment may involve medications and psychotherapy to  control the aggressive impulses.

DSM criteria include:

• Multiple incidents in which the person failed to resist aggressive impulses that resulted in deliberate destruction of property or assault of another person.
• The degree of aggressiveness expressed during the incidents is completely out of proportion with the precipitating event.
• The aggressive episodes aren’t accounted for by another mental disorder and are not due to the effects of a drug or a general medical condition. (more)

Mood disorders refer to a category of mental health problems that include four basic forms of mood disorders: Major Depression, cyclothymia, Seasonal Affective Disorder, and Mania. 

During the 1980s, mental health professionals began to recognize symptoms of mood disorders in children and adolescents, as well as adults. However, children and adolescents do not necessarily experience or exhibit the same symptoms as adults. It is more difficult to diagnose mood disorders in children, especially because children are not always able to express how they feel. Today, clinicians and researchers believe that mood disorders in children and adolescents remain one of the most under-diagnosed mental health problems. At any age, mood disorders put individuals at risk for other conditions that may persist long after the initial episodes of depression are resolved.

• Alternative/Complementary Treatments
• Causes
• Treatment

Restless legs syndrome (RLS) is a neurological condition that is characterized by the irresistible urge to move the legs.

It is believed that 10 million adults and 1.5 million children and adolescents have RLS in the United States.

RLS symptoms often begin during childhood or adolescence.

About 35% of patients report RLS onset prior to age 20, and one in ten report that the syndromeappeared during the first decade of life.

Despite all of this, RLS remains underdiagnosed and undertreated.

Symptoms of   RLS include:

• A strong urge to move your legs which you may not be able to resist. The need to move is often accompanied by uncomfortable sensations. Some words used to describe these sensations include: creeping, itching, pulling, creepy-crawly, tugging, or gnawing.
• RLS symptoms start or become worse when you are resting. Often people will complain that they are fine until they are at their most peaceful, and just about ready to fall asleep
• RLS symptoms get better when you move your legs. The relief can be complete or only partial but generally starts very soon after starting an activity. Relief persists as long as the motor activity continues.
• RLS symptoms are worse in the evening especially when you are lying down. Activities that bother you at night do not bother you during the day.

Children with RLS:

• May be uncomfortable, and irritable and may need understanding and support from the adults around them.
• May have impaired intellectual or emotional function that is caused by the discomfort of RLS or the sleep disturbances it causes, and treatment can have a very positive impact on their lives.
• May be able, with early treatment, to  prevent the progression of their symptoms with age.
• May be difficult to diagnose, since they may not be able to describe the symptoms listed above in words.

It is important to consider the diagnosis of RLS in  children with mood, behavioral or sleep disturbances when there is a biological relative with RLS.

RLS can make it difficult to fall asleep or stay asleep. Many sufferers of RLS will also have PLMS (Periodic Limb Movements of Sleep). These are jerking movments that can occur up to every 20-30 seconds, at various intervals throughout the night. This may lead to partial awakenings that disrupt sleep, but that the person may not even be fully aware of. This disrupted sleep can result in significant adversity at work/school, in relatonships, and for your health.

Imagine a child who:

• Screams when you show affection by softly patting her on the back

• Gags on most foods, including such typical crowd-pleasers as hot dogs and macaroni and cheese

• Hits, bites, pinches or grabs – not out of ill will; he just can’t help it

For the child with SPD, these symptoms are real and can often have a significant impact both on the child, and the family as a whole.

There is evidence that children with SPD are physiologically different (Miller et al., 2001). This has several implications.

1. SPD may always be present, even when your child is an adult. The symptoms may be less severe, but your child will need to recognize the impact of SPD and learn life-long coping strategies.
2. Early intervention is critical in the treatment of children with SPD.
3. SPD commonly appears with many other disorders, including autism, ADHD, fragile X, cerebral palsy, and mental retardation.

Current terminology categorizes sensory processing disorders to include three distinct patterns: 

1. sensory modulation disorder
2. sensory discrimination disorder
3. sensory based motor disorder.                   

RESOURCES for Sensory Processing Disorder

TREATMENT of Sensory Processing Disorders

(more)

“I try to go to bed but I can’t!”

Your mom or dad may yell, “Get in bed and go to sleep!” But that’s easier said than done. If you are like most teens, you like to stay up late. But why? You can blame it in part on TV, homework, instant messaging, and fun drinks filled with caffeine.

But there’s more to it than that. Researchers believe that teens are “pre-programmed” to fall asleep late and get up late, unlike adults and younger kids who can fall asleep early and get up early. Some think teens need more hormones for growth, and growth hormones are made during sleep. These experts now ask why schools start so early, if teens need to sleep longer to stay well.

If I sleep less, what’s the big deal?

Teens who get poor sleep have problems getting along at home and at school. They have poor grades. And sleep-deprived teens tend to be apathetic. They are also more at risk for car wrecks, making the problem of teens and sleep even more serious.

Studies have actually demonstrated that in communities where the high schools start times have shifted to an hour or more later, there is less truancy, student grades have improved, and there are fewer car accidents involving teens.

If you are not in one of these communities, there are still ways to help you sleep better,  and to do so in such a way that you can function with the rest of the world.

Why can’t I fall asleep? Why can’t I wake up?

Everyone has an internal clock that influences body temperature, sleep cycles, appetite and hormonal changes. The biological and psychological processes that follow the cycle of this 24-hour internal clock are called circadian rhythms. Before adolescence, these circadian rhythms direct most children to naturally fall asleep around 8 or 9 p.m. But puberty changes a teen’s internal clock, delaying the time he or she starts feeling sleepy — often until 11 p.m. or later. Staying up late to study or socialize can disrupt a teen’s internal clock even more.

How much sleep do I need

Most teens need about nine hours of sleep a night — and sometimes more — to maintain optimal daytime alertness. But few teens actually get that much sleep regularly, thanks to part-time jobs, homework, extracurricular activities, social demands and early-morning classes. More than 90 percent of teens in a recent study reported sleeping less than the recommended nine hours a night. In the same study, 10 percent of teens reported sleeping less than six hours a night.

This sleep deprivation can be serious.

Daytime sleepiness makes it difficult to concentrate and learn, or even stay awake in class. Too little sleep may contribute to mood swings and behavioral problems. And sleepy teens who get behind the wheel may cause serious — even deadly — accidents.

A Brown University study found that teens need just as much sleep as they did when they were preteens (about 9 to 10 hours). But teens get on average just over seven hours of sleep a night. In this study,  teens who got A’s on their report cards got an hour more sleep at night and went to bed an hour earlier than peers who got D’s and F’s.

An Irregular Sleep-Wake Schedule, the number one cause of insomnia!

An irregular sleep-wake schedule happens when you are awake most of the night, perhaps spending too much time on the computer or texting, or even reading a book.

Then you need to sleep much of the next day to feel good. Teens who stay up until the wee hours of morning on weekends have problems getting their bodies to fall asleep early on Sunday night so they can be fresh for school on Monday. Many teens have a lot of trouble waking for school, many teens are late to school, and many fall asleep in their first classes.

To fix this irregular sleep-wake schedule, you have to go to bed, and awaken at the same time each day. If you do not yet have a serious sleep problem, you can flex this about an hour.

Can I catch up on the weekends with my sleep?

Catching up on sleep during the weekends seems like a logical solution to teen sleep problems, but it doesn’t help much. In fact, sleeping in can confuse your internal clock even more.

A forced early bedtime may backfire, too. If you go to bed too early,  you may train your body to be awake in bed, as you lie there, awake,  for hours.

How can I reset my alarm clock?

You are not at the mercy of your internal clock. Try these things:

• Adjust the lighting. As bedtime approaches, dim the lights. Turn the lights off during sleep. In the morning, expose your teen to bright light. These simple cues can help signal when it’s time to sleep and when it’s time to wake up.
• Stick to a schedule. Tough as it may be,  you should go to bed and get up at the same time every day — even on weekends. Prioritize extracurricular activities and curb late-night social time as needed. If you have a job, limit working hours to no more than 16 to 20 hours a week.
• No naps. If you are drowsy during the day, a 30-minute nap after school may feel refreshing. But napping may only make it harder to fall asleep at night.
• No caffeine. You may feel that a  jolt of caffeine may help you stay awake during class, but the effects are minimal, and fleeting. And too much caffeine can interfere with a good night’s sleep.
• Keep it calm. Wind down at night with a warm shower (but not within an hour before bed). Dim the lights.  Turn off the television, computer, and other electronics that are a source of bright light and stimulation.  Avoid —  vigorous exercise, loud music, video games, text messaging, Web surfing and other stimulating activities shortly before bedtime.
• Do something boring. Try reading  a book or other relaxing activities. Consider using this time to fold your laundry.
• Use your bedroom for sleep only: Try not to spend too much awake time in your room, and especially in your bed. This trains your body to be awake and active in your room, and in your bed.

Sleeping pills and other medications generally aren’t recommended for teens.

Is it something else?

In some cases, excessive daytime sleepiness can be a sign of something more problematic than just having an adolescent internal clock. Other problems can include:

• Medication side effects. Many medications — including over-the-counter cold and allergy medications and prescription medications to treat depression and attention-deficit/hyperactivity disorder — can affect sleep.
• Depression. Sleeping too much or too little is a common sign of depression.
• Obstructive sleep apnea. When throat muscles fall slack during sleep, they stop air from moving freely through the nose and windpipe. This can interfere with breathing and disrupt sleep.
• Restless legs syndrome. This condition causes a “creepy” sensation in the legs and an irresistible urge to move the legs, usually shortly after going to bed. The discomfort and movement can interrupt sleep.
• Narcolepsy. Sudden daytime sleep, usually for only short periods of time, can be a sign of narcolepsy. Narcoleptic episodes can occur at any time — even in the middle of a conversation. Sudden attacks of muscle weakness in response to emotions such as laughter, anger or surprise are possible, too.

Ezzz Sleep Tips for Teens

1. Adjust the lighting. As bedtime approaches, dim the lights. Turn the lights off during sleep. In the morning, expose your teen to bright light. These simple cues can help signal when it’s time to sleep and when it’s time to wake up.
2. Stick to a schedule. Tough as it may be,  you should go to bed and get up at the same time every day — even on weekends. Prioritize extracurricular activities and curb late-night social time as needed. If you have a job, limit working hours to no more than 16 to 20 hours a week.
3. No naps. If you are drowsy during the day, a 30-minute nap after school may feel refreshing. But napping may only make it harder to fall asleep at night.
4. No caffeine. You may feel that a  jolt of caffeine may help you stay awake during class, but the effects are minimal, and fleeting. And too much caffeine can interfere with a good night’s sleep.
5. Keep it calm. Dim the lights.  Turn off the television, computer, and other electronics that are a source of bright light and stimulation.  Avoid —  vigorous exercise, loud music, video games, text messaging, Web surfing and other stimulating activities shortly before bedtime.
6. Do something boring. Try reading  a book or other relaxing activities. Consider using this time to fold your laundry.
7. Use your bedroom for sleep only: Try not to spend too much awake time in your room, and especially in your bed. This trains your body to be awake and active in your room, and in your bed.
8. Take a hot bath or shower about one hour before bed to boost deep sleep. Then keep your room cool (about 68 degrees) to cool your body. One study showed that sleep happens when the body cools. Wakefulness occurs when the body temperature warms up.
9. If you are stressed, relax with soft music or yoga right before bedtime.If you lie in bed worrying about things, then try writing the worrisome thoughts down. Now, take the paper and place it (along with all the worry) outside of your bedroom. You can address those concerns tomorrow.  If you can’t relax, work with your therapist, or your doctor, for help.
10. Go to bed early when you’re ill. Even an hour earlier each night can help give your body the sleep it needs to get well. Be sure to plan for this added sleep time if you have to get up early for school.
11. Try eating high-carb snacks before bed. This makes you feel warm and sleepy. Try pretzels, cereal, graham crackers, fresh fruit, dried fruit, fruit juice, vanilla wafers, saltines, popcorn, or toast with jam or jelly
12. Use good night “scents.” Aromatherapy can boost sleep. Try orange blossom, marjoram, chamomile, and lavender scents. (If you’re using a candle or incense, be sure to put it out before you crawl into bed.
13. Figure out what other things you use that might make sleep difficult. If you are taking medications, ask your doctor if these might cause poor sleep. If you like caffeinated drinks, cut these out for a few days to see that helps. Many people find that chamomile and valerian herbal teas help them feel sleepy. These days you can find either or a combination of both at most drug stores and supermarkets. Try one to two strong cups at bedtime. Note that if you are taking medications, there can sometimes be interactions with these and with valerian root, and with high doses of melatonin.

Chronic skin picking (CSP), also known as dermatillomania, is a serious and poorly understood problem. People who suffer from CSP repetitively touch, rub, scratch, pick at, or dig into their skin, often in an attempt to remove small irregularities or perceived imperfections. This behavior may result in skin discoloration or scarring. In more serious cases, severe tissue damage and visible disfigurement can result.

CSP is now thought of as one of many Body-Focused Repetitive Behaviors (BFRBs) in which a person can cause harm or damage to themselves or their appearance. Other BFRBs include chronic hair pulling (trichotillomania), biting the insides of the cheeks, and severe nail biting.

Though not currently listed in the Diagnostic and Statistical Manual of Mental Disorders – IV (DSM-IV) some researchers believe CSP should be listed as a separate diagnostic entity. (more)