Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a problem of not being able to focus, being overactive, not being able control behavior, or a combination of these. For these problems to be diagnosed as ADHD, they must be out of the normal range for a person’s age and development.

Causes

ADHD usually begins in childhood but may continue into the adult years. It is the most commonly diagnosed behavioral disorder in children. ADHD is diagnosed much more often in boys than in girls.

It is not clear what causes ADHD. A combination of genes and environmental factors likely plays a role in the development of the condition. Imaging studies suggest that the brains of children with ADHD are different from those of children without ADHD.

Symptoms

Symptoms of ADHD fall into three groups:

• Not being able to focus (inattentiveness)
• Being extremely active (hyperactivity)
• Not being able to control behavior (impulsivity)

Some people with ADHD have mainly inattentive symptoms. Some have mainly hyperactive and impulsive symptoms. Others have a combination of different symptom types. Those with mostly inattentive symptoms are sometimes said to have attention deficit disorder (ADD). They tend to be less disruptive and are more likely not to be diagnosed with ADHD.

Inattentive Symptoms

• Fails to give close attention to details or makes careless mistakes in schoolwork
• Has difficulty keeping attention during tasks or play
• Does not seem to listen when spoken to directly
• Does not follow through on instructions and fails to finish schoolwork or chores and tasks
• Has problems organizing tasks and activities
• Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
• Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
• Is easily distracted
• Is often forgetful in daily activities

Hyperactivity Symptoms

• Fidgets with hands or feet or squirms in seat
• Leaves seat when remaining seated is expected
• Runs about or climbs in inappropriate situations
• Has problems playing or working quietly
• Is often “on the go,” acts as if “driven by a motor”
• Talks excessively

Impulsivity Symptoms

• Blurts out answers before questions have been completed
• Has difficulty awaiting turn
• Interrupts or intrudes on others (butts into conversations or games)

RESOURCES „ Download this card and additional resources at http://www.sprc.org or at http://www.stopasuicide.org „ Resource for implementing The Joint Commission 2007 Patient Safety Goals on Suicide http://www.sprc.org/library/jcsafetygoals.pdf „ SAFE-T drew upon the American Psychiatric Association Practice Guidelines for the Assessment and Treatment of Patients with Suicidal Behaviors http://www.psychiatryonline. com/pracGuide/pracGuideTopic_14.aspx „ Practice Parameter for the Assessment and Treatment of Children and Adolescents with Suicidal Behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 2001, 40 (7 Supplement): 24s-51s ACKNOWLEDGEMENTS „ Originally conceived by Douglas Jacobs, MD, and developed as a collaboration between Screening for Mental Health, Inc. and the Suicide Prevention Resource Center. „ This material is based upon work supported by the Substance Abuse and Mental Health Services Administration (SAMHSA) under Grant No. 1U79SM57392. Any opinions/ fi ndings/conclusions/recommendations expressed in this material are those of the author and do not necessarily refl ect the views of SAMHSA. National Suicide Prevention Lifeline 1.800.273.TALK (8255) COPYRIGHT 2009 BY EDUCATION DEVELOPMENT CENTER, INC. AND SCREENING FOR MENTAL HEALTH, INC. ALL RIGHTS RESERVED. PRINTED IN THE UNITED STATES OF AMERICA. FOR NON-COMMERCIAL USE. SuicideAssessment Five-step Evaluation and T riage for Mental Health Professionals 1 IDENTIFY RISK FACTORS Note those that can be modifi ed to reduce risk 2 IDENTIFY PROTECTIVE FACTORS Note those that can be enhanced 3 CONDUCT SUICIDE INQUIRY Suicidal thoughts, plans behavior and intent 4 DETERMINE RISK LEVEL/INTERVENTION Determine risk. Choose appropriate intervention to address and reduce risk 5 DOCUMENT Assessment of risk, rationale, intervention and follow-up eAssessment Five-step SAFE-T NATIONAL SUICIDE PREVENTION LIFELINE 1.800.273.TALK (8255) Suicide assessments should be conducted at fi rst contact, with any subsequent suicidal behavior, increased ideation, or pertinent clinical change; for inpatients, prior to increasing privileges and at discharge. 1. RISK FACTORS D Suicidal behavior: history of prior suicide attempts, aborted suicide attempts or self-injurious behavior D Current/past psychiatric disorders: especially mood disorders, psychotic disorders, alcohol/substance abuse, ADHD, TBI, PTSD, Cluster B personality disorders, conduct disorders (antisocial behavior, aggression, impulsivity). Co-morbidity and recent onset of illness increase risk D Key symptoms: anhedonia, impulsivity, hopelessness, anxiety/panic, insomnia, command hallucinations D Family history: of suicide, attempts or Axis 1 psychiatric disorders requiring hospitalization D Precipitants/Stressors/Interpersonal: triggering events leading to humiliation, shame or despair (e.g., loss of relationship, fi nancial or health status—real or anticipated). Ongoing medical illness (esp. CNS disorders, pain). Intoxication. Family turmoil/chaos. History of physical or sexual abuse. Social isolation. D Change in treatment: discharge from psychiatric hospital, provider or treatment change D Access to fi rearms 2. PROTECTIVE FACTORS Protective factors, even if present, may not counteract signifi cant acute risk D Internal: ability to cope with stress, religious beliefs, frustration tolerance D External: responsibility to children or beloved pets, positive therapeutic relationships, social supports 3. SUICIDE INQUIRY Specifi c questioning about thoughts, plans, behaviors, intent D Ideation: frequency, intensity, duration–in last 48 hours, past month and worst ever D Plan: timing, location, lethality, availability, preparatory acts D Behaviors: past attempts, aborted attempts, rehearsals (tying noose, loading gun), vs. non-suicidal self injurious actions D Intent: extent to which the patient (1) expects to carry out the plan and (2) believes the plan/act to be lethal vs. self-injurious; Explore ambivalence: reasons to die vs. reasons to live * For Youths: ask parent/guardian about evidence of suicidal thoughts, plans, or behaviors, and changes in mood, behaviors or disposition * Homicide Inquiry: when indicated, esp. in character disordered or paranoid males dealing with loss or humiliation. Inquire in four areas listed above. 4. RISK LEVEL/INTERVENTION D Assessment of risk level is based on clinical judgment, after completing steps 1-3 D Reassess as patient or environmental circumstances change 5. DOCUMENT Risk level and rationale; treatment plan to address/reduce current risk (e.g., setting, medication, psychotherapy, E.C.T., contact with signifi cant others, consultation); fi rearm instructions, if relevant; follow up plan. For youths, treatment plan should include roles for parent/guardian. RISK LEVEL RISK / PROTECTIVE FACTOR SUICIDALITY POSSIBLE INTERVENTIONS High Psychiatric disorders with severe symptoms, or acute precipitating event; protective factors not relevant Potentially lethal suicide attempt or persistent ideation with strong intent or suicide rehearsal Admission generally indicated unless a signifi cant change reduces risk. Suicide precautions Moderate Multiple risk factors, few protective factors Suicidal ideation with plan, but no intent or behavior Admission may be necessary depending on risk factors. Develop crisis plan. Give emergency/crisis numbers Low Modifi able risk factors, strong protective factors Thoughts of death, no plan, intent or behavior Outpatient referral, symptom reduction. Give emergency/crisis numbers (This chart is intended to represent a range of risk levels and interventions, not actual determination

What is a Personality Disorder?

The term “Personality Disorder” implies there is something not-quite-right about someone’s personality. However, the term “personality disorder” simply refers to a diagnostic category of psychiatric disorders characterized by a chronic, inflexible, and maladaptive pattern of relating to the world. This maladaptive pattern is evident in the way a person thinks, feels, and behaves. The most noticeable and significant feature of these disorders is their negative effect on interpersonal relationships. A person with an untreated personality disorder is rarely able to enjoy sustained, meaningful, and rewarding relationships with others, and any relationships they do form are often fraught with problems and difficulties.

To be diagnosed with a “personality disorder” does not mean that someone’s personality is fatally flawed or that they represent some freak of nature. In fact, these disorders are not that uncommon and are deeply troubling and painful to those who are diagnosed with these disorders. Studies on the prevalence of personality disorders performed in different countries and amongst different populations suggest that roughly 10% of adults can be diagnosed with a personality disorder (Torgersen, 2005).

Many types of disorders are evidenced by a complete and total deviation from normal and healthy functioning (e.g., epilepsy). However, personality disorders cannot be understood independently from healthy personalities.  Since everyone has a personality (but not everyone has epileptic seizures), personality disorders reflect a variant form of normal, healthy personality. Thus, a personality disorder exists as a special case of a normal, healthy personality in much the same way as a square is a special case of the more general construct of a rectangle.   Therefore, it is useful for us to begin our discussion of personality disorders by first discussing the broader, more general construct of personality.

WEDNESDAY, March 11, 2015 (HealthDay News) — Rachel Waddingham hears voices.

“I hear about 13 or so voices,” she said in a news release from Durham University, in England. “Each of them is different — some have names, they are different ages and sound like different people. Some of them are very angry and violent, others are scared, and others are mischievous.”

In fact, “for me, the word ‘voices’ isn’t sufficient,” said Waddingham, a trustee of the National Hearing Voices Network in the United Kingdom, and the International Society for Psychological and Social Approaches to Psychosis.

She said that while she uses the word voices to convey her experience, the word also “hides the embodied parts of my experience for which I have few words to describe.”

Now, a new study from Durham University highlights the complexity and variety of the “voices” some psychiatric patients and others experience.

The study was led by Angela Woods of Durham’s Center for Medical Humanities. It included 127 people who had been diagnosed with a psychiatric disorder and 26 others with no history of mental illness. The participants completed an online questionnaire that asked them to describe their experiences of hearing voices in their head.

Many said they hear multiple voices (81 percent) with distinct, character-like qualities (70 percent). Two-thirds said they also experience physical effects from the voices, such as hot or tingling sensations in their hands and feet.

Voices that affected the body were more likely to be abusive or violent and, in some cases, were linked to traumatic experiences, respondents said.

Fear, anxiety, depression and stress were often associated with voices in the head, but 31 percent of the participants also felt positive emotions, according to the study published online March 10 in The Lancet Psychiatry.

Less than half of the people in the study said they heard purely auditory voices, with 45 percent reporting either thought-like or “in-between” voices with both thought-like and auditory features.

This finding challenges the belief that voices in the head are always auditory, and may prove important in future studies into what occurs in the brain when people hear voices, the researchers said.

The authors also reported that their study confirms that both people with and without mental illness hear voices.

“It is crucial to study mental health and human experiences such as voice-hearing from a variety of different perspectives to truly find out what people are experiencing, not just what we think they must be experiencing because they have a particular diagnosis,” Woods said in the news release. “We hope this approach can help inform the development of future clinical interventions,” she said.

Experts in the United States agreed the new findings are important. Dr. Sophia Frangou is chief of the psychosis research program at Icahn School of Medicine in New York City. She said that while the study of voices “goes back a very long way,” the new report “makes a small but interesting contribution.”

And Dr. Alan Manevitz, a clinical psychiatrist at Lenox Hill Hospital in New York City, added that auditory hallucinations are a hallmark of many psychiatric ills. “The treatment and resolution of this symptom has been the way medicine and psychiatry traditionally tracks improvement in patients,” he said.

Manevitz stressed that the new study had several limitations, including the fact that the survey was offered online under less-controlled conditions, had more than double the number of women than men, and didn’t adequately represent minority populations, which are known to have a higher incidence of these types of symptoms of psychosis compared to whites.

Still, Manevitz said the research revealed new details into the nature of voices. For example, “command” voices — the type thought to be most closely linked to the potential for physical harm — were relatively rare, “only prevalent in 5 percent of those participating,” Manevitz said.

In addition, four-fifths of survey respondents “heard multiple voices with different ‘character’ qualities — that means they were of specific age, gender and had distinct identities,” he said. Two-thirds also reported bodily sensations happening alongside the voices.

Those findings are echoed in Waddingham’s own experience. “Sometimes, I hear a child who is very frightened,” she said. “When she is frightened I can sometimes feel pains in my body — burning. If I can help the voice calm down, by doing some grounding strategies, the burning pains stop.”

Waddingham called the new research “a step forward. If we want to understand more about voice-hearing, it makes sense to ask a voice-hearer — and be willing to modify our perception of what it means to hear voices based on their answers.”

More information

The Hearing Voices Network has more about hearing voices and having visions.

This article: Copyright © 2015 HealthDay. All rights reserved.

Recognizing Mental Health Problems in Children Children’s mental health problems are real, common and treatable.Although one in five children has a diagnosable mental health problem, nearly two-thirds of them get little or no help. Untreated mental health problems can disrupt children’s functioning at home, school and in the community. Without treatment, children with mental health issues are at increased risk of school failure, contact with the criminal justice system, dependence on social services, and even suicide. Parents and family members are usually the first to notice if a child has problems with emotions or behavior. Your observations, along with those of teachers and other caregivers, can help determine whether you need to seek help for your child. The following signs may indicate the need for professional help: n Decline in school performance n Poor grades despite strong efforts n Constant worry or anxiety n Repeated refusal to go to school or to take part in normal activities n Hyperactivity or fidgeting n Persistent nightmares n Persistent disobedience or aggression n Frequent temper tantrums n Depression, sadness or irritability Early identification, diagnosis and treatment can help children reach their full potential. If you suspect a problem or have questions, talk with your child’s pediatrician or contact a mental health professional. An evaluation may include consultation with a child psychiatrist, psychological testing and medical tests to rule out any physical condition that could be causing the symptoms. A comprehensive treatment plan should include psychotherapy and, in some cases, may include medication.The plan should be developed with the family.Whenever possible, the child should be involved in treatment decisions. To learn more, contact your local Mental Health Association or the National Mental Health Association at 800-969-NMHA (6642)