Written by Dr. John Carosso

It’s only been a week:

It’s been barely a week since my last post about the difficulty deciphering research findings given the bias in the reporting. In that respect, you may already have heard the findings of a recent meta-analysis, regarding the effect of anti-depressants on self-stimulatory behavior, suggesting that studies reporting positive results were more likely to be published than those with negative or neutral results.

The Bane of Bias:

This type of misrepresentation is destructive for many reasons; including that it may dissuade parents from considering such medication even when their child is struggling significantly with self-stimulatory behaviors (hand-flapping, rocking, obsessing…). These findings only result in more confusion and cynicism, which is especially troubling given the evidence that these medications can have a positive impact on certain types of “stims.” I work as a Licensed Child Psychologist, not a psychiatrist, but I have seen countless kiddos benefiting greatly from an antidepressant. However, I have found such benefit more-so for obsessive tendencies, compulsive behaviors, and rumination rather than stims such as hand-flapping or rocking. In any case, it’s vital to consult with your child’s psychiatrist or pediatrician to thoroughly discuss the pro’s and con’s.

Behavioral interventions for “stims”:

Check out my prior post, “De-Stimulating those Stims” for a full description of how to use a litany of behavioral interventions to target those troublesome behaviors.

Speaking of depression:

Talk with your child’s psychiatrist, pediatrician, or DAN doctor about the natural supplement, SAMe (S-Adenosyl Methionine) for the treatment of depression. The recent studies, which appear to be well-done with valid results, have been exceedingly positive with a quick reaction time and few side effects.

Diet and ADHD:

Researchers from the University of Copenhagen just completed an extensive report reviewing the potential benefits of dietary modifications in the treatment of ADHD. The report suggests that any number of dietary changes have produced positive results, such as increasing fatty acids, as well as elimination diets (removing red dye). Okay, like we did didn’t already know this? In any case, the reports also highlights that more research is needed due to some contradictory findings (kinda already knew that too). Nevertheless, given that such dietary approaches are benign if not beneficial, experimentation would appear worthwhile. Professionally, I’ve seen a hundreds of children benefit; talk to a dietitian or DAN doctor in that regard.

More about Depression

There is evidence to suggest that a new computer game is beneficial for treating adolescent depression. The program, called “SPARX”, is interactive, 3-D, and involves the teen taking on various challenges that ultimately attack the child’s “Gloomy Negative Automatic Thoughts.” I don’t know if the program works, but clearly the underlying strategy is vitally important; I tell parents all the time about how to help their kids to view the world in a more positive way. The classic book “Feeling Good”, by Dr. David Burns, is a good read in that regard.

Sum it up

1. Don’t be afraid to talk to your child’s doctor about any troublesome self-stimulatory behavior, especially if obsessive in nature.
2. Do some research on SAMe
3. Go to cpcwecare.com, to our Parent Resource section, and find the dietary guide, which can be very helpful regarding ADHD.
4. Attack negative self-talk that contributes to depression.

I think that sums it up. Please comment about your experiences. God bless you.

Written by Dr. John Carosso

Tragedy happens: what can we say?
Whether it’s a school shooting, car crash, natural disaster, or a natural death of a loved one, we must regularly face the pain of tragedy and loss. I am often asked by parents how they can relieve the pain and fear experienced by their child. That’s a tough question; there is no way to completely alleviate pain, worry, and suffering from this life, but there are ways to help. Here it goes.

Time heals all wounds?
It may be true that time heals, but there are ways to help and speed-along the healing process, increase resiliency, and put things into perspective to promote acceptance of hardships. It makes a difference if a child is fearful of a tragedy they see on TV, or if they are directly experiencing the event. We’ll touch on both here in this post.

Worriers
I often work with kiddos who struggle with “what if’s” and fears that the worst will occur (someone will break into the house, a tornado will strike, the house will burn down, Mom or Dad will die…) and usually these fears are exacerbated by some recent tragedy witnessed on TV. Children who have a history of worry and anxiety are obviously more vulnerable to such fears (may be best to turn-off the TV).

Bolster the ‘Truth’ Army
We use the ‘truth’ to manage this problem; plain and simple. We’re honest with kids that bad things happen at times, and that there could be a robbery, or a tornado, or fire. However, the truth of the matter is that the likelihood is, generally speaking, remote. Other reassurances include that Mom and Dad are sleeping right down the hall, they are both healthy and show no signs of illness, we have an alarm and locks on the doors, there has not been a tornado around here in the past 50 years, we live in a relatively safe neighborhood, we’ve never been robbed (given these things are true)… During the countess encounters I’ve had with worrying kiddos, I’ve often found them to be ill-prepared to counter worries with such truthful and reassuring thoughts. So, we need to bolster the ‘army’ of reassuring self-talk through reminders, postings on the wall, and journaling, all of which invariably has a calming effect.

What else is there?
Children are remarkably perceptive to life events and realities. On many occasions young children have explained to me a recognition, on varying levels, that life is difficult and loss is to be expected, and there must be something more. To help children deal with loss, clinically, we’ve found that children experiencing loss need lots of extra attention, empathy, reassurance that their needs will be met, ongoing consistency and predictability in their environment (to the extent possible), patience, extra love, and adults who are emotionally strong and ‘keeping it together’. From a spiritual perspective, I have found the Judeo-Christian perspective quite helpful, which explains, in no uncertain terms: we live in a fallen world where bad things happen; we try to make the world a better place by showing God’s love; this world is not where we belong, this is not our home – we’re just passing through on our way to a better place; we will go through bad times; God will help us through the bad times; we all will die someday; and we have hope of all meeting together again in Heaven. This reality does not take away the pain, but helps kids (and adults) to recognize the realities of life, and squelch the destructive mentality of “why me” or “why did this happen”.

What not to say?
I’ve read that we should not tell kids who have experienced a loss of a loved one that, for example, “Grandpap is in a better place.” Well, I’m not sure we shouldn’t say that. It depends on lots of factors, but I think that we all take comfort believing our deceased loved ones are in a “better place” awaiting our arrival. This has been helpful for me, how about you? Of course, we also need to provide the reassurance I suggested above, both in what we do and say. People deal with loss in different ways; the goal is that we demonstrate resiliency, after a time of mourning, by ‘keeping on’ with life and finding joy where you can.

Now what?
There are no magic words to help a person heal. It’s a matter of listening, empathizing, at times being quiet and ‘just being there’, providing comfort and affection, and reminding that you’ll all be working together to move on with life, no matter how hard it may seem at the time.

I hope you found this to be somewhat helpful. I’d love to hear what has worked for you in managing your child’s fears or loss. Feel free to Comment here, or email me at jcarosso@cpcwecare.com. God bless you.

Written by Dr. Carosso

The Diagnostic and Statistical Manual is the primary manual psychologists use to diagnose. The upcoming Fifth Edition will have some significant revisions to how autism is diagnosed, and I’m hearing concerns from parents that this could effect insurance reimbursement and services.

Well, there are some significant changes; gone are the current diagnoses such as Autistic Disorder, PDDNOS, and Asperger’s. Instead, the more global term “Autism Spectrum Disorder” is used, but the specific diagnostic criteria, and qualifiers, seem to be quite explicit and appear to cover the necessary bases. Severity criteria is also forthcoming to help differentiate between the former diagnoses. Some might say the upcoming diagnostic criterion is more user-friendly and specific. Of course, between now and release in May 2013, some things could change, but have a look for yourself:

Autism Spectrum Disorder
Must meet criteria A, B, C, and D:
A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:
1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,
2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people
B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:
1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).
3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).
C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
D. Symptoms together limit and impair everyday functioning.

I’ll keep you informed of any other changes but, in the meantime, I hope this helps to squelch some fears. We’ll look at this further as the release date nears.
Please feel free to comment or ask any questions.
God bless.