ADHD and mental health therapy

Looks Like ADHD, Feels Like ADHD, but Guess What… it isn’t ADHD!

Everyone knows that when they have a headache, it could be for any number of reasons, from the innocuous to something quite serious. A good doctor will ask many detailed questions in her quest to determine the exact cause of the headache.

Without a thorough examination and assessment, it would be irresponsible for the doctor to declare a diagnosis of either the flu or a life-threatening brain tumor, either of which may be the culprit.

Mental illness and psychological disorders are no different. Entirely different diagnoses can easily explain the identical symptoms. That’s why a qualified, responsible mental health professional will submit your child to an exhaustive examination before declaring any conclusive determination.

Understanding what is causing a particular behavior is crucial as the diagnosis will drive the treatment in one direction or another. Medications designed to alleviate ADHD symptoms won’t work if the reason for the child’s inattention is something else entirely.

ADHD is the Common Diagnosis for Inattention

Teachers are generally the first to observe the child’s inability to focus or pay attention. She may notice that the child is susceptible to daydreaming, is unable to follow directions, or is easily distracted. While young children have shorter attention spans than their older counterparts, nonetheless a significant inability to focus stands will stand out.  

The marked inability to focus or pay attention, along with hyperactivity and impulsivity is one of the three symptoms of ADHD. So naturally, when a child is easily distracted, the first thing the clinician or parent jumps to is to proclaim it ADHD.

However, there is another, a perhaps, more chilling explanation that can explain these symptoms just as well.

Post-Traumatic Stress Disorder

Just a few years ago Dr. Nicole Brown, then a resident at Johns Hopkins Hospital in Baltimore, became quite frustrated by the ineffectiveness of standard ADHD treatments for many of the children she was observing. She hypothesized that perhaps the behavior, classically considered ADHD, was rather the result of some trauma.

Get your free copy of our groundbreaking ebook: Teletherapy Diminishes Client Engagement: Debunking The Myths

Dr. Brown performed a study to test this link between trauma and ADHD diagnosis. She found the following correlation: children who endured four or more adverse childhood events were three times more likely to use ADHD medication. From this study, Dr. Brown concluded that what she was actually seeing in these children may very well not have been ADHD but trauma.

What often seem to be classic ADHD symptoms; impulsivity, hyperactivity, and inability to focus could be masking hypervigilance, dissociation, and impulsivity that might be the result of exaggerated stress response due to some traumatic experience.

It is estimated that over 10% of American children, 6.4 million kids currently carry an ADHD diagnosis! However, some parents and mental health experts have begun to question if this growing epidemic of ADHD is more a function of hasty evaluations, the massive investment of pharmaceutical companies, and increased pressure on educators to produce high-performing students than ADHD.

Other researchers following in Brown’s path have pointed out a seeming eagerness to lean towards and ADHD diagnosis over PTSD. There is far more involved in diagnosing PTSD in a child than observing impulsive and hyperactive behavior. To discover the trauma more time needs to be spent in the evaluation going deeper into the child’s experience.

It’s unclear how many kids are misdiagnosed with ADHD annually. A 2010 study estimated that the number could be close to one million!

To make matters worse, the medications prescribed for ADHD patients are stimulants that increase levels of neurotransmitters in the brain associated with pleasure, movement, and attention. Mental Health professionals are concerned about the detrimental effect these medications will have on children who have PTSD and already feel agitated or hyper-vigilant.

One clinician who has accepted Dr. Brown’s findings is urging her colleagues to abandon the “all-knowing clinician” persona and replace it with the persona of the “really curious practitioner.” Instead of asking, "What is wrong with the child?”, it would be better to ask, “What happened in his or her life?”

autism awareness

Is Sensory Processing Disorder Just a Fancy Name for Autism?

Sensory Integration

Sensory Integration is the process performed by the central nervous system when it takes information in from your body’s eight senses and then responds accordingly. Yes, there are eight sensory systems in your body, not just five!

  • Auditory (sound/hearing)
  • Olfactory (smell)
  • Gustatory (taste)
  • Tactile (touch)
  • Vestibular (movement)
  • Proprioception (input from muscles and joints)
  • Interoception (internal sensors indicating physiological conditions)

What is Sensory Processing Disorder?

Sensory Processing Disorder (SPD) is a neurological disorder that compromises processing information from these eight senses. Unlike blindness or deafness where the sensory information is never received in the brain, the brain of children suffering from SPD receives the sensory information, but it is processed abnormally. This invariably causes child distress, discomfort, and confusion.

Sensory Processing Dysfunction

  • language delays or deficits
  • fine and gross motor delays
  • strong sensory interests
  • sensory aversions
  • an inability to interact with people and objects
  • a failure to stay within an interaction
  • repetitive sensory stereotypies (stimming)

A closer look at Autism and Sensory Processing Dysfunction

Although a sensory processing disorder doesn’t qualify a child for an autism diagnosis, many therapists claim that they have yet to meet a person on the autism spectrum who is not suffering in this area. In fact, most teenagers and adults who are on the spectrum claim that sensory processing challenges are their highest difficulty.

These same teenagers and adults claim that their sensory challenges have impacted every aspect of their lives - relationships, communication, self-awareness, safety and so on. It all begins at the beginning of life. Babies and toddlers learn about the new world around them by using their senses. If a baby processes information abnormally from her senses, she will acquire a distorted view of the world around her and also of herself.

Most teachers and parents are quite aware of how compromised visual and auditory processing can impair classroom learning. Yet, many don’t understand that sensory processing difficulties are a lot more complicated and can have more far-reaching consequences. For example, an LCSW explained that body and spatial awareness are so tricky that when he walks, he has to look at the ground because otherwise, he would lose his sense of balance.

Furthermore, many children on the spectrum find it difficult to tolerate everyday social situations. Meeting someone new can be overwhelming - a different visual stimulus, smell or voice can wreak havoc. This sheds new light on a child who is having difficulties with social relationships. The culprit is not only communication but the total sensory processing experience.

Get your free copy of our groundbreaking ebook: Teletherapy Diminishes Client Engagement: Debunking The Myths

So while all agree that some children do have severe sensory challenges, the debate whether SPD should be considered an independent disorder or is merely a manifestation of Autism goes on unabated. For most children, however, there is little practical consequence as they require the same help irrespective of the classification.

Who can help your child?

Occupational Therapist: Physical activities and strategies are used to help the child to meet their particular sensory needs and enhance processing sensory input in their everyday environments.

Speech Therapist: Helps the child to learn how to reduce sensitivities to sound and stimuli that help improve speech, muscle movements of the mouth and swallowing

Mental Health Therapist: Helps the child’s tolerance to overwhelming sensory experiences to gradually increase through cognitive behavioral therapy

With the advent of teletherapy, many more of these children with sensory processing difficulties can be helped. Teletherapy goes beyond the bounds of time and place and as such offers hope to those many of these suffering children previously unserviced.

parenting mindfulness teletherapy

Parenting with Mindfulness: A Recipe for Raising a Healthy Child

The scenario is all too familiar...

You are on the way to your 9-year-old son’s soccer game and decide to quickly pick up some groceries for supper. You’re choosing a delicious cut of meat and your 2-year old kicks off his shoes in the middle of the aisle. Putting those shoes back on isn’t as easy as it looks. Your toddler’s tantrum quickly spins out of control, and the more you try to force the shoe on his foot, the louder he screams.

When you think you have the shoe back on, your 9-year-old catches a glimpse of the time, and angrily informs you, “We’re gonna be late as usual! Can’t I ever be on time?”

Now you feel everyone’s eyes on you; judging you and your ineffective parenting. Your baby kicks the shoe off again just as your 9-year-old son begins to fly into his own tantrum. You feel the stress, the tightness and are just milliseconds away from losing it, again! For many of us, this is one of those trying moments where we must muster all of our strength not to lose it. And yet it is precisely such a moment that highlights the irreplaceable value of mindfulness in parenting.

Your natural reaction of just plunking your little son down into the shopping cart next to his shoes and castigating your 9-year-old, “Stop being such a cry baby, can’t you see that your baby brother is having a tantrum” is not only admitting failure, but has important ramifications beyond the moment. The angry expression on your face coupled with your sharp verbal jibes will frighten both your children. Instead of learning to improve their behaviors they will become frightened of you and your aggressive behavior that is out of control.

Get your free copy of our groundbreaking ebook: Teletherapy Diminishes Client Engagement: Debunking The Myths

However, there is another way. Mindfulness allows us to pause, step back from the situation momentarily, take stock of our emotional reaction, take a few deep breaths, and respond more calmly and rationally. Some simple replacement behaviors could wholly transform this parenting debacle. First of all, instead of lashing out at your 9-year-old why not lovingly look into your child's eyes and gently tell him, “I see that you are very frustrated and apologize that we will be late for practice.”

Instead of scaring your children, quell your 2-year-old’s emotional storm and restore a sense of safety while simultaneously validating the frustration of your older son.  Our precious children often trigger many different unpleasant emotions inside of us. Such moments of stress can elicit some painful unresolved issues from our past. If we accustom ourselves to practicing mindfulness by pausing before reacting, how we respond to our children will be more aligned with the way we want to treat our children.

Aside from the apparent benefits of regulating our own emotions, practicing mindfulness helps us to be more sensitive and attuned to our kids as well. What’s more, we can help our children to develop their prefrontal cortex enabling them to use their higher brain function to calm the limbic area which is the seat of emotion when they are stressed.

When a child is caught in an emotional storm, appealing to the child’s logic is not only useless but counterproductive. Instead of delivering directives it is more beneficial to connect to them by addressing their feelings. By validating their feelings, we show them that we understand and create an environment of safety. After the child finishes the tantrum and has calmed down, we can appeal to the logic of the left brain to help resolve or at least make sense out of the situation. Developing this logic helps wire the child’s brain to more effectively regulate difficult emotions in the future.

Mindfulness for parents has two parts. First of all, become a parent who practices mindfulness. And secondly, impart upon your children mindfulness tools they can use to make them more resilient when facing the stresses in their lives, including those involving school, bullying, peers, parents, and teachers.

Mindful Parenting

  • Let Intention Guide You: When you are involved in your children's’ activities, start with why. Why help them with homework? If it is merely one more task to check off the checklist, your engagement will be entirely different than if it is seen as an opportunity to bond and better understand their learning process.
  • Remain in the Present: When you spend time with your child, your objective is to be in the present with them. Put away your electronic device and listen to what they are saying. Devoting your complete attention conveys the message that you want to be there for them and that they are worth your time.
  • Communicate Feelings: Our children don’t necessarily react to situations the same way that we do. When parents and children communicate feelings in a safe way, the child feels validated and is encouraged to be true to his/her self; an absolute necessity for emotional health.
  • Listen: Instead of asking questions, encourage your child to talk on his/her own. Allow the conversation to go in the direction of your child’s choosing instead of using it to merely access information. Carefully wait to talk and respond, encouraging your child’s freedom.
  • Don’t Hide Your Mistakes: Who said that parents need to be perfect? We also make mistakes, and when we admit them to our children, we teach them honesty, that mistakes aren’t the end of the world, and that we can learn from our errors to improve.

Mindfulness Techniques to Teach Children

  • Deep breathing: Teach your child to do three consecutive rounds of kids of slow inhalation/exhalation. Slow, steady breathing will help calm the fight/flight response triggered by the amygdala and give them a sense that they can control their emotions instead of vice versa. Help them to picture the release of stress when they exhale.
  • Articulate gratitude: Make it a habit to speak about things for which you are grateful. Use the dinner table as a forum for everyone to share at least one instance in the day that is worthy of gratitude.
  • Meditation: Children generally can’t sit for longer than their age; a 7-year-old for seven minutes. Show them the calmness that comes when you slow down and try to get in touch with what is going on inside. Remember to model it, but don’t enforce it.
teletherapy adverse child experiences

Adverse Childhood Experiences: Disturbing Impact on a Child’s Brain

It would do parents and therapists well, whether the therapist delivers therapy face-to-face or via teletherapy, to better understand the source of anxiety, depression, and addiction that their children are suffering. Perhaps a place to begin is to become familiar with an eye-opening study conducted some 20 years.

Vincent Felitti and Robert Anda launched a large-scale epidemiological study of 17,000 adults in 1995 designed to search for connections between childhood experiences and their health records as adults.  

The results of this study shook the mental health world. Practically two-thirds of those individuals in the study had suffered at least one adverse childhood experience (ACE)—a term Felitti and Anda invented to describe those unpredictable, chronic stress-inducing, that some kids unfortunately experience.

These adverse experiences ranged from having a parent who was either an addict, alcoholic or depressed; parental death or divorce; being bullied or some other form of being humiliated; or being either physically, emotionally or sexually abused. The commonality of these traumas was that they were more destructive than the typical challenges that most of us experience as we grow up.

But beyond the sheer number of children who suffered these experiences was the nearly direct correlation between the number adverse childhood experiences and the ability to accurately predict the amount of medical care that the same child would require as an adult.

  • Those who had suffered from four categories of ACEs were twice as likely to contract cancer in adulthood than those who had not ACEs in their past.
  • For women, the risk of becoming hospitalized with an autoimmune disease jumped 20% with each ACE.
  • Anyone who had an ACE score of 4 was more than 400% more likely to be afflicted with depression than an individual with an ACE score of 0.
  • Those with an ACE score of at least 6 had a reduced life space of nearly 20 years.

For years neuroscientists across the country have been analyzing and interpreting the data of ACE Study to yield an entirely new understanding of that elusive brain-body connection. Taken down to the biochemical level, these scientists have shown how childhood stress impacts cells, DNA, and the brain resulting in life-altering changes as an adult.

1. Shifting Epigenetically

Children suffering ACE showed genetic differences that went beyond affecting the stress response, but also genetic changes responsible for a wide array of diseases found in adults. These findings seem to negate the long-held distinctions between what is considered “physical” disease and what is “mental” or “emotional.”

The child who is consistently thrust into stress-inducing situations is subjected to a physiological response that shifts her into overdrive. This constant stress ultimately compromises her ability to respond appropriately and effectively to future stressors even years later.  In neuroscience, this is known as gene methylation.

Methylation is when small chemical markers adhere to the genes responsible for regulating the stress response, compromising their effectiveness. When the function of these genes is altered, the genes resets the stress response on “high” for life, promoting inflammation and disease.  The consequence is a predisposition to several chronic conditions, including autoimmune disease, heart disease, cancer, and depression.

Get your free copy of our groundbreaking ebook: Teletherapy Diminishes Client Engagement: Debunking The Myths

2. Altering the Shape and Size of the Brain

MRI studies show that there is a direct relationship between a high ACE score and a reduction of the gray matter in vital areas of the brain, including the prefrontal cortex, the seat of decision-making and self-regulatory skills, and the amygdala, or fear-processing center.

Also, scientists have discovered that chronic brain stress causes the release of a hormone that shrinks the size of the hippocampus. The hippocampus is that area of the brain responsible for processing emotion and memory and managing stress.

As a result, those whose brains have been altered by their Adverse Childhood Experiences are generally more likely to become adults who will over-react to stressors that others consider minor and handle with relative ease.

3. Connectivity in the Brain

Children who have experienced chronic childhood adversity have weaker neural connections between the prefrontal cortex and the hippocampus, compromising several functions of the brain.

Girls, in particular, displayed weaker connections between the prefrontal cortex and the amygdala. The relationship of the prefrontal cortex and the amygdala plays a crucial role in determining how emotionally reactive a person is to those regular occurrences that happen in daily life, and how likely they have perceived these events as stressful.

What’s more, girls with these compromised neural connections were at a higher risk for developing anxiety and depression in later adolescence. This may partially explain why females suffer from mood disorders nearly twice as often as males at that age.

Hope After ACE

All of this science can be overwhelming, especially for parents and therapists. But the good news is that just as the understanding of how childhood adversity impacts the brain is growing, so too is the understanding of how better parenting and mental health therapy delivered either face-to-face or through teletherapy can help children heal.