Archives for October, 2011
It’s report card time here in New Mexico and I am getting lots of phone calls from parents who have recently had parent teacher conferences. By far, the biggest referral I get is for kids who are suspected of having attention deficit disorder (ADD or ADHD). Almost 20 years ago, I began collecting material for my dissertation which was about the relationship between ADHD, empathy, and perspective taking (the ability to understand that other people have thoughts and feelings). At that time, I was curious to learn more about a disorder that appeared to be increasing within the population. The majority of researchers believed that ADHD was, in most cases, related to genes or a problem during the pregnancy or birth.
“Study Confirms Your Worst Fears About Public Potties!” This headline bounced all around the Internet recently. Similarly, we often see television reporters swoop in like a swat team on hotels to check the cleanliness of their rooms. Invariably, they find hotel rooms teaming with bacteria. Other reporters have analyzed escalator railings and obtained similar, alarming findings. We saw a report a few years ago that detailed the dangers of buying used, refurbished mattresses due to bed bugs, fecal matter, and various body fluids that still inhabited such mattresses even after the refurbishing process.
I remember when e-mail started to become one of the primary ways people communicated with one another, and my mother refused to even consider learning how to use it. Sure, she was getting older, but she still had a very sharp, highly intelligent mind. I wondered why in the world she wouldn’t embrace this new, obviously more convenient way of communicating. She wouldn’t even consider looking at a totally simplistic device that had but one function: sending and receiving e-mail. She was also a rather stubborn person so I thought perhaps that was the problem. But, upon more reflection and observation, I realized that she simply was fearful, almost phobic about anything that even remotely seemed “technological” in nature. I also concluded that she wasn’t going to listen to me and that she would spend the remainder of her days on this earth avoidant of and resistant to new technologies. Oh well, I figured that was her right, even though I thought she should probably find a way to deal with her fear.
Social phobia is more than shyness. It involves intense worry about being with people you don’t know, or fear of unfamiliar situations. People with social phobia worry about being judged or evaluated for their actions. And they predict that those judgments will be harsh, negative, and humiliating. They understand that their concerns are greater than warranted, but find themselves overwhelmed with strong feelings of fear. These fears lead to avoidance of people or situations that make them uncomfortable—not to mention terrified. Children and teens with social phobia don’t answer questions in school even when they know the right answer. They don’t want to seek attention and can seem distant, unfriendly, and sometimes even arrogant to others. As adults, they may avoid speaking up at work, making presentations, being socially interactive, and being assertive. It’s understandable that those with social phobia are often underachievers—at school, at work, and in relationships. People with social phobia usually don’t seek treatment for their condition. That makes sense, because they tend to avoid attention of any kind and rarely ask for help. They don’t want to make a call to a mental health professional or seek a referral from their medical provider. Those with social phobia may lead restricted, lonely lives because of their condition.
No one really knows why there seems to be an incredible rise in the rates of people with autism. Conservative estimates point to a 300% increase. Some of the increase is likely due to better diagnosis. And we know that autism runs in families and appears to have a genetic component. Others point to environmental stressors such as increased exposure to pesticides and hormones. But there is little certainty in the scientific community about what is happening. Children and people with mild autism sometimes appear to others as self-contained and aloof. Others may assume that those with autism are pretty calm, cool, and collected. However, they are likely very wrong. Those with autism may suffer increased levels of anxiety and stress because of interpersonal isolation. They feel different from other people and worry that they may be disliked or misunderstood. This may lead the child or adult with autism to withdraw or avoid. This lack of contact with others can lead to more awkwardness and lack of opportunities to practice social interactions.
A colleague of mine (Dr. David Antonuccio) recently co-authored an article that he believes will be received with enthusiasm similar to that sparked by an army of fire ants at a picnic. In other words, he expects a lot of opposition and push back. But what would a serious academic like Dr. Antonuccio write that could evoke such a response?
Some of our readers may know that Chuck and I are returning to a small private practice. I’ve written before about the, shall we say, challenges of starting up a new practice after being away for several years. Nevertheless, we are marching along. We hope to focus on providing cognitive behavioral psychotherapy. But a small part of both of our practices will feature psychological assessment. The art and practice of psychological assessment and diagnosis can be fascinating. I get a great deal of satisfaction out of accumulating information, administering tests, delving through records, getting to know someone and putting it all together into a description and usually a diagnosis. It’s the sort of work that a good detective does; gathering facts, considering theories, and solving a mystery.
Like most professionals, states require psychologists to keep up with current research through continuing education. Yesterday, I attended a lecture on the differential diagnosis of ADHD and or Bipolar disorder in kids. Not surprisingly, the water is muddied by the similarity of some of the symptoms and the fact that most kids with Bipolar Disorder have other problems such as ADHD, Learning Disabilities, Opposition Defiant Disorder, among others. Another problem the presenters mentioned was that today there are 40 times more kids diagnosed as bipolar than in the mid-1990’s. Thus, the presenters raised the questions as to whether we are seeing more kids with bipolar, are we better at spotting this diagnosis, or are we over-diagnosing kids with bipolar disorder? Additionally there are troubling concerns that only a few research teams are responsible for most of the research on this topic.