Quick Answers to Five Common Questions About Childhood Disorders

Written by Dr. Carosso

Attention-Deficit/Hyperactivity Disorder

What are the core features of ADHD?
Distractibility, hyperactivity, and impulsivity.
What is ADHD?
ADHD can be conceptualized in different ways including as a neurobiological disorder (deficiency in the neurotransmitters dopamine and norepinephrine) and/or a subsequent deficiency in the prefrontal cortex of the brain, which inhibits executive functioning (planning, organizing, attention, impulse control…).
What is the cause of ADHD?
In many respects, we really don’t know, however, there appear to be strong genetic underpinnings. Toxins (lead…), and substance use during pregnancy can also contribute to the disorder.
What is the best treatment(s) for ADHD?
No particular order, these are all effective, especially when used together:

1. Increasing the level of structure

2. Counseling for the parent (to obtain help increasing structure) and for the child (to learn improved coping skills)

3. Medication

What is the prognosis of ADHD?
One-third of individuals improve and function well; 1/3 improve but still need occasional use of strategies and medication; 1/3 have a stable manifestation of their symptoms.
Do the medications work and do the pros outweigh the cons?
ADHD meds tend to be effective for upwards of 80% of diagnosed kids. Side effects are usually managed well by adjusting the dose or type of medication prescribed.

Autism Spectrum Disorder

What are the core features of autism?
Significant deficits in the ability to effectively socialize, use language, evidence of “self-stimulatory behaviors” and/or obsessiveness, and sensory issues.
What is Autism?
Autism is considered to be a neurodevelopmental disorder, i.e. impacts child’s neurological and developmental functioning.
What is the cause of Autism?
We really don’t know. Could be genetics (sibling and twin studies are remarkable in that respect), toxins, or something else.
What is the best treatment for Autism?
You’ll hear that Applied Behavioral Analysis is the best treatment, but that is an extraordinarily broad group of strategies. Usually, when you read of “ABA” for autism, they are actually referring to “Discrete Trial Teaching”, or Lovaas, that is, in fact, quite effective for lower functioning kiddos. Otherwise, counseling and social skills groups are the best option to work on improving coping skills and ability to socialize.
What is the prognosis for autism?
Children diagnosed with moderate to severe autism tend to always have autism and need extra supports though the symptoms can notably improve. Children with mild autism often improve and function quite well.
Is there medication to treat autism?
Medication is used to treat and improve some of the symptoms of autism, but not autism itself.

Oppositional Defiant Disorder (ODD)

What are the core features of ODD?
Child is oppositional and defiant. Not just the normal fussiness you see in children, but often being overtly defiant and argumentative.
What is ODD?
It’s considered to be a behavioral disorder that greatly interferes with daily functioning because the child, rather than complying with a routine and directives, tends to be defiant and argumentative but can also be aggressive and easily lose his or her temper.
What is the cause of ODD?
Children diagnosed with ODD are often born strong-willed and have always had a ‘chip on their shoulder’, so to speak (genetics may play a role). In addition, over-indulging parents don’t especially help the situation. However, in all fairness, sometimes parents simply get worn out and are conditioned, by their defiant child, to avoid butting-heads.
What is the best treatment for ODD?
Counseling for the child and parent to help the child learn to be more easy-going, and for the parent to help deal with the child’s defiance.
What is the prognosis for ODD?
The condition usually improves over time for most kids, especially for more mild cases, but about 10-15% continue to struggle and the condition remains stable or worsens, transitioning to a Conduct Disorder (delinquency). Counseling is vital for improvement.
Is medication effective for Conduct Disorder?
No, not so much.

Anxiety Disorders / Phobias

What are the core features of an anxiety disorder?
Anxiety is always based on fear. In that respect, fear of new situations, separation, talking, being singled-out, going to school, germs, or closed-in places, heights, etc.
What is an anxiety disorder?
Considered to be a disorder manifesting in generalized worry, obsessiveness, compulsive tendencies, panic, general phobia, or social anxiety. An anxiety disorder is not considered to be a mood disorder but can contribute to bouts of depression.
What is the cause of an anxiety disorder?
Genetics, or having experienced a traumatic situation (car accident leads to fear of being in a vehicle…)
What is the best treatment for anxiety?
Counseling based in cognitive-behavioral treatment using deep breathing, bolstering of coping skills with healthy and soothing self-talk, systematic desensitization, and exposure and response prevention techniques.
What is the prognosis for anxiety?
People who struggle with anxiety are usually born anxious and high-strung. Consequently, people with anxiety will likely always be a bit worrisome; however, with counseling and the learning of coping skills, they can adjust quite well and control the anxiety rather than the anxiety controlling them.
Is medication effective for anxiety?
Yes, if counseling proves to be less than effective, there are medications that can help reduce symptoms.

Childhood Depression

What are the core features of childhood depression?
Sad or depressed mood, loss of interest, changes in sleep or appetite, social withdrawal, agitation, and in more severe cases, thoughts of death.
What is a depressive disorder?
A stint of depression, usually persisting for a few weeks, manifesting in the aforementioned symptoms.
What is the cause of childhood depression?
Depression is based in genetics (runs in families) and/or the childhood experiences some loss or major disruption in their life. There is also consideration that deficiencies in particular neurotransmitters come into play.
What is the best treatment for depression?
Counseling based in cognitive-behavioral strategies, and medication.
What is the prognosis for childhood depression?
Depression tends to come and go. If a person experiences a bout of clinical depression (a severe bout), they are likely to experience another. However, counseling can be very helpful and ensure that the individual has a much better chance of maintaining control of the depression symptoms rather than the depression controlling them. Bonus question Are there medications to treat depression? Yes, I’m sure you’re familiar with the anti-depressants that, in fact, can be quite helpful.

Attachment Disorder

What are the core features of an Attachment Disorder?
Difficulty establishing proper bonding and attachment with others.
What is an attachment disorder?
Considered to be a child’s difficulty properly interacting with others because the child has not learned, through direct experience, during infancy and the toddler years that other humans are loving, dependable, trustworthy, and empathetic.
What is the cause of an attachment disorder?
Considered to be caused by neglect and abuse during the infancy and early childhood years. However, attachment can also be influenced by, for example, a parent who tends to the child’s basic needs, but is chronically depressed and not emotionally available for the child.
What’s the difference between an attachment disorder and Reactive Attachment Disorder?
The former is part of a spectrum and can be subtle in how it manifests, while the latter is an extreme and a diagnosable condition divided between the inhibited and disinhibited type (the latter being more severe).
What is the best treatment for an attachment disorder?
A loving and stable home. The research is clear that kids are remarkably amazing and can bounce back if provided with love and attention. Otherwise, counseling is indicated to bolster the relationship and help the child to develop improved coping skills. Trauma therapy may also be indicated.
What is the prognosis for an attachment disorder?
If a loving and stable home can be procured early enough, before the symptoms become more engrained, then the outcome is very good especially for the ‘inhibited type’. However, in more severe cases, the condition can transition into a personality disorder such as anti-social or borderline.
Are there effective medications for an attachment disorder?
Only for the symptoms (depression, anxiety, outbursts), not for the actual attachment disorder.

Dyslexia

What are the core features of dyslexia?
When speaking of dyslexia, the symptoms of writing letters or word backwards often is listed as a primary problem. However, in reality, the primary issue is, simply, problems with decoding words. In that respect, the child is unable to read with accuracy and fluency.
What is dyslexia?
Dyslexia is essentially a deficiency in processing written language. In that respect, the child is intelligent and fully capable of understanding information and concepts, they simply can’t read the written material.
What is the cause of dyslexia?
The condition is considered to be genetic.
What is the best treatment?
Tutoring based in a multi-sensory approach is the standard of care. At the same time, if the child is reading well below grade-level, we transition the child from being an eye-reader to being an ear-reader (listening to the material) and using voice-recognition software to provide a written response.
What is the prognosis for dyslexia?
The outcome is good for mild symptoms but, for more severe cases, the prognosis is less favorable in that child may never be a particularly proficient reader. However, the child can be very successful listening to the material, and using dictation software.