Adult Anxiety Disorders

Everyone worries. As our age increases, so do our worries. Finances, health, and children can all be things that keep us up at night. In many ways, worry is a good thing. It can be the motivating force that helps us stick with a problem or a project until we find a solution. But when the worry is excessive, and interferes with normal daily functioning, it may be a sign of a more serious anxiety disorder.

General symptoms of anxiety, as opposed to worry, include:

The following are five types of anxiety disorders that commonly occur in adults:

• Generalized Anxiety Disorder
• Obsessive-Compulsive Disorder
• Panic Disorder
• Social Phobia
• Post Traumatic Stress Disorder

Anxiety disorders can look like many different things, which may result in an inaccurate diagnosis. Therefore, it is important to receive a thorough evaluation of social, emotional, and academic functioning in order to fully assess the presenting symptoms and issues. If undiagnosed and untreated, anxiety disorders can have significant effects on an individual’s life, including poor social relationships, depression, poor academic/job performance, and may lead to other disorders, such as depression or substance abuse.

If you recognize any of these symptoms in yourself or a loved one, a psychological evaluation is recommended. The Tarnow Center offers both assessment and treatment for anxiety disorders using a biopsychosocial approach that addresses the medical and psychosocial needs of the individual and the family. Appropriate intervention for anxiety disorders includes:

• Individual Therapy: Individual work focuses on developing specific skills for managing anxiety, while also addressing the struggles with daily stressors and low self-esteem that often accompany a diagnosis of anxiety.

• Biofeedback: Like individual therapy, Biofeedback works by teaching specific anxiety management skills to the client. Biofeedback employs the use of technology to make the client more aware of the internal processes that contribute to anxiety, and in doing so, teaches the client to better control these processes.

• Family Therapy: Family work is important in the treatment of anxiety in that it focuses on developing open communication and expression of emotion, while teaching parents/loved ones techniques to utilize at home with the client.

• Group Therapy: Groups provide safe and appropriate social training where the client can get feedback from peers and professionals about how to regulate their behavior.

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Anxiety Disorders in Children

Anxiety is common in children and adolescents and can often be an understandable response to normal developmental challenges (e.g., not wanting to separate from parents during preschool, being scared of the dark, shy/fearful of strangers). These anxious responses are often short and do not lead to significant problems with the child’s daily life. What separates normal anxiety from an anxiety disorder is when the anxiety is irrational and persistent and significantly impairs the child’s daily functioning.

Anxiety disorders occur in approximately one out of eight children. Anxiety in children may often be misinterpreted or misdiagnosed as Attention Deficit Hyperactivity Disorder (ADHD) given that both disorders have many symptoms in common. due to the similar problems concentrating, distractibility, daydreaming, fidgeting or restlessness, and impatience. Children suffering from an anxiety disorder may have a co-existing disorder of depression, eating disorders, ADHD, or other learning problems; thus, a thorough evaluation is often necessary to fully evaluate the symptoms and differential diagnoses.

General symptoms of childhood anxiety may include:

• Worrying about things before they happen
• Constant concerns about family, school, friends, or activities
• Repetitive, unwanted thoughts (obsessions) or actions (compulsions)
• Fears of embarrassment or making mistakes
• Low self esteem and lack of self-confidence

The following are six primary types of anxiety disorders commonly occurring in children:

• Obsessive-Compulsive Disorder
• Pediatric Generalized Anxiety Disorder
• Social Phobia (Social Anxiety Disorder)
• Separation Anxiety
• Panic Disorder
• Post Traumatic Disorder

Anxiety disorders during childhood may appear as many different things, which may result in an inaccurate diagnosis. Therefore, it is important to receive a thorough evaluation of a social, emotional, and academic functioning in order to fully assess the presenting symptoms and issues. If undiagnosed and untreated, anxiety disorders can have significant effects on an individual’s life, including poor social relationships, depression, poor academic performance, and may lead to other disorders, such as depression or substance abuse.

The Tarnow Center offers a variety of approaches to the treatment of childhood anxiety disorders. Individual therapy and biofeedback focuses on developing specific skills for managing anxiety, while also addressing the struggles with daily stressors and low self-esteem that often accompany a diagnosis of anxiety. Family therapy focuses on developing open communication and expression of emotion and teaches the parents techniques to utilize at home with the anxious child. Additionally, group therapy provides safe and appropriate social training, where the child can get feedback from peers and adults about how to regulate their behavior.

The Tarnow Center offers a variety of approaches to the treatment of childhood anxiety disorders.

• Individual Therapy: Individual work focuses on developing specific skills for managing anxiety, while also addressing the struggles with daily stressors and low self-esteem that often accompany a diagnosis of anxiety.

• Biofeedback: Like individual therapy, Biofeedback works by teaching specific anxiety management skills to the client. Biofeedback employs the use of technology to make the client more aware of the internal processes that contribute to anxiety, and in doing so, teaches the client to better control these processes.

• Family Therapy: Family work is important in the treatment of anxiety in that it focuses on developing open communication and expression of emotion, while teaching parents techniques to utilize at home with the anxious child.

• Group Therapy: Groups provide safe and appropriate social training where the child can get feedback from peers and adults about how to regulate their behavior.

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Autistic Spectrum Disorders

Autistic Spectrum Disorders (ASD), also known as Pervasive Developmental Disorders, are “umbrella” terms used to refer to a family of disorders that share some characteristics, but that can differ in severity of impairment. Common Spectrum Disorders are listed below:

• Autistic Disorder
• Asperger's Disorder
• Rett’s Disorder
• Childhood Disintegrative Disorder

Most Spectrum disorders are characterized by children who don’t follow “typical” development of social and communication skills, and who display what are known as “repetitive, stereotyped” behaviors. Examples of these symptoms are listed in the tables below:

Social Impairments
Poor eye contact
Difficulty responding in typical “back and forth” communication
Seem indifferent to sharing their enjoyment of toys/objects with others
Difficulty understanding/empathizing with the emotions/feelings of others

Communication Delays
Delays in developing spoken language
Slow to respond to attempts at getting their attention
Repeat words or phrases they hear, also known as “echolalia”

Repetitive / Stereotyped Behaviors
Flapping hands or arms when excited
Intense preoccupation with specific topics/objects such as trains, calendars, planets
Extremely upset by changes in routine

ASD tends to affect 1 in 110 children, with boys being 4 to 5 times as likely to develop ASD. Scientists have not identified a specific factor that contributes to a child developing ASD, but believe that both environmental and genetic influences play a role. Previous theories tried to link ASD to certain vaccines given in infancy, but current research widely rejects this notion.

While there is no “cure” for ASD, early identification and treatment makes a significant difference in the ability of these children to reach their full potential. A good assessment that looks into the child’s interpersonal relationships, emotional functioning, learning style, and speech/language functioning is critical as soon as symptoms are suspected.

If you recognize any of these patterns in yourself, a friend, or a loved one, a psychological evaluation is recommended. The Tarnow Center offers both assessment and treatment for autistic spectrum disorders using a biopsychosocial approach that addresses the medical and psychosocial needs of the child and their family. Appropriate intervention for ASD includes:

• Family Therapy: Helps parents and siblings develop individualized strategies to manage the ASD child’s behaviors and anxiety. Family therapy also provides support to families with an ASD member.
• Group Therapy: Specifically focuses on strengthening the child’s social and communication skills, as well as develop the child’s “social radar.” Appropriateness for group therapy will depend on the child’s current language skills.
• Speech and language therapy: Address and strengthen difficulties in communication.
• Biologically based treatments: Medical (pharmaceutical) therapy or Neurofeedback can support and supplement skill building therapies.

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Attention Deficit/Hyperactivity Disorder

Attention Deficit/Hyperactivity Disorder (ADHD) is a neurobiological disorder affecting parts of the brain that control alertness, attention, and behavior regulation. It is commonly referred to as “ADD,” but there is no difference between the two. ADHD is typically diagnosed in children and adolescents, and can look different depending on whether the child is primarily Inattentive, or Hyperactive/Impulsive. There is also a third subtype of ADHD, the Combined Type, which includes both Inattention and Hyperactivity/Impulsivity. The features of both the Inattentive and Hyperactive/Impulsive subtypes are listed below:

Just because it looks like ADHD does not mean that it is ADHD. There are many other problems, such as Depression, Anxiety, or Learning Disorders, that can mimic ADHD or exist alongside ADHD. Therefore, a diagnosis of ADHD requires an in-depth evaluation of a child’s social, emotional, and academic functioning.

It is important to note that ADHD is not just a disorder of childhood, and is a lifelong condition. Symptoms of hyperactivity generally fade in young adulthood, but difficulties with impulsivity and inattention tend to be consistent throughout the lifespan. It cannot be “cured,” but effective treatment will teach the child how to develop the skills that he or she is lacking, and therefore better manage life with ADHD.

The Tarnow Center offers a variety of approaches to the treatment of ADHD. Individual therapy focuses on developing specific skills, while also addressing the struggles with mood and low self-esteem that often accompany a diagnosis of ADHD. Family therapy teaches parents how to incorporate the structure and support at home that will help the ADHD child thrive. And group therapy provides safe and appropriate social training, where the child can get feedback from peers and adults about how to regulate their behavior.

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Autistic Spectrum Disorders

Autistic Spectrum Disorders (ASD), also known as Pervasive Developmental Disorders, are “umbrella” terms used to refer to a family of disorders that share some characteristics, but that can differ in severity of impairment. Common Spectrum Disorders are listed below:

• Autistic Disorders
• Asperger's Disorder
• Rett’s Disorder
• Childhood Disintegrative Disorder

Most Spectrum disorders are characterized by children who don’t follow “typical” development of social and communication skills, and who display what are known as “repetitive, stereotyped” behaviors. Examples of these symptoms are listed in the tables below:

Social Impairments
Poor eye contact
Difficulty responding in typical “back and forth” communication
Seem indifferent to sharing their enjoyment of toys/objects with others
Difficulty understanding/empathizing with the emotions/feelings of others

Communication Delays
Delays in developing spoken language
Slow to respond to attempts at getting their attention
Repeat words or phrases they hear, also known as “echolalia”

Repetitive / Stereotyped Behaviors
Flapping hands or arms when excited
Intense preoccupation with specific topics/objects such as trains, calendars, planets
Extremely upset by changes in routine

ASD tends to affect 1 in 110 children, with boys being 4 to 5 times as likely to develop ASD. Scientists have not identified a specific factor that contributes to a child developing ASD, but believe that both environmental and genetic influences play a role. Previous theories tried to link ASD to certain vaccines given in infancy, but current research widely rejects this notion.

While there is no “cure” for ASD, early identification and treatment makes a significant difference in the ability of these children to reach their full potential. A good assessment that looks into the child’s interpersonal relationships, emotional functioning, learning style, and speech/language functioning is critical as soon as symptoms are suspected.

If you recognize any of these patterns in yourself, a friend, or a loved one, a psychological evaluation is recommended. The Tarnow Center offers both assessment and treatment for autistic spectrum disorders using a biopsychosocial approach that addresses the medical and psychosocial needs of the child and their family. Appropriate intervention for ASD includes:

• Family Therapy: Helps parents and siblings develop individualized strategies to manage the ASD child’s behaviors and anxiety. Family therapy also provides support to families with an ASD member.
• Group Therapy: Specifically focuses on strengthening the child’s social and communication skills, as well as develop the child’s “social radar.” Appropriateness for group therapy will depend on the child’s current language skills.
• Speech and language therapy: Address and strengthen difficulties in communication.
• Biologically based treatments: Medical (pharmaceutical) therapy or Neurofeedback can support and supplement skill building therapies.

Bereavement

Bereavement is a normal process that people go through when they have suffered a major loss. While grief is typically associated with the death of a loved one, people may also experience a grief reaction to an incurable illness, the end of a significant relationship, or a major life change such as job loss. Some of the symptoms of the grieving process include sleep and appetite changes, lack of productivity at work or school, withdrawal from social contacts and family members, and crying spells.

The immediate phase of the grieving process can last up to two months. Milder symptoms can last for a year or longer. If these symptoms persist without improving, or someone is not able to return to normal functioning within a reasonable time, psychological counseling may be helpful.

Here at the Tarnow Center for Self Management our experienced clinical staff can offer individual, family and group counseling for clients of all ages who have experienced a loss. Regardless of the nature of the loss, grieving proceeds through five distinct stages (listed below). This journey isn’t linear; we don’t just move straight through. Instead, most people go back and forth between stages several times before reaching Acceptance. For many, it is often helpful to have a professional to guide and support them as they move through the grieving process.

The Five Stages of Grief

• Denial: Denial is our mind’s way of protecting you from fully experiencing a loss. Initially, it may be a numb feeling, or a state of shock. As time goes on, denial becomes more of a distortion of the truth, a way of looking at things that tells us what we want to believe. The message of Denial is, “This isn’t happening.”
• Anger: As we move into anger, we’re starting to address the reality of the situation. Anger protects us from feeling the pain by focusing our pain outward. The message of Anger is, “Who is to blame?”
• strongBargaining: Eventually, we realize that it just doesn’t matter. Anger hasn’t gotten rid of the problem, and it may have actually created some problems of its own. So now we start looking for resolution. Sometimes we bargain to prevent a certain outcome (“If you just take this away from me, I’ll…”), and at times we bargain to avoid the pain (“If I just buy this car/suit/pair of shoes, I’ll feel better.”). The message of Bargaining is, “This will make it all better.”
• Depression: But many times, it doesn’t. There are just some things that cannot be undone, and some problems that cannot be fixed. Sooner or later, we have to face that from which we’ve been running all this time: reality. But reality is hard. Reality is painful. Reality is… depressing. It’s really difficult to sit with reality for very long, and we often bounce right back into Bargaining. But when we’re able to stay with our pain long enough to work through it, we work our way to Acceptance.
• Acceptance: Acceptance is exactly that. Where Denial tells us “This isn’t happening,” Acceptance tells us, “This is happening, and we’ll get through it.” Acceptance is when we stop running away from the truth, and instead accept that truth as part of our worlds, and then look ahead to how to make the best of it.

Bipolar Disorder

Bipolar Disorder is a mood disorder where the person “cycles” between a very good mood (or irritable mood) and a very depressed mood. It is known as “Bipolar” because the person’s mood seems to go between two extremes, or “poles.” The two extremes are known as “Mania” (elevated, or irritated mood) and “Depression” (sad, depressed mood). The symptoms for both Mania and Depression are listed below:

There are a few different types of Bipolar Disorders:

• Bipolar I and Bipolar II both involve episodes of depression. What distinguishes the two are the presence and intensity of the manic symptoms. People with Bipolar II experience levels of high energy and impulsivity that are not as extreme as mania, and are instead known as “Hypomania.”

• Cyclothymic Disorderis a mood disorder where the person’s mood alternates between less severe forms of mania and depression.

If you recognize any of these patterns in yourself, a friend, or a loved one, a psychological evaluation is recommended. The TarnowCenter offers both assessment and treatment for Mood Disorders using a biopsychosocial approach that addresses the medical and psychosocial needs of the individual and the family. Appropriate intervention for Bipolar Disorders includes:

• Medical Evaluation: Medication can be critical in helping the client better regulate his/her mood swings. Once medication and mood have been stabilized, the client can move on to learning Self-Management skills that help identify and control triggers for mood dysregulation.

• Individual Therapy: The goal of individual therapy is to help the client identify warning signs that their mood is going to change, and then practice strategies to regulate behavior and functioning.
• Family Therapy: Family therapy helps the client’s family to better understand the nuances of bipolar depression, and learn how to support the client as he/she works to control the mood transitions.

Conduct Disorder

Conduct disorder (CD) is sometimes thought of as a more severe form of Oppositional Defiant Disorder (ODD). It involves an ongoing pattern of behaviors in which the child violates the basic rights of others or routinely breaks society’s rules. The behavior typically involves destruction, aggression, and/or dishonesty. The conduct is divided into four groups, and examples of each are listed below:

Conduct Disorder is more typically seen in males than in females. Male children with Conduct Disorder frequently fight, steal, vandalize, and have school discipline problems. Female children with Conduct Disorder are more likely to lie, be truant, run away, or use substances. Boys demonstrate more confrontational aggression (fighting) and girls demonstrate more non-confrontational aggression.

If you recognize any of these patterns in a child or a loved one, a psychological evaluation is recommended. The Tarnow Center offers both assessment and treatment for Conduct Disorder using a biopsychosocial approach that addresses the medical and psychosocial needs of the individual and the family. Appropriate intervention for Conduct Disorder includes:

• Individual Therapy: Cognitive-behavioral approaches to individual therapy are most effective in treating Conduct Disorder. The goal of therapy is to develop skills which teach the child anger management, coping with peer relationships, and problem-solving, among others.
• Family Therapy/Parenting Skills: Family therapy helps the client’s parents learn specific strategies to provide the structure and support that the CD child needs while he/she is working to change maladaptive behaviors.

Depression

Depression is often described as feeling sad, “blue,” or “down in the dumps.” All of us feel this way at one time or another. There are a lot of events that occur in our lives that are hard to process, and it is normal to feel depressed after life hands you a tough loss. Examples might be:

• Loss of a loved one such as a family member, friend, or pet
• The end of a relationship (divorce, break-up, etc.)
• A traumatic event such as being in a car accident, or being the victim of an assault

But sometimes, the feeling of sadness won’t go away. What separates feeling “sad” from clinical depression is when the person is experiencing some (or all) of the following for 2 weeks or more:

If you recognize any of these patterns in yourself, a friend, or a loved one, a psychological evaluation is recommended. The TarnowCenter offers both assessment and treatment for Depressive Disorders using a biopsychosocial approach that addresses the medical and psychosocial needs of the individual and the family. Appropriate intervention for Depression includes:

• Medical Evaluation: Medication may be useful in cases where the depression is having a more severe impact on the client’s functioning. Medications can help the client fight off the “heaviness” of the depression in order to better practice effective coping skills.
• Individual Therapy: The goal of individual therapy is to reengage the client with his/her life. Therapy helps the client identify thoughts and behaviors that contribute to depression, and then practice specific techniques to challenge the depressive mindset.
• Family Therapy: Family therapy helps the client’s family to better understand depression, and learn how to provide the client the support and structure that he/she will need to work through the depression.
• Group Therapy: Group therapy serves to get the client into a room with his/her peers and away from isolation and rumination. Group enables the client to share his/her “automatic thoughts” that lead to depression, and thereby challenge these thoughts with feedback from the group.

Enuresis & Encopresis

Elimination Disorders

Daytime or nighttime wetting (diurnal or nocturnal enuresis) occurs in approximately 5-10% of school age children, and by definition, is not considered a “disorder” until the child is at least five years old. Further, a number of studies have found that as many as 4% of adolescents wet the bed. Nighttime wetting, which is more common after age 6, occurs twice as often in boys than in girls while girls appear to outnumber boys in the frequency of daytime wetting.

There are a number of possible reasons why a child might wet. Daytime wetting, in particular, may be associated with bladder or urinary tract infections and should be checked out medically before parents consider psychological or behavioral treatment. Wetting might also be caused by a small bladder, weak muscle control, anxiety, or simply forgetting to use the bathroom in time. The most common causes of nighttime wetness are a bladder that is too small to make it through the night, and/or a very deep sleep pattern that keeps the child from waking up and using the bathroom in time. In absence of medical factors, wetting may also be caused by anxiety or depression.

Soiling (encopresis) occurs in 2-8% of children and is most often associated with constipation. Ongoing constipation can stretch the rectum, which in turn dulls the nerve endings in the rectum. Without adequate sensitivity, these nerve endings do not send the child the signal that it is time to go to the bathroom. As a result, the child doesn’t feel the pressure to use the restroom, and often ends up soiling him or herself.

Not all soiling accidents are related to constipation. A child may be so busy playing that he either holds it until the urgency to go passes or doesn’t realize that he has to go until it’s too late. Shy or cautious children may be reluctant to use a strange toilet and may try to hold it until the urgency passes. Regularly holding bowel movements, however, will also lead to constipation and further problems with soiling.

Problems with wetting and soiling can also cause anxiety, low-self esteem, and shame in children. Often children cover their confusion and embarrassment by either developing a flippant or uncaring attitude about the elimination problem (including denying that it is really problem at all) or by hiding dirty or wet underwear.

The treatment of these disorders depends in large part on what leads to the problem. A full medical evaluation is recommended as a first step in order to rule out any biological reasons for the wetting or soiling behaviors. Following that, a psychological evaluation is recommended to determine the psychological and/or social factors at work. Regardless of the treatment plan, prognosis for successful treatment is dependent on a biopsychosocial approach that includes ongoing coordination with the pediatrician or gastroenterologist. The Tarnow Center offers several services that can be helpful in treating elimination disorders:

• Family therapy: empathic education about the causes of the problem, a supportive behavioral approach that emphasizes the importance of the child as a team member, and strategies to understand and manage the emotional aspects that can lead to or arise from the elimination problem.
• Individual therapy: The goal of individual treatment with elimination disorders will depend in large part on the psychosocial factors that contribute to the child’s difficulty with appropriate bathroom behavior. But a supportive approach can help the child to process feelings of shame and empower the child to exercise more control. However, individual therapy will not be as effective if parents are not doing their own work in learning how to work with the child at home.

To contact one of our clinicians, or to schedule an Intake Evaluation, please click on the link below or call 713-621-9515.

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Learning Disorders

“Learning Disability” is a general term that refers to someone’s difficulty in understanding or in using language, whether the language is oral (listening, speaking) or written (reading, writing). Learning disabilities can affect a great many areas of academic functioning, including:

• Listenting
• Speaking
• Thinking
• Reading
• Writing
• Spelling
• Mathematics

Learning disabilities may occur simultaneously with other conditions (sensory impairment, anxiety, ADHD, or other emotional issues), or alongside environmental influences such as cultural differences or lack of instruction. However, learning disabilities are not the result of those conditions or influences.

Even though learning disabilities are typically diagnosed in relation to a child’s academic struggles, the impact of a learning disorder goes well beyond the classroom walls. Difficulties in school often lead to low self-esteem, and problems communicating with others impact the child’s social skills and friendships. Learning disabilities are generally diagnosed in childhood, but they can occur across the lifespan. Some types of learning disorders are:

• Cognitive Disorders
• Auditory Processing Disorder
• Mixed Receptive-Expressive Language Disorder
• Mathematics Disorder
• Reading Disorder
• Written Expression Disorder

Since learning disabilities cover so many different areas of learning and communication, it is difficult to list a specific symptom or profile of symptoms that indicate a problem. However, there are some warning signs that are more common at certain ages:

If you recognize any of the above warning signs in your child or student, it is recommended that the child complete a comprehensive Learning Style Evaluation. Evaluation helps identify a student's cognitive strengths and weaknesses. T

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Adult Anxiety Disorders

Everyone worries. As our age increases, so do our worries. Finances, health, and children can all be things that keep us up at night. In many ways, worry is a good thing. It can be the motivating force that helps us stick with a problem or a project until we find a solution. But when the worry is excessive, and interferes with normal daily functioning, it may be a sign of a more serious anxiety disorder.

General symptoms of anxiety, as opposed to worry, include:

The following are five types of anxiety disorders that commonly occur in adults:

• Generalized Anxiety Disorder
• Obsessive-Compulsive Disorder
• Panic Disorder
• Social Phobia
• Post Traumatic Stress Disorder

Anxiety disorders can look like many different things, which may result in an inaccurate diagnosis. Therefore, it is important to receive a thorough evaluation of social, emotional, and academic functioning in order to fully assess the presenting symptoms and issues. If undiagnosed and untreated, anxiety disorders can have significant effects on an individual’s life, including poor social relationships, depression, poor academic/job performance, and may lead to other disorders, such as depression or substance abuse.

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Obsessive Compulsive Disorder in Children

Obsessive-Compulsive Disorder (OCD) is characterized by intense obsessions and/or compulsions that significantly interfere with daily functioning. Obsessions are recurrent and persistent unwanted thoughts, impulses, or images that are usually irrational and cause the child to have negative feelings such as anxiety, doubt, or feelings of incompleteness. Compulsions are intentional and repetitive behaviors that serve to quiet these thoughts and the negative emotions that accompany them.

Some examples of obsessions and the accompanying compulsions are listed below. It is important to note that for a diagnosis of OCD, the pattern of obsessions and/or compulsions must cause significant impairment to the person's life. Having the thought "Did I lock the door?" and going back to check once is not a sign of OCD. But going back to check it several times may be indicative of an anxiety disorder.

Obsessions and compulsions may vary with age. For example, a younger child may worry that he or his family will be harmed by an intruder breaking into the house (Obsession). So he will check all the doors and windows to make sure they’re locked. But he may then fear that he accidentally unlocked a door while checking, and will go back through the ritual a second, third, fourth time (Compulsion). An older child or a teenager with OCD may fear that she will become ill with germs, so she may cope through excessive hand washing, refusing to touch door knobs with her bare hand, or refusing to use restrooms away from home.

One important factor with OCD is that the person continues to have the obsessions or compulsions despite realizing that they are unreasonable. This can lead to feelings of shame or embarrassment for children who suffer from OCD, and they may be hesitant to disclose what is happening for them. Good communication between parents and children can increase understanding of the problem and help the parents appropriately support their child.

Research shows that OCD is a neurological disorder and that it tends to run in families, but this is not a direct correlation meaning that parents with OCD will not definitely pass it down to their children. Likewise, children may develop OCD even if there is no history of OCD in the family. As it is a neurological disorder and tends to run in the family, the most effective intervention is a combination of medication, individual therapy, and family therapy.

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Oppositional Defiant Disorder

Oppositional Defiant Disorder (ODD) occurs primarily in children and adolescents. It is characterized by negative, defiant, disobedient, or hostile behavior towards parents or other authority figures (teachers, grandparents, etc.). It is important to note that many children and teenagers display some of these behaviors, and it is normal for these kids to go through difficult periods as they try to become their own person. But if you notice several of the following behaviors, lasting longer than 6 months, it may be an indication of more severe difficulty.

Children with ODD are often disobedient. They become angry easily and may seem to be angry much of the time. Younger children may have temper tantrums that last for 30 minutes or longer. A child with ODD often starts arguments and will not give up. Winning the argument is very important to a child with ODD even if it means being punished.

If you recognize any of these patterns in yourself, a friend, or a loved one, a psychological evaluation is recommended.  Appropriate intervention for ODD includes:

• Individual Therapy: Individual work focuses on developing specific skills for managing anxiety, while also addressing the struggles with daily stressors and low self-esteem that often accompany a diagnosis of anxiety.

• Family Therapy: Family work is important in the treatment of anxiety in that it focuses on developing open communication and expression of emotion, while teaching parents/loved ones techniques to utilize at home with the client.

• Group Therapy: Groups provide safe and appropriate social training where the client can get feedback from peers and professionals about how to regulate their behavior.

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Personality Disorders

Your personality is the way you view, understand and relate to the outside world as well as to yourself. It is how your thoughts, feelings, and behaviors combine to make you unique. Personality forms during childhood and is shaped by genetic influences (parents’ own personalities) as well as by environmental influences (life experiences, friends, etc.).

Some people have difficulty understanding situations and relating to others. These people can have a rigid and unhealthy pattern of thinking and behaving which can lead to problems in relationships, social encounters, work, and school. When someone’s personality style and/or behaviors cause significant distress to themselves or to others, or when their behaviors consistently go against the expectations of society, the person may have what is known as a Personality Disorder. Some behaviors/beliefs that may indicate a personality disorder include:

It is important to note that many of these traits appear in childhood or adolescence and resolve themselves by early adulthood. It is not uncommon for a child to have sudden angry outbursts, or for a teen to have poor impulse control. It is considered a personality disorder when these problems continue, unchanged, into adulthood (18 years or older).

If you recognize any of these patterns in yourself, a friend, or a loved one, a psychological evaluation is recommended. Appropriate intervention for Personality Disorders includes:

• Medical Evaluation: Medication may be useful in treating certain symptoms of the personality disorder, or in treating co-occurring conditions that exist alongside the personality disorder.
• Individual Therapy: Individual therapy starts by identifying the client’s faulty cognitive and/or behavioral patterns that contribute to interpersonal difficulty. Then therapist and client work together to identify and practice Self-Management skills to replace ineffective patterns.
• Family Therapy (including couples/marital therapy): Family members often carry the lion’s share of the burden as they are the ones who are most often in contact with the client. Family therapy helps family members better understand the nature of the client’s disorder, and better prepare themselves to provide the empathy and support that the client will need.
• Group Therapy: Group therapy, specifically Dialectical Behavioral Therapy, provides clients with a supportive atmosphere to learn emotional regulation, practice self-calming techniques, and work on their interpersonal relationships.

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Relational Problems

Relational problems refer to problematic interactions between or among members of a “relational unit” (family, co-workers, etc.). It is expected that people who live together and/or work together will have conflicts from time to time. Siblings fight over who gets to sit up front, spouses argue over how to discipline their child, and co-workers often deal with work-related conflict. But these conflicts become a problem when they become excessive, or when the conflicts begin to impair one’s usual ability to function. Some behaviors and symptoms commonly associated with relational problems include:

• Recurring arguments and conflicts that do not resolve themselves
• Lack of communication, or hurtful communication
• Avoiding family members or co-workers who are believed to be the cause of the problem
• Irritability, sleeplessness, depression or social withdrawal
• “Kicking the cat,” or taking anger/frustration out on an uninvolved third party such as children or spouse
• Overprotection or over involvement in another persons life

TREATMENT GOALS:

Treatment of relational problems focuses on education and insight. It is important that each member in a conflict understands his/her own role in starting and in maintaining the conflict. What are each person’s triggers? What are the internal warning signs that communication is breaking down? From here, therapists work with the client to learn, develop, and practice effective communication strategies.

Specific treatment depends on the nature of the conflict. 

• Individual Therapy: Individual work focuses on developing specific skills for managing anxiety, while also addressing the struggles with daily stressors and low self-esteem that often accompany a diagnosis of anxiety.

• Biofeedback: Like individual therapy, Biofeedback works by teaching specific anxiety management skills to the client. Biofeedback employs the use of technology to make the client more aware of the internal processes that contribute to anxiety, and in doing so, teaches the client to better control these processes.

• Family Therapy: Family work is important in the treatment of anxiety in that it focuses on developing open communication and expression of emotion, while teaching parents/loved ones techniques to utilize at home with the client.

• Group Therapy: Groups provide safe and appropriate social training where the client can get feedback from peers and professionals about how to regulate their behavior.

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Schizophrenia and other Psychotic Disorders

Psychotic disorders refer to a group of disorders that are characterized by a loss of contact with reality. People who are psychotic may exhibit some of the following symptoms*:

* In order to be considered psychotic symptoms, the above symptoms must not be due to effects of a substance or due to a general medical condition.

Psychotic disorders are generally considered to be neuro-developmental conditions, meaning that contributing factors to psychosis can be found in both nature (genetics) and nurture (environment). It is rare to see psychotic disorders occur in people prior to their late teens, although some cases have been reported in children as young as 5 or 6 years old. A growing body of research is also showing that marijuana use in adolescence can increase one’s likelihood of developing a psychotic disorder in their late teens or early adulthood.

The challenges for the psychotic patient and his/her family are great. Without adequate treatment, psychotic patients have tremendous difficulty functioning on a daily basis. They often become quite isolated and withdrawn, which only adds to their difficulties. This also increases the burden on parents, who have to continue supporting their child past the age at which his peers are moving on to independence. The goals of treatment are to keep the person stable (i.e., not in active psychosis), and to keep the person engaged in his or her life. Active engagement in one’s life can stave off the cognitive deterioration that otherwise occurs when psychotic patients disengage and become stagnant.

People with psychotic disorders need a lot of support from the family and the community. Regular contact and monitoring of functioning are important. 

• Psychological Evaluation: Psychological evaluation is a critical step in treatment, as it can determine the nature and severity of the psychotic symptoms. In doing so, the evaluation can guide treatment.
• Medication Evaluation: Medical intervention plays an important role in treatment of psychosis. Medications help to regulate the biochemical imbalances that cause psychosis. The best intervention is a combination of medicine and psychotherapy.
• Family Therapy: Psychotic Disorders affect the entire family, as many psychotic patients are unable to live independently. Parents can feel powerless to help their child, and even the most patient siblings can become aggravated with the symptoms. The psychotic patient benefits the most when family members learn to develop a therapeutic and supportive environment that helps the patient achieve consistent progress.
• Group Therapy: Groups can be highly effective once the patient is stabilized on medication. Groups work by educating the clients in a supportive atmosphere, while also working out a goal-oriented curriculum.

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Sleep Problems and Sleep Disorders in Adulthood

Sleep problems are pretty clear: If you’re not sleeping, you’ve got a problem. A healthy night’s sleep is crucial to help you recover from one day’s activities and prepare for the next day’s pursuits. For adults, “healthy” means at least 8 hours of sleep per night. If you’re not getting that, you’re opening the door to a host of problems in your personal and professional life. Consider that:

A tired person looks…

• Depressed
• Irritable
• Anxious
• Distracted
• Sloooooow

A rested person looks…

• Energetic
• Happy
• Calm
• Focused
• On point

It’s easy to see how someone who looks depressed, anxious, or ADHD may just need a good night’s sleep. Many times, making some adjustments to your evening routine can make a world of change in your sleep hygiene. Some tips include:

• Make a Routine – Set daily goals for when you’re going to lay down to sleep, and when you’re going to wake up. But the quickest way to reset your internal clock is to wake up at the same time every morning. Eventually, your bed time will adjust itself. When setting your goals, you want to get those 8 hours, but make sure and allow enough time to...
• Relax – Your brain needs time to transition from the activity of the day to the calm needed for sleep. It helps to have a calming activity that you do in preparation for a good night’s sleep. Reading is an excellent way to make this transition: lying in bed prepares the body for sleep, and following a story helps you to let go of the day’s events. But don’t do your reading on the computer, because you need to…
• Unplug! – Kids aren’t the only ones who have addictions to screens. As adults, we also have too many gadgets that stimulate the brain and are so much more exciting than sleep. Television, iPod, iPad, computer, smart phone. All have the ability to get your brain humming, which moves you farther and farther away from the relaxation required to sleep.
• Diet – Be careful with sugary foods and caffeinated drinks, but especially not within 6 hours of bedtime. Also avoid large meals close to bedtime.
• Watch Your Naps – Naps can be a great way to provide a quick break and restore your energy, especially in the afternoon. But keep them limited to 30 minutes or less. Any longer, and you risk falling into a deeper sleep, then staying up later, and then limiting how much sleep you get that night. If you have insomnia, it’s recommended that you cut out naps entirely.

Sometimes, sleep problems don’t resolve easily. If you’re still struggling to sleep after you follow the guidelines above, it may be an indication of a more serious problem. Consult with your physician if you or a loved one observe any of the following:

• Breathing “pauses” while asleep
• Can’t sleep through the night
• Can’t stay awake during the day
• Unexplained drop in academic/work performance
• Unusual events during sleep:
• Sleep walking/li>
• Talking in sleep

The source of the problem may be medical, or it may be psychological. If your physician determines that the source of the problem is more psychological, then there are ways that I can help. Contact one of our clinicians to schedule an assessment.

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Sleep Disorders and Sleep Problems in Children

Sleep problems are pretty clear: If you’re not sleeping, you’ve got a problem. A healthy night’s sleep is crucial to help children recover from one day’s activities and prepare for the next day’s pursuits. For children and adolescents, “healthy” means at least 9 hours of sleep per night. Studies show that having a regular bedtime and a good night’s sleep is the most consistent predictor of healthy development in childhood. As a matter of fact, sleep is one of the first things that we look at when we first meet a child with behavioral or academic problems. Consider the following:

A tired child looks….

• Depressed
• Irritable
• Anxious
• Distracted
• Slooooow

A rested child looks…

• Energetic
• Happy
• Calm
• Focused
• On point

It’s easy to see how a child who looks depressed, anxious, or ADHD, may just need a good night’s sleep. Yet the National Sleep Foundation reports that nearly 70% of children under the age of 10 have some type of sleep problem. Many times, making some adjustments to the evening routine can make a world of change in a child’s sleep hygiene. Some tips include:

• Plan Your Evenings – Create a realistic timeline for the evening. Think about all of the activities that must be done, and set goals to complete each in a certain amount of time. But make sure and include time to...
• Relax and Read – Just like adults, children need time to unwind at the end of a day. A great way to do this is to spend time reading with parents. Reading makes a great transition to sleep: lying in bed prepares the body for sleep, and following a story helps a child to let go of the day’s events. Most importantly, it provides special time with you.
• Share Something – Offering your child a special time helps to support a growing child-parent bond. Your child is more likely to share feelings, fears, conflicts, and love when they know they have your full attention.
• Unplug! – Kids have access to so many gadgets that stimulate the brain and are so much more exciting than sleep. Television, iPod, iPad, computer, DS, smart phone. All have the ability to get your child’s brain humming, which moves them farther and farther away from the relaxation required to sleep. Set a time by which all screens need to be turned off (and turned in) so your kids get ample time to let their brains unwind.
• Diet – Be careful with sugary foods and caffeinated drinks, but especially not within 6 hours of the child’s bedtime. Also avoid large meals close to bedtime.

Sometimes, however, sleep problems don’t resolve easily. If your child is still struggling to sleep after you follow the guidelines above, it may be an indication of a more serious problem. Consult with your pediatrician if you observe any of the following:

• Breathing “pauses” while asleep
• Can’t sleep through the night
• Can’t stay awake during the day
• Unexplained drop in school performance
• Unusual events during sleep:
• Sleep walking
• Talking in sleep
• Night Terrors (differentfrom nightmares in that child will not be alert to your presence)

The source of the problem may be medical, or it may be psychological. If your pediatrician determines that the source of the problem is more psychological, then there are ways that I can help.

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Social Phobia in Adults

Everyone worries. As our age increases, so do our worries. Finances, health, and children can all be things that keep us up at night. In many ways, worry is a good thing. It can be the motivating force that helps us stick with a problem or a project until we find a solution. But when the worry is excessive, and interferes with normal daily functioning, it may be a sign of a more serious anxiety disorder.

General symptoms of anxiety, as opposed to worry, include:

The following are five types of anxiety disorders that commonly occur in adults:

• Generalized Anxiety Disorder
• Obsessive-Compulsive Disorder
• Panic Disorder
• Social Phobia
• Post Traumatic Stress Disorder

Anxiety disorders can look like many different things, which may result in an inaccurate diagnosis. Therefore, it is important to receive a thorough evaluation of social, emotional, and academic functioning in order to fully assess the presenting symptoms and issues. If undiagnosed and untreated, anxiety disorders can have significant effects on an individual’s life, including poor social relationships, depression, poor academic/job performance, and may lead to other disorders, such as depression or substance abuse.

If you recognize any of these symptoms in yourself or a loved one, a psychological evaluation is recommended. The Tarnow Center offers both assessment and treatment for anxiety disorders using a biopsychosocial approach that addresses the medical and psychosocial needs of the individual and the family. Appropriate intervention for anxiety disorders includes:

• Individual Therapy: Individual work focuses on developing specific skills for managing anxiety, while also addressing the struggles with daily stressors and low self-esteem that often accompany a diagnosis of anxiety.

• Biofeedback: Like individual therapy, Biofeedback works by teaching specific anxiety management skills to the client. Biofeedback employs the use of technology to make the client more aware of the internal processes that contribute to anxiety, and in doing so, teaches the client to better control these processes.

• Family Therapy: Family work is important in the treatment of anxiety in that it focuses on developing open communication and expression of emotion, while teaching parents/loved ones techniques to utilize at home with the client.

• Group Therapy: Groups provide safe and appropriate social training where the client can get feedback from peers and professionals about how to regulate their behavior.

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Social Phobia in Children

Social Phobia (or Social Anxiety Disorder) is an extreme fear of being judged or criticized by others. This often leads to the child avoiding situations where he or she may be exposed to new people, or to large groups of people. Children and adolescents with social phobia may experience excessive fear in social situations (e.g., meeting or talking to people) which causes significant distress and interferes with functioning. The disorder can be selective in that some children have significant difficulty in particular social situations but may be perfectly fine in other, seemingly similar, situations.

It is important to note that this is not “shyness,” which is a normal developmental challenge for all kids, and which typically resolves itself by the age of two. Social Phobia has a typical age of onset at 13 years old. However, early symptoms such as excessive clinginess and selective mutism (i.e., the failure to speak in certain situations, despite speaking in other situations) may initially appear in younger children.

Some of the most common things that the socially anxious child avoids include:

• Reading aloud in front of class
• Musical or athletic performances
• Starting or joining in on a conversation
• Speaking to Adults
• Writing on the blackboard
• Ordering food in a restaurant
• Attending dances or birthday parties

Social phobia is a severe, disabling form of shyness and can cause problems in people’s lives. Sometimes the problems are minor, such as not being able to speak up in class. Sometimes, however, the problems can be very serious. Children and adolescents with severe social phobia often have very few friends, feel lonely and have trouble reaching their personal and academic goals.

Social phobia is very common in that it affects one out of eight people at some point in their lives, and it is twice as common for girls as for boys. However, males are more likely to seek help for the problem. Social phobia usually starts when people are in their early teens, but it can begin much earlier. If people do not get help, the problem can last for years.

Appropriate intervention for anxiety disorders includes:

• Individual Therapy: Individual work focuses on developing specific skills for managing anxiety, while also addressing the struggles with daily stressors and low self-esteem that often accompany a diagnosis of anxiety.
• Biofeedback: Like individual therapy, Biofeedback works by teaching specific anxiety management skills to the client. Biofeedback employs the use of technology to make the client more aware of the internal processes that contribute to anxiety, and in doing so, teaches the client to better control these processes.
• Family Therapy: Family work is important in the treatment of anxiety in that it focuses on developing open communication and expression of emotion, while teaching parents techniques to utilize at home with the anxious child.
• Group Therapy: Groups provide safe and appropriate social training where the child can get feedback from peers and adults about how to regulate their behavior.

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Substance Use Disorder

Substance use disorders are classified into two categories: Substance Abuse and Substance Dependence. The substances can include alcohol, illegal drugs, and prescription drugs. Use of illegal drugs is concerning, to be sure, as is alcohol use in minors under the age of 21. But use alone is not necessarily a diagnosable disorder.

Substance Abuse describes a pattern of use that leads to significant problems such as:

• Failure to attend work or school
• Risky behaviors while intoxicated, such as driving a car
• Legal-problems resulting from substance use (arrest, traffic violations, etc.)
• Use interferes with friendships and/or family relationships

Substance Dependence is the term used when someone continues to use drugs or alcohol, even when significant problems related to their use have developed. Signs of substance dependence include:

• Needs greater amounts of the substance in order to attain the desired effect
• Suffers physical and/or psychological symptoms when not under the influence
• Has tried to quit or cut down, but hasn’t been successful
• Spends increasing amounts of time trying to obtain the substance
• Spending less time in social or recreational activities
• Continues to use the substance even though aware that use causes physical or psychological problems

Some warning signs of substance abuse or dependence may be that someone is:

• Getting high or drunk on a regular basis
• Lying, especially about how much they are using or drinking
• No longer spending time with non-using friends
• Talking a lot about using drugs or alcohol
• Believing they need to use or drink in order to have fun
• Pressuring others to use or drink
• Having legal problems, particularly related to substance use
• Driving under the influence of a substance
• Missing work or school, or performance suffers due to substance use
• Feeling depressed, hopeless, or having suicidal feelings

If you recognize any of these symptoms in yourself, a friend, or a loved one, a psychological evaluation is recommended. A variety of treatment programs for substance abuse are available on an inpatient or outpatient basis depending upon the extent of the problem. In more serious cases, detoxification may be needed.

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Tourette's Syndrome and Other Tic Disorders

Tic Disorders refer to disorders where the child (or adult) has involuntary, rapid, and repetitive movements of individual muscle groups. These movements, known as “Tics,” can be either motor (movements) or vocal (noises). The most common motor tics are: eye blinking, grimacing, nose twitching, eye brow raise, and squinting. Many common vocal tics include: clearing the throat, coughing, humming, sniffing, or snorting.

Tics are a way of responding to a build up of tension in the body. The person often feels an urge just before they tic, similar to when you feel an itch just before you scratch. While the patient can often suppress these tics for a short while, the build up can become unbearable after too much time. One common misunderstanding is that these tics are voluntary, and that the child is doing them on purpose. This misperception can lead to disciplinary problems at home and at school, as the adult may see the behavior as defiance, rather than as a neurobiological disorder. The good news is that tics often decrease in adolescence and may stop completely by adulthood. But early diagnosis and intervention has led to the most favorable outcomes in our experience.

Diagnosis of Tic Disorders can be tricky because Tic Disorders exist on a spectrum of severity; some are mild with infrequent flare-ups, and others are more severe and involve several complex symptoms. Patients with Tourette Disorders often also have Attention Deficit/Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD) . The most troubling symptoms of this disorder are the impulsivity, emotional lability, and aggression. Tourette Syndrome is also associated with Learning Disorders, which include impairments to visual-perceptual and visual motor skills, and Language Learning Disorders. These co-occurring difficulties can cloud the picture and may mask each other. An expert in Tourette Syndrome and other Tic Disorders is usually needed to make accurate diagnosis because they know the questions to ask to bring out all the relevant information.

The Tarnow Center’s clinicians have the expertise to diagnose and treat Tic Disorders. Our interdisciplinary approach to the diagnosis of these disorders understands the complexities and the struggle as each individual (and family) struggles to cope with symptoms that can be ever changing. Here is the example where the whole is greater than its parts.

• Neuropsychological Evaluation: Every child with a Tic Disorder should have an assessment of their learning. Not just their academic achievement scores, but also their learning style. This assessment insures that there are no learning disorders, and more importantly, informs parents and teachers in how to help the child cope.
• Individual therapy: The goal of individual treatment is not to stop the tics, but rather teach the client tools to help reduce frequency and severity of tics. Treatments include biofeedback, relaxation training, and cognitive behavioral approaches. Supportive therapy is also valuable in that it gives the client a place to process any secondary social and emotional problems that can occur with Tic Disorders.
• Group therapy: Many children with Tic Disorders experience social difficulties such as peer rejection or isolation resulting from their tics. Group therapy provides the client with a safe social environment to get support from peers, while also learning and practicing interpersonal skills.
• Family therapy: Tic Disorders affect the entire family. Parents can feel powerless to help the child, and even the most patient siblings can become aggravated with the symptoms. The child with a Tic Disorder benefits the most when family members learn to develop a therapeutic and supportive environment that helps the child grow and mature.
• Medication Evaluation: Medication is not always necessary in the treatment of Tic Disorders, and there is no medication specifically designed to treat Tic Disorders. But there are medications that can be helpful in helping one control tics. Medication may also be helpful in treating any co-occurring difficulties with ADHD, OCD or mood.

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