Monday, November 30, 2009

Bi-Polar Disorder

Bipolar disorder

Bipolar Disorder was once called manic-depression. This is a mood disorder that is chiefly identified by mood swings between the two “polar” states of mania and depression.

Manic episodes are periods of persistently elevated, expansive, or irritable mood. While in an elevated mood people typically experience periods of greatly increased self-esteem, decreased need for sleep, rapid speech, floods of ideas, increased activity levels to the point of hyperactivity, with possible hyper sexuality, and risk taking. People in manic states can be euphoric or highly irritable if their goals are blocked or interfered with. The combination of blind optimism, feelings of grandiosity, increased sex drive, and poor impulse control often lead to damaged personal, family, social and vocational relations.

These manic states alternate with periods of depression in ways unique to the individual.

Milder, yet still disruptive, mood swings are symptomatic of a more moderate mood swing problem named cyclothymia.

Case Study

One bipolar disordered grandmother remained rather isolated during depressed periods only to emerge from her depressed states and go on "rampages" that struck fear into the hearts of her adult children and their families. Her behavior was unpredictable and highly problematic. She was arrested by the police for swimming at a small town public beach in her underclothes. One Thanksgiving she pulled unannounced into the driveway of her daughter’s family and let several adult turkeys out of the back of a beat-up station wagon (she had been in numerous accidents) to run through the neighborhood. After all, it was Thanksgiving, and She had “brought the dinner”!

Perhaps this sounds amusing, but her adult daughter was mortified with fear of what was coming next. She was also known to pick-up well-to-do elderly men and spend their money before moving on to other relationships. As is often the case, this individual refused to take the medication, which could have helped to controlled her mood swings. My dear grandmother remained actively bipolar until she contracted a terminal illness in her late 70's.

As a young child I could not understand my mother's mortification at her arrival at my house. To me, she was just an exciting and fun grandma. I loved her dearly and still do.

Community samples suggest a life-time prevalence of .4% to 1.6%. However, the frequency of this diagnosis appears to be increasing in children and adults

Possible Causes

Bipolar disorder is thought to be caused by biological factors. One theory suggests that a combination of low levels of serotonin and high levels of norepinephrine combine to produce bipolar symptoms. Another theory suggest that the improper transport of sodium ions involved in neuronal transmission (or perhaps an abnormality in the neuronal membrane) increases the rate of neuronal impulses and leads to mania. There is also consistent evidence that bipolar disorder may be an inherited condition. Close relatives of those who suffer from bipolar disorder also show higher rates of this problem.

If you or your loved one shows indications of Bi-Polar Disorder see your family physician for a physical. If all is well with your physical check-up, I strongly recommend a psychiatric consultation. A psychiatrist is an MD who specializes in treating serious mental disorders, of which Bi-Polar Disorder is one.

If Bi-Polar Disorder is the problem, it cannot be regulated without medication management. In addition, education and counseling with an experienced therapist is very important for long-term management of this disorder. Bi-Polar Disorder cannot be cured, but it can be managed effectively.

God Bless,

Dr. Tom

Sunday, November 29, 2009

Suspected Causes of Depression

Many potential causes of depression have been identified on the basis of research and keen observation. Various of these factors can interact and summate as they determine the course and severity of depressive episodes.

The following is a brief summary of possible causes:

Genetic factors have been implicated by researchers who study the extended families of depressed individuals and find that relatives have a significantly higher incidence of depression than the general population. Closer relatives of depressed persons have higher rates of depression than do distant relatives.

In twin studies identical twins have a much higher chance of both suffering from depression than do fraternal (nonidentical) twins. These kinds of studies could be taken as evidence for the learning of depressed behavior in families as a result of similar experiences, and learning can be an important factor. Adoption studies have also suggest that genetics can play a significant role in the development of depression.

Biochemical factors may also be involved in depression. Neurotransmitters are molecules that move between the neurons (special nervous system cells in the brain) allowing neuro-impulses to travel from one cell to the next. The search is not over, but so far, two specific neurotransmitters have been found to occur at low levels in depressed individuals. It has also possible that these neurotransmitters could be present in sufficient quantity, but may not used effectively by the brain. These neurotransmitters are norepinephrine and serotonin. Anti-depressant medications are known to increase the availability of these brain chemicals and/or to improve the way the brain uses them, thereby relieving depression.

Hormonal factors may also be involved in depression. It has been found that people who are depressed frequently show elevated levels of cortisol. Cortisol is a hormone released by the adrenal glands when individuals are under stress. Stressful events are often found to have preceded episodes of depression. High levels of another hormone named melatonin have also been implicated in depression. It is thought that the lack of sun associated with winter months may cause a build up of melatonin and produce the depression that is called seasonal affective disorder.

Psychological theories have identified many life events that predispose individuals to depression. Psychodynamic theorists have noted that the death or loss of a loved one early in life increases the likelihood of depression for the person experiencing the loss. The separation of children under six from their mothers has been found to lead to a form of child depression (anaclitic depression). These findings also hold for infant monkeys separated from their mothers. It appears that maintaining early emotional attachments with caretakers is very important to mental health of children and the adults that they become.

Behaviorists have observed that depressed individuals have often lost a significant proportion of the rewarding people, places, things, or abilities that they have customarily enjoyed in life. In some individuals a loss of important sources of rewards are thought to precipitate a downward spiral of depression in which these people do fewer things and therefore obtain even fewer rewards in their lives. Also, studies have demonstrated a behavioral contagion effect in which non-depressed people were exposed to other individuals who acted depressed. The findings were that some of those who were simply exposed to a depressed person began to feel depressed themselves.

Cognitive factors refer to a persons beliefs, attitudes and ways of thinking about the world. Cognitive-behavioral research has found that feelings of helplessness accompanying depressed behavior can be produced by repeatedly experiencing painful events over which the individual has no control. More recent changes to this theory note that a perceived lack of control over such painful events is more important than the actual control which is available.

Other psychologists have examined cognitive factors that can lead to depression. For example people can learn to think negatively about their past, present and future. They can also magnify various minor problems and minimize the good things in their lives. Depressed people also frequently have automatic thoughts which they think in a “reflexive”-like and uncritical way. Such thoughts might include things like: "I certainly am damaged goods", “I’ll never amount to anything”, I'm the biggest screw-up on earth", or "I've got so many problems I just can't take it anymore."

It is good that you have taken the time to become familiar with some of the likely factors that may predispose people to periods of depression. Knowing your risk factors could help you to lower some of them. Perhaps you could share this information with your loved ones. Knowing our risk factors can help us all to be more alert for early indications of depression and to seek professional help early.

As always, prevention and early treatment are the best approaches.

Dr. Tom

Saturday, November 28, 2009

Look Out For Depression

Look Out For Depression

The most severe form of depression is called Major Depression. Major depression is diagnosed when a number of the following symptoms last two weeks or more. Some of its features are a loss of pleasure and interest in almost all activities. There are normally changes in appetite with weight loss or weight gain. Feelings of worthlessness, failure, guilt and inferiority can lead to thoughts of death. Suicidal thinking, planning and attempts may occur. Depressed individuals also have problems concentrating, thinking, and making decisions. They generally look sad and move like they have the weight of the world on thier shoulders, complaining of feeling tired and fatigued. They may complain of physical problems (aches and pains), report sadness, and become irritable, edgy, argumentative, angry and blame others for their own problems. Depressed people ofen withdraw from social activities and from activities and hobbies that once gave them pleasure. Insomnia (difficulty sleeping) and hypersomnia (excessive sleeping) are a common part of depression. Ocassionally, depression can become so intense that it can include mood consistent periods of psychosis in which the individual may develop false beliefs about his world.

Dysthymic Disorder is a more moderate, but still disruptive, form of depressed mood that characterized by at least two years of depressed mood that does not satisfy the requirements for major depression. Depression is often diagnosed in those who abuse and become dependent upon alcohol and illegal drugs.

Depression can be very destructive of the individuals who suffer from it and also destructive of social relationships and families. For example spouses and children of depressed people often feel their anger, negativity, and withdrawal as a lack of love and caring for them. If the depression goes on for years without treatment, as it often does, spouses feel building frustration, resentment, and anger in response to the depressed treatment they receive from their depressed mate. The result is that they frequently seek love and caring outside of their marriage and the ruinous effects of this infidelity then compounds their problems.

With proper marriage counseling and antidepressant medication (when warranted) some marriages can recover to become better than ever, but many simply fail in divorce. The same is true for couples that are not married.

The sad fact is that many of these couples never know what hit them—they simply conclude that they don't love each other any more.

The children of depressed parents (divorced, married, or not) see the same symptoms as the adult non-depressed mate, but they react differently. They often feel unacceptable, worthless, unloved and unwanted. Children also show the sad effects of constant bickering, fighting, or worse between their parents.

From this sad history frequently grows a life-time of psychological and relationship problems for these childdren who grow to adulthood and for their own children. In complex ways, with complex outcomes, untreated depression can easily become contagious across generations.

The life-time risk of Major depression, based upon community samples, is between 10% to 25% for women and 5% to 12% for men.

If you, or member of your family, or perhaps a friend shows signs of depression, talk to them about what can happen if depression is an untreated problem. Encouraged them to seek professional assistance.

God Bless, Dr. Tom

Friday, November 27, 2009

Preventing Depression in Children and Adolescents

Preventing Depression in Children and Adolescents

The symptoms of depression are likely to show themselves in different ways, depending upon the age of the child.

Infants may show listlessness, social unresponsiveness, and slowed physical development. Children up to about 2 yrs. of age are more likely to show little curiosity and interest in play. They may be clingy, fearful, have nightmares and night terrors and show an increase in oppositional and uncooperative behavior.

Between three and five years of age children may show sadness, tiredness, slow movement poor appetite and weight loss. They may also show withdrawal, apathy, irritability and anger. Some children may begin to express thoughts of suicide.

From 6 to 12 years depressed behavior begins to look more similar to that of adults. They may express their depressed feelings as well as suicidal thoughts. They may have difficulty feeling pleasure and show signs of low self-esteem, apathy, withdrawal, and low motivation. Poor school performance is common as are physical complaints, oppositional behavior, social problems, and delinquency

Pre-adolescents and adolescents ages 12-18 years are more likely to “act-out” their depression. They may show volatile moods, rage, various forms of delinquency, substance abuse, sexual promiscuity, suicidal thinking, self-abuse, and over-eating and sleeping. There may be guilt and feelings of worthlessness and the inability to concentrate and make decisions. School under achievement and suicidal thinking are also common.

It is estimated that 2-4% of our children under 17 yrs. Suffer from a major depression and the percent for teens is about 7%. There is no apparent difference in depression rates between boys and girls until about 11 years of age. After this time girls are twice as likely to be depressed as boys.

Causes of Depression

There are many causes of childhood depression. Genetics and changes in brain chemistry appear to play a role as does child abuse, abandonment, divorce, and loss of a loved ones to death or divorce. Other factors that are traumatic or negative life events can also be involved, such as rejection by significant others, imitation of significant depression in others, learning to be helpless, and the loss of rewarding people, things, and conditions. The factors that cause child and adolescent depression are similar to those that cause adult depression. Depression may go undetected by others until they intensify and are identified later in adult years. Frequently, adults will admit that they do not remember a time when they were not depressed. This is regrettable, because depression can severely limit ones success throughout life.

Depression can be improved or cured

A 16-year-old adolescent was brought to a therapist because he was flunking his tenth grade classes and was “into” Goth dress, literature, music and friends. He had ceased communicating with most people, stayed in his room at home, and was found to be using marijuana and cigarets. The teen would not communicate with the therapist. As a result of the various dangers involved in this case, the parents were advised to enter their son in an adolescent treatment center for psychological assessment, intensive individual and group counseling and substance abuse treatment. A psychiatrist prescribed antidepressant medication and after about two weeks he was discharged to his parents care and returned to his psychologist for further out-patient family and individual counseling. The teen’s thoughts, emotions, and behaviors gradually improved greatly in all ways.

It is important to review the known causes of Depression because in doing so we are in a better position to prevent, catch early and effectively treat depression in ourselves and our loved ones. If depression appears to be a problem in your children, schedule a visit with your family physician and also consider a a careful evaluation by a psychologist. Depression is a very treatable problem and it can often be cured.

An once of prevention is worth a pound of cure!

Dr. Tom

Thursday, November 26, 2009

Have A Blessed Thanksgiving

Happy Thanksgiving To You!

I hope that you will take this day to count your many blessings and be with, or think of , your friends and loved ones.

Thanksgiving should also remind us of the great gift we have in America and the sacrifices of all who keep it, and all of us, safe.

It is also good to ask, how can we continue to do our part in this great effort?

God’s Blessings to you and your loved ones.

Dr. Tom


Happy Thanksgiving From George Washington

Happy Thanksgiving From George Washington

George Washington's 1789 Thanksgiving Proclamation

Whereas it is the duty of all nations to acknowledge the providence of Almighty God, to obey His will, to be grateful for His benefits, and humbly to implore His protection and favor; and Whereas both Houses of Congress have, by their joint committee, requested me to "recommend to the people of the United States a day of public thanksgiving and prayer, to be observed by acknowledging with grateful hearts the many and signal favors of Almighty God, especially by affording them an opportunity peaceably to establish a form of government for their safety and happiness:"

Now, therefore, I do recommend and assign Thursday, the 26th day of November next, to be devoted by the people of these States to the service of that great and glorious Being who is the beneficent author of all the good that was, that is, or that will be; that we may then all unite in rendering unto Him our sincere and humble thanks for His kind care and protection of the people of this country previous to their becoming a nation; for the signal and manifold mercies and the favorable interpositions of His providence in the course and conclusion of the late war; for the great degree of tranquility, union, and plenty which we have since enjoyed; for the peaceable and rational manner in which we have been enable to establish constitutions of government for our safety and happiness, and particularly the national one now lately instituted for the civil and religious liberty with which we are blessed, and the means we have of acquiring and diffusing useful knowledge; and, in general, for all the great and various favors which He has been pleased to confer upon us.

And also that we may then unite in most humbly offering our prayers and supplications to the great Lord and Ruler of Nations and beseech Him to pardon our national and other transgressions; to enable us all, whether in public or private stations, to perform our several and relative duties properly and punctually; to render our National Government a blessing to all the people by constantly being a Government of wise, just, and constitutional laws, discreetly and faithfully executed and obeyed; to protect and guide all sovereigns and nations (especially such as have shown kindness to us), and to bless them with good governments, peace, and concord; to promote the knowledge and practice of true religion and virtue, and the increase of science among them and us; and, generally to grant unto all mankind such a degree of temporal prosperity as He alone knows to be best.

Given under my hand, at the city of New York, the 3d day of October, A.D. 1789.

From Founder's Quote Daily

Dr. Tom, 11/26/09

Wednesday, November 25, 2009

Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-Deficit/Hyperactivity Disorder (ADHD)

Some children seem unmanageable to both their parents and teachers. They have trouble paying attention to things that other children can easily focus in on. They frequently do not follow instructions, do not finish tasks, are careless and messy in their school work, and become frustrated and give up on challenging work. These children are also likely to be disorganized and easily distracted by irrelevant stimuli (trivial noises, or other features of people or the environment), and they have trouble following rules.

Children with attention problems may, or may not, show the additional problem of hyperactivity. What we call hyperactivity consists of frequently and rapidly doing a large number of annoying things such as squirming and fidgeting, running, jumping, shouting, climbing and walking on furniture or tables, all of which can lead to danger and make them accident prone. They may also annoy others by tapping, poking, pulling, and pushing on them, or the various things around them. Such children often talk loudly, rapidly and excessively which makes them difficult and irritating to be with.

Hyperactivity naturally includes actions that we call impulsive . These children may frequently knock things over, bump into people, or break and spill things. They interrupt, “goof around”, “blurt-out” interrupting comments, touch things and people that they should not, and do things that are dangerous without thinking about the consequences of their actions.

Children who behave in these ways tend to do so in a wide variety of settings (school, church, vacations, home), but some settings and activities worsen these problems. Generally conditions that require sitting still, concentrating, and doing monotonous tasks, requiring close attention and concentration, will produce more such troubles.

It is common for children to show some of these behavior patterns when they are younger than four of five years old. If these actions persist and intensify ADHD may be diagnosed in their early school years, when they first begin to encounter public social and educational problems. ADHD is diagnosed much more often in boys than it is in girls.

Untreated ADHD symptoms can lead to other very significant problems and impairments. About half of these children develop various learning and communication problems and about 80% of them misbehave, often quite seriously.

One preschool child showed almost all of these features. He ran away and climbed under the dresses of manikins in stores. In play, he ran jumped and yelled so loud that he could be heard though-out the neighborhood. School problems started in kindergarten when he constantly played and splashed the water in a shallow ceramic gold-fish pond built into the floor in his classroom. He wandered away from story time, and made noises and talked to others at rest time (they used to have children rest upon little mats on the floor). Due to the mischief he caused, teachers naturally suspected him whenever there was a problem of unknown origin. Negative expectations by teachers and others who care for such children is common. He was once accused of stealing things from his kindergarten teachers desk (he was innocent). Later he had great difficulty learning to read and to do mathematics. His parents tutored him and they became exceedingly frustrated while trying. But his parents never gave up and they hired tutors. In grade school, while the teacher was trying to hold class attention, he noticed the first snow of winter and loudly directed class attention out the windows to see that “great event”. He similarly interrupted class to announce that men were working on the traffic light at the corner, just outside of the school, and all of the students ran to the window to see. This boy was quite a challenge.

I am both happy and mildly embarrassed to report that this boy was me. I extend my deepest heartfelt appreciation to all of my heroic helpers of the distant past and, especially, to my beloved Mother and Father who did a wonderful job in a time when there was “no such thing as ADHD”. The experts said I was “just all boy”. That was indeed the truth, but it was not the whole truth!

Suspected Causes

ADHD behaviors appear to be caused by many things; and these things appear to summate and interact with each other. Attention-deficit/hyperactive disorder tends to run in families and may have an inherited biological basis (this was, and is, very true in my family). Also, the disorder was once called "Minimal Brain Dysfunction", attesting to the possibility of actual neurological damage attributable to fetal development or birth related problems. There is also the suspicion that ADHD may be caused by slowly maturing parts of the brain that filter extraneous stimuli and which are needed to help concentration.

Also, there is evidence that this pattern of behavior is more prevalent among homes that suffer high levels of stress, chaos and family dysfunction: This suggests that these behavior patterns can occur in children who simply failed to learn to follow rules, organize and attend in orderly ways to their environmental surroundings. As you can see, as with many psychological disorders, there is no one cause for ADHD.

Learning Disorders

ADHD puts children at increased risk of developing significant academic learning problems. A learning disorder is diagnosed when a child’s achievement test scores fall significantly behind those of his normal peers. The child’s existing learning problems then interfere with the learning of new information and the child falls further and further behind the academic achievements of his peers.

When an ADHD child has trouble being patient and focusing upon uninteresting details and activities they will have difficulty learning to read, learning mathematics, and learning to write. Putting information into memory, to a large extent, requires that we focus upon information and work to make sense of that information, or repeat it over and over again (i.e., do rote learning). Doing this effortful work is the main way in which we place our academic information in our long-term memory.

There are ways, other than having ADHD, that children can develop learning disorders. Research has implicated other possible causes of learning disorders such as: Inferior teaching, poor diet, lead poisoning, genetic defects, birth injuries, and sensory and perceptual problems. The true causes of a child’s learning disorder, in many cases, remain uncertain.

Effective treatment for ADHD involves early detection and treatment. The behavior problems involved in ADHD should be treated first with behavior modification methods. After consulting a pediatrician, further professional assistance from psychologists who can teach parents behavior modification skills can be very helpful.

If these methods do not reduce behavior problems significantly, psychological testing for primary school children to screen for ADHD is appropriate. If a formal diagnosis of ADHD is made, and behavior modification methods are not sufficient, treatment with both medication and behavior modification methods may be a necessary consideration.

ADHD is a condition that is preventable when it is a learned behavior pattern. Whether ADHD is a learned condition or not, like all psychological disorders, it is a problem that greatly benefits from early intervention.

An ounce of prevention, or early intervention, is worth a pound of late attempted cure.

God Bless

Dr. Tom

Tuesday, November 24, 2009

Oppositional-Defiant Disorder in Children

Oppositional-Defiant Disorder in Children


An all too common problem in our children is Oppositional-Defiant Disorder: This diagnosis is not given to children over 18 years of age, or to those who qualify for a more problematic diagnosis of Conduct Disorder (discussed preveiously).

Oppositional-defiant disordered children are disobedient, hostile, defiant, and negative toward authority figures. They fight compliance with instructions or requests and they are stubborn and will not compromise with adults or friends. They often test limits and do things to purposefully annoy others. These children show frequent hostility to authority figures and peers by arguing with and, in other ways, deliberately annoying them. They also purposefully break the rules that they are reasonably expected to follow. Oppositional-defiant children are often angry, resentful, spiteful and vindictive. Generally, their aggression remains at the verbal level and any physical aggression, if it occurs, remains mild to moderate in nature.

The oppositional and defiant behaviors displayed by these children are often focused intensively upon those who they are closest to (at home with parents and siblings), but they can also be directed at anyone who sets rules or limits upon their behavior. Psychologists and other therapists may not see a child’s oppositional-defiant behavior in their office (even with the parents present) but it will be abundantly present at home and sometimes elsewhere too. A child’s oppositional-defiant behavior may or may not be in evidence at school.

Rates of Oppositional-Defiant Disorder have been estimated to be from 2 to 16%, depending upon the populations sampled and the measures used.

Over the past 40 years, I have been called into schools to consult with teachers and principals to help with student’s behavior problems. I am convinced that oppositional-defiant rates have increased substantially. Rates of occurrence are higher for males before puberty, but are more equal between males and females after puberty is reached. Even so, males tend to be more confrontational than females.

These children may also show other psychological disorders such as ADHD, depression, anxiety, or learning and communication disorders.

Case Study

One adolescent male was born and raised in a family where the father was exceedingly demanding upon him. His mother was permissive and protective towards the boy and there was almost constant conflict between she and her resentful and compulsively demanding husband over the boys disciplinary issues. The boy was very bright and got good grades at school, but the father insisted upon all A’s stating that he was not living up to his potential. The boy’s behavior at school was exemplary and he was in various clubs and athletics. However, at home, he was manipulative and demanding of money, car privileges, and excessive freedom. His father almost always said “no” to these demands and his mother almost always countermanded the father’s judgement. The adolescent’s tactics involved angry, insulting and disrespectful behavior, and noncompliance with the requests of both of his parents. But, he was most likely to focus his blustery and unrelenting tantrum-like demands upon his mother. This was especially likely when his father was not at home. The mother frequently gave-in to her son’s demands. As you might guess, this rewarded the boy’s behavior and set the occasion for the next round of arguments between the mother and father. This adolescent’s oppositional-defiant characteristics appeared to be born of his parents polarized disunity, his resulting ability to further split and alienate them from each other, the ensuing conflict between the parents, and the family chaos that resulted. The adolescent was therefore in a better position to divide and conquer his parents authority in the future.

Suspected Causes

Oppositional-Defiant Disorder is more prevalent in families that have had many different care-givers and where inconsistent, harsh, abusive or neglectful child rearing methods have been used. It is also more likely to be found in homes where at least one parent has had a mood disorder (depression/bipolar), or other similar, perhaps more intense, disruptive disorders

Oppositional Defiant Disorder is more prevalent in males and children who are temperamental and show low self-esteem and low frustration tolerance. This disorder thrives on disorganization and is more common in homes where there have been many care-takers. Im my experience divorce or multiple mates and pregnancies out-of-wedlock frequently set the stage for this kind of chaos. Also, harsh or abusive treatment, irresponsible and neglectful parents, or significant mental illness, is frequently involved in the lives of children who show Oppositional-Defiant Disorder. Sometimes all that is necessary for the development of this problem is a clash between two parenting styles, one very demanding and the other very permissive.

Prevention or early correction

In many cases, parents can prevent these problems, they will recognize the development of this problem early and seek the assistance of an experienced behavior therapist with very good counseling and behavior modification skills. Almost always, with early intervention and treatment, the problem of oppositional defiant behavior in young children can be improved significantly.

Please pass this on to others who may need to know.

God Bless,

Dr. Tom

Monday, November 23, 2009

Conduct Disorder In Our Children and Youth

Children diagnosed with conduct disorder show a repetitive and persistent tendency to disrespect and violate the rights of others and to break normal societal rules and also laws. Conduct Disorder may be identified in children before 10 years and up to 18 years of age. It can be diagnosed in individuals older than 18 years, but only if they do not meet the criteria for Antisocial Personality Disorder which I will discuss in a later blog. Briefly, Antisocial Personality Disorder is a life-long disorder that is more severe than Conduct Disorder. The early appearance of Conduct Disorder in a child makes it more likely that the problem will continue into Antisocial Personality disorder in adulthood.

Conduct Disorder may be classified as mild, moderate or severe in nature. Frequently, children with mild cases of this disorder can be helped with therapeutic interventions and the problem may improve with maturity. Severe cases are more likely to continue into adulthood and form a long-term pattern of deeply ingrained antisocial behavior patterns that are highly resistant to change. The majority of our prison populations would be diagnosed as Antisocial Personality Disordered.

The list of actions shown by the children diagnosed with Conduct Disorder can be alarming. A partial list of such behaviors is as follows:

Recklessness and risk-taking
Curfew violations
Truancy from school
Running away from home overnight or longer
Lying, deceiving or “conning” others
Early sexual activity
Tobacco, drug and alcohol use
Bullying, threatening, intimidating and fighting
Using weapons (stones, clubs, knives, guns)
Breaking and entering homes, cars, or other buildings
Cruelty of people and/or animals
Property destruction (vandalism)
Robbery, extortion, mugging, purse snatching (while confronting the victim)
Assault and, rarely, murder

Conduct Disorder has increased in prevalence over several decades and rates are around 6% to 16% for males and 2% to 9% for females.

Suspected Causes

Many very bad childhood experiences appear to be tied to the development of Conduct Disorder. Parents who are drug involved, or have mental disorders of their own are more likely to have conduct disordered children. Research also suggests that the tendency to develop Conduct Disorder behavior patterns is genetically inheritable. Children so diagnosed frequently have experienced traumatic events, poverty, family disorganization, abuse, neglect, and abandonment. They have frequently lived in poverty and grown up around violent peers and adults. Children with a biological or adoptive parent with Anti-social Personality Disorder or a sibling with Conduct Disorder, are themselves at greater risk for developing a conduct disorder.

A Case Study

One 15 year old’s father was in prison for killing someone. The boy had visited his father in prison on numerous occasions and sometimes got phone calls from him. Despite his father’s pleadings to him to do good in school, follow the rules and stay out of trouble, the boy was failing in school, frequently suspended, and had been in a juvenile detention center for threatening and attacking other students. The boy’s mother had lived with several other men in the course of his short life-time and he had experienced drugs, violence, and the physical abuse of his mother and himself repeatedly. After frequently running away from home and being involved with older men and drug abuse, he was placed in a long-term adolescent treatment facility. The boys Conduct Disorder was severe in nature, with an early onset, and it was likely that his behavior patterns would continue into adulthood and then be diagnosed as Antisocial Personality Disorder.

We must find ways to save our infants and children from these incredibly damaging influences. The majority of these human tragedies can be prevented before their contagious effects spread throughout our population. Our current late remediation strategies are failing miserably and are doomed to fail by the very nature of this intractable psychological disability.

America must create bold preventive and very early interventions to avoid the continued escalation of the social havoc that we now experience due to our increasing rates of Conduct Disorders.

If you see the symptoms listed above in your own children, or a Friend or family member complains about them in their children, the best advice is to get professional help as soon as this behavior pattern begins to take shape. I recommend a conference with your family MD and if there are no health issues, an appointment with a psychologist with both counseling and behavior modification skills.

God Bless,

Dr. Tom

Sunday, November 22, 2009

Prevent Fetal Alcohol Syndrom (FAS)

Prevent Fetal Alcohol Syndrome (FAS)

Women who drink alcohol during pregnancy put their infants at risk for biological damage. Binge drinking among college students and early alcohol consumption among teens has increased dramatically. Alcohol consumption during pregnancy increases the risks of a newborn infant suffering from fetal alcohol syndrome (FAS). FAS often shows itself in head and facial deformities that tend to create elf-like facial features, slow growth, abnormal joints (feet, fingers, toes), heart defects, tremors and agitation in newborns, hyperactivity, learning disabilities, abnormal brain development and possible mild to moderate mental retardation.

Rough estimates of the occurrence of FAS are 1 to 2 of every 1000 babies. This figure increases to around 29 of 1000 women who heavily consume alcohol early in their pregnancies.

In general, alcohol consumption among our female population has also increased in recent decades. Guidelines for the safe consumption of alcohol during pregnancy are not clear and this has led many health professionals to recommend zero alcohol use during pregnancy.

This leaves society with three major problems: The first is that many pregnant women do not get this message. Secondly, many of the women who do understand that alcohol is dangerous to their in-utero developing babies simply behave irresponsibly: some knowingly take the risks of alcohol consumption during pregnancy. In many other cases pregnant women are addicted to alcohol and believe they cannot control their alcohol intake. Finally, and most diabolically, women may drink alcohol during that early time interval when they have not yet discovered that they are pregnant.

Physical and neurological damage caused by woman who consume alcohol or other drugs during pregnancy cannot be cured. These infants are damaged for the rest of their lives. The effects of these impairments will reverberate for at least three generations: the mother’s life, the child’s life, and the lives of the many others with whom the damaged and growing person will interact. The costs in lost human potential and financial resources of substance abuse to the unborn and society are huge and difficult to establish.

What, in general, are the costs of an impaired child through life? There are the costs of special education, unemployment, medical care and welfare. Insurance costs must increase as well as our taxes. What about the costs of crime, law enforcement, prosecution, and prison?

We seldom think about the costs to us all of the forms of behavioral contagion that I have outlined above. If we fail to control these costs to society through prevention, this human source drain upon our health and viabilitycan destroy America’s health and viability.

We must prevent FAS and other factors that destroy our children.

I am reminded of a nursery rhyme from my childhood:

“Humpty Dumpty sat on a wall. Humpty Dumpty had a great fall. All the Kings men and all the Kings horses couldn’t put poor Humpty Dumpty together again.”

The prevention of our human problems is the best and most cost-effective way.

God Bless,

Dr. Tom

Friday, November 20, 2009

Divorce When There Are Children?

Divorce When There Are Children ?

As a therapist, I find counseling with couples without children who contemplate divorce to be mildly stressful. I always want to help people to solve the problems that they are coping with.
But, with married couples without children who fail to remain together, the pain and stress to them and their families normally does not damage any children and I take solace in that. If one or both are determined to divorce, I shrug my shoulders with resignation and sadly say, O.K., go ahead.

When I am working with a married or formerly commited couple with children who fail to remain together, it is a gut-wrenching experience for me. I am pretty good at letting go of the therapeutic process when there is nothing left that I can do. But, I do everything in my power to persuade married or committed couples to consider the effects of their divorce upon their children.

Please allow me a brief fantasy.

If I were king, I would decree that no couple with children could separate before their children had graduated from high school. After all, the children did not ask to be brought into this world only to be separated from those who they have grown to love and depend upon for life, security. and normal growth and development.

In my fantasy, in this day and age of easy contraception, I would lecture to my kingdom:

"You brought that infant into the world and now it is your obligation to raise that child to the best of your ability. Your personal hopes and desires are secondary in importance to the needs of your child...and your child needs you to stay together to help him or her grow to the age of independence.
Sorry, that's just the way it is. Besides, when you were married you took an oath before God to remain married, 'Till Death Do Us Part'.
Why don't you now just commit to, 'Till Our Children Depart', and worry about the rest later.
Now, let's get to work to do the best job that you can possibly do raising your children and also find as much happiness during this process as is possible".

O.K., the fantasy is over. Don't get was only a fantasy!

The hard reality is that there are several good reasons to get a divorce, in spite of the hazards to the children involved. I am convinced by 30 + years of practice, that when children are involved, the marriage deal-breakers should only be 1. Physical or Sexual Abuse; 2. Chronic Untreatable Emotional Abuse; 3. Chronic Untreatable Infidelity; and 4. Chronic Untreatable Alcohol or Drug Addiction or Abuse.

I believe these family problems normally put children at greater risk for harm than a divorce.

But for all other cases that include children, there is a moral responsibility to the children involved and to society to enter marriage/couples counseling and to try as hard as possible to improve the existing problems. Reasonable estimates of improved relations in couple's relationships are between 60% and 70%.

If you are considering a divorce or terminating your relationship with your partner, and you have children, stop and think about what will happen to them. I ask that you please have the courage to study the following links and then protect your children with all of your might.

This first link describes the harms that are likely to occur to your children.

This second link describes the harms that accrue to society when marriages or couples with children break-up.

God Bless, Dr. Tom


Thursday, November 19, 2009

Protecting America's Children From Abuse

Protecting America's Children From Abuse

One of the most difficult problems we face is the physical and sexual abuse of America's children. The effects of these damaging experiences on children can ripple through at least three generations as its contagious effects stress our mental health, educational, welfare, law enforcement, and our prison systems. The social costs in the form of psychological harm to our population and tax revenues consumed are huge.

In all 50 states, we are required to report child physical and sexual abuse to the appropriate authorities. It is essential to call your regional Child Protective Services Agency (CPS) if you have an honest fear that any child you know is being abused, including your own.

It is very easy to turn away, to assume that someone else will take care of the problem, or that despite your real concerns, abuse might not really be happening. But children cannot protect themselves damaging abuse and it is not our responsibility to determine if abuse is truly happening or not. That is the responsibility of CPS.

It is very difficult to report abuse by members of our own families. Sometimes good people feel that they have found a way to protect their own children from further abuse and feel that the matter can therefore be closed. But the problem is not closed. The abused child may need counseling to minimize their harmful experiences. Furthermore, the abuser will most likely go on to abuse other children. Continued abuse of other children is virtually certain with those who are sexual abusers: whether they be adults, teens, or older children.

It is important that we understand that:

  • We are required to make a report.
  • If we honestly make a report of our fear for a child's welfare, this is called "good faith" and we are protected from prosecution.
  • If we fail to make a report, we can be prosecuted through legal or civil action.
  • We not only have a legal obligation to make a report of child abuse, we also have moral obligation to do so.
America's children are as precious as they are vulnerable. We must protect them.

Please go to the following link to learn more about the legal requirements that we all report suspected child abuse.

Dr. Tom

Wednesday, November 18, 2009

"An Once of Prevention Is Worth A Pound Of Cure"

"An Ounce Of Prevention Is Worth A Pound Of Cure"

Dear Parents,

Sailors do it the old and traditional way. They are more interested in enjoying the voyage than simply looking forward to reaching their destination. This is a great lesson for our parenting years, and life in general!

Though I did my best to enjoy my parenting years, I often find myself wishing that I would have taken even more time to appreciate and enjoy my my time with our young children and adolescents.

There is yet another lesson for parents, straight from our sailing heritage. Sailing a sailboat can be a wonderful, relaxing, and fulfilling experience. It can also have its times of danger, fear, and anxiety. Sailors are taught to "reef", or reduce their sails, at the first signs of a big blow, or a storm. It is unnecessarily hazardous to wait until the ship is in a big storm to go on deck and attempt to get the sails under control.

In all things, prevention is the best policy.

A very long time ago, I learned that helping parents who's children were showing psychological/behavioral problems normally worked best when when the children were young and/or, the problems were early in their development.

After over 30 years of psychological practice, I can tell you that this observation still holds true and I now consider it to be a very important Principle of Psychological treatment.

There is no reason for high anxiety. Developing children are constantly changing, as is their behavior patterns. Enjoy the process!

However, if emotional or behavioral problems appear to be emerging, monitor the situation carefully. If the difficulty continues for several weeks, or appears to be getting worse be sure to check with your pediatrician or family doctor. It is very important to rule-out any medical problems and get a professional opinion regarding the seriousness of your child's developmental problem.

If your concerns are validated, or if you still have uneasiness about your child's emotions or behaviors, do not be hesitant to consult a Licensed Child Psychologist in your State. It will be especially beneficial if this professional is skilled in Behavior Modification methods with children. The knowledge you will gain can give you confidence and help you to prevent the development of more serious problems in your child.

Remember to "reef "early! "An ounce of prevention is worth a pound of cure".

Dr. Tom

Tuesday, November 17, 2009

You Are Invited!

You Are Invited!

Dear Friends,

I hope you will visit my other blog site,

The reason I have two blogs is that each has its distinct purpose. As a professor, I studied and taught about how to help individuals and families with psychological problems. I also studied, and taught about the various things that sociocultures have done that strengthen or weaken their own ability to survive long and well.

The purpose of the blog you are now on, is to address the many things that we must do, or prevent from happening, in order to live our individual lives well: To have and maintain relationships with other individuals in our lives, to maintain our families, raise our children, and to care for ourselves and our loved one's psychological health and welfare.

The purpose of culturalsuvivalskills is to address the things that we must know and do, or prevent from happening, to strengthen America's psychological health and its ability to survive very long and very well. Yes, besides caring for ourselves and our loved ones, we must also care for our American Society. We may not think of it often, but our American Socioculture is the influential context in which we work to care for ourselves and our loved ones.

If the Socioculture in which we live is increasingly emotionally disturbed, destructive of its families and children, and its behavior is confused and maladaptive, that will spell disaster for all of us and our loved ones.

I am convinced that our American Socioculture is in decline. I think that many of the reasons for this decline have to do with our abandoning values and principles that made us great. These values and principles involve Judeo Christian rules for living life and other practices that generally conformed to science-based principles of psychology, economics and other sciences.

If you visit, you will come to understand my many concerns. Sociocultural evolution is in part a political process, so political matters are more frequently discussed there. Most of my suggestions and views are conservative but a few will be judged to be liberal. This is because it is clear to me that both parties are failing to care for our America Socioculture as they should. My friends are of all political persuasions.

At, my focus will normally not be on political matters or America's sociocultural health. As in my private practice, my political views and those of my clients do not matter. Like in my psychological practice, here we will focus upon the quality of our individual lives and what we need to do to help ourselves and our loved ones to live very well and happily.

God's Blessings to you and your loved ones.

Dr. Tom

Monday, November 16, 2009

Dear Reader,

My mission statement can be found on my lifecopingskills web site, but it is good to repeat it here, at the very beginning of my blog site.

If you are seeking advice on life's challenges, it is good to know how your advisor comes by his or her advice. No one has perfect knowledge, but there is much we can do to learn better ways to manage our personal emotional/psychological affairs, that will most likely bring rewarding outcomes in the long-run.

The following describes my value system and what I hope to achieve with my blogs.

I am dedicated to discovering the truth about the forces that shape our behavior for good and for bad. In this pursuit, I greatly respect the wisdom of the ages brought to us through the religions of the world, the great philosophers through history, and the findings of modern science. I also respect the many findings from my own life's experiences and that of my family and friends.
When the weight of all of these sources of information are in agreement, I am particularly impressed. Should my personal experiences and/or science reliably demonstrate that my beliefs, so derived may be false, I will make the appropriate changes necessary. Until then, I will strive to make all important decisions in my life, and similar recommendations to others, based upon this rational process.

As a psychologist, I will pray that I might benefit my clients, loved ones, friends and others in America and elsewhere by sharing what I have learned works well in life.

I am dedicated to strengthening good and beneficial thoughts and behavior in myself and all others who wish to join me in this effective life-coping-skills quest.

My blogs, to follow, will be comprised of many topics. Some will relate to solving particular problems, others will be primarily informational. I will speak to matters of family, children, and and adolescents. I will also try to address the many concerns and issues that arise as we live our lives among our adult loved ones, friends, or work peers and supervisors.

At times my blogs may be thematic, or they may deal with some concerns that are on my mind on any particular day.

If you are seeking in-depth written materials about meeting various life's challenges, please visit my web page and consider the manuals that are listed there and available for purchase at a very reasonable price. I have started with a manual on the use of Time-Outs, and other methods of teaching good behavior to children. Other manuals will follow in the weeks to come.

Also, I hope you will tell me the challenges and issues that you would personally like to see addressed in the future. Please feel welcome to Email topic requests to me, or leave your comments in my blog page. I will do my best to respond to them in a timely manner.

God's Blessings to you and your loved ones,

Dr. Tom

V. Thomas Mawhinney, Ph.D.
Health Services Provider in Psychology, HSPP 20090171A
Professor Emeritus of Psychology, Indiana University South Bend