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Mental Health and Behavior

Mental Health & Behavior

Treatment for Pediatric ADHD & Pediatric Mental Health, including Pediatric Depression, Pediatric Bipolar Disorder in Ocala, Williston and surrounding areas!

Englewood Pediatrics has time for your kids.

Treatment designed with YOUR child in mind.

Englewood Pediatrics offers hope, help and healing for children who deal with ADHD, Depression, Bipolar Disorder, Autism and Oppositional Defiant Disorder (ODD). While the illness may be similar, we understand that every child is different.

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At Englewood Pediatrics, we treat the individual child, not the disorder. Personalized care requires a personal focus and personal approach and we provide both.

Pediatric Mental Health Disorders

ADHD

What is ADHD?

ADHD (Attention Deficit Hyperactivity Disorder) is often overlooked or explained away as ‘typical busy behavior’. However, it generally becomes a serious issue when it affects a child’s ability to perform required tasks, specifically in a school setting. ADHD robs children of their ability to focus and pay attention. You’ll often hear that a child can’t seem to stay “on task”.

The Center for Disease Control estimates that 11% of school aged children are diagnosed with ADHD. National Institute of Mental Health estimates 3-5% of children have ADHD. Some experts believe that figure could be as high as 10%.

There are three subtypes of ADHD.

  • Combined ADHD, which involves symptoms of both inability to pay attention and hyperactivity/impulsivity.
  • Inattentive ADHD (previously called ADD), identified by impaired attention and concentration.
  • Hyperactive-impulsive ADHD, marked by hyperactivity without inattentiveness

What Are the Signs of ADHD?

Children with ADHD display signs of inattention, impulsivity and hyperactivity in definite ways.

These children:

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  • Move constantly
  • Squirm and fidget
  • Don’t seem to listen
  • Find it difficult to play quietly
  • Often talk excesssively
 
  • Interrupt and/or intrude on conversations or activities
  • Are easily distracted
  • Have trouble finishing tasks

It’s important to note that about two-thirds of children with ADHD also have other conditions, such as learning disabilities, anxiety, depression, oppositional defiant disorder and conduct disorder. These other conditions can make proper diagnosis of ADHD more difficult. Our ability to provide comprehensive care is one reason so many trust Premier Pediatrics.

What ADHD is not: (Adapted from Getting with the Guideline- Managing Pediatric ADHD in your Primary Care Practice)

  • Not merely a lack of effort, not trying hard enough
  •  Not laziness: most children with ADHD are functioning as well as they can and would rather be functioning well!
  • Not improved by negative, controlling or inconsistent parenting styles

Psychosocial problems at presentation predict ADHD severity, comorbitity and persistence (Blackwell DL. Vital &Health Statistics 2010,series 10 (246) :1-166)

  • Developmentally inappropriate expectations
  • Family discord, divorce
  • Poverty
  • Negative parenting styles

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  • Intimate partner violence
  • Parental depression, illness, death
  • Neglect, physical, sexual, emotional abuse

Untreated/undertreated ADHD outcomes:

School /vocational failure

  • Fewer years of education
  • Only 20% complete college
  • More unemployment
  • More often fired
  • More lost work
  • Lower income

Social failure

  • Poor family functioning
  • Deviant peer affiliation
  • More antisocial acts

     Accident/Injuries

  • More accidental injuries
  • More ER visits
  • Driving
  • More moving violations
  • More accidents
  • More physical injuries
  • More license suspensions
  • More license revocations

Substance abuse & sexual risks:

  • Earlier cigarette use
  • Lower cigarette quit rate
  • Higher substance abuse rates
  • Earlier sexual activities
  • More teen pregnancy
  • More sexual partners
  • 4x risks of STDs

High comorbidity rates:

  • Oppositional defiant disorder
  • Anxieties (often multiple)
  • Depression,dysthymia
  • Conduct disorder
  • Bipolar disorder
  • Obesity, eating disorders (females)

More legal problems

Higher healthcare costs

Higher risks of early death

  • Fatal accidents
  • Suicide

Adult ADHD family issues

  • Poor family functioning
  • More failed relationships
  • Higher divorce rates

Dispelling the Myths about ADHD

MYTH: “They just need more discipline.”

Often, parents believe it’s simply a lack of willpower or discipline. The fact is that ADHD is a medical disorder requiring medical attention. Providing clear, consistent expectations and behavioral boundaries help, but they won’t address the genetic or chemical influences. If pushed too hard, a child’s inability to model expected behavior could result in depression.

MYTH: “All fidgety kids have ADHD.”

Sometimes typical kid behavior might look like ADHD symptoms, but fidgeting, lack of organization and the inability to listen or follow instructions aren’t always symptoms of ADHD. Premier Pediatrics looks for MULTIPLE symptoms that affect your child in a variety of social situations, like home or school. We consider the history of the symptoms. In other words, we take the time to make an accurate diagnosis.

MYTH: “ADD and ADHD is the same thing.”

Actually ADD (Attention Deficit Disorder) was the term used to describe a certain type of attention problem, and it was used for years. Today, medical professionals use ADHD (Attention Deficit Hyperactivity Disorder) as the all-encompassing term under which the different subtypes fall.

MYTH: “You can’t diagnose ADHD until they’re at least 6-8 years old.”

New findings make it possible to accurately diagnose ADHD in children as young as 4 years of age. This is a major step towards improved care in that early diagnosis helps kids adapt to therapies that can increase their odds of success at school.

MYTH: “It’s a phase. They’ll outgrow it.”

The latest conventional thinking is that many kids never outgrow ADHD. In fact, about half of kids with ADHD have symptoms as teens and adults. With proper treatment and symptom management, some of these traits can actually be an asset in future careers.

MYTH: “Your kid’s teacher can let you know if they have ADHD.”

No teacher, aide or principal is qualified to diagnose ADHD. While they may be able to point out problems that they’ve witnessed in kids known to have ADHD, this obviously doesn’t qualify as a professional diagnosis.

What is Pediatric Anxiety?

Although often assumed to be no big deal, anxiety is actually quite prevalent in children and can be severe enough to warrant a diagnosis and treatment. Most children struggle with fears and worries as they learn how to process the world around them, but when those fears and worries become persistent over time, they can impact a child’s mental health and their life at home and school. 

Different types of anxiety in children

Separation Anxiety – It’s very common for children to experience a certain amount of anxiety when separated from their parents for any length of time. This can manifest in tantrums and other unusual behavior when one or both parents leave. 

Social Anxiety – This can manifest mainly as a fear of school, but can also come up in situations like family gatherings and being in large crowds, anywhere that the child is around a lot of people.

General Anxiety – When a child starts worrying about bad things that might happen, even when there’s no obvious connection to their present situation, this can be a sign of general anxiety. 

Phobias – Extreme fear of a thing or situation constitutes a phobia. Often these are linked to specific incidents, but not always. For example a child who was bitten by a dog might have a phobia of dogs going forward, but many children are afraid of spiders without having had any severely negative experience with one. 

Panic Disorder – Just like adults, many children experience panic attacks, which are repeated episodes of severe anxiety that come with physical symptoms like dizziness, difficulty breathing, excessive sweating, etc. A child is very unlikely to understand what this is when it’s happening and they will have difficulty communicating it, so these symptoms can be easy to confuse with other issues. 

Even well-intentioned parents may not always understand how anxiety presents in their children, and, depending on how they themselves were raised, they might think their child is faking or exaggerating for attention. Regardless of the reasons for this belief, it’s still better to take the child to the doctor to make sure. It’s also important to get on the child’s level and work with them to understand their symptoms and learn how to communicate about them effectively. 

Source:  https://www.cdc.gov/childrensmentalhealth/depression.html

What is Pediatric Autism? 

Autism Spectrum Disorder has become recognized as a very common disorder that affects about 1.7% of children in the US alone. In the decades that it’s been studied, it’s come to be recognized as a spectrum because it has a very wide range of effects on the people who have it. It may seem as though more people have it now than before, but in fact we’ve just come to understand it much better and screen for it much earlier. Autism generally manifests in children primarily through their social interactions and repetitive behavior patterns. Depending where on the spectrum they are, these factors can be more or less severe and require more or less help to manage. Children with autism can live perfectly happy lives with diagnosis and support, sometimes even getting to a point where they are no longer considered to be on the spectrum at all. 

Some symptoms of Pediatric Autism 

  • Minimal or no eye contact 
  • Not looking at items presented or indicated by a parent 
  • Not reacting to parents’ facial expressions, not being able to read others’ expressions in general  
  • Not having their own appropriate facial expressions 
  • Issues with socializing and communicating their own needs or problems 
  • Sensitivity to seemingly random sounds, less sensitivity to things like their name
  • Delayed speech, or disinterest in communication 
  • Excellent memory for seemingly random things 
  • Stimming, meaning performing repetitive behaviors that may help them self-soothe 
  • Preference for or a deep reliance on routine and rituals, while struggling with unexpected transitions or changes 
  • Ability to hyperfocus on special interests and hobbies that might seem unusual to others

Autism can often manifest differently depending on the child’s assigned gender and various environmental factors, or it may be missed entirely due to cultural differences or ingrained biases. For example, girls are diagnosed less often than boys because they’re more likely to mask their symptoms to fit in socially. 

Many make it to adulthood before they realize that things like depression, anxiety, and low self-esteem are due to undiagnosed autism and the pressures of constantly masking and trying to seem “normal.” Children of color may present the same symptoms as white children, but medical professionals are more likely to miss them due to systemic racism and cultural biases, as well as distrust and communication issues. 

Keeping these factors in mind is crucial for diagnosing children who may or may not fit the criteria perfectly but still need help and support in order to thrive. With the right attention and care, they can be diagnosed as early as 18 months and have no trouble adapting and managing any challenges that come their way throughout their lives. 

Sources:  https://pediatrics.aappublications.org/content/145/1/e20193447 

https://www.healthychildren.org/English/health-issues/conditions/Autism/Pages/Early-Signs-of-Autism Spectrum-Disorders.aspx

What is Pediatric Bipolar Disorder Disorder? 

Bipolar Disorder Disorder in adults is a well-known and well-documented phenomenon. It presents as extreme and prolonged swings between mania and depression, hence why it used to be known as manic depression. In children, it is less clear. Experts do not yet agree on the ways in which it presents in children that distinguish it from other issues such as ADHD (link to page) or oppositional behaviors (link to ODD page). If a child has symptoms that are in line with adult Bipolar Disorder, they’re more likely to be diagnosed as such, but many of the symptoms coincide with enough other potential issues that an actual diagnosis is challenging. Diagnosis is also accompanied by social stigma, which many medical professionals are reluctant to subject child patients to unless they feel very confident in their assessment. 

Possible symptoms of Bipolar Disorder disorder in children 

Rapid Mood cycling – This is often thought of as mood swings, especially in teens due to hormonal fluctuations associated with puberty. 

States of mixed Mania and Depression – Unlike adult Bipolar Disorder, pediatric Bipolar Disorder tends to involve mixed states rather than prolonged periods of either. 

Chronic Irritability – Irritability in children and teens is not uncommon, but when it becomes chronic to the point of affecting one’s quality of life, it can indicate a number of possible diagnoses, including Bipolar Disorder. 

Episodes of Euphoria, Grandiosity, and/or Paranoia – these feelings are more often associated with adult Bipolar Disorder but are not unheard of in children and teens. 

Hyperactivity – Often a symptom of ADHD, hyperactivity is not enough by itself to indicate Bipolar Disorder. However, it is not uncommon to see ADHD in children who also have a diagnosis of Bipolar Disorder disorder. 

Distractibility – As with hyperactivity, being easily distracted is not a clear indicator of Bipolar Disorder by itself. 

Pressured Speech, or speaking very quickly – Another symptom that should only be cause for concern when combined with other symptoms or when it severely impairs the child’s ability to function normally. 

Symptoms that persist through adolescence and come to more closely resemble adult symptoms – since so many of these symptoms coincide with other disorders, they cannot often be linked definitively to pediatric Bipolar Disorder until the child gets older and the symptoms continue and shift into the kind more easily identified as adult Bipolar Disorder. Seek a Medical Professional to make an accurate diagnosis. 

Diagnosis for pediatric Bipolar Disorder should not be taken lightly, as the downsides can be severe. Treatment can help a child manage the symptoms but medication needs to be carefully monitored. It’s also important to be sure it’s not ADHD, because treating one diagnosis when it is not the correct diagnosis can have adverse effects. This is not to say some people don’t develop Bipolar Disorder disorder very young, only that a cautious approach and keeping an open mind to all the possibilities is a wise course of action.

 

Source:  https://chadd.org/for-parents/pediatric-Bipolar-disorder

What is Pediatric Depression? 

Depression in children is as complex as depression in adults, but in different ways. It can be caused or impacted by a host of different risk factors, both physical and mental, as well as environmental, all of which should be taken into account when considering diagnosis. Things like traumatic life events or parents with depression play a big role in Pediatric Depression. Pediatric Depression is also often comorbid with other issues like ADHD (link to page) or Anxiety (link to page)

Symptoms of Pediatric Depression 

In adolescents – Teens often experience hormonal shifts that affect their mood and ability to function, but that doesn’t mean symptoms of depression should be ignored or dismissed. 

  • Excessive sleeping 
  • Decreased appetite and weight loss 
  • Delusions – a persistent belief in something despite evidence to the contrary

In children – Children can develop depression very young, often, but not always, as a result of external factors. Depression in children usually presents with the following symptoms:

  • Low self-esteem 
  • Hopelessness 
  • Hostility, especially towards authority figures like teachers 
  • Negative attributions 

Although depression often presents differently based on the child’s age group, certain symptoms are common among all ages and should be taken seriously. These symptoms include: 

  • Increased irritability 
  • Prolonged periods of depressed moods – depression as a symptom of depression may seem obvious, but it can still be easily overlooked or disregarded as less severe than it is 
  • Suicidal thoughts or ideation 
  • Self-harm, which can manifest in any number of ways

For children and teens, the treatment for depression should usually start out holistic – this means not merely medicating the child, but ensuring they have tried also in therapy and learning how to manage their symptoms effectively without medication first. However, if these approaches do not work, medication can be a great way to better manage depression. 

A diagnosis is not necessarily permanent. Many children and teens go through periods of depression due to the aforementioned risk factors, but can “grow out of it” with the proper care and support. Even if they experience depression again as adults, when given the right tools as children, they’ll have more success at managing it. 

Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532464/ 

https://www.aafp.org/afp/2012/0901/p442.html

What is Pediatric Dissociative Disorder? 

Dissociation is a common response to trauma. When experiencing a traumatic event like abuse, children, like adults, will sometimes completely disconnect from their thoughts and feelings during the event. Afterward, they may remember it as if it happened to someone else, or it may seem unreal. The dissociation may even continue for a period of time. By separating themselves from the thing that traumatized them, they find a way to cope with it. 

It’s only when the dissociation persists or the episode causes other issues that it develops into a Dissociative Disorder that requires treatment, often not until well into adulthood. For children especially, dissociation can be a frightening or deeply unsettling experience, even if they seem fine at the time; they can exhibit a range of symptoms or behaviors that might be hard to pin down or understand as evidence of dissociation. That’s why identifying the issue early on and helping the child through it can make a huge difference in their mental health as adults. 

Symptoms of a Dissociative Disorder in children

  • Various forms of amnesia or other memory issues that can’t be explained through other means like a head injury or other medical condition 
  • Entering trance-like states 
  • Sudden mood or behavior shifts without explanation 
  • A disconnection or disturbance from the self – may be particularly hard for a child to describe or explain 
  • Hallucinations, either auditory or visual 
  • Having vivid, imaginary friends 

These kinds of symptoms are often mistakenly diagnosed as other issues like attention-seeking, learning problems, or something more severe like psychoses. In order to accurately assess the source of the symptoms, it’s crucial to identify the underlying traumatic experience that could have caused the dissociation. Through this a treatment plan can be devised and the chance of the child developing a Dissociative Disorder later in life can be reduced. Examples of different Dissociative Disorders include Dissociative Amnesia, Dissociative Identity Disorder, Depersonalisation Disorder, and others. 

Sources: 

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dissociation-and-dissociative-disorders

https://pubmed.ncbi.nlm.nih.gov/8435785/

What are Pediatric Eating Disorders? 

Eating Disorders generally stem from psychological issues that result in unhealthy attitudes and behaviors around diet and food. If left untreated, they can lead to severe mental and physical harm, often resulting in hospitalization and even death. Conditions like anorexia, bulimia, and binge-eating fall under the umbrella. 

There are many factors that may cause a child to develop an Eating Disorder, from fat phobia in the media they consume, to peer pressure and trying to fit in, to observing their parents’ own body dissatisfaction, as well as major traumatic life events and smaller stressors that pile up over time. Children who suffer from an Anxiety Disorder (link to page) or Depression (link to page) first are more likely to develop an Eating Disorder than those who don’t. Catching an Eating Disorder early and providing the child or adolescent with compassionate treatment and support are key to managing it. 

Symptoms of Eating Disorders in children 

  • Unusual dietary habits or obsessions, like eating in secret, constantly dieting, only using one cup to drink from, not eating in front of others, eating in front of others but going to the bathroom immediately after, etc 
  • Persistent fatigue, often accompanied by physical signs of poor health
  • Suddenly becoming sensitive to cold 
  • Inability to stop eating, or frequent or secretive snacking or hoarding of food 
  • Any other behaviors around food and eating that negatively affect their life and mental health in a significant way 

A crucial thing to remember is that anyone can develop an Eating Disorder. It’s not limited by age, size, race, sexuality, gender identity, or any other factor. Because of lingering misconceptions around Eating Disorders and who is most likely to have them, many children don’t get the help they need. For example, it’s very common for doctors to miss Eating Disorder symptoms in larger children if they consider them to be overweight, even when those children are suffering from severe medical complications as a result of the Eating Disorder. It’s important to look for the signs and take them seriously before it’s too late. 

Sources: 

https://pediatrics.aappublications.org/content/147/1/e2020040279#sec-4 

https://www.betterhealth.vic.gov.au/health/healthyliving/eating-disorders

What is Pediatric OCD? 

OCD falls under the Anxiety Disorder (link to page) umbrella. It involves obsessive thoughts and thought patterns, and compulsive, recurring behaviors. Children generally benefit from routines, rituals, and later, hobbies, that provide them with a sense of stability in their day-to-day life because they know what to expect and what their role in their world is. OCD becomes serious when routines and rituals turn into obsessions and compulsions that disrupt the child’s life, rather than stabilize it. It takes things that help children learn to manage anxiety and instead exacerbates it. A well-known example is a phobia of germs that turns into compulsive hand-washing and extreme anxiety and fear around feeling dirty and unclean. 

Symptoms of OCD in children 

  • Intrusive, inappropriate, persistent thoughts, usually around sexual acts, taboo behaviors, or acts of violence, either towards others or towards one’s self. 
  • Excessive attention to detail. 
  • Needing to know unimportant details or information. 
  • Extreme preoccupation with order, needing things to be perfectly exact. This can include counting things a specific number of times and is sometimes linked with preventing certain imagined outcomes. 
  • Phobia of germs that prevents the child from enjoying normal activities. 

Compulsive behaviors linked to OCD in children 

  • Hoarding items 
  • Excessive hand washing 
  • Needing to check things over and over 
  • Arranging things in a certain order 
  • Repetition – words, sounds, questions, music, etc.

Many children struggle with symptoms of OCD. The exact cause of it is unknown, but it’s linked to a lack of a chemical called serotonin in the brain. It’s important to get it diagnosed once symptoms have been observed so the child can receive appropriate treatment before it begins to severely impact their quality of life. OCD can be very debilitating and understandably frightening for children in particular because they don’t know how to communicate what’s going on in their minds or why they need to do certain things. Getting treatment and support can help them learn to manage the disorder and feel calmer and more at ease, and prevent them from developing worse anxiety (link to page) down the road. 

 

Source: 

https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/o/obsessive-compulsive disorder-ocd-in-children.html

What is ODD?

ODD (Oppositional Defiant Disorder) is a condition in which a child displays ongoing and inordinate defiant, uncooperative, hostile and/or annoying behavior towards authority figures. This behavior generally disrupts the child’s normal daily activities at both home and school. Many children and teens with ODD also deal with other behavioral problems including ADHD, learning disorders, depression and anxiety.

The exact cause of ODD is unknown. Research indicates that a combination of genetic, biological and environmental factors may contribute to the condition.

What Are the Signs of ODD?

The most common signs of Oppositional Defiant Disorder include:

  • Repeated temper tantrums
  • Excessive arguing with authority figures
  • Consistent active refusal to adhere to rules and requests
  • Deliberate attempts to annoy or upset others /
    being easily annoyed by others
 
  • Laying blame on others for their own mistakes
  • Frequent outbursts of anger / resentment
  • Seeking revenge / acting spiteful
  • Swearing / using obscene language
  • Saying hateful things when upset

What is Pediatric PTSD? 

Post-Traumatic Stress Disorder, or PTSD, usually develops after exposure to a traumatic event or events, such as physical, emotional, or sexual abuse, divorce, death of someone close to them, a car accident, bullying at school, etc. 

For children, traumatic events may be particularly hard to process afterwards because they might lack the language or the life experience to understand what happened or how it affected them. PTSD develops when a child is unable to fully process their feelings in the wake of such an event and continues to experience strong, distressing reactions in situations that trigger memories of it. Although children can be very resilient sometimes, it’s still important to check for signs of PTSD to ensure they’re not suffering alone in silence from something they can’t explain. 

Symptoms of PTSD in children 

  • Nightmares and issues sleeping 
  • Recurring memories or flashbacks that force them to relive the event, often accompanied by panic responses 
  • Extremely negative reactions when reminded of the event, to the point of avoiding anything that reminds them of it 
  • Behavioral changes such as becoming more fearful, withdrawn, disengaged from normal activities, acting helpless, numbness, increased irritability 
  • Constantly alert for danger 
  • Easily startled 
  • Denial of the event altogether

It’s not always immediately obvious when a child is suffering from PTSD; sometimes this is because their reaction or subsequent behavior does not seem obviously connected to the traumatizing event. For example, some children who have been sexually abused will develop poor hygiene or strange, aggressive behaviors. Sometimes it’s because the PTSD might take a while to manifest in the ways we expect. It’s also hard for children to communicate what they’re experiencing if they have no idea how to describe it or that it’s connected to the traumatic event. 

Learning how to recognize the signs and see through odd behavior to understand the source is critical in helping children who are struggling to access the care they need. If the source is already known, keeping a close eye on children to monitor for signs of PTSD and treat it as it develops can often spare them a great deal of pain and struggle later on. 

 

Sources: 

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/post-traumatic-stress-disorder-ptsd#post traumatic-stress-disorder 

https://www.cdc.gov/childrensmentalhealth/ptsd.html

Premier Pediatrics takes the time to conduct a comprehensive evaluation that may include a complete medical history, physical exam and other tests that may expose a medical explanation for the behavior problems. If physical causes aren’t found, psychiatric and/or psychological evaluations may be suggested. Once we evaluate all results we can shape a treatment plan that meets the needs of your child. There is hope and there is help available for you and your child at Premier Pediatrics.

 

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