ADHD in young children: One of the most common difficulties of childhood

Working as a licensed clinical psychologist I am often faced with parents coming to me for help with their young child. These families may seek help with managing a number of concerns such as anger, excessive worrying, or attention problems. Now that summer vacation for children has ended and the school year is here, many parents and teachers will be confronted with over-active children. Some of these concerns may be due to limited opportunities to go outside and play, while others may have difficulties resulting from a more complex issue such as a diagnosable disruptive behavior disorder.

During early childhood children often have difficulty sitting still, paying attention, or controlling their impulses. This is part of the normal developmental process. However, for a small number of these children the problem is more persistent and impacts their daily lives at home and at school. Children with pervasive over-activity levels and inattention may have Attention-Deficit Hyperactivity Disorder also known as ADHD.  ADHD is a neurobiological disorder characterized by developmentally inappropriate impulsivity, inattention, and in some cases, hyperactivity. There are several types of ADHD that can be diagnosed and children may present with different symptoms. About 9.5 percent of children ages 4 to 17 in the United States have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. People with ADHD can be very successful in life. But without appropriate identification and treatment, ADHD can have serious consequences such as difficulties with school work, poor social skills, and conduct problems. Early identification and treatment are extremely important so if you notice concerns please consult with a psychologist.

The best outcomes for children with ADHD are associated with the use behavior therapy and medication management. According to Pediatrics, it is recommended that young children with ADHD receive behavioral interventions first, such as parent training in behavior management techniques. These treatments can be followed-up with medication if behavioral interventions are not successful.  In my practice, I typically recommend that parents attempt to implement behavior treatments. If the difficulties associated with ADHD are moderate or severe I will recommend consultation with a pediatrician or psychiatrist for medication management considerations. There is some evidence showing benefits of medication for treating ADHD in young children, however it is unclear how medication affects the child’s brain.

Below are a few suggestions for managing difficulties associated with ADHD:

• Provide positive attention to the child
• Target performance goals and monitoring behavior by tracking progress
• Implement individualized home and school reinforcement programs
• Utilize non-physical punishment procedures such as time-out or response cost systems

It should be noted that some of these recommendations may be implemented at home without a professional. However, if the child’s difficulties are persistent and long-standing you will benefit from contacting a psychologist in your area who can help tailor treatment to you and your child. Additionally, teachers and parents may consult with a school psychologist at their local school who can assist with interventions in the classroom settings and developing appropriate educational accommodations.

Additional suggestions for parents:

Driven To Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood By: Edward M. Hallowell and John J. Ratey

Taking Charge of ADHD: The Complete, Authoritative Guide for Parents  By: Russell A. Barkley PhD




© Copyright 2012 Erlanger A. Turner 

References:

http://www.chadd.org/ http://www.apa.org/monitor/2012/03/adhd-guidelines.aspx
http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml
http://www.cdc.gov/ncbddd/adhd/
http://kidshealth.org/teen/school_jobs/school/adhd.html#

Mental Health Services Use in Ethnic Minorities

Given July is designated as Minority Mental Health month; I decided to write a post on disparities in mental health. One of the reasons I pursued a Ph.D. in clinical psychology was because as an undergraduate student I felt that the research on mental health concerns in children was limited, specifically as it related to service utilization for ethnic minorities.

According to the Center for Disease Control (CDC) Office of Minority Health and Health Disparities₁, less than ½ of adults and 1/3 of children receive the needed mental health treatment. This is alarming given that over time these problems may become worse resulting in poor daily functioning and having a negative impact on relationships. Additionally, mental health difficulties can also impact health outcomes such as chronic diseases.

According to the research ethnic minority populations (e.g., African American, Hispanic American, and Asian American) are less likely to seek help from a mental health professional such as a psychologist. My own research_2,3 on child mental health services focuses on examining what are some contributing factors to preventing parents from seeking treatment. The US Surgeons General₄ has reported that for ethnic minority groups some of these barriers include financial considerations, racism, and discrimination. Other_{1, 2} report barriers such as stigma, attitudes, income, mistrust, and lack of health care providers. In my own research, I have found that attitudes toward mental health and mental health stigma are highly important to the lack of service use by ethnic minorities.

Given these disparities in mental health, what can be done to meet the needs of ethnic minorities? Personally, I believe there needs to be increased education about the benefits of psychological treatment. The American Psychological Association, Division 42 (Psychologist in Independent Practice) has developed a video that promotes seeking treatment. See below:

Additional ways to help decrease the stigma around mental health services include:

·         Ensuring that mental health and behavioral health services are covered by insurance

·         Training psychologist to provide culturally sensitive treatments

·         Applying a community based approach to treatment

·         Talk to a doctor about mental health (to increase the referral process)

Note: If you feel the need to seek treatment, you can access the following sites to locate a provider in your area.  

American Psychological Association

APA Division 42, Psychologist in Independent Practice

National Register Health Service Providers in Psychology

© Copyright 2012 Erlanger A. Turner 

Sources:

1. Fact Sheet on Mental Health Disparities (http://www.cdc.gov/omhd/amh/factsheets/mental.htm)

2. Turner, E.A., Heffer, R., & Jensen-Doss, A. (August, 2010). Disparities in Child Mental Health Services: The Role of Ethnicity, Attitudes, and Stigma. Presentation at the American Psychological Association Convention, San Diego, CA.

3.  Turner, E.A., & Liew, J. (2010). Children’s Adjustment and Child Mental Health Service Use: The Role of Parents’ Attitudes and Personal Service Use in an Upper Middle Class Sample. Community Mental Health Journal, 46,3, 231-240.

4. American Psychiatric Association, Minority Mental Health (http://www.psychiatry.org/mental-illness/people/minority-mental-health)

5. National Council of Community Behavioral Health (http://www.thenationalcouncil.org/cs/about_us/mental_health_stats_infographic)

Resources for Psychology Students

There is an abundance of information available on the internet for students who are interested in being a licensed psychologist. As a graduate student not so long ago, there was a time when I was overwhelmed with the knowledge base available. As a former member of the Committee for the American Psychological Association of Graduate Students (APAGS), I became abreast of some pertinent resources while serving at the Member at Large, Practice (2008-2010). Below is a list of sites that I have compiled. The goal is to provide practice oriented graduate students with information pertinent to the internship process, licensure preparation, and business of psychological practice.

-Erlanger Turner, Ph.D.

Licensed Psychologist

National Register Health Service Provider in Psychology

v  American Psychological Association  http://www.apa.org/

Find information about psychology and membership in APA.

v  Internships and Postdoctoral Programs

Association of Psychology Postdoctoral and Internship Centers (APPIC) http://www.appic.org/

The APPIC site provides information regarding internship and postdoctoral programs, internship match rates, and resources for internship preparation.

v  APAGS Listservs

Stay abreast of current topics related to graduate education and training. Join APAGS listservs targeting clinical psychology.

CLINAPAGS, for students studying clinical psychology

APAGSINTERNSHIP, focused on issues faced by students currently on internship

MENTORS, connecting students with practicing psychologists

Note: To subscribe to any listserv, send an e-mail to (listserv@list.apa.org) with the following in the BODY of the message (leave the subject line blank): SUBSCRIBE <listserv name in capital letters> <firstname> <lastname>

Example: SUBSCRIBE CLINAPAGS Jill Smith

v  APA Practice Central  http://www.apapracticecentral.org/

As an APAGS member, the Practice Central allows you access to protected content related to the practice of psychology.

Business of Practice: http://www.apapracticecentral.org/business/index.aspx

Staying competitive in the evolving health care marketplace requires you to take an active role in building, managing, marketing and diversifying your practice.

Becoming a Licensed Psychologist: http://www.apapracticecentral.org/ce/tools/index.aspx

Provides steps towards completing licensure and starting a practice.

v  Licensure and Certification Information

Association of State and Provincial Psychology Boards (ASPPB) http://www.asppb.net/

ASPPB is the association of psychology licensing boards. Information can be obtained regarding specific jurisdiction requirements for licensure, licensure mobility, and the Examination for Professional Practice in Psychology (EPPP)

           

American Board of Professional Psychology (ABPP) http://www.abpp.org

Interested in establishing a certified specialty area? Visit the ABPP site to obtain information about becoming a board certified psychologist. Specialty areas cover a variety of areas such as clinical, health, school, counseling, and neuropsychology.

National Register of Health Service Providers in Psychology http://www.nationalregister.org

The National Register of Health Service Providers in Psychology credentials doctoral level psychologists, offer free continuing education, and work closely with doctoral level psychology students to verify and bank their credentials.

v  APA Divisions for Student Practitioners

Find your niche within the psychology field by joining an APA Division that fits your career goals.

http://www.apa.org/about/division/index.aspx

v  Transitioning to an Early Career Psychologist

Get connected through APA Early Career Psychologist. The link provides information regarding financial planning, licensure, and career development.

http://www.apa.org/careers/early-career/index.aspx

© Copyright 2012 Erlanger A. Turner