What Is Seasonal Affective Disorder (SAD)?
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SAD or seasonal affective disorder is a depressive disorder that most often occurs in fall and winter. However, It is not to be confused with the common “winter blues” just described. Symptoms of SAD include fatigue (regardless of the amount of sleep one gets) and weight gain associated with overeating, particularly high-carb treats and sweets. It is associated with higher levels of distress and interference with daily functioning than what most experience in the darker, colder months.
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According to the American Psychiatric Association, SAD has been linked to a biochemical imbalance in the brain prompted by shorter daylight hours and less sunlight in winter. With seasonal changes, people’s biological clocks or circadian rhythms can fall out of step with their daily schedules. Symptoms of SAD may require the help of a mental health practitioner. 

Whether SAD or Just Blue, Take Action

You (or anyone) can benefit by being proactive and taking steps now to improve your health and wellness so that you’re better prepared to deal effectively with the challenges of fall and winter. Following are tips to give you a better chance of preventing the winter doldrums:  

1. Give yourself permission to say “no” or turn down invitations for holiday parties that could incite high anxiety. Spending time with family members, friends and neighbors that lead you to excessive levels of anxiety and depression may not be necessary. Choose what you attend wisely.
2. Give yourself permission to not repay every gift given to you (with a gift from you). Tit for tat isn’t necessary and can cause anxiety, especially if you find yourself struggling financially this season. True friends will love you regardless. If you feel it necessary, make them a gift or write them a card. After all, it’s the thought that counts.
3. Spending time with certain family members can agitate us, or increase stress, anger, or sadness. It may make sense to avoid getting together with these family members. Other times, they may be unavoidable in which case, try to be mindful of what you feel and think so that you can increase your chances of responding more thoughtfully, carefully and respectfully.   
4. Schedule regular time with people you love and enjoy spending time with. Quality time with people we love is helpful in times of stress.
5. Do things that bring you joy such as listening to music, baking, being creative, or establishing less stressful, new traditions with friends and family members.
6. Take advantage of the days when the sun is out by exercising outside. Bundle up and take a walk. By absorbing sunlight, you are treating your body to Vitamin D—a vitamin the body can lack in darker months. Vitamin D helps the body use the calcium in your diet.
7. Break from the same old routine. Try something new such as a new food, restaurant, form of exercise, or activity. Doing so can lift your spirits, if only just a bit.
8. Treat yourself. Warm baths, meditation, long walks, movie with a friend, a date night, dinner with a friend, or a massage could be just what you need to improve your mood.
9. Try light therapy. This requires sitting in front of a light therapy box that emits very bright light (and filters out harmful ultraviolet (UV) rays) for about 20 minutes or more a day. Improvements may occur within one or two weeks of treatment. You’ll want treatment to continue through winter so you don’t risk relapsing. Begin light therapy in the early fall to prevent symptoms.
10. Abstain from alcohol and drugs. Alcohol is a depressant. While it is very common for people to drink alcohol at holiday parties and gatherings, it does not need to be. Drugs may be used an escape from the pressures of the holidays and winter months. Both are harmful even in small amounts. You may need professional help to get you through the holidays without partaking in alcohol and drugs, and that is ok.  
11. If you continue to struggle, do not hesitate to call a therapist. Talk therapy with a counselor, social worker or psychologist can help. It is their job to understand you, listen, support you and help you identify and use healthy ways of coping. Compass Point offers Care Connect, a service where clients can be seen by a licensed professional within 48 hours of their call.
12. Medication may also help. Talk to your physician about what you’re experiencing. He or she may prescribe an antidepressant medication in addition to working with a therapist, as the combination of both is often helpful to those experiencing high levels of anxiety and depression.

​If your depression is severe or if you have suicidal thoughts, please consult a doctor immediately, seek help at the closest emergency room or call the National Suicide Prevention Lifeline – 800-273-TALK (8255).

Troubled sleep, insomnia, and oversleeping are classic symptoms of clinical depression. While not all depressed people have sleep disorders, many do. When evaluating patients for depression, doctors typically ask about sleep patterns as part of the diagnosis.
Problematically, sleep problems worsen mood and can cause depression themselves, creating a vicious cycle.
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What is depression?

The CDC estimates that just over 7% of Americans have moderate or severe depression. The severity and symptoms of depression vary, but the most common include:

• Feelings of despair, hopelessness, sadness
• Frequent or occasional thoughts of death or suicide
• Difficulty concentrating
• Lower energy
• Lower libido
• Reduced self-esteem
• Weight gain or loss
• Loss of interest in activities the person formerly enjoyed
• Excessive daytime sleepiness
• Insomnia

As you can see, sleep problems are core symptoms of depression. Both depression and severe sleep problems are major risk factors for suicide and health problems like heart disease, other mental disorders, and smoking. People with depression have trouble being productive in work or school, which can impact their career and social life. The sleep issues are often one of the reasons depressed people seek out professional help.
The symptoms of depression are persistent and pervade all aspects of an individual’s’ life, from work and play to basic needs like eating and sleeping. Within the larger category of depression, there are several different types of depression which come with their own sleep problems:

• Major Depressive Disorder: This is extreme depression where the individual feels sad, hopeless, or suicidal through much of the day, regardless of what they are doing. Feelings of pleasure and happiness are hard to come by. Major depression is associated with insomnia and excessive daytime sleepiness.
• Dysthymia: This is a milder form of major depression, also associated with fragmented sleep and hypersomnia. People with dysthymia experience fewer symptoms from the list above and in a less intense way, but symptoms typically persist for much longer.
• Bipolar Disorder: People with bipolar disorder swing between extreme highs and lows. When they’re high, they’re overly energetic and unable to sleep, even if they’re tired. When they’re low, they oversleep.
• Seasonal Affective Disorder (SAD): SAD is a type of seasonal depression. The vast majority of affected individuals experience it during the winter months, with symptoms like hypersomnia, insomnia, and worsened mood – although about 10% experience it during the summer. SAD is likely brought on by the changing levels of sunlight, which affect the circadian rhythms of affected individuals, messing with their sleep and emotions.

Who’s at risk for depression? Stress, a recent loss or illness diagnosis, and family history are all risk factors for depression.
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Anyone can become depressed, but it affects some people more than others, particularly women and adults in middle age. Coincidentally, these two groups are also more likely to have insomnia. The chart below from the CDC reveals the correlation between age and depression as well as the disproportionate prevalence between the genders:

General diary card instructions:
Each night as you are winding down for the day, take a few moments to reflect on what your daily experiences were. We fill out the diary card left to right, one day at a time.  The first thing you fill out is the day/date! If your session was on a Tuesday and the date was June 3rd, you would write 6/3 in the Tuesday box. Then move across as you would read a book.  There is ample research that shows a strong correlation between tracking and improved outcomes. Whether you want to increase or decrease a behavior, tracking it will help.

The first section asks you to rate your urges for use (drugs/alcohol), self-harm and suicide on an intensity scale from 0-5.  This column does not indicate action, you could have an urge for alcohol at a 5 and not actually drink.  5 is very intense; 0 is non-existent. 

The second section is for emotions.  You are asked to rank the highest intensity of each emotion that day.  5 is very intense; 0 is non-existent. The “P” stands for physical pain (which isn’t an emotion…it just fits there) and the “E” is for emotional pain (which many of my clients like to use as their general stress rating that day.  The goal is NOT all zeros…the goal is not all 3s…the goal is that you are honest. Over time in DBT®, what I tend to see is that a person’s negative emotions will go down first, then their positive emotions will raise up (At about the same time that they start using skills).  Having this sort of proof to look back on can be very helpful when you start to feel jaded or tired from the treatment. I have also found in this section that people tend to block feeling certain emotions; the diary card allows you and your therapist to find this out faster!

The next big section is about drug/alcohol use (including legal prescriptions).  We do need honesty here; your therapist is not going to use this information against you! This section allows us to discover trends much faster. For example, if you have anger outburst every day after a glass of wine…or if you have a depressive slump each time you miss a medication, then we can target that immediately! Some people also find that tracking their medication compliance helps them remember their medications more often.

Next you will find a few blank columns.  This is something for you and your therapist to decide on over time.  Common things to track are: hours slept, bedtime, whether or not you exercised, eating disordered behaviors, etc.

The last section is your actual actions.  This section asks you to indicate (yes or no) whether or not you engaged in self-harm (intentional tissue damage), whether or not you lied (either big lies through the week or lying on the actual diary card) and whether or not you used skills (this is a 0-7 scale indicated on the bottom of the diary card). 

The furthest section to the right and smallest section by far is the reward column. In the column we are asking you to remember that humans rarely learn unless someone rewards a behavioral change; we are asking if you rewarded yourself for a job well done.  This might mean that you had a 5 in anger and you coped well or that you made a choice to go out with friends resulting in a 4 of enjoyment.  A reward could be as simple as positive self-talk/praise or as big as buying yourself a new item (perhaps new workout clothes for going to the gym 3x that week).  A reward doesn’t have to cost anything!

Upon entering session, you are supposed to hand your diary card to your therapist for them to review with you and lay the path for that session. 

The DBT® individual session is structured in the following way:
1. we address any life-threatening behavior (self-harm, suicide attempts)
2. we address any therapy-interfering behavior (not doing diary card, being late to class or session)
3. we address any quality-of-life interfering behavior (substance use, not rewarding self, lying, etc)
 
Other helpful diary card hints:
1. Keep it where you will see it. Inside your planner, the front seat of your car, on your nightstand or where you eat breakfast. We don’t care what condition it’s in when we get it back…just that it’s filled out and that you bring it back!
2. Set a reminder alarm on your phone to complete it
3. Use diary card time as a reminder to do your DBT® homework and/or practice mindfulness
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Co-Occurring Disorders
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​A person with a co-occurring disorder has been diagnosed with a substance abuse disorder and another mental health disorder. Co-occurring disorders, sometimes called dual disorders, are best treated through integrated treatment that addresses both issues at the same time.

The brain is a complicated and delicate organ. It’s not surprising that alcohol and other drugs can cause symptoms of mental illness. The substances work by changing the way the brain operates. People who use drugs feel buzzed or high because the substances affect chemicals in the brain and the way brain cells communicate with one another.

In response to those changes, the brain adapts to the presence of alcohol and other drugs, increasing the chances that a person will develop a substance use disorder. Substance use disorders are types of mental health disorders that are more commonly called addiction.
It’s possible to have more than one mental health disorder. Substance use disorders often co-occur alongside other mental illnesses. More than half of people with substance use disorders also have a mental illness. Sometimes the mental illness comes first. In other people, substance abuse occurs first. In both situations, each disorder amplifies the symptoms of the other.
“A large number of people with substance use disorders also have some psychiatric disorders which may or may not be major,” Dr. Timothy Huckaby, medical director of Orlando Recovery Center, told DrugRehab.com. “A lot of people have underlying depression or underlying anxiety.”
Other common co-occurring disorders include personality disorders, behavior disorders and psychotic disorders. With comprehensive treatment, individuals can recover from addiction and most co-occurring mental health disorders. But failing to address co-occurring disorders during addiction treatment increases the chances of relapse.

What Are Mental Health Disorders?

The phrases “mental illness,” “mental health disorder” and “mental health issue” are often used synonymously. In its diagnostics manual, the American Psychiatric Association uses the term mental disorder to define mental illnesses, but the organization also recommends using the term mental health challenge.
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The American Psychiatric Association defines a mental disorder as: “a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning.”

Some mental disorders are more common than others. Conditions such as anxiety and depressive disorders, for example, occur more frequently than schizophrenia and psychosis. Each type of mental disorder can range in severity from mild to severe.
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Developmental Disorders

Mental disorders are different from developmental disabilities. Developmental disorders, such as autism spectrum disorder and learning disabilities, impair social interaction, mobility, language and self-sufficiency.

Substance use disorders and other mental health disorders can co-occur alongside developmental disorders. But the term co-occurring disorder most commonly refers to substance use disorders and mental disorders.

Dual Diagnosis & Comorbidity

Dual diagnosis is an outdated term for co-occurring disorders. Both of these terms are sometimes confused with comorbid disorders.
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Comorbidity is a broad term used to denote the existence of multiple physical or mental diseases or disorders. Co-occurring disorders and dual diagnosis are specific to substance use disorders and other mental health conditions.
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Mental Disorders that Co-Occur with Substance Abuse

Any mental health disorder can co-occur alongside substance use disorders. The most common types of co-occurring disorders include mood, anxiety, psychotic, eating, personality and behavioral disorders. Each category includes numerous types of mental disorders that can range in severity.

Symptoms of personality disorders vary widely based on the type and severity.

Behavioral Disorders
Behavioral disorders most commonly occur in children. Many healthy people exhibit behavior problems, such as inattention, defiance and hyperactivity. However, behavioral disorders are characterized by chronic behavior problems that last at least six months.
Common behavioral disorders include:

• Attention-deficit/hyperactivity disorder
• Oppositional defiant disorder
• Conduct disorder

Symptoms of Co-Occurring Disorders
The physical and emotional symptoms of co-occurring disorders vary depending on your life circumstances, the type of substances you use and the type of mental illness you possess.

​The symptoms of mental health disorders are similar to the side effects of addiction. Thus, it can be difficult to determine whether a mental illness is caused by substance abuse or vice versa. Reputable addiction treatment centers screen patients for mental illnesses and develop plans for treating co-occurring disorders simultaneously.
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If watching the news is hard today, you are not alone.

On Thursday, Dr. Christine Blasey Ford and Judge Brett Kavanaugh testified in front of the Senate Judiciary Committee regarding Ford’s allegation that Kavanaugh sexually assaulted her 35 years ago.

While this hearing is important, it can be hard to watch, especially if you’re a sexual assault survivor. If you’re feeling emotional, raw or triggered right now, we want you to know that support is out there. If listening to Ford or Kavanaugh’s testimony is triggering, turn it off, log out of social media and contact someone you trust.

We’re sending hugs to anyone struggling today, and want you to remember these seven things if this news has been difficult for you.

We’re here for you. We believe you, and we’re happy you’re part of our community.

If you need support right now, here are some resources you can turn to:

• Reach the National Sexual Assault Hotline by calling 1-800-656-4673.
• Text the Crisis Text Line by texting 741741.
• 67 Resources for Sexual Assault Survivors Who Aren’t Sure Where to Turn via Greatest

Take care of yourselves today,

While we cannot offer you a real or ghost hug, we can offer you an ear.  We are hear to listen if you want to talk. Please call us at 513-939-0300 for an appointment today.  You don't have to carry it all on your own.

​Cyber bullying is bullying, no doubt about it. In fact, it can feel even scarier because the victim is isolated at home when reading it...and they often feel they have no one to go to for support.  We believe this page does a great job defining the forms of on-line bullying and can be useful for teens, parents and educators alike! If you or someone you know is a victim of cyber bullying, please feel free to contact us for support.  With Care Connect, we can get you an appointment with a licensed therapist within 48 hrs.
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​Tips for parents on cyberbullying management and prevention
How to tell if your child or loved one is a cyberbullying victim

There’s a chance your child, friend or loved one is the victim of cyberbullying but too embarrassed to admit it. Here are some signs:

• They avoid social situations or groups of friends that they once enjoyed, preferring to spend more time alone.
• They act out, displaying angry or upsetting behavior in a manner unusual to them.
• They suddenly spend less time on social media platforms that they once frequented.
• New, unknown numbers or texts suddenly appear on their phone.

Comforting your child after an incident of cyberbullying

• Approach the situation gently, allowing them to explain the situation to you at their own speed free of interrogation.
• Let them know that online cruelty does not reflect their value as a person.
• Inform them that the cyberbullying may not be personal, and that the bully may not understand the harm they are causing since it is being done from behind a screen.
• Advise them that retaliation or responding to the bullying can only make the situation worse.
• Tell them it’s not the end of the world, what seems like a crisis now will inevitably pass.
• Counseling - If the damage done by cyberbullying is severe, and the victim feels ostracized from their peers or afraid to go to school, he or she may benefit from professional counseling. Professional counselors, at school and otherwise, are trained to deal with cyberbullying and use specific techniques to manage the situation and help victims overcome their pain and self-esteem issues.
  

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Tips on preventing cyberbullying from happening to your child

• Educate your child on how to properly conduct his or herself on social media, i.e., don’t pose revealing photos or overly personal information.
• Friend, or follow, your child on the social networking sites he or she uses. This way you can monitor their activity from afar.
• Tell your child not to friend strangers, and to allow only trusted friends and family members to view their posts.
• Don’t openly engage with your child publicly on social media, as this may encourage taunting and bullying. Don’t post potentially embarrassing photos or content, either.
• Keep your computers and devices in the common areas of the home. Discourage them from using social media in private areas.
• Report instances of cyberbullying to social networking sites where they take place (links located below).
• If cyberbullying is a repeat issue, restrict their usage, or bar them from social media, altogether.

Cyberbullying laws and in school policy
Often a child will not be able to deal with an instance of cyberbullying alone, and the situation may require intervention by the school in order to put a stop to the behavior.

You may believe that confronting the parents of the bully is a good solution, but they might react unpredictably, denying the charge, or becoming aggressive. Research finds that the bullies are often physically and verbally abused by their parents, and they may not be the best individuals to confront about a cyberbullying situation.

Approaching the school in order to deal with an incident of cyberbullying is the best choice. Even before going to the police, this is the best course of action, as the school will have the contacts of every student, as well as a law enforcement liaison on campus at all times who will best know how to proceed with the situation. If bringing in the cops is necessary, then they will likely do so.
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To prepare:

• Take screenshots of the cyberbullying activity for evidence to support your case. If the bully uses their Facebook or Instagram account to bully your child, rather than an anonymous account, the evidence will be undeniable.
• Gather any texts, emails or other messages from the bully.
• Once evidence of the incident is gathered, make a call to the principal’s office to set up an appointment to discuss the situation

​Schools are mandated by state law in every state, to have an official anti-bullying policy, with Montana being the last to do so in 2015. Many states have laws that require schools to deal with off-campus behavior as well. Even if cyberbullying incidents take place off school grounds and after the last bell, they may still be forced to take action. Schools are required to keep classrooms a safe place conducive to learning, and off-campus cyberbullying can negatively impact this environment.

Interested in learning more about Cyberbullying? You can read more on Alarm.org. ​If you or someone you know is a victim of cyber bullying, please feel free to contact us for support.  With Care Connect, we can get you an appointment with a licensed therapist within 48 hrs.

Interning in the mental health field is always exciting and never produces the same day twice. Mental health agencies are fast pace and always changing. As someone who is lucky enough to be on their second year of interning in the field I can say that it is a rewarding and challenging experience. It was once told to me, “this will be the hardest job you’ll ever love” and I do love every day of it.

What does a mental health intern do? A little bit of everything. There are hours of shadowing other clinicians, sitting in on sessions to learn from experienced therapists, meeting with your own clients, answering phones, and doing almost everything a licensed professional does in a safe learning environment. Interning is hundreds of hours of hands on experience that could never be taught from a book or in a classroom. Each session, observed or self-conducted, is a learning experience. Interning also involves consultation with a supervising clinician to help grow your skills and guide you on the correct path to good practice.

As a Compass Point intern, I have had the pleasure to work with a wonderful staff who have been patient and wonderful teachers. Compass Pont has a team style approach and upon stepping through the door on my first day I quickly felt that I was a part of that team. I have been given a unique learning opportunity through specialized trainings and learning from a diverse team of clinicians.

Why intern in the mental health field? If you have ever had an interest in helping others and how the brain works, working in the mental health field is a great place to be. Interning allows you to be a student of the field and learn what you may not have been able to from a professor and textbooks. The mental health field is fast growing and has lots of opportunities for those who enjoy empowering and supporting others.
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Julie Arnold, LSW

I am currently an intern at Compass Point working towards my Master’s degree in Clinical Social Work from the University of Cincinnati. I have also received my Bachelor’s degree from the University of Cincinnati in Social Work. I have previous experience in working in community mental health in the home and in the school. I have worked with children, adults, and families who have experienced symptoms of depression, anxiety, attention deficit hyperactivity disorder, grief, and behavioral problems.

I take a strength based and client centered approach. I believe that each person has skills and strengths they may not know they have and I would like to be there to help you to discover them.  ​If you would like to schedule with me please call the front office at 513-939-0300 and ask to schedule a first appointment. 

​             There is a very familiar rhythm that most couples who have been in a relationship for a while tend to notice. When the honeymoon phase slowly dies away, people begin to get into rhythms of life: wake up, go to work, come home, rest, sleep, repeat. And with kids, this can become even more complicated! Date nights quickly fade and get replaced with evenings of catching up on chores or work. Sex becomes compromised for television or sleep, because the physical exertion and the thought of seducing our partner just seems like too much work when you could just snuggle instead. So how do you fan the flame and rekindle some of that old passion that was present when you first got married?

            There are two bodies of thought regarding this matter (and probably a few others too!). One comes from Esther Perel, sex and relationship therapist, who discusses the importance of mystery in a relationship in order to continue to feel passion. She discussed in TedTalks and books how as people, we desire familiarity and trust in relationships, but we also desire mystery and the chase. This can be especially prevalent for couples who spend all of their time together. You drive to work together, go to the store together, hang out with friends together, watch the same shows together, etc. and have probably run out of things to talk about. It’s likely you’ve lost a sense of your individual identity and have morphed into the identity you have as a couple. To resolve this, start doing a few things on your own. Call up some old friends and have a girls’/guys’ night out (take turns watching the kids to permit this if you can’t find a sitter), pick a hobby that’s your own, read a book or listen to an audiobook in a genre that you particularly enjoy. Take some time to find things that you love. The saying “absence makes the heart grow fonder” is true. A little time apart and some individual development is great for having stories to come back and share with one another.

            The other line of thinking is to work on the development of friendship, which Dr.’s John and Julie Gottman discuss in their trainings. Oftentimes, people get caught in a habitual rut with their partner in which they spend time talking about chores and household tasks that need to get accomplished (are the bills paid, who’s taking the kids to soccer this week, etc.) that they’ve stopped connecting on a deeper emotional level. This can be true for couples in the aforementioned situations, or for those who spend too much time apart. You start becoming roommates and realize that your friends are more fun to hang out with than your spouse, who’s constantly reminding you of all the tasks you need to complete. How do you remedy this? Schedule more intentional time together. Set a weekly date night. Have a “State of the Union” conversation on a weekly basis to address what’s going well in the relationship and areas of growth. Pinterest “questions to ask other than ‘how was your day?’” if you’re struggling to think of topics to ask your partner. Be intentional about connecting with one another.

            Both of these schools of thought are relevant and the approach you take really depends on your situation with your partner and what aligns most with you. Something that pretty much all of my couples find useful is The Five Love Languages book, by Gary Chapman. Typically, we love people the way that we enjoy receiving love, rather than loving others the way that they enjoy receiving love. To better understand this, check out the book, or just take their free quiz online!

            Lastly, for sexual connection, once the emotional connection starts to get reignited, this tends to follow; however, it’s not always the case. Most couples don’t talk much about sex – so start by having an actual conversation about it. Discuss what turns you on and what turns you off. Discuss what situations open you up more for sex than others (is it a certain setting, such as candles and dark lighting? Or is it that the house is clean and the tasks for the day are able to be put away? Maybe a mixture of both!) Talk about what fantasies you have and how you’d like to utilize them in your time together. Practice giving each other a sensual massage. All sorts of options are out there, but often, couples aren’t having the conversation about sex, so they’re missing a beautiful connection that could occur.
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            Rekindling a relationship isn’t always easy. If you’re finding you’re having difficulty in this area and can’t seem to make it on your own, reach out to a couple’s therapist or relationship coach. They’re trained with tools and skills to help mediate the process and might have some new insights you hadn’t previously considered! 

Sleep is a major issue for many adults and children who have been diagnosed with autism spectrum disorder (ASD). Recent studies suggest that up to 80% of young people with ASD also have difficulty falling and/or staying asleep at night. The incidence rate of sleep problems and disorders is also high among adults with ASD, particularly those who are classified as ‘low-functioning’. Lack of sleep can exacerbate some of the behavioral characteristics of ASD, such as hyperactivity, aggression, and lack of concentration. As a result, people with ASD who have a hard time sleeping may struggle at work or in their classroom.

We’ll look at some of the most common sleep issues among adults and children with ASD, as well as some suitable treatment options and tips for managing ASD and sleep on a regular basis. First, let’s look at how the medical and psychiatric communities currently define ASD.
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What Is Autism Spectrum Disorder?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is considered the most authoritative guide for evaluating and diagnosing mental health disorders in the United States. According to the latest definition (last revised in 2013), the diagnostic criteria for autism spectrum disorder (ASD) are as follows:

• ‘Persistent deficits’ in communication and social interactionthat occur in multiple settings. These deficits may a lack of engagement in back-and-forth conversation, ‘abnormal’ approaches to social interaction, and failure to respond to social invitations. ‘Poorly integrated verbal and nonverbal communication’ is another common deficit; this may be accompanied by irregular eye movements, nervous tics, lack of facial expression, and other physical signs. Finally, people with ASD often have deficits in ‘developing, maintaining and understanding’ different types of relationships.
• Restricted, repetitive behavioral patterns. These patterns may be manifested in motor movements, speech, or use of everyday objects. Common examples of these tendencies include constantly lining up objects in the same manner, mimicking the speech of others (known as echolalia), or repeating ‘idiosyncratic’ phrases. People with ASD may also be unreasonably rigid about breaking from these patterns, and may express dismay when asked to do so. They also demonstrate ‘highly fixated’ interest on specific subjects, as well as ‘hyper- or hyporeactivity’ to sensory factors in their environment (such as smells and/or sounds).
• Although many people are diagnosed and treated for ASD as adults, symptoms must be or have been present during the early development period.
• The symptoms must be serious enough to cause ‘clinically significant impairment in social, occupational, or other important areas of current functioning’.
• The symptoms are not ‘better explained’ by the presence of another condition, such as an intellectual disability or a global development delay. The DSM-5 notes that ASD and intellectual disabilities are often co-morbid, or simultaneously present, in children and adults. However, both classifications carry different sets of diagnostic criteria.

​The latest DSM revisions also note three distinct ‘severity levels’ that can be used to assess how much support (if any) a person with ASD requires on a regular basis.
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Previous Definitions

Prior to 2013, ASD was broken down into different autism subtypes based on severity of symptoms. These subtypes were eliminated and omitted from the DSM-5, and their diagnoses have all been absorbed into the ‘ASD’ definition. Although these subtypes are no longer officially diagnosed, they are still widely discussed within the medical and psychiatric communities. Additionally, some are still included on other authoritative lists, such as the International Statistical Classification of Diseases and Related Health Problems (ICD) database maintained by the World Health Organization (WHO). The four most common subdivisions of ASD (as previously defined by the DSM) are:  

• Asperger syndrome: Asperger was once considered the mildest incarnation of ASD. Children and adults with Asperger display symptoms like inability to pick up on social cues, hypersensitivity to sensory stimuli, and preoccupations with hyperfocused areas of interest. However, many people with Asperger are high-functioning.
• Autistic disorder: This was once considered a middle-of-the-spectrum condition. Symptoms are more intense than those in people Asperger, but less severe than the most debilitating forms of autism.
• Childhood disintegrative disorder: This was considered the rarest — and most severe — form of autism prior to the DSM-5 revision. Most often diagnosed in children between the ages of two and four, CDD was characterized by strictly limited social, speech, and cognitive abilities. Many children with CDD also developed seizure disorders.
• Pervasive development disorder, not otherwise specified: PDD-NOS was essentially a term for any autism spectrum condition that didn’t meet strict criteria for one of the three disorders mentioned above. As a result, symptoms for PDD-NOS ranged from milder than Asperger to more severe than CDD.  

In addition, some disorders once considered part of the autism spectrum were removed from the ASD diagnostic criteria prior to the DSM-5 revision in 2013. Rett syndrome, for instance, can cause symptoms in children that are similar to those associate with autism; however, Rett syndrome is caused by a genetic mutation, and also carries symptoms not found in other ASD disorders. Social communication disorder is another example; people with SCD often struggle with everyday communication, but the disorder is distinguished from ASD due to a lack of repetitive behavior patterns.

The root cause of ASD remains unknown, though most researchers today believe that both genetic and environmental factors play a major role. Recent studies have pinpointed some genes that are prevalent in people with the disorder, and brain-imaging tests indicate that the brains of people with ASD develop differently than the brains of other individuals. The general consensus is that ASD originates from defects in the brain that affect how the brain grows and communicates with other areas of the body. Studies have yet to identify any specific environmental factors that directly cause or influence the development of ASD. However, the scientific community has debunked and rejectedthe longstanding belief among parents that child vaccinations lead to a higher incidence rate of ASD in developing children.

Diagnosing ASD in Children​
Most children with ASD begin to display symptoms by age three, so early detection and evaluation is critical. The ASD diagnosis process for children is divided into two stages: developmental screening and comprehensive diagnostic evaluation.
Parents are urged to begin developmental screening at a young age to evaluate their children for ASD and other intellectual disabilities. The Centers for Disease Control (CDC) recommends ASD screenings for all children at the ages of nine, 18, and 24-30 months, adding that a reliable ASD diagnosis can usually be made by age two. Additional testing may be required for children who are considered high-risk for ASD, including those with family members who have already been diagnosed or those who have displayed ASD-related behaviors.

During the developmental screening stage, doctors watch for signs and symptoms of ASD diagnostic criteria. These include deficits in communication and social interaction, restricted interests, and repetitive behaviors. Speech and language skills are often delayed in children with ASD; they typically will not respond to their own name after 12 months. Other ‘red flags’ include refusal to acknowledge or point at moving objects after 14 months, showing little interest in playing ‘pretend’ games after 18 months, and sustained repetition of words and phrases, as well as physical signs like avoiding eye contact, constantly rocking back and forth, compulsory hand waving, and/or exhibiting ‘unusual’ reactions to sensory stimuli. Additionally, children with ASD often display at least one of the following traits or behaviors:

• Hyperactivity
• Impulsive actions
• A limited or short attention span
• Aggression and tantrums
• Self-injury or self-harm tendencies
• Abnormal eating or sleeping patterns

According to the CDC, the most commonly used developmental screening tools include the following:

• Ages and Stages: This series of 19 questionnaires focuses on the child’s communication, motor skills, and other areas of development. The questionnaires are age-specific, allowing doctors to evaluate children as specifically as possible.
• Communication and Symbolic Behavior Scales (CSBS): This ‘Infant-Toddler Checklist’ evaluates children based on the following criteria: emotion and eye gaze; communication; gestures; sounds; words; understanding; and object use.
• Modified Checklist for Autism in Toddlers (MCHAT): This questionnaire features 23 ‘yes or no’ questions related to the toddler’s interests, speech, motor skills, and behavior. The questionnaire is scored on a scale of 0 to 20, with 20 being considered extremely high risk.
• Parents’ Evaluation of Developmental Status (PEDS): This evidence-based screening evaluates children based on ‘language, motor, self-help, early academic skills, behavior and social-emotional/mental health.’
• Screening Tool for Autism in Toddlers and Young Children (STAT): Designed for children between the ages of 24 and 36 months, this evaluative test consists of 12 separate segments; most children complete the screening within 20 minutes.

If developmental screening yields results that are consistent with ASD symptoms, then a comprehensive diagnostic evaluation may be recommended. Family participation during this second phase is vital. Parents can describe symptoms and behaviors to the evaluation provider, who can then take these statements into account when conducting the diagnosis. The presence of at least one parent can ease the evaluation process for the child, as well.
In order to perform an accurate evaluation of ASD in children, doctors rely on a set of diagnostic tools. The CDC notes that a comprehensive ASD evaluation should include at least two diagnostic tools; the following four diagnostic tools are most widely used:

• Autism Diagnosis Interview-Revised (ADI-R): Used to evaluate children 18 months or older (as well as adults), the ADI-R interview includes specific questions related to social communication and interaction, restricted interests, and repetitive behaviors.
• Autism Diagnostic Observation Schedule-Generic (ADOS-G): This ‘standard measure of social and communication deficits’ consists of four 30-minute evaluation modules based on the subject’s expressive language abilities.
• Childhood Autism Rating Scale, Second Edition (CARS2): This scale designed for children two and older is designed to achieve two ends: distinguish symptoms between ASD and other disabilities; and gauge the severity level of ASD symptoms. Different tests are administered based on the subject’s functionality level, and the assessor rates the child based on frequency, duration, and intensity of each ASD diagnostic criterion.
• Gilliam Autism Rating Scale – Second Edition (GARS-2): This evaluation tool for teachers and clinicians can be used to evaluate anyone between 3 and 22 years of age. The 42 items on the scale are grouped into three categories: stereotyped behavior; communication; and social interaction.

Once the comprehensive diagnostic evaluation is complete, parents can discuss the outcome with their physician and — if the child receives an ASD diagnosis — explore possible treatment options.

Considerations for Diagnosing ASD in AdultsASD is a lifelong condition. People with ASD typically begin to show symptoms of the disorder during their early childhood. In some cases, however, these symptoms will not become apparent until the individual has reached adulthood.  
Due to the wide range of symptoms and severity levels, diagnosing ASD in adults can be a tricky process — particularly for those who have not received an ASD diagnosis as children. According to neurologist David Beversdorf of the Autism Speaks Autism Treatment Network, an adult seeking an ASD evaluation should first discuss the matter with his or her physician. During this consultation, the patient should explain why they are seeking an ASD diagnosis. These reasons may include changes in the way he or she behaves or interacts with others, as well as heightened sensitivity to sensory factors, acquired repetitive behaviors, or newly restricted interests.

Most licensed physicians are not trained to diagnose ASD themselves, but they will be able to steer the patient in the right direction — and, in some cases, refer them to a specialist with a background in ASD diagnosis. Due to a widespread scarcity of clinicians that specialize in ASD, Dr. Beversdorf suggests meeting with a medical professional that evaluates and treats young people for the disorders. These include developmental pediatricians, child psychiatrists, and pediatric neurologists.
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One major issue for diagnosing adults with ASD has been a lack of reputable screening and diagnostic evaluation tools. With the exception of the Gilliam Autism Rating Scale — which evaluates subjects up to 22 years of age — these tools are designed for child subjects, not adults, who tend to be less honest and more secretive when undergoing these tests. Deceased parents are another obstacle for diagnosing adults, since mothers and fathers provide key information to clinicians during the early screening and evaluation stages of child ASD testing.
The Adult Repetitive Behaviours Questionnaire-2 (RBQ-2A) appears to be a step in the right direction. Introduced by the Journal of Autism and Developmental Disorders in 2015, the ADBQ-2A is designed to evaluate adults based on repetitive behaviors and restricted interests. Because the questionnaire excludes social communication and interaction, it should not be seen as a definitive evaluation tool for ASD in adults. However, RBQ-2A can be used to help adults decide whether their behaviors and interests are indicative of a disorder that may necessitate formal treatment.
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How Does ASD Affect Sleep?

A 2009 study published in Sleep Medicine Reviews noted parents report sleep problems for children with ASD at a rate of 50% to 80%; by comparison, this rate fell between 9% and 50% for children that had not been diagnosed with ASD. The rate for children with ASD was also higher than the rate for children with non-ASD developmental disabilities.

In a recent study titled ‘Sleep Problems and Autism’, UK-based advocacy group Research Autism noted that the following sleep issues are common among children and adults with ASD.

• Difficulty with sleep onset, or falling asleep
• Difficulty with sleep maintenance, or staying asleep throughout the night
• Early morning waking
• Short-duration sleeping
• Sleep fragmentation, characterized by erratic sleep patterns throughout the night
• Hyperarousal, or heightened anxiety around bedtime
• Excessive daytime sleepiness

The study also pinpointed several underlying causes for these sleep problems that are directly or indirectly related to the individual’s ASD diagnosis. These include:

• Irregular circadian rhythm: The circadian rhythm is the 24-hour biological clock that regulates the sleep-wake cycle in humans based on sunlight, temperature, and other environmental factors. The circadian rhythm is processed in the brain, and many people with ASD also exhibit irregularities with their sleep-wake cycle. Additionally, some studies have noted a link between children with ASD and irregular production of melatonin, a natural hormone that helps regulate circadian rhythm.
• Mental health disorders: Conditions like anxiety and depression are often co-morbid with ASD; these conditions often lead to insomnia and other sleep disorders. Studies have also suggested that as many as half of all children with ASD also exhibit symptoms of attention-deficit hyperactive disorder (ADHD), which can cause elevated moods around bedtime.
• Medical problems: Epilepsy is often co-morbid with ASD, and seizures can greatly impact sleep — even on a regular basis, in severe cases. Other common medical issues among people with ASD include constipation, diarrhea, and acid reflux.
• Medication side effects: People with ASD who take medication may experience side effects that interfere with sleep. Selective serotonin reuptake inhibitors (SSRIs), for instance, may cause agitation and hyperactivity prior to bedtime. Antipsychotics like haloperidol and risperidone, on the other hand, may cause excessive drowsiness during the day that leads to sleep onset and sleep maintenance problems. Please scroll down to the ‘Treatment’ section for more information about ASD medications.

People with ASD often struggle with daily pressures and interactions more than individuals who do not live with the disorder. Lack of sleep can greatly exacerbate the feelings of distress and anxiety that they experience on a frequent basis. As a result, may people with ASD who have trouble sleeping may struggle greatly with employment, education, and social interaction — all of which can impact their outlook on life.
Persistent sleep problems in people with ASD may indicate a sleep disorder. Insomnia is the most commonly reported sleep disorder among adults and children with ASD. Insomnia is defined as difficulty falling and/or remaining asleep on a nightly or semi-nightly basis for a period of more than one month. A study published in Sleep found that 66% of children with ASD reported insomnia symptoms. A similar study from 2003 found that 75% to 90% of adults then-diagnosed with Asperger syndrome reported insomnia symptoms in questionnaires or sleep diaries.

In addition, parasomnias such as frequent nightmares, night terrors, and enuresis (bedwetting) have been widely reported among children with ASD, particularly those once diagnosed with Asperger syndrome. The child’s inability to express their fears and discomforts upon waking — often due to ASD — can complicate the way parasomnias are addressed and treated. Additionally, children with ASD often wake up in the middle of the night and engage in ‘time-inappropriate’ activities like playing with toys or reading aloud.
Sleep researchers are currently studying the relationships between other sleep disorders and ASD. For example, Dr. Steven Park recently noted a possible connection between ASD and obstructive sleep apnea (OSA), a condition characterized by temporary loss of breath during sleep resulting from blockage in the primary airway that restricts breathing. Dr. Park’s theory suggests that the intracranial hypertension found in many babies and infants with ASD may also cause the child’s jaw to take on an irregular shape, which can lead to sleep-disordered breathing as well. Other studies have explored the link between ASD and disorders like narcolepsy and REM Behavior Disorder. However, insomnia and parasomnias remain the most common sleep disorders among adults and children with ASD.
Next let’s look at treatment options and considerations for adults and children with ASD who are experiencing a sleep disorder.
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Sleep Therapy Options

If the preliminary assessment indicates the presence of a sleep disorder in a child with ASD, then treatment will likely be the next step. Cognitive behavioral therapy (CBT) has proven fairly effective in alleviating sleep disorder symptoms for young people with ASD. CBT is designed to improve sleep hygiene in patients by educating them about the science sleep and helping them find ways to improve their nightly habits. A study published in the Journal of Pediatric Neuroscience noted that children with ASD are often set in their routines, so establishing a consistent bedtime schedule can be quite beneficial to them. A healthy bedtime schedule might consist of the following:

• Putting on pajamas
• Brushing teeth
• Using the toilet
• Washing hands
• Getting in bed
• Reading a book (or being read to)
• Shutting off the light

Additional behavioral interventions may help children with ASD improve their difficulties with sleep. According to a ‘Sleep Tool Kit‘ published by the Autism Treatment Network, these interventions include the following:

• Create a ‘visual schedule checklist’ with pictures, objects and other visual aids that can help a child with ASD grasp the concepts more easily.
• Keep the bedtime routine concise, and limit it to roughly 30 minutes before bed. Otherwise the child might become overwhelmed with too many commitments.
• Order the routine so that stimulating activities like television and video games come first, followed by reading and other relaxing activities.
• Physically guide the child to the schedule at first, and use verbal cues to remind them to check the schedule. Teach them how to cross things off on the checklist themselves.
• Provide positive reinforcement whenever the child follows the schedule correctly.
• If the routine must be changed, let the child know in advance so that they can mentally prepare for the disruption. Alter the checklist ahead of time to reflect these changes.

In addition to CBT, light therapy (also known as phototherapy) may also help children with ASD sleep better. This form of therapy is usually conducted using a light-transmitting box kept near the child’s bed. By exposing the child to bright light early in the morning, this therapy can help boost melatonin production and make children feel more alert throughout the day.

Dialectical Behavior Therapy (DBT®) might seem to be an intense modality; however, it is quite worth it for clients who struggle in multiple domains and cannot "seem to catch a break".  It is an evidence-based treatment for persons struggling with emotion regulation issues (e.g., rapid mood changes, intense and debilitating emotions, etc.). It was developed by Dr. Marsha Linehan and colleagues at the University of Washington (The Linehan Institute and Behavioral Tech). Since its creation in the early 1990’s, DBT® has been shown to be effective for a broad range of issues from severe suicidal thoughts to problems in maintaining relationships. It is a highly effective and comprehensive treatment modality that requires intensive training (and retraining!).  Our trainers at Compass Point work hard to attend trainings across the country and bring the knowledge back to our trainings here at Compass Point!

We strive to write our trainings as both stand-alone and comprehensive building blocks. By that, we mean that any therapist would benefit from attending one of the series.  The most frequently asked questions we get are: 

1. If I attend these trainings, do I have to be a DBT therapist?
The answer here is NO. The behavioral strategies, core therapeutic skills, suicide risk assessment protocol and mindfulness based ideals will help ANY therapist using ANY modality! Come on in and check one out, we try to provide an adequate description on our training center page. I cannot promise that you won't want to become a DBT therapist though!
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2. Will attending this training series result in me being certified?
There is no training anywhere (not even Behavioral Tech), that results in DBT certification; however, receiving good quality, comprehensive training is a required step in the certification process.  I have personally attended more than 100 hours of Behavioral Tech training in recent years, a good percentage with Marsha Linehan herself as the trainer and I assure you that ours are of an upstanding quality. 

click on any of the below pages to learn more about the training as well as to add to your cart to register and reserve your seat. 

​These trainings can be taken individually, out of order or as a five day training series.  
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