What Is Seasonal Affective Disorder (SAD)?
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.
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:
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.
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:
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:
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:
The cyclical relationship between depression and sleep
The sleep problems brought on by depression – or the ones that caused it in the first place – make it much more difficult to get better. Sleep deprived people have stronger emotional reactions in general, so it’s tougher to regulate the emotional volatility associated with depression.
Abnormal sleep interferes with mood and energy levels during the day, so it’s difficult to stay motivated to engage with others, exercise, and even go to work. To cope, people who are depressed may self-isolate, which can lead to more sleep problems: loneliness itself is associated with fragmented sleep.
The cause-and-effect runs both ways. Even if you’re not depressed, lack of sleep increases your chances of depression and other mental illnesses. Depression causes insomnia and hypersomnia.
An article in the Journal Sleep reported that children with both insomnia and hypersomnia are more likely to be depressed, to be depressed for longer periods of time, and to experience additional problems such as weight loss.
Particularly for young adults, there is a strong correlationbetween insomnia and major depressive disorder. Genes involved in the molecular clock and circadian cycle are known to be involved with bipolar disorder, although nobody exactly knows how. When scientists examine mice with mutations in the so-called CLOCK gene (important in the circadian cycle), they find the mice act like humans with mania. When the mice are given lithium (a treatment for bipolar disorder), their behavior reverts to normal. So it appears that this important part of the sleep control cycle is tied up with mood and mood disorders.
Teens who don’t get enough sleep are at a significantly greater risk for depression and suicide.
Treatment for depression-related sleep disorders
The good news is that treating either depression or related sleep problems tends to improve the symptoms of the other. Getting good sleep is essential for overcoming depression.
You may have seen stories of sleep deprivation as the new cure to depression, but be wary of these. Researchers have indeed found that a night of sleep deprivation reduces symptoms of depression the following day. However, they can experience a rebound effect (known as “residual insomnia”) the following day. Moreover, sleep deprivation on a long-term basis is simply impractical – and also dangerous, given the serious side effects for your mental, physical, and emotional health.
Rather, the recommended treatment for depression typically combines psychotherapy and/or pharmacology.
One popular form of psychotherapy is cognitive-behavioral therapy (CBT). CBT focuses on helping the individual recognize the negative or destructive thoughts (the cognitive aspect) that make them feel depressed, and the behaviors they’ve become accustomed to responding with. Once they learn to recognize these thoughts and behaviors, they develop new ways of thinking or responding. A sub-type of CBT is CBT-I, which applies the same techniques to curing insomnia.
Although both depression and insomnia can be treated without drugs, there are pharmacological interventions for both, and not coincidentally, both can be addressed with antidepressants. The most common antidepressant medications today are selective serotonin reuptake inhibitors (SSRIs). Those with insomnia who start taking one of those drugs often find relief for their sleeping problems.
The pharmacological treatment for idiopathic hypersomnia is usually a stimulant – something that works opposite of sleeping pills. That’s why it is important for doctors to evaluate whether long-sleeping patients might have depression and be a better candidate for anti-depressant medication.
Tips for getting better sleep with depression
In addition to the therapies suggested above, the following advice can help you get better sleep while you’re getting treated for depression and related sleep problems.
1. Keep a sleep diary. If you believe you are suffering from depression and/or a comorbid sleep disorder, keep a sleep/mood diary for 2 weeks to share with your doctor.
Note when you go to bed, how long it takes you to fall asleep, when you wake up, and how much time you spent asleep. Also note your level of fatigue or energy throughout the day, as well as any changes in mood, diet, libido, or thought patterns.
2. Turn your bedroom into a sleep haven. Use your bedroom exclusively for sleep and sex. Everything else, from watching television to working to socializing, should take place elsewhere. You want your mind to see your bedroom as a place of rest, not of worry, stress, or social activity. Keep your bedroom as cool and as dark as possible by removing electronics and using blackout curtains if necessary. Invest in a comfortable, supportive mattress that makes sleep come easier.
3. Stick to a regular sleep schedule. Go to bed and wake up at the same time every day, even weekends. Ensure you leave enough room for you to conceivably get at least 7 hours of sleep, but don’t worry about whether you spend all of that time asleep. Your only goal is to stick to the schedule; eventually your brain will catch up and train itself to sleep and wake at those times more naturally. Avoid napping if you can. If you’re absolutely exhausted, limit them to short power naps of 30 minutes or less.
4. Create a calming bedtime routine.Depression and anxiety-producing thoughts are a recipe for insomnia. Help ease your mind of worries with a calming bedtime routine. Try relaxation techniques, deep breathing exercises, or meditation. Take a warm bath or light some candles.
If your mind continues to race at night, take time to write your thoughts down in a worry journal – getting them out of your head and onto the page will diminish their power. Relieve anxieties by listing out any remaining to-do items you can take care of tomorrow.
5. Get plenty of sunshine. Natural sunlight facilitates a healthy sleep-wake cycle. Aim to get plenty of sunshine, ideally by exercising outdoors in the morning or early part of the day. This will give you an energy boost that makes it easier to feel better and less fatigued during the day time. Then, as it gets dark, your brain will recognize it’s time to wind down and fall asleep.
While you’re at work or school, sit by the windows to increase your amount of sunlight.
6. Eat well and avoid stimulating substances. Foods that are high in sugar or fats mess with your sleep, your health, and your mood. Instead, fill your diet with foods that promote healthy energy levels and sleep. Also take care to avoid any stimulating substances in the afternoon or evening that interfere with sleep, such as caffeine, alcohol, or nicotine.
7. Stay calm when you wake up. Unfortunately, retraining your body to sleep well is not an overnight process. Expect – and accept – that you’ll continue having disturbed sleep during this process.
When you do wake up, practice your deep breathing or progressive muscle relaxation exercises. Meditate or visualize something that makes you feel happy or calm. Turn on a soft lamp and read a book. Stay calm and sleep will come.
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
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.
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.
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.
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.
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 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:
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.
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:
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.
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:
Comforting your child after an incident of cyberbullying
Tips on preventing cyberbullying from happening to your child
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.
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.
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.
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.
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.
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:
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.
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:
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:
According to the CDC, the most commonly used developmental screening tools include the following:
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:
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.
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.
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.
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.
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:
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:
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!
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.
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