There are two key things to assess from the beginning when a child or adolescent has problems. The first is to see if the problem or symptom is there for a reason. Many symptoms are like car alarms – they are “going off” to alert people that there’s a problem. Anxiety for example, is supposed to be present sometimes, to alert the person and others that there’s a problem – there’s something wrong that needs to be attended to. In children and adolescents, the presence of a symptom can be a signal that there’s a problem in the family system that needs to be attended to.
The second thing to consider about child or adolescent problems is whether the problem is developmentally typical or not. Adolescents are developmentally more moody than adults. Younger children are thought disordered by adult standards. A good assessment uses tools which compare children and adolescents to others of the same gender and age.
Common problems seen at Heritage which deserve professional attention include ADHD/ADD, depression, academic underachievement, anxiety, phobias or pronounced fears, peer problems, Asperger’s disorder, oppositional defiant behaviors, conduct problems, and learning disorders.
There are many reasons that a student may be underachieving in school. These can include problems such as ADHD, learning disabilities, motivational problems, depression, anxiety, or family conflicts. Other times, it’s not technically underachievement that leads to low grades. A student may have a lower ability level to begin with. We are well equipped at Heritage to assess these problems and offer practical solutions.
We offer services which include coaching adoptive parents through the adoption process, providing psychological evaluations which can be a requirement of becoming adoptive parents, as well as counseling around a number of struggles associated with adoption such as attachment problems, identity issues, as well as a range of emotional and behavioral problems commonly seen in adopted children.
ADD / ADHD
Attention deficit disorder (ADD), or as it is now formerly known, Attention Deficit Hyperactivity Disorder (ADHD) refers to an array of cognitive and behavioral symptoms which create school underachievement in children, and job performance issues in adults. It may be diagnosed in young children particularly if they are hyperactive, making their symptoms more noticeable at an earlier age. But, there are also very bright, well-behaved individuals who are not diagnosed for the first time until they are much older.
The letters associated with attention deficit have changed over the years. What used to be called ADD and ADD-H (hyperactive type) are now both under the category of ADHD (attention deficit hyperactivity disorder (or ADHD). However, it comes in three variants: (1) ADHD-inattentive, (2) ADHD-hyperactive, and (3) ADHD-combined (with both inattention and hyperactivity).
Even with the change in the letters, ADD or ADHD really is not a matter of a deficit in attention. Rather it is more an issue of wandering attention and focus. People with ADHD focus on whatever is the most interesting thing around them, even if it is deemed to be less important than something else at the moment.
Symptoms include problems with:
- attentions and concentration
- planning and organization
- sustained, disciplined effort
- staying on task
- reviewing one’s work for careless mistakes
- working memory (working memory is the human equivalent of RAM on a computer. It involves the ability to hold multiple pieces of information in immediate memory, process them, prioritize them, and plan a response to each ‘piece’ without losing track of the other ones. It is essential to being able to multi-task, to compute math problems, and to follow a set of instructions).
How is it diagnosed?
If ADD/ADHD is suspected, a thorough ADHD evaluation is strongly recommended. For ADHD to be diagnosed, it needs to be documented as occurring in more than one setting, is chronic in nature, and the symptoms cannot be explained by other factors such as depression, anxiety, motivational problems, discipline problems, or learning disabilities. At Heritage Professional Associates, we use a thorough diagnostic procedure to determine if executive function problems are present, by comparing the person to others of similar gender and age. We take a careful history, and make sure that other conditions are not present that could better explain the symptoms. We might also directly measure a person’s executive functions using carefully constructed psychological instruments.
What Does an ADHD Evaluation Consist of?
An ADHD evaluation consists of:
- A review of any prior evaluations and school records including report cards and standardized testing.
- Then, there is a diagnostic interview. Often with younger children, there’s a parent interview first before the child comes for the evaluation. The purposes of the interview include understanding the presenting symptoms, finding out how long they have been present, and if they occur in more than one setting (e.g., home as well as school or work). It’s important to rule out whether other conditions might be present which mimic ADHD (such as depression, anxiety, motivational problems, substance abuse problems, learning disabilities and in rare cases, psychotic disorders).
- If ADHD looks like a possibility, then standardized rating forms are distributed. With children, the rating forms are completed by parents and teachers. With teens, parents, teachers, and the teen fills out the forms. With adults, the adult in question fills out a self report form and then others fill this out as well such as a spouse, friend, co-worker or even supervisor. A key question answered by these forms is whether or not the symptoms are beyond what is typical for someone’s age and gender. Common rating forms used at Heritage include the Behavior Rating Form of Executive Function (BRIEF) as well as the Conner’s Scales
- Some direct measurement of ADHD symptoms is also recommended. This might include a performance measure of attention and concentration, using such instruments as the Integrated Visual and Auditory Continuous Performance Test (IVA+) Tasks of Executive Control (TEC) or the Conners Continuous Performance Test (CPT). It may also involve the administration of tests of Working Memory.
- It is not unusual for other conditions to develop because of the presence of ADHD. So, there may be additional testing to look at levels of depression, anxiety, or other conditions which commonly occur in conjunction with ADHD.
- Then, the data are studied and compared. A report is then generated which includes the findings, conclusions, and recommendations.
How is it treated?
If ADHD is present, we introduce an array of treatment options from a medication consult, to educational and behavioral training sessions to help one adjust to the presence of this condition. We also can train working memory through a special program known as Cogmed.
For more information visit our web-based mental health resources
To get started, call our main number at (630) 325-5300 and ask to complete an intake.
Anxiety or Fears
Anxiety includes such experiences as worry, dread, the anticipation of something negative looming in the near future; it includes restlessness, distractibility, inattention and problems with immediate memory. Sometimes anxiety is tied to a specific person, event, or place. Mostly, anxiety is vague, ill-defined and its presence is not tied to anything specific; it is more free-floating. Anxiety is always accompanied by unwanted physical sensations such as ‘butterflies in the stomach,’ muscle tension, headaches, tightness in the chest, hot or cold sensations in the arms and feet, dizziness, and nausea. Treatment includes cognitive behavioral therapy (CBT) and can include medication when the symptoms are severe and/or there is a significant family history of anxiety problems.
We may also use specialized tests such as the Beck Anxiety Inventory or the Revised Children’s Manifest Anxiety Scale to assist in diagnosis and treatment planning.
For more information visit our web-based mental health resources
Attachment disorders occur when there is insufficient quality and quantity of emotional nurture in the critical first few years of life. This most commonly occurs with children who have been adopted from certain parts of the world after living in an orphanage for a year or two. But, it can also occur in non-adopted children when a parent dies while the child is an infant, or the parent becomes less available due to health issues, mental health problems, serious marital conflict, or if the child is seriously abused in the first few years of life. Signs of attachment pathology are seen in children who are unusually reluctant / unable to separate from a parent when going to preschool, or when the child separates with unusual ease without seeming anxious or fearful at all. As the child with an attachment disorder grows older, he/she can have behavioral problems marked by an apparent absence of guilt or remorse. They don’t seem to care about the feelings of others; they don’t learn from their mistakes, and they lack emotionally close / intimate connections with others. They are often impulsive, are thrill-seeking and even seem to court danger. They seem to have little, if any respect for authority.
Autism Spectrum / Asperger’s Syndrome
Asperger’s syndrome is a pervasive developmental disorder (PDD) in the mild end of the autism spectrum of disorders. This condition can involve a variety of different symptoms, including social and emotional symptoms, communication problems, cognitive problems, an unusual degree of focus on one area of interest, and physical coordination problems. It can cause significant problems in social functioning, problems with being flexible and adaptive to changes in routine, a tendency to take things too literally, and a preference for spending time with things and objects as opposed to people.
How is it diagnosed?
Specialized psychological tests such as the Autistic Spectrum Rating Scale (ASRS) allows parents and teachers to rate a child on an array of symptoms associated with Asperger’s. The scores are then compared to other children of the same gender and age.
What causes it?
The cause of Asperger’s is unknown. Recent research has examined everything from environmental toxins to vaccines. So far, no conclusive scientific evidence had been able to show a cause.
What can be done about it?
The treatment of Asperger’s involves communication groups with peers as well as individual sessions which are videotaped to provide important social feedback.
For more information visit our web-based mental health resources
What’s the next step?
Call (630) 325-5300 and ask for an intake worker
There is only one definition of a reward: someone does a behavior and you respond in such a way that the behavior persists of it grows in frequency and / or intensity. A child behaves politely, you praise the child, and the child’s positive behavior increases. You have rewarded your child. But, consider this example. Your child throws a tantrum and you yell at your child and explain why the behavior is a problem. The tantrums continue. By definition, your yelling is a reward because of its effect on your child.
In a similar vein, there is only one definition of a punishment. Someone does something and you respond in such a way that they stop doing the behavior or the behavior is reduced. Your child stays up too late playing video games. You take away his computer for a week. After getting his computer back, he doesn’t stay up late again. But consider this example: your son finally open up while you’re driving in the car. You respond with enthusiasm and start asking lots of questions. Your son shuts down. By definition what you thought was enthusiasm actually was a punishment.
Good behavior therapy helps to identify the rewards and punishments that shape behavior.
Depression affects millions of people each year. There are some 21 symptoms of depression; only one of the symptoms is sadness. Depression can also include changes in sleep, appetite, sex drive (.libido), as well as loss of attention, concentration and memory. Things which used to be fun or pleasurable no longer are. There can be increased irritability, sensitivity to criticism, and a general sense that things will never get better. Suicidal thoughts and behaviors can be part of the picture as well. The type of treatment for depression depends upon its type and severity. It may include cognitive behavior therapy (CBT), insight-oriented therapy, psychodynamic therapy, and often we work with qualified physicians who provide medication for the treatment of depression.
We may recommend the use of specialized psychological measures of depression such as the Beck Depression Inventory, the Reynolds Child Depression Scale or the Reynolds Adolescent Depression Scale to assist in formulating the best treatment plan for you.
For more information visit our web-based mental health resources
Fewer events have a more dramatic effect on a family than divorce. Generally, divorce is not good for children and every effort is made to help couples find solutions to their marital problems. However, if divorce seems inevitable (or already has occurred), there are important guidelines, boundaries, and methods of communication and conflict management which helps to mitigate the harmful effects of divorce on kids.
Family therapy or family psychotherapy can be a very powerful means of helping all of the members of a family system grow and change. Heritage therapists assess the family system in an effort to understand its ‘culture.’ Different behaviors mean different things in different family systems. Each has a somewhat unique set of values and rules that govern the system. Family therapy can help parents better support and encourage one another, and help them become a more united front in dealing with their children. Children will be provided coaching with effective and appropriate ways of communicating with their parents. In the Chicago area, contact Heritage Professional Associates at (630) 325-5300 x’0′ to speak to an intake coordinator to get started in this powerful form of therapy.
Learning disabilities often occur when there is a difference between what someone should be capable of learning (based upon an IQ assessment) and what they are actually learning (based upon an achievement test). The most commonly known learning disability is dyslexia which is one of the reading disabilities. But, learning disabilities can also occur in other areas such as math, oral expression, written expression, and auditory processing. There is even a non-verbal learning disability (NVLD) which involves difficulties ‘reading’ and using non-verbal communication cues. The preliminary work-up for a learning disability evaluation is conducted at Heritage. This involves making sure that other factors (such as ADHD, depression, anxiety, motivational problems, and even psychotic conditions) are not better explanations for the school underachievement. Then, an individually administered IQ test such as the WICS-IV and an individually administered achievement test such as the WIAT-II is administered. If a learning disability is then suspected, we refer out to one of several talented learning disability specialist for a more precise evaluation of the suspected specific deficits / disabilities.
Also known as ‘ODD’ this condition involves the persistent presence of problems in being able to follow the direction and guidance of those in authority. For this condition to be diagnosed, the problems need to occur in more than one setting (such as home and school). Treatment begins with an assessment of symptoms, and then uses behavioral techniques which are then implemented in the settings where the symptoms occur.
ODD often occurs when parents lack consistency, particularly in applying rewards and consequences in a consistent fashion. While it is desirable that both parents be fairly similar to one another regarding what they reward and punish, it is even more important that each parent be consistent themselves. That is, keep the same set of rules for for your child regarding rewards and punishments today that you did yesterday.
Parenting is often described as one of the most difficult and challenging jobs in the world. At no time in history has there been such an abundance of resources for parenting. While many parents have benefitted from these, many also report confusion regarding the conflicting advice and philosophies offered by parenting experts. Most experts and parents do agree that appropriate parenting goals include keeping their children healthy and safe while also developing and equipping them with the self-esteem, skills and resources needed to succeed as an adult. At Heritage, we have many clinicians who work with parents on their own unique parenting challenges. This work might include helping parents with children who have significant behavioral and/or psychological issues, identifying and working through issues from a parent’s past that impact parenting approach and style, and/or helping couples develop unity regarding discipline and other aspects of parenting. We believe that the parent-child relationship is crucial in healthy development, and we enjoy helping parents develop a safe, nurturing environment for their children with appropriate boundaries, limits and discipline.
Panic Attacks are a particular sub-type of anxiety problems. They involve the sudden eruption of severe anxiety symptoms such as pounding heart, perspiration, dizziness, nausea, and the overwhelming urge to get out of the situation. This often occurs when in crowds (such as churches, airplanes, the left lane of an expressway, elevators, etc.). Cognitive behavioral therapy (CBT) is used to help re-interpret the experience from dangerous to discomfort. Behvaior Therapy is then used to re-expose the person to the dreaded situations with panic. A referral for medication is made when the symptoms are more persistent and/or severe.
Phobias involve the presence of an intense, unrealistic fear often in response to a specific identifiable ‘trigger’ or situation. Some of the most common phobias include germs, flying, closed in spaces (elevators, airplanes, trains), heights, speaking in public, storms, and crowds. Phobias a very treatable often with behavioral therapy (BT) alone. In more pronounced cases, medication may also be recommended.
Self esteem has been defined as both a confidence in, and a satisfaction with oneself. Healthy self esteem is seen in the person who is neither mousey nor boastful. They are neither cowering nor arrogant. In the world in-between is the person who seems comfortable in his or her own ‘skin.’ The best source of self esteem is the routine and predictable experience of feeling the love, support, nurture and attention from one’s care givers based upon the child’s needs and not the parents’. When this happens routinely, the child feels his or her own worth simply for being who they are and not because they have had to do something extraordinary to receive these things.
Self esteem problems generally take two forms. The more commonly recognized one is seen in people who lacks self confidence. They put themselves down, expect themselves to fail and be a disappointment to themselves as well as others. The other form is merely the flip sign of the proverbial ‘coin.’ The person who is arrogant, boastful, exaggerating his/her accomplishments, who is craving admiration and attention, actually has low self esteem too. It just may not be consciously experienced this way by the boastful person.
Treatment for self esteem typically involves some form of psychotherapy. This can be individual, couples, family or group psychotherapy. The essence of the therapy experience is for the person to come to feel their value and acceptance by others in the room based on who they are fundamentally and not based upon how well they perform at something. Other therapy techniques such as Acceptance Commitment Therapy (ACT), a branch of cognitive behavior therapy (CBT) teach people to react differently to the negative triggering thoughts that commonly result in negative attitudes and feeling directed against the self.
Self harm behaviors such as cutting are maladaptive ways people use to relieve tension and stress. Sometimes such behaviors are hidden from others, with less visible sites on the body chosen for cutting. At other times, the cutting is quite visible to others and also becomes a mean of communicating pesonal distress. One of the most potent ways to change this behavior is through Dialectical Behavior Therapy (DBT).
There is no one universal definition of sexual abuse and definitions vary from a legal and clinical perspective. Clinically, sexual abuse is often defined as any sort of non-consensual sexual contact, but it can also include noncontact abuse, such as unwanted exposure to voyeurism or pornography. Most often it involves a power differential, usually physical and/or psychological, between the abuser and the victim. Sexual abuse can happen to men or women of any age. For children, sexual contact and/or inappropriate sexual behavior by an adult or older child (usually defined as 5 years or older) is considered abuse. If abuse is suspected, it is important to consult with an appropriately trained health professional as soon as possible.
It is difficult to obtain accurate statistics on the prevalence of sexual abuse, but most mental health and child protection professionals agree that sexual abuse is not uncommon and is a prevalent and serious problem. The impact of sexual abuse can vary widely and there is no one typical set of symptoms. There are many variables that effect the degree of impact of the abuse. Examples include the relationship between the abuser and victim, type of abuse, duration and frequency of the abuse, level of aggressiveness and intrusiveness; and age of the victim. Many victims experience physical, psychological, and/or behavioral effects as a result of being abused. For example, symptoms of experiencing this type of trauma might include: fear of physical contact, difficulty trusting and getting close to people, sexual behavior and/or knowledge that is not age-appropriate, acting out behaviors (sexual or otherwise), and mood problems. Some victims develop Post Traumatic Stress Disorder (PTSD).
Victims of abuse report that in addition to psychotherapy, social support, education about abuse through attending workshops and reading about abuse, and spirituality are helpful in recovering from sexual abuse. At Heritage, we have a number of caring clinicians who work with victims of sexual abuse as well as caregivers and family members of victims. We welcome the opportunity to be a part of the healing process.