Transcranial Magnetic Stimulation: High Tech Help For Treatment Resistant Mood Disorders

Despite therapy and the use of medications, we occasionally find that the effects of a mental health disorder persist in some people. For these individuals, brain stimulation therapies like transcranial magnetic stimulation (TMS) may provide relief from their symptoms. TMS may also be an alternative for those who cannot tolerate mood stabilizing medications.

The National Institute of Mental Health (NIMH) reports that TMS and other brain stimulation therapies “involve activating or inhibiting the brain directly with electricity.” TMS is the most noninvasive of these treatments and is given via energy pulses that are generated by an electromagnetic coil held near or against the person’s head.

Because these magnetic pulses are given over and over in a repetitive rhythm, the most technically correct term for TMS is repetitive transcranial magnetic stimulation (rTMS).

What Is Transcranial Magnetic Stimulation Used For?

In 2008, the Food and Drug Administration (FDA) approved repetitive transcranial magnetic stimulation to treat major depressive disorders and their associated cases of severe depression and anxiety. It has also been studied as a therapy for psychosis and researchers are looking into how it may help conditions like post traumatic stress disorder (PTSD). Additionally, another form of rTMS, called deep transcranial magnetic stimulation (dTMS), has been FDA-approved for the treatment of obsessive compulsive disorder (OCD).

In 2010, the NIMH funded a clinical trial on the effectiveness of transcranial magnetic stimulation. Initial results showed that the effectiveness of rTMS was around 14 percent compared with a placebo-type procedure, which was only 5 percent effective. However, when participants were put into a second-phase trial, the remission rate of rTMS increased to 30 percent.

How Does A TMS Work?

When you go through a session of rTMS, you will be fully awake. Each session lasts between 40 and 60 minutes and no anesthesia is required. It is an outpatient procedure so you can drive yourself to the appointment and back home again. Typically, a person is treated four to five times per week for between four and six weeks.

During the rTMS session, an electromagnetic coil, which is about the size of your hand, will be passed over your forehead and scalp along the region of the brain thought to regulate mood. This coil produces short electromagnetic pulses similar in strength to the ones generated by a magnetic resonance imaging (MRI) machine. According to the Anxiety and Depression Association of America (ADAA), “The magnetic pulses cause small electrical currents that stimulate nerve cells in the targeted region of the brain.”

As scientists gain more knowledge about how rTMS can help people, they are developing new treatment methods. In fact, the FDA has sanctioned the use of theta burst stimulation, which is a variation of rTMS. In the theta burst procedure, the person only receives transcranial stimulation for about 10 minutes per session, however they still need to have daily sessions for several weeks.

In addition, another form of rTBS, called iTBS or intermittent theta burst stimulation, is now being given in 3 minute treatments. iTBS (also FDA-approved) gives intensive bursts of high frequency stimulation and has shown results comparable to the customary rTMS therapy.

Does TMS Therapy Hurt?

While rTMS therapy doesn’t hurt, the person may feel some mild sensations as the electromagnetic pulses are administered. These sensations might include:

  • A light knocking or a mild tapping feeling on their skull.
  • The muscles in their face, jaw, or scalp tingling when the magnet is applied.
  • These same muscles contracting while the magnet is in use.

Is Transcranial Magnetic Stimulation Safe?

Although most people do very well with it, rTMS does have some temporary, mild side effects for a small number of people. They can include:

  • Mild headaches
  • Lightheadedness
  • Scalp discomfort

Rare, but possible, is the chance of a seizure, however no seizures were reported during the two large studies that have been done on the safety of rTMS, according to the NIMH.

Additionally, Johns Hopkins reports that people who have non-removable metal objects in their head (for example: stents or aneurysm clips) should not receive rTMS. This is because the magnets can cause these objects to move or heat up, which could produce a serious injury or even death.

It’s worth noting that because transcranial magnetic stimulation is relatively new, we haven’t been able to study its long term effects. That said, treatment data has been compiled and studied since the mid-1990s and there have been no long term complications from its use, to date.

We Can Help

If you are struggling with anxiety, depression, or other mental health concerns, consider speaking with the professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida. For more information on how we can help, contact us or call us today at 561-496-1094.

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What Problems Do Adopted Adults Have?

When we think about adopted children, most of us picture a happy family of cooing parents bonding with an adorable infant. For the adult who was adopted as a child, however, this blissful image is often tarnished by issues that carry over from childhood.

What problems do adopted adults have? Among other things, they often suffer from:

  • Feelings of loss and grief
  • Problems with developing an identity
  • Reduced self-esteem and self-confidence
  • Increased risk of substance abuse
  • Higher rates of mental health disorders, such as depression and PTSD.

In fact, Childwelfare.gov reports that, “…most of the literature points to adopted adolescents and adults being more likely to receive counseling than their nonadopted peers (Borders et al., 2000; Miller et al., 2000).”

What Are The Psychological Effects Of Adoption?

Way back in 1982, Silverstein and Kaplan did a study that identified seven core issues in adoption that still hold true today. They are:

  • Loss
  • Rejection
  • Guilt/Shame
  • Grief
  • Identity
  • Intimacy
  • and Mastery/Control

The study reports that, “Many of the issues inherent in the adoption experience converge when the adoptee reaches adolescence. At this time three factors intersect: an acute awareness of the significance of being adopted; a drive toward emancipation; and a biopsychosocial striving toward the development of an integrated identity.”

Loss first comes into the adoptee’s life when they are given up by their birth parents. Although the child is taken into a new family, there is still a sense of loss, even if the child is an infant. We know that it is very beneficial for newborns to bond with their mother – imagine how it can affect a baby who does not make this crucial connection.

Later, as the child matures and finds out they were adopted, that sense of loss becomes a theme running through the person’s subconscious. As such, adopted children typically feel succeeding losses much more deeply than their non-adopted counterparts.

Rejection is part of the initial loss the adoptee experiences. In order to be adopted, they had to be rejected by their birth parents. Later in life, if a birth parent blocks the adoptee’s search for them, the person experiences yet another rejection.

Guilt/shame comes from the adoptee’s feelings of rejection. As we know, children tend to blame themselves when something bad happens, therefore an adopted child naturally questions what they must have done wrong (or what was wrong or “bad” about them) that made their birth parent give them away. Even if the adoptee knows the reason they were placed for adoption, they often still secretly harbor the idea that they were somehow “broken” or could have been a “better” baby, which is why their birth parents rejected them.

Grief is part of adoption because the child lost their birth parents. We see adoption as a joyous occasion for the parents who are adopting the child, therefore the thought is that adopted kids should feel thankful to have a new family. Grieving for what they lost doesn’t usually have a place in the child’s life – it is considered a rejection of the adoptive parents if the child grieves.

Additionally, children sometimes don’t feel the effects of their deep-seated loss until they reach adolescence or adulthood and have developed a high enough cognitive level to understand what the loss means to their life. In many cases, this leads to substance abuse, depression, or aggression.

Identity is another loss the adopted adult must face. While they have been given a new name and identity by their adoptive parents, is it who they truly are? Or are they really the person they were before the adoption?

Even if they fully embrace their new family, the adoptee still suffers a loss of identity because they often know nothing about their birth family. What medical concerns do they need to watch out for (i.e.” does heart disease run in their birth family)? Who are their ancestors? What do they know about inherited genetic ties or family backgrounds?

Intimacy is frequently difficult for the adopted adult because they have such deeply rooted feelings of rejection, guilt or shame, and don’t truly have an identity. Often people who have gone through these negative emotions subconsciously push others away to avoid experiencing another loss.

The Silverstein and Kaplan study notes that, “Many adoptees as teen[s] state that they truly have never felt close to anyone. Some youngsters declare a lifetime emptiness related to a longing for the birth mother they may have never seen.”

Lastly, adoptees often feel little sense of mastery/control over their lives because they had no say in the matter of their adoption. Whether placed with their adoptive family at birth or as an older child, they were not given an option. As they mature, this can result in power struggles with authority figures and a reduced sense of responsibility.

How To Cope With Being Adopted

The first step to coping with being adopted is to recognize that the experience itself leaves residual problems. When the adoptee learns about and acknowledges the core issues inherent to adoption, they can begin to talk about them with someone, such as their adoptive parents, support groups, or a professional.

Accepting and exploring these core issues helps the adoptee work through them. The open adoptions that are the norm nowadays may reduce their sense of loss and guilt, while interacting with other adopted adults can allow the person to feel less alone.

It should be said that, while finding the birth parents can give the adoptee answers and closure, this is a deeply emotional process. Before contacting their birth family, the individual should prepare themselves to experience possible further rejection if a reunion is not what they dreamed it would be (or if the birth parents refuse to meet them once they have been found).

In addition, if an adoptee seeks out a therapist, they should make sure they talk to a professional who has special training in adoption issues.  

We Can Help

If you are an adopted adult and are struggling with your feelings, the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-496-1094.

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breast cancer awareness ribbon

PTSD In Breast Cancer Survivors

October is Breast Cancer Awareness month and pink ribbons abound. Everywhere you look, people are wearing pink and various organizations are engaging in fundraising for cancer research. For survivors of the disease, this outpouring of hope is welcome, but at the same time, these visual reminders of their fight can bring up symptoms of post traumatic stress disorder (PTSD).

Even though it is best known for affecting war veterans or people who have been through violent events like mass shootings, PTSD is also found in cancer survivors. “It’s common for cancer patients, even if they don’t have full-blown PTSD, to have some of the symptoms of it,” says Fremonta Meyer, MD, of Dana-Farber’s department of Psychosocial Oncology and Palliative Care.

The color pink isn’t the only thing that can trigger PTSD in breast cancer survivors. Simple actions such as driving past their treatment centers or seeing cancer care commercials on the television can do it, as can hearing about someone else’s diagnosis (or breast cancer scare).

Cancer And PTSD Symptoms

A contract employee of ours went through treatment for stage 1 breast cancer last year. She recently told me how her niece’s routine exam triggered her own PTSD earlier this month.

During an annual exam, the doctor found a lump in her niece’s breast, which led to a mammogram and ultrasound. The results were negative, but our employee found herself crying for no reason, depressed, and sleepless for about two weeks following her niece’s “all clear,” despite the fact that she was obviously very happy that her niece was fine. When she mentioned her symptoms to me, it was clear that she was experiencing some post traumatic stress.

Symptoms of PTSD can include any of the following:

  • Insomnia
  • Startling easily
  • Inability to think clearly or concentrate
  • Re-experiencing the traumatic event – this can happen through nightmares, flashbacks, or memories.
  • Avoidance of situations or places that remind the person of the event
  • Feeling defensive, fearful, or angry
  • Negative self-perceptions

These symptoms could be triggered when the person encounters certain sights, smells, or sounds that remind them of their diagnosis, going through chemotherapy, or other cancer treatments. Additionally, post treatment screening, testing, and waiting for test results can bring the original trauma back to the forefront.

In general, PTSD symptoms begin soon after the initial traumatic event, but sometimes they do not appear for months or even years after the trauma occurred. This happens because, for cancer survivors, the traumatic event continues from the time of diagnosis to the end of treatment, which can take a year or longer. Thereafter, survivors often spend years worrying about recurrence, which may keep their PTSD active.

It also should be noted that the parents of children who go through cancer treatment can also suffer from PTSD, with similar triggers and symptoms.

Factors Contributing To The Development Of PTSD After A Cancer Diagnosis

The National Cancer Institute (NCI) at cancer.gov reports that “certain physical and mental factors that are linked to PTS [post traumatic stress] or PTSD have been reported in some studies:

Physical factors

  • Cancer that recurs (comes back) was shown to increase stress symptoms in patients.
  • Breast cancer survivors who had more advanced cancer or lengthy surgeries, or a history of trauma or anxiety disorders were more likely to be diagnosed with PTSD.
  • In survivors of childhood cancers, symptoms of post-traumatic stress occurred more often when there was a longer treatment time.

Psychological, mental and social factors

  • Previous trauma.
  • High level of general stress.
  • Genetic factors and biological factors (such as a hormone disorder) that affect memory and learning.
  • The amount of social support available.
  • Threat to life and body.
  • Having PTSD or other psychological problems before being diagnosed with cancer.
  • The use of avoidance to cope with stress.

Cancer patients may have a lower risk of post-traumatic stress if they have the following:

  • Good social support.
  • Clear information about the stage of their cancer.
  • An open relationship with their healthcare providers.”

Treatment for Cancer PTSD

Therapy for cancer-related PTSD is similar to treatment for other forms of the disorder and usually involves a combination of therapies:

  • Relaxation techniques, such as deep breathing, mindfulness training, and meditation can help survivors release muscle tension, lower blood pressure, and reduce anger and anxiety levels.
  • Cognitive Behavioral Therapy (CBT) helps survivors challenge and change the negative thoughts and thinking patterns that are causing them stress. CBT helps people cope with their situation in a healthy way.
  • Support groups for survivors in which coping skills and emotional support can come from others who have gone through similar experiences.
  • Sometimes medications are used in the short term to help survivors who have severe trauma symptoms or flashbacks.

Above all, therapy helps the person understand that a disorder like this one develops because of extraordinary stress, not because of weakness.

The key is to get treatment early. Symptoms and mental distress are often long-lasting and can affect your relationships, your job, and your overall health. Please seek help before these symptoms have a chance to further disturb your life.

We Can Help

If you or someone you love have gone through cancer treatment and find that you have some PTSD after your treatment, the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-496-1094.

Resources

PDQ® Supportive and Palliative Care Editorial Board. PDQ Cancer-Related Post-traumatic Stress. Bethesda, MD: National Cancer Institute. Available at: https://www.cancer.gov/about-cancer/coping/survivorship/new-normal/ptsd-pdq. Accessed 10/12/2019. [PMID: 26389374]

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HOCD and Intrusive Thoughts

HOCD (homosexual obsessive compulsive disorder) is a subgroup of Obsessive Compulsive Disorder (OCD). It causes relentless questioning of one’s sexual orientation via the intrusive thoughts that are characteristic of OCD. HOCD is also known as Gay OCD or Sexual Orientation OCD (SO-OCD).

The term HOCD is not a recognized scientific or diagnostic name. Instead, it is more of a reference name or “title” that is used within the OCD community. This term defines the mental anguish that comes from experiencing intrusive, unwanted thoughts that you might be gay. If you have HOCD, these thoughts can come so often that, over time, it can become unbearable.

Part of the frustration with HOCD is that, once the intrusive thoughts are triggered, the person’s mind refuses to accept the reality that they have never been attracted to the opposite sex before. They can try to convince themselves that they are content with their straight orientation, but their OCD won’t allow them to do so. Eventually, these thoughts can become intrusive enough to make a person quit a job or leave a relationship because they are so convinced that they have been lying to themselves their entire life.

If you have HOCD, you might:

  • Fear that you have been living in denial of your true orientation.
  • Worry that just the fact that you are questioning your sexual identity means you are gay, because “I wouldn’t wonder about my orientation if I was straight.”
  • Fear losing your “self” and your previous identity.
  • Be concerned that homosexuality is “catching” in the same way that a cold or the flu can be caught.
  • Worry that being around a gay person will trigger your own latent tendencies and cause you to act out.
  • Fear that being unable to perform sexually means you are gay.
  • Think that other people will see you as gay because of a certain mannerism or because of how you dress or act.

HOCD Is All About Intrusive Thoughts

The truth is, HOCD is not about the person’s sexual orientation – it is really about their intrusive thoughts and how they react to those thoughts.

People without OCD will have a random thought and then dismiss it because it has no meaning. Those who have OCD and HOCD, however, attach deep meaning to these random thoughts and often spend countless hours searching for one hundred percent assurance that the thought is or is not true.

These intrusive thoughts don’t go away, either. For someone with OCD, once an intrusive comes into their mind, they cannot dismiss the thought because it sets up a cycle of doubt and questioning that repeats over and over again.

As far as OCD goes, no proven cause has been found for the disorder. And, since there isn’t just one concrete cause for OCD, there also is no exact reason for why someone with OCD will go on to develop HOCD or another subgroup. What we do know is that OCD and its subgroups revolve around whatever it is that the person fears. For example, while some may worry that they are actually gay (HOCD), another may worry that they will hurt themselves or others (Harm OCD).

Help for HOCD

Because there are only a few studies out there on HOCD, many mental health professionals don’t realize this subcategory exists. Therefore, they don’t understand how to properly diagnose and treat it. In many cases, clinicians either miss the diagnosis or they call it “sexual identity confusion” instead of HOCD. But, remember – HOCD is not about sexual identity, it is about the person’s OCD (whether it has been diagnosed or not).

There is a big problem with labeling and treating HOCD as “sexual identity confusion.” It can cause the individual to believe that their misinterpretation of their sexual orientation is actually meaningful and true. For this reason, when seeking help for HOCD, it is extremely important to find a therapist who specializes in treating either OCD or the HOCD subgroup.  

A therapist who is familiar with the condition will also understand that HOCD is not something that can be cured through reasoning and talk therapy because there is no underlying homosexuality to uncover. Instead, treatment for HOCD should involve the same therapies clinicians use when treating classic OCD. These include cognitive behavioral therapy (CBT), exposure and response therapy (ERP), exposure and ritual prevention therapy (EX/RP), and sometimes the short term use of medication to help with depression and anxiety.

We Are Experts In The Treatment of HOCD

Learn more about HOCD in Dr. Rosen’s newest book, HOCD: Everything You Didn’t Know – A primer for Understanding & Overcoming Homosexual Obsessive Compulsive Disorder. Find it online here.

In addition to this book, our clinic has therapists who are specially trained to treat OCD, HOCD, and other subgroups of the disorder. For more information or to schedule an appointment, contact The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida or call us today at 561-496-1094.

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HOCD: Everything You Didn’t Know – A Primer for Understanding & Overcoming Homosexual Obsessive Compulsive Disorder

HOCD: Everything You Didn’t Know – A Primer for Understanding & Overcoming Homosexual Obsessive Compulsive Disorder

If HOCD has left you struggling with relentless questions about your sexual identity, a new book by Dr. Rosen, Founder and Clinical Director of The Center for Treatment of Anxiety and Mood Disorders will be an indispensable and compassionate guide that will demystify the disorder and offer hope.

HOCD (Homosexual Obsessive Compulsive Disorder) is a debilitating condition that attacks without warning in those who already struggle with classic OCD. It leaves its victims reeling with uncontrollable doubt about their sexual orientation (despite never having questioned it before), while igniting a vain pursuit of certainty over the question of whether they are truly straight.

In this HOCD primer, Andrew Rosen, Ph.D. draws on more than forty years of clinical practice to give readers insight into the disorder, as well as offering practical help to those who are fighting against a sexuality they know deep down really doesn’t exist for them.

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What Is Harm OCD?

Studies show that the vast majority of us occasionally have unwanted violent thoughts about injuring ourselves or others. For example, we might briefly fantasize about harm befalling the guy who just cut us off in traffic and then scared us even more when he immediately slammed on his brakes to avoid other cars. Although we don’t like to acknowledge them, about 85 percent of people do experience some type of random harmful thoughts, but they are fleeting and don’t disturb our normal lives.

For people who have obsessive compulsive disorder (OCD), however, having unwanted thoughts about hurting someone may not be able to be dismissed so easily. In fact, these thoughts can become frequent enough to become intrusive, taking over the person’s life. When this happens, the individual is dealing with Harm OCD.

Defining Harm OCD

Harm OCD is a subset of classic obsessive compulsive disorder (OCD). The condition is characterized by having aggressive, intrusive thoughts of doing violence to someone, as well as the responses the person uses to cope with these thoughts.

OCD makes the individual feel that they can’t trust their own mind. Wherein someone without OCD could have a violent thought and recognize that it is simply a thought, a person with OCD who has the Harm OCD subset worries that just having the thought is somehow meaningful. As a result, they want full assurance that they won’t act on the thought.

Having these intrusive thoughts leads to engaging in compulsions and rituals to decrease the anxiety the person feels about the thought. Once they complete the ritual, they feel less anxious, but then the intrusive thought comes again, setting up endless cycles of doubt and fear.

Harm OCD Symptoms

Those who suffer from Harm OCD may:

  • Have aggressive thoughts or see images in their minds of violence and worry that this means they will carry them out.
  • Fixate on the idea that they could inadvertently be responsible for causing harm and not realize it (for example, they may worry about running someone over by accident, and then leaving the scene because they were unaware of what they had done).
  • Be terrified that they will hurt someone (or themselves) on impulse – whether intentionally or not.
  • Worry they are hiding their true nature from themselves and others and that they are really a vicious, aggressive person who will act out someday because they will lose control.

In response to their intrusive thoughts, people who experience Harm OCD engage in compulsions and rituals to help relieve their anxiety. These may include such actions as:

  • Hiding dangerous objects (kitchen knives, poisonous chemicals, medications, ropes, razor blades, and the like) so they aren’t tempted to use them to hurt someone.
  • Reviewing their every action to see if they could have, or did, cause harm
  • Avoiding watching the news or such things as violent movies, television shows or videos, so as to keep from triggering violent ideas.
  • Spending excessive amounts of time online, researching violent crimes and ideology in an effort to know whether they have things in common with the offenders.
  • Compulsive praying or carrying and using spiritual items so that they won’t lose control.
  • Asking others if they think the person with Harm OCD could hurt others.
  • They may also endlessly question themselves in an effort to answer, once and for all, if they are capable of injuring anyone (including themselves).

Treatment for Harm OCD

As with classic OCD, Exposure and Ritual Prevention (ERP) is the treatment for any OCD subset, like Harm OCD.

The first part of the therapy – exposure – happens when the individual allows themselves (with the help of their therapist) to encounter the triggering object, image, or environment that begins their cycle of intrusive thoughts. The idea is to confront what they fear, but to refrain from using their compensating compulsions (ritual prevention).

By resisting the urge to complete a ritual after the exposure and then finding that they do not act on the violent thought, the person builds self-confidence and begins to retrain their brain. This leads to learning to trust that their thoughts are simply thoughts. Over time, consistently avoiding the use of compulsions while remaining nonviolent helps break the cycle of doubt.

For the best chance of overcoming Harm OCD, find a therapist who specializes in treating classic OCD. Trying to get past intrusive thoughts on your own can keep you stuck because it can be difficult to stop “testing” yourself to see how you are reacting – which is a ritual that could reinforce your false beliefs.

Have Further Questions?

If you are concerned about your violent thoughts or worried that you may harm yourself or someone else, seek help from the OCD-trained therapists at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida. For more information, contact us or call us today at 561-496-1094.

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Counseling Adults with Autism

Our very own Dr. Ali Cunningham recently released a book, Counseling Adults with Autism. The cover art for the book was produced by a local man with autism, Michael Vidal (pictured here with Dr. Cunningham).

Counseling Adults with Autism is a practical guide for counselors, psychologists, and other mental health professionals looking to improve their confidence and competence in counseling adults diagnosed with mild to moderate autism spectrum disorder (ASD). Organized into 11 chapters based on key areas for guiding assessment and treatment planning for this population, this book highlights evidence-based practices and therapeutic interventions through case examples to demonstrate how assessment and treatment can be applied. Replete with insights from a variety of disciplinary approaches, this is a comprehensive and accessible resource for practitioners looking to support and empower clients struggling with social and behavioral challenges. Buy the book here.

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toddler with social anxiety

Social Anxiety in Toddlers

Toddlerhood is defined as the age range from 12 to 36 months. During this period, a child’s emotional and cognitive development grows by leaps and bounds, as do their social skills. This also coincides with the time when children are likely to go into a daycare environment or head off to preschool. As they engage more often with other children and adults, it may also be the stage when a toddler’s social anxiety begin to emerge.

Just as with adults, some children are comfortable with social interactions while others may not be. Each group of kids will have the social butterfly as well as the “shy” child who quietly observes and doesn’t interact as much. It is one thing to be shy, however, and another to be intensely fearful and anxious in a social setting. Because we know it can show up early in life, a toddler who shows such strong reactions in a social environment is often regarded as having social anxiety.

What causes social anxiety in toddlers?

We aren’t really sure what causes social anxiety in toddlers. Genetics likely plays a role, since it contributes to a child’s temperament and personality. We also know that some genetic traits can influence certain mental health conditions.

A toddler’s environment could also predispose them to social anxiety. For a young child who already has a higher genetic risk, living with trauma or a severe parenting style may be enough to initiate social anxiety. Social anxiety may also be learned from a parent, according to a 2006 study by de Rosnay, et al. Their research focused on indirect expressions of a mother’s social anxiety on their infant. The results showed that, “compared to their responses following their mothers interacting normally with a stranger, following a socially anxious mother-stranger interaction, infants were significantly more fearful and avoidant with the stranger. Infant-stranger avoidance was further modified by infant temperament; high fear infants were more avoidant in the socially anxious condition than low-fear infants.”

Is social anxiety a form of autism?

Studies have shown that social anxiety is not a form of autism, although the two have overlapping indicators, such as separation anxiety and avoiding eye contact. In fact, not only are they two distinct disorders, but the symptoms and diagnostic criteria for each are vastly different.

As the name implies, social anxiety is driven by anxiety. A child who has social anxiety will function within the parameters of their level of unease. For instance, they may simply keep to themselves, avoid other children, or might talk too quietly. Some kids may not talk at all.

On the other hand, a child with autism spectrum disorder doesn’t behave based on their anxiety level. Instead, this child has trouble understanding social cues and the nuances of communication. They might speak too loudly, may push their way into a group of children, or might misinterpret facial expressions or gestures.

Does my kid have social anxiety?

Children who have social anxiety may be branded as difficult kids because their anxiety can show up in forms other than just in social interactions.

Toddlers with social anxiety often show certain signs, such as:

  • Being a picky eater
  • Easily startled by noises
  • Not adapting well to new situations
  • May have a higher sensitivity to tactile sensations
  • Acting shy around new people and fearing strangers
  • Disliking being separated from their parents (separation anxiety) and distraction doesn’t calm them
  • Having strong emotional reactions and difficulty self-soothing
  • Might have sleep issues
  • Seems afraid to interact with peers, both individually or in a group setting
  • Often has other phobias or fears

How to help a child with social anxiety

At home, parents can demonstrate healthy social interactions when their child is with them, so the toddler learns not to be so fearful.

They can also rehearse a new situation with their child before it comes up. For example, a toddler who will be going to daycare for the first time might role-play some of the things they’ll do while they are there. Practicing certain aspects of the day or even dropping by the daycare a couple of times before officially attending can ease fears because the daycare will already be familiar. It would also be helpful to let the teachers or caregivers know about your child’s fears, so they can help build confidence.

Other supportive methods include:

  • Encouraging your toddler, but not forcing them in social interactions
  • Using praise when the child successfully navigates a scary situation
  • Not criticizing them for their fears
  • Being calm and showing the toddler that you are confident
  • Not being overprotective, which only reinforces the idea that the toddler has something to be afraid of
  • Reading books or watching videos that show confident children

Have Further Questions?

If your toddler is experiencing social anxiety, the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-496-1094.

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Asperger’s And Diagnosing Autism In Adults

We usually think of autism as being a childhood disorder because it is typically talked about in kids. Nowadays, children are screened for the signs of autism by their pediatricians during their 18- and 24-month well checks. This means that most cases of autism will have been identified by the time a child is two years of age. But, this screening procedure is fairly recent, so what if you are an adult who was told you had a learning disorder years ago or were called a “difficult” child before this protocol? Is it possible that you may have undiagnosed autism spectrum disorder (ASD), even if your symptoms are mild?

Autism In Adults

Back in the day, autism spectrum disorder was often misdiagnosed or mistaken for other conditions, like obsessive compulsive disorder (OCD) or attention deficit hyperactive disorder (ADHD). Many adults who were labeled with behavioral concerns as kids might wonder now if they actually have ASD instead. Currently, it can be problematic to get an answer, however. There is no set protocol for screening adults for the disorder and it isn’t a common practice for doctors to watch for signs of autism in adults.

But, that will change as we learn more about ASD. According to a 2016 study by Murphy, et al, “Autism spectrum disorder is a lifelong neurodevelopmental disorder that has a potentially detrimental impact on adult functioning.” Today it is widely thought to be a disorder that comes from a combination of inherited genetic causes and environmental factors

Initially, autism was considered rare. Back in the 1960s, it was believed that only about 4 in 10,000 people had it. We now know, however, that ASD affects around one percent of adults and children.

This upsurge in cases is not due to an increase in the condition. Rather, it is because we have increased our awareness of it. We also have better diagnostic tools and classification systems in place now. For instance, in 2013, Asperger’s syndrome was reclassified as part of ASD after it was decided there wasn’t enough evidence to show it was a separate condition from autism.

Adult Autism Checklist

At present, adult autism spectrum disorder is diagnosed through behavioral observations. There is no test or checklist to identify it, although one is in the process of being developed.

Still, there are symptoms that can indicate possible ASD. These behavioral signs of autism in adults include:

  • Wanting to stick to a strict routine, schedule, or firm guidelines.
  • Problems adjusting to change or emotional outbursts when something doesn’t happen according to plan.
  • Increased chance of having an accompanying mood disorder, anxiety, or having obsessive compulsive disorder (OCD).
  • Difficulty with social interactions. It can be hard to make friends and a struggle to keep them.
  • Issues with making inferences from verbal cues, making predictions, sequencing tasks, or problem solving.
  • Problems interpreting other people’s points of view.
  • Difficulty with communication skills, especially in group settings. Not good at making small talk.
  • Rituals or repetitive behaviors.
  • Specific and extreme interest in a particular topic or hobby (bordering on obsession). It may be difficult for the person to relate socially until a favored topic is introduced, then they can easily converse on it at length.

The problem with diagnosing adults with spectrum disorder comes from the fact that someone who has had it for a long time has gotten good at hiding their symptoms. Since there hasn’t been as much research into autism in adults, usually a doctor will rely on observation and either your childhood memories or those of a close family member to help with carrying out an in-depth assessment.

Despite these issues, it can be good to get a diagnosis. In this way, you might begin to understand your youthful difficulties a little better and you can learn coping skills to help you in the future.

Interventions For Adults With Autism

Clinicians treat autism differently in adults than they do in children. In part this is because other mental health conditions like anxiety or OCD may also be playing a role in the person’s life, and must be addressed. Also there can be other concerns to treat at the same time, such as job or relationship difficulties.

A formal diagnosis opens the doors to resources and autism-related services, like vocational training and job placement. These programs vary by state and may not be available everywhere in the country, however.

The 2016 study authors noted that, “service provision for adults with ASD is in its infancy. There is a lack of health services research for adults with ASD, including identification of comorbid health difficulties, rigorous treatment trials (pharmacological and psychological), development of new pharmacotherapies, investigation of transition and aging across the lifespan, and consideration of sex differences and the views of people with ASD.“

Although this is discouraging, today’s children with ASD are aging, so things will change to accommodate them and we’ll see more adult services in the coming years. Meanwhile, in addition to the programs that are currently in place, adults have access to professional treatment and things like books, online forums, and in-person support groups.

While ASD can’t be cured, it can be successfully managed. Behavioral interventions and learning targeted skills can reduce the challenges that those with autism may face throughout their lives.

Have Further Questions?

If you or someone you love have questions or would like further information about the assessment and diagnosis for adults with spectrum disorder, the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-496-1094.

Resources

Murphy CM, Wilson CE, Robertson DM, et al. Autism spectrum disorder in adults: diagnosis, management, and health services development. Neuropsychiatr Dis Treat. 2016;12:1669–1686. Published 2016 Jul 7. doi:10.2147/NDT.S65455

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