Attention Deficit Hyperactivity Disorder (ADHD) is one of the world’s most common childhood disorders, with an estimated prevalence of 5.29%. It is also a highly misunderstood neurodevelopmental condition.
Whilst many associate it with hyperactivity and overmedication, particularly in young boys, ADHD encompasses a wide range of symptoms. ADHD is also being increasingly diagnosed in adults and girls.
ADHD is diagnosed three times more frequently in boys than girls. Not long ago, however, this figure was closer to 10 to 1. Although the margins are narrowing, by adulthood the level of diagnoses across the sexes is roughly the same - so to what can we attribute the lower rates identified in childhood?
One potential explanation is that the symptoms observed in girls and boys can be quite different. Boys tend to exhibit the more “obvious” signs of ADHD such as hyperactivity and conduct disorder, whereas the difficulties experienced by girls tend to be attentional such as daydreaming in class.
For this reason, ADHD in girls may not be as obvious in an educational setting and therefore fall under the radar.
The hyperactive symptoms more commonly displayed by boys are more likely to be problematic in the home or classroom, and may therefore more quickly draw the attention of teachers, special needs officers etc.
Girls on the other hand, tend to experience the difficulties of ADHD in a more internal manner. It has also been argued that as girls are socialised by society to behave in a more reserved manner that they are better than boys at covering up symptoms.
There is also limited public knowledge in terms of the different ways ADHD may express itself among the sexes.
So in what ways may ADHD look different in girls than boys?
An interesting paper by Rucklidge (2010) explored gender differences in ADHD. In a review of previous studies, she found a number of differences in a variety of areas.
This is potentially the most widely recognised symptom of ADHD and is the main symptom that boys tend to exhibit more than their female counterparts. Children with ADHD may find it difficult to sit still and may also exhibit impulsivity for example non- stop talking, making inappropriate comments and being impatient.
Although many children may be high-energy, in order to meet the clinical criteria for these facet of ADHD the hyperactivity and impulsivity demonstrated must be impacting the child’s life and have been doing so for six months or more.
Inattentive ADHD is that which leads to trouble focusing and being easily distracted. Children with ADHD are daydreamers who get bored easily. Whilst this could easily be said of many children, in the case of those with inattentive ADHD this leads to trouble completing schoolwork and avoiding tasks requiring focus. Children with ADHD may also be highly disorganised with messy rooms.
Again, whilst many of these are common childhood traits, those with ADHD will suffer both at home and at school due to the severity of these symptoms.
Girls display attentional ADHD more so than boys.
Tactile Defensiveness (TD) refers to both behaviours and emotional responses which are out of proportion to tactile (relating to sense of touch) stimuli. Children with TD may be overwhelmed by sensory overload and in extreme cases may find everyday activities such as having hair brushed or eating cold food intolerable.
TD is commonly associated with ADHD and is exhibited more frequently by females.
Social and Psychological Functioning:
Studies have also found some marked differences in these areas between girls and boys. Boys have been found to be more aggressive, particularly with peers. Interestingly, it has been found that girls suffer from lower self-esteem and demonstrate poorer coping strategies than boys.
This could be due to the more internalised nature of female ADHD but could also be the result of later diagnosis.
Effects of late diagnosis
Early identification and intervention are obviously important in terms of determining future outcomes. Children who receive support at home and at school are much more likely to manage their condition into the future.
Unfortunately, at present ADHD tends to be diagnosed later in girls than in boys. Until recently, the American Psychiatric Association diagnosis manual specified 7 as the cut- off age for symptoms to be evident. Although this has recently been increased to 12, it is quite possible that the narrow age- range previously provided prevented some diagnoses from being made.
Some studies estimate that as many as 50- 75 percent of girls with ADHD are not diagnosed.
Studies have found that both men and women diagnosed as adults struggle in a wide array of domains and have lower self- esteem, poorer coping strategies and higher levels of depression. In addition adults identified with ADHD later in life tend to have negative attributions about themselves.
The lack of a diagnosis may lead individuals to having their difficulties attributed to laziness or lack of ability both by themselves and others.
As of yet however, no study has compared those diagnosed during adulthood with those diagnosed during childhood.
So what should you look out for in order to spot the signs of ADHD in girls?
The following signs may indicate that ADHD is going unnoticed:
If this sounds familiar it may be worth speaking to a GP or therapist in order to further investigate the basis of these problems. Given the lack of awareness regarding girls with ADHD, and the detrimental impact of later diagnosis, it is important not to let girls with ADHD continue to fall under the radar.
By Dr. Syras Derksen
Hamed, A. M., Kauer, A. J., & Stevens, H. E. (2015). Why the diagnosis of attention deficit hyperactivity disorder matters. Frontiers in psychiatry , 6 .
Rucklidge, J. J. (2010). Gender differences in attention-deficit/hyperactivity disorder. Psychiatric Clinics of North America , 33 (2), 357-373.
“I hated high school. I don’t trust anybody who looks back on the years from 14 to 18 with any enjoyment. If you liked being a teenager, there’s something wrong with you.” ― Stephen King
The teenage years are tumultuous to say the least. It can be easy to forget how miserable and self- doubting the teenage self can be, as a wave of drastic change and hormones sweeps over your developing mind and body. With this uncertainty comes a predictable amount of moodiness, fluctuations in confidence, and conflict with parents.
Sometimes however, these common teenage symptoms go beyond what is normal for this life stage. When depression manifests itself in teenagers it can often be attributed to hormones etc. when it is in fact a real and pervasive psychological problem. Conversely, some parents may mistake their teens natural growing-up stage for depression when it is completely harmless.
An Underestimated Problem
The important thing to note is that undetected depression in the early years can have lifelong consequences. The average age of depression onset in lifelong sufferers is 14 years old, so those that experience lifelong depressive episodes will most likely start as teens.
The Association for Young People’s Health report that the number of young people aged 15- 16 with depression has almost doubled between the 1980s and now. They also estimate that 1 in 10 young people suffer from a diagnosable mental health disorder. These are statistics that are replicable in most developed countries around the world.
Untreated depression in the early years can lead to eating disorders, academic difficulties, and substance abuse. There is no shame in seeking the help of mental health experts and, in fact, early positive experiences with these services can set your child up for a lifetime of positive mental health.
So how do you tell when your teenager is suffering from depression and needs a little help? Listed below are some common signs of teenage depression. Although many of these occur during the teenage years, the presence of most or all of them over the space of several weeks indicates your teen may have depression.
Please bear in mind that this list is not exhaustive, but merely a guide to identifying when your teen may have a problem. In order to be diagnosed the help of a trained mental health professional is required.
Signs to Look Out For
Mood: This is one of the hardest ones to disentangle, but if your child is consistently sad, cranky, and irritable then you may need to explore why this is so pervasive. This, combined with a belief that life is meaningless is a warning sign for depression.
Appetite: If your teen is eating a lot more or a lot less than usual and has experienced significant weight loss/ gain then this may be a depressive symptom. It is common for weight to fluctuate during adolescence but if this is combined with several of the other symptoms listed here then it may be a warning sign.
Loss of interest: Sometimes teens move away from things they used to enjoy as children. This is perfectly normal, but if your teen completely withdraws from things they truly love such as a particular sport, instrument or even friends then this is not to be ignored. A loss of interest in enjoyable pursuits is particularly worrying as the lack of activity and fun will only exacerbate any pre-existing depression.
Sleep: An excessive amount of sleep is not normal, nor are highly irregular sleeping patterns. Parents should look out for ongoing fatigue and/ or exhaustion.
Physical complaints: If your child regularly reports headaches, nausea and other without any seeming explanation or cause then this may be a sign of deeper issues.
School performance: A sudden worsening in school performance, frequent absences and seeming disinterest in school life may hint at depression.
Difficulty concentrating: Difficulty concentrating at home and at school should be taken note if. Your child may seem restless or agitated and be unable to relax.
Tearfulness: Teens who become easily tearful or cry frequently may be experiencing deeper unhappiness.
What to Do if You Think Your Child May Have Depression?
Again, this list should not be used to diagnose your child but should merely be used as a guide if you already have concerns. Most of these behaviours will be evident at some stage or another throughout the teenage years. If however, these behaviours are ongoing and pervasive then you should consider your options.
Parents of depressed teenagers should do their best to listen to their teenagers concerns. Try to schedule some time to really listen to how they are feeling. Do not judge or lecture as tempting as this can be. Statements such as “when I was a teen” or “you’ll grow out of it” are not helpful.
Structure and self- care are extremely important when it comes to alleviating depression. Encourage your child to get enough sleep and make sure they are getting the nutrients they need. Simple things like these can make a difference.
Whether as a teenager or an adult it is vital to talk through your depression. There are many mental health experts who are trained to work with depressed teens. Most schools have a counsellor or psychologist and there are a range of valuable community services.
Don’t feel as though “fixing” depression is your parenting duty. If you suspect that your teen is depressed, get in touch with these services and ensure that the correct support they need is obtained.
Sometimes the best example to set is that it is okay to ask for help!
By Dr. Syras Derksen
Machoian, L. (2006). The disappearing girl: Learning the language of teenage depression. Penguin.
Mental Health Foundation (2006). Truth hurts: report of the National Inquiry into self-harm among young people. London: Mental Health Foundation
Oster, G. D., & Montgomery, S. S. (1995). Helping your depressed teenager: A guide for parents and caregivers. John Wiley.
Romantic relationships are a fundamental part of life, and healthy, loving relationships can lead to some of the greatest joys available in the human experience.
Recent scholarship utilizing a conceptual framework called Self-Determination Theory has identified several core components of successful romantic relationships. Here we will examine the theory and some of its contributions to our understanding of romantic relationships.
What Is Self-Determination Theory?
Self-determination theory is a fundamental theory of human behavior that serves to organize the different tendencies and needs of human beings in order to explain the motivation for their behavior and the personalities they develop. It is a theoretical framework which is useful for exploring and explaining certain human experiences.
The fundamental concept of Self-Determination Theory, as is apparent by the name, is the idea that human beings, when they are operating as a true self, are performing actions that are self-motivated and self-determined. This is to say that an individual’s behavior is not so much determined by their surroundings, their context, or the external influences acting upon them, but rather by their own conscious ability to choose what is best and to act upon their desires.
This theory is in contrast to other theoretical frameworks, such as several frameworks that fall under the heading “Behaviorism,” which maintain that human behavior contains almost no element of true agency, and that individual actions are determined – in part or in full – by influences that are outside of the individual’s control.
Self-Determination Theory posits that three processes are responsible for a human being’s ability to act: first, there is present a mindful, reflective awareness of what the individual needs and what tendencies they desire to act upon. Second, an acknowledgment that the environment of the individual is sufficient to support the actions that it intends to take. And third, that the actions of an individual are enfolded, by various degrees, into that individual’s personality: That the individual “owns” their actions, so to speak.
Recent research utilizing a framework of Self-Determination Theory reviewed what the theory has to say on the topic of romantic relationships.
What Self-Determination Theory Says about Romantic Relationships
In a 2015 study entitled “Self-Determination Theory and Romantic Relationship Processes,” published in the journal Personality and Social Psychology Review, the authors took a close look at past research involving Self-Determination Theory and romantic relationships, and attempted to synthesize the findings and present patterns found in the literature.
For the purposes of the study, the authors took an interest in how a true self acts in a romantic relationship, and what consequences there are to those actions. By true self, the authors referred to the self as defined by Self-Determination Theory, namely a self that has been fully internalized, fully adopted, and fully endorsed by an individual as part of their identity.
Thus, a true self in relationships is one who fully endorses one’s own involvement in a relationship, and does not blame that involvement on any other external factors such as manipulation, coercion, guilt, or lack of knowledge. The researchers were interested in examining the patterns of romantic relationships when the individuals involved are truly, wholly committed at the level of their identity.
The first useful takeaway that becomes immediately apparent from this conceptual framework is the simple idea that not all actions are performed by a true self. A very powerful feeling of awakening can arise inside a relationship when one or both parties realize that they are not truly acting according to their own needs or according to the interests of their true self, but rather simply preserving and going through the motions of what they believe they must do, or what role has been thrust upon them.
A second major takeaway of considering romantic relationships using the framework of Self-Determination Theory is the idea that the more one invests one’s identity in one’s activities, the more satisfying and fulfilling they become. This includes relationships. When the true self is acting in a relationship, there is a resounding sense of affirmation: The individual is in the relationship because they want to be, and because it is important to them. This authenticity spills over into a host of other relational benefits, including partners feeling affirmed and becoming more honest and aware of the other’s needs.
One final takeaway we will mention here among the many cited in the article is the Self-Determination Theory perspective on goals. There is a big difference in romantic relationships on the function of goals, depending on whether the individual adopts more of a victim mentality or if they act as a true self. Research has demonstrated that people who are able to pursue their own intrinsic goals autonomously inside a relationship have greater overall well-being. When both partners in a relationship are aware of what they want and can verbalize those desires so as to actively pursue them together, growth takes place and mutual satisfaction often follows.
Why This Theory Matters
In the end, Self-Determination Theory is just that – a theory. A “theory,” in the scientific sense of the word, defines a coherent and cohesive set of concepts and ideas that together form a framework of hypotheses. These hypotheses have dual value: to provide a working explanation of the phenomena of the world around us, as well as to generate specific questions that can be tested.
With this conception of Self-Determination Theory, it is apparent why there is value in considering romantic relationships from this perspective. If, using this theory, an individual is able to consider what their romantic relationships would look like if they were acting as a true self, according to the theory, they have the opportunity to learn a lot about who they are, what they want, what their relationships are like, and any number of other questions.
This is not to say that Self-Determination Theory is “true,” necessarily. Competing theories that more highly emphasize the role of the environment and of the situation in motivating human action also contain an element of truth.
Nonetheless, by interacting with these various different theories and understanding what they say about human action, an individual has the opportunity to develop their self-understanding. And with more self-understanding, particularly in the realm of intimacy and romantic awareness, comes a greater ability to experience the great joys that life has to offer.
For more information, feel free to read the above-mentioned research article, to check out any number of books on Self-Determination Theory, or to consult with a psychologist or trained mental health professional with experience in this theory.
Knee, C. R., Hadden, B. W., Porter, B., & Rodriguez, L. M. (2013). Self-Determination Theory and Romantic Relationship Processes. Personality and Social Psychology Review, 17(4), 307-324.
It is old news that dysfunctional or insecure relationships in childhood may lead to difficulties down the line. Whilst this has long been known, a recent study has shed further light on the reasons for this, and the specific effects poor attachments may have.
Attachments are the relationships we have with caregivers from an early age. In general, attachment styles may be divided into four categories: secure, anxious-preoccupied, dismissive-avoidant and fearful-avoidant. The type of attachment style we develop is directly linked to the quality of care we receive. For example, a neglectful parent may contribute to their child’s dismissive- avoidant attachment style (Cassidy, 1999).
Insecure attachment styles have been linked to range of adult mental health issues. These range from anxiety and depression to relationship issues and even health problems. Obviously attachment styles are an important research area, but why does the human brain react so negatively to poor parenting?
The study, published in Frontiers in Human Neuroscience, found that insecure childhood attachments can negatively influence our ability to deal with stress as adults (Leyh, 2016). We are all aware that there is huge variability in how individuals deal with stress. This is evident in any office in the world! Some people remain calm and proactive in the face of adversity, whilst some crumble and become extremely negative.
One of the reasons for this, according to Dr. Rainer Leyh and his team, is that our negative childhood experiences and attachment styles stay with us throughout adulthood, and rear their heads when we are faced with a stressful or anxiety provoking scenario.
In this report on the study, Dr Christine Heinsich gives the example of a car approaching a traffic light. For the driver, when they are in a neutral state, following the signal is easy and may even come automatically. For an emotional driver however, following the signal is much more difficult. They may stop late or fail to stop altogether, driving straight through the light.
What moderates our ability to stay calm under emotional strain? For those of us that had emotionally attentive parents or caregivers it can be a lot easier. The key term is “emotional regulation”. Emotional Regulation is our ability to control our emotions, and our reactions and subsequent behaviours in response to them. Attachment styles have been directly linked to emotional regulation.
In the aforementioned study, adults were recruited who had a wide range of childhood parental/ caregiver experiences. Participants were asked to perform a task which involved identifying a target letter from a series of flashing letters. The task was conducted in different conditions, some which evoked a positive emotional response, some which evoked a negative response and others which evoked neutral. The participants’ brain activity was recorded using a type of brain scanning called “EEG”.
Subjects with insecure childhood attachments had significantly more trouble performing under the negative conditions than those with secure childhood attachments. Another interesting finding was that those with insecure attachments also exhibited lower brain activity under negative conditions when attempting to identify the target letter.
The poorer the task performance, the poorer the strategies for emotional regulation. One theory put forth by the researchers, is that the more effort you have to exert on inhibiting your emotion, the less resources you have to perform on the task. Therefore, negative childhood experiences may make all those day- to- day struggles we encounter just that little bit more difficult.
Were there any potential limitations to this study? It could be argued that as the target letters were unrelated to the emotional cures, it is difficult to generalise them to everyday life. Future studies will have to find a way to make the testing environment more realistic.
Despite this, it does see clear that poor relationships with our caregivers can have long- lasting consequences.
How do I know if I have difficulties with attachment and/ or emotional regulation?
It can be difficult to know whether any of this applies to you. You may have difficulties with emotional regulation if:
Implications for relationships
Those who are negatively attached may bring these issues and insecurities into relationships. Attachment style can have massive connotations, particularly for romantic relationships, and it is important to be aware of how it can affect you.
It is easy to see the connection between a turbulent relationship, and the findings of the study we have just discussed. Being resilient and calm when faced with stressful situations, arguments and all that comes with a relationship, is often central to its success. For those with poor emotional regulation, this can be difficult.
What can you do about insecure attachment?
New research is increasingly shedding light on how our past experiences can shape our present and future. It is fascinating what we area learning, but also important to stress that your past does not necessarily dictate your future, and we all have the ability to change long- learned behaviours.
By Dr. Syras Derksen,
Cassidy, J. (1999). Handbook of attachment: Theory, research, and clinical applications. Rough Guides.
Leyh, R., Heinisch, C., Kungl, M. T., & Spangler, G. (2016). Attachment representation moderates the influence of emotional context on information processing. Frontiers in Human Neuroscience, 10, 278.
For many of us, the word “assessment” conjures up negative associations.
In reality, though, the fact of the matter is that even though from the outside psychological assessments might prompt a fear of judgment or an image of subjective evaluation, the exact opposite is true: Psychological professionals use assessments to gather objective information in order to find the best way to help an individual grow.
Let’s take a closer look at what psychological assessments entail, common biases to note, and the best way for you to think about psychological assessment.
What Is Psychological Assessment?
The notion of psychological assessment defines an individualized, holistic information-gathering process. It’s not something that can be summarized in a single sentence: there are as many different ways to perform a psychological assessment as there are individuals.
Although there is diversity in how assessments are performed, there is a general method that is consistent across different realms of psychology and different types of disorders. This method involves integrating the results of a variety of different psychological tests in order to create a balanced, objective view of the psychological profile of an individual
Multiple Sources of Information
A psychological professional generally integrates multiple sources of information when coming to a conclusion. This will generally include observation of the person (e.g., interview), historical information (e.g., grades), and the results from multiple tests hopefully done by multiple people. For example, when diagnosing Attention-deficit/Hyperactivity Disorder (ADHD) our clinic will gather information from teachers, parents, and the child. We would rule out various learning difficulties and emotional/behavioural challenges.
Is the Issue A Disorder?
Tests are norm-referenced, which means that an individual’s performance is compared against the average performance of a group of people. For example, a height measurement is a kind of test – it provides a single, discrete measurement of a physical characteristic (not a psychological characteristic). But an individual’s height is only meaningful if it is compared to others; for instance, a child’s height compared to the norms for his or her age group. This can let you know if there is an issue with the child’s growth.
Finding Important Factors that are Hard to Observe
It may be clear that a person is having difficulty managing life. However, the real issues may be harder to see. They may be difficult to see because the person is hiding it, or because they are just not aware. Children, for example, often benefit from psychological assessments because they don’t know how to describe the issues they are facing.
It’s not just children who may not be aware of their issues. For example, a client may be consuming a large amount of alcohol, which is causing anger and relationship problems. This alcohol problem is more obvious and is the issue that attracts the attention of family and friends. A psychological assessment my show that this the alcohol use is an issue, but it may also show that their level of anxiety is very high. This combination of issues may suggest that the individual is using the alcohol to manage their anxiety difficulties. A recommendation of therapy or using an anti-anxiety medication may be the result of this type of assessment. Treating the anxiety may then help the person to stop the alcohol abuse.
Multiple Tests to Rule out Other Potential Issues
Psychological assessments aren’t there to just measure one symptom. The tests chosen are also there to ensure that other issues may not be causing the problem. For example, in an ADHD diagnosis, it is important to know that the observed attention problem is not a symptom of a different disorders.
In the case of ADHD, the primary pharmacological treatment is a stimulant. However, bipolar can look like hyperacitvity and a stimulant medication can make bipolar worse. Psychological assessments are there to make an accurate diagnosis to avoid making mistakes that can lead to months or years of extra pain and confusion.
Tests Can only Be Used With Certain Groups
It’s important when interpreting the results of an individual test to notice the assumptions that the test makes about its subject population. Every individual is different, and it’s dangerous to oversimplify these differences by measuring the averages of a group of people.
Psychological tests are generally meant for specific populations. When these rules are broken, the results may not be accurate. For example, a test that was developed with North American’s may not be accurate with people who grew up in India. Although psychologists sometimes break these rules because no better test is available, clinical judgement is important in interpreting the results.
How to Approach Psychological Assessment
One helpful way to think about psychological assessment is to approach as you would a trip to the doctor’s office.
In both cases, whether it’s a medical professional running a blood test to check for signs of a physical illness, or a psychological professional performing a mental health evaluation to check for signs of a psychological disorder, the basic idea is the same. A professional with the patient’s best interest at heart is simply gathering information in order to inform themselves as to the best next steps.
This comparison also illustrates how one should prepare for the assessment: You wouldn’t study for a blood test. When you go to the doctor, the goal isn’t to present yourself as perfectly healthy and to ignore the physical ailments that are bothering you. How would that help?
Instead, the goal should be to open up lines of honest communication between you and the professional devoted to your care and well-being. With both medical and psychological assessments, you want to be as completely honest as possible, even if you feel afraid or embarrassed. The individual trained to help you is on your team, and will help as best they can.
In conclusion, psychological assessments are an information-gathering process performed by psychological professionals in a number of different contexts. While the process is open to some amount of human bias, if approached like a medical examination, the process of psychological assessment can be a helpful part of psychological care for individuals in all situations.
By Dr. Syras Derksen,
Eabon, M. F., and Abrahamson, D. (2016). Understanding psychological testing and assessment. American Psychological Association. Retrieved from www.apa.org.
We all know individuals who are of a more melancholy disposition than others. In A. A. Milne’s popular set of children’s stories, the friends of Winnie-the-Pooh include both Tigger – the bouncing, happy tiger; and Eeyore – the somber, plodding donkey. Even from a young age, we all understand that it is completely acceptable for individuals to have their own unique dispositions and levels of emotional valence.
However, when a friend or loved one’s general tendency towards being blue seems to worsen, and perhaps begins to impair day-to-day functioning, it is exceptionally difficult to assess the seriousness and potential danger of the situation. In particular, it can be hard to know when a period of melancholy crosses the line into untreated major depression.
Depression Can Be Misdiagnosed
A recent study published in the JAMA Internal Medicine journal by the American Medical Association indicated that in the United States, a large proportion of individuals seeking attention for depression-related symptoms are misdiagnosed. The study surveyed over 46,000 US adults aged 18 or older in 2012-2013.
Using an established scale to measure depressive symptoms, the study established that around 8.4% of the participants in the sample had depression. However, only 28.7% of those individuals had received treatment. Meanwhile, of those who were undergoing treatment for depression (either psychotherapy or antidepressant medication), only 29.9% screened positive for symptoms of major depression.
This means that there are some serious challenges associated with the correct identification of depression, and diagnosis and treatment is not necessarily always straightforward.
In an effort to widen the scope of research into the prevalence of depression misdiagnosis, another study conducted a meta-analysis of 118 different studies assessing the accuracy of depression diagnoses. The final analysis contained data from more than 50,000 patients across 41 different studies, in countries including the United States, Canada, and various European countries, among others.
In the end, the study suggested that for every 100 cases of potential depression seen by a primary care physician, 15 cases are false positives (treatment was prescribed when there was no real depression), 10 cases are missed (treatment is not prescribed when there is real depression), and 10 cases are correctly identified (treatment is provided for real, identified depression).
One reason for this pattern of diagnosis is the difficulty in ascertaining the difference between depression and psychological distress. The AMA study described in the previous section measured the difference between depression and serious psychological distress, and found that among adults who were undergoing treatment for major depression, 29.9% had depression and 21.8% had serious psychological distress.
In addition, factors such as age, culture, and available medical resources can impact diagnoses. In general, the studies concluded that developing a relationship with a mental health care professional and undergoing multiple diagnostic visits over a longer period of time can substantially increase diagnostic accuracy.
Signs to Look For
To address the complexity of depression diagnosis, there are several mnemonics that have been developed in an effort to make the symptoms of depression more memorable. The mnemonic below, published by Blenkiron, 2006, lists 10 symptoms of depression aligning with the 10 letters of the word. Here we present the list and supplement each item with a brief description.
As was apparent from the list above, each symptom presented must recur in an individual for a period of multiple days before it should be considered a possible indicator for major depression. Generally speaking, until multiple of the symptoms above are present much of the time for a sustained period lasting around two weeks, there should not be major cause for concern.
However, anyone with any concern over the mental health or safety of a friend or loved one should consult with a mental health professional. Individuals who fear for anyone’s immediate safety should contact emergency services.
By Dr. Syras Derksen,
Blenkiron, P. (2006). A mnemonic for depression. BMJ: British Medical Journal, 332(7540), 551.
Mitchell, A. J., Vaze, A., & Rao, S. (2009). Clinical diagnosis of depression in primary care: a meta-analysis. The Lancet, 374(9690), 609-619.
Olfson, M., Blanco, C., & Marcus, S. C. (2016). Treatment of Adult Depression in the United States. JAMA Internal Medicine, 176(10), 1482.
In our increasingly digital age, addiction to internet use is growing in prevalence, and has recently received more and more attention from medical and scientific researchers. Nowhere is the problem more alarming than with adolescents, who have the greatest access to internet-based technologies, and also have the most at stake developmentally.
Some rather sensationalized news sources have even referred to the rise of internet addiction as a new “electric heroin,” citing the research demonstrating how internet use and serious substance abuse demonstrate similarities in their symptomologies and in the way that they stimulate the reward pathways of the brain.
While the danger and addictive potential of heroin use makes the comparison a little strained, excessive internet use is nonetheless a condition that merits serious attention.
The History Of Internet Addiction
The possibility for addictive behavior related to internet use was first proposed in 1995. The term was initially used in jest, because at the time the rarity of personal computers and the unlikelihood of any individual developing an addiction to internet use made the idea ridiculous.
In the ensuing years, however, the explosion of internet technologies rapidly made internet addiction a reality. By 1998 a diagnostic tool known as the Internet Addiction Tool (IAT) was developed by Dr. Kimberly Young in order to assess whether an individual’s internet use was pathological.
The assessment was based on the criteria for pathological gambling listed in the DSM-IV (the American Psychological Association’s diagnostic manual for mental disorders). This was based on the logic that despite the fact that internet addiction had not yet been recognized by the psychological establishment as a real disorder, the symptoms it presented were similar enough to gambling addiction that the two could be diagnosed in a comparable fashion. When the DSM-V was released in 2013, pathological gambling was updated to a condition now called “gambling disorder,” but problem internet use was once again left out.
Notwithstanding, psychological and medical researchers across the world have begun devoting major resources towards studying the effects of internet use, especially on school age populations ranging from ages 5-22. This field of research has been especially active in Asian countries such as China, Japan, Korea, and Taiwan; countries in which the vast majority of the population have access to the internet and incidence of internet addiction is especially high. Recent studies have found that an estimated 19.8% of adolescents in Taiwan and 20% of adolescents in Korea screened positive for either internet addiction or excessive internet use.
The Diverse Manifestations of Excessive Internet Use
Internet Addiction has been grossly understudied, and additional research is required to establish prevalence rates in European and North American countries. The various diagnostic tools currently available are often times outdated, and assess patterns of internet use that are no longer relevant. Future research is needed to validate measuring tools that more accurately reflect the actual patterns of internet use in today’s adolescents.
In the 1990s, the internet functions available to the average user were so limited that one of the only possible types of pathological use was compulsively checking websites, in a pattern that closely mirrored compulsive gambling. However, today’s adolescents use the internet for so many different things that, depending on their pattern of use, the internet can either enable or catalyze a host of different disordered patterns of thinking.
For example, online gaming can be associated with the impulsivity often marked in cases of Attention Deficit Hyperactivity Disorder (ADHD). Adolescents with a bent towards narcissistic personality disorder might gravitate towards excessive self-promotion on networking outlets like Twitter, Facebook, or Instagram. The constant stream of world news and cultural information present on social media websites can enable a crippling fear of missing out (or “FOMO”) that might co-occur with an anxiety disorder. And the internet also provides opportunities for the destructive cyber-bullying perpetuated by over-aggressive adolescents.
Of course it is impossible to determine if the disordered or problematic patterns of thinking listed above are caused by internet use or if the internet use simply enables preexisting pathological tendencies to manifest. It is also possible that there is a reciprocal relationship, with excessive internet use both fostering and enabling the expression of negative behavior patterns.
Diagnosis and Understanding
While this diversity of the symptomology of internet addiction makes it difficult to issue blanket statements, the important thing is to have the discernment to distinguish between frequent internet use and the excessive patterns of use that can lead to addiction.
Internet use should not be judged to be excessive until several of the following criteria are met (among others): impaired psychological well-being; worsened academic performance; physical abnormalities including back pain, eye strain or carpal tunnel syndrome; severely decreased family and peer interactions; and finally the traditional markers of addiction, including increased tolerance, signs of withdrawal after lack of use, disregard for consequences, and difficulty controlling behavior.
While discussions of internet addiction can often alarm parents who may believe that their child spends too much time online, it’s important not to jump to conclusions nor to inhibit overall internet use wholesale. Internet use is not per se harmful or inhibiting; in fact, there is a mountain of evidence that adolescents with regular internet access generally have higher test scores, a greater motivation to learn, greater access to health information, and a general feeling of empowerment compared to adolescents without internet access.
As was noted above, there are many diverse uses for internet technologies, and each has the potential to enable various different disordered patterns of thinking. What is required in such a complex situation is a sensitivity to the overall developmental context of an adolescent’s physical, emotional, and social situation.
While internet addiction has recently been given increasing attention by mental health professionals and should be taken seriously, parents of adolescents should not jump to conclusions. Using the criteria listed above, in addition to outside research and, if necessary, consultation with a certified health professional, parents of adolescents can be more secure in their ability to discern between the excessive internet use that marks internet addiction and the frequent internet use that marks 21st century adolescence.
By Dr. Syras Derksen,
Guan, S. S. A., & Subrahmanyam, K. (2009). Youth Internet Use: Risks and opportunities. Current Opinion in Psychiatry, 22(4), 351-356.
Ong, S. H., & Tan, Y. R. (2014). Internet Addiction in Young People. Annals of Academy of Medicine, Singapore, 43(7), 378-382.
Tao, R., Huang, X., Wang, J., Zhang, H., Zhang, Y., & Li, M. (2010). Proposed Diagnostic Criteria for Internet Addiction. Addiction, 105(3), 556-564.
Wallace, P. (2014). Internet Addiction Disorder and Youth. EMBO Reports, 15(1), 12-16.
On the surface, social media may seem to have a positive impact in our lives. After all, they are platforms where we can reconnect with friends and relatives who are geographically separated from us or whom we haven’t spoken to for years. However, many can get caught up into the virtual world of social media that it becomes about far more than reconnecting.
Social Media and Depression
A very recent study on this topic has looked into the direct relationship between the psychological health of teenagers ages 11-17 and the time they spent on social media platforms. The study, which was presented in September 2015 at the British Psychological Society conference in Manchester and yet to be published, showed that night-time specific usage of social media may cause poorer sleep quality, lower self esteem and higher risk of anxiety and depression among teenagers.
While the researchers consider this as another piece of evidence into the theory that social media use can affect well-being, they admitted that the real causes why this is so are yet to be established.
Use of Facebook
A number of studies have shown that social networking is linked with depression among adolescents. Steers, M., Wickham, R. & Acitelli, L. (2014) found in the first part of their study that Facebook can be linked to depressive symptoms through the already well-established psychological phenomenon known as “social comparison.” This is when you compare the mundane parts of your life to the “highlight reels” your Facebook friends posted on their walls.
In the second part of the study, they tried to tap the differences between the three types of social comparisons, namely: upward, downward and nondirectional. Upward social comparisons happen when you look at someone better than yourself in different aspects, such as external appearances and material ownership. Downward social comparison, on the other hand, is when you look down on people and think you are more superior. In nondirectional social comparisons, you simply compare yourself with others with no particular “direction.” It turned out that the subjects in the study showed depressive symptoms across the three types of comparisons.
The research concluded that Facebook interaction may negatively affect the psychological health of those who use the platform. Moreover, the more one spends time on the networking site, the higher is the chance for them to spontaneously engage in social comparisons. As a result, they may suffer from depressive symptoms.
Adolescence is the stage of increased vulnerability for anxiety and depression. This is when teenagers navigate through the maze of finding what they want, who they truly are and where they can fit in.
Although teen years can be really tough, many can get through the angst through good friendships, loving family, success in school, outdoor and extracurricular activities, and an overall positive outlook in life. Teenagers do experience the occasional blues, but when it comes to depression, it’s a different thing altogether.
Numerous studies regarding the relationship between social media usage and depression among teens can pave the way to better understanding on how this vulnerable population can be helped.
Steps to Consider
Giving up social media once and for all may not be the solution. The attitude towards social media could be the better answer. For teenagers, here are some tips to balance your need to check your social media account and maintaining a positive mind.
By Dr. Syras Derksen
2015, September 11. Pressure t be available 24/7 on social media causes teen anxiety and depression. University News - University of Glasgow. Retrieved from http://www.gla.ac.uk/news/headline_419871_en.html
Steers, M., Wickham, R. & Acitelli, L., 2014. Seeing Everyone Else’s Highlight Reels: How Facebook Usage is Linked to Depressive Symptoms. Journal of Social and Clinical Psychology. 33(8): 701-731; doi: 10.1521/jscp.2014.33.8.701
Adolescence is a time of immense physical, emotional, and social change. The growth teenagers are experiencing prepares them for great opportunities, but also leaves room for great risk. They are preparing to take on the responsibilities of adults, but are experiencing a world of pressures and confusion.
One of the key features of adolescence is their increasing need for independence from their parents. Teenagers are developing their own identity, learning how they view themselves and their values, as well as worrying about what others think of them. This is natural and can be a healthy part of their life, but it can cause tension in even the closest parent-teen relationship. Talking with a therapist can be helpful for a teen to work through their struggles and enable them with skills to face new problems.
Just a Phase?
With all its ups and downs, adolescence shouldn’t be seen as something just to “get through” or outgrow. It’s an important time of maturation and can be a time for teens to thrive. The teenage brain is going through substantial and rapid changes which can enable them to succeed; however, the malleability of the brain at this stage also means that unhealthy experiences and patterns can result in further risk-taking and maladaptive behaviour.
Additionally, symptoms of most mental health disorders begin in adolescence, around age 14, but the majority of people do not seek help until about 10 or more years later, when their symptoms have become disabling to their work and relationships. Seeking early treatment in teen years is important to help develop coping skills and understanding of their emotions. Earlier treatment and assessment can reduce later severity of symptoms and prevent the development of addition, co-occurring disorders.
Extra support will help teens access the benefits of their developing brains and can help teens and their families enjoy this time instead of waiting for it to be over.
Is My Teen's Behaviour Normal?
It is normal to see a change in behaviour when your child reaches adolescence, but sudden, extreme, or long-lasting changes in mood and behaviour may be cause for concern. Additionally, if your teen is showing signs of depression or anxiety, it is important to seek appropriate assessment and treatment.
Stress is a typical part of teenage life, but for some teens, stress becomes anxiety, which is intense worry that is out of proportion to the actual event and its possible consequences. When that anxiety starts to impair daily functioning, it may be part of a disorder.
As teens take risks and try new things, they will inevitably experience disappointments, failure, and loss. They may demonstrate more extreme reactions to seemingly trivial things, so distinguishing normal periods of depression from a clinical diagnosis involves judging whether they are able to recover themselves, how long it takes to get back on track, and how quickly they fall back into a depressed state. After a failure or loss, if your teen doesn’t show much improvement even when other things are looking up, they may be showing signs of clinical depression.
Is Medication Enough?
Studies have repeatedly shown that when it comes to mental health, best outcomes are seen when medication is combined with therapy. Medication can help reduce anxiety or regulate emotions so that we are ready to engage in therapy in order to learn healthy ways of thinking and relating and put them into practice.
By Kristi MacDonald
Institute of Medicine (US) and National Research Council (US) Committee on the Science of Adolescence (2011). The science of adolescent risk-taking: Workshop report. Washington (DC): National Academies Press (US). Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK53420/
National Institute of Mental Health (June 2005). Mental Illness Exacts Heavy Toll, Beginning in Youth. Retrieved from: http://www.nimh.nih.gov/news/science-news/2005/mental-illness-exacts-heavy-toll-beginning-in-youth.shtml
White, A. M. & Swartzwelder, S. (2013). What are they thinking?!: The straight facts about the risk-taking, social-networking, still-developing teen brain. W.W. Norton & Company, Ltd: New York, NY.
Being around people doesn't help loneliness, at least not for people suffering from depression or an anxiety disorder. Perhaps you've noticed that sometimes getting someone to the party just isn't enough to get them out of their funk. It seems that being around people just isn't enough sometimes.
Loneliness can be a very significant issue. It is associated with depression and other mental disorders, including suicide. Many people suffer loneliness in silence, making it all the more dangerous. It should be mentioned that loneliness is not the same as solitude. Being alone does not necessarily make a person feel lonely, sometimes solitude can be a welcome break and sometimes a preferred lifestyle.
A group of researchers from the United Kingdom recently investigated the effect of social support on loneliness and had some surprising results. They asked about feelings of loneliness, their symptoms of mental illness, and finally their social participation and social support.
They found that social participation and support were helpful for getting rid of loneliness for most of the participants, just not the ones who were suffering from depression or anxiety. This finding is important because many therapists recommend participating in social events as treatment for depression and some anxiety problems.
For people who are suffering from depression and anxiety, it is more important to consider their thoughts as they mingle with others. These thoughts and anxieties may highjack the benefits of being in the group. For example, if the person is so down that they see every person in the group as rejecting them, then being with others might not be so helpful.
Fortunately, it is possible to examine and change how people think in social situations. Therapy has been shown to be helpful for overcoming negative thinking and emotion. Once the distressing thoughts are handled, social situations would once again have the benefit of dispelling feelings of loneliness.
By Dr. Syras Derksen
Meltzer, H., Bebbington, P., Dennis, M. S., Jenkins, R., McManus, S., & Brugha, T. S. (2013). Feelings of loneliness among adults with mental disorder. Social Psychiatry Psychiatric Epidemiology, 48, 5-13.