Child abuse is a harrowing topic of discussion. While childhood is meant to be an oasis of happiness in the lifespan, the actions of others can sometimes shatter this precious time.
Dealing with the aftermath of child abuse is difficult for both the individual and their families and requires early and ongoing intervention.
In this article we will discuss the effects of child abuse and the various treatments that are recommended in order to piece things back together.
WHAT DO WE MEAN BY "CHILD ABUSE?"
Child abuse is often divided into four main categories:
Neglect is when the child suffers harm due to being denied something by a caregiver. This may be food, clothing, warmth, supervision etc. Neglect normally occurs over a period of time and will be apparent in a variety of ways. Sometimes neglect will be materially obvious from poor clothing or hygiene. Other times it may manifest itself in other ways; for example, if a child injures themselves due to lack of supervision.
Emotional abuse is normally seen in the relationship between child and parent/caregiver as opposed to a set pattern of events. Emotional abuse does not refer to anything physical but refers to a range of behaviours exhibited by the caregiver that prevent the child from obtaining his or her emotional need for affection, safety and security amongst others.
Examples include excessive criticism, under or over protection, emotional unavailability and unrealistic expectations. Emotional abuse may manifest itself many ways including low self-esteem and unhappiness as well as unhealthy attachment styles.
Physical abuse involves any behaviour by the parent or caregiver that either directly or inadvertently results in physical harm. This form of abuse may refer to a once off incident or a repeated series of events. Physical abuse may involve severe physical punishment, pushing/shaking, induced illness and forced observation of violence.
Sexual abuse is when an adult uses a minor for their own sexual gratification. Examples of sexual abuse include, amongst others; sexual intercourse with a child, exposing sexual organs to a child, involving a child in masturbation and sexual exploitation. As children cannot give sexual consent any act between an individual over 18 and an individual under 17 is considered sexual abuse.
For a full description of sexual abuse types and ways to identify whether sexual abuse may be taking place, please follow this link. If you have concerns for a child then make sure to check out the information provided here.
What is the Impact of Abuse on Children?
Child abuse can have a major impact on any young person. Research indicates that the most serious mental health problems often arise from repeated trauma. This is because repeated trauma such as child abuse can often last years or even decades of a young person’s life, leaving them little time to experience the stability required for secure development.
In addition to this, some psychologists have made the case that the most severe psychological effects arise from relationships in which the child is dependent. The most obvious example if this is parent- child relationships. When this relationship is abused by a caregiver it deeply disrupts the ability of the child to form attachments, develop self-esteem and resilience.
It is hard to pinpoint the results of child abuse as it depends on the individual’s subjective experience, length of abuse and severity of abuse. Research has linked child abuse to a variety of emotional and behavioural issues however. These include:
Child abuse may also have long- term effects for the individual. Neglect as well as emotional, physical and sexual abuse in childhood have all been linked to range of poor long-term mental health outcomes. Depression, anxiety and addiction have all been linked to adverse experiences in childhood. In addition to this child abuse has also been linked to poorer physical outcomes. It is important to note however, that not all children who experience abuse will go on to develop such issues.
Interventions for Children who have Experienced Abuse
Treatment methods that have the most scientific backing are based on CBT (Cognitive Behavioural Therapy) and focus on the abuse itself. CBT addresses the child’s thinking patterns, emotional responses and behavioural reactions to the abuse.
In particular the treatment will attempt to correct any misattribution of blame the child may demonstrate i.e. blaming themselves as opposed to the adults for the abuse. It is important not to force the child to directly discuss the abuse too quickly, but rather ease into a discussion of it. In this way, the child’s embarrassment and anxiety is reduced as much as possible.
The therapist may also teach the child skills to cope with the negative emotions arising from the abuse. These may include stress or anger management techniques. The child is taught to identify any triggers they may have for negative behaviours and ways to minimise the effect they have on them. The aim of such training is to improve social and interpersonal functioning as well as reducing daily distress.
The aftermath of abuse may be highly stressful and the child may be dealing with court proceedings or the social care system. In such cases the therapist may work with the child to teach relaxation techniques. This aims to reduce anxiety levels and to reduce any fear surrounding reminders of the abuse. For example some children may be afraid of being in smaller rooms or startle easily around adults.
The most important thing for any child is that they receive the support they need as quickly as possible. Suitable intervention in the aftermath of abuse has been shown to reduce the impact in the long- term. Childhood abuse is something no child should have to suffer and they deserve as much help and compassion as we can provide.
Afifi, T. O., MacMillan, H. L., Boyle, M., Cheung, K., Taillieu, T., Turner, S., & Sareen, J. (2016). Child abuse and physical health in adulthood. Health reports, 27(3), 10.
Nemeroff, C. B. (2016). Paradise lost: the neurobiological and clinical consequences of child abuse and neglect. Neuron, 89(5), 892-909.
Wamser-Nanney, R., Scheeringa, M. S., & Weems, C. F. (2016). Early treatment response in children and adolescents receiving CBT for trauma.Journal of pediatric psychology, 41(1), 128-137.
Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder affecting approximately 3.4% of adults. Symptoms vary, but amongst the most common are distractedness and impulsivity as well as hyperactivity.
The number of children being diagnosed with ADHD in the US has been increasing in recent years. ADHD however, may also be diagnosed in adulthood, with many adults realising that the lifelong difficulties they have faced may be due to something more underlying.
Given the lower prevalence of ADHD worldwide, it is remarkable that approximately 25% of those treated for alcohol and substance abuse problems also have co-occurring ADHD. The link between ADHD and substance abuse is well-documented but the reasons behind it are less understood.
WHY IS THERE A LINK?
This is a complex question as it is unclear whether the qualities of ADHD lead to addiction, or whether the way ADHD is treated (medication etc.) may lead to substance abuse.
There is little evidence for the latter. Treating ADHD with medications like Adderall does not increase the abuse of other substances, but reduces risk. Engaging with medication and treatment programmes has been found to reduce the likelihood of becoming involved in criminal behaviour. Another study which followed children with ADHD into adulthood found that stimulant medications did not increase the risk of drug and/or alcohol abuse into adulthood.
The evidence therefore, seems to indicate that the actual traits associated with ADHD – like hyperactivity, impulsivity etc. may make individuals vulnerable to substance use.
An interesting study conducted by Harvard Medical school, found that out of those with ADHD who were abusing substances, only 30% were doing it for enjoyment only. The other 70% used it to improve sleep, mood etc. This tells us that individuals with ADHD may be self-medicating to treat the problems they may be experiencing.
The restlessness and hyperactivity associated with ADHD makes concentrating on repetitive tasks difficult. Therefore, those with ADHD are prone to boredom, which substance use can help them to deal with. Without a diagnosis, those enrolled in programmes of study may turn to substances to help them cope with study stress or an inability to concentrate during lectures.
ADHD, particularly when left undiagnosed and untreated, can be a stressful disorder to live with. Tasks that may take a person without difficulties two hours may take an individual with ADHD four. This can make schoolwork or the working environment extremely stressful, with self-esteem often suffering as a result.
Those with ADHD tend to be less successful academically, and this in time can lead to difficulties holding down jobs and earning money. Again, this leads individuals vulnerable to substance abuse.
Treating Co-occurring Disorders
ADHD, when undiagnosed, also makes substance abuse harder to treat. The difficulties associated with it make engaging in regimented treatment programs more difficult. Individual talk-therapy, often requiring long, concentrated sessions, can be difficult to focus on and the impulsivity associated with the disorder may make relapse more likely.
What Can Be Done to Help?
It is extremely important for those with ADHD to be diagnosed. An experienced professional will have a range of clinical interviews and measures at their disposal in order to accurately assess whether ADHD is present.
This often requires the professional to take case history and they may also call on a parent or sibling to ascertain how long symptoms have been present and the effects they have had at various stages of the individual’s life.
Often, when those with ADHD and addiction issues present for treatment, it is primarily due to the addiction problems. The realisation that ADHD is also present can be a remarkable moment for the addict, as the complicated tapestry of difficulties and addiction problems they have faced can begin to make sense.
Once diagnosis has been made, treatment can be tailored to take the comorbid ADHD into account. This is far more effective than treating the addiction only.
Simple changes and learning how to better organise time and money can all make a massive difference to adults with ADHD. With time coping strategies can be developed to help minimize distractions and improve attention spans.
In terms of prevention for those already diagnosed with ADHD, exercise has been found to be an effective habit for those with ADHD to adapt. Regular exercise provides structure and stimulates the brain, making it less likely that those with ADHD will turn to substance abuse.
The strong relationship now evident in the scientific literature means that it can be stated with some certainty that ADHD places individuals at risk of abusing substances. It may be helpful for parents of children with ADHD to speak to them about the risks they may encounter in the future, and the added complications they may face when experimenting with substances.
By: Dr. Syras Derksen
Registered Psycholog and Winnipeg Therapist
Conners, C. K., Erhardt, D., Epstein, J. N., Parker, J. D. A., Sitarenios, G., & Sparrow, E. (1999). Self-ratings of ADHD symptoms in adults I: Factor structure and normative data. Journal of Attention Disorders, 3(3), 141-151.
Lee, S. S., Humphreys, K. L., Flory, K., Liu, R., & Glass, K. (2011). Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clinical psychology review, 31(3), 328-341.
Mannuzza S, Klein RG, Truong NL, Moulton JL 3rd, Roizen ER, Howell KH, Castellanos FX. Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: Prospective follow-up into adulthood. American Journal of Psychiatry. 2008; 165: 604-609
Wilens, T. E., Biederman, J., Mick, E., Faraone, S. V., & Spencer, T. (1997). Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders. The Journal of nervous and mental disease, 185(8), 475-482.
A recent study published by the Journal of the American Medical Association highlights some extremely alarming current trends. This 15 year study, which recorded emergency room visits from 66 hospitals around the country has found that the number of teenage girls admitted for nonfatal self-harm has risen since 2008. Curiously, before 2008 rates were stable, so it is important to examine why this rise is taking place. Although suicide rates are on the rise for both boys and girls in the US, the rise in self-harming behaviours is limited to girls.
Self-harming behaviours including cutting, poisoning and overdosing on drugs are strong indicators of suicidal intentions or co-occurring mental illness such as anxiety or depression. Amongst the self-harming behaviours recorded, ingesting pills or poison was the most common method.
Self-harming is more common than many people may be aware. Prevalence rates are estimated to lie around the 10% mark and is not limited to young people.
It is also worth noting that the data discussed as part of this study involves admissions to emergency rooms only. It does not include injuries that were treated in doctors’ offices or that were never treated at all. As a result, the worrying findings highlighted by this study may not even reflect the full scope of the problem.
Why is This Happening?
One theory which has been put forward by researchers is that teens are spending too much time on their smartphones. It has been found that teens who spend five hours a day or more on their smartphone are 71% more likely to be at risk of suicide than those who spend an hour or less.
Although smartphone use may not be the actual cause of self-harm, it may put already vulnerable teenagers at further risk as it leads to increased social isolation (spending time alone scrolling through social media) and detracting from healthier behaviours such as exercise.
A more sinister reason that smartphone use may have a role to play in the rise of self-harm amongst girls is the growing online culture where teenagers encourage each other to self-harm and share photos and videos of the practice.
Social media may be normalising a behaviour that is extremely dangerous. It would be remiss to attribute all the blame to social media platforms, but it is certainly likely to be a factor, and with numbers rising it may be pertinent for parents and educators to speak openly to teenagers about self-harming behaviour.
Signs of Self-Harming
It can be hard to tell if someone has been self-harming, but often family members or friends will have a sense that something is not right. If you are worried someone you know may be self-harming then look out for any of the following signs:
Why Do People Self-Harm?
Self-harm is an extremely complicated behaviour which may be rooted in a myriad of issues. Often the individual who is self-harming may be experience emotional issues for which they require an outlet. It would be impossible to list all the possibilities but the following are some of the more common causes:
Social Problems: This encapsulates all the interpersonal difficulties an individual may be having. This could be being bullied at school, difficulties with co-workers or coming to terms with their sexuality.
Psychological problems: There is a link between self-harming and borderline personality disorder. Sometimes, those who self-harm have heard voices telling them to do so or have been disassociating (losing touch with their surroundings).
Trauma: Individuals who self-harm may often (but not always) have a history of trauma. This could be a bereavement, a history of physical or sexual abuse or any incidence which causes a high level of distress.
These issues, whether alone or combined, can lead to a build-up of negative emotions such as anger or self-hatred. The individual will often feel like they cannot speak openly of these feelings or turn for help, and so self-harm becomes an alternative method through which to express this.
What Can You Do if You Suspect That Your Child or Someone You Know is Self-Harming?
It is important not to respond in a negative manner to suspected self-harm. Don’t react in anger or disgust, or minimize the behaviour as “attention seeking”.
Ask what is going on in their life generally, and try to ascertain whether there is anything which may make him/her want to self-harm. Let them know that you are there to listen or to give any help that they may need right now.
Although it is difficult, it does not help to “confiscate” any tools that are being used to self-harm without prior agreement. The individual will find a way around this, ultimately eroding the trust you are trying to build.
It’s also important to express to them that this is a worry for you and something which needs a plan of action.
The first point of contact will often be your GP who can put you in touch with the relevant services. Schools may also have a child protection officer, or someone qualified who you may speak to.
Treatments include individual, group and family treatments and the family often have an important role to play in recovery.
The following resources may be helpful when a family member or friend is self-harming.
It is also important to remember to look after yourself when dealing with a loved one who is self-harming. This will ultimately be distressing for you too and make sure to speak to someone you trust or seek help when needed.
Mercado, M. C., Holland, K., Leemis, R. W., Stone, D. M., & Wang, J. (2017). Trends in Emergency Department Visits for Nonfatal Self-inflicted Injuries Among Youth Aged 10 to 24 Years in the United States, 2001-2015. Jama, 318(19), 1931-1933.
NHS Choices. (2015, June 04). Self-harm. Retrieved December 07, 2017, from https://www.nhs.uk/conditions/self-harm/
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.
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.
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.
For as long as most of can remember, the Canadian Paediatric Society (CPS) and American Academy of Pediatrics (AAP), among others, have held strict guidelines about kids and screen time: Little or no screen-based activities for children under two, and only one to two hours of television for older children.
But to reflect the new realities of digital media and the many forms it takes, the AAP recently revised its guidelines to relax its hard-and-fast rules and acknowledge that time on a device might now be as important as how they are using that device.
For instance, an article in the Wall Street Journal points out that sitting down to read a book with your child on an e-reader isn’t all that different than reading a hard copy. You’re still having a high-quality, interactive experience. That’s a huge improvement over parking your toddler in front of a cartoon and calling it educational.
In the right context—such as using video chat to stay in touch with an out-of-town relative—digital media can be an adequate or even equal alternative to activities we normally consider to be developmentally healthy.
Small Children Shouldn’t Be Left Alone With Technology
Children are naturally curious about what your device can do, so one danger is that you sit them down for a video chat with your sister, walk away and find they’ve navigated away from the video chat into dangerous territory.
Dangerous territory doesn’t have to mean a pornographic website. For a child old enough to read, just opening your email could raise questions about a seemingly tense exchange between you and your spouse, or a note from his or her teacher not intended for their eyes. We sometimes forget how much information is available on our devices. So remember that smartphones, computers and tablets are tools, not toys, and require supervision.
As kids get older, you’ll give them more freedom to explore, and it will likely become impossible to keep them from using the Internet outside of your presence. But for now, take advantage of the control you do have to make sure that Internet access is never unsupervised.
Not Recommended as a Pacifier
So often, we see a child grow bored, irritable or on the verge of a tantrum, only to watch a parent hand over their smartphone to calm the child. You might have even done this yourself—after all, it usually works, doesn’t it? But I don’t recommend it.
While no one wants to deal with an angry, screaming toddler—especially in public—these can be teachable moments both for you and your child. Practice taking deep breaths and talking with your child about why he’s upset and how he can express his emotions more constructively.
Be A Good Digital Role Model
“Limit your own media use,” the AAP recommends in its newsletter, AAP News, adding that “attentive parenting requires face time away from screens.” Kids naturally mimic the behaviour of the adults around them, and spending all your time glued to a tablet or smart phone is no different. If you’re repeatedly checking email during dinner, kids will pick up on that, so make sure that if the rule is “no phones at dinner,” it applies to adults at the table, too. Even at other times—including when you’re working—make a point of modelling healthy behaviour by taking breaks from the computer to go outside, stretch your legs or just have face-to-face conversations with people.
No doubt you have even more concerns and questions about older children and the Internet, from cyber bullying to privacy and safety. Those are topics for another day, but remember that if you lay the groundwork by setting healthy boundaries early on, continuing the dialogue will be easier as they get older.
Shapiro, J. The American Academy Of Pediatrics Just Changed Their Guidelines On Kids And Screen Time. (2015, Sept.). Forbes. Retrieved from
Reddy, S. Pediatricians Rethink Screen Time Policy for Children. (2015, Oct.). The Wall Street Journal. Retrieved from (http://www.wsj.com/articles/pediatricians-rethink-screen-time-policy-for-children-1444671636)