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Specific Conditions Explained

• Attention Deficit (Hyperactivity) Disorder (ADHD/ADD)
• Autistic Spectrum Disorder (ASD)
• Post Traumatic Stress Disorder (PTSD)
• Physical Health / Pain

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Attention Deficit (Hyperactivity) Disorder (ADHD/ADD)

ADHD is the most widely used term for a disorder characterised by overactivity, impulsivity, and attention difficulties. Between 1% and 5% of children are diagnosed with ADHD, and it is more common in boys than girls, and in early rather than late adolescence. ADHD is often life-long, and sometimes there are other associated problems.

• Attention: short attention span, easily distracted, does not seem to listen to instructions, easily frustrated
• Behaviour: fidgets, excitable, impulsive, takes risks, immature physical co-ordination
• Emotion: low mood, poor self-esteem, depression
• School: difficulties organising tasks, loses things, interrupts others' conversation

In order to assess a child it is important to get reliable accounts of the child's behaviour at home and at school, normally using a checklist. For example, the Conner's Rating Scales for 3-17 year olds provides questionnaires for parents and teachers to verify which problem behaviours a child displays. Sometimes other psychometric assessments are used, such as intelligence tests or language assessments, as there may also be difficulties in these areas. It is useful to get a bigger picture by getting information on past factors that could have had an impact on a child (e.g. pre-natal difficulties or low birth weight). Also factors that can make behaviour worse (e.g. stress), or factors that are helpful and protect a child (e.g. good relationships or good health).
There are various ways of helping a child or young person with ADHD.

• Education: Providing clear information about the disorder, about support groups and local resources.
• Medication: Sometimes medication is prescribed to address the biological factors involved. Side-affects can include headaches, stomach-aches and loss of appetite.
• Family Intervention: Sessions with the family can look at how to give commands, which behaviours to attend to and how to manage problem behaviours, problem solving and communication.
• School Intervention: This addresses the needs for an assistant in the classroom or additional tutoring, the type of curriculum and how to manage behaviour.
• Child Intervention: Sessions with the child can focus on self-awareness, managing anger and impulsivity, and help with academic and social skills.

To be a professional psychologist you must obtain an undergraduate degree in psychology and a post graduate qualification in one of the specialist areas of psychology. These post graduate degrees can either be at the level of a Masters or a Doctorate degree, which is why some psychologists titles are Dr and others are not. These qualifications represent a minimum of four years full time academic study but can often extend beyond seven years.

Autistic Spectrum Disorder (ASD)

ASD is characterised by problems in communicating, relating to others and repetitive behaviour. It affects around 2 to 5 children in every 10,000, and is more common in males than females. The biological factors linked to ASD are still not very well understood, so the treatment focuses on education, skill learning and behaviour management.
A child with ASD finds it difficult to guess what others are thinking or to predict behaviour. They may show little eye contact and warmth towards others. They have a strong wish to maintain routines, and may react aggressively to change. They often have very limited play skills, repeating the same patterns of behaviour. Their language development may be delayed, and they may lack creativity.

These characteristics fall into three categories:

• Social Development: Difficulties guessing what other people are thinking, absence of eye contact, and lack of reciprocity in social relationships.
• Language: Development is delayed and shows abnormalities like repeating exactly the words spoken to them, or creating their own words. There may also be little extended conversation and a lack of creativity in language use.
• Behaviour: An absence of imaginative or make-believe play. Repetitive play patterns. A desire to maintain routine and sameness. Inappropriate emotional expression.

A proportion of children with ASD also have cognitive difficulties (eg below average intelligence), and a smaller proportion develop epilepsy in late adolescence.

There are a few methods of assessment used to identify characteristics of ASD.

• Parental Interviews are used to get information on the child's early development, family history, and family relationships.
• Teacher Interviews can assess a child's behaviour during school.
• Psychometric Assessment can involve specific tests and checklists designed to assess characteristics of ASD, adaptive behaviour, intelligence, and language.
• Observations of a child's typical behaviours in the home or school.

The assessment should bring together a profile of the child's strengths and weaknesses to help decide what would benefit the child.
Characteristics of ASD are life-long, but the child and family can be helped by:

• Education: This involves giving parents and families information about ASD, including details of available help and services.
• Educational Support: Advice can be given regarding the child's educational needs, and whether they would be best placed in a special school with other children with ASD, or in main stream school with assistance.
• One to one work: Individual work with the child can look at managing challenging behaviour, self-care, educational training, and social and communication skills.

Post Traumatic Stress Disorder (PTSD)

IN CHILDREN

Post Traumatic Stress Disorder in children relates to ongoing difficulties following the experience of a catastrophic trauma, such as a natural disaster (fire, flood) or man-made disaster (boat sinking), physical or sexual abuse, serious accident, witnessing violent death of others or being a victim of crime. The experience is seen as potentially life-threatening to themselves or others and causes feelings of fear and helplessness.

• Re-experiencing the trauma: a child may experience recurrent, intrusive memories of the trauma in the form of flashbacks or dreams which invoke fear and anxiety as severe as when the trauma originally occurred.
• Avoidance: a child may avoid things that are associated with the event, such as places or people, and numbing out the painful feelings it caused. This may contribute to overall disengagement and decreased interest in activities.
• Arousal: an increase in physiological arousal, which may make a child jumpy, irritable or aggressive, impairment in concentration and academic performance at school and can disturb sleeping patterns.

There are various tools used to assess the wide range of symptoms associated with PTSD. These include 'Trauma Symptom Checklist for Children' and 'The Impact of Events Scale'. Through talking to and/or playing with the child or getting them to complete a scale it is possible to look at what the child is afraid of, both external stimuli (people, places and objects) and internal stimuli (dreams and images), and how the child reacts to them.
The treatment for PTSD is often regular long-term family or individual therapy. It aims to provide opportunities to process the trauma emotionally by providing a safe place to address the intrusive symptoms or to express the painful experiences the child has been avoiding.

To vent feelings and address the stimuli that evoke fear therapy can involve visualising the incident or symptom through creative activities (writing, drawing, drama). For example; expressing a fear from a recurrent dream in picture form and finding ways of re-working the story so that it is manageable with a positive outcome.

Therapy aims to provide a safe environment where the impact of the trauma on the child's view of the world can be addressed. This is essential because traumatic events can violate assumptions about the safety of the world and cause a child's outlook to become very negative.

Family, school and peer support are all important. Sometimes it helps to have separate sessions for parents and others if they were involved in the trauma, to allow them space to process their own memories so they can better provide support for their child. If parents were not involved in the trauma they may need educational input to help them understand the nature of PTSD.

IN ADULTS

Post Traumatic Stress Disorder describes ongoing difficulties following the experience of a catastrophic trauma, such as a natural disaster (fire, flood) or man-made disaster (boat sinking), physical or sexual abuse, serious accident, witnessing violent death of others or being a victim of crime. The experience is seen as potentially life-threatening to themselves or others and causes feelings of fear and helplessness.

• Re-experiencing the trauma: recurrent, intrusive memories of the trauma in the form of flashbacks, frightening thoughts or dreams which invoke fear and anxiety as severe as when the trauma originally occurred.
• Avoidance: avoiding things that are associated with the event, such as places or people, and numbing out the painful feelings it caused. This may contribute to overall disengagement and decreased interest in activities.
• Arousal: an increase in physiological arousal, which may cause jumpiness, irritability or aggressive outbursts, impairs concentration and can disturb sleeping patterns.

PTSD can sometimes be difficult to diagnose as it often occurs with other disorders including depression, anxiety and substance abuse.

There are various tools used to assess the wide range of symptoms associated with PTSD. These include 'The Impact of Events Scale' and the 'PENN Inventory' for PTSD. These self-report scales address the various symptoms related to PTSD including avoidance, intrusive thoughts, coping and motivation.
The treatment for PTSD is often regular long-term therapy. It aims to provide opportunities to process the trauma emotionally in a controlled environment. Sometimes medication is prescribed to deal with the effects of anxiety and depression.

To vent feelings and address the stimuli that evoke fear therapy can involve visualising the incident or symptom through creative activities (writing, drawing, drama). For example; expressing a fear from a recurrent dream in picture form and finding ways of re-working the story so that it is manageable and controlled with a positive outcome.

Therapy aims to provide a safe environment where the impact of the trauma on the view of the world can be addressed. This is essential because traumatic events can violate assumptions about the safety of the world and cause a negative outlook.

Overall therapy aims to address issues around avoiding the painful aspects of the trauma, to decrease the intrusive symptoms and to provide an environment in which the world can be reconstructed based on total life experience rather than an isolated traumatic event.

Chronic Pain

Chronic Pain is a pain that lasts beyond the usual recovery time and usually for an extended period of months. Chronic pain is not completely understood and may be associated with an illness, disability or the result of an accident. While in most cases the cause of pain is usually known, in many other cases the reasons are not clear. Approximately 1 in 10 people will suffer from chronic pain at some point in their life and it is most common in middle age. Chronic pain can disrupt sleep patterns, reduce energy levels, impact on our social, work and family activities and can be the cause of significant anxiety or depression especially when the legitimacy of the pain is questioned.
Medication is beneficial in managing chronic pain, but careful consideration should be given to the use of medication over an extended period due to the potential problems with long term side effects. Psychologists use several different techniques to help people with chronic pain to improve the quality of their lives. Specific techniques include support, education, techniques for relaxation and stress management, problem solving, goal setting and assertiveness.
Psychologists may use cognitive approaches to help the chronic pain suffer develop a state of mind that is better able to manage a life with pain. Psychologists can also help sufferers plan their lives in ways that would provide more control without increasing the discomfort of pain. Psychologists are also able to assess a persons interests, aptitudes and abilities and can advise changes in the way they perform their activities to better manage their pain. Psychologists are also able to help treat the anxiety and depression that often accompanies chronic pain.
Psychological techniques work. The psychological approach to pain management has been proven to help people improve the quality of their lives. People report to be more active, feel more in control of their lives and suffer less anxiety and depression, and even though the pain continues people report that their lives are more manageable.

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