Treatment Issues

Applewood Academy has provided a short list of common mental health issues a child might experience in their lifetime. Mental health issues take many forms and are not limited to the list made available here.

This list includes, but is not limited to: Depression, Anxiety, Attention Deficit Hyperactivity Disorder (ADHD), Post-Traumatic Stress Disorder (PTSD), Learning Disability (LD), and Eating Disorder.

If the information you are looking for does not appear here, or you have questions, please do not hesitate to contact us and the staff at Applewood will put you in touch with the answers you need.

We look forward to hearing from you.

Depression: Definition

Depression is a medical condition characterized by long-lasting feelings of intense sadness and hopelessness coupled with additional mental and physical changes. The condition often affects a person’s personal, social, and/or professional life.

Depression: Who it Affects

About one in five women and one in ten men will suffer from depression at some point in life. Depression in children and adolescents occurs less commonly than in adults. Almost 1.5 million Canadians have serious depression at any given time, but less than one third of these people seek medical help.

Depression: Different Types

There are several different types of depression, and the diagnosis is mostly determined by the nature and intensity of the mental and physical symptoms, the duration of the symptoms, and the specific cause of the symptoms, if that is known.

Clinical depression (or major depressive disorder, MDD)
MDD is the most serious type of depression, in terms of the number and severity of symptoms, but there are significant individual differences in the symptoms and severity. People affected with major depression may not have suicidal tendencies, and may never have received medical treatment. The person’s interest and pleasure in many activities, energy levels, and eating and sleeping patterns are usually altered.
Dysthymia (or minor depression)
Dysthymia refers to a low-to-moderate level of depression that persists for at least two years, and often longer. While the occurrence of symptoms is not as frequent as in major depression, dysthymia can result in as much disability as major depression. It is often not recognized that dysthymia is a medical condition that responds equally effectively to the same treatments as major depression. Some people with dysthymia develop a major depression at some time during the course of their depression.
Bipolar depression (or manic depression)
Bipolar includes both high and low mood swings, and a variety of other significant symptoms not present in other types of depression.
Seasonal Affective Disorder (SAD)
SAD is a sub-type of depression that regularly occurs at the same time of year (most often in the fall or winter months in North America).
Post-partum depression
Post-partum begins a few weeks after giving birth and is a sub-type of depression. Post-partum depression is different from the temporary state known as the “baby blues” that often happens 24 to 72 hours after a woman gives birth. The temporary state of “baby blues” is caused by the hormonal changes that occur during pregnancy and after giving birth and typically resolves in less than a week.

Depression: Varying Symptoms
and Degree of Intensity

Although we all feel sad sometimes, clinical (major) depression is diagnosed when a person experiences depressed mood (sadness) and/or loss of interest or pleasure in daily activities for at least two weeks, plus five of the following symptoms:

  • Changes in appetite or weight
  • Slowed reactions
  • Lack of motivation or energy
  • Insomnia (trouble sleeping) or chronic oversleeping
  • Noticeable changes in activity level (agitated or slowed down)
  • Feelings of worthlessness or guilt
  • Difficulty concentrating or making decisions
  • Recurring thoughts of death or suicide

Clinical depression may vary in its severity, and in its extreme forms (i.e., thoughts of suicide) can be life threatening and require immediate medical attention.

Symptoms of other forms of depression, although generally milder, may still negatively affect a person’s daily activities and quality of life.

Depression: Treatment

Medication:
Most types of depression respond to either an antidepressant medication or psychotherapy. Sometimes people with depression are unaware that medications can help them, or they are at first hesitant to take antidepressant medications to manage their condition. However there are many different medications available today to help treat depression. You and your doctor can work together to decide what medication is best for you.Medications used to treat depression begin to work after 2 to 4 weeks of treatment, although improvements in some symptoms may be seen within the first few weeks. In some situations, more than one medication will need to be tried until the most appropriate one is found for an individual. All medications, including antidepressants, can have side effects. Your doctor and pharmacist should explain common side effects to you and help you to manage them should they occur.

Psychotherapy:
Psychotherapy can be an important part of managing depression. Psychiatrists, psychologists, and some family doctors are trained to help people recognize and overcome the kind of thinking that causes depression. Support groups, friends, and family can also help.
Other Treatments:
In more severe cases, Electro Convulsive Therapy (ECT) is used, but is generally reserved for those who do not respond to medications.Light therapy (or “photo therapy,” which involves controlled exposure to artificial sunlight) can help some people overcome symptoms associated with Seasonal Affective Disorder.

Physical activity and sports can improve depression by helping to relieve anxiety, increase appetite, aid sleep, and improve mood and self-esteem. Exercise also increases the body’s production of endorphins, a natural mood-elevating hormone.

An active lifestyle, supportive family and friends, and a positive outlook can go a long way in coping with depression.

Anxiety: Definition

Everyone feels worried, tense, or anxious at times – the butterflies in the stomach before making a speech, the pounding heart after a near-miss with the car, the tension felt waiting for the results of a test. Anxiety or fear is a normal response to a threatening situation. Some level of anxiety can be helpful. Anxiety can help people deal with a threatening situation, study harder for an exam, and perform better in sports.

When anxiety becomes persistent and interferes with the ability to cope and disrupts daily life, the person may have an anxiety disorder. Anxiety disorders are illnesses that may make people feel anxious most of the time, without an obvious reason. People may get occasional but intense moments of anxiety that immobilize them.

Anxiety: Varying Symptoms
and Degree of Intensity

The common symptoms of anxiety disorders can include:

  • Inability to relax
  • Chronic and exaggerated worry and tension
  • Trouble falling asleep or staying asleep
  • Trembling
  • Headaches
  • Irritability
  • Sweating
  • Muscle tension
  • Hot flashes
  • Startling easily
  • Feeling tired
  • Feeling a lump in your throat
  • Trouble concentrating
  • Recurring unpleasant thoughts
  • Repetitive habits (e.g., washing hands)
  • Chest pain or discomfort
  • Choking
  • Dizziness or faintness (actual fainting is extremely rare)
  • Fear of dying
  • Fear of going crazy or losing control
  • Feelings of unreality, strangeness, or detachment from the environment
  • Flushes or chills
  • Nausea or diarrhea
  • Numbness or tingling sensations
  • Palpitations (“fluttering” in the chest) or accelerated heart rate
  • Shortness of breath or smothering sensation.

Complications of anxiety disorders are mostly linked to feelings of inadequacy or depression, because people with these conditions know their behavior is irrational and damaging to their lives. Depression is particularly common with obsessive-compulsive disorder. People with social phobia often rely on alcohol to reduce their inhibitions. Unfortunately, this can lead to dependency.

Anxiety: Treatment

Anxiety disorders are the most common of all mental disorders. Many people misunderstand these disorders and think they can get over them on their own (i.e., without treatment). This is usually not the case. Fortunately, there are many treatments available today to help.

Doctors use a two-pronged approach to manage anxiety disorders, based on the belief that the condition is part physical and part psychological in nature.

Medication:
There are medications that will help control anxiety, including some types of antidepressants (the serotonin reuptake antidepressants, in particular) and anti-anxiety agents (benzodiazepines). For a small number of the population, benzodiazepines can be habit-forming.
Psychotherapy:
An alternative treatment is psychological interventions, including specific effective psychotherapies, such as, cognitive therapy or exposure therapy.With cognitive therapy, irrational fears are challenged in a logical fashion. Exposure therapy involves confronting the object of the fear. This may need to be done slowly. Exposure therapy works best for specific phobias (like fear of spiders or flying) that often don’t respond to medications.

Lifestyle Modification:
  • Determining the cause of anxiety and confronting it. (For example, if money is a worry, draw up a budget.)
  • Reducing caffeine intake
  • Reducing alcohol intake
  • Reducing or stopping smoking
  • Using relaxation techniques
  • Exercising regularly
  • Gaining perspective by talking about your feelings with someone close or a professional counselor.

Attention Deficit
Hyperactivity Disorder (ADHD): Definition

ADHD refers to a family of related chronic neurobiological disorders that interfere with an individual’s capacity to regulate activity level (hyperactivity), inhibit behavior (impulsivity), and attend to tasks (inattention) in developmentally appropriate ways.

The core symptoms of ADHD include an inability to sustain attention and concentration, developmentally inappropriate levels of activity, distractibility, and impulsivity. Children with ADHD have functional impairment across multiple settings including home, school, and peer relationships.

Attention Deficit
Hyperactivity Disorder (ADHD): Common Signs

ADHD refers to a family of related chronic neurobiological disorders that interfere with an individual’s capacity to regulate activity level (hyperactivity), inhibit behavior (impulsivity), and attend to tasks (inattention) in developmentally appropriate ways.

A. Inattentive Symptoms
  • Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
  • Often has difficulty sustaining attention in tasks or play activities
  • Often does not seem to listen when spoken to directly
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the work place
  • Often has difficulty organizing tasks or activities
  • Often avoids or is reluctant to engage in tasks that require sustained mental effort
  • Often loses things necessary for tasks or activities
  • Is often easily distracted by extraneous stimuli
  • Is often forgetful in daily activities
B. Hyperactive/Impulsive Symptoms
  • Often fidgets with hands or squirms in seat
  • Often leaves seat in classroom or in other situations in which remaining seated is expected
  • Often runs about or climbs excessively in which it is inappropriate
  • Often has difficulty playing or engaging in leisure activities quietly
  • Is often “on the go” or often acts as if “driven by a motor”
  • Often talks excessively
  • Often blurts out answers before questions have been completed
  • Often has difficulty waiting turn
  • Often interrupts or intrudes on others (butts into conversations or games)

Attention Deficit
Hyperactivity Disorder (ADHD): Treatment

Attention Deficit Hyperactivity Disorder affects each client differently and there are several different treatment methods; therefore, each client’s treatment will be different.

Medication:
There are several different types of medication that can help to control ADHD. Some medicines used to assist ADHD are called psycho stimulants. Some of the more common medications are: Concerta, Ritalin, Dexedrine, and Adderall. Although these medicines have a stimulating effect in most people, they have a calming effect in children and adults who have ADHD.
Psychotherapy:
The treatment of ADHD through different types of Psychotherapy can always be of benefit, not only to the client, but also to the family living with the client. Family counseling keeps parents informed and also shows them ways they can work with the client at home. Communication and interpersonal relationships within the family can be supported and increased with this type of therapy. Individual counseling helps clients with ADHD to better understand their behavior and to learn coping skills.
Lifestyle Modification:
  • Establish rules, routines, and schedules for the home to provide general structure.
  • Plan specific scheduling and routines with your child for everyday tasks.
  • Establish consequences.
  • Organize your child’s room so things are easy to find and easy to put away.
  • Utilize a quite space for doing homework.
  • Use calendars and give each family member a different color.
  • Restrict TV use while trying to accomplish other tasks.
  • Play different types of music in the home to assist in increased productivity.
  • Create a space where physical activity is accepted in the home and make sure enough time gets spent outside doing such physical activities.
  • Purchase items that your child can construct and destruct with their hands.
School/Academic Modifications:
  • Have your child sit in the front of the class.
  • Teacher needs to establish good eye contact while talking to child.
  • Teacher can use an agreed upon signal for your child to come back to focus.
  • Teacher can use certain code words to bring back focus, such as, “Remember this”.
  • Long instructions should be avoided and broken into smaller chunks.
  • Check and recheck for comprehension.
  • Teacher can use the child as a helper to allow them more mobility within the classroom.
  • For issues with handwriting, explore the use of a computer, graph paper for math, and possibly carbon copies of class notes from a peer.
  • For issues with math problems, explore the use of a calculator and reducing the number of questions required to complete.

Post-Traumatic Stress Disorder (PTSD): Definition

Post-traumatic Stress Disorder, or PTSD, is a psychiatric disorder that can occur following the experience or witnessing of life threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape.

Post-Traumatic Stress Disorder (PTSD): Symptoms

People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person’s daily life.

PTSD is marked by clear biological changes, as well as, psychological symptoms. PTSD is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. The disorder is also associated with impairment of the person’s ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting.

Post-Traumatic Stress Disorder
(PTSD): Treatment Plan

Treatment for PTSD typically begins with a detailed evaluation, and development of a treatment plan that meets the unique needs of the survivor.

  1. Generally, PTSD-specific-treatment is begun only when the survivor is safely removed from a crisis situation. For instance, if currently exposed to trauma (such as, ongoing domestic or community violence, abuse, or homelessness), severely depressed or suicidal, experiencing extreme panic or disorganized thinking, or in need of drug or alcohol detoxification, addressing these crisis problems becomes part of the first treatment phase.
  2. Educating trauma survivors and their families about how persons get PTSD, how PTSD affects survivors and their loved ones, and other problems that commonly come along with PTSD symptoms. Understanding that PTSD is a medically recognized anxiety disorder that occurs in normal individuals under extremely stressful conditions is essential for effective treatment.
  3. Exposure to the event, via imagery, allows the survivor to re-experience the event in a safe, controlled environment, while also carefully examining their reactions and beliefs in relation to that event.
  4. Examining and resolving strong feelings such as anger, shame, or guilt, which are common among survivors of trauma.
  5. Teaching the survivor to cope with post-traumatic memories, reminders, reactions, and feelings without becoming overwhelmed or emotionally numb. Trauma memories usually do not go away entirely as a result of therapy, but become manageable with new coping skills.

Post-Traumatic Stress Disorder
(PTSD): Therapeutic Approaches Commonly Used

Cognitive-behavioral therapy (CBT): Definition
CBT involves working with cognitions to change emotions, thoughts, and behaviors.Exposure therapy, is one form of CBT unique to trauma treatment which uses careful, repeated, detailed imagining of the trauma (exposure) in a safe, controlled context, to help the survivor face and gain control of the fear and distress that was overwhelming in the trauma. In some cases, trauma memories or reminders can be confronted all at once (“flooding”). For other individuals or traumas it is preferable to work gradually up to the most severe trauma by using relaxation techniques and either starting with less upsetting life stresses or by taking the trauma one piece at a time (“desensitization”).

Coping Skills are learned for anxiety (such as breathing retraining or biofeedback) and negative thoughts (“cognitive restructuring”), managing anger, preparing for stress reactions (“stress inoculation”), handling future trauma symptoms, as well as addressing urges to use alcohol or drugs when they occur (“relapse prevention”), and communicating and relating effectively with people (“social skills” or marital therapy).

Pharmacotherapy (medication):
Medication can reduce the anxiety, depression, and insomnia often experienced with PTSD, and in some cases may help relieve the distress and emotional numbness caused by trauma memories. Several kinds of antidepressant drugs have achieved improvement in most (but not all) clinical trials, and some other classes of drugs have shown promise. At this time no particular drug has emerged as a definitive treatment for PTSD, although medication is clearly useful for the symptom relief that makes it possible for survivors to participate in psychotherapy.

Learning Disability (LD): Definition

LD is a disorder that affects people’s ability to either interpret what they see and hear or to link information from different parts of the brain. These limitations can show up in many ways: as specific difficulties with spoken and written language, coordination, self-control, or attention. Such difficulties extend to schoolwork and can impede learning to read, write, or do math.

Learning Disability (LD): Treatment Plan

Individuals with learning disabilities are capable of academic learning, relationship building and employment success, with the right instruction and guidance.

Usually a parent feels that their child is not achieving to their full potential and/or that their educational standing could benefit from:

  • Increased individual or small group instruction
  • Additional time allowances for written assignments
  • A different instructional style
  • Better teacher awareness of his/her strengths
  • The right behavioral management plan

These benefits could be a reality through professionally identifying learning styles and proper identification of behavioral and emotional factors. A child’s self-confidence and perception of school can grow once this is accomplished.

Learning Disability (LD):
Common Signs for Preschool Age

  • Pronunciation difficulties
  • Slow vocabulary growth
  • Difficulty rhyming words
  • Trouble learning numbers, alphabet, colors, shapes
  • Extreme restlessness, distractibility or poor persistence
  • Reluctance to draw or trace
  • Weak social skills.

Learning Disability (LD):
Common Signs for Grades K-4

  • Slow to learn the connection between letters and sounds
  • Makes consistent reading and spelling errors including letter reversals (b/d), inversions (m/w), transpositions (felt/left), and substitutions (house/home)
  • Slow recall of facts
  • Confuses arithmetic signs (+, -, x, /, =)
  • Poor planning skills & impulsivity
  • Unstable pencil grip
  • Trouble learning about time

Learning Disability: Common Signs for Grades 5-8

  • Reverse letter sequences (soiled/solid, left/felt)
  • Slow to learn prefixes, suffixes, root words, and other spelling strategies
  • Avoids reading aloud and writing compositions
  • Trouble with word problems
  • Slow or poor recall of facts
  • Extremely messy handwriting; awkward pencil grip
  • Inconsistent performance between environments
  • Difficulty making friends
  • Poor reader of body language and facial expressions

Learning Disability: Common Signs for Grades 9 and Beyond

  • Avoids reading and writing tasks
  • Spelling difficulties
  • Trouble summarizing
  • Weak memory skills
  • Slow work performance
  • Poor grasp of abstract concepts
  • Misreads information

Eating Disorder: Definition

Eating disorders are not just about food but can be an outward sign of deep psychological and emotional turmoil. Clients have a serious disturbance in their eating behavior and an overwhelming, often irrational, concern over their body size and weight. There are three common Eating Disorders: Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. This group of disorders is characterized by physiological and/or psychological disturbances in appetite or food intake.

Eating Disorder: Treatment Plan

An Eating Disorder treatment plan is a multi-disciplinary approach and the treatment team would assess each client individually. The treatment team may consist of a pediatrician, psychiatrist, psychologist, social worker and nutritionist, among possible others. The client’s treatment plan is developed based on individual needs.

Family Therapy:
A family-based approach is fostered with family/parental therapy sessions, as well as, support groups for parents. Psycho-educational sessions teach parents and clients about eating disorders, how to treat them and how to recognize signs of relapse. Families learn coping strategies to help them deal more successfully with their eating disordered child.
Psychotherapy / Counseling:
Dependent on treatment needs, individual counseling is offered to provide an opportunity for clients to explore the links between their thoughts, feelings and symptoms. Strategies taught within groups sessions are reinforced within the individual sessions. Any coexisting psychological difficulties are integrated into the client’s treatment plan.
Pharmacology:
If needed, doctors sometimes prescribe antidepressant medications to treat eating disorders with coexisting psychological difficulties of depression and anxiety. Commonly, doctors prescribe selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). At this time no particular drug has emerged as a definitive treatment for Eating Disorders, although medication is clearly useful for the symptom relief that makes it possible for clients to participate in psychotherapy.