ADHD and your child

I recently presented on ADHD across the age spectrum at the Anxiety and Depression Association of America.

Here are some neat facts and figures from the presentation I hope you find helpful

  1. ADHD is the actual diagnosis-there is no such diagnosis as “ADD”1.
    1. Diagnostic criteria
      1. A child or adolescent needs to meet six out of nine possible inattentive symptoms and/or six out of nine possible hyperactivity/impulsivity symptoms.
      2. ADHD has three iterations: (1) predominantly inattentive, (2) predominantly hyperactive/impulsive, and (3) combined, based on how many symptoms in each diagnostic category an individual meets.
        1. 6 or more symptoms of inattention:
          1. Poor attention to detail poor sustained attention
          2. Poor task completion poor organization
          3. Procrastination distractibility
          4. Forgetfulness
      3. 6 or more symptoms of hyperactivity/impulsivity:
        • Behaving as “driven by a motor”
        • Excessive talking interrupting
        • Difficulty waiting one’s turn
        • Fidgeting leaving one’s seat
  1. 3-5% of child and adolescent populations have ADHD, some studies reporting as high as 11% (Michielsen et al., 2013).
  2. 10% of preschool children (ages 2-5) will have pre-pathological ADHD behaviors that begin to emerge.
  3. Highest rate of comorbidity is with externalizing disorders  (conduct disorder and oppositional defiant disorder) and secondarily, Depression and generalized anxiety were among the most comorbid internalizing disorders.
  4. 20-30% of children (<18 years of age) will have a diagnosable, comorbid anxiety disorder with ADHD.
  5. CBT treatment has better effectiveness rates than stimulant medication (longer-lasting).

More on this topic in the next blog!


Spring time stress and kids

Right about now, it has been a few months since your child has been on a significant break from school. In my practice, I have been witnessing children and adolescents experience high levels of stress before spring break.  In the time between Christmas/winter break and spring break parents can enact several strategies to decrease the stress in their child (and therefore increase their academic performance and emotional stabilization):

  1. Give them a break as needed (e.g., 1x per 2 months). If they need to take a half day off or a full day of school, it is ok to allow them to have a “mental health day” (although make sure that it is not an unhealthy trend that is beginning).
  2. Encourage them to participate in behavioral activation activities (i.e.,  combining pleasurable activities with ones that get them up and physically moving).
  3. Monitor sleep and electronic use. Too much electronic use can disrupt sleep and can negatively affect how your child is regulating their emotions. Also monitor how they are currently sleeping, are they getting enough sleep? (should be 7-9 hours per night).

Try these and see if it makes a difference in your child’s and your family’s quality of life!

New parent anxiety

There is a lot of research out there regarding postpartum depression, but a lot of parents do not know about the postpartum clinical anxiety.

Some quick facts and figures:

  1. Approximately 75% of women experience postpartum blues (looks like clinical depression, but self-resolves within 2 weeks post birth) after birth.
  2. Of those women, around 20% will go on to experience postpartum depression.
  3. 16% will go on to experience postpartum anxiety (although you do not have to experience postpartum blues beforehand)
  4. Only 20% of OBGYNS screen for postpartum anxiety (which, although related, is different from assessment for postpartum depression)
  5. The majority of OBGYNs first line of treatment are SSRIs, antidepressants, which take 4-6 weeks to BEGIN working
  6. A small majority of OBGYNS recommend CBT (cognitive-behavioral therapy) treatment
    1. CBT treatment for postpartum anxiety and depression is evidence-based and begins to work right away. The effects will also maintain post SSRI treatment completion.

Great sites for finding a CBT therapist, especially ones that can do home visits in the postpartum period are and

And if you are in the DC area, our center also does this type of treatment, with home visits (

Remember that a happy mommy and daddy means a happy baby!

How to know when to get help for your child

The medical field, including the mental health field, typically addresses curative problems as opposed to preventative. Curative refers to problems only after they have reached a diagnosable clinical level. Oftentimes, people wait for their problems to reach the clinic/curative level before coming in for treatment. This can result in longer, more intensive and expensive treatment. What can you look out for when it comes to knowing when to come in?

  1. Has your child’s problem become too frequent (i.e., more than 2x a week)?
  2. Has your child’s problem become severe (i.e., even if not occurring frequently, when it comes, does it come with a very high intensity)?
  3. Do you find your child’s self-report is inconsistent with the school’s report?
  4. Does your child ask for outside help?
  5. Pay attention to your parental intuition. Clinical psychologists/mental health providers may be the experts in anxiety, depression and behavior, but you are the expert in your child. If your alarms go off (even in the slightest bit), it’s time to pay attention now, and not wait until the alarm is glaring.
  6. Has school mentioned more than 1x that your child demonstrates anxious, depressed or behavioral problems?
  7. Has school asked for a meeting with you about your child’s behavior or anxiety/depression?

If you answer “yes” to any of these questions, it may be time to seek professional help. Remember that if you get help sooner rather than later you can reduce expense, duration, and intensity of treatment.

Recommendations on how to take care of yourselves as parents this holiday season

  1. Take 30 minutes 2-3x a week to “refill your energy cup.” With all the small stressors in life, especially during the holiday season, our “cups” can become depleted. Here are some activities that can help replenish your mental health energy resources (self-care strategies that combine behaviorally activating/getting up and moving):
    1. Going for a walk (and listening to music)
    2. Going to an enjoyable volunteer event
    3. Going shopping (but only if it’s enjoyable)
    4. Taking a pleasurable exercise class
    5. Cooking
    6. Playing a family game
    7. Fill in the blank—just make sure it combines you becoming physically activated with an enjoyable activity
  2. Quiet your mind
    1. Plan out mindfulness activities, including mindful eating, or scanning your body for stress and employing strategies such as progressive muscle relaxation or diaphragmatic breathing can be very helpful
  3. Saying “No”
    1. The holidays are a time where we can say “yes” to everything. It is important to know your limits. Don’t overextend!
  4. Knowing when to ask for Help
    1. Don’t be afraid to ask your kids for help, in addition to friends and family. Kids are more than capable of holding their own, we just have to give them that opportunity.

To all my parents reading this blog. You are amazing!!! Remember you are just as important to prioritize! Happy holidays!

Reinforcements and Holiday Presents for Your Kids

There are very few things that parents actually owe their children. These are shelter, education, nutrition, and healthcare. However, in today’s society, a large majority of children and teenagers have the expectations that they are owed the “add-ons” in life. These things can include (but are not limited to) toys, video games, cell phones, screen access, you-tube/Netflix access, etc.

Along with the approaching end of the school semester (prior to winter break), comes a lot of stress, and with stress comes dysfunctional behavior. In young children, this can mean not sleeping well at night, temper tantrums, bad grades, etc. In teenagers, this can translate to bad language, not completing chores, neglecting homework or other home responsibilities.

Sometimes, but not all the time, parents want to solve the experience of stress in their children with more “extras/add-ons.” This not only reinforces/increases the expectation of “add-ons” when they are stressed, but more importantly, does not allow for a child to internally cope and manage their emotions.

At our practice, we like to think of “add-ons” as reinforcements, specifically the use of these being tied to prosocial behaviors (e.g., expressing your needs verbally without throwing a temper tantrum). Feel free to use the reinforcements, but only when your child has demonstrated the ability to internally cope with their emotions.

Some tips for internal coping mechanisms (i.e., things kids can do and say):

Anxiety is a temporary state and cannot last forever

I have handled difficult situations before and I can do it again

How can I go about solving this problem and can I ask for help?

Don’t forget to breathe and be mindful of where I am, and what I am experiencing without making a judgment on it

Pre-and post-natal depression

This is an article that our director, Dr. Johanna Kaplan, contributed to the authors at Brit and Co.  Please take a read,  as the writer of the article does a very good job capturing the personal experience of pre and post-natal depression/anxiety and getting a professional’s take on clinical assessment and treatment.

The Surprising Relationship Between Prenatal and Postpartum Mental Health

What is real Cognitive-Behavior Therapy (CBT)?

At our center, we practice Cognitive-Behavioral therapy, otherwise known as “CBT.”

CBT is an evidence-based treatment employed for the treatment of anxiety, depressive, and obsessive-compulsive spectrum disorders. It involves examining and challenging how our thought processes can contribute to and maintain feelings of anxiety and depression, how feelings of isolation and inactive interests can increase feelings of depression, and it focuses on how we can gradually confront the places, situations, or people that we fear so our fear reduces in the present and future.

Currently, only a small percentage (some studies estimate around 15%) of clinical psychologists are trained in exposure therapy. Exposure therapy is the most evidence-based treatment for anxiety. Exposure therapy comes in two iterations: gradual and flooding. It involves either a graduated, systematic approach to confronting one’s fears or facing the main fear directly. Most patients opt for the gradual approach, but both approaches are effective.

For example, a gradual approach with a specific phobia such as a snake phobia would start by looking at pictures of snakes, then movies of snakes, being in the vicinity of a snake, and finally touching and interacting with a snake. Exposure to these places, situations, people, etc. are accompanied with specific coping skills and allow for habituation (getting used to the anxiety at each stage) to be achieved.

Exposure therapy has effectiveness rates between 60 and 90%. CBT therapists also work to give the skills in their own repertoire to patients with the hope of empowering them the rest of their lives.

For more information, take a look at an article I co-authored on Exposure Therapy: