Topics addressing concerns related to children and adolescents, their education and upbringing will be included on this page.

Is Problem Video Game Playing Related to Symptoms of Psychopathology in Adolescents?

In a recently presented study at the American Academy of Child and Adolescent Psychiatry Annual Meeting, David R. Topor PhD, Fellow in Psychiatry at the Deptartment of Psychiatry  of Warren Alpert Medical School of Brown University in Providence, Rhode Island, presented interesting information, from reaserch he authored:

234 adolescents admitted to an inpatient psychiatric unit with various diagnoses including Bipolar Disorder, PTSD, ADHD, mood disorders and psychotic disorders were asked to complete a questionnaire about video game usage as well as several self-report measures for Depression/Hopelessness, Anxiety, Suicide Probabiliy, Trauma Symptom and Self-Perception Profile and State-Trait Anger Scales.

Results showed : Both male and female adolescents who played video games due to reinforcing effects experienced decreased perceived romantic appeal. Females also experienced increased symptoms of depression, anxiety and dissociation. Adolescents who played video games and who engaged in behaviors that have a negative social impact, such as lying and stealing, due to their video game use, also had symptoms of dissociation. Dr. Topor says "Given how prevalent video game use is among adolescents, clinicians should be cognizant of video game use among their adolescent patients and the reason(s) for potentially excessive video game use and should also assess for social, emotional or academic functioning that may be adversely affected by video game use."

Please keep this information in mind as parents, as it is advisable for you to curb uncontrolled use of video-games that may affect academic performance or social involvement in age-appropriate activities that foster further development.

Article authored by Karen L. Spittler and Published in Neuropsychiatry Reviews, December 2008, Volume 9, Number 12

Could your snoring be a sign of something serious?

A combination of the following symptom(s) and risk factor(s) are particularly suggestive of Sleep Apnea; mention any of these to your doctor:

1) Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?

2) Do you often feel tired, fatigued or sleepy during the daytime?

3) Has anyone observed you stop breathing during your sleep?

4) Do you have or are you being treated for high blood pressure?

5) Is your neck circumference greater than 15.75 inches?

Dr. Bernal has started to suggest using "Deplin", that is L-methylfolate, as an adjunct to treat depression. Is this really of any value?

 This substance is a water soluble B vitamin (B9), considered one of the 13 essential vitamins. And, the reality is that, there are numerous functions at the Central Nervous System level for L-methylfolate.The primary  function of folate is the transfer of methyl and formyl groups at molecular level, and is therefore essential for cell growth and reproduction, breakdown and utilization of proteins, formation of nucleic acids, red blood cell maturation and various CNS reactions. 

 L-methylfolate is known to act as an important regulator of a critical cofactor needed for neurotransmitter synthesis (tetrahydrobiopterin or BH 4). The enzymes requiring BH4 as a cofactor are those involved in synthesis of Dopamine and Norepinephrine.

DEPRESSION IS WELL KNOWN TO  INVOLVE A DYSREGULATION OF SEROTONIN, NOREPINEPHRINE AND DOPAMINE.

So, in conclusion, when Dr. Bernal suggests this, he is actually trying to enhance the physiologic processes already expected to happen in your body. This may actually help your depression !!!

Dr. Bernal has suggested that my child's lack of capacity to understand idiomatic expressions, humor and sarcasm constitutes one marker for an Autistic Spectrum Disorder (ASD). Why is that?

The understanding of such items in language and situations involves the understanding of the "true meaning" of  "meaning behind the meaning" of situations/statements. This IS NOT a skill that is readily available to children with ASD.

Happe's Strange Stories were designed to evaluate for such skill: This assesses the ability to interpret a nonliteral statement. Relative to normal controls who were IQ and age-matched, individuals with autism or Asperger syndrome performed less well on the task, while performing normally on a non-mentalistic control task. Individuals with autism or Asperger syndrome could provide mental state answers, but had difficulty in providing contextually appropriate mental state answers. Rather, their answers tended to concentrate on the utterance in isolation. Although the majority of both clinical groups provided context-inappropriate interpretations, the autism group had the greater difficulty. 

A Selection of Strange Stories - Presentation Transcript

1. A selection of ‘Strange Stories’ Adapted from: Kaland et. al (2005) The Strange Stories test. A replication study of children and adolescents with Asperger syndrome. and Jolliffe & Baron-Cohen (1999) The Strange Stories Test: A Replication with High-Functioning Adults with Autism or Asperger Syndrome.
2. The Mentalistic Stories
3. Story Type: Pretend Katie and Emma are playing in the house. Emma picks up a banana from the fruit bowl and holds it up to her ear. She says to Katie, “Look! This banana is a telephone!” – Is it true what Emma says? • Yes/No/Don’t know – Why does Emma say this?
4. Story Type: Joke Today James is going to Claire’s house for the first time. He is going over for tea, and he is looking forward to seeing Claire’s dog, which she talks about all time. James likes dogs very much. When James arrives at Claire’s house Claire runs to open the door, and her dog jumps up to greet James. Claire’s dog is huge; it’s almost as big as James! When James sees Claire’s huge dog he says, “Claire, you haven’t got a dog at all. You’ve got an elephant!” – Is it true, what James says? • Yes/No/Don’t know – Why does he say this?
5. Story Type: White Lie One day Aunt Jane came to visit Peter. Now Peter loves his aunt very much, but today she is wearing a new hat; a new hat, which Peter thinks is very ugly indeed. Peter thinks his aunt looks silly in it, and much nicer in her old hat. But when Aunt Jane asks Peter, “How do you like my new hat”, Peter says, “Oh, its very nice”. – Was it true, what Peter said? • Yes/No/Don’t know – Why did he say it?
6. Story Type: Figure of Speech Emma has a cough. All through lunch she coughs and coughs. Father says: “Poor Emma, you must have a frog in your throat!” – Is it true, what Father says to Emma? • Yes/No/Don’t know – Why does he say that?
7. Story Type: Irony Ann’s mother has spent a long time cooking Ann’s favorite meal; fish and chips. But when she brings it to Ann, she is watching TV, and she doesn’t even look up, or say thank you. Ann’s mother is cross and says, “Well, that’s very nice, isn’t it! That is what I call politeness!” – Is it true what Ann’s mother says? • Yes/No/Don’t know – Why does Ann’s mother say this?
8. Story Type: Misunderstanding Late one night old Mrs. Peabody is walking home. She doesn’t like walking alone in the dark because she is always afraid that someone will attack her and rob her. She is really very nervous! Suddenly, out of the shadow comes a man. He wants to ask Mrs. Peabody what time it is, so he walks towards her. When Mrs. Peabody sees the man coming towards her, she starts to tremble and says, “Take my purse, just don’t hurt me”. – Was the man surprised at what Mrs. Peabody said? • Yes/No/Don’t know – Why did she say that, when he only wanted to ask her the time?
9. Story Type: Forgetting Yvonne is playing in the garden with her doll. She leaves her doll in the garden when her mother calls her to come in for lunch. While they are having lunch, it starts to rain. Yvonne’s mother asks Yvonne: “Did you leave your doll in the garden?” Yvonne answers: “No, I brought her in with me”. – Is it true, what Yvonne says? • Yes/No/Don’t know – Why does Yvonne say this?
10. The Physical Stories
11. Army Two enemy powers have been at war for a very long time. Each army has won several battles, but now the outcome could go either way. The forces are equally matched. However, the Blue army is stronger than the Yellow army in foot soldiers and artillery. But the Yellow army is stronger than the Blue army in air power. On the day of the final battle, which will decide the outcome of the war, there is a heavy fog over the mountains where the fighting is about to occur. Low-lying clouds hang above the soldiers. By the end of the day the Blue army have won. – Why did the Blue army win?
12. Glasses Sarah is very long-sighted. She has only one pair of glasses, which she keeps losing. Today she has lost her glasses again and she needs to find them. She had them yesterday evening when she looked up the television programmes. She must have left them somewhere that she has been today. She asks Ted to find her glasses. She tells him that today she went to her regular early morning keep fit class, then to the post office, and last to the flower shop. Ted goes straight to the post office. – Why is the post office the most likely place to look?

Jolliffe, T., and Baron-Cohen, S., (1999) The Strange Stories Test: A Replication with High-Functioning Adults with Autism or Asperger Syndrome. Journal of Autism and Developmental Disorders, 29(5): 395-406 Kaland, N., Moller-Nielsen, A., Smith, L., Mortensen, E.L., Callesen, K., and Gottlieb, D., (2005) The Strange Stories test. A replication study of children and adolescents with Asperger syndrome. European Child and Adolescent Psychiatry, 14(2): 73-82. WWW.PSYCHBLOG.CO.UK

Should my child have an ECG before starting stimulant medication?

A joint advisory statement from the American Academy of Pediatrics (AAP) and the American Heart Association(AHA), endorsed by the American Academy of Child and Adolescent Psychiatry and the American College of Cardiology has suggested that it is important to assess for heart conditions in children who will be receiving medication for treatment of ADHD. A patient and family health history as well as a physical examination, with focus on cardiovascular disease risk factors, are recommended before pharmacotherapy begins.

In addition, "it is also reasonable for a physician to consider obtaining an ECG as part of evaluation of children being considered for stimulant drug therapy, but this should be at the physician's judgment, and it is not mandatory to obtain one".

Dr. Bernal uses frequently the term "Executive Functions". What does that mean?

Executive functions encompass a wide variety of functions that primarily happen in the Frontal Lobe of the Brain. They are listed and described below:

1) Activation: organizing tasks and materials, estimating time, prioritizing tasks, getting started on work tasks: this explains to some extent the frequent complaints coming from ADHD individuals in regards to procrastination.

2) Focus: focusing, sustaining focus, shifting focust to tasks.  The general description of individuals is "being distracted easily not only by things that are around , but also by my own thoughts".

3) Effort: regulating alertness, sutaining effort, and processing speed. Common complaints of individuals with issues in this realm include: "I am able to perform short-term projects but ha ve much more dificulty with sustained effort,  when they are projects over longer periods of tiime". They may also complain of staying up too late, unable to "shut my head off".

4) Emotion: managing frustration and modulating emotions.  NOT INCLUDED WITHIN THE CURRENT RECOGNIZED CRITERIA FOR DIAGNOSIS OF ADHD; nevertheless, frequently is a complaint brought up by individuals with "difficulties managing frustration, anger, worry, disappointment, desire, and other emotions...with emotions taking control of their thinking, making it impossible for me to give attention to anything else".

5) Memory: using working memory and accessing recall. "I am able to recall things that happened long time ago, but may not remember where I just put something, what someone just said, what I've  just read, what I was about to say".

6) Action: monitoring and regulating self-action. "I have problems with being impulsive, jumping into inaccurate conclusions; I may not notice when other people are hurt, puzzled, annoyed by what I just said".