What is ADHD?

Posted on by Dr Mark Parisi

Attention Deficit Hyperactivity Disorder, or ADHD as it is commonly called, is a disruptive behavior disorder that is characterized by a chronic pattern of inattention, hyperactivity, and poor impulse control or a combination of the three that affects how children, adolescents, or adults function in their day-to-day life.  ADHD is, technically, a childhood disorder and, if diagnosed in an adult, must have been evident during childhood.  Recent, emerging research from the National Institute of Mental Health suggests that ADHD has a strong genetic link – that is, often runs in families – and is about three times more prevalent among boys verus girls.

Once referred to as Attention Deficit Disorder, or ADD, the disorder was renamed in 1994 to ADHD where it was broken down into three subtypes. The three types of ADHD are predominantly inattentive type, predominantly hyperactive-impulsive type, and the combined type.

The predominantly inattentive type is when an individual finds it difficult pay attention to details and difficulty with following instructions or conversations. The person is easily distracted, makes careless errors, has problems with organization, forgets details of daily routines, and has a tendency to lose things.  The hyperactive-impulsive type is characterized by fidgety behavior, difficulty sitting still, excessive energy levels, poor decision-making, and a tendency to act before thinking.  An individual with the combined type of ADHD may display elements of multiple elements described above.

Treatment for ADHD depends on the unique constellation of symptoms displayed by the individual.  Treatment options are also guided by the severity of the ADHD symptoms.  Often times, prescription stimulant medication can prove invaluable in controlling the symptoms of moderate to severe ADHD.  However, in more mild forms of ADHD, changes to daily routine, the classroom environment, and behavior modification training can produce lasting results.  Cognitive Training involving computer-assisted training of attentional skills, sequencing ability, and short-term auditory and visual memory can also prove helpful in improving the symptoms of mild to moderate ADHD.  Often times, a combination approach which involves a combination of medication management, behavior modification, school-based accommodation, and Cognitive Training is the most helpful way to manage ADHD.

What is Expressive Play Therapy?

Posted on by Dr Mark Parisi

The use of expressive play therapy as a tool in helping children work through emotional issues dates all the way back to the time of Sigmund Freud in 1909 when he introduced this modality of treatment into his work with children.  Freud’s theories were later expanded upon by his students, most notably his daughter, Anna, who systematized and expanded upon the use of play therapy as a legitimate treatment modality when working with children.

The practice of expressive play therapy is focused on helping children work through emotional upset by allowing them to express themselves through play. 

There are a variety of types of expressive play therapy including dramatic and fantasy play, sandbox play, and art-focused play.  All types of expressive play therapy are premised on the idea that play is essential to the normal development of children.  Because children are often unable to communicate and talk about their feelings the same way adults do, expressive play therapy allows a natural vehicle for children to recreate, and with assistance from the child therapist, discuss feelings such as sadness, anger, and worry that might be influencing their daily lives.

As with any method of treatment focused on children, considerable effort must be devoted in the beginning stages of therapy in building rapport and trust that will enable children to express themselves through play.  Initially, the child therapist  attempts to foster rapport and trust – often referred to as a “therapeutic alliance” – by allowing the child to explore the office and select play activities that are developmentally appropriate and personally appealing.  The child therapist may choose to target certain types of play activities in order to elicit certain types of emotions or reactions.  For example, the child therapist might introduce doll house figurines and furniture in order to elicit emotions or reactions pertaining to his or her family life.

Through expressive play therapy, children gradually learn how to deal with difficulties they may be experiencing in daily life.  In so doing, they begin to develop a sense of efficacy and improved self-esteem that, ultimately, leads to improved adjustment and resolution of any problems they may have been experiencing.

Childhood Attachment and Bonding

Posted on by Dr Mark Parisi

During the first year of life, children form strong bonds with their parents and caregivers. You might not think that children are aware of much during that first year, but in reality they are forming very important bonds with people around them. These bonds will lead to an attachment style being adopted by the child; and, each child’s individual attachment style will depend on the types of interaction he or she has with his or her caregivers.

There are four main types of Childhood attachment styles: secure attachment, anxious-resistant insecure attachment, anxious avoidant insecure attachment, and disorganized attachment.

Children who are happy and healthy will typically display secure attachment.  These children understand that their parents will return to them, and they probably don’t cry or fuss a lot when their parents are separated from them, as they are secure in the knowledge that they will come back. To help keep your child secure, snuggle with them, be calm around them, and be consistent with your bonding.  Insecure children consist of those with anxious avoidant, anxious-resistant and disorganized insecure attachment. These children are often frightened, crying when their parents leave their side, but also seeming wholly unconcerned when their parents return. These children are anxious, unsure of what will happen next, so they waffle between wanting parental attention and shunning it.

Children with insecure attachment styles have often witnessed or endured abuse, inconsistent bonding, or live in an environment that is filled with stress.  Avoid this scenario by providing your child with a calm environment, plenty of love, and a lot of positive interaction. Children who are secure in their attachments are often happier and healthier throughout life, forming stronger, more psychologically-balanced relationships.

If you suspect that your child is not bonding properly, or you would like to form better bonds with your child, please seek the advice of a licensed therapist.