IMPACT OF SOCIAL MEDIA

Highlights from Dr. Jonathan Haidt regarding social media use:

Members of Generation Z are suffering from anxiety, depression, self-harm, and related disorders at levels higher than any other generation for which data is available. Recommended new norms include the following-

• No smartphones before high school

  • A norm of delaying constant internet access until ninth grade would help to protect adolescents during the very vulnerable first few years of puberty.

• No social media before 16

  • If the majority of adolescents were not on these accounts until they are 16, families and adolescents could more easily resist the peer pressure of opening accounts so they can keep up with posts and gossip.

• Phone-free schools

  • Schools that have gone phone-free always seem to report that is has improved the culture, making students more attentive in class and more interactive with one another. Published studies back them up.

• More independence, free play, and responsibility in the real world

  • Parents are encouraged to replace screen time with real-world experiences involving friends and independent activity.

What is executive functioning?

You may have heard of the term “executive functioning” and wondered what that meant. Executive functioning refers to a broad group of mental skills that enable people to complete tasks and interact with others. These skills include working memory, planning, organization, problem solving, shifting, controlling emotions and behavior, and response inhibition. Essentially they refer to an individual’s “doing skills”. These are skills that we use everyday such as: 

• Making plans

• Keep tracking of time and finish work on time

• Keeping track of more than one thing at once

• Evaluating ideas and reflecting on one’s own work

• Asking for help or seeking more information when needed

• Making mid-course corrections while thinking, reading or writing

These skills are typically more difficult for a child, adolescent or adult with ADHD who usually already struggles with forgetfulness, losing things or an inability to focus. Therefore, carrying out executive functioning skills can be very challenging for those with ADHD. In addition to individuals with ADHD, executive functioning challenges are also common in other mental health disorders such as obsessive-compulsive disorder (OCD) and Autism Spectrum Disorders (ASD).

So how can executive functioning skills be improved? There are many strategies that can be implemented to help improve difficulties experienced due to weaknesses in executive functioning. Some of these include:

• Using visuals (e.g., white erase board) to jot down morning routines/chores/etc.

• Utilizing simple planners to keep track of assignments/due dates/deadline

• Setting timers to assist with time-management

• Setting alarms to hep with remembering daily activities (e.g., taking medication, getting up in the morning, etc.)

How can a neuropsychological/psychological evaluation help if I think that I/my child has executive functioning difficulties? An evaluation can help identify executive functioning weaknesses through formal assessment of these skills using neuropsychological tests created to measure executive functions (e.g., working memory, cognitive flexibility, planning/organization, etc.). Additionally, individuals, parents/caregivers, and/or teachers are also asked to complete rating scales to assess the individual’s executive functioning skills. Lastly, careful observation of executive functioning skills (e.g., approach to a task) is also conducted throughout the evaluation process. All of this information is collected and analyzed to determine if there are weaknesses in executive functioning and more importantly what specific areas of executive functioning are impacted. Given the complexity of executive functioning, it is not uncommon for an individual to have weaknesses in only some executive functions.

IF YOU BELIEVe THAt you/YOUR CHILD IS STRUGGLING WITH executive functioning CONTACT DR. SCARBOROUGH Today TO DISCUSS YOUR CONCERNS.

ADHD Testing-What is included in an evaluation to determine if someone has ADHD?

What is included in an evaluation to determine if someone has ADHD? The first step is a clinical interview also referred to as a diagnostic interview. During this appointment the clinician will gather information about your/your child’s family, birth, developmental, school/educational, work and psychosocial history. The individual’s history is important because it can provide information about ADHD risk factors. For example, it is important to gather family history because there is a genetic component to ADHD. Meaning that it often runs in families. (e.g., 30-50% of 1st degree relatives of children with ADHD also have the disorder). Other factors also increase the risk of ADHD including environmental risk factors such as prematurity, birth complications, maternal smoking, lead exposure/toxicity, and moderate to severe brain injury. During the clinical interview information about current concerns /problems are also reviewed. This information along with background history is then used to determine if testing is warranted. The clinician will also request school records, pertinent medical records, and any previous testing to review as part of the evaluation.

After the clinical interview is completed the testing session is scheduled. The testing is scheduled on a separate day and usually takes anywhere from 3-5 hours depending on the individual’s age as well as presenting concerns. As part of the evaluation, parents, other family members, teachers/supervisors may be asked to complete rating scales assessing the individual’s attention and behavioral functioning. It is important to gather information about the individual’s functioning across settings (e.g., home, school, work, etc.) to gain a better understanding of how the attention problems are affecting the individual. Throughout the testing session the clinician is also observing the individual. How someone approaches a task is just as important as how they actual perform on the task! The clinician is also observing other aspects of the individual’s behavior such as distractibility, ability to stay focused, need for redirecting, fidgeting, and restlessness.

The clinician reviews and analyzes the information gathered during the clinical interview, records obtained (e.g., school records, previous testing, etc.), ratings scales, results from tests administered, and observations made throughout the testing session to determine if the individual meets criteria for ADHD. The clinician’s diagnostic impressions are shared with you the day of testing.

Approximately 2 weeks after the evaluation is complete, you will receive a report that includes all of the background information gathered, behavioral observations, test results, diagnostic impressions, and most importantly recommendations. Recommendations are provided to help support the individual in all setting including home, school and/or work (e.g., preferential seating, scheduled breaks, extra time, reduced work load, etc.). Resources including books, workbooks, websites are also provided.

IF YOU ARE/YOUR CHILD IS STRUGGLING WITH ATTENTION PROBLEMS AND/OR HYPERACTIVITY/IMPULSIVITY CONTACT DR. SCARBOROUGH TO DISCUSS YOUR CONCERNS.

Did you know that there are different types of AD/HD?

Problems with attention including difficulty focusing and concentrating is a common reason people undergo psychological testing or neuropsychological testing. Difficulty with attention is one aspect of AD/HD. Another common problem often found in individuals with AD/HD is hyperactivity/impulsivity. But my child is not hyperactive/impulsive, does this mean they don’t have AD/HD? The answer is no. You do not need to be hyperactive/impulsive to receive a diagnosis of AD/HD. So many people are surprised to learn that there are different types of AD/HD. The Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5) published by the American Psychiatric Association identifies three types of AD/HD:

• Inattentive type (predominantly inattentive presentation)

• Hyperactive/impulsive type (predominantly hyperactive/impulsive presentation)

• Combined type (combined presentation)

Inattentive Symptoms

• Does not pay close attention to details or makes careless mistakes in school or job tasks.

• Has problems staying focused on tasks or activities, such as during lectures, conversations or long reading.

• Does not seem to listen when spoke to (i.e., seems to be elsewhere).

• Does not follow through on instructions and does not complete complete school work, chores or job duties (may start task but quickly loses focus).

• Has problems organizing tasks and work (e.g., does not manage time well; has messy , disorganized work; misses deadlines).

• Avoids or dislikes tasks that require sustained mental effort (e.g., length reading assignments, preparing reports and completing forms).

• Often loses things needed for tasks or daily life (e.g., school papers, books, keys, wallet, cell phone, glasses, etc.).

• Forgets daily tasks (e.g., chores, running errands, returning phone calls, paying bills).

Hyperactive/Impulsive Symptoms

• Fidgets or taps with hand or feet, or squirms in seat.

• Not able to stay seated (e.g., classroom, workplace).

• Runs about or climbs where it is inappropriate (e.g., library).

• Unable to play or do leisure activities quietly.

• Always ‘on the go,’ as if driven by a motor.

• Talks too much.

• Blurts out an answer before a question has been finished (e.g., may finish people’s sentences, cannot wait to speak in conversations).

• Has difficulty waiting for turn (e.g., waiting in line).

• Interrupts or intrudes on others (e.g., cuts into conversations, games or activities, or starts using other people’s things without permission).

Psychological Testing or Neuropsychological Testing

Psychological/neuropsychological testing can help determine if you have AD/HD as well as what type of AD/HD. This is important because recommendations including what supports will be most helpful will be different depending on the type of AD/HD.

If you are/your child is struggling with attention problems and/or hyperactivity/impulsivity contact Dr. Scarborough to discuss your concerns.