Dysthymic Disorder with school age and adolescent boys.

“Sad, Mad, Irritable and Moody”; a summary of long-term low level depression, Dysthymic Disorder with school age and adolescent boys. 

Many parents are not familiar with “Dysthymic Disorder” but it is the most common form of depression and it is typically the longest lasting form; sometimes lasting for years. Often Dysthymic Disorder, or “Dysthymia” and when it occurs in boys it can be mistaken for other things. Typical symptoms parents see are mild anxiety, lack of motivation, negative self-talk or automatic expectation of failure, as well as difficulty focusing and unstable mood. Many times boys struggle with Dysthymic Disorder and are misdiagnosed or assumed to have ADHD Attention Deficit Hyperactivity Disorder (ADHD), or Attention Deficit Disorder (ADD). Let’s take a closer look at what a child or adolescent with Dysthymia looks like.

Dysthymic is common and at times can run in families but also can be the result of life transitions and or the result of a person’s inability to cope with negative situations. An overall negative outlook on life and on the future is common. Boys typically suffer in silence because many of them do not like to ask for help because they feel it may be a sign of weakness or that they cannot handle things on their own.

Here are some real world examples:
Sadness; Feelings of sadness are common of boys with Dysthymia. Many parents report, “I don’t know what his problem is, he’s always annoyed, negative, or pessimistic.” Another example would be loss of or reduced self-esteem. Many have an attitude like this, “I’m not going to try doing that, It’s not like I will succeed.” As a parent watching and hearing your child speak about their life in such a negative light is heart wrenching. For many parents they have been watching their child struggle for years and are not sure what to do.
Anger and Being Mad; Many boys struggle with a persistent and consistent mean streak. I have heard so many parents report that their sons “Sometimes have their good days but sometimes he just seems to be angry all the time for no reason.” When addressing the emotions these boys are feeling they typically report, “I don’t know, there is nothing wrong I’m find.” In reality their behavior is not aligned with their words. For many they struggle in silence until they enter a crisis and yell their discontent at the top of their lungs.
Irritability and Moodiness; The irritability and moodiness becomes more obvious as demands on the child increase. Many parents encounter this phenomenon when they ask for a chore to be completed, or homework to be started, or just attempt to interact with their adolescent and get a sarcastic/rude response. The moodiness is not just isolated to just the words a child uses but, also the avoidant behaviors which accompany the moods swings. Keep in mind you may notice some overlapping between these characteristics in Dysthymic Disorder and Oppositional and Defiant Behavior.

For boys who are struggling with the symptoms of Dysthymic Disorder, they typically struggle in silence because they seldom want to share their feelings. Many boys feel that it would be sign of weakness if they were to open up, and other simply do not realize that they are feeling symptoms because they have been experiencing them for such a long time. More often than not, parents are the first to notice. Many parents speak about how “Everything seems to bother him” or about “He does not seem motivated to do much of anything but activities he enjoys but, even those activities become boring.” Other parents spoke about how, “Almost everything can be a struggle, we have tried medication and a bunch of different things and not much has helped.” In reality, the improvements for Dysthymia are more gradual than it’s more sever counterpart “Major Depressive Disorder,” also known by many as Clinical Depression.

Situations that result in consistent sadness and or personal rejection increase the persistence of Dysthymia. For example, if a talented 16 year-old athlete suddenly receives a traumatic injury that cripples their ability to perform at their pre-injury condition they have an increased risk of developing Dysthymic Disorder symptoms. If we break the situation down to its elements it looks like this; “I was an amazing athlete and have been for years. All of a sudden I have an injury that robbed me of something I was very proud of. Now I have to wait to recover and if I try to perform like I did in the past I risk re-injuring myself. And now I am embarrassed to try because I can’t perform and I will re-injure myself.” This is devastating for a young man’s self-esteem as well as putting them in a situation where he may not have the skills to cope with the trauma of the injury and loss of personal strength. This situation creates a long road to developing pessimism and self-defeating ideas about new limitations and the loss of bragging rights, and self-esteem boosting activities with peers. In addition to the chronic long-term sadness this teen is also struggling with Post-Traumatic Stress.

Another example would be a 7 year-old boy with a diagnosed Learning Disability who struggles with making and maintaining friendships. As times goes on he tries to interact with peers but is consistently rejected, many times parents notice that he tries but left out of games and activities. Over time his already sensitive, self-esteem dwindles and he feels that he is unlikable. Parents typically see two different extremes with regards to the child’s behavior from this point. In some situations the boy will tell extravagant stories about how he has many friends and all of the dramatic interactions they have together, and on the other hand he may speak very little about his interaction with friends and report that he is liked by no one. The effects of this social situation developed long term, low level depression “Dysthymia” which later can escalate to more severe conditions such as Major Depression, Oppositional and Defiant Disorder (ODD), as well as Anxiety Disorder.

These difficulties are treatable and treatment results are long lasting but they take time. Dysthymic Disorder can be difficult to treat, especially with school age and adolescent boys because they typically do not admit any type of unhappiness due to a shortcoming or weakness. It is important that the clinician is fluent in a variety of different approaches in order to create an individualized plan of care to meet the child’s needs.
At the Success Source, Troy spends a significant amount of time creating a relationship with the child and their parents to best understand the youth’s functioning.

Strategies for Guiding Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD), and Attention Deficit Disorder (ADD); strategies for parents and caregivers to use between Counseling sessions to improve the effectiveness of therapy without the use of medication or combined with medication management.

As an a Professional Counselor, I have been providing individual and family therapy services for many children and adults with ADHD and ADD. This is a brief summary of interventions I typically recommend to clients and their families to improve the effectiveness of Counseling/Psychotherapy between sessions.

Prior to successfully implementing any of these strategies, it is important that the parent or caregiver has adequate self-care strategies in place. For example, if a parent/teacher is struggling with burnout, the strategies may not be implemented correctly because of personal fatigue. It is important that caregivers take care of themselves. Activities such as: exercise, eating balanced meals, getting adequate sleep, as well as having regular personal time, and  having a solid support network are needs which typically need to be met prior to implementing interventions. In addition, formal supports such as Individual, Family, and Group Counseling are formal supports which can be used to increase the chances of caregiver success.

The first things to keep in mind regarding ADHD and ADD, are the functional limitations which are part of the disorder. Let’s break down the characteristics in easy to understand parts.

  1. Inattentiveness; the person’s inability to focus on a multitude of tasks because they have significant difficulty multi-tasking. Keep in mind that stress also comes into play; many adults and children struggle with inattentiveness based on life stressors and not ADHD/ADD. Even if the sources of inattentiveness are different, the strategies for managing the situation are very similar.

Caregivers can help children, who have difficulty focusing, by giving them a single task with very specific directions. For example; “Johnny, when you pick up every sock, shirt, pair of underwear, pair of pants, and pair of shorts and place them in this laundry basket; then we can…”

In addition, making a game of the task will also increase the likelihood that the child will focus with more intensity. For example, “Also, Johnny I bet you can’t get it done in less than 2 minutes, I dare you!” Of course you would have a big smile on your face. Once Johnny starts going and you see him run around the room gathering clothes, you would cheer him on and praise him for his speed and accuracy.

  1. Hyperactivity; the person has significant difficulty with sitting sedentary for periods longer than a moment. Hyperactivity can make it very difficult to manage especially if the child is bored or being directed to participate in an undesired activity. Children with significant amounts of unstoppable energy can be very exhausting for caregivers; which emphasizes the importance of caregiver self-care.

Hyperactivity can be overwhelming at time,s but here is one of many strategies which may be helpful for managing the symptom. A mother brings Johnny, a 6 year old boy who has been diagnosed with ADHD, to a doctor’s appointment and there is a 20 minute wait. Immediately, the mother’s anxiety shoots up and the thought goes through her head “I don’t know if we are going to make it waiting that long.”

After a few moments Johnny is now squirming in his chair, swinging his arms and legs and proceeds to leave his chair and roam around the room. A first step for guiding him would be stay calm and explain exactly what his expectation is “Johnny, come sit by mommy in the chair next to me, and if you need to get up ask me. When you sit down we can play a game.”

The organization and opportunity to play a game is important for children with ADHD because their symptoms typically exacerbate when they are bored or stressed. The mother say’s “Hey! lets play 20 questions: I am thinking of a tasty food you get twenty ‘Yes’ or ‘No’ Questions to figure it out.” Once the game starts, you praise him for “Asking good questions,” “Great job sitting by me, I love when we sit together,” and “You have been sitting so nicely and waiting patiently for the past few minutes, I wonder how much longer you can go?” Be sure to make the game initially easy, take turns, and increase the difficulty as the game continues. This is one of many strategies which I have seen significant success working with children with ADHD; with hyperactivity difficulties.

  1. Impulsivity; one of the hardest behaviors to manage for many caregivers is, the uncertainty and danger impulsive behavior can create. Keeping in mind, impulsivity is best described as uncertain, random behaviors which occur without much forethought.

Impulsivity can be extremely anxiety provoking and many parents of children with significant impulsivity difficulties sadly avoid many social situations entirely.  

An example of a plan I have assisted in creating for a 5 year old boy with ADHD who visited my office looked like this – Johnny would typically run around and sometimes run away when his family would go the baseball field to watch his 9 year old brother play baseball. Johnny would typically run around whimsically and at times would even run in the street. The situation was simply dangerous and frightening for his mother.

The strategy which worked for his mother was to keep his time planned and keep him busy. Because impulsivity is a disorder which is aggravated by unplanned activity, Johnny’s mother and I planned several activities which would keep him busy. When Johnny was engaged he seldom was impulsive. For the beginning of the game she engaged Johnny at the playground and then brought him over to the field so she could watch her other son play.

When near the field, she allowed Johnny to play Angry-Birds on her iPhone. After that, she moved on to activity number two. This strategy is a generalized explanation of a complex but effective intervention which can be planned in a counseling session prior to implementing it. Nonetheless, there is hope. The overall message is to avoid idle time for children with difficulties with impulsivity. In addition, even a typical child without ADHD/ADD can become impulsive if bored or idle.

I hope you found the general information covered in this article helpful. Please keep in mind that each one of these examples are from real-life situations, but the interventions were carefully planned to meet the needs of each one of these children.

Franklin Lakes ADHD Counseling

Franklin Lakes ADHD Counseling: Attention Deficit Hyperactivity Disorder, ADHD, can affect young and old lives – from personal to professional. There is a common misconception that ADHD is only found in children; however, this is not true.

Below is a video that shows how ADHD can effect adults also:

ADHD can be detrimental from child to adult. ADHD is often described as a “hidden disorder” – meaning it can go unnoticed and untreated for years. In our experience, our counselors and psychiatrist have helped many people with ADHD have successful lives in their careers and personal lives. If you think you may have ADHD, examinee some of these common symptoms:

  • You get distracted in the middle of conversations
  • You can’t seem to pay attention and stay on task
  • You tend to overthink past mistakes
  • You are described as a bad listener
  • You can’t seem to follow directions
  • You can’t seem to pay attention as you read this article
  • You are disorganized and procrastinate often
  • You misplace everything
  • Yo have poor self control
  • You interrupt others

Treatment of ADHD

If you went through the list above, and feel as if you have ADHD, you are not alone. But before you diagnose yourself with ADHD, having some of the symptoms does not mean you have ADHD.

There are different treatments for ADHD: some are psychotherapy based; such as learning skills and techniques to handle common symptoms. There are also medications that can help.

If you think you have ADHD, you are not alone. Contact Troy in Bergen County to schedule an appointment, and start making important changes to alleviate ADHD symptoms.

ADHD Quiz for Child ADHD

Bergen Country Child ADHD Counseling Quiz

If you suspect the person is experiencing ADHD, use this symptom checklist to better determine. The American Academy of Child Adolescent Psychiatry (AACAP) considers it necessary that the following be present before diagnosing a child with ADHD:

  • The behaviors must appear before age 7.
  • They must continue for at least six months.

The symptoms must also create a real handicap in at least two of the following areas of the child’s life:

  • in the classroom
  • on the playground
  • at home
  • in the community, or
  • in social settings

There are some circumstances in which a child or adolescent’s behavior might seem like ADHD, but might not actually be ADHD. Many other conditions and situations can trigger behavior that resembles ADHD. For example, a child might show ADHD symptoms when experiencing:

  • A death or divorce in the family, a parent’s job loss, or other sudden change
  • Undetected seizures
  • An ear infection that causes temporary hearing problems
  • Problems with schoolwork caused by a learning disability
  • Anxiety or depression
  • Insufficient or poor quality sleep
  • ADHD Therapy Advice

It is normal for every person to zone out in a boring biology class, forget their homework in the kitchen counter, and act in a excited—high energy way. This is not ADHD. Persons with ADHD experience these issues to a degree that is drastically negatively impacts their performance in school and in life.

When helping someone with ADHD, a multimodal approach is often used. Medication in combination with therapy has been found effective in treating ADHD. Informing teachers, coaches, and others is also an effective approach to ensure appropriate approached to learned are used with the person with ADHD.

ADHD Counseling Therapy Action Steps

Below are several action steps for helping a person with ADHD.

1) Medication

Certain medicines can help people with ADHD by improving their focus and attention and reducing the impulsiveness and hyperactivity associated with ADHD. People with ADHD used to have to take medicine several times a day, but now there are some that can be taken at home once a day in the morning.

2) Counseling Therapy

Counseling can be used to help the person learn new strategies for coping with ADHD symptoms. In addition, family counseling helps treat ADHD because it keeps parents informed and also shows them ways they can work with their kids to help.

3) Maintain structure and supervision.

One of the hardest parts of helping a person with ADHD is that a higher level of structure will consistently be necessary. Parents of ADHD persons often ask “when can we finally relax the increased structure we have created to monitor our person’s school performance and home behavior?” The answer is often that parents should maintain the established structure until the person leaves for college. This does not mean being a prison warden, this means adding additional structure and supervision to help the person be happy and succeed .

4) Remember ADHD is a Disability.

Parents must remember that their person with ADHD has a neurologically based disability, and that there is a “can’t do” as well as a “won’t do” component to their unthinking actions. This means that parents of person with ADHD need to provide an extra helping of grace, patience, and forgiveness with their person.

5) Help them build on their Strengths.

Having ADHD is not just practically difficult for a person, it is also emotionally difficult. Parents and caretakers should be a constant positive force in the life of a person with ADHD. In addition, help the person find and build on his or her strengths. Personal strengths always overshadow the weaknesses caused by having ADHD.