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Dr. Rosen and Dr. Spinner recently presented a session on The Uses of Virtual Reality in Social Anxiety Treatment for the National Social Anxiety Center.
View the presentation on The Uses of Virtual Reality in Social Anxiety Treatment.
We Can Help
If you are worried about your child’s social anxiety, discuss your concerns with our clinicians, who specializes in childhood anxiety. For more information, contact us or call us today at 561-223-6568.
Growing up in the United States, we remember our childhoods as filled with fun and games – tag on the playground, sports competitions with friends – a seemingly endless well of energy. Unfortunately, too many kids today are facing a different reality; they’re falling victim to a crisis that’s been mounting for years – childhood obesity.
It’s no secret that junk food and technology are taking over our kid’s lives. At the same time, physical activity has become a thing of the past, leading to a public health crisis that is only getting worse as each year passes. If we don’t take action now, future generations will be faced with even more detrimental effects from the growing childhood obesity epidemic. We can’t afford to wait any longer – it’s time to step up and make a change!
2022 was the final year of available statistics related to childhood obesity, and the numbers are staggering – it’s a crisis that needs attention. This crisis affects children all around the world, and it’s clear that we need to do something to stop this problem before it gets any worse.
One of the most important ways parents and caregivers can help children stay at a healthy weight is by teaching them good habits early on. It’s also beneficial if healthcare providers give kids and their parents support and guidance.
As with anything, there isn’t just one answer for today’s childhood obesity crisis. Among the contributing factors are:
Unhealthy Eating Habits: Poor eating habits, such as not eating breakfast, skipping meals, consuming too much sugar, and snacking on unhealthy foods throughout the day can all cause weight gain in children.
Lack Of Exercise: Today’s kids are much more sedentary than a generation ago. This is due to increased technology use and it means that children often miss out on important physical activity opportunities that help keep them fit and healthy. If calorie intake isn’t balanced with physical activity, it can lead to weight gain and a higher chance of developing chronic health problems.
Stress: Stressful life situations can cause children to overeat or engage in other unhealthy behaviors that lead to weight gain. They can also create other physical and mental health issues. Without healthy coping strategies, kids may manage their stress by resorting to unhealthy behaviors.
Genetics: Due to genetics, some young people may be more prone to storing more fat than the average person, leading to an increased risk of being overweight or obese.
Not Enough Sleep: Some studies have shown that not getting enough sleep might make kids more likely to be obese.
Medications: Certain medications have been linked to weight gain in children. Be sure to speak with your child’s doctor or a pharmacist about any potential side effects of any prescribed medications and ask whether any lifestyle changes may be necessary while the child is taking them.
Fortunately, it’s not too late to take steps to reverse the obesity trend. To be sure, preventing childhood obesity is a group effort, but it starts in the home.
To reduce the chances of their children becoming obese, parents can take the following steps. They should also check in with their pediatrician regularly to make sure their child’s weight is healthy.
These steps include:
Pediatricians should screen their patients for risk factors for obesity and provide nutrition education to parents. They should also refer to community resources as needed. In addition, pediatric doctors must counsel parents on creating a supportive home environment and encouraging healthy behaviors in their children.
Schools can also help kids stay healthy by creating and enforcing policies promoting physical activity and healthy eating habits. Nutrition education programs can teach their students the importance of making nutritious food choices and maintaining a healthy weight.
The key to reversing childhood obesity is to get kids involved in their own health from an early age and empower them with knowledge about the benefits of good nutrition and regular physical activity.
If we make small changes in our lifestyles and provide proper guidance and tools at home and in the schools, we can break the cycle of childhood obesity and our children can grow into happy, healthy adults.
We Can Help
If you are worried about your child’s weight and health, discuss your concerns with our pediatric psychologist, who specializes in childhood obesity. For more information, contact us or call us today at 561-223-6568.
For this month’s Consult The Expert interview, I spoke with Brittany Schulman, Psy.D. She is a licensed clinical psychologist here at the Center and has a special interest in the diagnosis and treatment of Attention Deficit/Hyperactivity Disorder (ADHD).
Most of us have heard about ADHD, but may have only a vague understanding of the condition, so I asked Dr. Schulman to tell us what ADHD encompasses.
“ADHD is a neurodevelopmental disorder that first occurs in childhood,” she answered. “Research has shown that there is a difference in the brain chemistry of people with ADHD, with one of the main brain areas affected being the frontal lobe and specifically, the prefrontal cortex. The prefrontal cortex controls our executive functioning which includes impulsivity, planning, problem solving, and emotional flexibility and regulation. “
“A good analogy for understanding what happens in those with weaknesses in executive functioning is to imagine the prefrontal cortex as the conductor in an orchestra. If the conductor is off on the directions they give to the musicians, the orchestra suffers and doesn’t work in sync. In the same way, a child can have high cognitive skills, but if the prefrontal cortex isn’t regulating these other areas, the result is frustration and behavioral challenges.”
“ADHD is very genetic and we know it runs in families,” she continued. “In fact, between 20 – 35 percent of diagnosed children also have a parent with the disorder. ADHD is more common in boys and is typically first seen in elementary school, when it is often identified as inattention. Difficulty sitting still becomes less visible in ‘tweens and teens, but then we tend to see more restlessness or inability to control impulses.”
I asked if ADHD is the same as ADD and also why we don’t hear much about ADD anymore.
“Years ago, we had Attention Deficit Disorder (ADD) and there was also ADHD,” she said. “As research has evolved, the most recent version of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) categorized the two diagnoses under the same umbrella, but with different presenting characteristics. As a result, they’ve been combined and are officially recognized as ADHD today, but with three subtypes. These subtypes are ADHD with predominantly inattentive presentation, ADHD with predominantly hyperactive/impulsive presentation, and ADHD, with a combined presentation.”
Dr. Schulman acknowledges that these similar-yet-distinct terms can seem confusing at first, so she broke down the subtypes a little further. “For a child to be diagnosed with predominantly inattentive ADHD, they must meet six criteria in the inattentive category, which includes behaviors like being forgetful, losing things, or frequently wandering off-task. Maybe they fail to pay attention or to sustain it. They may have trouble organizing tasks or may avoid tasks that require a more sustained mental effort.”
“On the other hand, if a child falls into the hyperactive/impulsive category, they must meet at least six criteria from that subtype, such as being restless or squirming a lot, often leaving their seat in class, talking excessively or blurting out answers, interrupting frequently or having trouble engaging in quiet activities. Adults must meet five of the symptoms instead of six to be diagnosed, and children who are diagnosed with a combined presentation must have at least six symptoms each from both categories.”
I asked her what steps are taken to make a diagnosis.
“First, the individual must have displayed some of the ADHD indicators before age 12. Symptoms typically start in the toddler years,” she explained, “but some criteria aren’t generally recognized until age 7 and above – in the early elementary school years when the child is less attentive in class.”
“To be diagnosed, the symptoms have to have lasted at least 6 months and have to have occurred in more than one setting – for example, both at home and at school. This is because being in different settings can change the child’s responses.”
As for the process of diagnosis, Dr. Schulman told me that a comprehensive evaluation is vital.
“Diagnosis is based on a thorough history and observation of the child, plus information obtained from parents, teachers, and others. We observe the child in various settings because kids can often pay better attention in a one-to-one setting or with peers or in play, but may have a hard time in school where more concentration is required. By watching how the child acts in a structured versus unstructured setting, the psychologist can see behavior differences. Another important factor in the assessment of ADHD is looking at the individual’s executive functioning skills, as those diagnosed with ADHD typically have difficulties in executive functioning.”
I asked Dr. Schulman if ADHD can mimic other conditions. “On a surface level, yes,” she answered. “Bipolar disorder, for example, can have impulsive activity, as well as poor concentration and poor impulse control. So, we tend to look at the person’s mood episodes, when they occur, and how long they typically last. For the most part, we do not see the level of mood instability seen in mood disorders in young children with ADHD. Furthermore, the onset of bipolar disorders is typically later than the onset of ADHD.
“Autism is another condition that can co-occur with ADHD, however, a child on the spectrum will often have social differences, in that they may prefer to play alone or have trouble making eye contact. The child with ADHD may misbehave because of impulsivity, but an autistic child may misbehave because there were changes in the expected plan for the day, which is unrelated to an impulsive response.”
“That said, ADHD can also occur in conjunction with other disorders,” she continued. “So, when we are diagnosing a child, it’s important to be extremely thorough with our evaluations and observations to be sure that it is ADHD and not another comorbidity.”
I was surprised when Dr. Schulman mentioned that the Covid pandemic has increased the number of children who show signs of ADHD.
“We have had many, many kids come in to our clinic recently, who never had symptoms before the pandemic, but do now. In children, the symptoms of anxiety and depression can look similar to ADHD. A child may be inattentive because they are depressed or because they are worried and ruminating, so we definitely take a deep look to decide which condition is causing the problem.”
“A simplistic way of distinguishing between the two is by understanding that a child with ADHD-related inattentiveness is more easily distracted by new things. In depression, the inattentiveness shows up as having more difficulty concentrating.”
“Depending on what we feel will benefit the child most, they may go on medication after diagnosis. We now have not only the traditional stimulant medications, but also two non-stimulant medications for children who do not have optimal results on stimulants or for those who have side effects due to the stimulants. Medications alone don’t usually help the child entirely, though,” she said.
“Typically they must undergo some form of behavior therapy, as well. Depending on their challenge areas, the child might get executive function coaching, or behavior therapy teaching certain skills. Another important piece is implementing school interventions and putting accommodations in place so the school day is less challenging for them.”
“We will also likely recommend parent training,” Dr. Schulman said. “This is so the parent learns why the child acts the way they do, along with how to work with the child more successfully and to gain more effective ways to help the child’s behavior. For example, most kids don’t want to act defiantly, but sometimes they can only hold it together long enough to get through the school day and then lose it at home, so parent training teaches the parent how to redirect the child’s behavior.”
I asked if a child could be treated for ADHD without the use of medications. “It’s possible, depending on the case and the child,” she answered. “Some kids can possibly do better with just behavior modification. Some people can do better just by learning the skills they need to be successful.”
I had read that an ADHD diagnosis in a child is only valid for five years, so I asked Dr. Schulman why that is. “Actually, we try to have a client come back within two to three years to get an updated diagnosis for school requirements,” she answered. “Also, symptoms can manifest in different ways as a child ages and matures, so this requested intervention can help to reduce any concerns these changes bring up.”
When asked if there was one final thing she would like people to understand about ADHD, Dr. Schulman was quick to emphasize that a professional diagnosis is needed before someone labels themselves as having the disorder.
“A lot goes into an ADHD diagnosis and it’s important to have a complete evaluation. You cannot diagnose yourself!” she emphasized. “Some social media laypersons have become popular lately by taking one or two pieces or symptoms and telling you that you may have ADHD, but that is a simplistic way to see the condition. If you are concerned about the possibility of having ADHD, you owe it to yourself to go through an in-depth evaluation to be sure.”
If you or someone you love has questions or would like further information about ADHD or other mental health concerns, the professionals at The Children’s Center for Psychiatry, Psychology, & Related Disorders in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-223-6568.
Dr. Brittany Schulman is a licensed clinical psychologist who provides assessment and therapy services to children, adolescents, and adults. Although she specializes in providing evaluations for individuals presenting with an array of concerns, she has a keen interest in anxiety and anxiety-related disorders. During her clinical training, she completed a rotation providing therapy services to individuals with a variety of anxiety disorders including generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, hoarding disorder and specific phobias. Dr. Brittany is known for her ability to be personable, warm, and empathetic towards her clients while creating an environment where they feel comfortable expressing their challenges. In therapy, Dr. Brittany generally works from a cognitive behavioral approach, incorporating mindfulness and ACT techniques into her practice, but tailors each therapy session to every client’s individual needs.
Dr. Brittany completed her doctoral degree in Clinical Psychology at Nova Southeastern University in 2019. She received double bachelor’s degrees with honors in Psychology and Sociology from Florida State University. Dr. Brittany completed her doctoral internship at NSU’s Psychology Services Center specializing in school-related comprehensive psychological evaluations. During her training, Dr. Brittany provided services for individuals presenting with a variety of developmental, behavioral, and emotional challenges including attention and executive functioning, anxiety, depression, and autism spectrum disorders. She has worked in both outpatient and private practice settings. Dr. Brittany completed her post-doctoral residency at Child Provider Specialists in Weston, FL, conducting comprehensive psychoeducational and psychological evaluations.
Another year of college is in full swing across the country. In an effort to control the spread of Covid-19 among their students, some schools have gone to strictly virtual learning. Others, however, are combining this option with in-person classes, which creates a higher chance of exposure to the virus. In addition, many campuses are dealing with students who flaunt social distancing guidelines and gather for parties, which spreads it even more. While many young people were eager to get back to college after being fairly isolated during the summer, we are finding that these seemingly reckless situations are negatively impacting the mental health of many students.
Earlier this year, the American College Health Association collected information for their Spring, 2020, National College Health Assessment. At that time, an average of 49.6 percent of the 50, 307 respondents reported moderate levels of stress. Another 24.9 percent said they were experiencing high levels of stress – and that survey only included schools who had begun their data collection prior to March 16, 2020, when many states began shutting down. Today, those numbers are much higher.
In fact, the results of a study done at nine public research universities across the U. S. and led in part by the University of California, Berkeley, Center for the Study of Higher Education (CSHE), shows the incidence of major depressive disorder among college students has more than doubled since Spring, 2019.
The virus pandemic has certainly had an impact on all of us. Not being able to meet with my patients in person has required a major clinical adjustment. Thankfully, telemedicine has provided me with the ability to provide necessary ongoing treatment. But I also know firsthand how difficult and taxing social isolation and sheltering in place can be.
What has made this viral illness so stressful? After all, we have been dealing with annual episodes of influenza for decades. We also successfully made it through the fears of the bird flu, SARS, and swine flu. What makes Covid 19 so special and so scary? Covid 19 is called a novel virus because it is a protein that is totally new to the world’s human population’s immune systems. Our immune systems therefore do not have the capacity to adequately fight off this infection. The elderly and those with chronic illnesses are especially at risk. But 20 to 65 year olds are not immune from infection and risk severe illness if they are not cautious and follow CDC guidelines.
We can all agree that there are reasons to be fearful of this unique virus. We would all agree that sheltering in place and social isolation plays a role in our unease and insecurity. The inability to see loved ones and friends certainly takes a toll. Job loss and the subsequent financial stressors contributes as well. Lack of definitive treatment or a protective vaccine adds to our worries. But the level of emotional unrest seems to be much greater than what these issues would suggest. So what accounts for our level of apprehension?
We hope that you, your children and families are doing well in the midst of this unprecedented time. After carefully considering the CDC guidelines, we at The Children’s Center have decided that we will no longer be conducting therapy in our office at this time.
In good news, we have the capability to conduct appointments either over the phone or via Telehealth. We are happy to keep all appointments during this time. If you already have a scheduled appointment but you would prefer to postpone your to a later date or an alternate time, we are happy to do that as well.
We greatly appreciate your understanding during this difficult time. Please do not hesitate to contact us with any questions or to schedule an appointment at (561) 223-6568.
We are all so “connected” nowadays. Everywhere you look, you see people of all ages engrossed in the online world. Children are asking for cellphones at younger and younger ages, while parents often seem so attached to their devices that they barely pay attention to their children. This brings up the question of how being connected to your own phone and devices might be affecting your child.
A colleague recently told me what she had witnessed during her last dental visit: a father came in with two young children under the age of 6. All three of them were on their own devices (dad had a phone, each child had an iPad).
When the little boy was being examined, he was told he had his first loose tooth. The child was so excited and he kept exclaiming, “Daddy! Daddy, my tooth is loose!”
The father barely acknowledged this milestone, even after several attempts by his son to get his attention. Finally, although he did not even look up from his phone, he muttered, “Uh huh, that’s great.” My colleague’s heart broke when she saw how disappointed the little boy was with his father’s lack of response.
In effect, the father had just told his son that whatever he was looking at on his phone was much more important than his child.
We all have our anxious moments or times when we are depressed. It’s normal to feel these emotions when we are in stressful situations. In children, anxiety and depression can manifest differently than it does in adults. We often see more dramatic signs of frustration, irritability, and even anger. Kids might be restless, withdraw socially, or lose their appetite.
Usually these conditions go away once conditions improve. For many children, however, anxiety or depression can drag on and on. It may get worse over time and might even start to interfere with their school life, social relationships, or daily activities. When it reaches this point, it is likely that the child has an anxiety or mood disorder that requires treatment from a child psychologist. Be assured that these conditions are highly treatable.
Traditionally, children who are undergoing treatment for anxiety or depression will see their therapist once or twice a week for 30-60 minute sessions. These sessions often continue for three to four months, but could go on much longer depending on the severity of the child’s disorder. However, a relatively new concept in psychotherapy, called intensive outpatient therapy, is showing promise for helping kids get better faster.
It’s just one month past the first anniversary of the massacre at Marjorie Stoneman Douglas High School and we have all been saddened to hear that two students who survived the attack recently took their lives within days of each other. Also, the father of a child who was killed in the 2012 Sandy Hook school shootings died this week in an apparent suicide. Now experts are concerned that these deaths may be the result of suicide contagion.
Recently, the media has been reporting that 2018’s online Momo challenge has resurfaced. They talk about children encountering it in seemingly innocent YouTube videos. Originating on WhatsApp, the reemergence of the scary social media game has prompted schools and police stations to issue warnings about the challenge so that parents can discuss it with their kids.