Evidence of ADHD’s effects into adulthood mounting

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ADHD is often thought of as a childhood disorder. Although it may only affect some people during childhood, it continues to affect many into adulthood. Several studies have looked at the long-term effects of ADHD. One of the most recent ones gives us a look not just at the persistence of ADHD, but also at its effects on those who suffered from the disorder as children.

The Wall Street Journal ran a story last Sunday which reports the results a new study of adults who were diagnosed with ADHD as children. That study compared the incarceration rates, mortality rates, and incidents of other psychiatric disorders in adults who had been diagnosed with ADHD as children to adults from the same age group who had not been diagnosed. The adults with childhood ADHD were at greater risk of suffering from ADHD as adults but were also at greater risk of incarceration, and over three-quarters of those with adult ADHD were found to be suffering from at least one other mental disorder while fewer than half of those without adult ADHD (whether or not they had ADHD as children) had additional diagnoses.

Similar results were found in an earlier study that compared men who were diagnosed with ADHD as boys to men who had not. That study found that those who had been diagnosed were less likely to have a high school diplomas or college degrees. They were less likely to be employed, and those who were employed were making less money on average than those who did not have ADHD in childhood. They also had less successful marriage and were more likely to abuse drugs.

The authors of that study recommend continued monitoring of children diagnosed with ADHD, and Dr. William Barbassi, an author of the recent study mentioned in the Wall Street Journal recommends that children with ADHD be evaluated for other conditions.

Finally, an even earlier study found that children diagnosed with ADHD who received long-term follow-up care had better outcomes, regardless of the kind of treatment received.

The results of this and other research suggest that if you were diagnosed with ADHD as a child, further assessment and care may be wise, even if you no longer have apparent symptoms.

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The Role of Genetics in Mental Health

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“Nature or nurture,” has long been the debate when it comes to diagnosing the cause behind mental illness. Researchers have conducted innumerable studies searching for the factors that contribute to overall mental development, specifically the factors that determine whether or not an individual is predisposed to a mental illness such as major depression, schizophrenia, or bipolar disorder.

The degree to which genetic factors (i.e. nature) determine whether or not an individual develops an illness is known as its “heritability”. An illness that is completely determined by genetics would be 100% heritable.

Almost all mental illnesses have a genetic component (nature); however, the importance of genetics in determining the onset of illness differs a great deal between disorders.

One of the best methods for determining the contribution of genetic factors has been to compare identical twins. Basically, scientists determine if one twin has the disorder the odds that other twin also has the disorder. Schizophrenia has been found to be one of the most heritable of all psychiatric disorders with a heritability score of 0.8—the onset of Schizophrenia is 80% based on genetics and 20% based on environmental factors.

Psychiatric illnesses that are also highly heritable include Autism (0.9), Bipolar disorder (0.85), and Attention Deficit Disorder (0.7). In contrast, Unipolar Major Depressive Disorder (0.37) and anxiety disorders (0.32) are much more dependent on environmental factors rather than genetic.

The “nurture” factor is comprised of everything else that has happened during an individual’s life. Stressful events/home environments and medical problems early in life are two of the most common environmental contributors towards development of a mental illness.

Some of the most common medical problems include (1) problems during pregnancy (e.g. mother’s alcohol or drug use), (2) problems during delivery (e.g. low oxygen levels), (3) gastrointestinal problems related to feeding (e.g. reactions to elements of mother’s diet), (4) specific health problems (e.g. asthma), (5) medications needed to treat health problems, (6) reaction to vaccinations, (7) prolonged high fevers, and (6) injuries – particularly to the head.

Probably the greatest contributing factors leading to development of mental illness relate to traumatic childhood experiences. Sexual, physical and emotional abuse during childhood all lead to a dramatic increase in the likelihood that an individual will later develop a mental illness. Highly stressful home environments are also a major contributor; examples include frequent conflicts and arguments between parents (or between parents and siblings) and witnessing violence. Children can also be traumatized by the death of a family member or by the change in the home when a family member becomes severely ill. Finally, parents with substance abuse problems or untreated psychiatric disorders have a very negative impact on their children’s emotional development.

We are also becoming increasingly aware of the emotional harm that can be caused by negative school experiences. For example, bullying by other children and even by teachers can also result in severe long-term emotional damage. The realization of these issues has led to anti-bullying campaigns nationwide, and the implementation of these campaigns has placed a larger importance on the overall mental health of school-aged children and teenagers.

While the issue of, “nature or nurture,” may not ever be black and white, research has developed many tools to determine if an individual is predisposed to a mental illness. For more information regarding mental illnesses, please visit the National Alliance on Mental Health (NAMI) website here.

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Dr. Sarkis receives back-to-back honors

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Last September, Elias H. Sarkis, MD, Founder of Sarkis Family Psychiatry,  became a Distinguished Fellow of the American Academy of Child and Adolescent Psychiatry. Attaining this status requires, among other things, three other AACAP Fellows writing letters of recommendation that attest to the candidate’s excellence in several areas of scholarship and service. You can read about the full requirements on the AACAP’s website.

The following month, the American Board of Psychiatry and Neurology honored Dr. Sarkis by asking him to be an examiner for the Child and Adolescent Psychiatry oral examinations in Houston. These exams are given to practicing psychiatrists who have already received board certification in psychiatry and are seeking certification in the sub-specialty of child and adolescent psychiatry.

“It’s a great honor,” Dr. Sarkis said of the invitation. “Most psychiatrists don’t get to do it.”

Board certification, though not required to practice medicine, is a testament to a physician’s competency. Sitting for the exams is, therefore, a major event in a doctor’s career. To earn this certification, candidates must pass a written exam covering both general and child and adolescent psychiatry and an oral exam.

“One of the more traumatic events of my life was being examined,” said Dr. Sarkis, who received his certification in Child and Adolescent Psychiatry in 1992. “You’re having to examine a real patient in front of two examiners. It’s a very intimidating experience.”

Not every doctor who takes these exams passes. “There is a 25% fail rate,” Dr. Sarkis said, “which is remarkable given how much they’ve done to get that far.”

After examining a patient in the presence of two examiners, the candidate describes to the examiners his or her findings and recommendations and then answers the examiner’s questions.

“I’m very happy to say that most of the candidates were rather excellent.” Dr. Sarkis said.

Among the qualities Dr. Sarkis says he looks for in a candidate are respect for patients, effective and appropriate communication, an ability to get good and useful information from a patient, and an ability to come up with a good treatment plan. These are, of course, the same things Dr. Sarkis looks for when hiring a provider for his clinic, but he says there are differences.

“It’s very different because you’ve got a lot more power,” he said of his role as an examiner, “and you’re having them examine a patient, which isn’t something you can do when you’re hiring.”

Now that Dr. Sarkis has served as an examiner, it is likely he will serve again in the future. So, in addition to serving patients in the Gainesville area, Dr. Sarkis will continue to make sure that other doctors are fully capable of serving theirs.

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Coping Mechanisms Come in Many Shapes and Sizes

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Throughout the years, hip hop has gotten a bad “rap” for degrading women, racial slurs, and other offensive material. Most people think of hip hop stars as thugs with music only suitable for adults. That’s why when reading this story of a soldier’s battle with PTSD, and how he’s using rap as an outlet to help himself and others it’s such an inspiring story. Jeff Barillaro is a former Army Tank Gunner that is using his talent and love of hip hop to inspire veterans suffering from PTSD to take back control of their lives.

For more information about this inspirational veteran, please visit the full story at NBC’s Website.

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We’ve given our logo a facelift!

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As we celebrate 22 years of exemplary service to the Gainesville community with quality mental health care, we are proud to announce our new logo design, focusing on the iconic adult and child images found in our most recent Sarkis Family Psychiatry logo. With this new image, we are better able to maintain a cohesive branding throughout our various offerings. With the implementation of cutting-edge services such as Memory Training and Transcranial Magnetic Stimulation, it is important that physicians, other companies, and potential patients are aware of the association of these programs with the Sarkis brand. As our company evolves with new treatment options, new staff and new patients, so does our brand. This new logo signals the continued growth of the Sarkis brand.

Previous Logos

New Logo Designs

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Dr. Sarkis on how to talk to your children about the Connecticut shooting

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Dr. Elias SarkisElias H. Sarkis, MD., founder of Sarkis Family
Psychiatry offers some recommendations for parents
who have the difficult task of talking to their children,
who may be scared and confused, about the deadly
shooting that happened this week at Sandy Hook Elementary in Connecticut.

1. Limit media exposure.

Repeated images of violence on television will impact children negatively. Depending on the age of the child, watching the scenes of the shooting site over and over again will increase anxiety and fear.

2. Ground yourself first.

Children are very sensitive to their parents’ emotional states. It is important for you to calm yourself first before talking to your child. You can do this by communicating with parents, teachers, religious leaders or others that you trust. The calmer you are, the better your child will respond. Being authentic and sharing your emotions with your child provides your child a model on how to process his/her own emotions.

3. Be honest.

It is important to maintain perspective on these tragic events. They are rare. Schools are in fact safe places for children the vast majority of the time.
It’s important to reassure children but to maintain sincerity and to remain genuine. False reassurances will only make your child more insecure.

4. Maintain open lines of communication.

Sometimes children repeat the same questions over and over again. Make sure you remain available to them and maintain your patience. It’s important to listen to your children’s concerns and to respond specifically to those concerns. You may have to do this many times. Something may remind them of the tragedy, from time to time. Do not be surprised by this. Answer their questions honestly and reassure them appropriately.

5. You know your Children best.

Every child is different. Children respond differently to the same events. Even siblings in the same family will respond differently. Some children may respond with increasing clinginess while others may be more withdrawn and detached. Some may be more fidgety and restless. It’s important to realize that these different emotional responses may be attributed to this tragic event. Understanding this, you may invite your child to talk about what’s bothering him or her and not take the behaviors at face value. If your child continues to overreact despite your best ability, please remember that there are professionals that can help your family.

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Dr. Sarkis on Talking to Your Children About the Connecticut Shooting

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Dr. Sarkis spoke to WUFT’s Chris Peralta today about the Connecticut shooting. He offered some important advice about talking to your children about this tragedy. You can read his comments here. He offered the same advice that he offered after the movie theater shooting in Colorado. “I think the impact is really mediated by the adult’s response,” he said today. Dr. Sarkis also pointed out that, while these events may feel common, they are actually very rare. But he also emphasized the need for parents to talk to their children about the violence they are exposed to.

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Dr. Sarkis Discusses the Connecticut Shooting at 4pm on 89.1, WUFT FM

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Today’s shooting at an elementary school in Connecticut comes at the end of a year that now seems full of news about deadly shootings. Earlier this month, a man opened fire in an Oregon mall, and last July a man fired into the audience of a Colorado movie theater, killing 12 people and injuring 58. After that shooting in Colorado, Dr. Sarkis talked to Blake Alderman on 89.1, WUFT FM about how to talk to your children about tragic events like these.

Here are some of the recommendations Dr. Sarkis made for parents:

  • Limit the amount of coverage children see.
  • Ground yourself before discussing the event. If you are anxious, you will communicate that anxiety to the child.
  • Listen to them and answer their questions honestly.
  • Tell them only what they need to know.
  • Try not to scare them. Emphasize that these things are rare.

At 4:00 this afternoon, Dr. Sarkis will be back on WUFT to discuss today’s tragedy.

You can listen to it today on the radio or on their website.

 

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Liesle will see you now

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A tiny Yorkshire terrier, so small she could sit in an upturned helmet, was found in a foxhole in New Guinea during World War II. Her eventual owner, Corporal William Wynne, named her Smokey and took her with him on the missions he flew over the South Pacific and into the battlefield. Smokey gave such comfort to the soldiers on the battlefield and, later, in the hospitals that, in the 1990s, Wynne wrote a book about her called Yorkie Doodle Dandie. Because of her work with hospital patients, Animal Planet has called her the first therapy dog.
Later, in 1976, registered nurse Elaine Smith noticed how well the patients reacted to a golden retriever that belonged to one of the chaplains. It occurred to Smith that trained dogs could be used to help patients elsewhere. Elaine Smith founded Therapy Dogs International (TDI) to test, certify, and register therapy dogs.
Now, one of Smokey’s many successors will be joining us at Sarkis Family Psychiatry. Liesle, a TDI certified therapy dog, will join psychiatric nurse practitioner Heather Sarkis at the office every Friday.
“She actually started out as our pet, and we realized that she was a very therapeutic, well-behaved, and nurturing dog, so we did the training for her to become a therapy dog,” Sarkis said.
Reducing anxiety about coming to the office is one of the benefits Sarkis believes Leisle will provide.
“Kids may feel comfortable enough around a dog to talk about things they would otherwise not feel comfortable talking about with grownups.”
In her research on therapy dogs, Sarkis read a lot about how they can not only reduce anxiety, but can help therapists build rapport with patients.
“It can really help facilitate some of that communication,” Sarkis said.
And she has seen that effect in her own practice. “It really breaks the ice. They’ll pet the dog and they’re more likely to talk about things that they might not otherwise talk about.”
Even patients who have appointments with Heather Sarkis on Fridays will not be required to have Liesle in the room, but anyone who would like to include her can ask.
“Even if it’s with another provider we can definitely arrange for Liesle to be there.”
Sarkis hopes to expand Liesle’s role in other ways.
“We might be able to do some therapeutic walks.”
This idea comes from one of the case studies Sarkis read about involving a child suffering from separation anxiety when the parents weren’t around. That therapist started taking the family on walks with a therapy dog. Eventually, the child was able to go on those walks without anxiety while the parents stayed behind in the office.
Liesle will be up the job, too. According to Sarkis, Liesle loves coming to the office, and she has charmed both her patients and her coworkers.
“She has a really calming effect on everyone. She’s a natural.”

 

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