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IN THIS ISSUE
This issue allows us to introduce two new members to our team. First, we would like to welcome our newest member, Raina Fernandez, to our outstanding group of front office coordinators. In addition, we are delighted to welcome Dr. Tramaine Presley, a psychologist, to our excellent cadre of health care providers. Dr. Presley brings a passion for working with families and helping clients and the community explore the intersection of behavioral health and diversity.
This issue provides in-depth information about young people with externalized behavioral disorders. We began work on this issue before the recent tragic events in Parkland, FL. We hope these articles can make a timely contribution to the ways our schools and communities strive to treat young people with mental health issues and to support families who are raising children with complex needs. As always, these articles seek to explain the particular disorders under discussion and describe evidence-based treatments for individuals with these diagnoses.
A brief interview with Dr. Tramaine Presley opens this issue. Read more about her training, areas of expertise, and the philosophy that drives her approach to providing behavioral health care services. Dr. Julie Steck then provides a data-based framework for this issue by noting some sobering statistics about Externalized Behavior Disorders in Children and Adolescents. Dr. Presley then contributes two related articles. The first, Understanding Disruptive Behavior Disorders, provides us with a background on these diagnoses. The companion article, Disruptive Behavior Disorders and the Family, then explores effective treatment approaches using an ecological framework. Dr. Steck then broadens the discussion with the next article, Walking on Eggshells: Understanding Disruptive Mood Dysregulation Disorders. In the final article, ADHD: What Do We Know?, Dr. Steck helps us understand how a more commonly-known disorder fits into this issue's framework.
As potholes in central Indiana get filled and gardens see the first hint of spring emerging during brisk, sunny days, we wish you good health and a sense of purpose that gives each day new meaning.
CRG Newsletter Editor
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Welcome Dr. Tramaine Presley!
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CRG is pleased to welcome Dr. Tramaine Presley, Psy.D. to our team. Dr. Presley is a psychologist who is already seeing patients for testing, therapy, and consultation services. She earned her doctorate at Wright State University School of Professional Psychology in Dayton, Ohio. We invite you to learn more about her by visiting the CRG website and reading her responses to the following questions.
Dr. Parker: Why did you pursue a career in psychology?
Dr. Presley: I decided to pursue a career in psychology at a very young age after a countless number of friends and classmates sought me out for advice. Offering support and building relationships with others came very naturally to me, so I further looked into the field of psychology. Going into high school, I knew I was going to be a psychologist. As I began seeing clients, I discovered I had a way of creating a sense of safety and knew that I had chosen the right career path.
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Externalized Behavior Disorders in Children and Adolescents:
Identification and Treatment
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In the past several years, we have seen an increase in gun violence and mass shootings in the U.S. As a result, there is increased discussion about gun control and the right to bear arms. Many are questioning the cause of aggression and violent behavior in youth and pointing to the impact of violent video games, television shows and movies. Occasionally, the issue of mental illness is raised, mostly in regard to preventing those with mental illness from possessing firearms.
Unfortunately, the issue of recognizing, diagnosing and treating of mental illness is rarely raised. There seems to be no movement toward better funding of mental health treatment or better access to care. There is a great deal of research and knowledge about mental health disorders and their impact on individuals and families. However, this information is being overlooked and lost in the current political climate.
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Understanding Disruptive Behavior Disorders
by Tramaine Presley, Psy.D.
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What Are Disruptive Behavior Disorders (DBD)?
Most children and adolescents have occasional temper tantrums or emotional outburst. However, when such behavioral/emotional outburst repeatedly occur, it can cause disruption to their academic and social functioning and cause family distress. Disruptive behavior disorders (DBD) are a group of behavioral disorders that are often characterized by a lack of self-control in behavior and emotions. While disruptive behaviors may present in a variety of ways, they commonly manifest as temper tantrums, physical and verbal aggression, violating the rights of others, defiance, and resistance to authority. DBD often include the following diagnoses: Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). Although Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, ADHD is often comorbid with ODD and CD. According to the
Centers for Disease Control and Prevention
, about one in four children with ADHD have a diagnosed behavior disorder. Individuals who have both conditions tend to experience more difficulty in their daily functioning because of the defiant behavior that leads to numerous conflicts.
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Disruptive Behavior Disorders and The Family
by Tramaine Presley, Psy.D.
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While there are a number of treatment options for individuals with disruptive behavioral disorders (DBD), the most effective treatments are tailored to their individual needs and the behavioral symptoms of each child. A combination of individual and family psychotherapy are commonly used treatment approaches.
A clinician may prescribe medication to help treat the symptoms, especially if there are co-occurring conditions.
Parent/caregivers often find themselves in distress due to the nature of the behaviors that their child tends to display. Parents tend to feel added pressure to monitor and supervise their child while also attending to other parental responsibilities. In addition, siblings of children with a DBD also experience challenges managing their emotional reactions to their sibling's disruptive behavior. This can lead to poor school performance as well as interfere with their mental health functioning.
Of the number of treatment options available, interventions involving the family system have been found to be the most effective.
For younger children, the family is often utilized as the primary target for intervention. When providing treatment to adolescents, involving the family in treatment can serve as a useful source of support.
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Walking on Eggshells:
Understanding Disruptive Mood Dysregulation Disorder
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Disruptive Mood Dysregulation Disorder (DMDD) was first included in the Diagnostic and Statistical Manual of Mental Disorders in the 5th edition (2013). Thus, it is a relatively new diagnosis. The diagnosis of DMDD was established to address a concern about the over-diagnosis of bipolar disorder in children. However, the constellation of symptoms in children and adolescents is now new. The primary symptoms of DMDD are "persistent irritability and frequent episodes of extreme behavioral dyscontrol." Parents of children with DMDD report that their children do not have tantrums; they have rages. The family reports that they "walk on eggshells" around the child. The child may not show these rage behaviors at school until they "perceive" that the work is too difficult for them or that there is too much work.
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Attention-Deficit/Hyperactivity Disorder (ADHD):
What Do We Know? What Can We Do?
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Over the years, there has been a great deal of debate about ADHD. Does ADHD really exist? Is it over-diagnosed? Is it over-treated? Are we seeing more ADHD? Does excessive use of video games cause ADHD? Can we treat ADHD through changing a child's diet or through re-training the brain? These are some of the questions raised by parents, teachers and others who work with children and adolescents. The good news is that we have a lot of research-based information about ADHD: the causes, the evidence-based treatments, the long-term outcomes if left untreated, and the other conditions that often co-occur with ADHD.
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