Don't Take My Phone Away!

Adolescents & Cell Phones

So, when I was growing up, "cell" phones weighed about 10 pounds and were hardly convenient. Cell phone sizes gradually decreased over the past 20 years to make way for pocket-sized phones. Next, texting evolved. Then, internet access from phones began. Now, just about everything, from banking to paying for a latte at the coffee shop, can be done on a cell phone, instantaneously.

Plenty of adults have found themselves in a bind because of a post, text message, email typo, or other issue that occurs via the cell phone. Should we be surprised that youngsters are increasingly getting themselves into trouble with phones too?  Children and teens have not fully developed the ability to predict possible consequences of their actions, cannot fathom their future past the current school year, and have "raging" hormones which may make them eager to interact with others in a sexual nature.

I do not think a week goes by that I do not have to have a candid discussion with my patients and their parents about expectations for responsible cell phone use. Unfortunately, I have heard too many stories of adolescents "sexting," posting explicit or compromising pictures of themselves, communicating with strangers (possibly adults posing as teens) , writing public blogs of a very personal nature, "cyber bullying," accessing age inappropriate content, and handling mature issues with their cell phone. Yes, these phones have apps, music, cameras, dictionaries, GPS devices, and may feel like a lifeline to the world. BUT, they are also very dangerous. 

I advise parents to keep in mind that cell phones are a privilege and not a survival tool. 

1) If your child will not give you the passcode or otherwise prevents you from accessing their phone, then they do not need to be able to continue using it. 

2) Implement parental controls. There are programs that you can use to block certain sites and content as well as monitor texts, calls, and activity.

3) It is totally appropriate to take away the cell phone at bedtime until morning. If they are using their phone, they aren't sleeping. 

4) Use their cell phone as an incentive for good behavior and consequence for bad behavior. It proves to be very effective.

Are you panicking yet? Some parents have a look of fear in their eyes when mean Dr. Sniff starts talking about these rules. They are anticipating a major meltdown at the suggestion of limiting their child's phone access.

Remember that you are the adult, and you have a much better understanding of what dangers exist in the world. Your child most likely does not. It is your responsibility to keep them safe. If they want to have access to their phone, they will likely be motivated to follow the rules.

Dr. Shannon Sniff, M.D., is a Board Certified General and Child & Adolescent Psychiatrist at Fort Bend Psychiatry in Missouri City, Texas.  www.FortBendPsychiatry.com

Don't Panic!

"I Think I'm Dying"

Many people, who end up in the ER or their primary care physician's office complaining that they feel like they're having a heart attack or dying, are actually having a panic attack. They report having sudden racing heart, shortness of breath, tingling hands, and intense fear.  Understandably so, patients go to their doctor to find out what is wrong.  After medical tests come back with normal results, the doctor comes in and explains, "You're experiencing a form of anxiety called a panic attack."  While this provides some relief to know that they aren't dying, it might leave patients wondering, "What do I do about it?" In some cases, a panic attack may be an isolated incident.  In other situations, people find themselves in a pattern of frequent panic attacks and begin worrying about when the next one will unexpectedly occur.

Signs and Symptoms of Panic Attack

• Palpitations or increased heart rate
• Sweating
• Trembling
• Shortness of breath; sensation that one cannot get a deep enough breath
• Chest pain
• Nausea; stomach upset
• Dizziness; feeling lightheaded or faint
• Feeling out of one's body
• Fear of losing control
• Fear of dying
• Numbness or tingling (in hands, feet, face)
• Hot flushes; chills

The symptoms listed above are generally considered to be typical experiences during a panic attack. Individuals may have only some or all of the symptoms.  

What Next?

The first step is to have a full medical evaluation to eliminate possible causes related to cardiac, pulmonary, endocrine, or other medical concerns.  Panic attacks do not have to interfere with day to day functioning.  Here are some things you might want to try on your own:

• Exercise 
• Eliminate nicotine, caffeine, alcohol
• Relaxation techniques: deep, slow breathing; yoga; meditation
• Eliminate / manage stressors
• Adequate sleep

If you try the above techniques but still experience significant anxiety and panic attacks, it is advisable to seek help from a professional, such as a psychiatrist or therapist. Psychotherapy and/or medications are often very beneficial.  According to the National Institute of Mental Health (NIMH), 4.7% of adults meet criteria for panic disorder in their lifetime. 

Dr. Shannon Sniff, M.D., is a Board Certified General and Child & Adolescent Psychiatrist at Fort Bend Psychiatry in Missouri City, Texas.  www.FortBendPsychiatry.com

The "Zombie" Phenomenon and ADHD

"I just don't want my child to be a zombie." This is what parents almost always tell me when discussing the possibility of using medication to treat Attention Deficit Hyperactivity Disorder (ADHD).  My response is always, "I don't want your child to be a zombie either."  Unfortunately, it is a widely accepted stereotype that children who are treated for ADHD will turn into zombies. However, in the current pop culture, I guess it is at least popular to be a zombie, if you look at shows like The Walking Dead.  Perhaps it's better to be a zombie than a vampire?

In all seriousness, though, no child should seem like a "zombie" when they are taking medication. For children who are very hyperactive, it is certainly beneficial in the academic and social setting for them to be less hyperactive. And for children who tend to be very inattentive, but perhaps not hyperactive, it is beneficial for them to be more focused.  The challenge is trying to find the right balance.  A good child psychiatrist will not want any child to be "zombie-like," and will be willing to work slowly to find the correct balance.

Common symptoms of ADHD include: fidgeting, blurting out things without permission (i.e., forgetting to raise hand to answer questions in class), difficulty remaining in seat (i.e., getting up frequently to sharpen pencil or throw things away), excessive talking (despite frequent reminders), interrupting others often, difficulty waiting for one's turn, always "on the go," climbing on things, difficulty playing quietly, losing things frequently, easily distracted, inability to complete tasks, inability to follow instructions, seeming not to listen when spoken to directly, avoiding tasks that require effort to concentrate/focus, and forgetfulness.  Each person may have a different combination and degree of symptoms, but psychiatrists look at the overall scenario, number of symptoms, and severity of symptoms.  Child psychiatrists will usually ask for information from the child, parent, and teachers to correctly diagnose ADHD.  As treatment progresses, we use this information as a baseline, or comparison, to track improvement.

I always reassure parents and patients that I will not continue treatment with a medication if everyone does not agree that there is improvement. Unfortunately, many of the symptoms of ADHD can cause academic difficulty as well as social difficulty.  Some children may be labeled as "lazy," when that is not the case.  Children with ADHD are often quite intelligent and wish they could demonstrate that academically, but their hyperactive and inattentive traits make it difficult to do so.  They also may have difficulty relating to other children and end up labeled as "the class clown" or "the bad kid."  Studies have shown that children with ADHD do much better in the long run if their symptoms are managed. They can excel academically and have lower drop-out rates.  They also have lower rates of drug, criminal, and gang involvement if treated.

So, yes, there are some cases in which children may be on too high of a dose of medication, but a good child psychiatrist will ensure that the dose is high enough to show results, but not so high that there are negative effects.  If your child seems like a "zombie," then something needs to be changed.  Ideally, children who are treated for ADHD will not seem to be "medicated," but will behave and concentrate better than if they were not treated.  

Dr. Shannon Sniff, M.D., is a Board Certified General and Child & Adolescent Psychiatrist at Fort Bend Psychiatry in Missouri City, Texas.  

www.FortBendPsychiatry.com

The Holidays & Depression

Most people associate the holidays with happiness, excitement, family, and joy. Unfortunately, not everyone is ushering in the holidays with the eagerness of a child waiting for Santa to drop down the chimney. For many people, the holidays are one of the most difficult times of the year. In my office at Fort Bend Psychiatry last week, one of my patients said "I can't stand the sound of Christmas music this year!" (Meanwhile, holiday tunes were playing in the waiting area.) For her, the holidays come with extra pressure to be happy, host family, and give from a tank that is already running on empty. Looking through the eyes of a depressed person, every day life is a burden, and the holidays may seem like climbing Mount Everest.

Holidays can be difficult for many reasons. Some individuals or families may have had a particularly difficult year, financially. Parents going through bankruptcy, for instance, may be unable to provide the gifts they would like to give to their children or other family members. This can lead to added anxiety about how to make the holidays special. Or, what about the families who are separated by several continents as a result of a spouse, parent, sibling, or child serving in the military or working overseas? Not only do loved ones at home worry on a daily basis, but the holidays are an exclamation point on the daily reminder of being separated. On another note, let us not forget that lives can be turned upside down in a matter of 365 days. Families that celebrated together during last holiday season may have lost someone during the past year. The absence of that person may be heart wrenching, leading to sorrow rather than joy. Families may have also been torn apart by divorce, leaving an obvious void in the minds of adults and children. Children may now have to balance spending holidays between two houses.

If someone you care has a tough time during the holidays, there are things you can do to help:

• Offer to help with whatever tasks may feel overwhelming to them; whether that means cooking, running errands, shopping, or cleaning up around the house
• Encourage them to get outside! Sunlight and fresh air naturally improve mood.
• Plan a coffee or lunch date. Just getting out of the house can help someone who is depressed to feel better. Isolation can perpetuate depression.
• Let them know you are concerned and are ready to listen. Many people feel better after having gotten their worries "off their chest." Check in with them frequently so they know you are concerned.

If YOU are feeling DEPRESSED:

• Exercise - Physical activity produces endorphins which naturally improve mood.
• Get some sunlight - Getting 15-20 minutes of direct sunlight a day can help boost mood. You can do this by sitting near a window, opening your blinds, or drinking your coffee outside in the morning.
• Stay connected to family and friends! Isolating yourself allows more time to dwell on things that are bothering you. 
• Eat healthy foods - Yes, even during the holidays, your body and brain need nutrients to function properly.
• Sleep - It is important to get 8 hours of sleep each night. Poor sleep can affect mood, lead to increased appetite, raise cortisol ("stress hormone") levels, and cause weight gain, irritability and, depression.
• If your depression or anxiety impairs your ability to function or affects your quality of life, it is time to consult a mental health professional. Counseling and/or medication management (psychopharmacotherapy) may be indicated. 

Psychiatrists and therapists can provide much help during this time of the year. Children and adults are susceptible to feeling down during the holidays. Another possible culprit is Seasonal Affective Disorder, which will be discussed in a future blog. In the meantime, Happy Holidays and Happy New Year!

Shannon Sniff, M.D., is a Board Certified General and Child & Adolescent Psychiatrist at Fort Bend Psychiatry in Missouri City, Texas.

Dr. Shannon Sniff: Psychiatric Diagnostic Changes

Dr. Shannon Sniff: Psychiatric Diagnostic Changes: The American Psychiatric Association has just approved the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders , also...

Psychiatric Diagnostic Changes

The American Psychiatric Association has just approved the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM-V.  This project has been underway for years, and provides guidance for how all psychiatrists diagnose various conditions. Important changes include eliminating Asperger's Syndrome and adding a new disorder known as Disruptive Mood Dysregulation Disorder (DMDD).

Asperger's Syndrome has been a hot topic over the past several years, and is commonly known as a "mild" form of Autism among the lay population. The recent change involving eliminating Asperger's Syndrome actually moves toward creating an "Autism Spectrum." While this change will certainly cause some discord, it also allows professionals and patients to acknowledge that there is a group of common symptoms within Autism that can vary in degree among individuals.

Disruptive Mood Dysregulation Disorder is a new diagnosis that will be geared toward children. Previously, many children with disruptive behaviors and temper tantrums would prematurely or mistakenly be diagnosed with Bipolar Disorder. However, this diagnosis did not always follow the course of Bipolar Disorder diagnosed in adolescents and adults. This new Disruptive Mood Dysregulation Disorder serves as a separate diagnosis that can better identify mood problems in children without labeling them as "Bipolar."

These are a few highlights of the new DSM-V, but there are more changes slated to be revealed in the 2013 publication.