RESOURCES

 
 
Helpful Links:

College of Psychologists of Ontario https://cpo.on.ca
Ontario Psychological Association https://www.psych.on.ca
Canadian Psychological Association https://cpa.ca

Anxiety

When you have an anxiety disorder, it can be as disabling as a major medical disease. It’s just not as visible to family, coworkers or friends, and one’s suffering is internal.
Through human evolution, a normal amount of anxiety has been inherited as necessary to survival. (Are there poisonous snakes near the children? Is that woolly mammoth going to charge? Do I have enough dried berries and fish for the winter?). But like any human trait, some of us may inherit a few too many of these genes. Combined with some personality traits, life experiences, stressors or lifestyle habits and…..there you go – you’re in your doctor’s office knowing something is terribly wrong, or lying awake half the night gripped with fear and dread.
 
Whether its panic attacks, OCD, health anxiety, generalized anxiety, posttraumatic stress, social or other phobia, there are very effective techniques that can be learned to recover from an anxiety disorder. Although some people will also need medication in their recovery, research shows that Cognitive Behavioural Therapy is an equally effective and longer lasting treatment than medication.
 
If you suspect you suffer from an anxiety disorder, browse these links for further information, see your family doctor (first to rule out simple things like a thyroid irregularity), and seek help for yourself. We’d be happy to see you here at Markham Psychologists.

Helpful Links:
Anxiety Disorders Association of America www.adaa.org

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Mood Disorders

As the name suggests, mood disorders are characterized by disturbance in mood as a predominant feature. Mood Disorders fall into two general categories: the Depressive Disorders (e.g. Major Depressive Disorder, Dysthymic Disorder, Post-Partum Depression, Seasonal Affective Disorder) and the Bipolar Disorders (e.g. Type I, Type II, Cyclothymia).  Mood disturbance may also occur due to medical conditions and use of substances.
 
Depression has often been referred to as the “common cold” of mental health difficulties due to its high prevalence. Approximately 15-25% of women and 10-15% of men will experience a major depressive episode during their lifetime. Depression is different than simple unhappiness or grief following the loss of a loved one. It encompasses a range of symptoms that include emotional (low mood, feeling hopeless), physical (change in appetite or sleep), behavioural (talking slowly, social withdrawal) and cognitive (negative thoughts, difficulty concentrating) symptoms.
 
Depression may be treated by medication, psychotherapy or a combination of these two approaches. Numerous studies have shown that Cognitive Behavioural Therapy (CBT) can effectively treat depression by targeting behaviour and thinking patterns that cause and maintain depression.
 
The Bipolar Disorders are characterized by episodes of depressive and manic/hypomanic (elevated mood) symptoms. Manic-type symptoms include decreased need for sleep, an increase in goal-directed tasks, grandiose ideas, agitation, and inflated self-esteem. This class of disorder is best managed by a combination of medication, and psychotherapy that targets active coping strategies, stress management, medication compliance and negative thinking.
 

It is important to emphasize that suicidal thoughts and difficulty with daily functioning are common for those experiencing a mood disturbance. It is extremely important to consult with your physician, or seek the help of a qualified mental health professional, if you believe that you or someone you care about may be struggling with a Mood Disorder. Mood disturbance can be effectively treated or managed with the assistance of skilled health care providers.

 

Helpful Links:

Mood Disorders Association of Ontario www.mooddisorders.ca

 

Suggested Reading:
 
The Bipolar Workbook: Tools for controlling your mood swings. (2006).
By Monica Ramirez Basco.  New York, NY: The Guilford Press.
 
Ending the Depression Cycle: A step-by-step guide for preventing relapse. (2003).
By Peter J. Bieling and Martin M. Antony. Oakland, CA: New Harbinger Publications, Inc.
 
Mind Over Mood: Change how you feel by changing the way you think. (1995).
By Dennis Greenberger and Christine A. Padesky. New York, NY: The Guilford Press.
 
The Feeling Good Handbook: Revised Edition. (1999).
By David D. Burns. New York, NY: Penguin Putnam, Inc.
 
The Mindful Way through Depression. (2007).
By M. Williams, J. Teasdale, Z. Segal, and J. Kabat-Zinn. New York: NY: The Guilford Press.

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Eating Disorders

Eating Disorders have become an increasingly common problem over the past five decades. These disorders most commonly affect adolescent girls and young adult women. However, adolescent boys, men, young children and middle aged and elderly individuals may also be affected. Eating disorders can involve different combinations of symptoms.
 
Individuals with Anorexia Nervosa are significantly below a healthy weight for their age and height and females may have stopped menstruating. They may perceive themselves to be overweight and are fearful of weight gain. They place a great deal of emphasis on physical appearance when evaluating their self worth. About half of those effected by Anorexia purge after eating.
 
Individuals with Bulimia Nervosa may be overweight or normal weight. These individuals engage in recurrent episodes of binge eating followed by inappropriate compensatory behaviours to prevent weight gain. Compensatory behaviours may include self induced vomiting, laxative abuse, starvation or excessive exercise. These individuals experience a feeling of lack of control over eating and like those with Anorexia, their self evaluation is unduly influenced by their body shape and weight.
 
Individuals with Binge Eating Disorder are likely to be overweight, though they may be normal weight. These individuals engage in recurrent episodes of binge eating in the absence of compensatory behaviours.
 
Many individuals have some of the symptoms of the above disorders but would not be given the diagnosis. However, whether an individual experiences a full blown eating disorder or just some of the symptoms of an eating disorder, these disorders are extremely painful and medically dangerous. If you see yourself in any of the above descriptions it is important that you seek help immediately. Eating Disorders have the highest fatality rate of any mental health issue and many more people become chronic and are never able to fully recover. The most common cause of death in eating disorders is heart failure due to an electrolyte imbalance which is caused by purging. There may be no warning sign that your electrolytes are out of balance so a blood test is necessary to determine if you are at risk of heart failure. Research studies have shown that early detection and treatment is associated with better outcomes.
 
If you are experiencing Anorexia Nervosa the initial focus of treatment will be on the restoration of normal body weight and normal eating patterns. This is because your brain is in a state of starvation and you cannot fully benefit from therapy until you’re brain is adequately fed. For individuals with Anorexia the idea of gaining weight is frightening. Rest assured that your psychologist is aware of this and will assist you to cope with this fear. You will be provided with information about the medical complications associated with your symptoms and this in itself may help you to start changing your behavior. Your psychologist will help you to gradually increase your food intake through motivational techniques and body image work. As your weight approaches normal the focus of treatment will shift to weight maintenance and exploration of the underlying issues, which must be addressed to prevent relapse.
 
Treatment of Bulimia also requires the normalization of eating patterns and acceptance of normal body weight. In treatment you will learn strategies for reducing the frequency of binges and purges with the ultimate goal of eliminating these behaviours. Once again treatment of Bulimia includes body image work as well as an examination of underlying issues. A similar treatment approach is utilized for Binge Eating Disorder.
 
Treatment approaches utilized primarily include Cognitive Behavioural Therapy and Family Therapy. In most cases mid- to long-term treatment is required, though short term treatment may be effective if treatment is commenced early on. Early intervention is associated with better long-term outcome and a higher likelihood of full recovery.
 
Due to the significant medical dangers associated with self starvation, binge eating and purging, it is imperative that you are under the care of a Medical Doctor throughout your treatment. This is an absolute requirement for individuals receiving treatment for an eating disorder at Markham Psychologists. If you do not have a medical doctor, or are embarrassed to tell your family doctor about these behavours, we can assist you in finding one.
 

Helpful Links:

 

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Rehabilitation

Rehabilitation as a Result of Injury/Trauma, Accident, or Illness
Psychologists working in the area of rehabilitation are concerned with assisting individuals dealing with limitations in their physical, sensory, emotional, cognitive, social, or occupational capacities as a result of injury, accident, trauma, or illness. Injuries or accidents such as a motor vehicle collision, work-related accident, or illnesses like cancer or stroke can impact a person’s capacity to work, to learn to manage personal or family responsibilities, to maintain relationships, or to participate in social, household or recreational activities. The ultimate therapeutic aim to help individuals reclaim meaning and hope in their lives, increase quality of life, and to restore previous functioning to the extent possible.
 
Individuals recovering from an injury, trauma, illness, or accident may deal with a number of issues that impact their functioning such as chronic pain, fibromyalgia, post-traumatic stress, phobic and anxiety reactions, and depressive symptoms. For example, an individual recovering from an auto accident may struggle with chronic pain, physical limitations, decreased activity level, loss of independence, post-traumatic reactions (e.g., flashbacks and/or nightmares, hypervigilance symptoms), driving anxiety and avoidance, concentration and memory problems, irritability/anger, low mood, energy, and motivation, sleeping disturbances, in addition to social withdrawal.
 
Psychologists use several different techniques to help people to recover their strength and sense of self and improve the quality of their lives, in spite of their difficulties. Specific techniques include support, education and skill building in areas such as relaxation, stress and anger management, problem solving, realistic goal setting, pain management, sleep hygiene, and assertiveness. Cognitive approaches foster thoughts, emotions and actions that are adaptive for managing life. Behavioral approaches help people plan their activities in ways that give them more control.
 
 
 
Suggested Reading:
 
Managing pain before it manages you (2002).
By Margaret A. Caudill. New York: NY: The Guilford Press.
 
Overcoming post-traumatic stress disorder – client manual. A cognitive-behavioral exposure-based protocol for the treatment of PTSD and other anxiety disorders (1999).
By Larry Smyth.  Oakland, CA: New Harbinger Publications, Inc.
 
Coping With Mild Traumatic Brain Injury: A Guide To Living With The Problems Associated With Brain Trauma (1998).
By Diane Roberts Stoler and Barbara Albers Hill. New York: NY. Avery Publishing Group.

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Learning Disabilities

What is a Learning Disability?

The diagnosis of a learning disability, now referred to as a specific learning disorder in the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5), requires consistent difficulties learning and using academic skills (in reading, writing, spelling, and/or math) during school-age years, below what is expected given a child’s age.

To receive this diagnosis, academic difficulties must not be caused by developmental, neurological, sensory (vision or hearing), or motor disorders, inadequate educational instruction, poor academic performance in a second language, and must significantly interfere with school or work performance, or with activities of daily living. There are various definitions and criteria for identifying a learning disability. While the DSM-5 outlines diagnostic criteria, the various Departments of Education in Canada and beyond have also established criteria for identifying a learning disability and determining the interventions and accommodations that might be required.

What about adults?

A learning disabilities is essentially a lifelong condition that continues into adulthood, and may interfere with functioning at university, work, or during activities of daily living.

What a Learning Disability is Not

A learning disability is not the same as an intellectual disability (intellectual developmental disorder), which in the past was referred to as mental retardation. Individuals with an intellectual disability have below average levels of intelligence (IQ) and have significant difficulties across mental abilities (e.g., language, knowledge, reading, writing, math, reasoning, memory). Individuals with an intellectual disability also struggle significantly with adaptive functioning or daily activities (e.g., getting dressed, feeding themselves, social interactions etc.).

Where Do Learning Disabilities Come From?

As discussed in DSM-5: Environmental risk factors: Prenatal exposure to nicotine, alcohol, being born early (premature), or extremely low birth weight increase risk for a specific learning disorder.

Genetic/Biological risk factors: Specific learning disorders tend to run in families.

Behavioural/Cognitive risk factors: Preschool children with significant difficulties paying/sustaining attention are more at risk for developing later difficulties in reading and mathematics (not necessarily to the extent of a specific learning disorder). Early speech difficulties/delays and cognitive difficulties (e.g., short-term memory) also increase risk for specific learning disorders in reading or writing.

What Are Common Signs of a Potential Learning Disability in Children?

Along with struggling and/or getting low marks in some subjects at school, children suffering from a specific learning disorder may also show a number of behavioural and/or psychological symptoms; however, having these symptoms does not necessarily imply that a child is having learning difficulties as they can also originate from other causes.

Behavioural signs:

  • Boredom/distractibility: if children are having a hard time understanding the lesson/work at home/school they can lose focus/stop paying attention, and engage in more interesting tasks (e.g., talking to friends, walking around). Often times, without a proper assessment, children with a learning disorder can be mis-labelled as having attention-deficit/hyperactivity disorder (ADHD).
  • Behavioural outbursts: children often become frustrated when they don’t understand something, and since they often can’t express their difficulties in words to their teacher/parents, they often do so by acting out (e.g., arguing, yelling, or leaving the class).
  • Defiance: children may refuse to do what a teacher/parent asks of them because they don’t know how, not because they are trying to be difficult on purpose.
  • Needing extra time to do work: when a subject is really difficult for children and they need extra time to understand, they may not finish tests in the given amount of time and may take longer than classmates to complete homework/assignments.

Psychological signs:

  • Anxiety/worries: children who have difficulty learning often start to worry about not doing well at school. This can lead to avoiding school, being emotional the night before or morning of school, increased stress/anxiety/outbursts around homework/tests/assignments etc.
  • Low self-esteem/mood: until identified with a disability, children often don’t know why they are struggling to learn and so often blame themselves and think they are “stupid” or “not as smart as other kids.”

What To Do If You Suspect Your Child Has A Learning Disability?

Share your concerns with your child’s teacher/school. Ask about what he or she has observed in terms of your child’s learning. Teachers are often a good source for identifying available school resources and are often willing to come up with different strategies to try in the classroom and at home to help support your child’s specific learning needs (e.g., using visual aids, more hands on activities). If trying new learning strategies is not successful, consider getting a formal assessment in order to identify your child’s difficulties/needs. The sooner these needs are identified the better.

How Do I Have My Child Assessed For a Learning Disability?

As noted above, it is important to get an educational assessment for your child, in order to fully understand his or her needs, and to consider all of the reasons why he or she may be struggling at school (e.g. learning disorder, ADHD, language disorder, intellectual disability, anxiety, stress at home etc.). A specific learning disorder is diagnosed through a review of your child’s developmental, medical, educational, and family history, reports of test scores (intelligence/academic/achievement), and parent and teacher observations.

Where Do We Go For An Assessment?

A comprehensive psycho-educational assessment can be obtained in several ways Assessments are often provided through your child’s school, community mental health centres, psychologists in private practice, and less frequently through mental health at the local hospital. Insurance plans will often cover a large portion of the assessment when obtained from outside of publicly funded institutions. Be sure to check with your insurance provider and that of your partner/spouse before ruling out this option.

If seeking a psychologist who does assessments in your area, visit the following website: http://www.cpa.ca/public/findingapsychologist/; remember, because of the high demand for these assessments, wait times can be long.

Having your child’s assessment done through their school is ideal. School psychologists work in collaboration with your child’s teacher to provide comprehensive assessments of classroom functioning and develop plans for appropriate intervention. Any plans will be reviewed with you, and will be monitored and evaluated on a regular basis to ensure that the plan continues to meet your child’s developmental and learning needs. If the assessment is completed outside of the school, consultation with your child’s teacher as part of the assessment, if possible, is preferred.

If wait times are too long, another option is to have an assessment done through a private practice in the community. Wait times are much shorter, however, private assessments can be quite costly, but may be covered by insurance.

How Can You Help Your Child Be Successful?

Once your child has received a diagnosis of a specific learning disorder, the school will often create an Individualized Education Plan (IEP) to support your child’s learning, based on the recommendations in the assessment report. The IEP is a formal document that will be kept in your child’s school record and will follow him or her from year to year to ensure an understanding of needs and stability of services; it is also important to have this document reviewed and revised each year to reflect current functioning. The IEP includes instructions to teachers on how your child learns best and how to help your child succeed in the classroom. For example, children with a writing disability may be given a computer to type assignments and tests. IEPs are reviewed and modified throughout your child’s schooling and can even follow them to university or college. Similarly, accommodations can also be made in the workplace. IEPs DO NOT reflect poorly on your child, or his or her chances of success after school (e.g. when applying to university or jobs), they simply show that your child learns differently than others and when supported the right way can be just as successful!

There are a number of famous people with a learning disability who are/were leaders in their fields. For example, Alexander Graham Bell who invented the telephone, Walt Disney, the former US president John F. Kennedy, and the actress and now television host Whoopi Goldberg all have/had a diagnosis of dyslexia (a form of reading disorder). At home, and throughout your child’s learning be flexible, understanding, and supportive that children with learning disabilities learn differently. Also don’t be afraid to stand up for his or her learning needs; you are their parent and advocate!

Helpful Links:

Learning Disabilities Association of Canada website: http://www.ldac-acta.ca/learn-more
National Centre for Learning Disabilities: http://www.ncld.org/

Source: Psychology Works Fact Sheet, Canadian Psychological Association,
by Lyndsay Evraire, M.Sc. Created: January 2015

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Attention Deficit Hyperactivity Disorder?

What is attention-deficit/hyperactivity disorder (ADHD)?
ADHD is characterized by developmentally inappropriate levels of inattention, hyperactivity, and impulsivity, that impair a person’s functioning. Some individuals have problems with all three types of symptoms, whereas others have problems primarily with inattention, or primarily with hyperactivity/impulsivity. Related to problems with inattention, people with ADHD often have difficulty following instructions, keeping things organized, and following through on tasks. Related to problems with hyperactivity and impulsivity, they also may tend to act without thinking, interrupt others, talk excessively, or feel fidgety or restless. ADHD begins in childhood and many individuals continue to show ADHD symptoms into adulthood. ADHD occurs in approximately 5-8% of school-aged children and adolescents, and is more common in males than females.

In addition to the problems with inattention, hyperactivity, and impulsivity, people with ADHD often have academic or employment problems and difficulties in their social interactions and relationships. ADHD often co-occurs with problems such as oppositional defiant or conduct disorder, learning disorders, and depression or anxiety disorders.

ADHD appears to have a biological basis, and for some people, it is an inherited condition. However, the specific cause of the disorder is not known and it may differ for different people; it is likely that multiple possible causes or contributing factors exist. The family environment does not cause ADHD, but it may affect the way that symptoms are expressed, as well as help people manage their ADHD.

There is no one test for ADHD that can determine whether someone has the disorder or not. Instead, assessment requires gathering information from several sources (e.g., parents, teachers, observations, testing), across multiple domains (e.g., home and school), and using standardized measures. Assessment should also carefully consider of other possible causes of ADHD symptoms, such as other disorders or stressors. A thorough assessment can be a complex process, and psychologists are well qualified to conduct such assessments.

What psychological treatments are used to treat ADHD?
For most school-aged children and adolescents, the best treatment for ADHD is a combination of behaviour therapy and medication. Behaviour therapy is particularly important in addressing family stress and social behaviour problems in individuals with ADHD, and may help to prevent or treat other problems that can occur with ADHD.

Behaviour therapy involves many techniques and focuses on establishing clear behavioural expectations for the individual and providing frequent and consistent feedback about behaviour, which could include rewards and consequences. Behaviour therapy can also include modeling, problem-solving, and skills training. For children, behaviour therapy is often conducted both in the classroom and at home, and parents and teachers are essential in implementing the therapy. For adolescents and adults, cognitive-behavioural therapy focused on the individual’s self-management of their own behaviours may be useful.

Where do I go for more information?
More information regarding ADHD and effective treatments (psychological and medication) can be found on a website developed by the US National Institute of Health at http://www.nimh.nih.gov/health/publications/adhd-listing.shtml

There is also a website of factsheets operated by Children and Adults with ADHD, an advocacy group, at https://chadd.org/understanding-adhd/adhd-fact-sheets/

Information about psychological interventions for ADHD can also be found in this article:

Evidence-based psychosocial treatments for children and adolescents with attention deficit/hyperactivity disorder, Journal of Clinical Child & Adolescent Psychology, By Evans, S.W., Owens, J.S., Wymbs, B.T., & Ray, A.R. (2018) 47:2, 157-198, DOI: 10.1080/15374416.2017.1390757

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services.

For the names and coordinates of provincial and territorial associations of psychology, go to https://cpa.ca/public/whatisapsychologist/ptassociations/.

This fact sheet has been prepared for the Canadian Psychological Association
by Dr. Amori Yee Mikami, Department of Psychology, University of British Columbia. Revised: January 2021

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