Childhood Trauma Resources

by Aunt Becky | Apr 11, 2019

What Is Trauma?

Trauma is any injury, physically or emotionally inflicted upon a person. Trauma has both a medical and a psychiatric definition. For the purposes of this site, we will focus primarily upon psychological trauma and its effects.

Emotional, or Psychological, Trauma is an intense, emotional reaction to a traumatic or severe situation. Trauma may be caused by stressful events such as natural disasters, incidences of abuse, assault, or death. Trauma can also be caused by more minor events, like a car accident or sports injuries.

A traumatic event involves a single event, or a repeating pattern of events that completely overwhelm an individual’s ability to cope or integrate the emotions involved in that experience. That feeling of being overwhelmed can last days, weeks, even years as the person struggles to cope.

Trauma can be caused by a number of events, but there are a few common aspects. There’s often a violation of the person’s familiar ideas about the world and of their rights, which puts the person into a state of extreme confusion and insecurity.

Psychological trauma may be accompanied by physical trauma or exist independently.

Trauma, while often involving a threat to life or safety, can also involve any situation that leaves you feeling stressed or alone, even if it didn’t involve physical harm. It’s not the objective facts that determine if an event is traumatic, but the subjective emotional experience of the event. The more frightened and helpless you felt at the time, the more likely that you will feel traumatized afterwards.

A traumatic event or situation creates psychological trauma when it overwhelms the individual’s ability to cope, and leaves that person fearing death, annihilation, mutilation, or psychosis. The individual may feel emotionally, cognitively, and physically overwhelmed. The circumstances of the event commonly include abuse of power, betrayal of trust, entrapment, helplessness, pain, confusion, and/or loss.

This definition of trauma is fairly broad. It includes responses to powerful one-time incidents like accidents, natural disasters, crimes, surgeries, deaths, and other violent events. It also includes responses to chronic or repetitive experiences such as child abuse, neglect, combat, urban violence, concentration camps, battering relationships, and enduring deprivation. This definition intentionally does not allow us to determine whether a particular event is traumatic; that is up to each survivor. This definition provides a guideline for our understanding of a survivor’s experience of the events and conditions of their life.

There are two components to a traumatic experience: the objective and the subjective:

It’s is the subjective experience of the objective events that constitutes the trauma. The more you believe you are endangered, the more traumatized you will be. Psychologically, the bottom line of trauma is overwhelming emotion and a feeling of utter helplessness. There may or may not be bodily injury, but psychological trauma is coupled with physiological upheaval that plays a leading role in the long-range effects.

In other words, trauma is defined by the experience of the survivor.

Two people could undergo the same noxious event and one person might be traumatized while the other person remained relatively unscathed. It is not possible to make blanket generalizations such that “X is traumatic for all who go through it” or “event Y was not traumatic because no one was physically injured.” In addition, the specific aspects of an event that are traumatic will be different from one individual to the next. You cannot assume that the details or meaning of an event, such as a violent assault or rape, that are most distressing for one person will be same for another person.

Trauma comes in many forms, and there are vast differences among people who experience trauma. But the similarities and patterns of response cut across the variety of stressors and victims, so it is very useful to think broadly about trauma.

What Conditions Co-Occur in Children And Adults Who Have Experienced Childhood Trauma?

Adults who experienced childhood trauma are at a greater risk for a number of complications and co-occurring disorders that may require diagnosis and treatment:

• Chronic pain and physical illnesses like diabetes or heart disease
• Depression
• Anxiety disorders
• Obsessive-compulsive disorder
• Substance use disorders
• Post-traumatic stress disorder and other trauma-related mental illnesses
• Dissociative disorders
• Self-harm
• Suicide

What Are Some Statistics About Childhood Trauma?

60% of adults report experiencing abuse or other difficult family circumstances during childhood.

26% of children in the United States will witness or experience a traumatic event before they turn four.

Four of every 10 children in American say they experienced a physical assault during the past year, with one in 10 receiving an assault-related injury.

2% of all children experienced sexual assault or sexual abuse during the past year, with the rate at nearly 11% for girls aged 14 to 17.

Nearly 14% of children repeatedly experienced maltreatment by a caregiver, including nearly 4% who experienced physical abuse.

1 in 4 children was the victim of robbery, vandalism, or theft during the previous year.

More than 13% of children reported being physically bullied, while more than 1 in 3 said they had been emotionally bullied.

1 in 5 children witnessed violence in their family or the neighborhood during the previous year.

In one year, 39% of children between the ages of 12 and 17 reported witnessing violence, 17% reported being a victim of physical assault and 8% reported being the victim of sexual assault.

More than 60% of youth age 17 and younger have been exposed to crime, violence and abuse either directly or indirectly.

More than 10% of youth age 17 and younger reported five or more exposures to violence.

About 10% of children suffered from child maltreatment, were injured in an assault, or witnessed a family member assault another family member.

About 25% of youth age 17 and younger were victims of robbery or witnessed a violent act.

Nearly half of children and adolescents were assaulted at least once in the past year.

Among 536 elementary and middle school children surveyed in an inner city community, 30% had witnessed a stabbing and 26% had witnessed a shooting.

Young children exposed to five or more significant adverse experiences in the first three years of childhood face a 76% likelihood of having one or more delays in their language, emotional or brain development.

As the number of traumatic events experienced during childhood increases, the risk for the following health problems in adulthood increases: depression; alcoholism; drug abuse; suicide attempts; heart and liver diseases; pregnancy problems; high stress; uncontrollable anger; and family, financial, and job problems.

People who have experienced trauma are:

• 15 times more likely to attempt suicide
• 4 times more likely to become an alcoholic
• 4 times more likely to develop a sexually transmitted disease
• 4 times more likely to inject drugs
• 3 times more likely to use antidepressant medication
• 3 times more likely to be absent from work
• 3 times more likely to experience depression
• 3 times more likely to have serious job problems
• 2.5 times more likely to smoke
• 2 times more likely to develop chronic obstructive pulmonary disease
• 2 times more likely to have a serious financial problem

What Is a Traumatic Event?

A traumatic event is a frightening, dangerous, or violent event that poses a threat to a child’s life or bodily integrity. Witnessing a traumatic event that threatens life or security of a loved one can also be traumatic, particularly for young children as their sense of safety depends on the safety of their guardians.

Traumatic experiences can lead to strong emotions and physical reactions that may persist long after the event is over. Children may feel terror, helplessness, or fear, as well as physiological reactions such as heart pounding, vomiting, or loss of bowel or bladder control. Children who experience an inability to protect themselves or who lacked protection from others to avoid the consequences of the traumatic experience may also feel overwhelmed by the intensity of their physical and emotional responses.

Who Is At Greater Risk For Childhood Trauma?

Some groups of children and families are disproportionately represented among those experiencing trauma, which means that they may be exposed to trauma at particularly high rates or be at increased risk for repeated victimization and traumatic experiences. For some populations, co-occurring issues and unique adversities can complicate recovery from trauma.

Others may face major challenges related to access to services or require services that are specially adapted for their needs.

Trauma and Substance Abuse:

There is a strong connection between traumatic stress and substance abuse that has implications for children and families, whether the user is an adolescent or a parent or caregiver.

Research studies have shown that adolescents who engage in problematic substance use are more likely to experience traumatic events and develop PTSD, depression, violent behavior, suicide, and other mental health problems compared to those who do not use substances. Additionally, adolescents exposed to traumatic events are more vulnerable to problematic substance use. Psychoactive substances can both dull the effects of stress and place teens at increased risk for experiencing trauma.

Caregiver substance use carries many risks for child and adolescent development. Starting even before children are born, parental substance use increases children’s risk for later mental health problems and victimization. Children and adolescents with substance-using parents may be exposed to other high-risk situations, such as violence in the home and community.

Economic Stress:

Whether living in urban, suburban, or rural settings, people face the reality of economic downturns: being laid off, being unable to find a job, having difficulty supporting a family, or the closing of community organizations or local services upon which they depend. Economic challenges can affect feelings of safety, the ability to remain calm, relationships with others, and hope and belief that things will improve. When times are uncertain, people feel frustrated, angry, scared, or hopeless; they may have to plan new ways to overcome obstacles.

As children hear, see, and read about what is happening in their homes, communities, and the world, they experience economic stress alongside their parents; when their parents are worried, children begin to worry too.

Military and Veteran Families:

Children of military and veteran families experience unique challenges related to military life and culture. These include deployment-related stresses such as parental separation, family reunification, and reintegration; disruption of relationships with friends and neighbors due to frequent moves; and adaptation to new schools and new community resources.

Added to this, some children face the trauma of a parent returning home from combat with injuries or illness; others must face their parent’s death. Research indicates that although most military children are healthy and resilient and have positive outcomes, certain deployment stresses put some groups at risk: young children; children with preexisting health and mental health problems; children whose parents serve in the National Guard, are reserve personnel, or have had multiple deployments; children who do not live close to military communities; children who live in places with limited resources; children in single-parent families with that parent deployed; and children in dual-military parent families with one or both parents deployed.

Intellectual and Developmental Disabilities:

Research indicates that youth living with intellectual and developmental disability (IDD) experience exposure to trauma at a higher rate than their non-disabled peers. Children with IDD appear to be at an increased risk for physical abuse, physical restraint, seclusion, sexual abuse, and emotional neglect. Additionally, this psychological distress comes second to medical problems and procedures and is more common among children living with IDD than their typically developing peers, as they also may have chronic medical problems that necessitate surgeries and other invasive procedures.

When trauma occurs with children and families with IDD, it is challenging to effectively address the psychological impact of the event.

Homeless Youth:

As many as 2.5 million youth per year are homeless. Along with losing their homes, community, friends, and routines – and their sense of stability and safety – many homeless youth are also victims of violence or other traumatic events. While coming from a variety of backgrounds, research suggests that most of these youth have experienced early and multiple traumas. Their responses to these events have been shaped—at least in part—by age, gender, ethnicity, and sexual orientation.

This history of trauma in turn can cause significant mental health problems, including depression, anxiety disorders, PTSD, suicidal ideation, attachment issues, and substance abuse disorders. Once they arrive on the street, many youths are re-traumatized. Then they struggle to recover from earlier traumatic events at the same time that they are trying to survive in a hostile street environment replete with countless dangers, including an increased likelihood of substance abuse and a vulnerability to being trafficked.

LGBTQ Children and Teens:

Lesbian, gay, bisexual, transgender, and queer, or questioning (LGBTQ) youth experience trauma at higher rates than their straight peers. Common traumas experienced by these youth include bullying, harassment, traumatic loss, intimate partner violence, physical and sexual abuse, and traumatic forms of societal stigma, bias, and rejection. Historically, professionals have failed to recognize and meet the needs of traumatized LGBTQ youth, leading to poor engagement and ineffective treatments that, in some cases, perpetuate the youth’s traumatic experiences.

What Experiences Might Be Traumatic?

• Physical, sexual, or psychological abuse and neglect (including human trafficking)
• Bullying is a deliberate and unsolicited action that occurs with the intent of inflicting social, emotional, physical, and/or psychological harm to someone who often is perceived as being less powerful.
• Natural and technological disasters or terrorism
• Family or community violence
• Sudden or violent loss of a loved one
• Substance use disorder (personal or familial)
• Refugee and war experiences (including torture)
• Serious accidents or life-threatening illness
• Military family-related stressors (e.g., deployment, parental loss or injury)

When children have been in situations where they feared for their lives, believed that they would be injured, witnessed violence, or tragically lost a loved one, they may show signs of child traumatic stress.

How Does Trauma Affect Children?

While adults work hard to keep children safe, dangerous events still happen. This danger can come from outside of the family (such as a natural disaster, car accident, school shooting, or community violence) or from within the family, such as domestic violence, physical or sexual abuse, or the unexpected death of a loved one.

Traumatic experiences are often shattering and life-altering for children. These experiences may effect all levels of functioning and result in an array of distressing symptoms:

Physical Symptoms of Exposure to Trauma Can Include:

• nervousness,
• tiredness
• headaches
• stomach aches
• nausea
• palpitations
• pain
• difficulty sleeping
• nightmares
• worsening of existing medical problems

Emotional Symptoms of Exposure to Trauma Can Include:

• fear
• anxiety
• panic
• irritability
• anger
• withdrawal
• numbness
• depression
• confusion
• hopelessness
• helplessness

Academic Symptoms of Exposure to Trauma Can Include:

• inability to concentrate or remember
• missing school
• poor academic performance.

Relational Symptoms of Exposure to Trauma Can Include:

• emotional barriers between caregivers and children
• distrust and feelings of betrayal
• attachment problems

Nearly all trauma survivors have acute symptoms following a traumatic event, but these generally decrease over time.

Factors That Impede Processing Childhood Trauma:

• Previous exposure to trauma: This may include neglect, physical abuse, sexual abuse, or abrupt separation from a caregiver.
• Duration of exposure to trauma: A one-time exposure, such as a car accident, results in very different responses than exposure over several years, such as domestic violence.
• The longer the exposure, the more difficult the healing process.
• Severity of exposure: An incident that happens directly to a child or in front of a child will have different impacts than an incident that happened to someone else or one a child was told about later. The more severe the exposure, the more difficult it will be to heal.
• Prior emotional and behavioral problems: Pre-existing problems with being able to pay attention, being hyperactive, fighting or not following rules, or a prior history of depression or anxiety may complicate a child’s response to a traumatic event.
• Caregiver’s response after the exposure: It matters whether a caregiver validates the child’s experience or blames the child, or if the caregiver is able to provide comfort and reassurance instead of having difficulty responding to the child. When a caregiver experiences a high level of distress, a child often responds similarly. Caregiver’s support is one of the most important factors in a child’s recovery from trauma.

What Is Childhood Traumatic Stress?

Children who suffer from childhood traumatic stress have been exposed to one or more traumas over their lifetime and develop a reaction that lasts longer than the traumatic event; this reaction affects their everyday life.

Traumatic reactions can include a variety of responses, such as intense and ongoing emotional upset, depressive symptoms or anxiety, behavioral changes, difficulties with self-regulation, problems relating to others or forming attachments, regression or loss of previously acquired skills, attention and academic difficulties, nightmares, difficulty sleeping and eating, and physical symptoms, such as aches and pains.

Older children may use drugs or alcohol, behave in risky ways, or engage in unhealthy sexual activity.

Children who suffer from traumatic stress often have these types of symptoms when reminded in some way of the traumatic event.

While many of us may experience reactions to stress some of the time, when a child is experiencing traumatic stress, these reactions interfere with the child’s daily life and ability to function and interact with others. At no age are children immune to the effects of traumatic experiences. Even infants and toddlers can experience traumatic stress. The way that traumatic stress manifests will vary from child to child and will depend on the child’s age and developmental level.

Without treatment, repeated childhood exposure to traumatic events can affect the brain and nervous system and increase health-risk behaviors (such as smoking, eating disorders, substance use, and high-risk activities).

Research shows that child trauma survivors can be more likely to have long-term health problems (such as diabetes and heart disease) or to die much younger than average people. Traumatic stress can also lead to increased use of health and mental health services and increased involvement with the child welfare and juvenile justice systems.

Adult survivors of traumatic events may also have difficulty in establishing fulfilling relationships and maintaining employment.

Factors That May Increase The Likelihood Of Children’s Recovery From Trauma (Resilience Factors)

Individual Traits:

• Easy temperament
• Feeling of control over one’s life
• High self-esteem/self-confidence
• Sense of humor
• Optimism
• Sociable
• Intelligent

Family Traits: 

• Safe, warm, caring, supportive environment
• High expectations for achievement
• Good communication
• Strong family cohesion
• Reasonable structure and limits
• Strong relationship with at least one caregiver

School-Based Traits

• Considers school a safe place to be
• Warm, caring, supportive environment
• High expectations for achievement
• Significant adult committed to child
• Academic achievement
• Models from peers of developmentally appropriate behavior
• Good relationships with peers
• Involvement and participation in school community/activities

Community Traits: 

• Safe community (or safe places to go)
• Access to resources and supports (e.g., church, mentor, clubs)
• Involved in community activities

 Factors That May Interfere With Children’s Recovery From Trauma (Risk Factors):

Individual Traits

• Difficult temperament (e.g., fussy, irritable, sensitive)
• Sense of a lack of control over life events
• Dependency beyond what is age-appropriate
• Low self-esteem/self-confidence
• Feeling of uncertain or poor future outcomes
• Shy/difficulty making friends

Family Traits:

• Physical or sexual abuse, neglect, domestic violence
• High levels of parental distress
• Lack of parental support
• Expectation that child will fail or act out
• Lack of structure, limit-setting
• Negative relationships with caregivers

School-Based Traits

• Exposure to school violence
• Lack of support from adults at school
• Poor academic performance
• Difficulty with peer relationships
• Lack of participation in school community/activities

Community Traits

• Violence in the community
• Unable to identify a safe place to go
• Unable to identify resources or supports in the community
• Disconnected from the community

Childhood Trauma: Reminders and Adversities

Traumatic experiences can set in motion a cascade of changes in children’s lives that can be challenging and difficult. These can include changes in where they live, where they attend school, who they’re living with, and their daily routines. They may now be living with injury or disability to themselves or others. There may be ongoing criminal or civil proceedings they must cope with.

Traumatic experiences leave a legacy of reminders that may persist for years. These reminders are linked to aspects of the traumatic experience, its circumstances, and its aftermath.

Children may be reminded and triggered by persons, places, things, situations, anniversaries, or by feelings such as renewed fear or sadness.

Physical reactions can also serve as reminders and triggers, for example, increased heart rate or bodily sensations.

Learning children’s responses to trauma and loss triggers is an important tool for understanding how and why children’s distress, behavior, and functioning often fluctuate over time. Trauma and loss reminders can reverberate within families, among friends, in schools, and across communities in ways that can powerfully influence the ability of children, families, and communities to recover.

Addressing trauma and loss triggers is critical to enhancing ongoing adjustment.

Childhood Trauma: Risk and Protective Factors

Fortunately, even when children experience a traumatic event, they don’t always develop traumatic stress. Many factors contribute to symptoms, including whether the child has experienced trauma in the past, and protective factors at the child, family, and community levels can reduce the adverse impact of trauma. These may include:

• Severity of the event. How serious was the event? How badly was the child or someone she loves physically hurt? Did they or someone they love need to go to the hospital? Were the police involved? Were children separated from their caregivers? Were they interviewed by a principal, police officer, or counselor? Did a friend or family member die?
• Proximity to the event. Was the child actually at the place where the event occurred? Did they see the event happen to someone else or were they a victim? Did the child watch the event on television? Did they hear a loved one talk about what happened?
• Caregivers’ reactions. Did the child’s family believe that he or she was telling the truth? Did caregivers take the child’s reactions seriously? How did caregivers respond to the child’s needs, and how did they cope with the event themselves?
• Prior history of trauma. Children continually exposed to traumatic events are more likely to develop traumatic stress reactions.
• Family and community factors. The culture, race, and ethnicity of children, their families, and their communities can be a protective factor, meaning that children and families have qualities and or resources that help buffer against the harmful effects of traumatic experiences and their aftermath. One of these protective factors can be the child’s cultural identity. Culture often has a positive impact on how children, their families, and their communities respond, recover, and heal from a traumatic experience. However, experiences of racism and discrimination can increase a child’s risk for traumatic stress symptoms.

What Are Some Effects Of Trauma Among Children?

Unexpectedly losing a loved one or being involved in a natural disaster, motor vehicle accident, plane crash, or violent attack can be overwhelmingly stressful for all of us – especially our children. A traumatic event can undermine their sense of security, leaving them feeling helpless and vulnerable, especially if the event stemmed from an act of violence, such as a physical assault, mass shooting, or terrorist attack. Even kids or teens not directly affected by a disaster can become traumatized when repeatedly exposed to horrific images of the event on the news or social media.

No matter the age of your child, it’s important to offer extra reassurance and support following a traumatic event. A child’s reaction to a disaster or trauma can be greatly influenced by their parents’ response, so it’s important to educate yourself about trauma and traumatic stress.

The more you know about the symptoms, effects, and treatment options, the better equipped you’ll be to help your child recover. With your love and support, the unsettling thoughts and feelings of traumatic stress can start to fade and your child’s life can return to normal in the days or weeks following the event.

What is Acute Traumatic Stress?

Acute trauma is generally a onetime event, such as a car accident or a natural disaster. Because children’s responses to acute trauma vary, awareness of the wide array of possible responses allows caregivers to provide a sense of safety and security, and support healing.

We each have an “alarm system” in our brain that signals us when we might be in danger. When our brain perceives danger, it prepares our body to respond. Our response often depends on the nature of the danger, but we are likely to react in one of three ways:

1. Fight
2. Flight
3. Freeze

Two parts of our brain respond to danger:

The “doing brain” signals the need for action, while the “thinking brain” tries to solve the problem and make a plan.

When the brain perceives danger, the “thinking brain” makes an assessment. If it’s a false alarm because there is no real danger, the “thinking brain” shuts the alarm off and we move on.

If there is actual danger, the “doing brain” signals the body to release chemicals, to provide energy for us to respond.

When this happens, the “thinking brain” shuts off to allow the “doing brain” to take over.

As a result of this alarm system, people often experience intense emotional responses after a traumatic event. These responses are generally short-lived and most people eventually return to their usual level of functioning after the event. To cope with traumatic exposure, people often need time and support to process the event. During this time, any reminder of the event may lead to a reactivation or increase in their responses.

Some people are unable to recover from acute trauma in a timely way. As a result, they are more likely to develop an Acute Stress Disorder or Post-Traumatic Stress Disorder. The type, severity, and duration of exposure to traumatic stress will influence the course of recovery. The situation is compounded for children by their developmental stages.

What Are Childhood Developmental Stages?

As children grow and mature, they are faced with age-specific challenges they must master before moving along to the next stage.

At each developmental stage, a child is faced with different tasks that build upon one another: a toddler learns to explore his world; school-aged children are interested in making friends; an adolescent tries to separate and become more independent.

When faced with traumatic stress, a child’s energy is diverted and she has less capacity to master developmental challenges.

Most children rebound from traumatic experiences and continue to achieve expected developmental milestones. One of the crucial ways children are able to heal is with support from caregivers to make them feel safe, secure, and protected. The level of support a child receives from a caregiver is the most significant factor in how well a child fares after a traumatic event.

Children’s Developmental Stages

Early Childhood (0 – 5 years) The tables below outline primary developmental tasks and how they may be impacted by exposure to an acute traumatic stressor. These tables include developmental tasks from birth to age twelve, and are not inclusive of every developmental task that may occur.

Histrionic Personality Disorder Subtypes (As Suggested by Million)

What Is Complex Trauma in Children?

Children experience complex traumatic stress when they have had prolonged exposure to trauma, (as would occur if the child suffers regular physical or sexual abuse), experience multiple traumatic events over time, or when different traumatic events occur at the same time (such as separation from a parent or caregiver that’s followed by physical abuse, neglect).

Complex trauma profoundly impacts children’s physical, emotional, behavioral, and cognitive development. It impairs their ability to feel safe in the world and to develop sustaining relationships.

Traumatic experiences change the way the brain functions. According to Judith Herman: “Traumatic events produce profound and lasting changes in physiological arousal, emotion, cognition, and memory. Moreover, traumatic events may sever these normally integrated functions from one another.”

The brain’s alarm system prepares the body to respond to danger. The “thinking brain” assesses the situation to determine if there is danger or not.

For children who have experienced multiple traumatic events, such as physical abuse, sexual abuse, or witnessing domestic violence, this danger alarm goes off too often. When faced with repeated alarms, the “thinking brain” gets tired of checking things out, and assumes that the signal always means real danger, which causes the “thinking brain” to shut down and allows the “doing brain” take over.

False alarms or “triggers” can be set off when children hear, see, or feel something that reminds them of previous traumatic events. In the brains of children who have complex trauma, are trained to recognize these triggers, because in the past when they heard, saw, or felt that way, it meant they had to react quickly to a dangerous situation.Triggers can range from loud sounds such as sirens or yelling to smells, subtle facial expressions, or hand gestures. Triggers vary from child to child and are unique to each child’s experience

These triggers may not seem alarming to others, they don’t always seem to make sense to an outsider, including other children. Most of the time, children do not understand why they are acting this way.

Whatever the trigger, it sets off the alarm and the body “fuels” itself to prepare to deal with danger. When the danger is real, this response is helpful. When the body prepares, but there isn’t any danger, the child is left with pent up energy and no outlet. As a result, children may feel angry, want to fight, or hide in a corner to get far away from what their body perceives as danger.

How Does Complex Trauma Effect Children’s Developmental Milestones?

Attachment and Complex Trauma In Children

Attachment is the long-enduring, emotional bond between a child and a primary caregiver, as their caregiver serves as the child’s source of safety, provides for the child’s needs, and guides them in understanding themselves and others. In turn, the child meets the caregiver’s need to provide nourishment and guidance. This is a natural and automatic process that begins from the moment a child is born and a caregiver looks into the infant’s eyes.

Healthy attachments provide the building blocks for later relationships and a child’s ability to master developmental tasks by:

Regulating Emotions And Self-Soothing: A child learns how to calm down when a caregiver uses soothing techniques such as rocking, holding, and cooing. Over time, the child learns how to calm down by himself.

Developing Trust In Others: When the caregiver and child are attuned to each other, the caregiver knows how to respond to the child’s needs and the child learns that he can depend on others, which leaves the child with a sense the world is predictable and safe.

Encouraging Children To Freely Explore Their Environment: As the child has already learned that they can rely on others, they feels safe to explore the world knowing that someone will be there if they are in distress or needs help. This exploration is the way children learn.

Helping Children Understand Themselves And Others: The caregiver-child relationship provides the child with a model for understanding who she is, who the caregiver is, and how the world works. Because the caregiver responds, the world is seen as a safe place where people can be trusted and depended upon.

Teaching Children That They Can Have An Impact On Their World: Through interactions with the caregiver, the child learns that he has an impact on others. The child smiles and the caregiver smiles back; the child laughs and the caregiver plays with her; the child cries and the caregiver picks her up.

This natural process of attachment may be eroded by complex trauma in various ways:

• The caregiver may be the source of the trauma.
• The availability, reliability, or predictability of the caregiver may be limited.
• The child may not learn to regulate his emotions or calm himself down when experiencing intense emotions.
• The child’s ability to learn by exploring the world may take a back seat to the child’s need for protection and safety.
• The child begins to see the world as dangerous, leading to a sense of vulnerability and distrust of others.

As the child has little sense of her impact on others, their lack of control over her life leads to a sense of hopelessness and helplessness.

Coping With Acute And Complex Traumatic Stress in Children:

Suddenly losing a loved one or being involved in a natural disaster, motor vehicle accident, plane crash, or violent attack can be overwhelmingly stressful for children. A traumatic event can undermine their sense of security, leaving them feeling helpless and vulnerable, especially if the event stemmed from an act of violence, such as a physical assault, mass shooting, or terrorist attack. Even kids or teens not directly affected by a disaster can become traumatized when repeatedly exposed to horrific images of the event on the news or social media.Whatever the age of your child, it’s important to offer extra reassurance and support following a traumatic event.

A child’s reaction to a disaster or trauma can be greatly influenced by their parents’ response, so it’s important to educate yourself about trauma and traumatic stress. The more you know about the symptoms, effects, and treatment options, the better equipped you’ll be to help your child recover. With your love and support, the unsettling thoughts and feelings of traumatic stress can start to fade and your child’s life can return to normal in the days or weeks following the event.

When caring for a child who has recently experienced an acute traumatic event, it is helpful to think about meeting the child’s needs for safety, stabilization, and support.

Safety

Acute traumatic experiences challenge children’s idea that the world is a safe and predictable place. When scary things happen, children rely on caregivers to keep them safe. These are some of the ways you can help children feel safe:

Help the child find safe places to go when they’re feeling overwhelmed. At school, perhaps a safe place is in the reading corner, where the child can sit comfortably, look at books, or listen to music until they feel calm again. Perhaps it’s the guidance counselor’s office, the nurses office, or an area of the room separate from the main activities of the class. Ask the child what would make them feel safe when they’re feeling afraid, overwhelmed, or sad. Make sure if the child shows signs of acute traumatic stress (acting up, crying, withdrawing) that you ask the child if they would want to go to the safe place to calm down.

Find safe people for the child to talk with when they feel overwhelmed, asking the child who they feel comfortable being with when they’re upset. Reduce unnecessary secondary exposures and separations.

Routines can be a lifesaver. Tell children what to expect throughout the day, leading them to understand when the routine changes, always helps children feel comforted and secure.

It’s important to note that these children need to feel safe everywhere they go. Some children may feel safe in the classroom, but become overwhelmed in other environments. Helping children throughout the day and beyond the classroom may require communicating with other school personnel about how to accomplish this.

Be aware of Mandated Reporter laws. Many caregivers are required to report suspected abuse to child welfare authorities. Be aware of the laws in your state and work with your team to determine when you should file a report to protect a child.

Stabilization

Children who have been traumatized require stabilization to provide a sense of predictability, consistency, and safety – the very things that are lost when a traumatic event occurs. Stabilization allows children to process their experience and be able to move on.

Create a routine. Structure and predictability help children feel safe and secure.

• Start and end each day in the same way.
• Write down a schedule to be posted next to the child’s bed, on a classroom bulletin board, or at the child’s desk.
• Provide support so that the child and family feel safe and secure
• Help the child to return to typical routines (such as school) as soon as possible

Create a support system for the child; when children are supported by the people around them, their feelings of distress often decrease.

• Maintain a connection with children’s support network. Teachers and primary caregivers should communicate consistently with each other.
• A support system can include a child’s teachers, primary caregivers, as well as family members, guidance counselor, friends/peers, clergy, pediatrician, and neighbors.
• Advocate a supportive role by caregivers and others
• Maintain healthy relationships with the child’s primary caregivers and other close relatives/friends
• Create a supportive milieu for the spectrum of reactions and different courses of recovery
• Encourage and support help-seeking behaviors

Ensure the child’s physical needs are met. Traumatic experiences often affect physical health and emotional health.

• During acute stress following trauma, children may experience headaches, stomach aches, and muscle aches. Determine first if there is a medical cause for these symptoms. If none are found, provide comfort and reassure the child that these feelings happen to many children after a traumatic event. Be matter-of-fact with the child and beware that non-medical complaints too much attention may increase them.
• At home, be sure children sleep nine to ten hours a night, eat well, drink plenty of water, and get regular exercise.
• At school, be sure children drink plenty of water, have a well-balanced lunch, and get exercise during the school day.

 Recognize “triggers.”

Triggers are events/reminders/cues that cause children to become upset again (such as rain or thunder for children who experienced a hurricane). These reminders may seem harmless to other people, but they can be devastating to survivors. These triggers will vary from child to child.

• If a child becomes upset, it may be helpful to explain the difference between the event and reminders of the event.
• Protect children from reminders of the event as much as you can, particularly media coverage.
• Avoid secondary trauma by reducing the child’s exposure

Provide clear and honest answers.

• Be sure children understand the words you use. Find out what other explanations children have heard about the event and clarify inaccurate information. If the danger is far away, be sure to tell the child that it is not nearby. Avoid details that will scare the child.
• Use developmentally appropriately terms when talking about the event and the trauma

Practice relaxation techniques

Deep breathing, listening to soothing music, and muscle relaxation will help children relieve some of their stress.

Children may have trouble sleeping.

• Young children may be scared to be away from their caregivers, particularly at bed or nap times. Reassure the child that she is safe. Spend extra quiet time together at bed or nap time.
• Let the child sleep with a dim light on. Some young children may not understand the difference between dreams and real life, and will need reassurance and help in making this distinction.
• School age children may have sleeping problems due to nightmares. Ask the child to tell you about the bad dreams. Explain that many children have bad dreams after a traumatic event and the dreams will go away.

Self-Care is key

• It is important that caregivers take care of themselves.
• Dealing with traumatized children may trigger intense and difficult feelings in caregivers, leaving them feeling depleted and exhausted.

Minimize media impact:

Children who’ve experienced a traumatic event can often find relentless media coverage to be further traumatizing. Excessive exposure to images of a disturbing event—such as repeatedly viewing video clips on social media or news sites—can even create traumatic stress in children or teens who were not directly affected by the event.

• As much as you can, watch news reports of the traumatic event with your child. You can reassure your child as you’re watching and help place information in context.
• Limit your child’s media exposure to the traumatic event. Don’t let your child watch the news or check social media just before bed, and make use of parental controls on the TV, computer, and tablet to prevent your child from repeatedly viewing disturbing footage.
• Avoid exposing your child to graphic images and videos. It’s often less traumatizing for a child or teen to read the newspaper rather than watch television coverage or view video clips of the event.

Engagement:

You can’t force your child to recover from traumatic stress, but you can play a major role in the healing process by simply spending time together and talking face to face, free from TV, games, and other distractions. Do your best to create an environment where your kids feel safe to communicate what they’re feeling and to ask questions.

• Provide your child with ongoing opportunities to talk about what they went through or what they’re seeing in the media. Encourage them to ask questions and express their concerns but don’t force them to talk.
• Young children may have trouble expressing their feelings. Encourage them to put their feelings into words, such as anger, sadness, and worry about the safety of friends and family. Don’t force them to talk, but let them know that they can at any time.
• School age children may have concerns that they were to blame or should have been able to change what happened, and may hesitate to voice these concerns to others. Provide a safe place for them to express their fears, anger, sadness. Remind them that they can cry or be sad. Don’t expect them to be brave or tough. Offer reassurance and explain why it wasn’t their fault.
• Facilitate open but not forced communication with the child about his/her reactions to the traumatic event
• Focus on constructive responses
• Talk to child in developmentally appropriate terms
• Acknowledge and validate your child’s concerns. The traumatic event may bring up unrelated fears and issues in your child. Comfort for your child comes from feeling understood and accepted by you, so acknowledge their fears even if they don’t seem relevant to you.
• Young children may not have the words to express their fears, but may be able to process their emotions through play and drawing.
• School age children may retell or play out the traumatic event repeatedly. Allow the child to talk and act out these reactions. Let them know that many children respond to events like this in similar ways. Encourage positive problem-solving in play or drawings.
• Encourage children to write or draw. Suggest to children that they write about or make drawings of their experiences without forcing them to do so.
• Engage in positive distracting activities such as playing sports, games, reading, and hobbies
• Reassure your child. The event was not their fault, you love them, and it’s OK for them to feel upset, angry, or scared.
• Don’t pressure your child into talking. It can be very difficult for some kids to talk about a traumatic experience. A young child may find it easier to draw a picture illustrating their feelings rather than talk about them. You can then talk with your child about what they’ve drawn.
• Be honest. While you should tailor the information you share according to your child’s age, honesty is important. Don’t say nothing’s wrong if something is wrong.
• Do “normal” activities with your child that have nothing to do with the traumatic event. Encourage your child to seek out friends and pursue games, sports, and hobbies that they enjoyed before the incident. Go on family outings to the park or beach, enjoy a games night, or watch a funny or uplifting movie together.

Encourage physical activity:

Physical activity can burn off adrenaline, release mood-enhancing endorphins, and help your child sleep better at night.

• Find a sport that your child enjoys. Activities such as basketball, soccer, running, martial arts, or swimming that require moving both the arms and legs can help rouse your child’s nervous system from that “stuck” feeling that often follows a traumatic experience.
• Offer to participate in sports, games, or physical activities with your child. If they seem resistant to get off the couch, play some of their favorite music and dance together. Once a child gets moving, they’ll start to feel more energetic.
• Encourage your child to go outside to play with friends or a pet and blow off steam.
• Schedule a family outing to a hiking trail, swimming pool, or park.
• Take younger children to a playground, activity center, or arrange play dates.

Eat Well:

The food your child eats can have a profound impact on their mood and ability to cope with traumatic stress. Processed and convenience food, refined carbohydrates, and sugary drinks and snacks can create mood swings and worsen symptoms of traumatic stress. Conversely, eating plenty of fresh fruit and vegetables, high-quality protein, and healthy fats, especially omega-3 fatty acids, can help your child better cope with the ups and downs that follow a disturbing experience.

• Focus on overall diet rather than specific foods. Kids should be eating whole, minimally processed food—food that is as close to its natural form as possible.
• Limit fried food, sweet desserts, sugary snacks and cereals, and refined flour. These can all exacerbate symptoms of traumatic stress in kids.
• Be a role model. The childhood impulse to imitate is strong so don’t ask your child to eat vegetables while you gorge on soda and French fries.
• Cook more meals at home. Restaurant and takeout meals have more added sugar and unhealthy fat so cooking at home can have a huge impact on your kids’ health. If you make large batches, cooking just a few times can be enough to feed your family for the whole week.
• Make mealtimes about more than just food. Gathering the family around a table for a meal is an ideal opportunity to talk and listen to your child without the distraction of TV, phones, or computers.

Rebuilding trust and safety:

Trauma can alter the way a child sees the world, making it suddenly seem a much more dangerous and frightening place. Your child may find it more difficult to trust both their environment and other people. You can help by rebuilding your child’s sense of safety and security.

As children look to their caregivers to provide safety and security. Try not to voice your own fears in front of the child. Remind the child that people are working to keep them safe. Help the child regain confidence that you aren’t leaving him and that you can protect him.

The child may need on-going support long after the traumatic experience has occurred.

• Create routines. Establishing a predictable structure and schedule to your child’s or teen’s life can help to make the world seem more stable again. Try to maintain regular times for meals, homework, and family activities.
• Minimize stress at home. Try to make sure your child has space and time for rest, play, and fun.
• Manage your own stress. The more calm, relaxed, and focused you are, the better you’ll be able to help your child.
• Speak of the future and make plans. This can help counteract the common feeling among traumatized children that the future is scary, bleak, and unpredictable.
• Keep your promises. You can help to rebuild your child’s trust by being trustworthy. Be consistent and follow through on what you say you’re going to do.
• If you don’t know the answer to a question, don’t be afraid to admit it. Don’t jeopardize your child’s trust in you by making something up.
• Remember that children often personalize situations. They may worry about their own safety even if the traumatic event occurred far away. Reassure your child and help place the situation in context.

When Do I Seek Help For Childhood Traumatic Stress?

Usually, your child’s feelings of anxiety, numbness, confusion, guilt, and despair following a traumatic event will start to fade within a relatively short time. However, if the traumatic stress reaction is so intense and persistent that it’s interfering with your child’s ability to function at school or home, they may need help from a doctor, preferably a trauma specialist.

Warning signs include:

• Six weeks have passed, and your child is not feeling any better
• Your child is having trouble functioning at school
• Your child is experiencing terrifying memories, nightmares, or flashbacks
• The symptoms of traumatic stress manifest as physical complaints such as headaches, stomach pains, or sleep disturbances
• Your child is having an increasingly difficult time relating to friends and family
• Your child or teen is experiencing suicidal thoughts
• Your child is avoiding more and more things that remind them of the traumatic event

How Is Childhood Traumatic Stress Treated?

Immediate support for a child who has experienced trauma can help prevent many of the negative consequences. In some cases, the nurturing and support of parents and other family or caregivers is enough to avoid long-term harm. For those children who need professional care, mental health professionals may use cognitive behavioral therapy or trauma-focused therapies to help them learn to cope in healthy ways.

Cognitive-behavioral therapies are still the leading choice by most therapists, especially as the available research tends to be far stronger than research looking at psychoanalytic or purely medication-based treatment, which doesn’t address the underlying issues related to the trauma.

Although there are other CBT approaches that are used to treat trauma in children and adolescents including exposure therapy, art therapy and EMDR, a CBT-type approaches seem to work best for dealing with post-traumatic symptoms. All CBT methods that have been developed specifically for younger clients, there are some common features:

• Education to teach children about traumatic stress and the effects it can have on them
• Relaxation techniques
• A trauma narrative that encourages children to describe their experience in detail
• Cognitive restructuring to correct thoughts about the traumatic experience.

For all of the recognized CBT approaches for treating traumatized children, it is vital that children be encouraged to face their traumatic experience gradually and only in a way that they can handle emotionally. Since all children do not develop emotionally at the same pace, a therapist must tailor the treatment to the child’s level of emotional and cognitive development. If not, the therapist could end up doing more harm than good by re-traumatizing and re-exposing their child patients.

While CBT was first developed for trauma in adults and later adapted to adolescents, the special needs that adolescent trauma patients have has inspired the development of treatment methods focusing on children and adolescents alone. These treatment approaches include:

Multi-modality trauma treatment (MMTT) – was developed in 1998, MMTT is based on the idea that trauma at a young age can disrupt normal physical and emotional development and uses age-appropriate CBT strategies to help children or adolescents cope with trauma.  Usually seen in school settings, these programs have a format that can include education, narrative writing (writing about the traumatic experience), exposure, relaxation techniques, and cognitive restructuring. Empirical studies of MMTT have shown marked reduction in trauma symptoms with similar results for symptoms of depression, anger and anxiety. The advantage of using this type of therapy is that it was specifically developed for traumatized adolescents; however the nature of this therapy tends to focus on adolescents who have experienced only one traumatic event, but may be used in children who have experience many different traumas.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) – developed in 2006, this type of treatment was developed specifically for children between the ages of three and eighteen who have experienced trauma. Treatment using TF-CBT can include a number of sessions involving the child alone or the child and a parent/caregiver. The goal of this type of therapy is to help children and adolescents learn coping skills that will help them deal with traumatic memories. In treatment, children receive education, are taught relaxation skills, as well as affective expression and modulation, and cognitive coping skills. Children are also encouraged to use trauma narration and to cognitively process the trauma, use exposure to master trauma reminders, have parent/child sessions, and increase their feelings of safety.

Stanford Cue-Centered Therapy (SCCT) – Developed Stanford School of Medicine’s Early Life Stress Research Program, this is a short-term treatment approach that uses one-on-one therapy for children and adolescents dealing with trauma. It was created to treat problems with a child’s cognitive, affective, behavioral, and physical functioning, and uses cognitive-behavioral techniques, relaxation training, narrative use, and parental coaching. The goal of this type of therapy is to reduce the child’s negative thoughts and beliefs as well as sensitivity to traumatic memory. This form of therapy encourages children to build coping skills including relaxation and self-empowerment, and helps children to learn how trauma affects them, while teaching them that they are able to control how they respond to traumatic triggers.

Seeking Safety was developed for use with substance abuse and trauma in adults and adolescents, Seeking Safety was specifically adapted for treating adolescents and, like the other treatment models, uses education, training in specific coping skills, and cognitive restructuring. Parental involvement is only needed in one Seeking Safety session.

Seeking Safety has five principles:

1. Personal safety is a priority
2. Integrated trauma and substance abuse therapy
3. Focusing upon the child’s needs
4. Attention to the therapeutic process
5. Focuses on thoughts, behaviors, interpersonal interactions, as well as case management.

Tips For Caregivers Of Children Who Have Acute And Complex Trauma:

Caring for children after a traumatic event is incredibly stressful. Caregivers or parents work to make sure their children’s needs are met, which can be draining and rewarding at the same time. Many caregivers report that they become extremely frustrated with the things they cannot control.

To understand self-care, you must understand what self-care is not:

• Self-care is not an “emergency response plan” to be activated when stress becomes overwhelming.
• Self-care is not about acting selfishly (“It’s all about me!”).
• Self-care is not about doing more or adding more tasks to an already overflowing “to-do” list. Healthy self-care can renew our spirits and help us to become more resilient.
• Self-care is most effective when approached proactively, not reactively.

Think of self-care as having three basic aspects: awareness, balance, and connection — the “ABC’s” of self-care.

Awareness:

Self-care begins while being quiet. By quieting our busy lives and entering into a space of solitude, we can become awareness of our own needs, then act accordingly. This is the contemplative way of the desert, rather than the constant activity of the city. Too often we act first, without real understanding, then wonder why we feel more burdened rather than relieved.

Balance:

Self-care is a balancing act between action and mindfulness. Balance guides decisions about embracing or relinquishing certain activities, behaviors, or attitudes. It also informs the degree to which we give attention to the physical, emotional, psychological, spiritual, and social aspects of our being. In other words, how much time we spend working, playing, and resting. Think of this healthy prescription for balanced daily living: eight hours of work, eight hours of play, and eight hours of rest!

Connection:

Healthy self-care cannot take place solely within oneself. It involves being connected in meaningful ways with others and to something larger. We are interdependent and social beings. We grow and thrive through connections that occur in friendships, family, social groups, nature, recreational activities, spiritual practices, therapy, and a myriad of other ways.

There is no formula for self-care. Each of our “self-care plans” will be unique and change over time. As we seek renewal in our lives and work, we must listen well to our own bodies, hearts, and minds as well as to trusted friends. Caregivers should rely on other adults and support systems (such as a support group or church) to help meet their own emotional needs so they will have enough energy to support a child who is stressed.

Hotlines For Childhood Trauma:

Childhelp National Child Abuse Hotline

800-4-A-CHILD (800-422-4453)
The mission of the Childhelp hotline is to provide help or answer questions about child abuse or neglect 24 hours a day.

FEMA Disaster Aid Hotline

800-621-FEMA
This hotline is available to provide direct and financial assistance to individuals, families, and businesses in an area whose property has been damaged or destroyed by disaster.

National Center for Missing and Exploited Children

800-THE-LOST (800-843-5678)
The mission of the National Center for Missing and Exploited Children is to help prevent child abduction and sexual exploitation; provide assistance with finding missing children; and assist victims of child abduction and sexual exploitation, their families, and the professionals who serve them 24 hours a day.

Center For Victims of Crimes

800-FYI-CALL (800-394-2255)
The National Center for Victims of Crime provides information, education, and referrals to local resources across the country. The hotline is available Monday through Friday from 8:30 am to 8:30 pm and is offered in numerous languages.

National Domestic Violence Hotline

800-799-SAFE (800-799-7233) and 800-787-3224 (TDD)
The mission of the National Domestic Violence Hotline is to provide crisis intervention, safety planning, information, and referrals for individuals experiencing domestic violence. The hotline is available 24 hours a day, and assistance is offered in numerous languages.

Mental Health America

800-969-6MHA (6642)
The mission of MHA is to promote mental wellness for the health and well-being of the nation. MHA offers information and resources on numerous mental health topics.

National Organization for Victim Assistance

800-TRY-NOVA (800-879-6682)
NOVA’s mission is to promote rights and services for victims of crime and crisis. The hotline provides information and referrals and is available 24 hours a day.

Homelessness Resource Center

617-467-6014
The Center is focused on the effective organization and delivery of services for people who are homeless and who have serious mental illnesses by providing technical assistance and training.

National Sexual Assault Hotline

800-656-HOPE (800-656-4673)
This hotline is operated by the Rape, Abuse & Incest National Network (RAINN), which also carries out programs to help prevent sexual assault, assist victims, and ensure that perpetrators are brought to justice.

National Suicide Prevention Lifeline

800-273-TALK (800-273-8255)

This suicide prevention service is available to anyone in suicidal crisis and is available 24/7.

National Teen Dating Abuse Helpline

866-331-9474 and 866-331-8453 (TTY)
This hotline was created to help teens ages 13-18 that experience dating abuse and it is available 24/7.

SAMHSA’s National Clearinghouse for Alcohol and Drug Information

800-729-6686
The Clearinghouse is a one-stop resource for information about substance abuse prevention and addiction treatment.

SAMHSA’s Substance Abuse Treatment Facility Locator

800-662-HELP (4357); 800-487-4889 (TDD); 877-767-8432 (Español)
A searchable directory of drug and alcohol treatment programs that shows the location of facilities around the country that treat alcoholism, alcohol abuse, and drug abuse problems.

Witness Justice

800-4WJ-HELP (800-495-4357)
Witness Justice is a national grassroots organization that provides assistance, support, and advocacy for survivors of violence and trauma.

Additional Childhood Traumatic Stress Resources:

Center For Trauma, Assessment, Intervention Services, and Treatment: The purpose of our Center is to provide national expertise on interventions for the developmental effects of trauma across child-serving settings, including child welfare, behavioral health, educational and juvenile justice settings.

Child Mind Institute offers Free Trauma Resources in a number of languages, all of which can be used to help the child recover from the trauma and heal the family as well.

Child Welfare.Org offers a number of free programs for children and their families who are coping with different types of trauma.

Substance Abuse and Mental Health Services Administration: This US government site helps to identify a number of different types of trauma, including reading on military families, substance abuse, for families, and for educators.

Autism and ASD Spectrum Disorders In Children

by Aunt Becky | Apr 9, 2019

What Is Autism?

An Autism Spectrum Disorder (ASD) is a range of complex neurological conditions marked by communication disorders, social impairments, and repetitive behaviors by the time a child is three years old. Those who have an autism spectrum disorders handle information in the brain differently than other people.In the psychiatric community, thinking about autism has changed, as reflected in the new DSM-5 guidelines.

What had been considered a set of distinct conditions described as pervasive developmental disorders — autism, Asperger’s disorder, childhood disintegrative disorder (CDD), and pervasive developmental disorder not otherwise specified (PDD-NOS) — are now considered one disorder that presents along a spectrum of symptoms and behaviors of varying severity.

Autism spectrum disorder (ASD) impacts a child’s development in two core areas: the first is social communication and social interaction, and the second is restricted, repetitive patterns of behavior and interests. Although a child is born with an ASD, we may not see the sign until social demands exceed a child’s limitations.

We understand that there is not one specific autism but many subtypes, most influenced by a combination of genetic and environmental factors. Because autism occurs on a spectrum, each person with autism has a distinct set of strengths and challenges. The ways in which people with autism learn, think, and problem-solve can range from highly skilled to severely challenged. Some people with ASD may require significant support in their daily lives, while others may need less support and, in some cases, live entirely independently.

Several factors may influence the development of autism, and it is often accompanied by sensory sensitivities and medical issues such as gastrointestinal (GI) disorders, seizures or sleep disorders, as well as mental health challenges such as anxiety, depression, and attention issues.

Indicators of autism usually appear by age 2 or 3. Some associated development delays may appear even earlier, and often, it can be diagnosed as early as 18 months.  From as early as 1 to 2 years of age, people with ASD have an impaired ability to interact with other people; they are often more comfortable dealing with objects. These affected children have difficulty understanding and using non-verbal social cues such as eye contact, facial expressions, gestures, and body language. The inability to recognize and use these cues makes it hard for affected children to understand the feelings of others or communicate their own feelings appropriately. Behavioral signs of ASD, such as reduced eye contact and social interaction, can sometimes be detected before age 2. However, the condition is usually diagnosed between ages 2 and 4, when more advanced communication and social skills, such as learning to play with others, typically begin to develop. Research clearly shows that early intervention leads to positive outcomes later in life for people with autism.

Autism is not a single disorder, but a spectrum of closely related disorders with a shared core of symptoms. Every person on the autism spectrum has problems (to some degree) with social interaction, empathy, communication, and flexible behavior. But the level of disability and the combination of symptoms varies tremendously from person to person. In fact, two kids with the same diagnosis may look very different when it comes to their behaviors and abilities.

No matter what doctors, teachers, and other specialists call the autism spectrum disorder, it’s your child’s unique needs that are truly important. No diagnosis can tell you exactly what challenges your child will have. Finding treatment that addresses your own child’s needs, rather than focusing on what to call the problem, is the most helpful thing you can do. You don’t need a diagnosis to start getting help for your child’s symptoms.

Keep in mind that just because your child has a few autism-like symptoms, it doesn’t mean he or she has Autism Spectrum Disorder. Autism Spectrum Disorder is diagnosed based on the presence of multiple symptoms that disrupt a person’s ability to communicate, form relationships, explore, play, and learn.

Several diagnoses that used to be classified as separate conditions are now grouped together under the diagnosis of ASD. For example, autistic disorder was a term that was used when affected people had limited or absent verbal communication, often in combination with intellectual disability. By contrast, Asperger syndrome was a diagnosis formerly applied to affected individuals of average or above-average intelligence who were not delayed in their language development.

This broader diagnosis of ASD was established because many people fall outside of the strict definitions of the narrower diagnoses, and their intellectual and communication abilities may change over time. However, this also means that some individuals who were previously diagnosed with one of the subtypes now do not meet all the criteria of the new umbrella diagnosis.

Autism Spectrum Disorders, including Asperger’s Syndrome – which is no longer a diagnosis in the DSM-V, though it remains well used for psychiatrists and their patients  – represent a continuum of disorders ranging from mild to very severe. While those with ASDs share similar problems, there are many differences in onset, severity and nature of symptoms.

ASDs occur across all racial, ethnic and socioeconomic groups and ASDs are four times more likely to occur in boys than in girls.

What’s With All Of The Name Changes?

There is a great deal of confusion about the names of various autism-related disorders. Some professionals speak of “the autisms” to avoid addressing the usually subtle differences among the conditions along the autism spectrum. Up until the release of the DSM-V in 2013, there were five different “autism spectrum disorders.” These differences among those five made it hard for parents trying to figure out which – if any – of these conditions affected their child.

If you’re a parent raising a child on the autism spectrum, you may hear many different terms including high-functioning autism, atypical autism, autism spectrum disorder, and pervasive developmental disorder. These terms can be confusing, not only because there are so many, but because doctors, therapists, and other parents may use them in dissimilar ways.

Things To Look For In Your Child:

As a parent, you’re in the best position to spot the earliest warning signs of autism. You know your child better than anyone and observe behaviors and quirks that a pediatrician, in a quick fifteen-minute visit, might not have the chance to see. Your child’s pediatrician can be a valuable partner, but don’t discount the importance of your own observations and experience. The key is to educate yourself so you know what’s normal and what’s not.

If autism is caught in infancy, treatment can take full advantage of the young brain’s remarkable plasticity. Although autism is hard to diagnose before 24 months, symptoms often surface between 12 and 18 months. If signs are detected by 18 months of age, intensive treatment may help to rewire the brain and reverse the symptoms.

The earliest signs of autism involve the absence of normal behaviors—not the presence of abnormal ones—so they can be tough to spot. In some cases, the earliest symptoms of autism are even misinterpreted as signs of a “good baby,” since the infant may seem quiet, independent, and undemanding. However, you can catch warning signs early if you know what to look for.

Some autistic infants don’t respond to cuddling, reach out to be picked up, or look at their mothers when being fed.

Early signs: Your baby or toddler doesn’t:

• Make eye contact, such as looking at you when being fed or smiling when being smiled at
• Respond to his or her name, or to the sound of a familiar voice
• Follow objects visually or follow your gesture when you point things out
• Point or wave goodbye, or use other gestures to communicate
• Make noises to get your attention
• Initiate or respond to cuddling or reach out to be picked up
• Imitate your movements and facial expressions
• Play with other people or share interest and enjoyment
• Notice or care if you hurt yourself or experience discomfort

Regression of any kind is a serious autism warning sign: Some children with autism spectrum disorder start to develop communication skills and then regress, usually between 12 and 24 months. For example, a child who was communicating with words such as “mommy” or “up” may stop using language entirely, or a child may stop playing social games he or she used to enjoy such as peek-a-boo, patty cake, or waving “bye-bye.” Any loss of speech, babbling, gestures, or social skills should be taken very seriously, as regression is a major red flag for autism.

Monitor your child’s development: Autism involves a variety of developmental delays, so keeping a close eye on when—or if—your child is hitting the key social, emotional, and cognitive milestones is an effective way to spot the problem early on. While developmental delays don’t automatically point to autism, they may indicate a heightened risk.

Take action if you’re concerned: Every child develops at a different pace, so you don’t need to panic if your child is a little late to talk or walk. When it comes to healthy development, there’s a wide range of “normal.” But if your child is not meeting the milestones for his or her age, or you suspect a problem, share your concerns with your child’s doctor immediately. Don’t wait.

Don’t accept a wait-and-see approach: Many concerned parents are told, “Don’t worry” or “Wait and see.” But waiting is the worst thing you can do. You risk losing valuable time at an age where your child has the best chance for improvement. Furthermore, whether the delay is caused by autism or some other factor, developmentally delayed kids are unlikely to simply “grow out of” their problems. In order to develop skills in an area of delay, your child needs extra help and targeted treatment.

Trust your instincts. Ideally, your child’s doctor will take your concerns seriously and perform a thorough evaluation for autism or other developmental delays. But sometimes, even well-meaning doctors miss red flags or underestimate problems. Listen to your gut if it’s telling you something is wrong, and be persistent. Schedule a follow-up appointment with the doctor, seek a second opinion, or ask for a referral to a child development specialist.

Developmental Red Flags Parents Should Watch For:

What Causes Autism?

One of the most common questions asked after diagnosis of autism is: “what caused the disorder?”

Currently we understand that there’s no singular cause of autism. Research leans toward the idea that autism develops from a combination of genetic, non-genetic, and environmental, influences working together.

Some of these influences appear to increase the risk that a child will develop autism, but it’s important to remember that increased risk factors are not the same as cause. As an example, certain gene changes that have been identified as associated with autism are also found in people who don’t have the disorder. Likewise, not everyone exposed to an environmental risk factor for autism will develop the disorder; in fact, most will not.

Genetics:

ASD has a tendency to run in families, but the inheritance pattern is usually unknown. People with gene changes associated with ASD generally inherit an increased risk of developing the condition, rather than the condition itself. When ASD is a feature of another genetic syndrome, it can be passed on according to the inheritance pattern of that syndrome.

If a parent carries one or more of these gene changes, they may get passed to a child (even if the parent does not have autism). Other times, these genetic changes arise spontaneously in an early embryo or the sperm and/or egg that combine to create the embryo. Again, the majority of these gene changes do not cause autism by themselves. They simply increase risk for the disorder.

Changes in over 1,000 genes have been reported to be associated with ASD, however a large number of these associations have not yet been confirmed. Many common gene variations, most of which have not been identified yet, are thought to affect the risk of developing ASD, however it must be noted that not all people with the gene variation will be affected.

Most of the gene variations have only a small effect, and variations in many genes can combine with environmental risk factors, such as parental age, birth complications, and others that have not been identified, to determine an person’s risk of developing autism. Non-genetic factors may contribute up to about 40 percent of the risk for development of ASDs.

In about 2 to 4 percent of people with ASD, rare gene mutations or chromosome abnormalities are thought to be the cause of the condition, often as a feature of other syndromes that involve additional signs and symptoms affecting various parts of the body. For example, mutations in the ADNP gene cause a disorder called ADNP syndrome. In addition to ASD and intellectual disability, this condition involves distinctive facial features and a wide variety of other signs and symptoms. Other syndromes can include Fragile X Syndrome and Tuberous Sclerosis. Some of the other genes in which rare mutations are associated with ASD, often with other signs and symptoms, are ARID1B, ASH1L, CHD2, CHD8, DYRK1A, POGZ, SHANK3, and SYNGAP1, but the significance is currently unknown. In most people who have ASD caused by rare gene mutations, the mutations occur in only a single gene.

Many of the genes associated with ASD involve the development of the brain. The proteins produced from these genes affect multiple aspects of brain development, including production, growth, and organization of neurons. Some affect the number of neurons that are created, while others involve the development or function of the connections between neurons (synapses) where cell-to-cell communication takes place, or of the cell projections (dendrites) that carry signals received at the synapses to the body of the neuron. Many genes affect development by controlling (regulating) the activity of other genes or proteins.

The specific ways that changes in these and other genes relate to the development of ASD are unknown. Studies indicate that during brain development, some people with ASD have more neurons than normal and overgrowth in parts of the outer surface of the brain (the cortex). Additionally, there are often patchy areas where the normal structure of the layers of the cortex is disturbed. Normally the cortex has six layers, which are established during development before birth, and each layer has specialized neurons and different patterns of neural connection. The neuron and brain abnormalities occur in the frontal and temporal lobes of the cortex, which are involved in emotions, social behavior, and language. These abnormalities are believed to underlie the differences in socialization, communication, and cognitive functioning characteristic of ASD.

Environmental Risk Factors:

The role of environmental factors in the development of autism is a crucial area of study. We know that genetics strongly influence the risk for developing autism spectrum disorder (ASD). However, genetics alone do not account for all instances of autism. For good reason, the increasing prevalence of autism has generated great interest in the potential involvement of toxins in our environment. For example, prenatal exposure to the chemicals thalidomide and valproic acid has been linked to increased risk of autism and other disorders.

However, it must be made clear that there are any number of factors that are being currently (or will be) studied to determine the pertinent environmental factors – and not all the research is conclusive.

The most widely accepted risk factors operate during gestation or around the time of birth. Various pregnancy and birth complications, such as maternal hypertension, abdominal bleeding, as well as prematurity, preterm labor, low birth weight, maternal diabetes have been causally linked to the development of autism.

Also noted, the maternal immune system appears to play a role in autism risk. Infections (especially those that cause fever), serious illnesses (like the flu), and hospitalizations during pregnancy have been linked to an increased risk of autism in a child. Women with autoimmune diseases, in which the body attacks its own tissues, are also at an elevated risk of having an autistic child.

Exposure to the drug valproate, which is used to treat bipolar disorder and epilepsy, in the womb is known to increase the risk of autism, as well as a variety of birth defects.

Other Associated Risk Factors:

• Advanced parent age (either parent)
• Pregnancy and birth complications (e.g. extreme prematurity [before 26 weeks], low birth weight, multiple pregnancies [twin, triplet, etc.])
• Abdominal bleeding during pregnancy
• Pregnancies spaced less than one year apart

Decreased risk:

• Prenatal vitamins containing folic acid, before and at conception and through pregnancy

No Effect On Risk:

• Vaccines. Each family has a unique experience with an autism diagnosis, and for some it corresponds with the timing of their child’s vaccinations. At the same time, scientists have conducted extensive research over the last two decades to determine whether there is any link between childhood vaccinations and autism. The bogus “research” that purported to show a causal link was fraudulent and has been retracted, and no reliable evidence has ever emerged to support it. The results of this research is clear: Vaccines do not cause autism. The American Academy of Pediatrics has compiled a comprehensive list of this research.
• Maternal Vaccinations During Pregnancy: Despite the links between maternal immune factors and autism, routine vaccinations given during pregnancy, such as those against influenza and whooping cough, do not appear to boost autism risk.
• Maternal Smoking: Scientists have also exonerated smoking during pregnancy as a contributor to autism. Of course, smoking during pregnancy is harmful for many other reasons and should never be encouraged.

How do these genetic and nongenetic influences give rise to autism? Most appear to affect crucial aspects of early brain development. Some appear to affect how brain nerve cells, or neurons, communicate with each other. Others appear to affect how entire regions of the brain communicate with each other. Research continues to explore these differences with the aim to developing treatments and supports that can improve quality of life.

While scientists have not pinpointed an exact cause for autism, it’s likely that environmental and genetics work together to cause autistic spectrum disorders. A number of genes are associated with autistic spectrum disorders, as are certain brain irregularities.

And, please let me say it again:

It has been disproved time and time again that autism is caused by vaccines. Autism is in no way related to vaccinations.

What Are Common Signs and Symptoms of Autism?

Signs of autism spectrum disorders usually begin before age three and last a person’s lifetime – although the severity of symptoms may diminish over time. Children with autism spectrum disorder are characterized by a combination of two unique kinds of behaviors: problems in communication and social skills, as well as restricted or repetitive behaviors. These symptoms, as this is a spectrum disorder, will vary greatly in severity from child to child – even within families.

It’s important to note that while many of these behaviors occur in children with autism, autism is a SPECTRUM disorder, meaning that the severity of the symptoms will vary from child to child. Some infants display symptoms of autism spectrum disorders, while other children may not exhibit signs of autism until 24 months old. The hallmark of autism is impaired social interaction with adults, parents, and other children.

Social Behavior And Social Understanding:

The signs of social deficits you may see in a developing child include aversion and avoidance of displays of affection such as cuddling and hugging, with a preference for solitary play. In kids under 3, you may note a failure to respond to their own name ass a red flag, as is disinterest in giving, sharing, or showing objects of interest. In older children, warning signs can include difficulty carrying on a conversation with someone else, a profound lack of eye contact, as well as difficulty using and reading body language. Children who may fall on the ASD spectrum, may have difficulty recognizing others’ emotions, responding appropriately to different social situations, and a decided lack of understanding social relationships.

While social and communication difficulties and unusual behaviors define ASD, affected individuals can have a wide range of intellectual abilities and language skills. The majority of people with autism have mild to moderate intellectual disability, while others have average to above-average intelligence. Some have particular cognitive abilities that greatly surpass their overall level of functioning, often in areas such as music, mathematics, or memory.

Some people with ASD do not speak at all, while others use language fluently. However, fluent speakers with ASD often have problems associated with verbal communication. They might speak in a monotone voice, have unusual vocal mannerisms, or choose unusual topics of conversation. Some children with autism don’t talk; while others talk in a stilted, “robotic” tone, or in an exaggerated singsong. A child with autism may also repeat certain phrases without appearing to understand their significance, or possess what experts call “non-functional knowledge”- information the child can recite, but not actually use to solve problems or carry on a conversation.

Young children who have autism don’t point at objects of interest, don’t make eye contact, and don’t use gestures to communicate a need or describe something.

As kids with autism age and acquire language skills, their tone or pattern of speech can be odd; some have a habit of reversing pronouns – a child asking his mom for juice might say “You want juice” instead of “I want juice.” High-functioning children with autism may monopolize conversations while showing little capacity for reciprocity, or  displaying any type understanding what the other party wants or feels.

Basic social interaction can be difficult for children with Autism Spectrum Disorders. Signs may include:

• Resistance to being touched
• Difficulty or failure to make friends with children the same age
• Unusual or inappropriate body language, gestures, and facial expressions (like avoiding eye contact or using facial expressions that don’t match what he or she is saying)
• Lack of interest in other people or in sharing interests or achievements (showing you a drawing, pointing to a duck)
• Unlikely to approach others or to pursue social interaction; comes across as aloof and detached; prefers to be alone
• Difficulty understanding other people’s feelings, reactions, and nonverbal cues

Speech And Language

Many children with Autism Spectrum Disorder struggle with speech and language comprehension. Signs can include:

• Delay in learning how to speak (after the age of two) or the child may be nonverbal
• Speaking in an abnormal tone of voice, or with an odd rhythm or pitch
• Repeating words or phrases over and over without communicative intent
• Trouble starting a conversation or keeping it going
• Difficulty communicating needs or desires
• Doesn’t understand simple statements or questions
• Taking what is said too literally, missing humor, irony, and sarcasm

Restricted Behaviors And Play:

Major behavioral signs of an ASD include the performance of repetitive actions and rituals, and fixation on tiny details to the point of being distracted. Children with autism can often be upset by the slightest change in daily routine. In young kids, signs of autism include ordering toys instead of playing with them. In older children, the repetitive behavior can manifest as a consuming interest in a specific topic or object.

Repetitive behaviors in ASD can include simple actions such as rocking, hand-flapping, or repetition of words or noises (echolalia). Affected children often dwell on, or repeatedly express, particular thoughts; this behavior is called perseveration. People with ASD tend to be rigid about their established routines and may strongly resist disruptions such as changes in schedule.

They may also have difficulty tolerating sensory stimuli such as loud noises or bright lights. The DSM-V behavioral criteria now includes sensory processing problems. Many children with autism are unusually sensitive to sounds, lights, textures, or smells. They may be overwhelmed by too much sensory input, or be disturbed and uncomfortable because of a lack of sensory input, which they may try to get by bumping into things, and excessively touching and smelling things.Children with Autism Spectrum Disorder are often restricted, rigid, and sometimes obsessive in their behaviors, activities, and interests. Signs can include:

• Repetitive body movements (such as, hand flapping, rocking, spinning); constant movement
• Obsessive attachment to unusual objects (such as smoke detectors, rubber bands, keys, light switches)
• Preoccupation with a narrow topic of interest, sometimes involving numbers or symbols (such as the planets, maps, license plates, sports statistics)
• A strong need for sameness, order, and routines (lines up toys, follows a rigid schedule).
• Child becomes upset by any change in their routine or environment.
• Clumsiness, abnormal posture, or odd ways of moving
• Fascinated by spinning objects, moving pieces, or parts of toys (spinning the wheels on a race car, rather than playing with the whole car)
• Hyper- or hypo-reactive to sensory input (reacts badly to certain sounds or textures, seeming indifference to temperature or pain)

How Children With Autism Spectrum Disorder Play

Children with Autism Spectrum Disorder are often less spontaneous than other kids. Unlike a typical curious child, pointing to things that catch their eye, children with ASD often appear disinterested or unaware of what’s going on around them. They also tend to show differences in the way they play. They may have trouble using toys that have a basic intended use, such as toy tools or cooking set. They usually don’t “play make-believe,” engage in group games, imitate others, collaborate, or use their toys in creative ways.

Related Signs And Symptoms of Autism Spectrum Disorders

While not part of autism’s official diagnostic criteria, children with autism spectrum disorders often suffer from one or more of the following problems:

Sensory problems: Many children with autism spectrum disorders either underreact or overreact to sensory stimulus. At times, they may ignore people speaking to them, even to the point of appearing deaf. However, at other times they may be disturbed by even the softest sounds. Sudden noises such as a ringing telephone can be upsetting, and they may respond by covering their ears and making repetitive noises to drown out the offending sound. Children on the autism spectrum also tend to be highly sensitive to touch and to texture. They may cringe at a pat on the back or the feel of certain tag on clothes against their skin.

Emotional difficulties: Children with autism spectrum disorders can have difficulty regulating their emotions or expressing them appropriately. For example, your child may start to yell, cry, or laugh hysterically for no apparent reason. When stressed, he or she may exhibit disruptive or even aggressive behavior (breaking things, hitting others, or harming him or herself). The National Dissemination Center for Children with Disabilities also notes that kids with ASD may be unfazed by real dangers like moving vehicles or heights, yet be terrified of harmless objects such as a stuffed animal.

Uneven cognitive abilities – ASD occurs at all intelligence levels. However, even kids with normal to high intelligence often have unevenly developed cognitive skills. Not surprisingly, verbal skills tend to be weaker than nonverbal skills. In addition, children with autism spectrum disorder usually do well on tasks involving immediate memory or visual skills, while tasks involving symbolic or abstract thinking are more difficult.

What Other Conditions Occur With Autism?

There are a number of diseases and conditions associated with autism and autism spectrum disorders.

Fragile X Syndrome – a genetic disorder caused by changes in the FMR1 gene. The FMR1 gene creates a protein vital for brain development. A defect in the gene causes the body to produce too little of the protein or – in some cases – none at all. This can cause developmental problems.

Tourette’s Syndrome – a tic disorder in which a person has multiple motor tics, including at least one vocal tic. This disorder is diagnosed in childhood, but may appear at any point, and is not related to any medication or substance.

Tuberous Sclerosis – a genetic disorder that causes noncancerous (also known as benign) tumors to grow in various parts of the body. Tuberous sclerosis is part of a group of diseases called “neurocutaneous syndromes,” which means that both the skin and central nervous system are affected.

Epilepsy – episodes of altered brain function that cause motor, cognitive, and sensory changes thought to result from changes in excitability in neurons.

ADHD – is a disorder characterized by excessive restlessness, inattention, distraction, and an impulsive nature that interferes with the person’s daily life, and his or her ability to function in everyday activities

Learning Disabilities- refers to difficulties in learning and using skills due to disturbances in neurological functioning. Typically, the most affected skill areas include reading, writing, listening, speaking, reasoning, and math

How Are Autism Spectrum Disorders Diagnosed?

The path to an ASD diagnosis can be long, winding, difficult, and time-consuming. Unfortunately, it can be two or three years since the appearance of ASD symptoms before a diagnosis can be made. This may be related to concerns about labeling or diagnosing a child so you. In addition, an ASD diagnosis may be delayed if the doctor doesn’t take a parent’s concerns seriously or if the family isn’t referred to health care professionals who specialize in developmental disorders.

If you’re worried that your child has ASD, it’s important to seek out a clinical diagnosis. Don’t wait for the full diagnosis to get your child into treatment. Early intervention during the preschool years will improve your child’s chances for overcoming his or her developmental delays. As your pediatric physician for a referral to certain kinds of treatments for, look into treatment options and try not to fret if you’re still waiting on a definitive diagnosis.

Putting a potential label on your kid’s problem is far less important than treating the symptoms.

Diagnosing Autism Spectrum Disorder

In order to determine whether your child has autism spectrum disorder or another developmental condition, clinicians look carefully at the way your child interacts with others, communicates, and behaves. Diagnosis is based on the patterns of behavior that are revealed.

If you are concerned that your child has autism spectrum disorder and developmental screening confirms the risk, ask your family doctor or pediatrician to refer you immediately to an autism specialist or team of specialists for a comprehensive evaluation. As the diagnosis of autism spectrum disorder is complicated, it is essential that you meet with experts who have training and experience in this highly specialized area.

Diagnosing ASDs is not a brief process. Unfortunately, there exists no single medical test that can diagnose ASDs definitively; instead,  multiple evaluations and tests may be necessary.

The team of specialists that should be involved in diagnosing your child can include:

1. Child psychologists
2. Child psychiatrists
3. Speech pathologists
4. Developmental pediatricians
5. Pediatric neurologists
6. Audiologists
7. Physical therapists
8. Special education teachers

Evaluation and Diagnosis of ASDs May Include The Following:

Depending on your child’s and symptoms and their severity, the diagnostic assessment may also include speech, intelligence, social, sensory processing, and motor skills testing. These tests can be helpful not only in diagnosing autism, but also for determining what type of treatment your child needs:

Speech and language evaluation: A speech pathologist will evaluate your child’s speech and communication abilities for signs of autism, as well as looking for any indicators of specific language impairments or disorders.

Cognitive Testing: Your child may be given a standardized intelligence test or an informal cognitive assessment.

Adaptive Functioning Assessment: Your child may be evaluated for her/his ability to function, problem-solve, and adapt in real-life situations. This may include testing social, nonverbal, and verbal skills, as well as the ability to perform daily tasks such as dressing and feeding him or herself.

Sensory-Motor Evaluation – Since sensory integration dysfunction often co-occurs with autism, and can even be confused with it, a physical therapist or occupational therapist may assess your child’s fine motor, gross motor, and sensory processing skills.

Is There Treatment for Autism?

Today, there are no cures for autism. Furthermore, most people who have autism do not feel that they have a disease or anything that needs curing. Here are some of the ways autism can be managed in some children and families:

Early Intervention Services

Research shows that early intervention treatment services may greatly improve a child’s development. Early intervention services help children from birth to 3 years old (36 months) learn important skills. The early intervention services include therapy to help the child talk, walk, and interact with others. This is why it’s crucial to talk to your child’s doctor as soon as possible if you think your child has an ASD or other developmental problem. Diagnosis of an ASD can take a great many months, so as soon as you suspect any ASD symptoms, early intervention should be explored.

Even without a an ASD diagnosis, your child may be eligible for early intervention treatment services. The Individuals with Disabilities Education Act (IDEA )says that children under the age of 3 years (36 months) who are at risk of having developmental delays may be eligible for services. These services are provided through an early intervention system in your state. Through this same system, you can ask for an evaluation.

In addition, treatment for particular symptoms, such as speech therapy for language delays, often does not need to wait for a formal ASD diagnosis. While early intervention is extremely important, intervention at any age can be helpful.

Other Treatment Ideas

There are many different types of treatments available, including auditory training, discrete trial training, vitamin therapy, anti-yeast therapy, facilitated communication, music therapy, occupational therapy, physical therapy, and sensory integration.

The different types of treatments can generally be broken down into the following categories:

• Behavior and Communication Approaches
• Dietary Approaches
• Medication
• Complementary and Alternative Medicine

Behavior and Communication Approaches

According to reports by the American Academy of Pediatrics and the National Research Council, behavior and communication approaches that help children with ASD provide structure, direction, and organization for the child in addition to family participation.

Applied Behavior Analysis (ABA)

An important treatment approach for people with an ASD is Applied Behavior Analysis (ABA) as it has become widely accepted among health care professionals and used in many schools and treatment clinics. ABA encourages positive behaviors and discourages negative behaviors in order to improve a variety of skills, while tracking and monitoring for progress.

There are different types of ABA. Following are some examples:

Verbal Behavior Intervention (VBI): VBI is a type of ABA that focuses on teaching verbal skills.

Discrete Trial Training (DTT): DTT is a style of teaching that uses a series of trials to teach each step of a desired behavior or response. Lessons are broken down into their simplest parts and positive reinforcement is used to reward correct answers and behaviors while incorrect answers are ignored.

Pivotal Response Training (PRT): PRT aims to increase a child’s motivation to learn, monitor their own behavior, and initiate communication with others. Positive changes in these behaviors should have widespread effects on other behaviors.

Early Intensive Behavioral Intervention (EIBI):This is a type of ABA for very young children with an ASD, usually younger than five, and often younger than three.

Other therapies that can be part of a complete treatment program for a child with an ASD include:

Speech Therapy
Speech therapy helps to improve the person’s communication skills. Some people are able to learn verbal communication skills. For others, using gestures or picture boards is more realistic.

Occupational Therapy:
Occupational therapy teaches skills that help the person live as independently as possible. Skills might include dressing, eating, bathing, and relating to people.

Developmental, Individual Differences, Relationship-Based Approach (DIR; also called “Floortime”):
Floortime focuses on emotional development (feelings, relationships with caregivers) as well as to focus upon how your child deals with sights, sounds, and smells.

Treatment and Education of Autistic and related Communication-handicapped Children (TEACCH)
TEAACH uses visual cues to teach skills, such as picture cards to teach a child how to get dressed by breaking information down into small steps.

Sensory Integration Therapy:
Sensory integration therapy helps the person deal with sensory information, like sights, sounds, and smells. Sensory integration therapy could help a child who is bothered by certain sounds or does not like to be touched.

The Picture Exchange Communication System (PECS)
PECS uses picture symbols to teach communication skills. The person is taught to use picture symbols to ask and answer questions and have a conversation

Dietary Approaches

Some dietary treatments have been developed by reliable therapist, however, many of these treatments do not have the scientific support needed for widespread recommendation. An unproven treatment might help one child, but may not help another.

Many biomedical interventions call for changes in diet. Such changes include removing certain types of foods from a child’s diet and using vitamin or mineral supplements. Dietary treatments are based on the idea that food allergies or lack of vitamins and minerals cause symptoms of ASD. Some parents feel that dietary changes make a difference in how their child acts or feels.

If you are thinking about changing your child’s diet, talk to the doctor first. Or talk with a nutritionist to be sure your child is getting important vitamins and minerals

Medications For Autism and ASD

There are no medications that can cure ASD or treat the core symptoms, but there are medications that can help some people with ASD function more easily, such as medication to manage high energy levels, inability to focus, depression, or seizures.

Medications might not affect all children in the same way so you must work with a medical team who has experience in treating children with ASD, as these medications must be closely monitored to determine each child’s progress and reactions to the medications and to be sure that any negative effects do not outweigh the benefits.

Remember that children with ASD can get sick or injured just like children without ASD so regular medical and dental exams should be part of a child’s treatment plan. Sometimes, it’s hard to determine whether or not a child’s behavior is related to the ASD or is caused by a separate health condition, such head banging, which could be a symptom of the ASD, or it could be a sign that your child is having headaches. In those cases, a thorough physical exam is needed. Monitoring healthy development means not only paying attention to symptoms related to ASD, but also to the child’s physical and mental health, as well.

Complementary and Alternative Treatments

To relieve the symptoms of ASD, some parents and health care professionals use treatments that are outside of what is typically recommended by the pediatrician. These types of treatments are known as complementary and alternative treatments (CAM).; and may include special diets, chelation (a treatment to remove heavy metals like lead from the body), biologicals (e.g., secretin), or body-based systems (like deep pressure).

These types of treatments are very controversial. Current research shows that as many as one third of parents of children with an ASD may have tried complementary or alternative medicine treatments, and up to 10% may be using a potentially dangerous treatment. Before starting such a treatment, check it out carefully, and talk to your child’s doctor.

If You’re Concerned That Your Child Has Autism:

Research has proven that early intervention services can greatly improve development. If you think your child may have an ASD, contact your pediatrician for a thorough evaluation. You can request a referral for a specialist for an in-depth evaluation if you remain concerned. Don’t wait for a diagnosis; take the steps now.

First, call your state’s early childhood intervention system for a free evaluation to see if your child qualifies for services. You don’t need a referral to contact early intervention.

If your child is under three, call National Dissemination Center for Children with Disabilities (NICHCY) at 1-800-695-0285.

If your child is three or older, contact your local public school system even if your child isn’t yet school-aged. They’re well-equipped to handle it.

If you’re unsure who to contact, call National Dissemination Center for Children with Disabilities (NICHCY) at 1-800-695-0285.

Additional ASD And Autism Resources:

While Autism Speaks is a nonprofit that raises awareness of autism and ASD, while looking for a cure, however we at Band Back Together do not include it in our references on purpose as we do not believe that people who have ASD need or want to be cured.

The Complete Guide to Asperger’s Syndrome by Tony Attwood. A heavy read, almost like a textbook.

Look Me in the Eye: My Life with Asperger’s by John Elder Robison.  Written by a man who was not diagnosed with Asperger Syndrome until he was an adult.  It’s a great first-person account.

The OASIS Guide to Asperger Syndrome: Completely Revised and Updated: Advice, Support, Insight, and Inspiration by Patricia Romanowski Bashe and Barbara L. Kirby. This book was written by two mothers of children with Asperger Syndrome. It compiles information they’ve gathered from studies, personal experience, and the experiences of the many, many parents who come to the website they founded — one of the first resources for parents of children with AS.

The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder, Revised Edition and The Out-of-Sync Child Has Fun, Revised Edition: Activities for Kids with Sensory Processing Disorder by Carol Kranowitz.

Postpartum Depression Resources

by Aunt Becky | Mar 20, 2019

Postpartum psychosis should be considered a medical emergency requiring immediate medical attention. Call 911 if you or someone you love is experiencing postpartum psychosis.

What is Postpartum Depression?

If you’ve just had a baby, you understand the mood swings that go along with your postpartum hormones. No matter how you love your child, how long you’ve wanted a baby, a new baby is stressful. Period. Lack of sleep, new important responsibilities, and a distinct lack of personal space and time to yourself, both parents can experience the baby blues. It’s extremely normal, but once symptoms of the baby blues last for a few weeks or worsen, you may be coping with postpartum depression.

Approximately 15% of new mothers and fathers will experience what is classified as postpartum depression (PPD). Symptoms may occur a few days after delivery or sometimes as late as a year later. People who experience postpartum depression will have alternating good days and bad days. Symptoms can be mild or severe, usually lasting for over 2 weeks.

There are lots of ways to help women suffering from postpartum depression, and remember that this is common, and you are never alone, no matter how you feel.

Is This Postpartum Depression or Is This The Baby Blues?

We know that you’ve just had a baby, and you’re expecting to be basking in the glory of a new life into this world. You thought you’d be celebrating with loved ones and enjoying every single second. But you’re not. In fact, you feel like crying or hiding away.

You thought you’d be joyous and excited, not weepy, exhausted, and anxiety-ridden. While you may not have intended this, you should know that mild depression, anxiety, and mood swings are totally normal. So normal that we can refer to them as the Baby Blues.

Approximately 50% to 75% of all new mothers will experience some negative feelings after giving birth. Normally these feelings occur suddenly four to five days after the birth of the baby.

Most women – to a greater or lesser extent – experience some symptoms of the baby blues after giving birth; the hormones that kept you pregnant are replaced by new hormones, lack of sleep, delivery, social isolation, major sleep loss, and stress, and it’s natural to notice them. Some women report that they feel emotionally fragile, sad, and overwhelmed. Generally the Baby Blues occur within a couple days of your delivery, last a week, and taper off by the second postpartum week.

What Are The Symptoms of Postpartum Depression?

In stark contrast from the baby blues, postpartum depression is a serious medical issue that should not be ignored. But how do you know the difference between postpartum depression and the Baby Blues?

PPD, as it’s often abbreviated, can look like the baby blues, so much so that they share many of the same symptoms, however the symptoms of postpartum depression last longer and are more severe. You may also feel hopeless and worthless, and lose interest in the baby. You may have thoughts of hurting yourself or the baby. Very rarely, new mothers develop something even more serious – postpartum psychosis –  may have hallucinations or try to hurt themselves or the baby. They need to get treatment right away, often in the hospital.

The difference is that with postpartum depression, the symptoms are more severe (such as suicidal thoughts or an inability to care for your newborn) and longer lasting. Symptoms of postpartum depression begin either during pregnancy or within four weeks after having a baby.

The symptoms of postpartum mood disorders don’t differ from the non-postpartum mood disorders except that the feelings of guilt and inadequacy about being an incompetent mother feed a person’s worries about being less than an adequate parent.

• You might find yourself withdrawing from your partner or being unable to bond well with your baby.
• You might find your anxiety out of control, preventing you from sleeping—even when your baby is asleep—or eating appropriately.
• You might find feelings of guilt or worthlessness overwhelming or begin to develop thoughts preoccupied with death or even wish you were not alive.
• Feelings of profound sadness, emptiness, emotional numbness, irritability, or anger.
• A tendency to withdraw from relationships with family, friends, or from activities that are usually pleasurable for the PPD sufferer
• Constant fatigue or tiredness, difficulty sleeping, overeating, or loss of appetite
• A strong sense of failure or inadequacy
• Intense concern and anxiety about the baby or a lack of interest in the baby
• Thoughts about suicide or fears of harming the baby
• People with postpartum depression feel guilty about being depressed at a time when they are supposed to be happiest and may be reluctant to discuss their feelings.
• People with postpartum depression often experience a loss of appetite, leading to extreme weight loss.
• People with postpartum depression often report an increased yearning for sleep, sleeping heavily, but awakening (and unable to get back to sleep) the moment their baby makes a noise.
• The distinguishing feature in postpartum depression is irritability. Episodes of irritability may be unprovoked or provoked by the slightest infraction. These episodes of irritability are often directed at the significant other or baby and may escalate to violent outbursts or uncontrollable sobbing.
• People with severe postpartum depression often have terrible panic attacks, severe anxiety, and spontaneous crying, long after the duration of the “baby blues.”
• These people with PPD may feel jealous of their infant and have difficulties bonding with their babies.

These are all red flags for postpartum depression.

The Edinburgh Postnatal Depression Scale is a screening tool designed to detect postpartum depression. Follow the instructions carefully. A score greater than 13 suggests the need for a more thorough assessment because you could have postpartum depression.

If you’re a new mother or father, please don’t hesitate to bring up these feelings with your doctor. Don’t let your doctor brush it off. If s/he does, find another doctor.

Signs And Symptoms of Postpartum Psychosis:

Postpartum psychosis is a rare, but extremely serious disorder that can develop after childbirth, characterized by loss of contact with reality. Because of the high risk for suicide or infanticide, hospitalization is usually required to keep the mother and the baby safe.

Postpartum psychosis (PPP) is the most severe form of postpartum depression, but fortunately it is the rarest form. It occurs in 1 to 2 out of every 1,000 pregnancies. The onset is very sudden and severe, normally within 2 to 3 weeks after giving birth. Postpartum psychosis develops suddenly, usually within the first two weeks after delivery, and sometimes within 48 hours. 

Symptoms are characterized by a loss of touch with reality and can include:

• Bizarre, erratic behavior
• Thoughts of hurting the baby
• Thoughts of hurting yourself
• Rapid mood swings
• Hyperactivity
• Hallucinations (seeing things that aren’t real or hearing voices)
• Delusions (paranoid and irrational beliefs)
• Extreme agitation and anxiety
• Suicidal thoughts or actions
• Confusion and disorientation
• Inability or refusal to eat or sleep
• Thoughts of harming or killing your baby

Postpartum psychosis should be considered a medical emergency requiring immediate medical attention. Call 911 if you or someone you love is experiencing postpartum psychosis.

What Causes Postpartum Depression?

Just as in all types of depression, there is no single reason to point to as the definitive cause of postpartum depression. A variable combination of lifestyle, physical, and emotional factors can all play a part.

There’s no single reason why some new mothers develop postpartum depression and others don’t, but a number of interrelated causes and risk factors are believed to contribute to the problem.

• Hormonal changes. After childbirth, women experience a big drop in estrogen and progesterone hormone levels. Thyroid levels can also drop, which leads to fatigue and depression. These rapid hormonal changes—along with the changes in blood pressure, immune system functioning, and metabolism that new mothers experience—may trigger postpartum depression.
• Physical changes. Giving birth brings numerous physical and emotional changes. You may be dealing with physical pain from the delivery or the difficulty of losing the baby weight, leaving you insecure about your physical and sexual attractiveness.
• Stress. The stress of caring for a newborn can also take a toll. New mothers are often sleep deprived. In addition, you may feel overwhelmed and anxious about your ability to properly care for your baby. These adjustments can be particularly difficult if you’re a first-time mother who must get used to an entirely new identity.

Risk Factors For Postpartum Depression:

Several factors can predispose you to postpartum depression:

• The most significant is a history of postpartum depression, as a prior episode can increase your chances of a repeat episode to 30-50%.
• Mood Disorders: A history of non-pregnancy related depression or a family history of mood disturbances is also a risk factor.
• Addiction: People with any history of depression, anxiety, alcohol or another substance use disorder prior to the pregnancy are at risk for developing depression during the pregnancy or within a few weeks after delivery.
• Prenatal depression – Depression during pregnancy may be the strongest predictor for later suffering from PPD.
• Prenatal anxiety
• History of previous depression – Although not as strong a predictor as a depressive episode during the pregnancy, it appears that women with histories of depression previous to conception are also at a higher risk of PPD than those without
• Examples of specific illnesses that have been associated with being associated with the potential to develop postpartum depression include any form of major depression, such as premenstrual dysphoric disorder, bipolar disorder, and generalized anxiety disorder.
• Maternity blues – Especially when severe, the blues may herald the onset of PPD.
• Recent stressful life events
• Inadequate social supports
• Poor marital relationship – One of the most consistent findings is that among women who report marital dissatisfaction and/or inadequate social supports, postpartum depressive illness is more common.
• Low self-esteem
• Childcare stress – Difficult infant temperament

In addition, three factors are less definitively predictive, but still arise consistently as factors that increase a woman’s risk of PPD, especially in combination with one or more of the factors listed above:

• Single marital status
• Unplanned or unwanted pregnancy
• Lower socioeconomic status

What Is The Treatment For Postpartum Depression?

Postpartum depression (PPD) sometimes goes away on its own within three months of giving birth. But if it interferes with your normal functioning at any time, or if “the blues” lasts longer than two weeks, you should seek treatment. About 90% of women who have postpartum depression can be treated successfully with medication or a combination of medication and psychotherapy. Participation in a support group may also be helpful. In cases of severe postpartum depression or postpartum psychosis, hospitalization may be necessary. Sometimes, if symptoms are especially severe, electroconvulsive (ECT) therapy may be used to treat severe depressions with hallucinations (false perceptions) or delusions (false beliefs) or overwhelming suicidal thoughts

Untreated postpartum depression can affect your ability to parent. You may:

• Not have enough energy
• Have trouble focusing on the baby’s needs and your own needs
• Feel moody
• Not be able to care for your baby
• Have a higher risk of attempting suicide

Feeling like a bad mother can make depression worse. It is important to reach out for help if you feel depressed.

Researchers believe postpartum depression in a mother can affect her child throughout childhood, causing:

• Delays in language development and problems learning
• Problems with mother-child bonding
• Behavior problems
• More crying or agitation
• Shorter height and higher risk of obesity in pre-schoolers
• Problems dealing with stress and adjusting to school and other social situations

Postpartum depression, like other mental illnesses, presents along a continuum, and the type of treatment selected is based on the severity of the depression and type of symptoms present.  However, before beginning psychiatric treatment, medical causes for mood disturbance (such as, thyroid dysfunction, anemia) must be excluded. Initial evaluation should include a thorough history, physical examination, and routine laboratory tests.

Non-pharmacological therapies are useful in the treatment of postpartum depression, including CBT, ITP, and couples counseling.

In a randomized study, it was shown that short-term cognitive-behavioral therapy (CBT) was as effective as treatment with fluoxetine (Prozac) in women with postpartum depression.

Interpersonal therapy (IPT) has also been shown to be effective for the treatment of women with mild to moderate postpartum depression. Not only is IPT effective for treating the symptoms of depression, women who receive IPT also benefit from significant improvements in the quality of their interpersonal relationships

These non-pharmacological interventions may be particularly attractive to those reluctant to use psychotropic medications (such as women who are breast-feeding) or for people with milder forms of depressive illness. Women with more severe postpartum depression may choose to receive pharmacological treatment, either in addition to or instead of, these non-pharmacological therapies.

Only a few studies have systematically assessed the pharmacological treatment of postpartum depression. Conventional antidepressant medications have shown efficacy in the treatment of postpartum depression at standard antidepressant doses were effective and well tolerated.

The choice of an antidepressant should be guided by the person’s prior response to antidepressant medication and a given medication’s side effects.

• Specific serotonin reuptake inhibitors (SSRIs) are ideal first-line agents, as they are anxiolytic, non-sedating, and well tolerated (examples include: fluoxetine, sertraline, fluvoxamine, and venlafaxine)
• For women who cannot tolerate SSRIs, bupropion (Wellbutrin) may be an alternative; although one pilot study suggests bupropion may not be as effective as SSRIs.
• Tricyclic antidepressants (TCAs) are frequently used and, because they tend to be more sedating, may be more appropriate for women who present with prominent sleep disturbance.
• Given the prevalence of anxiety symptoms in this population, adjunctive use of a benzodiazepine (e.g., clonazepam, lorazepam) may be very helpful.

Can I Breastfeed My Child If I’m On Medication?

The nutritional, immunologic, and psychological benefits of breastfeeding have been well documented. Women who plan to breastfeed must be informed that all psychotropic medications, including antidepressants, are secreted into the breast milk. Concentrations in the breast milk appear to vary widely. The amount of medication to which an infant is exposed depends on several factors, including dosage of medication, rate of maternal drug metabolism, and frequency and timing of feedings (Llewelyn and Stowe).

Over the past five years, data have accumulated regarding the use of various antidepressants during breastfeeding (reviewed in Newport et al 2002). Available data on the tricyclic antidepressants, fluoxetine, paroxetine, and sertraline during breastfeeding have been encouraging and suggest that significant complications related to neonatal exposure to psychotropic drugs in breast milk appear to be rare. While less information is available on other antidepressants, there have been no reports of serious adverse events related to exposure to these medications.

For women with bipolar disorder, breastfeeding may be more problematic.

First is the concern that on-demand breastfeeding may significantly disrupt the mother’s sleep and thus may increase her vulnerability to relapse during the acute postpartum period. Second, there have been reports of toxicity in nursing infants related to exposure to various mood stabilizers, including lithium and carbamazepine, in breast milk. Lithium is excreted at high levels in the mother’s milk, and infant serum levels are relatively high, about one-third to one-half of the mother’s serum levels, increasing the risk of neonatal toxicity. Exposure to carbamazepine and valproic acid in the breast milk has been associated with liver damage in the nursing infant.

Can We Prevent PPD?

While it is difficult to reliably predict which women in the general population will experience postpartum mood disturbance, it is possible to identify certain subgroups of women (i.e., women with a history of mood disorder) who are more vulnerable to postpartum affective illness. Current research indicates that prophylactic interventions may be instituted near or at the time of delivery to decrease the risk of postpartum illness.

Several studies demonstrate that women with histories of bipolar disorder or puerperal psychosis benefit from prophylactic treatment with lithium either prior to delivery (at 36 weeks gestation) or no later than the first 48 hours postpartum.

For women with histories of postpartum depression, several studies have described a beneficial effect of prophylactic antidepressant (either TCAs or SSRIs) administered after delivery. Patients with postpartum psychiatric illness are offered a variety of services by clinicians with particular expertise in this area:

• Clinical evaluation for postpartum mood and anxiety disorders
• Medication management
• Consultation regarding breastfeeding and psychotropic medications
• Recommendations regarding non-pharmacological treatments
• Referral to support services within the community

Coping With Postpartum Depression:

The most important task of infancy is the bonding process between the infant and parents, as the success of this wordless relationship enables a child to feel secure enough to develop fully, and affects how the child will interact, communicate, and form relationships throughout life.

A secure attachment between parent and child is formed when the parent responds warmly and consistently to your baby’s physical and emotional needs. When your baby cries, you quickly soothe him or her. If your baby laughs or smiles, you respond in kind. You and your child are in synch. You recognize and respond to each other’s emotional signals.

Postpartum depression can interrupt this bonding. Depressed parents may be loving and attentive sometimes, but others may react negatively or not respond at all. Sadly, parents with postpartum depression tend to interact less with their babies, and are less likely to breastfeed, play with, and read to their children. They may also be inconsistent caregivers.

However, learning to bond with your baby not only benefits your child, it also benefits you by releasing endorphins that make you feel happier and more confident as a parent.

Make yourself and your baby the priority. Give yourself permission to concentrate on yourself and your baby – there is more work involved in this 24/7 job then in a full-time job.

Try to remember that we, as human beings are naturally social. Positive, happy, and supportive social contact relieves stress faster and more efficiently than any other means of stress reduction. Historically and from an evolutionary perspective, new parents received help from those around them when caring for themselves and their infants after childbirth. In today’s world, new mothers often find themselves alone, exhausted, and lonely for supportive adult contact.

When you’re feeling depressed and vulnerable, it’s more important than ever to stay connected to family and friend – even if you’d rather be left alone. Isolating yourself will only make your situation feel even bleaker, so make your adult relationships a priority. Let your loved ones know what you need and how you’d like to be supported.

In addition to the practical help your friends and family can provide, they can also serve as a much-needed emotional outlet. Share what you’re experiencing – all of it – with at least one other person, preferably face to face. It doesn’t matter who you talk to, so long as that person is willing to listen without judgment and offer reassurance and support.

Even if you have supportive loved ones, you may want to consider seeking out other women who are dealing with the same transition into motherhood. It’s very reassuring to hear that other mothers share your worries, insecurities, and feelings. Good places to meet new moms include support groups for new parents or organizations such as Mommy and Me. Ask your pediatrician for other resources in your neighborhood.

Additional Resources For Postpartum Depression:

Postpartum Health Alliance is a non-profit organization dedicated to raising awareness about perinatal mood and anxiety symptoms and disorders and providing support and treatment referrals to women and their families.

• If you are struggling or have questions, please call our warmline at 619-254-0023. Our trained volunteers can provide you with support and referrals.
• If you need immediate support please call the San Diego Access and Crisis Line at 1-888-724-7240. The toll-free call is available 24-hours a day, 7-days a week

Postpartum Depression International: source of great information about all types of Postpartum Mood Disorders and also offers women resources for where to go for local help. Call or Text our HelpLine

• They offer online support groups for mom’s and dad’s with PPD.
• Call 1-800-944-4773 (4PPD)
  English and Spanish
• Text 503-894-9453
• Available 24 hours a day, you will be asked to leave a confidential message and a trained and caring volunteer will return your call or text. They will listen, answer questions, offer encouragement and connect you with local resources as needed.

Eating Disorders Resources

by Aunt Becky | Mar 19, 2019

What Are Eating Disorders?

Eating disorders are illnesses in which the people experience severe disturbances in their eating behaviors and related thoughts and emotions. People with eating disorders typically become pre-occupied with food and their body weight.

There is a commonly held misconception that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that are associated with severe disturbances in people’s eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder

Eating disorders affect several million people at any given time, most often women between the ages of 12 and 35; however there is burgeoning research that indicates more and more men are developing eating disorders as well.

There are three main types of eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder.

People with anorexia nervosa and bulimia nervosa tend to be perfectionists with low self-esteem and are extremely critical of themselves and their bodies. They usually “feel fat” and see themselves as overweight, sometimes even despite life-threatening semi-starvation (or malnutrition). An intense fear of gaining weight and of being fat may become all-pervasive. In early stages of these disorders, patients often deny that they have a problem.

In many cases, eating disorders occur together with other psychiatric disorders like anxiety disorders, panic disorder, obsessive compulsive disorder, and alcohol and drug abuse problems. New evidence suggests that heredity may play a part in why certain people develop eating disorders, but these disorders also afflict many people who have no prior family history. Without treatment of both the emotional and physical symptoms of these disorders, malnutrition, heart problems and other potentially fatal conditions can result. However, with proper medical care, those with eating disorders can resume suitable eating habits, and return to better emotional and psychological health.

While eating disorders may seem to be about beauty, weight, and image, they’re actually about control or avoidance of stress and emotional issues. Eating disorders may be a result of being unable to express strong feelings and emotions.

Those who suffer from eating disorders generally try to hide the problem, but there are signs of a problem if you know what to look for. Early detection and treatment of eating disorders makes for an easier recovery. It’s important to note that, while you may confront someone whom you suspect has an eating disorder, you cannot force someone with an eating disorder into treatment. Making an effort to be a caring, compassionate support system is often the best thing that can be done when a loved one suffers from an eating disorder.

Eating disorders involve extreme disturbances in eating behaviors, such as gorging, following rigid diets, throwing up after meals, and counting calories obsessively; they are more than just an unhealthy eating habit. The core of eating disorders involves self-critical, distorted attitudes about weight, body image, and food, all of which lead to the damaging eating behaviors.

Food, for those with eating disorders, is used to deal with painful emotions. Restricting food (as is the case with anorexia nervosa) is used to feel in control. Overeating soothes sadness, anger, and loneliness. Purging combats feelings of self-loathing and helplessness. Over time, food and weight obsessions dominate the life of someone with an eating disorder.

What Are Some Common Warning Signs of Eating Disorders?

In the early stages of an eating disorder, it may be really hard to ascertain the difference between an eating disorder and normal weight concerns and dieting. As an eating disorder progresses, the red flags and warning signs become more apparent. Those who suffer eating disorders are particularly good at hiding their disorders, so knowing the common warning signs may help to spot an eating disorder.

• Hoarding high-calorie food
• Constant dieting – even when thin
• Rapid unexplained weight gain or loss
• Preoccupation with body or weight
• Binging – usually performed in secret
• Purging – disappearing after every meal or frequent trips to the bathroom
• Obsession with food, calories or nutrition
• Usage of laxatives, diuretics, or diet pills
• Compulsive exercising
• Making excuses to get out of eating
• Eating tiny portions or refusing to eat
• Intense fear of being fat
• Distorted body image
• Strenuous exercising (for more than an hour)
• Hoarding and hiding food
• Eating in secret
• Disappearing after eating—often to the bathroom
• Large changes in weight, both up and down
• Social withdrawal
• Depression
• Irritability
• Hiding weight loss by wearing bulky clothes
• Little concern over extreme weight loss
• Stomach cramps
• Menstrual irregularities—missing periods
• Dizziness
• Feeling cold all the time\
• Sleep problems
• Cuts and calluses across the top of finger joints (from sticking finger down throat to cause vomiting)
• Dry skin
• Puffy face
• Fine hair on body
• Thinning of hair on head, dry and brittle hair
• Cavities, or discoloration of teeth, from vomiting
• Muscle weakness
• Yellow skin
• Cold, mottled hands and feet or swelling of feet

What Are Some Common Myths About Eating Disorders?

There are many myths about the causes eating disorders, how serious they are, and who develops an eating disorder. Let’s dispel them now:

Are eating disorders a choice?

Eating disorders are not a choice. They are complex medical and psychiatric illnesses that people don’t opt to have. Eating disorders are bio-psycho-social diseases, which means that genetic, biological, environmental, and social elements all play a role.

• Several decades of genetic research show that biological factors are an important influence in who develops an eating disorder. A societal factor (like the media-driven thin body ideal) is an example of an environmental trigger that has been linked to increased risk of developing an eating disorder.
• Environmental factors also include physical illnesses, childhood teasing and bullying, and other life stressors.
• Eating disorders commonly co-occur with other mental health conditions like major depression, anxiety, social phobia, and obsessive-compulsive disorder. Additionally, they may run in families, as there are biological predispositions that make people more vulnerable to developing an eating disorder.

Are eating disorders really that serious?

Eating disorders have the highest mortality rate of any psychiatric illness. Besides medical complications from binge eating, purging, starvation, and over-exercise, suicide is also common among individuals with eating disorders. Potential health consequences include heart attack, kidney failure, osteoporosis, and electrolyte imbalance. People who struggle with eating disorders also have intense emotional distress and a severely impacted quality of life.

The consequences of eating disorders can be life-threatening, and many individuals find that stigma against mental illness (and eating disorders in particular) can obstruct a timely diagnosis and adequate treatment.

Doesn’t everyone have an eating disorder?

Although our current culture is highly obsessed with food and weight, and disordered patterns of eating are very common, clinical eating disorders are less so.

About 20 million women and 10 million men will struggle with an eating disorder at some point during their lives. A study in 2007 found that:

• 0.9% of women and 0.3% of men had anorexia during their life
• 1.5% of women and 0.5% of men had bulimia during their life,
• and 3.5% of women and 2.0% of men had binge eating disorder during their life

If eating disorders are linked to my genetic makeup, how do I recover?

Biology isn’t destiny. There is always hope for recovery.

While biological factors do play a large role in the onset of eating disorders, they are not the only factors.

The predisposition towards disordered eating may reappear during times of stress, but there are many good techniques people who have eating disorders can learn that will help manage their emotions and keep behaviors from returning.

Early intervention is a key part of eating disorder prevention, and helps reduce serious psychological and health consequences. Recovery from an eating disorder can be a long process and requires a qualified team of professionals and the love and support of family and friends.

Aren’t eating disorders a ‘girl thing’?

Eating disorders can affect anyone, regardless of their gender or sex.

While eating disorders are more common in females, researchers and clinicians are becoming aware of a growing number of males and non-binary individuals who now are seeking help for eating disorders. A 2007 study by the Centers for Disease Control and Prevention found that up to one-third of all eating disorder sufferers are male, and a 2015 study of US undergraduates found that transgender students were the group most likely to have been diagnosed with an eating disorder in the past year (Diemer, 2015).Eating disorders most often affect girls and women, but boys and men can also have an eating disorder.

One out of every four pre-teen kids with anorexia is a boy.  Binge eating disorder affects females and males about equally.

It’s currently unclear whether eating disorders are actually increasing in males and transgender populations or if more of those people who are suffering are seeking treatment or being diagnosed. As some physicians may have preconceptions about who eating disorders affect, their disorders have generally become more severe and entrenched at the point of an actual diagnosis.

Don’t you have to be underweight to have an eating disorder?

People who have eating disorders come in all shapes and sizes – many of those people happen to be normal or overweight.The two best-known types of eating disorders are anorexia nervosa and bulimia nervosa and can occur separately or in the same person, additionally, binge-eating is another type of eating disorder.

Aren’t people with eating disorders super vain?

It’s not actually vanity that drives people with eating disorders to obsess about their food. Eating disorders are a product of feelings of shame, poor body image, anxiety, and powerlessness.

Do parents cause eating disorders?

Organizations from around the world, including the Academy for Eating Disorders, the American Psychiatric Association, and NEDA, have published materials that indicate that parents don’t cause eating disorders.

Parents, especially mothers, were frequently blamed for their child’s eating disorder, but recent research discovered that eating disorders have a firmer biological root. Eating disorders develop differently for each person, and there is no single set of rules that parents can follow to guarantee prevention of an eating disorder, however there are things everyone in the family system can do to play a role in creating a recovery-promoting environment. such as including parents and other family members in the treatment process.

Can someone be too young or too old to develop an eating disorder?

Eating disorders can develop or re-emerge at any age. Eating disorder specialists are reporting an increase in the diagnosis of children, some as young as five or six. Many eating disorder sufferers report that their thoughts and behaviors started much earlier than anyone realized, sometimes even in early childhood. Although most people report the onset of their eating disorder in their teens and young adulthood, there is some evidence emerging that people are being diagnosed at younger ages.

It’s not clear whether people are actually developing eating disorders at younger ages or if an increased awareness of eating disorders in young children has led to improved recognition and diagnosis.

Men and women at midlife and beyond are being treated for eating disorders, either due to a relapse, ongoing illness from adolescence or young adulthood, or due to the new onset of an eating disorder.

Doesn’t recovery from an eating disorder take a long time?

Recovery time from any mental illness varies from person to person. Some people get better relatively quickly, while others take longer to improve. While not everyone who has an eating disorder will recover fully, many people do improve with treatment. Even with full recovery, many people with eating disorders find that they have to take steps to make sure they stay well. This can include:

• planning meals
• regular check-ins with a therapist, dietitian, or doctor
• medication
• proper support
• proper education
• stress management

What Are The Types of Eating Disorders?

Currently, doctors have discovered that there are 6 types of eating disorders.

Anorexia Nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many people, a  distorted body image.Avoidant Restrictive Food Intake Disorder (ARFID), once referred to as “selective eating disorder,” involves limitations in the amount and/or types of food consumed without any distress about body shape or size, or fears of being overweight.

Bulimia Nervosa is characterized by a cycle of binge eating and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Binge eating disorder is the most common eating disorder in the United States and is characterized by episodes of eating large quantities of food; a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures to counter the binge eating.

Orthorexia was coined in 1998 to describe an obsession with proper or ‘healthful’ eating.

Pica is an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and/or paint chips.

Rumination disorder involves the regular regurgitation of food that occurs for at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.

Unspecified feeding or eating disorder (UFED) applies to presentations where symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class.

What Is Anorexia?

Anorexia nervosa is an eating disorder characterized by weight loss (or lack of appropriate weight gain in growing children); difficulties maintaining an appropriate body weight for height, age, and stature; and, in many people, a distorted body image. People who have anorexia generally restrict the number of calories and the types of food they eat. Some people with the disorder also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.

Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. Historians and psychologists have found evidence of people displaying symptoms of anorexia for hundreds or thousands of years.

Although the disorder most frequently begins during adolescence, an increasing number of children and older adults are also being diagnosed with anorexia. You cannot tell if a person is struggling with anorexia by looking at them. A person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity.

Most turn to this obsession as a sense of control in a reality where they feel they have none.

People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, often exercise excessively, and/or may force themselves to vomit or use laxatives to lose weight. Anorexia nervosa has the highest mortality rate of any mental disorder.

Anorexia, with severity in relation to length of time, is a potentially life-threatening disorder marked by extreme fasting or restriction of food intake, often eating as little as 200 calories a day. Anorexics have an intense fear of weight-gain; even while underweight, they see themselves as fat. Females with anorexia develop amenorrhea, or the absence of menstruation.

While many people with this disorder die from complications associated with starvation, others die by suicide.

If you or someone you know is in crisis and needs immediate help, call the toll-free National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255), 24 hours a day, 7 days a week.

This eating disorder can affect males, females, and non-binary people, however, 90-95% of those diagnosed are girls and women and of these, it’s estimated that 5-20% of people affected by this eating disorder will die,

Do I Have Anorexia?

If you think you may have anorexia, please make an appoint to see your doctor as soon as possible. Delaying treatment can make recovery a bit more challenging. Your doctor will probably ask you if you have experienced any of the below questions:

• Have you recently noticed a drastic decrease in weight?
• Do you struggle with maintaining a healthy self-esteem?
• Are you overly concerned about gaining weight?
• Do you find yourself refusing or making excuses not to eat?
• Are you self-conscious about your body image?
• Do you exercise excessively?
• Do you obsess over dieting?
• Have you been distancing yourself from friends and family?
• Are you often depressed?
• Have you noticed dry or yellow tinted skin?

How Is Anorexia Diagnosed?

To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met:

1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.

Other diagnostic criteria can include:

• A person 15% below their ideal weight
• Person with an intense fear of being fat, even though they are underweight
• He/She/They may have a distorted view of their body or deny that their low weight is a problem
• (among women) missing at least 3 periods in a row
• People who have anorexia may or may not also binge and purge, use laxatives, or other means of losing weight

 If left untreated anorexia can have devastating effects.

When the body is starved of proper nourishment, the system slows down to conserve energy and can lead to injury of the organs, and even death.

What Are The Dangers Of Anorexia?

Systemic Symptoms: 

• Heart rates drop to an abnormally slow rate
• Blood pressure drops
• Blood count becomes abnormal
• Risk of heart failure increases
• Risk of osteoporosis and reduction in bone density
• Muscles deteriorate
• Body suffers from dehydration, leading to kidney failure

Physical Symptoms

• Extreme thinness
• Irregular periods in women
• Lower testosterone in men
• Feeling weak, fatigued, or dizzy, or experiencing fainting spells
• Dry skin that may also take on yellowish tint
• Bluish color on the tips of the fingers
• Dry hair and hair loss
• Downy hair that grows over the skin in order to keep warm

Anorexia affects all of the organs in the body. If left untreated, the body becomes severely malnourished. This can result in damage that is not treatable, even if the disease is taken under control.

Emotional Symptoms

• Lying about whether or not you have eaten
• Irritability
• Withdrawing from social activities
• Emotionally flat affect
• Obsessing over weight gain
• Feeling insecure about the way you look
• Decreased interest in sex
• Feeling depressed
• Thoughts of suicide

If the above resonates with anything you’re experiencing, it’s time to see a doctor.

Medical attention doesn’t have to be scary. Think of it as a moment of clarity that’s bringing you closer to your desired result of being a healthy, happy human being.

Mortality and Binge Eating Disorders:

It is well known that anorexia nervosa is a deadly disorder, but death rate varies considerably between studies. This variation may be due to length of follow-up, or ability to find people years later, or other reasons. In addition, it has not been certain whether other subtypes of eating disorders also have high mortality. Several recent papers have shed new light on these questions by using large samples followed up over many years. Most importantly, they get around the problem of tracking people over time by using national registries which report when people die.Overall people with anorexia nervosa had a six fold increase in mortality compared to the general population. Reasons for death include starvation, substance abuse, and suicide.

In summary, these findings underscore the severity and public health significance of all types of eating disorders.

What Is Bulimia?

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

How is Bulimia Diagnosed?

According to the DSM-5, the official diagnostic criteria for bulimia nervosa include:

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  • Eating, in a discrete period of time (such as within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
  • A feeling of lack of control over eating during the episode (such as a feeling that one cannot stop eating or control what or how much they are eating).
• Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
• The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
• Self-evaluation is unduly influenced by body shape and weight.
• The disturbance does not occur exclusively during episodes of anorexia nervosa

It’s really important to remember that people with bulimia may be anywhere from underweight, to normal weight, to overweight.

Common Warning Signs That Of Bulimia: 

Emotional and behavioral 

• Generally speaking, new behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns
• Evidence of binge eating, such as disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics
• Appears uncomfortable eating around others
• Develops food rituals (including eating only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)
• Skips meals or takes small portions of food at regular meals
• Fears of eating in public or with other people
• Steals or hoards food in strange places
• Drinks excessive amounts of water or non-caloric beverages
• Uses excessive amounts of mouthwash, mints, and gum
• Hides body with baggy clothes
• Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories
• Creates lifestyle schedules or rituals to make time for binge-and-purge sessions
• Withdraws from friends and activities
• Shows extreme concern with body weight and shape
• Frequent checking the mirror for feared flaws in appearance
• Secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most people would eat under similar circumstances); feels lack of control over ability to stop eating
• Purges after a binge (such as self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)
• Extreme mood swings

Physical Symptoms of Bulimia:

• Unusual swelling of the cheeks or jaw area
• Calluses on the back of the hands and knuckles from self- induced vomiting
• Teeth are discolored, stained from vomiting
• Noticeable fluctuations in weight, both up and down
• Body weight is typically within the normal weight range; may be overweight
• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux)
• Difficulties concentrating
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
• Dizziness
• Bloating from fluid retention
• Fainting/syncope
• Feeling cold all the time
• Sleep problems
• Cuts and calluses across the top of finger joints (a result of inducing vomiting)
• Dry skin
• Dry and brittle nails
• Swelling around area of salivary glands
• Fine hair on body
• Thinning of hair on head, dry and brittle hair
• Muscle weakness
• Cold, mottled hands and feet or swelling of feet
• Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
• Poor wound healing
• Increased infections due to poor immune response

Many people with bulimia nervosa also struggle with co-occurring conditions, such as:

• Self-injury (cutting and other forms of self-harm without suicidal intention)
• Substance use and abuse
• Impulsivity (risky sexual behaviors, shoplifting, drugs)
• Diabulimia (intentional misuse of insulin for type 1 diabetes)

What Is Binge Eating Disorder?

Binge eating disorder (BED) is a severe, life-threatening, and treatable eating disorder that is characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress, or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g., purging) to counter the binge eating. It is the most common eating disorder in the United States.

BED is one of the newest eating disorders formally recognized in the DSM-5. Before the most recent revision in 2013, BED was listed as a subtype of EDNOS (now referred to as OSFED). The change is important because some insurance companies will not cover eating disorder treatment without a DSM diagnosis.

What Are The Diagnostic Criteria for Binge Eating Disorder?

According to the DSM-5, the official diagnostic criteria for bulimia nervosa include:

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
  • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
• The binge eating episodes are associated with three (or more) of the following:
  • Eating much more rapidly than normal.
  • Eating until feeling uncomfortably full.
  • Eating large amounts of food when not feeling physically hungry.
  • Eating alone because of feeling embarrassed by how much one is eating.
  • Feeling disgusted with oneself, depressed, or very guilty afterward.
• Marked distress regarding binge eating is present.
• The binge eating occurs, on average, at least once a week for 3 months.
• The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors (e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

What Are The Warning Signs for Binge Eating Disorder?

Emotional and Behavioral Signs and Symptoms

• Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food.
• Appears uncomfortable eating around others
• Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
• Fear of eating in public or with others
• Steals or hoards food in strange places
• Creates lifestyle schedules or rituals to make time for binge sessions
• Withdraws from usual friends and activities
• Frequently diets
• Shows extreme concern with body weight and shape
• Frequent checking in the mirror for perceived flaws in appearance
• Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating
• Disruption in normal eating behaviors, including eating throughout the day with no planned mealtimes; skipping meals or taking small portions of food at regular meals; engaging in sporadic fasting or repetitive dieting
• Developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, and not allowing foods to touch).
• Eating alone out of embarrassment at the quantity of food being eaten
• Feelings of disgust, depression, or guilt after overeating
• Fluctuations in weight
• Feelings of low self-esteem

Physical Symptoms of Binge Eating Disorder

• Noticeable fluctuations in weight, both up and down
• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Difficulties concentrating

What Are The Health Risks of Binge Eating Disorder?

The health risks of BED are most commonly those associated with clinical obesity, weight stigma, and weight cycling (aka, yo-yo dieting). Most people who are labeled clinically obese do not have binge eating disorder. However, of individuals with BED, up to two-thirds are labelled clinically obese; people who struggle with binge eating disorder tend to be of normal or higher-than-average weight, though BED can be diagnosed at any weight.

What Is Orthorexia? 

While not formally recognized in the Diagnostic and Statistical Manual, awareness about orthorexia is on the rise. The term ‘orthorexia’ was coined in 1998 and means an obsession with proper or ‘healthful’ eating. Although being aware of and concerned with the nutritional quality of the food you eat isn’t a problem in and of itself, people with orthorexia become so fixated on so-called ‘healthy eating’ that they actually damage their own well-being.

Without formal diagnostic criteria, it’s difficult to get an estimate on precisely how many people have orthorexia. We still don’t know whether orthorexia if is a stand-alone eating disorder, a type of existing eating disorders like anorexia, or a form of obsessive-compulsive disorder. Studies have shown that many people with orthorexia also have been diagnosed with obsessive-compulsive disorder.

What Are Some Of The Symptoms of Orthorexia?

• Compulsive checking of ingredient lists and nutritional labels
• An increase in concern about the health of ingredients
• Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
• An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
• Unusual interest in the health of what others are eating
• Spending hours per day thinking about what food might be served at upcoming events
• Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
• Obsessive following of food and ‘healthy lifestyle’ blogs on social media
• Body image concerns may or may not be present

What Are The Health Consequences of Orthorexia?

Like anorexia, orthorexia involves restriction of the amount and variety of foods eaten, making malnutrition likely. Therefore, the two disorders share many of the same physical consequences.

How Is Orthorexia Treated?

There are currently no clinical treatments developed specifically for orthorexia, but many eating disorder experts treat orthorexia as a variety of anorexia and/or obsessive-compulsive disorder. Thus, treatment usually involves psychotherapy to increase the variety of foods eaten and exposure to anxiety-provoking or feared foods, as well as weight restoration as needed.

What is Avoidant Restrictive Food Intake Disorder?

Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis in the DSM-5, and was previously called “Selective Eating Disorder.” ARFID is similar to anorexia in that both disorders involve limitations in the amount and/or types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size, or fears of being overweight.

While many children go through phases of picky or selective eating, a person with ARFID does not consume enough calories to grow and develop properly and, in adults, to maintain basic body function. In children, this results in stalled weight gain and vertical growth; in adults, this results in weight loss. ARFID can also result in problems at school or work, due to difficulties eating with others and extended times needed to eat.

How is ARFID Diagnosed?

According to the DSM-5, ARFID is diagnosed when:

• An eating or feeding disturbance (such as, apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
  • Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
  • Significant nutritional deficiency.
  • Dependence on enteral feeding or oral nutritional supplements.
  • Marked interference with psychosocial functioning.
• The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
• The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
• The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

What Are The Risk Factors for Developing ARFID?

As with all eating disorders, the risk factors for ARFID involve a range of biological, psychological, and sociocultural issues. These factors will interact differently in different people, which means two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms. Researchers know much less about what puts someone at risk of developing ARFID, but here’s what they do know:

• People with autism spectrum conditions are much more likely to develop ARFID, as are those with ADHD and intellectual disabilities.
• Children who don’t outgrow normal picky eating, or in whom picky eating is severe, appear to be more likely to develop ARFID.
• Many children with ARFID also have a co-occurring anxiety disorder; these children are also at high risk for other psychiatric disorders.

What Are The Warning Signs of ARFID?

Behavioral and psychological 

• Dramatic weight loss
• Dresses in layers to hide weight loss or stay warm
• Reports constipation, abdominal pain, cold intolerance, lethargy, and/or excess energy
• Reports consistent, vague gastrointestinal issues (“upset stomach”, feels full, etc.) around mealtimes that have no known cause
• Dramatic restriction in types or amount of food eaten
• Will only eat certain textures of food
• Fears of choking or vomiting
• Lack of appetite or interest in food
• Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens).
• No body image disturbance or fear of weight gain

Physical

Because both anorexia and ARFID involve an inability to meet nutritional needs, both disorders have similar physical signs and medical consequences.

• Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
• Menstrual irregularities—missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
• Difficulties concentrating
• Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
• Female after puberty loses menstrual period
• Dizziness
• Fainting/syncope
• Feeling cold all the time
• Sleep problems
• Dry skin
• Dry and brittle nails
• Fine hair on body (lanugo)
• Thinning of hair on head, dry and brittle hair
• Muscle weakness
• Cold, mottled hands and feet or swelling of feet
• Poor wound healing
• Impaired immune functioning

What Are The Health Consequences of ARFID?

In ARFID, the body is denied the essential nutrients it needs to function normally.  Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences. The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death.

Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body

What is Pica?

Pica is an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and paint chips.

• It is unclear how many people are affected by pica. It most likely is more prevalent in developing countries.
• Pica can affect children, adolescents, and adults of any genders.
• Those who are pregnant and craving nonfood items should only be diagnosed with pica when their cravings lead to ingesting nonfood items, and the ingestion of those items poses a potential medical risk (either due to the quantity or type of item being ingested).
• Pica can be associated with intellectual disability, trichotillomania (hair-pulling disorder), and excoriation (skin picking) disorder
• There are no laboratory tests for pica. Instead, the diagnosis is made from a clinical history of the patient.
• Diagnosing pica should be accompanied by tests for anemia, potential intestinal blockages, and toxic side effects of substances consumed (i.e., lead in paint, bacteria or parasites from dirt).

What Are The Warning Signs of Pica?

• The persistent eating, over a period of at least one month, of substances that are not food and do not provide nutritional value.
• The ingestion of the substance(s) is not a part of culturally supported or socially normative practice (e.g., some cultures promote eating clay as part of a medicinal practice).
• Typical substances ingested tend to vary with age and availability. They may include paper, soap, cloth, hair, string, wool, soil, chalk, talcum powder, paint, gum, metal, pebbles, charcoal, ash, clay, starch, or ice.
• The eating of these substances must be developmentally inappropriate. In children under two years of age, mouthing objects—or putting small objects in their mouth—is a normal part of development, allowing the child to explore their senses. Mouthing may sometimes result in ingestion. In order to exclude developmentally normal mouthing, children under two years of age should not be diagnosed with pica.
• Generally, those with pica are not averse to ingesting food.

What Are The Risk Factors for Pica?

• Pica often occurs with other mental health disorders associated with impaired functioning (e.g., intellectual disability, autism spectrum disorder, schizophrenia).
• Iron-deficiency anemia and malnutrition are two of the most common causes of pica, followed by pregnancy. In these individuals, pica is a sign that the body is trying to correct a significant nutrient deficiency. Treating this deficiency with medication or vitamins often resolves the problems.
• A medical professional should assess if the behavior is sufficiently severe to warrant independent clinical attention (e.g., some people may eat nonfood items during pregnancy, but their doctor may determine that their actions do not indicate the need for separate clinical care).

How is Pica Treated?

The first-line treatment for pica involves testing for mineral or nutrient deficiencies and correcting those. In many cases, problematic eating behaviors disappear as deficiencies are corrected. If the behaviors aren’t caused by malnutrition or don’t stop after nutritional treatment, a variety of behavioral interventions are available.

Scientists in the autism community have developed several different effective interventions, including redirecting the person’s attention away from the desired object and rewarding them for discarding or setting down the non-food item.

What Is Rumination Disorder?

Rumination disorder involves the regular regurgitation of food that occurs for at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out. Typically, when someone regurgitates their food, they do not appear to be making an effort, nor do they appear to be stressed, upset, or disgusted.

How is Rumination Disorder Diagnosed?

The DSM-5 criteria for rumination disorder are:

• Repeated regurgitation of food for a period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
• The repeated regurgitation is not due to a medication condition (e.g., gastrointestinal condition).
• The behavior does not occur exclusively in the course of anorexia nervosa, bulimia nervosa, BED, or avoidant/restrictive food intake disorder.
• If occurring in the presence of another mental disorder (e.g., intellectual developmental disorder), it is severe enough to warrant independent clinical attention.

What Is The Treatment for Rumination Disorder?

Once a physical cause for rumination disorder has been ruled out, the most common way rumination disorder is treated involves a combination of breathing exercises and habit reversal. A child with rumination disorder is taught to recognize the signs and situations when rumination is likely, and then they learn diaphragmatic breathing techniques to use after eating that prevent them from regurgitating their food. They eventually learn to prevent the rumination habit by replacing it with deep breathing techniques.

Seeking Treatment for Eating Disorders:

Recovery from an eating disorder can be a long process that requires not only a qualified team of professionals, but also the love and support of family and friends. It is not uncommon for someone who suffers with an eating disorder to feel uncertain about their progress or for their loved-ones to feel disengaged from the treatment process. These potential roadblocks may lead to feelings of ambivalence, limited progress, and treatment drop out. Therefore, knowing about the Stages of Change Model, as defined by Prochaska and DiClemente, will help everyone involved better negotiate the road to recovery.

The Stages of Change in the process of recovery from an eating disorder are a cycle rather than a linear progression. The person may go through this cycle more than one time or may need to revisit a particular stage before moving on to the next. They may also go through the stages for each individual eating disorder symptom. In other words, if they are recovering from anorexia, they could be in the Action Stage for restrictive eating (e.g., eating three meals a day along with snacks, engaging in social eating, and utilizing support system) while, at the same time, they could be going through the Contemplation Stage for body image and weight concerns (e.g., becoming aware of how body image is tied to self-esteem and self-worth, defining oneself as a body or number, and identifying the negatives of striving for the “perfect body”). This is precisely why recovery from an eating disorder is complex and individualized.

If you are a parent or friend of someone struggling, you no doubt suffer right along with them, so it is crucial for you to pay attention to your own needs as well as be present for your child or friend during her recovery process.

What Are The Stages of Change?

There are five Stages of Change that occur in the recovery process: Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance. Let’s examine them further.

1) The Pre-Contemplation Stage is evident when a person does not believe they have a problem. Close family and friends are bound to pick up on symptoms such as restrictive eating, the binge/purge cycle, or a preoccupation with weight, shape, and appearance even before the person admits to it. They may refuse to discuss the topic and deny they need help. At this stage, it is necessary to gently educate the person about the devastating effects the disorder will have on their health and life, and the positive aspects of change.

• Do not be in denial of your child or friend’s eating disorder.
• Be aware of the signs and symptoms.
• Avoid rationalizing their eating disordered behaviors.
• Openly share your thoughts and concerns with your child or loved one.

2) The Contemplation Stage occurs when an person is willing to admit that they have a problem and are now open to receiving help. The fear of change may be very strong, and it is during this phase that a psychotherapist should assist the person in discovering the reason they have an eating disorder so they can understand why it is in their life and how it no longer serves them. This, in turn, helps the person move closer toward the next stage of change.

• If your child is under the age of 18, insist that they receive professional help from a qualified eating disorder specialist.
• Educate yourself about the disorder.
• Be a good listener.
• Do not try to “fix” the problem yourself.
• Seek your own encouragement from a local eating disorder support group for family and friends.

3)The Preparation Stage the person transitions into the Preparation Stage when they are ready to change, but aren’t sure how to do it. Time is spent establishing specific coping skills such as appropriate boundary setting and assertiveness, effective ways of dealing with negative eating disorder thoughts and emotions, and ways to tend to their personal needs. Potential barriers to change are identified. This is usually when a plan of action is developed by the treatment team, (i.e. psychotherapist, nutritionist, and physician) as well as the person and designated family members. This generally includes a list of people to call during times of crisis.

• If supporting a loved one in their recovery, identify what your role is in the recovery process.
• Explore your own thoughts and beliefs about food, weight, shape, and appearance.
• Ask your child/loved one and the treatment team how you can be best involved in the recovery process and what you can do to be supportive.
• ACTION STAGE

4) The Action Stage begins when the person is ready to start their strategy and confront the eating disorder behavior head on. By now, they are open to trying new ideas, behaviors, and are willing to face fears in order for change to occur. Trusting the treatment team and their support network is essential to making the Action Stage successful.

• Follow the treatment team’s recommendations.
• Remove triggers from your environment: no diet foods, no scales, and no stress.
• Be warm and caring, yet appropriate and determined with boundaries, rules, and guidelines.
• Reinforce positive changes without focusing on weight, shape, or appearance.

5) The Maintenance Stage evolves when the person has sustained the Action Stage for approximately six months or longer. During this period, they actively practice new behaviors and new ways of thinking as well as consistently use both healthy self-care and coping skills. Part of this stage also includes revisiting potential triggers in order to prevent relapse, establishing new areas of interests, and beginning to live their life in a meaningful way.

• Applaud your loved one’s efforts and successes.
• Continue to adjust to new developments.
• Redefine the boundaries at home as necessary.
• Maintain positive communications.
• Be aware of the possibility of recovery backsliding and relapse to prior distorted eating.

6) The Termination Stage & Relapse Prevention. Relapse is sometimes grouped with the maintenance stage since recovery doesn’t occur all at once, and it’s normal for some relapsing behaviors.

So, how do you know when it is time to discontinue treatment? With the understanding that this decision is best made in consultation with your treatment team, ask yourself the following questions:

• Have I mastered the Stages of Change in the major areas of my eating disorder?
• Do I have the coping skills necessary to maintain these changes?
• Do I have a relapse prevention plan in place?
• Am I willing to resume treatment in the future if necessary?

To prevent relapsing ask for help, communicate your thoughts and feelings, address and resolve problems as they arise, live a healthful and balanced life, and remember that you would not have made it this far if it were not for your strong determination and dedication toward recovery.