There are an increasing number of children coming into our practice with overlapping conditions. These children have been diagnosed with ADHD, Bipolar Disorder, Learning Disability, Tourette’s, and/or Asperger’s.  Many of these children also experience depression, anxiety, and obsessive thoughts and compulsive behaviors. Often they are defiant and oppositional.  No single diagnosis seems to apply to these children, so we say they are in the “syndrome mix.”

Assessment and treatment of these children cannot be accomplished by any single provider. These children require a multi-disciplinary assessment and multi-modal intervention.  A complete evaluation may include the following: psychological (which would likely include educational and neuropsychological tests), medical, neurological, and psychiatric evaluations. Many of these children also need to be evaluated by speech and language, physical, and occupational therapists.  Treatment will most likely include psychotherapy, medication management, and educational interventions. Many of these children also require language therapy, social skills training, physical therapy, and occupational therapy. The most successful kids are those whose parents are willing to take an active case management and advocacy role. Providers can help by supporting and counseling these parents. 

Most children in the “syndrome mix”  experience deficits in executive functioning.  Most definitions suggest executive functioning is the ability to formulate a plan, initiate the plan, and carry it through to the end. Executive functioning is sometimes compared to the conductor of an orchestra.               

Almost every human endeavor requires executive functioning. A short list of the regulatory functions carried out by executive functioning  includes: perceiving, initiating, inhibiting, modulating/adjusting, gauging, shifting, manipulating, organizing, storing, retrieving, pacing, time sense, focusing attention, focusing effort, sustaining attention, stopping, anticipating, time management, monitoring, and correcting.  Deficits in executive functioning will impair most aspects of daily life, from getting out of bed, to completing homework, to responding to a simple command.

FAQ

1) What is a Pervasive Developmental Disorder?

The term "pervasive development disorders" (PDDs) refers to a group of developmental conditions that involve delays or impairments in the development of many basic skills, such as communication and social skills. Autism is the most well-known of the pervasive developmental disorders, so PDDs also are known as autism spectrum disorders. The Pervasive Development Disorders are:

• Autism
• Asperger's syndrome
• Childhood disintegrative disorder
• Rett's syndrome
• Pervasive development disorder not otherwise specified (PDDNOS)

2) What is Asperger's Disorder?

Asperger's Disorder is the term for a specific type of Pervasive Developmental Disorder which is characterized by problems in development of social skills and behavior. A child with Asperger's Disorder functions at a higher level than the typical child with autism. Individuals with Asperger's Disorder typically have normal intellectual functioning.  Children with Asperger's Disorder are usually using words by the age of two, although their speech patterns may be somewhat odd.  Most children with Asperger's Disorder have difficulty interacting with their peers. They may be loners and some display “eccentric” behaviors.  Children with Asperger's, often have preoccupations or obsessions, for example spending hours each day preoccupied with counting cars passing on the street, reading and studying dinosaurs, or watching only the weather channel on television.  Coordination difficulties are also common with this disorder.

3) What is Childhood Onset Bipolar Disorder (COBPD)?

Bipolar Disorder is characterized by mood swings that alternate from periods of severe highs (mania) to severe lows (depression).  In late adolescence and adulthood  these abnormally intense moods usually last for weeks or months. However in COBPD children can experience such rapid mood swings that they commonly cycle many times within a day. The most typical pattern of cycling among those with COBPD, called ultra-ultra rapid or ultradian, is most often associated with low arousal states in the mornings followed by increases in energy towards late afternoon or evening. Children with COPD are sometimes diagnosed with Major Depression and/or ADHD, but as they are followed in treatment it becomes apparent that the correct diagnosis is COBPD.  Diagnosing COBPD is order is difficult and complex and care should be taken in selecting treatment providers. More information can be obtained from BPkids.org.

4) What is executive functioning?

Executive functioning is the ability to formulate a plan, initiate the plan, and see it’s execution through to the end.  Executive functioning is sometimes referred to as the “conductor” of all our cognitive skills. Executive functioning is command central for carrying out our actions.  Executive functions help manage life tasks of all types, including organizing homework, planning a project, organizing a shopping list and a trip to the store, and getting to practice on time with the necessary equipment.  Deficits in organization are a typical characteristic of problems with executive functioning.

LDonline.org has a very good article on Executive Functions.

RESOURCES

An excellent resource is the book Kids In The Mix of ADHD, LD, Asperger’s, Tourette’s, Bipolar, and More! By Martin L. Kutscher, MD.

Also, check out our resources page on myparentingpage.com

TREATMENT

A proper assessment is required in order to correctly diagnose your child and develop a treatment plan. Information needs to be obtained from the child, parents, and teachers.  A battery of psychological tests may be required (see our assessment page). Typically a multi-modal approach is required and may include psychotherapy, occupational therapy, physical therapy, language therapy, educational modifications, medication management, special education, behavior management, and parent training.