Hilber Psychological Services
Therapy for Children, Teens, & Adults in San Diego
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Hilber Psychological Services

San Diego Therapists | Child Therapist | Couples Counseling | ADHD | Anxiety | Parenting | Behaviors | Relationships | Marriage and Family Therapists | Psychologists | Professional Clinical Counselors

Posts tagged Psychotherapy
Parental Therapy for Children who have Anxiety

In the article, “New Childhood Anxiety Treatment Focuses on the Parents,” author Matt Kristoffersen discusses how Supportive Parenting for Anxious Childhood Emotions (SPACE) is an alternative to behavioral therapy used to treat childhood anxiety. He acknowledges that it all starts with the parents and how they perceive their child’s anxiety in the given situation.

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Stated by the National Institute of Mental Health, “nearly one in three American children will experience at least some kind of anxiety disorder before reaching adulthood.” Although drugs and therapy techniques have shown to be proven successful in the past years, a recent study published in the Journal of the American Academy of Child & Adolescent Psychiatry, promulgates a new technique developed for the parents.

A team of Yale researchers randomly selected 124 children with anxiety and assigned them to a therapy-based group or a parent-only group for 12 weeks. In these meetings they were divided into two groups, one in cognitive behavioral therapy and one in SPACE therapy. They learned how to control their symptoms and confront their fears through therapeutic exposure. The researchers observed that children in the first group never spoke to a therapist about their specific anxiety during the trial. The researchers suggested that parents should support their child in a sense of letting them figure out how to cope with anxiety on their own, by using the SPACE treatment, rather than continuing to oblige to their child’s behavior. For example, “if a child gets anxious when there are guests in the house, parents may stop inviting people over. However, according to the study, children can grow accustomed to these accommodations over time, which can lead to greater difficulty with anxiety later in life.” In this case, parents should take a step back and “replace accommodation with words of support and with expressions of confidence in their children’s abilities to deal with anxiety on their own.”

In the first study administered in 2013, author Lebowitz prompted parents to follow a script of ways to be supportive and reassuring in order to reduce accommodations for their child with anxiety:

We understand it makes you feel really anxious or afraid,” the script said. “We want you to know that this is perfectly natural and everyone feels afraid some of the time. But we also want you to know that it is our job as your parents to help you get better at things that are hard for you, and we have decided to do exactly that. We are going to be working on this for a while and we know it will probably take time, but we love you too much not to help you when you need help.”

Through SPACE therapy, parents were able to form a much closer relationship with their children than those of the children in the cognitive therapy-based group and help them work on their anxiety problem. Because of this study, “SPACE will provide an alternative for children with anxiety who may not respond well to traditional therapy or who refuse to participate.”

For more information on therapy for anxiety with the parents or the children, or any other therapy, please contact us at Hilber Psychological Services.

-Written by Lily Schmitt and Tanya L. Hilber, PsyD

Reference

Kristoffersen, Matt.New Childhood Anxiety Treatment Focuses on the Parents.” Yale News. Scitech. Web. 26 March 2019. https://yaledailynews.com/blog/2019/03/26/new-childhood-anxiety-treatment-focuses-on-the-parents/?fbclid=IwAR1_yDjSIF9njsJ6ATplIrWwivPIqbj-OgqtehNYIxvfE85vrVkfTFoOj7k

Consistent Use of ADHD Medication May Stunt Growth by 2 Inches

According to the article, "Consistent Use of ADHD Medication May Stunt Growth by 2 Inches, Large Study Finds", written by Dr. David Rabiner, "although the benefits of medication treatment on ADHD symptoms dissipate, the impact on adult stature persists". The Multimodal Treatment Study of ADHD (MTA Study) tested 600 7–9-year-old children with ADHD. These children were randomly assigned into one of these four groups: 
1. Carefully monitored medication treatment
2. Intensive behavior therapy
3. Medication treatment combined with behavior therapy
4. Community care (parents obtained whatever treatment they want)

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After 14 months, the study showed that those children who received carefully monitored medication treatment or medication treatment combined with behavior therapy had lower levels of overall ADHD symptoms and better overall adjustment compared to those children who received intensive behavior therapy or community care. The results stayed the same after an evaluation 10 months later. However, evaluation after 1 year and again after several groups showed no group differences based on the initial group treatment assignments. Therefore, the initial benefits of the medication had disappeared. The study continued annually through age 18 and then reduced visits to age 25. Within this group, individuals were categorized based on their medication usage:
a. Consistent, i.e,. those who had met the minimum threshold during each year;
b. Inconsistent, i.e., those meeting the minimum threshold in some but not all years; and
c. Negligible, i.e., below the minimum threshold in all years. 

At the last evaluation, age 25, participants self- and parent-reported, and doctors measured the patient's height compared to other individuals around the area that had not been diagnosed with ADHD in their childhood. Based off of the medication categorized above, only 14.3% of participants consistently used medication through age 18. After comparing the other participants, participants with ADHD maintained substantially higher ADHD symptoms over time regardless of their initial treatment. It was clear that ADHD symptoms in young adulthood are not related to patterns of medication use through adolescence. 

There was thus no indication that consistent medication treatment over a number of years had any persistent impact. However, there was a relationship found between persistent medication use and adult height. According to Dr. Rabiner, "Students in the Consistent and Inconsistent medication treatment groups had average heights — combined across these groups — that were about an inch shorter than those in the Negligible treatment group. And, participants in the Consistent Group were nearly an inch shorter on average than those in the Inconsistent group, i.e., nearly 2 inches shorter than those in the Negligible group". 

Overall, the study concluded there was substantial persistence of ADHD symptoms into adulthood and although the benefits of medication treatment on ADHD symptoms dissipate, the impact on adult stature persists. However, it is possible that some other factor that contributed to some participants taking medication more consistently, e.g., more severe symptoms, also explains the reduced height attainment in this group.

There are many take home messages:
1. Relatively few youth with ADHD use medication consistently over their development.
2. Many individuals with ADHD will continue to struggle with ADHD symptoms into adulthood. 
3. Although medication helps control symptoms in the short-term, it is not a cure.
4. It is unknown whether optimal medication treatment maintained over many years would have a greater impact.
5. Parents and clinicians need to balance the need for persistent treatment in some children with the likely consequences of reduced adult height. 

Due to the symptoms that may occur from using persistent medication, an optimal solution would be to find the lowest effective dose of medication, or combine medication treatment with other behavior therapy and/or other approaches.

If you have questions about ADHD and how it can affect you or your child or would like to schedule an appointment, please contact us. For more information on therapy, visit FAQ at Hilber Psychological Services

~Written by Allison Parker and Tanya L. Hilber, PsyD

Reference: Rabiner, David. “Consistent Use of ADHD Medication May Stunt Growth by 2 Inches, Large Study Finds.” SharpBrains, SharpBrains, 28 Mar. 2018.

How do you start therapy? What is it like?
Deep breathing

Ever wondered how to start therapy? How does it work? What is it like behind the closed doors? What happens in the beginning? Every therapist is different in their personality, orientation and type of therapy, and style of conversation in therapy. To be brief, there are a few types or orientations to psychotherapy that include humanistic, cognitive-behavioral, behavioral, psychodynamic, and psychoanalytic. Some therapists focus on one type and others may integrate a few of these. Some therapists may ask more questions and others may allow space for clients to fill. Hilber Psychological Services therapists provide therapy mostly from a Cognitive-Behavioral therapy orientation or CBT. Since all personalities and office procedures are different, this will give you a good idea of what it's like to start your work together with us at Hilber Psychological Services.

Before the Appointment Before setting up an appointment at Hilber Psychological Services, there will be a short conversation via phone or email to verify important details. These details include whether there are custody issues and if both parents are supportive of treatment and your insurance carrier if you choose to use your insurance plan.

After you have discussed these details, an appointment is set up. If you consent to an email, you will receive a confirmation email with the office address, your appointment time, and the paperwork for you to fill out in the privacy of your own home. You may bring that paperwork with you to the first appointment.

First Appointment or "Intake" At the first session, there will be a brief review of the paperwork you signed. The rest of the session is then focused on getting to know you and your situation. This is the time to bring up your concerns and presenting issues you want help with, as well as any questions you may have for us. At the end of the first session you may make a follow up appointment if you felt like the appointment and therapist was a good fit with you.

Second Appointment For adults and teens, typically the second appointment is to get to know each other better, talk about any topics that you feel are important but haven't mentioned yet, and move forward to discuss the steps recommended and continue with your treatment.

For children, the second appointment is about meeting the child, getting to know each other, discussing emotions and "wild card" coping skills of deep breathing and muscle relaxation. Typically the last part of the session is saved for playing a game to build the relationship, reward the child for working so hard, and practice the skills they have just learned. Finally, during the last few minutes, the parent is brought into the room and given a brief overview of the topics discussed and skills introduced.

Now you are ready for the following appointments. These are more dependent on the situations and individuals, but you may find that you are comfortable in session.

For detailed questions, please contact us via Hilber Psychological Services or at drhilber@hilberpsychsandiego.com to set up an appointment. For more common questions about therapy, see FAQ at HPS.