Interview with Dr Laurie Mazzuca
The below interview is by child and adolescent psychologist Dr. Laurie Mazzuca and psychiatrist Dr. Orlanda Varela from Sinews. For more information, or to make an appointment with a Sinews professional, please call: ( 34) 911020610 (Mon-Fri: 8:30 AM to 8:00 PM) or visit www.sinews.es. The offices of Sinews Multilingual Therapy Institute are located at Calle Sagasta, 8, 1•, 28004 Madrid.
**Interview questions answered by child and adolescent psychologist Dr. Laurie Mazzuca
1. What are the most common behavioral and emotional problems you treat in children?
Children can suffer from a wide range of mental, behavioral, and emotional disorders; the most common childhood disorders we treat at Sinews include anxiety disorders, ADHD, depression, learning disorders, and disruptive behavior disorders, such as Oppositional Defiant Disorder and Conduct Disorder. Other common problems for which parents often seek treatment include difficulties coping with divorce, problems in the parent-child relationship, sibling rivalry, adjustment or acculturation problems, and trauma-related issues.
2. What do you think causes these problems? Is it a child’s environment or is it in the child’s nature?
In reality, mental health disorders in children and adolescents are caused by a combination of both biology and the environment. Research shows that biological factors (e.g. genetics, chemical imbalances, traumatic brain injury, etc.) play a strong role in many childhood disorders, such as ADHD, Bipolar Disorder, or Autism; whereas, environmental factors (e.g. loss of a loved one, disruption in the family environment, stress, exposure to violence, etc.) are closely linked to disorders such as Oppositional Defiant Disorder and eating disorders or substance abuse disorders commonly seen in adolescents. However, it is important to keep in mind that in all of the aforementioned disorders, both biology and environment are affecting a child’s physical, emotional, and psychological well-being.
3. Are any of these problems more prevalent in Expat children due to them adjusting to life in another country / multiple languages, moving away from friends and family etc?
We don’t really have reliable statistics related to rates of mental health problems among Expat children, especially in Spain. However, our clinical experience suggests that Expat kids may have a higher risk of experiencing anxiety disorders, adjustment disorders, and depression, due to the stressors that accompany the transition from one culture to another. In addition, when parents are under more stress, as is often the case among Expat parents, their children are more likely to show behavioral and emotional problems.
4.How do you know if your child has a behavioral problem or if they are just going through a difficult phase?
Growing up is difficult! All children have good days and bad days; it is very common for children and teenagers to have difficulty paying attention sometimes, to feel anxious, sad, or blue once in a while, or to break rules and test limits at home and at school. In most cases, these problems are part of normal development. However, when a child’s mood or behavior starts to interfere with his/her ability to do well in school, to get along with family and friends, or to take part in the normal activities of a child the same age, it is probably time to consult a child mental health professional.
5.How can behavioral problems affect a child’s performance at school?
Children with behavior problems often have difficulty paying attention, following instructions from the teacher, staying seated, getting along with peers, and staying organized. Furthermore, children with behavior disorders have a higher risk of also having a learning disorder, which makes it even more challenging for them to learn and succeed in the classroom. In addition, teachers of children with ADHD or other disruptive behavior disorders report higher levels of stress and often feel unable to cope with the child’s behaviors, so this can lead to problems in the teacher-student relationship, and can be very frustrating for both parents and teachers alike.
**The following questions were answered by psychiatrist Dr. Orlanda Varela (Dr. Varela is experienced in treating child and adolescents with ADHD and other disorders)
6.How good are schools in Spain at detecting behavioral problems in children?
Spanish teachers are probably not as alert to the behavioral problems that are a result of a physical or mental disorder as teachers in the USA or the UK.
Instead the tendency is for bad behavior to be attributed to naughtiness, a bad
upbringing or problems at home. On the other hand, Spanish teachers tend to be more
prudent when it comes to labeling a child with an unconfirmed diagnosis or to medicate any behavior that is "different". However, teachers are becoming more and more aware that there are certain disorders, especially ADHD, that can influence poor performance in school. Other problems like dyslexia or similar learning disorders that do not usually manifest obvious behavioral disturbances go unnoticed.
7. How are children in Spain with behavioral problems treated differently (if at all) in the classrooms?
Teachers in Spain will most commonly monitor the child more closely, move him or her to the front of the class, seat them at the same table with students who will set a good example and are helpful, etc. In most cases teachers will seek consultation from school counselors or psychologists and will inform the parents of what is going on.
8. What is the attitude of medical professionals in Spain towards behavioral problems?
Health care professionals (pediatricians, pediatric nurses, etc.) are very knowledgeable about childhood psychological and psychiatric disorders and share the same information that is available in other developed countries. Likewise, almost all types of medicine (with rare exceptions) available in the USA, UK and Canada can be found in Spain. However, it's important to keep in mind that child psychology and child psychiatry as formal specialties do not exist in Spain. Not just any psychologist or psychiatrist is qualified to treat children. It’s important to do your research on mental health professionals to make sure that they have the academic credentials and training to work with children.
**The following interview questions were answered by child and adolescent psychologist Dr. Laurie Mazzuca
9. What is ADHD and what are the symptoms of ADHD?
ADHD stands for Attention Deficit Hyperactivity Disorder, and it is estimated that it affects 3-7% of school age children. A child or adult with ADHD has difficulty sustaining attention and controlling his/her impulses, and is fidgety or hyperactive (ie. is restless, has trouble sitting still or playing quietly for more than a few minutes). A person with ADHD is also usually forgetful, disorganized, often interrupts others, and has difficulty finishing tasks. Although the causes of ADHD are not fully understood yet, scientific research suggests that ADHD is a neurological deficit or disorder, for which the primary cause is heredity or genetics.
10. At what age can you start to detect the first symptoms of ADHD?
To receive a diagnosis of ADHD, the problems with inattention and hyperactivity must begin before the age of seven. In general, most parents and teachers start to observe problems or differences in their child’s attention and concentration skills compared to other kids when they enter school for the first time, usually between the ages of four and six years. It is more difficult to confirm a diagnosis of ADHD when the child is under five due to the fact that some inattention, impulsivity, and distractibility is considered to be normal at this age.
11. How can ADHD be treated? Can ADHD be treated by therapy alone or do children also need to take medication?
Research studies show that the most effective way to treat ADHD is multimodal treatment including a combination of pharmacotherapy (medication) and cognitive-behavioral therapy. Medication has been shown to be helpful in improving a child’s ability to focus and concentrate, and it also has a positive effect on goal-directed behavior, which is required to do things like organize, plan, and complete a homework assignment. However, medication does not “cure” ADHD; rather, it helps to reduce the symptoms of the disorder. That means that the symptoms will return when the child is not taking the medication, such as in the evening or during the weekend. For this reason, a combination treatment method including cognitive-behavioral therapy (CBT) is usually necessary in order to achieve long-term, consistent improvement. In CBT, parents and children learn how to manage ADHD symptoms on a long-term basis, which allows them to cope with the disorder both when the child is and is not taking the medication, and even after they have stopped going to therapy. CBT for ADHD can include social skills training, behavior management, parent education, and modification of the classroom or learning environment. CBT can also address secondary problems that are often part of ADHD, such as low self-esteem, peer problems, or aggression. It is possible to treat ADHD without medication using CBT; however, parents should be aware that it may take longer to see improvement in their child’s symptoms, as it takes time to learn and practice the new techniques.
12. How can a parent help a child with ADHD?
The first thing a parent can do to help their child is consult a professional to discover the nature of the problem. Once a diagnosis of ADHD is confirmed, parents can help their child with ADHD by taking an active role in the treatment process. Parents should think of the therapy process as a learning experience, in which they will become educated about the disorder, learn to understand their child’s individual needs, and learn new ways of communication and behavior management that will allow them to help their child both at home and at school. For example, parents may learn how to give simple, one-step instructions that are easier to understand and follow for children with ADHD, or they may learn new ways to help their children get along with siblings or peers.
13. Can children grow out of ADHD?
This is common myth about ADHD; children do not “grow out” of it. It is common for attention and concentration skills to improve naturally due to the normal maturation process, and in some mild cases, it is possible that the symptoms will not be noticeable when the child reaches adulthood. However, in most cases, although the severity of symptoms may reduce, the symptoms usually persist into adolescence and adulthood. Research strongly suggests that ADHD is a neurological problem which will affect the person throughout their life. In fact, it is estimated that between 2 and 5% of adults have ADHD. However, this myth came about because many individuals had symptoms of ADHD when they were children, and they went on to lead successful, productive lives. This can usually be explained in one of two ways: First, children who never receive any treatment for their ADHD learn to compensate for their difficulties in other ways, and this helps to reduce the impact of their limitations on their daily lives. For example, individuals with ADHD naturally gravitate towards activities that are highly stimulating, therefore, it is common for children and adults with the disorder to select activities or careers that are active and that do not require them to sit down and focus for a long period of time. So, an adult with ADHD may have difficult getting through the long lectures in law school, and therefore may shy away from this career. A second explanation for this phenomenon is that children who engage in CBT when they are young can become very adept at managing their own symptoms, so much that the symptoms no longer cause significant problems. ADHD has nothing to do with a person’s intelligence level, and studies show that children and adults who receive proper treatment for ADHD can lead healthy, successful, productive lives.
14.What are the most common anxieties in children? How can these be treated?
It is very normal for children to experience anxiety (nervousness, worry, fear, uneasiness, dread, or even terror), and in fact, at certain ages or during certain periods of development, we expect them to feel anxious or afraid. However, for some children, the anxiety persists for a long time, even when other children their age have “grown out of” the fear or worry; or the intensity of the anxiety is severe and interferes with their daily lives. When the anxiety is this bad, it is possible that a child has an anxiety disorder. Anxiety disorders represent the most common mental health problem in children and adolescents. Most estimates suggest that approximately 10% of children and adolescents suffer from some type of anxiety disorder, and of those children, about half will have another anxiety disorder or mental disorder. Prevalence rates do vary based upon the specific disorders, but in general, Generalized Anxiety Disorder, Separation Anxiety Disorder, and Phobias are among the most commonly diagnosed anxiety disorders in children. Whereas, adolescents tend to have higher rates of Panic Disorder and Social Phobia. Other anxiety disorders sometimes seen in children and adolescents include Obsessive Compulsive Disorder and Post-traumatic Stress Disorder. Research suggests that while rates of anxiety disorders among young girls and boys seem to be equivalent, during adolescence, girls are more affected by anxiety than boys.
15. If left untreated can anxieties in children affect their social and educational development?
Children with severe anxiety that is left untreated may experience a variety of problems in their daily lives. The nature of the impairment differs based upon the exact nature of the anxiety disorder (for example, a child with a specific phobia of water will struggle in a different way than a child with social phobia), but all children with anxiety will experience a significant amount of distress (as will their parents!) when they are confronted with the situation or object that triggers the anxiety. If left untreated, children with anxiety disorders may avoid certain places, such as school or shopping malls, and may refuse to take part in activities that would be normal for a child of his/her age. This can lead to low self-esteem, loneliness, poor relationships with peers, frequent absences from school, low academic achievement. In addition, children with untreated anxiety often suffer from insomnia and complain of aches and pains, such as stomachaches, dizziness, or nausea, that have no apparent physical or medical cause. Adolescents with untreated anxiety may begin to abuse drugs and/or alcohol, which they may use to “self-medicate” or take the edge off of their anxiety. Of course, as anxious children and teens progress into adulthood, the anxiety may become more severe, and can really impair their ability to finish college, get a new job, maintain a healthy relationship, or even live independently.
16. What treatments are available to treat childhood anxieties?
There are a variety of treatment methods available for anxiety disorders in children. As is the case with most childhood mental health disorders, most research studies support the use of a multimodal treatment approach that incorporates cognitive-behavioral therapy (in which children learn new ways of thinking that help reduce fear and anxiety, or in which they are encouraged to confront their fears) and medication. In addition, treatment can be enhanced with specific techniques like relaxation training, and parents often participate in family therapy or parent training so that they too can learn to help their child with his/her anxiety. The utility of each one of these methods varies based upon the specific anxiety disorder; for example, medication may be more effective in treating certain kinds of anxiety disorders than others. For this reason, it is very important to obtain a proper assessment/diagnosis from a trained mental health professional before beginning treatment. At that point, the professional and parents can design a treatment plan that is appropriate for the individual child.
What services does your company provide?
At Sinews, we provide a wide range of assessment and treatment services for children and adolescents. Services include: Psychological assessment (evaluation of intelligence, learning disabilities, psychological/emotional functioning); individual therapy for children and adolescents with problems such as anxiety, depression, defiant behavior, stress management, school problems, ADHD, traumatic loss, abuse, divorce, children coping with chronic illness, and cultural adaptation; and family therapy to address issues such as parent-child relationship problems, sibling rivalry, behavioral problems, or bereavement. We are also available to provide consultation with teachers of therapy clients, and we offer psychoeducational workshops for teachers and staff related to school-based behavioral health problems (behavior management, ADHD, conduct problems, anger management, bullying, school violence, social skills). In addition, we will be offering a variety of psychoeducational workshops for parents, siblings, and family members related to issues that are very relevant to family life, such as parenting, positive discipline, or grandparents who are raising their grandchildren. Lastly, because Sinews is a multidisciplinary, multilingual therapy institute, we offer both neurology, psychiatry, and speech therapy services for children and adolescents, and all services are currently available in English, Spanish, and French (note: Speech therapy services are currently only available in English and Spanish.) For more information, or to make an appointment with a Sinews professional, please call: 91 10 20 610 (Mon-Fri: 8:30 AM to 8:00 PM). We can also be found on the World Wide Web at www.sinews.es . The offices of Sinews Multilingual Therapy Institute are located at Calle Sagasta, 8, 1•, 28004 Madrid.
Sep 08
