Social Media Misdiagnosis

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Social Media Misdiagnosis

February 7, 2024 | Vanessa Buonopane, Psy.D. | 7 min. read

TikTok. Instagram. YouTube. What do all of these social media platforms have in common? They are wonderful for getting mass amounts of information out to people. One type of information provided is information related to mental health.

Although this is a great way to educate people on mental health disorders, it can also lead to self-diagnosis and, often, misdiagnosis.

Social Media Misdiagnosis OMHG Blog

So, what’s the problem?

While mental health clinicians want people to learn about their diagnoses and connect with others who share similar experiences, we also want you to take in accurate information about mental health diagnoses. One study examined the reach and accuracy of information on autism on TikTok, finding that “videos associated with the #Autism hashtag accrued 11.5 billion views collectively. An examination of the top 133 videos providing informational content on autism…showed that 27% of the videos were classified as accurate, while 41% were classified as inaccurate and 32% as overgeneralized. Videos created by healthcare professionals were more likely to include accurate information” (Aragon-Guevara, Castle, Sheridan, and Vivanti, 2023).

For instance, numerous individuals come into our office for psychological evaluations to determine if they have Attention-Deficit/Hyperactivity Disorder (ADHD) after stating they are having problems with attention and concentration in school, at work, at home, and/or in public settings. While there is a portion of people who legitimately meet the diagnostic criteria for ADHD, many individuals’ difficulties with attention and concentration might be linked to other concerns, such as depression and anxiety (Note: Check out this article for more information on ADHD).

If you or someone you know believes that they identify with a diagnosis on social media but are not formally diagnosed, it can be helpful to encourage the individual to undergo a psychological evaluation to determine if they meet the criteria for a specific diagnosis.

It is important to note that not all symptoms are clinical, meaning we all experience normal ups and downs in life that do not constitute a mental health diagnosis. You can have normal anxiety when giving a presentation and not be diagnosed with Social Anxiety Disorder. Similarly, you can have a bad day and not meet the criteria for Major Depressive Disorder. When it comes to diagnosing, individuals must meet a certain number of the clinical criteria and, in some cases, those symptoms must be present for specific time periods. They must also cause significant distress in a variety of areas, such as at home, work/school, and in social settings.

Ultimately, social media is not all bad, as it has provided platforms for discussing mental health and has made great strides for “visibility, reducing stigma, and helping people gain the insight they may have no other way to access.” For some people, social media has helped them feel less alone. When attempting to understand yourself or your child, the best thing to do is seek professional help and do your research on more than social media (e.g., research articles, academic/educational websites, and government agencies such as the National Institutes of Health).

References:

Aragon-Guevara, D., Castle, G., Sheridan, E. et al. The Reach and Accuracy of Information on Autism on TikTok. J Autism Dev Disord (2023). https://doi.org/10.1007/s10803-023-06084-6 

https://www.verywellmind.com/people-are-using-social-media-to-self-diagnose-5217072 

https://www.cnn.com/2023/07/20/tech/tiktok-self-diagnosis-mental-health-wellness/index.html 

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Getting Older: Memory and Cognitive Concerns

Home » Blog » Getting Older — Memory and Cognitive Concerns

Getting Older — Memory and Cognitive Concerns

August 10, 2023 | Vanessa Buonopane, Psy.D. | 7 min. read

As we get older, it is inevitable that we are going to experience memory and cognitive concerns.

Many people who begin to have memory complaints worry that it is a sign that they are developing Alzheimer’s disease. However, not all people with memory problems have Alzheimer’s. There are many other reasons why an individual is experiencing memory and/or cognitive concerns, including medical complications, psychological issues, mild cognitive impairment, or another type of dementia.

Forgetfulness can be a normal part of aging and growing older. Middle-aged and older adults may begin to notice that it takes longer to learn new things, recall information, and lose things that might be right in front of them (e.g., cell phone or glasses). These are common to the human experience and are likely not a cause for concern.

So, when should you start to worry that something more serious is going on?

If you or a loved one starts to engage in poor decision-making, loses track of the date and time of the year, forgets important details of conversations, misplaces things often, and has problems taking care of activities of daily living or those pertinent to living (e.g., paying bills, transportation, hygiene), you may want to consider speaking with your primary care physician (PCP). Your PCP can do a medical evaluation to determine if there may be any medical reasons for your memory and cognitive complaints. For example, did you know that urinary tract infections (UTIs) can cause sudden confusion (also known as delirium) in older individuals, as well as individuals with dementia? This confusion, along with increased agitation and withdrawal can mimic some of the same symptoms as dementia. When a UTI is treated, the memory and cognitive concerns typically resolve as well.

Other medical conditions can also contribute to and cause memory problems, including tumors, blood clots, or infections in the brain; thyroid, kidney, or liver disorders; excessive alcohol use; head injuries; medication side effects; and lack of important vitamins and minerals (e.g., B12). Typically, once these problems are treated, any associated memory problems subside or go away altogether.

There are some psychiatric diagnoses, such as anxiety and depression, that can contribute to forgetfulness and may mimic symptoms of dementia.

Significant stressors or transitions, such as recent retirement or the death of a loved one, can lead to an individual feeling sad, lonely, worried, or bored, and can also leave people feeling confused or forgetful. Similar to certain medical conditions, once the psychiatric issue is resolved, the memory or cognitive concerns typically also resolve.

Getting Older — Memory and Cognitive Concerns OMHG Blog

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Some older adults may be experiencing a condition called mild cognitive impairment (MCI), which means that they are experiencing more memory or other cognitive concerns than other people their age; however, individuals with MCI are able to continue their normal activities and take care of themselves.

Currently, there is no standard treatment or approved medication for MCI, but there are many things an individual can do to stay healthy and manage memory and cognitive changes, such as learning a new skill, following a daily routine, exercising regularly, eating well, limiting alcohol use, and finding meaningful activities to engage in (e.g., volunteering, hobbies/interests). It is important to check-in with your PCP every six to twelve months to track any changes in memory and other thinking skills over time, as this can help understand the progression of a specific condition.

Ultimately, it is possible that MCI can progress into a specific dementia. Dementia is the loss of cognitive functioning, which includes thinking, remembering, learning, and reasoning, in addition to behavioral abilities to the extent that it interferes with the person’s quality of life and activities. Other concerns may be present, such as problems with language skills, visual perception, paying attention, and personality changes. Most people believe that Alzheimer’s is the only form of dementia; however, there are actually many different kinds of dementia.

If you, a family member, or a loved one believes that significant memory and cognitive concerns are present, it is best to talk with your PCP. Your PCP may recommend a neuropsychological evaluation, which will not only assess for any abnormal memory concerns, but can pick up on any cognitive deficits. An assessment psychologist or a neuropsychologist can look at the test results to determine if the individual might be matching the cognitive profile of someone experiencing normal aging concerns, mild cognitive impairment, or a specific type of dementia. Recommendations and “next steps” can also be made at the conclusion of the evaluation and are often catered to the individual needs of the person.

Dementia OMHG Blog

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What exactly is ADHD?

Home » Blog » What Exactly is ADHD?

What Exactly is ADHD?

July 20, 2023 | Vanessa Buonopane, Psy.D. | 10 min. read

Boy with ADHD | What is ADHD?

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that is most often diagnosed in childhood (symptoms must be present prior to age twelve) and can persist into adulthood.

While many individuals struggle with attention and focus at times, individuals with ADHD can experience severe symptoms that impact them academically, socially, and in a variety of other settings.

Some of the most common symptoms that individuals with ADHD exhibit are:

  • Difficulty focusing and paying attention
  • Squirming and fidgeting
  • Making careless mistakes or not paying attention to details
  • Daydreaming often
  • Forgetfulness or losing necessary items (e.g., schoolwork, pencils, books, clothing)
  • Difficulty taking turns or interrupting others

Many people are unfamiliar with the changes that this diagnosis has been through in the last thirty years, often using ADHD and Attention-Deficit Disorder (ADD) interchangeably.

While they are essentially the same condition, our understanding of the diagnosis has grown and the name has been changed to reflect that knowledge. You can still use either acronym, as your doctors and other people will almost certainly understand you; however, ADHD is the most accurate and up-to-date term.

What is ADHD Blog

There are three ways that ADHD manifests itself, depending on the predominant symptoms that the individual displays.

  • Predominantly Inattentive Presentation: The individual may have difficulty paying attention to details, becomes easily distracted, forgets details of daily routines or previously learned information, struggles to organize and finish tasks, and difficulty following along and keeping up with conversations.
  • Predominantly Hyperactive/Impulsive Presentation: The individual may fidget or become restless; have difficulty sitting for long periods; run, jump, or climb constantly; interrupt others during conversations; have difficulty waiting their turn; and may struggle with impulsivity.
  • Combined Presentation: The individual struggles with symptoms from both the inattentive presentation and the hyperactive/impulsive presentation.  The individual must exhibit six symptoms from each presentation for a total of twelve symptoms to be diagnosed with the combined presentation.
ADHD Alien

Graphic credit: @ADHD_Alien (Twitter and Instagram)

As children grow up, they may receive intervention or learn strategies to manage their symptoms, ultimately compensating for their difficulties. Because the symptoms of ADHD can change over time, the presentation may change over time as well.

Research suggests that there are several possible causes and risk factors for developing ADHD, including:

  • Brain injury
  • Exposure to environmental risks (e.g., lead) during pregnancy or at a young age
  • Alcohol and tobacco use during pregnancy
  • Premature birth
  • Low birth weight

There are several other popular views and opinions that are not supported by the research, such as ADHD is caused by eating too much sugar, excessive screen time, parenting styles, and environmental factors (e.g., poverty or family chaos). While these things can certainly exacerbate existing symptoms for individuals with ADHD, the evidence is simply not strong enough to conclude that they are the main cause of ADHD.

Given the significant research done over the years, we now know that many adults have never been diagnosed with ADHD in childhood and continue to experience symptoms in adulthood.  

While it is possible to diagnose ADHD in adulthood, it is important that the clinician consider when the symptoms began, as they must have been present before age twelve.  Symptoms also need to be present in at least two settings (e.g., home, school, work, socially, etc.) and there must be clear evidence that the symptoms interfere with or reduce the quality of the individual’s functioning. A diagnostic intake and psychological evaluation is usually one of the best (and most objective) ways to diagnose ADHD.

In terms of treatment, many individuals find success with a combination of behavioral therapy and medication.

Behavioral interventions are typically encouraged prior to medication, which usually includes strategies for parents, especially for young children. Taking care of your physical health is also important and individuals with ADHD are encouraged to develop or maintain healthy eating habits, exercise regularly, limit screen time, and receive adequate sleep each night.

References:

American Psychiatric Association. (2013).  Diagnostic and statistical manual of mental disorders (5th ed.). 

Centers for Disease Control and Prevention (n.d.). What is ADHD?   

(2023, May 23). Are ADD and ADHD the Same Condition? Very Well Mind.

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How to Understand Your Psychological Evaluation Results and Recommendations

Home » Blog » How to Understand Your Psychological Evaluation Results and Recommendations

How to Understand Your Psychological Evaluation Results and Recommendations

July 13, 2023 | Vanessa Buonopane, Psy.D. | 10 min. read

This blog post is a follow-up to my previous post, What is a Psychological Evaluation?

Psychological evaluations can be very scary for many individuals and can invoke a lot of anxiety as individuals wait for their test results. It can also bring relief to many individuals, as they confirm diagnoses they thought might be present. Often times, a psychological evaluation can rule out diagnoses that are not present, but rather, are likely linked to emotional difficulties, such as cognitive concerns that are related to anxiety and/or depression rather than Attention-Deficit/Hyperactivity Disorder (ADHD).

After completing a psychological evaluation, you (the client or the parent of a child client) might be wondering what’s next?

Assessment clinicians must “score” the test data and interpret the data prior to providing any sort of feedback/results. The raw scores are translated into standard scores, scaled scores, T-scores, and percentiles, which are the different types of statistics used to compare an individual’s performance to their same-age peers. This is necessary because a sixteen-year-old is going to perform much differently than a sixty-year-old individual.  Translating scores based upon population norms is helpful in understanding what is considered neuropsychologically appropriate for that age.

How to Understand Your Psychological Evaluation Results and Recommendations OMHG Blog

After results are interpreted and written into a report detailing the individual’s performance, the assessment clinician will schedule a feedback session to go over all of the results and recommendations, as well as to answer any questions that the individual might have.

The feedback session should include an understanding of what the test results mean and what can be done to help in the future. For instance, if a child is not diagnosed with ADHD, the assessment clinician can help the parent understand why the child did not meet the clinical criteria or testing profile for an individual with ADHD. At times, receiving an unexpected diagnosis or not receiving a diagnosis that was believed to fit the individual’s experience can feel upsetting. The assessment clinician will help the client feel heard and understood even if the client does not agree with the clinician’s diagnostic opinion.

In some cases, the individual can request that another clinician review the data to either confirm or rule out the diagnosis in question. At Orchard Mental Health Group, our assessment team meets regularly to discuss challenging cases, so it is very possible that the individual is receiving a diagnosis or lack of a diagnosis based upon the clinical judgment and opinions of not just one clinician, but several. Of note, the client is always informed if their case will be discussed with multiple people to maintain their privacy. If a clinician is under the supervision of a licensed psychologist, it will always be stated at the intake appointment along with the clinician’s credentials.

Although some individuals may feel like receiving a diagnosis means that there is something “wrong” with them, this is simply untrue.

An evaluation can be beneficial in understanding specific concerns or differentiating between diagnoses; however, an evaluation can also highlight an individual’s strengths and abilities. For instance, an individual with a specific learning challenge might discover that they learn best with visual material compared to verbal material, so the supports around them would be encouraged to play up to the individual’s strengths. In other situations, an evaluation can determine if a recommendation should be made for a child to participate in advanced coursework or gain admission to a private school.

The feedback session is a great time to address any questions that you may have as well. While you may not have any specific questions, there are many parents and individuals who wonder “what questions should I be asking?” There are no right or wrong questions to ask and questions are highly dependent on the individual and the diagnoses. In many cases, the assessment clinician will provide recommendations or “next steps,” such as recommending therapy, providing the report to the individual’s school or university for formal accommodations, and a variety of techniques and strategies that could be beneficial for the individual’s unique challenges.

Ultimately, an assessment clinician hopes to provide a sense of hope for many individuals no matter the diagnosis.

There are some diagnoses with generally poor treatment prognosis (e.g., dementia); however, there are many things that the individual and their family members can do to maintain a good quality of life and find the appropriate resources for ongoing care. Even after the feedback session has come and gone, the assessment clinician is available to answer follow-up questions and can be a useful resource for continuity of care.

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What is a Psychological Evaluation?

Home » Blog » What is a Psychological Evaluation?

What is a Psychological Evaluation?

June 6, 2023 | Vanessa Buonopane, Psy.D. | 7 min. read

Hello and welcome to our blog! My name is Dr. Vanessa Buonopane and I am a clinical assessment psychologist at Orchard Mental Health Group.

I am part of the testing team at OMHG, where I primarily assess individuals of all ages for various neuropsychological concerns, including Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), anxiety, and depression. I am also certified to provide gender-affirming care, as well as conduct evaluations prior to major surgeries and procedures.

If you are a parent or an adult wondering if you have some sort of neurodivergence, a psychological evaluation might be able to help you find answers.

An assessment psychologist conducts a series of “tests” to understand an individual’s cognitive and emotional functioning. In some cases, an assessment psychologist can assess academic skills and motor functioning too. While brain imaging (e.g., MRIs and CT scans) can show the structure of the brain, the tests in a psychological evaluation show the function of the brain. These tests can help us determine diagnoses and can aid in treatment planning.

Often, parents begin to notice their child is experiencing difficulties in school at the end of a grading period and want to be proactive about helping their child get back on track. They might notice that their child is having difficulties learning or paying attention in class. Sometimes, parents have seen emotional and behavioral issues persist for years and just had no idea about the clinical utility of a psychological evaluation. In other cases, many adults have experienced significant executive functioning challenges during the pandemic or even since childhood, and they want to understand what the underlying cause could be.

Boy with ADHD | What is ADHD?

Before I start any evaluation, I explain to my patients that “testing is not the same as the types of tests you might take in school where you have to study.

My tests are not ones you can study for and, unfortunately, I cannot tell you the answers to any of the questions. The only rule I have is that you try your best. This evaluation is not invasive and I am not hooking you up to any machines. I will simply ask you a ton of questions and have you complete a variety of tasks to understand how your brain works. From there, I can determine if there are any diagnoses that you might meet and what to do moving forward.” I allow each person to ask any questions before, during, and after the evaluation.

When you go to the doctor to have blood drawn, you might get your results back within a few days. Unfortunately, a psychological evaluation simply cannot be completed in the same timeframe.

There is a lot of thinking (and often research) that goes into each case, meaning it could take between two to three weeks to complete a psychological evaluation report. Many times, individuals request a psychological evaluation expecting to receive school or work accommodations following the evaluation; however, an assessment psychologist can only recommend accommodations and do not have any authority in the school or work setting. If you or your child needs accommodations to perform successfully, it is the assessment psychologist’s job to provide the evidence for those needs based on the individual’s performance. In any case, the results can provide answers and relief for many individuals, and the individual will typically be given recommendations to follow-up on to address their concerns.

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