Moncrieff’s Parenting Expert, David Carey, gives advice on how to spot and deal with OCD in teens.

I feel my 15 daughter has OCD. For example She finds it hard to concentrate at school due to intrusive thoughts and has checking compulsions but I can’t persuade her to go for professional help. Do you have any suggestions which would help me to persuade her to go?

Thank you for your question. At the start I would like to ask you a question. If you daughter was experiencing severe vomiting and a high fever would you be concerned about persuading her to go to a doctor or would you take control and get her to one?  The answer is obvious. Of course the comparison isn’t quite equal but the point is, I believe, simple: when a child needs help (and is under age 18) we take them for help. We don’t give them choices. Good parenting means doing what is right and taking charge.

Obsessive compulsive disorder (OCD) is a psychological condition effecting about 1.7 to 4% of the population. It is generally considered that in primary care settings (your GP) it frequently goes undiagnosed and as a consequence untreated. The condition is usually associated with anxiety and the obsession and compulsions are means to control the anxiety. Control is the central factor in OCD. The individual has a deeply rooted fear of loss of control. Rituals and compulsions become attached to the fear and are experienced as anxiety reducing tactics. The resulting cycle can be quite debilitation in  some cases.

It will be helpful to look at the best and mostly widely used descriptors of what behaviours or cognitions constitute obsessions and compulsions. This information is taken from the Diagnostic and Statistical Manual of Mental Disorders-4th edition (DSM-IV) which is used in the United States and Ireland to diagnose mental health conditions.

Obsessions are defined in the DSM-IV by the following 4 criteria:

• Recurrent and persistent thoughts, impulses, or images are experienced at some time during the disturbance as intrusive and inappropriate and cause marked anxiety and distress. Persons with this disorder recognize the pathologic quality of these unwanted thoughts (such as fears of hurting their children) and would not act on them, but the thoughts are very disturbing and difficult to discuss with others.
• The thoughts, impulses, or images are not simply excessive worries about real-life problems.
• The person attempts to suppress or ignore such thoughts, impulses, or images or to neutralize them with some other thought or action.
• The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without, as in thought insertion).

Compulsions are defined in the DSM-IV by the following 2 criteria:

• An individual performs repetitive behaviours (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) in response to an obsession or according to rules that must be applied rigidly. The behaviours are not a result of the direct physiologic effects of a substance or a general medical condition.
• The behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviours or mental acts either are not connected in a way that could realistically neutralize or prevent whatever they are meant to address or they are clearly excessive.

I caution the reader that only a qualified mental health practitioner can assess for OCD. Do not use these criteria on your own and come to conclusions. They are meant as guidelines to help you recognise when someone needs professional assessment.

At some point in the course of the disorder the individual will recognise that their symptoms are illogical, out of control, not rational and interfering with life tasks. Reaching this point may take a long time. The people around the individual with OCD usually recognise this before the individual him or herself.

OCD is a condition that, if left untreated, will usually spiral out of control. The number, frequency and severity of obsessions and compulsions can increase dramatically. In severe cases attending to life tasks can become impossible. Children and adolescents with the condition will begin to have difficulties in school and with peers. Often they will try to conceal the symptoms through a variety of means or simply begin to isolate themselves. The earlier you go for help the easier it will be to treat the condition successfully.

Treatment

OCD is a condition that can usually be treated in an out-patient setting. Anxiety disorders (including OCD) are amongst the easier mental health conditions to treat successfully. Early intervention is essential. Treatment consists of a combination of relaxation therapy, cognitive behaviour therapy, family advisement and patient instruction and education. Even young children can be informed about their OCD and taught how to control it.

In some cases anti-depressant medication is required and it works best when combined with beahviour and cognitive behaviour therapy. Patients typically respond well to behavioural and cognitive interventions and recover well. Sometimes they experience a relapse and a short course of remedial therapy is required. In a small number of cases, the most severe ones, hospitalisation may be necessary. In severe cases there may be suicidal ideation associated with the condition but this is rare.

Conclusion

You need to bring your daughter to a qualified practitioner for assessment and possibly treatment. Get in touch with your GP soon for advice. Left unchecked the condition is likely to get worse. Treatment is usually short-term and quite effective. Your professional will liaise with your GP. Do not be afraid of upsetting your daughter. All children under the age of 18 need to know their parents will take control and get them help, regardless of how much they may oppose you in the process.

 

Moncrieff’s Parenting slot is every Wednesday at 3pm with David Carey,  a psychologist in practice in Stillorgan, Dublin. He is the author of the book, The Essential Guide to Special Education in Ireland.

Email your questions to the show afternoon@newstalk.ie.

http://www.newstalk.ie/Does-my-daughter-have-OCD-david-careyteenage mental health, mental health, Moncrieff, Parenting Slot, David Carey, OCD, Consulting pyschologist, adolescence advice

Caroline Clarke

@carolineclarkewww.facebook.com/newstalkfm

Producer

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We all feel down or panicky at times. But when does it translate to a mental illness requiring treatment? Kasmiah Mustapha look at seven recognised mental disorders and their symptoms

THERE are different types of mental illnesses and it is important to recognise the symptoms and to seek the right medical treatment. Here are some of them:

ANXIETY DISORDERS
The most common of mental illnesses, anxiety disorder is the umbrella that groups together panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social phobia (or social anxiety disorder), specific phobias and generalised anxiety disorder (GAD).

According to the US National Institute of Mental Health (NIMH), anxiety disorders last at least six months — unlike the relatively mild, brief anxiety caused by an event such as speaking in public or a first date — and can get worse if not treated.

Panic disorder is characterised by sudden attacks of terror, usually accompanied by a pounding heart, sweating and feeling weak, faint or dizzy. Those with OCD will have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. Most of the time, the rituals end up controlling them.

A person who faces traumatic events can suffer from PTSD. They will lose interest in daily things, become irritable, aggressive or even turn violent.

Social phobia, also called social anxiety disorder, is when people become overwhelmingly anxious and excessively self-conscious in everyday social situations. They have an intense, persistent and chronic fear of being watched and judged by others and of doing things that may embarrass them.

They can worry for days or weeks before a dreaded situation. The fear may become so severe that it interferes with work, school and other ordinary activities, making it hard to make and keep friends.

NIMH states that most people who have one anxiety disorder may also have at least one more. Nearly 75 per cent of those with an anxiety disorder will experience their first episode by the age of 2.
•     Women are 60 per cent more likely than men to have an anxiety disorder at some point in their lives.
•  Famous people who suffer from anxiety disorders include Eric Clapton, Sheryl Crow, Johnny Depp, Anthony Hopkins, Nicole Kidman and Oprah Winfrey.

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
This commonly diagnosed mental disorder in children is more common in boys than in girls. It is usually discovered in the early years. The American Academy of Pediatrics expanded the age range of diagnostic guidelines to include children as young as 4 and up to age 18.

There are three subtypes: Predominately hyperactive-impulsive, predominately inattentive, and combined hyperactive-impulsive and inattentive.

A child may have all the symptoms in one category, or several from each. These include not paying attention to details, making careless mistakes, trouble focusing on tasks, not listening when spoken to directly, not following instructions, failing to finish work or chores (because of failure to understand, not defiance), having trouble organising activities and being easily distracted and forgetful in daily activities.

According to the Malaysian Psychiatric Association (MPA), a child may show inattention, distractibility, impulsivity, or hyperactivity at times but the one with ADHD shows these symptoms and behaviours more frequently and severely than his peers.

Children with ADHD would display these behaviours so frequently and severely that they interfere with normal activities, leaving them confused, frustrated or angry.

According to MPA, ADHD occurs in three to five per cent of school-going children. It usually begin before the age of 7 and  can continue into adulthood.
•     It runs in families, with about 25 per cent of biological parents having a similar condition.
•     People diagnosed with ADHD include  Britney Spears, Liv Tyler, Michael Phelps, Salma Hayek, Zooey Deschanel, Robin Williams, Justin Timberlake, Jamie Oliver, Will Smith and Jim Carrey.

BIPOLAR DISORDER
This serious mental illness, previously known as manic depression, is characterised by extreme changes in mood. Someone with bipolar disorder experiences alternating “highs” (what clinicians call mania) and “lows” (also known as depression).

Both manic and depressive periods can be brief, from just a few hours to a few days or longer and can last up to several weeks or even months.

Patients experience unusually intense emotional states in distinct periods called “mood episodes”. An overly joyful or overexcited state is called a manic episode and an extremely sad or hopeless state is called a depressive episode.

But because the pattern of highs and lows varies in individuals, bipolar disorder is a complex disease to diagnose.

When a sufferer is in a mania mood, he or she will be very happy or outgoing, behaves impulsively and takes part in high-risk behaviours. When experiencing depression, he or she will be restless, has trouble sleeping and eating, thinks of death or suicide and even attempt suicide.

Bipolar disorder is recurrent, meaning that more than 90 per cent of those who have had a single episode will go on to experience more.
•     Roughly 70 per cent  of manic episodes in bipolar disorder occur immediately before or after a depressive episode.
•     People who suffer from bipolar disorder include Carrie Fisher, Linda Hamilton, Sinead O’Connor, Vincent van Gogh, Catherine Zeta-Jones, Kurt Cobain and F. Scott Fitzgerald

BORDERLINE PERSONALITY DISORDER
The sufferers have brief psychotic episodes and experts originally thought of this illness as atypical or borderline versions of other mental disorders. According to NIMH, borderline personality disorder sufferers will show extreme reactions — including panic, depression, rage, or frantic actions — to abandonment, whether real or perceived.

They will have a pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love to extreme dislike or anger, distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future.

They will engage in impulsive and often dangerous behaviours, such as spending sprees, unsafe sex, substance abuse and binge eating as well as have recurring suicidal behaviours or threats or self-harming behaviour, such as cutting themselves.

The US National Education Alliance Borderline Personality Disorder (NEABPD) states that the illness rarely stands alone. People with borderline personality disorder often have other diagnosis. This is called co-morbidity or having co-occurring disorders. Common co-occurring disorders include substance abuse, eating disorders, anxiety disorders, bipolar disorder as well as other personality disorders. Over half of those with borderline personality disorder population suffers from major depressive disorder.

NEABPD states that the illness is more common than schizophrenia or bipolar disorder.
•     An estimated 11 per cent of outpatients, 20 per cent of psychiatric inpatients and six per cent of primary care visits meet the criteria for the disorder.
•     Obtaining an accurate diagnosis can be difficult.

DEPRESSION
We all feel depressed at one time or another. Some of us will be able to overcome the feeling but some may need to seek treatment as it can interfere with daily life and their ability to to function normally.

There are different types of depression —  major depressive disorder or major depression, dysthymic disorder or dysthymia, psychotic depression and postpartum depression.

Depression is characterised by a number of common symptoms, including a persistent sad, anxious, or “empty” mood and feelings of hopelessness or pessimism. A person who is depressed often feels guilty, worthless and helpless.

They also lose interest in activities or hobbies that they once found pleasurable. They experience fatigue and decreased energy, have difficulty concentrating and remembering details, insomnia (or they sleep excessively), overeat (or have no appetite), think of or attempt suicide and suffer aches and pain such as headaches, cramps, or digestive problems that do not ease with treatment.

The condition often goes undetected as we tend to dismiss the signs. Depression doesn’t need to strike all at once. It can be a gradual and nearly unnoticeable change from your normal life.

The World Health Organisation (WHO) has called for an end to the stigmatisation of depression and other mental disorders and for better access to treatment for all people who need it.

WHO states that globally, more than 350 million people suffer from depression but because of the stigma still attached to it, many fail to acknowledge that they are ill and do not seek treatment.
• People who have had to deal with depression include Ashley Judd, Billy Joel, Brooke Shields, Emma Thompson, Harrison Ford, Heath Ledger, J.K. Rowling, Olivia Newton-John, Owen Wilson and Rosie O’Donnell.

EATING DISORDERS
Eating disorders are real and treatable. They frequently coexist with other illnesses such as depression, substance abuse or anxiety disorders.

A person with an eating disorder may start by eating smaller or larger amounts of food but, at some point, the urge to eat less or more spirals out of control. Severe distress or concern about body weight or shape may also characterise an eating disorder.

Common eating disorders are anorexia nervosa, bulimia nervosa and binge-eating. Anorexia nervosa is characterised by a relentless pursuit of thinness and the unwillingness to maintain a normal or healthy weight, an intense fear of gaining weight, a distorted image of one’s body, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight.

Those who suffer from bulimia nervosa seem to lack control over recurrent and frequent episodes of overeating. This is followed by forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise or a combination of these behaviours.

Some patients maintain what is considered a healthy or normal weight, while some are slightly overweight. But they also have the fear of gaining weight, want desperately to lose weight and are intensely unhappy with their body size and shape. Usually, bulimic behaviour is done in secret because it is often accompanied by feelings of disgust or shame.

The binge eating and purging cycle can happen several times a week to many times a day. With binge-eating disorder, a person loses control over his or her eating pattern but, unlike bulimia nervosa, this is not followed with purging, excessive exercise or fasting. As a result, sufferers are often overweight or obese. They experience guilt, shame and distress about their binge-eating, which can lead to more binge-eating.

People with anorexia nervosa are 18 times more likely to die early compared with people of similar age.
•     Singer Karen Carpenter died of complications from anorexia nervosa.
•     Others who have struggled with eating disorders include Paula Abdul, Lily Allen,  Victoria Beckham, Kate Beckinsale,  Kelly Clarkson, Katie Couric, Sally Field, Calista Flockhart, Lady Gaga, Demi Lovato, Mary-Kate Olsen and Oprah Winfrey.

SCHIZOPHRENIA
According to Mayo Clinic, schizophrenia is a group of severe brain disorders in which people interpret reality abnormally. Schizophrenia may result in a combination of hallucination, delusion and disordered thinking and behaviour. It is not split personality or multiple personality.

Symptoms fall into three categories — positive, negative and cognitive. Positive symptoms reflect an excess or distortion of normal functions and include delusion, hallucination, thought disorder and  disorganised behaviour.

The negative symptoms refer to a diminishment or absence of characteristics of normal function. These include loss of interest in everyday activities, appearing to lack emotion, reduced ability to plan or carry out activities, social withdrawal and loss of motivation.

Cognitive symptoms involve problems with thought processes. These may be the most disabling in schizophrenia because they interfere with the ability to perform routine daily tasks. A person with schizophrenia may be born with these symptoms which include having a problem making sense of information, difficulty paying attention and memory problems.

Sufferers often aren’t aware that they require medical attention, so it is important for family members and friends to get them help.

Schizophrenia typically begins in early adulthood between the ages of 15 and 25. The average age of onset is 18 in men and 25 in women.
•     Schizophrenia onset is quite rare for people under 10 years of age, or over 40 years of age.
•     People with schizophrenia are not usually violent. In fact, few violent crimes are committed by people with schizophrenia who instead, are more inclined to  attempt suicide. About 10 per cent (especially young adult males) die by suicide.

 

Having frequent full-blown and long-lasting panic attacks mean treatment is required.

A child with ADHD often has trouble paying attention in class.

Catherine Zeta-Jones was diagnosed with bipolar disorder.

Depression is common yet many do not seek treatment even when the symptoms last a long time.

Karen Carpenter died of complications from anorexia nervosa.

There’s a new development in the soap opera surrounding Royce White and the Houston Rockets.

Late Saturday night, the Houston Chronicle published a letter that Rockets general manager Daryl Morey sent to White on Nov. 20. The letter surfaced just hours after it was reported that White confirmed his desire for the team to hire a physician to monitor his mental health on a daily basis.

According to the Chronicle‘s Jonathan Feigen, Morey sent the letter to White after a series of meetings in November.

Also, if you are into this sort of thing, here is Daryl Morey’s letter to Royce White after their November meetings: blog.chron.com/ultimaterocket…

— Jonathan Feigen (@Jonathan_Feigen) January 20, 2013

In the letter, Morey emphasized the team’s willingness to cooperate with White, and he states that the team has done everything it can to accommodate his needs:

As we have told you repeatedly, our goals are for you to be fully integrated into the Team and to have a healthy and productive season, both on and off the court. We have been committed to these goals from the day we drafted you, and have acted consistently with those goals ever since. We have bent over backwards to accommodate your requests and help you meet these goals…The bottom line is that we remain willing to work with you on issues that arise from legitimate medical need, but you have to come to games, practice and everything else that you are able to do, just like any other player.

Morey then listed some of White’s requests and how the team attempted to help him. He also says that White did not live up to his end of their agreements:

To revisit from the beginning, before we drafted you, you told us that your fear of flying was not an issue and that you were ready to be an NBA player. Shortly after we drafted you, you apologized for having to mislead us. You later indicated that you were feeling anxious about flying to the NBA’s rookie orientation program this summer. When you missed your scheduled flight, we arranged for a later flight and for Matt Brase to travel with you, working with the NBA to accommodate your concerns. Shortly after that, we informed you that we thought it would be beneficial for you to meet with Dr. Aaron Fink, a world-renowned psychiatrist, who could provide you with access to an appropriate professional in Houston to help should any situations arise. We gave you Dr. Fink’s contact information and several available times for an interview. You and your representatives responded that you viewed this as a very helpful step and confirmed that you would meet with Dr. Fink. You did not do so.

 

At the end of the letter, Morey quoted an addendum that White requested be included in his contract.

The page labeled “Mental Health Protocol” begins as follows:

In order for the working conditions to be safe and healthy for someone with mental illness/disability, it is the belief of the medical experts and myself credited for this document that a protocol has to be developed on how to appropriately deal with an individual in respect to mental illness(s)/disabilities from an operational and medical standpoint. A protocol will not only ensure the safe and healthy work conditions for a player like myself with mental illness, but also will lend a system of accountability for both the team and I to use to base what is the appropriate route of action.

Due to the lack of protocol regarding mental illness, this agreed upon document will serve as an addendum to insert into the medical category of the contract and team rules.

1. Protocol terms

a: Acknowledgment: Acknowledging mental illness/disability as being in the category of mental condition.

i. Recognizing the individualistic nature of mental illness

1. All mental illnesses unique to each individual despite similar diagnosis.

It’s unclear how the Chronicle obtained the letter, but it may not be a coincidence that it surfaced Saturday night. Earlier in the day, details emerged from White’s interview with correspondent Bernard Goldberg of HBO’s Real Sports With Bryant Gumbel.

White expressed various concerns about how the team was handling his highly publicized anxiety and obsessive compulsive disorders. The 16-minute segment will air Tuesday night.

The Rockets drafted White 16th overall in the 2012 NBA draft. He has yet to play a game with the team this season, and he hasn’t practiced with Houston since Nov. 6.

CINCINNATI (AP) — A former high school teacher is accusing school district administrators of discriminating against her because of a rare phobia she says she has: a fear of young children.

Maria Waltherr-Willard, 61, had been teaching Spanish and French at Mariemont High School in Cincinnati since 1976.

Waltherr-Willard, who does not have children of her own, said that when she was transferred to the district’s middle school in 2009, the seventh- and eighth-graders triggered her phobia, causing her blood pressure to soar and forcing her to retire in the middle of the 2010-2011 school year.

In her lawsuit against the district, filed in federal court in Cincinnati, Waltherr-Willard said that her fear of young children falls under the federal American with Disabilities Act and that the district violated it by transferring her in the first place and then refusing to allow her to return to the high school.

The lawsuit seeks unspecified damages.

Gary Winters, the school district’s attorney, said Tuesday that Waltherr-Willard was transferred because the French program at the high school was being turned into an online one and that the middle school needed a Spanish teacher.

“She wants money,” Winters said of Walter-Willard’s motivation to sue. “Let’s keep in mind that our goal here is to provide the best teachers for students and the best academic experience for students, which certainly wasn’t accomplished by her walking out on them in the middle of the year.”

Waltherr-Willard and her attorney, Brad Weber, did not return calls for comment Tuesday.

Winters also denied Walter-Willard’s claim that the district transferred her out of retaliation for her unauthorized comments to parents about the French program ending — “the beginning of a deliberate, systematic and calculated effort to squeeze her out of a job altogether,” Weber wrote in a July 2011 letter to the U.S. Equal Employment Opportunity Commission.

The lawsuit said that Waltherr-Willard has been treated for her phobia since 1991 and also suffers from general anxiety disorder, high blood pressure and a gastrointestinal illness. She was managing her conditions well until the transfer, according to the lawsuit.

Working with the younger students adversely affected Waltherr-Willard’s health, the lawsuit said.

She was “unable to control her blood pressure, which was so high at times that it posed a stroke risk,” according to the lawsuit, which includes a statement from her doctor about her high blood pressure. “The mental anguish suffered by (Waltherr-Willard) is serious and of a nature that no reasonable person could be expected to endure the same.”

The lawsuit was filed in June and is set to go to trial in February 2014. A judge last week dismissed three of the ex-teacher’s claims, but left discrimination claims standing.

The lawsuit says that Waltherr-Willard has lost out on at least $100,000 of potential income as a result of her retirement.

Winters said that doesn’t make sense, considering that Waltherr-Willard’s take from retirement is 89 percent of what her annual salary was, which was around $80,000.

Patrick McGrath, a clinical psychologist and director of the Center for Anxiety and Obsessive Compulsive Disorders near Chicago, said that he has treated patients who have fears involving children and that anyone can be afraid of anything.

“A lot of people will look at something someone’s afraid of and say, ‘There is no rational reason to be afraid of that,'” he said. “But anxiety disorders are emotion-based. … We’ve had mothers who wouldn’t touch their children after they’re born.”

He said most phobias begin with people asking themselves, “What if?” and then imagining the worst-case scenario.

“You can make an association to something and be afraid of it,” McGrath said. “If you get a phone call that your mom was just in a horrible accident as you’re locking the door, you can make an association that bad news comes if you don’t lock the door right. It’s a basic case of conditioning.”

A boy with autism. For the Artistic Mother’s Group: Samuel Study. (Photo credit: Wikipedia)

Let’s start with the headlines blaring the news about a recent autism study. They almost invariably use the phrase “grow out of autism,” even though the study itself does not use that phrase or even reference “grow” except to talk about head circumference. Instead, the authors of the report, published in The Journal of Child Psychology and Psychiatry, use the term “optimal outcomes” to describe what they detected in a group of 34 people who were diagnosed as autistic when they were under age 5.

As the study authors themselves state, this idea that autistic people might show reduced deficits to the point of losing a diagnosis is not new. In fact, first author Deborah Fein and colleagues cite studies identifying frequencies of “optimal outcomes” as high as 37% among autistic people. The lingering open questions relate to whether or not the autistic people in these studies had received the correct diagnosis in the first place. The only “novelty” of these latest results appears to be confirmation that indeed, the 34 people they identified as having an “optimal outcome” did receive an accurate diagnosis of autism in childhood. In other words, they are confirmed to have had a developmental disorder, a neurobiological condition called autism — yet, they “grew out of it.”

The rest? Nothing new. The people who show these optimal outcomes tend to have started out with, as the authors describe it, “higher cognitive functioning and somewhat milder initial symptoms.” Many of them had behavioral interventions in childhood. The researchers point out that the perception that everything’s all hunky-dory for the 34 people they evaluated does not rule out their having “residual difficulties” with various aspects of autism, including executive function–think project management–or language or social interaction.

For each participant, whose ages ranged from 8 to almost 22 years, the researchers interviewed the parents. One of the required parental answers for a participant to be considered for the optimal outcome category? The parent had to report that their child/adult child “had typically developing friends.” That question seems to imply a certain low expectation for autistic people, many of whom I know have “typically developing friends” despite themselves still being autistic. It certainly suggests that for people who continue to meet the criteria for an autism diagnosis, any pursuit of a friend of the “typical” sort would be futile.

How did those 34 “optimal outcome” participants do on the various measures of “are you autistic or not”? Well, seven of them–that’s 20% of the group–turned out to have “some impairment” in nonverbal social interaction. For reasons that are unclear, the researchers decided that these impairments were not the result of “an autistic quality” but of “inhibition, anxiety, depression, inattention and impulsivity, embarrassment, or hostility.” Of course, each of those themselves could be secondary to autism. Even though this 20% showed impairment, they were retained as being “optimal outcome” folk, those who, as the news media report might say, “grew out of” autism.

To determine whether or not these autistic people were still autistic, the research team administered a battery of tests; they list eight in their paper. Of these eight, three were parent completed. One consisted of clinician observation and scoring. One was an IQ test. One was a handedeness test (left-handedness is more common among autistic people), and the remaining two evaluated facial recognition and language. ETA: None of them examined if the participants retained any of the positive aspects of being autistic–refined sensory detection, detail orientation, pattern finding, etc.

Let’s go back to those news media stories. In one interview, lead author Fein commented that “these people did not just grow out of their autism.” She then goes on to credit the hard work of the parents and therapists of “these people” for any improvements, but I’d suggest that “these people” also did a lot of hard work–and probably still are doing so. The thing is, no one seems to have asked “these people” about that.

Among the many articles covering this study, I couldn’t find a single one featuring an autistic person commenting about the report. As you can see from how the researchers evaluated their 34 “optimal outcomers,” they don’t appear to have asked said optimals about how their internal function jibes with the external results or what they do to achieve those results. Because no one else seems to have bothered to ask autistic people these questions, I did. I polled the autistic community via social media, asking autistic adults what’s going on inside them when they appear outwardly typical and asking any readers if they felt they’d “grown out of” autism.

Their response was immediate and intense. “I don’t ‘look’ like I have it, but I do,” responded one autistic woman, who went on to describe how she’s learned over time about different expectations for behavior and tried to apply those. Others describe using pattern recognition to navigate socially, while still others report having an “optimal outcome”-like period in later childhood but then experiencing a trough of struggles in early adulthood as new responsibilities and expectations arose. They wrote to me about self-monitoring, about working hard to compensate in social situations but then experiencing crashing exhaustion afterward. They talked about self-selecting their social groups as adults as a way of feeling more socially at ease. The concepts that came up again and again and again were “compensating” and “coping.”

It’s not a huge surprise that autistic people with average or above-average cognitive abilities might be able to intellectualize social rules and algorithms and put them convincingly into practice. Does that ability mean that they aren’t really autistic? The real crux to answering that is this: Do we view autism only as a clinical diagnosis based solely on behavior and outward function, or do we talk about it as a neurobiological construct and identification, with an understanding of the context of the hidden disability and the hard work that those outward behaviors require?

Many conditions that we measure either directly with lab tests or behaviorally can lie under a mask of apparent normalcy or typicality. A woman with diabetes who maintains her blood sugar at a healthy level through diet and medication still has diabetes. A person with obsessive-compulsive disorder who fights successfully every second of every day against caving to obsession or compulsion still has the disorder. Anyone who has ever put on a public face when all they wanted to do was stay in bed should understand something about doing the internal hard work of compensating for a disability without showing outward manifestations of it.

Does that capacity mean, in the parlance of the news media reports or an editorial accompanying the paper, that the up to 25% of autistic people who can do this are “recovered” and no longer autistic? Or does it mean, rather, that they’ve become increasingly adept at meeting the interaction standards of the social majority?

We live in a busy society: always changing, always on-the-go.  Although the hustle and bustle of the holiday season is behind us, many people struggle with stress and anxiety year-round.  And, according to the National Institute for Mental Health, up to one in four children and adolescents struggle with an anxiety disorder.  KSMU’s Theresa Bettmann reports.

When kids develop stress-related conditions, it’s often in the form of anxiety disorders.  Kara Davis, a licensed school counselor for Springfield Public Schools, says she sees more and more of kid’s “outside problems” being brought to school.

“You know, we have all of these things that are happening in the world and we have access to so much information, and I feel like that also is anxiety producing.  So that may very well have an impact on kids’ worries.  You know, not only worrying about their own lives, but worrying about the lives of other people, and what’s going on in the world,” Davis says.

Davis says everyone worries on some level.  She explains that when worry, compulsion, or anxiety reaches a point where it affects a child’s everyday life, it’s a serious problem.

Davis works with middle-school students—that’s an age at which anxiety-related problems first take root.  She says during this time of their lives, children are even more susceptible to stress, and are especially vulnerable to what others think of them. Davis encourages parents who are concerned about anxiety problems to begin by talking.

“I think it’s really, really important to talk to your kids.  In talking about, you kind of get a sense of how deep this really goes.  Talk to the school and find out if your student is doing well at school.  Are teachers seeing this? Are other people seeing this?  Is this something across the board, or is it something that is coming home to you?” Davis says.

Anxiety disorders include panic disorder, obsessive-compulsive disorder—known as OCD—post-traumatic stress disorder (PTSD), social phobias, and general anxiety disorder, or GAD. 

Todd Williams is outreach specialist for Burrell Behavioral Health. He says OCD is one disorder that often can become debilitating for the person experiencing its effects.

“The thing to watch out for with OCD is that the obsessions become recurrent and persistent.  So it’s not something such a passing fad, not something that just occurred once or twice.  Usually these obsessions become frequent, often times they’re unrealistic or irrational to the situation,” says Williams.

Davis and Williams both say that diet, exercise, sleep and stress reduction can help with anxiety disorders.  In some cases, counseling and other therapy may be helpful.  Williams says Cognitive Behavior Therapy, or CBT, helps change patterns of thinking. It “re-trains” the brain.

“One of the other types of therapies that I’ve found useful when I’ve worked with children, especially those with OCD or a social phobia disorder, is called an exposure therapy.  Which is basically that you gradually give them encounters to either the feared situation or object, where they gradually ease into the situation,” Williams says.

Williams says the worst thing a parent can do is ignore the issue.  He urges parents to seek guidance from a family doctor, or other clinical sources. 

For KSMU News, I’m Theresa Bettmann.

 

 

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The National Eating Disorder Information Centre recently launched a poster and pamphlet campaign to raise awareness about
men with eating disorders.

Photo credit: Robert Popkin

Consider these two words: eating disorder. What image springs to mind? A father of three who works in the oil industry? A
male lawyer? A young man with muscular shoulders on a college wrestling team?

Chances are, these were not the people you first associated with an eating disorder. Most likely, you thought of a very
different type of person.

“A young adolescent girl from a relatively privileged background,” says Leigh Cohn, author of Making Weight: Men’s Conflicts with Food, Weight, Shape Appearance. “That was the image because that was the type of person showing up for treatment. All the emphasis was on women.”

For many years, it was thought that men accounted for only about 10% of cases of eating disorders such as anorexia
nervosa and bulimia. But this estimate, based on people in treatment, is now believed to be way off the mark. A growing body
of research suggests as many as 25% of people with these conditions are male, and for binge eating, that increases to about
40%.

Though a decade’s worth of research indicates eating disorders in men are a bigger problem than imagined, the public perception
that these are “female diseases” lingers. This certainly isn’t helping to get more men to recognize they have a problem and
need treatment, experts suggest — especially considering the stigma already associated with eating disorders and the fact
that men are less likely to seek medical treatment in general.

“Raising awareness is probably the most important thing. We have to lower the bar a little bit about being concerned when
men lose a lot of weight,” says Dr. Blake Woodside, medical director of the eating disorders program at the Toronto General
Hospital in Ontario and a professor in the psychiatry department at the University of Toronto.

“Parents don’t think about this for skinny teenage boys. Boys grow tall quickly and are expected to be skinny for a while,”
adds Woodside, whose research indicates men and women who do seek treatment for eating disorders are similar in clinical
presentation (Am J Psychiatry 2001;158:570-4).

One difference between genders, however, is that men with eating disorders seem to be more likely to also have other mental
health issues, such as anxiety, depression and obsessive–compulsive disorder. A  study of male twins in Finland, for instance,
concluded that anorexia nervosa “in males in the community is more common, transient and accompanied by more substantial
comorbidity than previously thought” (PLoS ONE 2009;4:e4402).

“I was surprised by how many problems they had,” says lead author Dr. Anu Raevuori, a postdoctoral research fellow in the
department of public health at the University of Helsinki in Finland. “They had a pretty rough life.”

It was also quite apparent that the stigma of having a disorder typically associated with females made men reluctant
to talk about it. “When I interviewed twin males with eating disorders, many of them hadn’t even told their co-twin,” says
Raevuori. “I was the first person they were telling.”

The reasons men and women develop eating disorders are similar. It can be about projecting emotional issues onto
the body, having a sense of control over food or poor body image. In recent years, the male body has become objectified in
popular media just as much as female bodies, says Dr. Ted Weltzin, medical director of eating disorders services at Rogers
Memorial Hospital in Oconomowoc, Wisconsin. As a result, the diet and exercise industry have begun targeting men, offering
special fitness and nutrition regimes with promises to make them lean and muscular.

“These things introduced men to dieting in a way that was never seen before,” says Weltzin. “It opened up this big diet
and weight-loss market for men.”

This appears to be an even bigger problem among homosexual men. They live in a community where there is tremendous
pressure to look fit, according to David Brennan, assistant professor in the Factor-Inwentash Faculty of Social Work at the
University of Toronto. In a study of participants in Pride Toronto 2008, Brennan found that men who have sex with men report
high levels of body dissatisfaction and are at higher risk for eating disorders (Int J Mens Health 2011;10:253-68).

“There is a strong focus in the culture on the body and body image,” says Brennan. “It is heavily influenced by media,
by imagery in gay clubs, gay bars and pornography. It does impact how people feel about their bodies.”

Though there is no malicious intent behind the lack of attention given to males with eating disorders, it is high time
that the problem be corrected, according to Merryl Bear, director of the National Eating Disorder Information Centre, a nonprofit
organization based in Toronto. “It’s been a longstanding gap in the areas of understanding early intervention and treatment
in eating disorders,” she says. “Men have been neglected in that area.”

To redress that, her organization recently launched a poster and pamphlet campaign (www.nedic.ca/store/poster_psa5.shtml). Eating disorders can be devastating, Bear says, not only to the body but also the mind. “Malnutrition impacts everything.
We are losing some of our brightest minds and most compassionate people.”

DEAR DOCTOR K: I believe my second-grader suffers from anxiety. How is anxiety treated in children?

DEAR READER: Many kids have anxiety disorders. There are several different kinds, and most are suffered both by kids and adults, such as generalized anxiety disorder, social phobias, panic disorder and post-traumatic stress disorder. Some anxiety disorders affect only children. The prime example is separation anxiety — an extreme difficulty being away from home or loved ones.

Before your child is diagnosed with an anxiety disorder, however, consider this: Some children who are anxious have good reason to be afraid. For example, your child may be a victim of abuse by a relative or a classroom bully. Try to find out if this is the case.

If your child is diagnosed with an anxiety disorder, the treatment options are:

— Cognitive behavioral therapy (CBT). CBT is the best-confirmed treatment for anxiety disorders in children.

A common CBT method is called graduated exposure. In this method, young children with phobias, for example, are placed near the feared object while doing something reassuring and enjoyable. Older children can learn how to use deep breathing or muscle relaxation, or they can be taught to talk themselves out of fear-provoking thoughts. Another technique is modeling. This involves asking the anxious child to emulate the therapist or another child who shows no fear.

— Drug therapy. The FDA has not approved any drugs for childhood anxiety disorders. (The only exception is the use of selective serotonin reuptake inhibitors (SSRIs) for obsessive-compulsive disorder.) But some SSRIs are effective and approved for the treatment of anxiety disorders in adults. As a result, many doctors prescribe these antidepressants for anxious children.

— Combination treatment. Among children and teens especially, combining CBT and drug therapy is often successful.

You and other family members can also help your child. For example, learn techniques for managing your child’s anxiety. Provide models of self-confidence and problem-solving, and give rewards for overcoming fears.

Sometimes a family problem is the source of the child’s anxiety, or an anxious child may think he or she is the cause of any trouble in the family. In that case, joint family therapy may be a good idea.

Many years ago, a patient of mine was having trouble in his marriage. He and his wife were very different personalities. With some marriages, people of like mind find each other. With other marriages, opposites attract.

That was their marriage. He was meticulous, cautious, a man of few words who rarely expressed emotion. She was a volcano — always on the go, talked a blue streak, and emotional every minute of her life except when she was asleep. They grew apart.

Their 12-year-old daughter, who had been a confident and independent child, became fearful and insecure. Therapy revealed that she blamed herself for breaking up their marriage. Sessions with her parents finally absolved her of that guilt — and of her suffocating anxiety.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K,10 Shattuck St., Second Floor, Boston, MA 02115.)

Announce
Date: January 10,
2013

BeyondOCD.org Tackles Obsessive-Compulsive
Disorder Treatments and Information

URL: http://beyondocd.org

Beyond
OCD is the most comprehensive list of resources for this neurobiological
anxiety disorder for adults and children of all backgrounds. Find the symptoms
and causes of
OCD and how to manage this disorder.

Share This Site

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your twitter followers

…

BeyondOCD.org is a leading resource
to help those with Obsessive-Compulsive Disorder (OCD) to get beyond OCD.
OCD can be very disruptive in the lives of those who suffer from this frequently
misunderstood affliction and their families. Since 1994, the mission of
Beyond OCD (originally known as OCD Chicago) has been to outline options
for OCD treatment, therapy and support for educators, clergy, families
and the mental health professional community to address OCD.

Beyond OCD is the most comprehensive
list of resources for this neurobiological anxiety disorder for adults
and children of all backgrounds. Find the symptoms and causes
of OCD and how to manage this disorder.

BeyondOCD.org is a place to
share personal stories, data and reading material for OCD facts, OCD sufferers
and to dispel OCD myths. BeyondOCD.org provides insight from professionals
in the medical field on industry news, trends, technologies, therapies
, new resources and more including helpful guides on specific topics published
in English and Spanish.

OCDEducationStation.org is another
website owned by BeyondOCD.org that is specifically geared to educators
and administrators facing the struggle with OCD in schools including universities
around the world. 

OCD Chicago changed to Beyond
OCD in May 2012 to broaden the topics and horizons outside the Chicago
area to provide OCD resources, facts and guides in English and Spanish
to people afflicted with OCD in all 50 states and more than 100 countries
worldwide. Beyond OCD is spreading the message that OCD can be managed
successfully.    

Visit BeyondOCD.org or call
773-661-9530 for information. Media inquiries welcome.

Posted by
Eric Ward on 01/10/13

Archived URLwire
page: http://www.urlwire.com/news/011013.html

 

  One in ten girls right now in Canada is dealing with an eating disorder. It’s a devastating illness that can destroy families — and take young lives.

   It also takes a lot of courage and determination to overcome. That’s the message tonight from a young Renfrew woman who spoke to CTV about her battle — and victory over the life-threatening disease.  19 year old Jessica Mahusky “graduated” nearly two years ago from the Eating Disorder Day Unit at the Children’s Hospital of Eastern Ontario, after a lengthy battle with anorexia that started when she was 12. 

   “I think the main thing that led to my eating disorder is different things were going on in my life that I felt I had no control over,” says Mahusky.  “The eating disorder is all about control, it likes to control you and your life.  It comes across as your best friend but meanwhile it’s your worst enemy and killing you inside,” she adds.

   Dr. Wendy Spettigue is the psychiatric director of the Eating Disorder Program at CHEO.  She says since CHEO began its day unit in 2000, it has treated about 800 patients, mostly girls.

   “It can be up to almost 10 percent of teenage girls who have disordered eating or eating disorders and that’s too many I’m afraid,” says Dr. Spettigue.

   She says while males do suffer from eating disorders. About 90% of the patients who come to the clinic are female. 

   “I think there’s lots of pressure on females to look a certain way and a “thin ideal” that is held up in the celebrity culture,” says Dr. Spettigue. “And I can’t help think that’s why we’re seeing more and more referrals to our program over the years.”

   She says an eating disorder is best thought of as a form of an anxiety disorder, a severe phobia or obsessive compulsive disorder where the girls have these obsessive worries about their weight. The treatment at CHEO is multi-disciplinary and involves the whole family.

   “That’s not to say the family needs to be fixed because we know parents don’t cause eating disorders,” says Dr. Spettigue, “but we know they’re the main support for their children so we empower parents to help their child to recover.”

   Dr. Spettigue says eating disorders can be genetic or inherited.  But they tend to affect young people who are anxious and always trying to please. She says parents can help their kids by focussing on the fun in exercise, not the fat-burning part of it and by eating together as a family.

   “As a working mom, I know that’s a whole lot easier said than done but it turns out that families that have at least 4 or more meals per week with their children are actually protecting their children from eating disorders.”

   Jessica Mahusky says the program at CHEO saved her life.  She is now nearly two years into her recovery. “I couldn’t be happier. It was the battle for my life but it was worth it.”  

   Mahusky is now in college studying social work and hopes to focus on eating disorders.  She also speaks to girls with eating disorders in the hopes of turning their lives around.

“I try to help them, let them know they’re not alone, there is help out there and not to get discouraged.”

Houston Rockets’ officials announced Sunday that the organization would be suspending rookie Royce White amid ongoing debate over how to best address his anxiety disorder and overall mental health during the NBA season.

According to the Mayo Clinic, White’s condition, identified as generalized anxiety disorder, is characterized by ongoing anxiety that interferes with day-to-day activities. It affects some 6.8 million American adults, or about 3.1 percent of people age 18 and over in a given year.

Though different from panic disorder, obsessive-compulsive disorder and other types of anxiety, generalized anxiety disorder does share similar symptoms, including constant worrying or obsession about small or large concerns; restlessness and feeling keyed up or on edge; fatigue; difficulty concentrating or your mind “going blank;” irritability; muscle tension or muscle aches; trembling, feeling twitchy or being easily startled; trouble sleeping; sweating, nausea or diarrhea; and shortness of breath or rapid heartbeat, Mayo Clinic explains.

White’s suspension comes on the heels of rising concern about mental health among athletes and black men.

“Mental health has a stigma that is tied into weakness and is absolutely the antithesis of what athletes want to portray,” Dr. Thelma Dye Holmes, executive director of the Northside Center for Child Development, told the New York Times last year.

Others say that similar stigmas are what’s keeping the issue from being addressed in the black community as well.

“Many African-Americans have a lot of negative feelings about, or not even aware of mental health services. They may not be aware of the symptoms of many mental disorders, or they may believe that to be mentally ill is a sign of weakness or a sign of a character fault,” said Dr. William Lawson, a professor and chairman of psychiatry at Howard University College of Medicine, in a discussion with NPR.

Overlap between the two groups — including the suicides of San Diego Chargers’ Junior Seau and the Kansas City Chiefs’ Jovan Belcher — have prompted officials to prioritize mental health screening among athletes. (Though some have questioned how effective the safety really is.)

White stopped participating in team activities in October, saying his mental health took precedence over his NBA career, the Associated Press reports.

“Just knowing what I know about anxiety and mental health, there is a side of my mind that can’t look away from the fact that I do think about it every day. I wake up (and think), ‘Am I cut out for this?'” White said in a phone interview with CNN, noting plans to roll out a campaign that raises awareness about mental illness and helps to destigmatize it.

According to the Anxiety and Depression Association of America, anxiety disorders are treatable, and the vast majority of people who suffer from them can be helped with professional care. Treatments include medications such as antidepressants and sedatives for short-term relief, and psychotherapy, which aims to tackle underlying life stresses and prompt behavior changes that may offer relief.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

Related on HuffPost:

Which State Has The Most (And Least) Mental Illness?

Loading Slideshow

• 51. Maryland

  The report shows 16.7 percent of Maryland residents experienced some form of mental illness.

• 50. Pennsylvania

  The report shows 17.7 percent of Pennsylvania residents experienced some form of mental illness.

• 49. North Dakota

  The report shows 18 percent of North Dakota residents experienced some form of mental illness.

• 48. Florida

  The report shows 18.1 percent of Florida residents experienced some form of mental illness.

• 47. Illinois

  The report shows 18.1 percent of Illinois residents experienced some form of mental illness.

• 46. South Dakota

  The report shows 18.1 percent of South Dakota residents experienced some form of mental illness.

• 45. New Jersey

  The report shows 18.3 percent of New Jersey residents experienced some form of mental illness.

• 44. Virginia

  The report shows 18.5 percent of Virginia residents experienced some form of mental illness.

• 43. Alaska

  The report shows 18.8 percent of Alaska residents experienced some form of mental illness.

• 42. Arizona

  The report shows 18.8 percent of Arizona residents experienced some form of mental illness.

• 41. South Carolina

  The report shows 18.9 percent of South Carolina residents experienced some form of mental illness.

• 40. Iowa

  The report shows 19 percent of Iowa residents experienced some form of mental illness.

• 39. New Mexico

  The report shows 19 percent of New Mexico residents experienced some form of mental illness.

• 38. Minnesota

  The report shows 19.1 percent of Minnesota residents experienced some form of mental illness.

• 37. Georgia

  The report shows 19.3 percent of Georgia residents experienced some form of mental illness.

• 36. Hawaii

  The report shows 19.5 percent of Hawaii residents experienced some form of mental illness.

• 35. Mississippi

  The report shows 19.5 percent of Mississippi residents experienced some form of mental illness.

• 34. California

  The report shows 19.6 percent of California residents experienced some form of mental illness.

• 33. Delaware

  The report shows 19.6 percent of Delaware residents experienced some form of mental illness.

• 32. New Hampshire

  The report shows 19.6 percent of New Hampshire residents experienced some form of mental illness.

• 31. North Carolina

  The report shows 19.6 percent of North Carolina residents experienced some form of mental illness.

• 30. Texas

  The report shows 19.6 percent of Texas residents experienced some form of mental illness.

• 29. Connecticut

  The report shows 19.7 percent of Connecticut residents experienced some form of mental illness.

• 28. Louisiana

  The report shows 19.7 percent of Louisiana residents experienced some form of mental illness.

• 27. Vermont

  The report shows 19.7 percent of Vermont residents experienced some form of mental illness.

• 26. New York

  The report shows 19.9 percent of New York residents experienced some form of mental illness.

• 25. Kentucky

  The report shows 20 percent of Kentucky residents experienced some form of mental illness.

• 24. Massachusetts

  The report shows 20.2 percent of Massachusetts residents experienced some form of mental illness.

• 23. Montana

  The report shows 20.2 percent of Montana residents experienced some form of mental illness.

• 22. Alabama

  The report shows 20.3 percent of Alabama residents experienced some form of mental illness.

• 21. Nebraska

  The report shows 20.4 percent of Nebraska residents experienced some form of mental illness.

• 20. Ohio

  The report shows 20.4 percent of Ohio residents experienced some form of mental illness.

• 19. Michigan

  The report shows 20.5 percent of Michigan residents experienced some form of mental illness.

• 18. Kansas

  The report shows 20.6 percent of Kansas residents experienced some form of mental illness.

• 17. Oregon

  The report shows 20.6 percent of Oregon residents experienced some form of mental illness.

• 16. Colorado

  The report shows 20.8 percent of Colorado residents experienced some form of mental illness.

• 15. Maine

  The report shows 20.9 percent of Maine residents experienced some form of mental illness.

• 14. Missouri

  The report shows 20.9 percent of Missouri residents experienced some form of mental illness.

• 13. Washington, D.C.

  The report shows 21 percent of Washington, D.C., residents experienced some form of mental illness.

• 12. Washington

  The report shows 21.2 percent of Washington state residents experienced some form of mental illness.

• 11. Wisconsin

  The report shows 21.2 percent of Wisconsin residents experienced some form of mental illness.

• 10. Arkansas

  The report shows 21.3 percent of Arkansas residents experienced some form of mental illness.

• 9. Tennessee

  The report shows 21.5 percent of Tennessee residents experienced some form of mental illness.

• 8. Nevada

  The report shows 21.6 percent of Nevada residents experienced some form of mental illness.

• 7. Oklahoma

  The report shows 21.6 percent of Oklahoma residents experienced some form of mental illness.

• 6. Wyoming

  The report shows 21.8 percent of Wyoming residents experienced some form of mental illness.

• 5. Indiana

  The report shows 22 percent of Indiana residents experienced some form of mental illness.

• 4. West Virginia

  The report shows 22 percent of West Virginia residents experienced some form of mental illness.

• 3. Idaho

  The report shows 22.5 percent of Idaho residents experienced some form of mental illness.

• 2. Utah

  The report shows 24.1 percent of Utah residents experienced some form of mental illness.

• 1. Rhode Island

  The report shows 24.2 percent of Rhode Island residents experienced some form of mental illness.

HOUSTON (AP) — The Houston Rockets suspended first-round pick Royce White for ”refusing to provide services” required by his contract on Sunday.

General manager Daryl Morey said Sunday that the team will continue to work with White in hopes of finding a resolution.

White will not be paid during his suspension.

White refused his assignment to Houston’s D-League affiliate a week ago. The 16th overall pick in the June draft has spent most of the season on Houston’s inactive list while he and the team figure out how to handle his anxiety disorder and overall mental health.

White has been vocal on Twitter throughout this saga, and he continued to voice his opinions on the Web site after the announcement Sunday.

”What’s suspending me suppose to do. I’ve been away from the team for a month 1/2. Guess we want to give it a title to shift accountability,” he tweeted.

That was the first in a string of tweets on the subject, and he then addressed Morey in the second one.

”Threat, Fines, Suspension won’t deter me. I won’t accept illogical health decisions, I will keep asking for safety health. (hash)BeWell (at)dmorey,” he tweeted.

The Rockets chose White in the first round after a season at Iowa State, where he helped the Cyclones to their first NCAA tournament berth in seven years by leading the team in scoring (13.4 points a game), rebounds (9.3), assists (5.0), steals (1.2) and blocks (0.9).

The 6-foot-8 White missed the first week of training camp to work with the Rockets to create an arrangement to deal with his anxiety disorder within the demands of the NBA’s travel schedule. He and the team agreed to allow him to travel by bus to some games while he confronted his fear of flying and obsessive-compulsive disorder. He flew to Detroit with the team for the season opener and then traveled by bus to Atlanta and Memphis for games.

But he soon stopped participating in team activities and said on Twitter that dealing with his mental health took precedence over his NBA career. Then came his decision last Sunday to refuse his assignment to the D-League. Despite that decision, he said then that he still hopes to return to basketball in the future.

”And daily I’m just trying to stand up for my health and make sure that my health isn’t neglected in an operation where, me and you both know, it’s mostly about money,” White said in a recent interview with Sirius/XM Radio. ”And I’m kind of the only one that’s going to sit in the situation and say, ‘Hey, let’s put the health thing first.”’