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Elisha Eveleigh Clipson, Ph.D.
Child Psychologist, Lindner Center of HOPE
Assistant Professor – Clinical, University of Cincinnati College of Medicine
Department of Psychiatry and Behavioral Neuroscience

 

 

Parents bring their children for psychological testing to answer the same question: How do I best help my child navigate through life? Increased autism awareness has led to a greater sense of identity and connectedness among many members of the autism community. There have been opportunities to highlight the strengths of individuals with autism spectrum disorder (ASD) and their families. With increased autism awareness, more parents notice symptoms and wonder if the diagnosis applies to their child.

I spend much of my professional time determining whether a child meets the criteria for autism. Part of the process is ruling out other explanations, and possibly ruling out autism. Sometimes families are upset when their child does not meet the criteria for autism.

Recently, a teen without ASD symptoms reported she was upset I did not “give her the diagnosis of autism” because she knew she had it. I deeply wanted this teen to better understand her experience, but she was not sufficiently trained to provide an accurate diagnosis.

Psychologists aim for accurate diagnosis. This informs the answer to the question of how to best help a child navigate through life. It is worth educating parents on what other issues have overlapping symptoms with autism.

When it is Autism

Individuals with ASD have differences in social communication and social interaction. Part two of the diagnosis has to do with restricted, repetitive patterns of behavior, interests, or activities.

On the communication side, we see significant difficulty in the following areas:

  1. Social-emotional reciprocity.
    1. This may include trouble with back-and-forth conversations or failure to initiate or respond to social interactions.
  2. Nonverbal communication used for social interaction.
    1. For example, trouble understanding or using nonverbal gestures, lack of facial expressions or avoiding eye contact.
  3. Developing, maintaining, and understanding relationships.
    1. For instance, trouble sharing in imaginative play, making friends or a seeming absence of interest in peers.

Restricted, repetitive patterns of behavior might include:

  1. Repetitive motor movements or speech. Classic examples include repetitive phrases and unusually repetitive lining up of toys.
  2. Some children with autism have inflexible routines, unusual greeting rituals, or distress with small changes.
  3. The experience of abnormally restricted, fixated interests or preoccupations may be present.
  4. Many children with autism have differences in sensitivity to sensory input. This may include indifference to pain, excessive smelling of objects or visual fascination with the movement of an object.

 

What else could it be?

Social (Pragmatic) Communication Disorder

This involves persistent trouble with the social use of verbal and nonverbal communication. Symptoms include difficulty with:

  • Greeting others and sharing information.
  • Changing communication to match the context, e.g. communicating differently with a teacher than a peer.
  • Knowing how to use nonverbal signals to regulate social interactions.

Attention Deficit/Hyperactivity Disorder

  • Children with ADHD experience more sensory processing issues than other children. They may be more sensitive to sounds or smell.
  • They may have difficulty taking turns or picking up on social cues.
  • May become distracted and disengage in the middle of a conversation.
  • Some children with ADHD can become, “hyper-focused” on an interesting task.

Anxiety Disorders and OCD

  • Individuals with anxiety disorders may avoid social situations.
  • Anxiety can make a person feel less comfortable with eye contact.
  • Some children refuse to talk outside of the home.
  • Rigid patterns of behavior and thinking are possible.

Sensory processing difficulty

Individuals with a range of developmental and psychological experiences have sensory processing difficulty. This is more commonly experienced with mood disorders, anxiety or ADHD. It is also more prevalent in children with Intellectual Disability or Global Developmental Delay.

Behavioral concerns

  • Not all children with autism have behavior problems. In fact, many do not.
  • Children with behavioral concerns may have trouble understanding and regulating their emotions.
  • Some children with speech and communication delays exhibit behavior problems when unable to express themselves.

Depression

  • The range of facial expression or tone of voice may be more neutral.
  • A person may become socially withdrawn.

“Overcontrolled” personal traits

Some of my colleagues at LCOH provide Radically Open DBT. This is for people who experience a spectrum of problems that result in being “overcontrolled.”

  • May exhibit less emotional expression, saying, “I’m fine” when they are not.
  • Show a limited range of facial expressions.
  • Their lives may be rigid, and rule governed.
  • May seem aloof or distant in relationships. For instance, they might avoid sharing personal information.

 

Having Autism does not exclude a person from also experiencing the conditions described above. Yet, meeting the criteria for one or more of these conditions does not mean a person has autism. Providing an accurate diagnosis honors the experience of people with ASD and other conditions. It empowers families to best support their children throughout the lifespan.

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The Scurry is an annual event hosted by TiER1 Performance to raise money for local organizations that provide mental health services. On Friday, May 17, the event will start at noon with a three-hour team competition (think CBS’s The Amazing Race) featuring challenge stations throughout Covington,

Kentucky, and the Cincinnati Riverfront and end with an epic after party at Covington Yard from 4-7 pm. Register your team at thescurry.com by April 26!

Proceeds from the event will directly benefit the mental health initiatives at Lindner Center of HOPE, Children’s Home of Northern Kentucky, and the Adapt for Life program at Cincinnati Children’s. Since its launch in 2010, The Scurry has helped raise more than $400,000 for local mental health efforts.

Whether you participate in the team competition, sponsor the event, attend the after party, or donate to the cause, every form of support is appreciated and makes a positive impact on the community.

Visit THESCURRY.COM for more information.

 

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Crafting Change on the Road to Recovery

The experience of substance use and/or mental illness is unique to each person, affected by a combination of biological, psychological, and social factors that contribute to behavioral health conditions. This event offers exposure to a variety of pathways to recovery.

DR. CHRIS TUELL’S SESSION
Addicted to Numbing Mental Illness

5/10/2024
8 AM – 4:30 PM EST
3867 Olympic Blvd. Erlanger, KY 47078

Click here for flyer

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By: Dr. Nicole Bosse, PsyD, Lindner Center of HOPE

 

OCD is a disorder that responds very well to a form of Cognitive Behavioral Therapy called Exposure and Response Prevention. Brain imaging studies found that people with OCD have excessive levels of activity in the orbital cortex, the caudate nucleus, the cingulate gyrus, and the thalamus. Differences are unrelated to intelligence and most other cognitive abilities. These studies also show that the brain changes in response to Exposure and Response Prevention. The overactive parts of the brain become less active and similar to others without OCD after engaging in Exposure and Response Prevention.

Exposure and Response Prevention consists of confronting what you are afraid and abstaining from the related compulsions. Specifically, exposures are purposeful and gradual confronting and maintaining contact with feared objects, thoughts, or images to allow the anxiety to rise, peak, and subside. Response Prevention is the halting of neutralizing actions and/or thoughts (i.e., compulsions) to allow habituation to a feared stimulus (e.g., not washing after touching a doorknob). This is done with the help of a trained therapist. It is a form of therapy that is collaborative and the individual works with the therapist to brainstorm various exposure ideas to start forming a hierarchy.

A hierarchy ranges from items that bring about low to high distress/anxiety. An example hierarchy for someone that has a fear of snakes could look like: reading about snakes, looking at pictures of snakes, watching videos of snakes, looking at snakes behind glass, being in the room with someone holding a Gardner snake, being in the room with someone holding a boa constrictor, touching a Gardner snake while someone else is holding it, touching a boa constrictor that someone else is holding, holding a Gardner snake, and being in a bathtub with boa constrictor snakes. The last item can be something that wouldn’t necessarily be done for exposures, it is just used as a something to help scale other exposures.

There are two types of exposures I usually talk about with patients, planned vs. spontaneous. Planned exposures can take various forms, from in vivo to imaginal. In vivo exposures are exposures that are completed in person, for example touching things that could be contaminated with germs or breaking down avoidance of certain people for fear of harming them. Imaginal exposures are usually implemented when it is impossible/unethical to do in person exposures. For example, the individual can be instructed to write sentences about hurting someone or write an imaginal script detailing their worst fear. These exposures can be done over and over in one sitting until it starts to get boring.

Spontaneous exposures are things that happen throughout the day that are unplanned and typically cause significant anxiety. For instance, if someone is afraid of germs and someone sneezes on food etc. With spontaneous exposures, I usually instruct individual to do one of two things, either abstain from the compulsion or do something called ritual weakening. Ritual weakening is completing the compulsion but doing it differently than the OCD desires. For example, postponing washing hands or writing down that you are giving into a compulsion in order to be able to do the compulsion. The idea is it makes it slightly less convenient to do the compulsion, which over time weakens OCD.

In sum, Exposure and Response Prevention is a very successful form of treatment for OCD. To be effective, the individual must be willing and motivated. An individual is never made to do something they are uncomfortable with. It is best to go slow in order for the individual to learn their anxiety will decrease over time.

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REGISTER NOW! 1 CME/CEU OFFERED

Please join us May 14, 2024
5:30 – 6:30 p.m. EST

For a free webcast

How to Treat Psychosis with CBTp

 

PRESENTED BY:
Nicole Bosse, PsyD, Staff Psychologist

Participants in the webcast will be able to:

  1. Outline how to engage and support individuals with psychosis.
  2. Adapt CBT strategies for individuals struggling with psychosis.
  3. Implement specific strategies for individuals with psychosis.

Click here for flyer

Register here

Target Audience:
Psychiatrists, Primary Care Physicians, Non-psychiatric MDs, Nurse Practitioners, , Social Workers, Psychologists, Registered Nurses, and Mental Health Specialists and interested parties as well

ACCREDITATION STATEMENT
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing
Medical Education (ACCME) through the joint providership of the University of Cincinnati and the Lindner Center of HOPE. The University of Cincinnati is accredited by the ACCME to provide continuing medical education for physicians.

The University of Cincinnati designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credits
commensurate with the extent of their participation in the activity.

The Ohio Psychological Association under approval number P099-311067501 (2010-2012) approves the University of Cincinnati College of Medicine
Department of Psychiatry for 1 mandatory continuing education credit for Ohio Licensed Psychologists.

The This activity has been approved for 1 clock hour of CEU by The State of Ohio Counselor, Social Work, Marriage and Family Therapist Board.

DISCLAIMER
The opinions expressed during the educational activity are those of the faculty and do not necessarily represent the views of the University of Cincinnati. The information is presented for the purpose of advancing the attendees’ professional development.

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By Jennifer B. Wilcox Berman, PsyD, Lindner Center of HOPE

 

OCD and OCPD are often mistaken for one another or used interchangeably. Although there is some overlap between the two disorders, it’s important to distinguish between them because they are quite different in many ways. It is important to note that although there are differences, some people may have symptoms of both OCD and OCPD. The two disorders are differentiated below.

Obsessive-Compulsive Disorder (OCD) is a debilitating psychiatric disorder that presents in many forms. OCD is comprised of obsessions, which are persistent and unwanted intrusive thoughts, images, or urges. To reduce or eliminate this distress or discomfort, OCD sufferers begin to engage in compulsive behavior, which is ritualized behavior or mental acts, that serve to reduce their discomfort and anxiety. It should be noted that not all compulsions are outwardly observable and may include avoidance of triggers or engaging in mental compulsions. Unfortunately, engaging in compulsions or avoidance of triggers reinforces obsessive thinking. Therefore, the goal of treatment is to reduce compulsions while learning how to tolerate the distress that comes from intrusive thoughts. Some subtypes of OCD include fears related to contamination, scrupulosity (religious-based fears)/morality, fear of harming others (aggressive or sexual), ordering and arranging, repeating, and checking. There are several other subtypes of OCD not noted here. In OCD, these intrusive thoughts are considered ego-dystonic, meaning they are inconsistent with someone’s self-image, beliefs, and values. Therefore, these obsessions cause significant distress, anxiety, and worry and can greatly interfere with one’s life. People with OCD tend to seek help when these thoughts and behaviors cause problems in their life.

According to the Diagnostic and Statistical Manual of Mental Disorders (5th edition), Obsessive-Compulsive Personality Disorder (OCPD) is “a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control.” Due to this, people with OCPD struggle with flexibility, openness to new ideas, and are often inefficient at completing tasks due to perfectionism. Their rigidity and inflexibility can lead to preoccupation with details, rules, lists, order, organization, and schedules. They can hold themselves to perfectionistic standards that interfere with their ability to complete tasks. They are often overly devoted to work and productivity at the expense of leisure activities and interpersonal relationships, leading to a poor work-life balance. People with OCPD can be overly conscientious, very scrupulous, and are often inflexible about matters of ethics, morality, and personal values. Some people with OCPD tend to be miserly, may hoard money for the future, and may have difficulty discarding worn-out or useless items. They may appear to be stubborn or rigid, and may struggle to delegate tasks or work with others because they don’t believe others will do things to their high standards. OCPD is considered ego-syntonic, meaning that it is consistent with someone’s self-image, beliefs, and values. People with OCPD tend to feel validated in their patterns of rigidity and perfectionistic rules and schedules. Therefore, people with OCPD are less likely to seek treatment, unless their behavior begins to negatively impact those around them.

While Exposure and Response Prevention (ERP) is considered the “gold standard” treatment for OCD, there is no such definitive standard intervention for OCD. Exposure and Response Prevention (ERP) is a type of Cognitive-Behavior Therapy (CBT). Cognitive-Behavior Therapy varies from other types of talk therapy in that it is focused on changing thinking patterns and behaviors. It tends to be directed at the present, rather than the past and is goal-oriented and solution-focused. ERP aims to change behavioral patterns, allowing someone to confront their fears and therefore, reduce their OCD symptoms. Exposure refers to the direct confrontation of one’s fear through voluntarily taking steps towards their fears and triggers. Response Prevention refers to someone voluntarily agreeing to reduce their usual rituals and compulsions. It is very important for someone who is working on doing exposures to simultaneously refrain from engaging in compulsions. Without reducing or refraining from the related compulsions, the person cannot learn that they can tolerate the exposure or that the compulsion is unnecessary.

Treatment for OCPD tends to focus on the identification of rigid rules and lifestyle and how these things may be negatively impacting one’s life. Therapeutic intervention includes working on flexibility, willingness to make changes, and focusing on one’s values as motivation for change.

For those suffering from symptoms of OCD or OCPD, therapeutic intervention can be helpful. It is important to seek a specialized provider that can accurately diagnose and treat these disorders.

 

References:

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

Grant, J. E., Pinto, A., & Chamberlain, S. R., (Eds.) (2020). Obsessive compulsive personality disorder.    American Psychiatric Association Publishing.

Hyman, B. M., & Pedrick, C. (2010). The OCD workbook: Your guide to breaking free from obsessive-compulsive disorder (3rd ed.). New Harbinger.

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Kevin Hines, a mental health advocate and survivor of a suicide attempt from the Golden Gate Bridge, will share his story

High Hopes, Lindner Center of HOPE’s fundraising auxiliary, presents An Evening of HOPE, May 30, 2024, at MegaCorp Pavilion. This will be a unique and impactful event featuring the renowned speaker, Kevin Hines, a mental health advocate and survivor of a suicide attempt from the Golden Gate Bridge.

An Evening of HOPE will take place on Thursday, May 30, 2024, at MegaCorp Pavilion, 101 W. 4th Street, Newport, Kentucky starting at 6pm with a cocktail hour and dinner and program to follow. Co-chairs are Amy Russert & Blake Gustafson.

There are several ways to get involved through registration or sponsorship.

Visit lindnercenter.ejoinme.org/HighHopes.

All proceeds from the event benefit Lindner Center of HOPE’s Transforming HOPE Campaign. Funds enable the Center to add more treatment units, expand wellness facilities, add clinical staff, increasing the number of patients served, and lessen the suffering of people with mental illness.

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Kevin Hines, a mental health advocate and survivor of a suicide attempt from the Golden Gate Bridge, will share his story

High Hopes, Lindner Center of HOPE’s fundraising auxiliary, presents An Evening of HOPE, May 30, 2024, at MegaCorp Pavilion. This will be a unique and impactful event featuring the renowned speaker, Kevin Hines, a mental health advocate and survivor of a suicide attempt from the Golden Gate Bridge.

An Evening of HOPE will take place on Thursday, May 30, 2024, at MegaCorp Pavilion, 101 W. 4th Street, Newport, Kentucky starting at 6pm with a cocktail hour and dinner and program to follow. Co-chairs are Amy Russert & Blake Gustafson.

There are several ways to get involved through registration or sponsorship.

Visit lindnercenter.ejoinme.org/HighHopes.

All proceeds from the event benefit Lindner Center of HOPE’s Transforming HOPE Campaign. Funds enable the Center to add more treatment units, expand wellness facilities, add clinical staff, increasing the number of patients served, and lessen the suffering of people with mental illness.

Lindner Center of HOPE in Mason is a comprehensive mental health center providing excellent, patient-centered, scientifically-advanced care for individuals suffering with mental illness. A state-of-the-science, mental health center and charter member of the National Network of Depression Centers, the Center provides psychiatric hospitalization and partial hospitalization for individuals age 12-years-old and older, outpatient services for all ages, diagnostic and short-term residential services for adults, and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.

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Trip to honor wife’s memory and raise awareness of the importance of friendship for mental wellness

Michael G. Leadbetter, MD, retired plastic surgeon, will launch his year-long friendship bus tour of the United States June 2024 raising awareness around the importance of friendship and connection for mental wellness. The trip is in memory of Leadbetter’s wife, Debbie, his life partner for 49 years. The couple had planned much of the trip before Debbie passed, with the goal of visiting friends around the country, highlighting the significant role friends played in their lives and their mental wellness. Leadbetter intends to donate $25 to Lindner Center of HOPE, a mental health center of excellence in Mason, Ohio, for every friend he interacts with on his journey. He is also hopeful that interested individuals that he meets will contribute to Lindner Center of HOPE and/or mental health causes of their own in recognition of his year-long tour. Leadbetter has a list of 150 friends he would like to visit who have played an important part in he and his wife’s journey.

Leadbetter and his wife lost their oldest daughter, who was living with bipolar disorder, to progressive illness caused by years of depression and uncontrolled addiction in 2020.  This devastating loss has fueled his passion for mental health.

“A person can hear, but a friend listens for meaning. A person can look, but a friend sees the heart. A person can know, but a friend understands your dreams. When in need, the Lindner Center of HOPE is where you will find your friends,” Leadbetter shared.

“A friend loveth at all times.” Proverbs 17:17

Leadbetter and Lindner Center of HOPE will have a launch party for the friendship bus tour on May 19, 2024, as part of Lindner Center of HOPE’s Community Education Day at The Manor House in Mason. The community event offers mental health education to local community members during a half-day event that includes a key-note speaker, resource fair and break-out sessions on mental health and wellness topics.

The official tour will begin in Brookville, Ohio, Leadbetter’s hometown on June 2 at a reunion with classmates from the classes of 1965 and 1966.

About Dr. Leadbetter

Leadbetter was a 1965 graduate of Brookville Ohio High School. He graduated from Otterbein University in Westerville, Ohio in 1969. In 1974 he graduated from The Ohio State College of Medicine. He completed his general surgery residency at The University of New Mexico in Albuquerque, New Mexico. He went on to complete his plastic surgery residency at The Christ Hospital, Cincinnati, Ohio. He was a founding member of the Plastic Surgery Group in Cincinnati where he practiced for 40 years before retiring in 2020. He is a board member of the Reid Rizzo Foundation. He is past president of the Ohio State College of Medicine Alumni Society and a past board member of The Cincinnati Music and Wellness Coalition.

Launch Events:

Lindner Center of HOPE Community Education Day
Sunday, May 19, 2024
Time: 12:45pm
Manor House, 7440 Mason Montgomery Rd., Mason, Ohio

 

Brookville Ohio
Monday, June 3, 2024
Time:  2pm
Location:  Golden Gate Park with high school classmates

 

Lindner Center of HOPE  provides excellent, patient-centered, scientifically advanced care for individuals suffering with mental illness. A state-of-the-science mental-health center and charter member of the National Network of Depression Centers, the center provides psychiatric hospitalization and partial hospitalization for adults, outpatient services for all ages, diagnostic and short-term residential services for adults, intensive outpatient program for substance abuse and co-occurring disorders for adults and research. The center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The center is also affiliated with the University of Cincinnati (UC) College of Medicine.

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Half Day Workshop May 19th to Increase Awareness of Mental Health and Wellness

Lindner Center of HOPE will host Community Education Day on Sunday, May 19, 2024 in acknowledgement of May Mental Health Month at Manor House in Mason from 11am to 4pm. The half-day workshop offers an opportunity for community members to enhance their awareness of mental health and wellness. Knowledge helps break down stigma and open the conversation around prevention, treatment, and the mental health journey.

Brandon Saho, Creator of The Mental Game Podcast, Cincinnati native and former sports reporter with WLWT-TV will be the keynote speaker. Saho said goodbye to his dream job in 2022 to focus on his mental health. Saho says he was at his lowest. He was depressed and alone and he didn’t know how to live. Saho spent time as a patient at Lindner Center of HOPE and realized that he didn’t want anyone to struggle like he did, so he started The Mental Game podcast. Saho spends time talking with athletes, musicians, and celebrities with the goal of saving lives through these conversations.

Three sets of breakout sessions follow the keynote presentation. Attendees can design their afternoon according to their areas of interest with 12 total breakout sessions to choose from varying topics such as:  depression, self-care, empowered parenting, finding a therapist, addictions and more.

Just prior to the breakout sessions, attendees will be invited to participate in a friendly farewell to Michael G. Leadbetter, MD. Dr. Leadbetter, retired plastic surgeon, will launch his year-long friendship bus tour of the United States June 2024 raising awareness around the importance of friendship and connection for mental wellness. The trip is in memory of Leadbetter’s wife, Debbie, his life partner for 49 years. The couple had planned much of the trip before Debbie passed, with the goal of visiting friends around the country, highlighting the significant role friends played in their lives and their mental wellness.

Community Education Day also offers a resource center for participants to gather information on other community services and offerings.

Community Education Day 2024 Schedule

11am                     Registration and Resource Center Opens

11:30am              “Nourishing the Mind” Buffet

12pm                    Welcome by Paul Crosby, MD, MBA, President and CEO, Lindner Center of HOPE
Keynote by Brandon Saho, Creator, The Mental Game Podcast

12:45pm               Friendship Bus Launch for Michael Leadbetter, MD

1:15pm                 Breakout Session 1

2:15pm                 Breakout Session 2

3:15pm                 Breakout Session 3

Lindner Center of HOPE in Mason is a comprehensive mental health center providing excellent, patient-centered, scientifically-advanced care for individuals suffering with mental illness. A state-of-the-science, mental health center and charter member of the National Network of Depression Centers, the Center provides psychiatric hospitalization and partial hospitalization for individuals age 12-years-old and older, outpatient services for all ages, diagnostic and short-term residential services for adults, and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.