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.


  • 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.

By: Jessica Kraft, APRN, PMHNP-BC
Lindner Center of HOPE, Psychiatric Nurse Practitioner

Seasonal affective disorder (SAD) is a type of depression that is more isolated to the changing of the seasons. It can happen in the spring and summer but occurs most commonly in the fall and winter months. We know that everyone is going to have a bad day from time to time, and it’s not uncommon for some to face more challenges in the winter months when the weather is colder and the days are shorter. But when does this become a problem that requires intervention?

What are some of the common symptoms of SAD? 

  • Feeling down or depressed for most of the day, almost every day
  • Less interest in hobbies, social activities, or things that have brought you joy in the past
  • Decreased concentration at home and at work
  • Fatigue, sluggishness, or low energy
  • Sleeping too much or too little
  • Changes in appetite (increased craving for carbohydrates) or changes in weight
  • A general feeling of hopelessness
  • Low self-esteem
  • Thoughts of self-harm or suicide

It is hard to estimate the number of people who have SAD, as many do not know they have it. It’s also thought that the number in recent years has been higher due to the COVID-19 pandemic. Women can be at higher risk for developing SAD as well as those who live further north. SAD most commonly develops in young adulthood, it often runs in families, and can often be co-morbid with other mental health conditions including depression, bipolar, anxiety, ADHD, and eating disorders.

It is not entirely understood what causes SAD, but research indicates that people with SAD may have reduced activity of serotonin, too much melatonin production, or even vitamin D deficiency. Changes in these areas may impact the body’s daily rhythm that is tied to the seasonal night-day cycle. Negative thoughts and feelings about the winter and its associated limitations and stresses are common among people with SAD, as well as others. It is unclear whether these are “causes” or “effects” of the mood disorder, but they can be a useful focus of treatment especially when seeking therapy.

If the above symptoms start to interfere with day-to-day life, it may be beneficial to seek out care for SAD. For some it may be ideal to start with their primary care provider in order to rule out other medical conditions that could be responsible for symptoms of SAD including alterations in thyroid hormones, low blood sugar, anemia, or viral infections like mono. If there is not an identifiable medical cause, seeking psychiatric help may be beneficial.

What are some of the common symptoms of SAD?

  • Light therapy – a common approach to SAD since the 1980s. The thought is that exposure of bright light every day can supplement the lack of natural sunlight/sun exposure in the winter months. Sitting in front of a light box of 10,000 lux daily during the winter months in the morning can be a helpful intervention.
  • Talk therapy – the most common type of talk therapy for SAD is cognitive behavioral therapy (CBT).
  • Vitamin D supplementation – there is mixed research on how helpful supplementation of Vitamin D is for SAD but some find it helpful and a good option to try prior to trying a psychiatric medication.
  • Psychiatric medication – for those who haven’t seen much improvement with light therapy or CBT, psychiatric medication can be an option including SSRIs (Prozac, Zoloft, Lexapro, etc.) or Wellbutrin. It is important to keep in mind that treatment with one of these medications may take several weeks in order to be efficacious, for some up to 6-8 weeks.
  • When doing research on this topic I came across many anecdotal stories from those struggling with SAD and what interventions they tried and found helpful. Some examples included going outside more often, taking a trip, caring for something like a plant or a pet, finding a new hobby or interest, staying social, creating new rituals, consistent exercise, quality nutrition, good sleep, and maintaining a consistent schedule.

What are some of the common symptoms of SAD?

One of the helpful things about treating SAD is the predictability of when symptoms set in compared to other sub-types of depression that are much more variable. Unfortunately there is little research answering the question of whether or not this can be prevented or if there is a significant benefit to starting treatment early. Of the limited data available the medication Wellbutrin was found to be the most helpful intervention to start early.








By Danielle J. Johnson, MD, FAPA
Lindner Center of HOPE, Chief
of Adult Psychiatry


Innovations in Mental Health Treatment

By Danielle J. Johnson, MD, FAPA
Lindner Center of HOPE, Chief
of Adult Psychiatry
The past year has brought exciting innovations in treatment options for people with attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), and obsessive-compulsive disorder (OCD.) The U.S. Food and Drug Administration (FDA) approved the marketing of two devices which offer non-medication alternatives for the treatment of OCD and ADHD.  In August 2018, the Brainsway Deep TMS (Transcranial Magnetic Stimulation) system was approved for the treatment of OCD.  Deep TMS uses specially designed magnets to stimulate specific larger volume areas of the brain beneath the surface of the skull.  It is a non-invasive treatment that involves five 20-minute sessions per week for six weeks while sitting in a chair wearing a helmet with a sensation of tapping during the treatment.  Patients can continue medication and psychotherapy while receiving deep TMS.  According to the National Institute of Mental Health (NIMH), the lifetime prevalence of OCD among U.S. adults is 2.3% and 50% of these have had serious impairment.  Having another treatment option will bring hope to many people with severe OCD.

In April 2019, the Monarch eTNS (external trigeminal nerve stimulation) system was approved for the treatment of pediatric ADHD as monotherapy in children ages 7 through 12 years old who are not currently taking prescription ADHD medications. The Monarch eTNS System is intended to be used at home under the supervision of a caregiver when the child is sleep. The cell-phone sized device generates a low-level electrical pulse that feels like a tingling sensation and connects via a wire to a small patch that adheres to a patient’s forehead, just above the eyebrows. The system delivers electrical stimulation to the branches of the trigeminal nerve, which sends therapeutic signals to the parts of the brain thought to be involved in ADHD. The NIMH reports that the prevalence of ADHD is increasing, and severe ADHD is being diagnosed at an earlier age. This can be a treatment alternative for parents who prefer to avoid medications at an early age. Clinical response is expected in four weeks.

The mechanism of action of most antidepressants involve the neurotransmitters serotonin, norepinephrine, and dopamine. In March 2019, two antidepressants with novel mechanisms
of action were approved. Zulresso (brexanolone) was the first drug specifically approved for postpartum depression. Postpartum depression affects about 15% of women. Zulresso modulates the neurotransmitter GABA. It is administered as a 60-hour intravenous infusion in a registered healthcare facility. Symptom improvement was seen at the end of the infusion and at the end of 30-day follow-up. There has never been a medication that treats the symptoms of postpartum depression so rapidly, so this can significantly improve the quality
of life for the mother, infant, and her support system.

Spravato (esketamine) nasal spray was approved for treatment-resistant depression in conjunction with an oral antidepressant. Patients must have tried at least two antidepressant treatments at adequate doses for an adequate duration in the current depressive episode before trying Spravato. The spray must be administered in a certified medical office where the patient can be monitored. Spravato is taken twice a week for four weeks then once a week for a month, then once a week or once every two weeks. It is an antagonist of the NMDA receptor, a type of glutamate receptor. Approximately 30% of people with MDD are considered to have treatment-resistant symptoms and have the potential to benefit from esketamine.

For more information about these treatment options: https://www.brainsway.com/treatments/obsessive-compulsive-disorder 





Free Community Education Series Offered the Third Wednesday of Every Other Month

The second session of a free education series to help community members increase awareness of mental health, substance use disorders, treatment and strategies for coping is April 18, 2018. Stacey Spencer, EdD, Lindner Center of HOPE staff psychologist, will present ADHD Through the Lifespan.

Lindner Center of HOPE with the support of Manor House in Mason, Ohio is once again offering a Free Community Education Series to increase awareness of mental health issues and substance use. The series offers expert discussion of Mental Health, Substance Use Disorders, Treatment and Strategies for Coping for community members seeking information.

The series is held at Manor House, 7440 Mason-Montgomery Rd., Mason at 6 p.m. the third Wednesday of every other month.

Register by calling Pricila Gran at 513-536-0318. Learn more by visiting lindnercenterofhope.org/education.

On October 28, 2015, Dr. Elizabeth Wassenaar, Lindner Center of HOPE Psychiatrist and Williams House Medical Director, joined Lon Woodbury on the Woodbury Report radio show.  Their discussion focused on outlining the benefits of a residential assessment for mental health concerns in adolescents.

Click here to listen.

By: Jennifer Bellman, Psy.D.

Ah, fall. For many it means a time for apples, visiting fall farms, enjoying the cooler respite from the days of Indian summer, and purchasing any pumpkin-spice-infused food or drink or scent that hits the consumer-driven market. It’s also the time of year when parents (who might have been holding their breath for the first few weeks of school) may grow concerned about their homework-resistant child and when interim reports and/or parent-teacher conferences provide knowledge about a child’s academic progress and behaviors at school. And for some families, notices and emails of concern from teachers arrive well before the parent-teacher conferences are even scheduled.

Fall. It is when parents wonder if their child might have Attention Deficit/Hyperactivity Disorder (ADHD).

ADHD takes on different forms, depending on the age of the child. Generally speaking, the younger the child, the more behavioral problems he or she has likely exhibited in the classroom. These can include anything from talking in class, interrupting the teacher, blurting out answers, pushing others as they form a line, invading others’ personal space, and needing continual reminders to sit in one’s chair. All these are symptoms of impulsivity and hyperactivity and are the most noticeable symptoms teachers observe in class, and they are the most “disruptive” to the process of teaching and learning. It is not uncommon for these children to start exhibiting these difficulties in preschool, when they first enter into a structured group environment with expectations of age-appropriate rules and directions.

Struggles with inattentiveness (without impulsivity or hyperactivity) may start being observed in children as early as the 2nd or 3rd grades, when the fundamentals of reading and math are already expected to have been sufficiently established. Many of these children are not exhibiting outward signs of problems, nor are they causing enough of a disturbance in the class for teachers to place on their radars. Instead, these children are ones who may struggle to complete their seatwork and are required to take it home to finish, make “simple” mistakes in their work, sometimes “stare into space,” forget to turn in their homework, become distracted by other tasks, and/or “do not seem to be performing up to their academic potential.” Due to the quiet nature of inattention, it is also not uncommon for children to first become identified as having ADHD in junior high or high school, when the demands for the academic work become increasingly more difficult. Sometimes, high intelligence in a child can mask underlying inattention and distractibility; the child may still grasp the academic work without showing any difficulties. The more complex the work in school becomes, though, the more opportunities there are for a highly intelligent child with ADHD to exhibit their underlying struggles.

Many people only focus on struggles with inattentiveness, distractibility, impulsivity and/or hyperactivity when wondering if a child has ADHD. The less obvious (and yet very important) areas to consider are those of executive functioning. These are higher-order cognitive abilities “housed” within the frontal lobe of the brain, which is the last lobe of the brain to develop and is not fully formed until one’s mid-to-late 20’s. These skills involve planning, organizing, inhibiting (or, controlling) one’s impulses or behaviors, and other complex skills. We can easily observe how behavioral disinhibition (i.e., dyscontrol) is represented by impulsive acts. Two other areas of executive functioning that are especially noteworthy to consider when wondering about ADHD (and how impairments are observed) include:

Poor time management:   procrastination; conceptually minimizing the time it actually takes to complete a project or an activity; rushing; arriving late most of the time; not utilizing one’s time most effectively; taking longer to complete homework than is expected

Disorganization: having a messy backpack; keeping a messy bedroom or other areas of personal space; being unprepared; losing or misplacing belongings; difficulty knowing how to prioritize tasks in terms of importance; problems completing tasks or projects; forgetting assignments, due dates, appointments, or other tasks

Many parents question whether their child is just “not motivated enough” to complete their work. This is certainly of note to consider. It is important to understand, though, that for individuals with ADHD, it is much less about internal motivation to complete a task and much more about the desire to avoid the difficult work one faces with having to sit for a seemingly long duration, sustain one’s attention, organize one’s thoughts, and minimize distractions. We have a natural tendency to avoid what we find difficult; so, of course, individuals with ADHD try to put off tasks that require significant mental effort.

Besides medication, strategies to help improve attention, inhibitory control, organization, and time management involve implementing structure and routine. Limits and expectations, especially for house rules such as not allowing leisure or “screen” time until homework is completed, are helpful. Reminding children about the differences between tasks that are required (i.e., homework) versus optional (i.e., play time) can also be helpful. Using multiple forms of scheduling items also is recommended, such as a daily agenda, a week-in-view planner, and a month-in-view calendar help to prioritize activities and time so as to accomplish tasks.

Of course, the struggles discussed here may also represent other underlying issues beyond ADHD. For instance, problems with impulsivity, inattentiveness, behavioral disruption, and physical restlessness could be accounted for by an underlying medical condition (e.g., hyper- or hypo-thyroidism), insufficient or poor quality of sleep, adjustment to significant changes in one’s life (e.g., a move or a parents’ divorce), affective or mood states (e.g., anxiety or depression), a behavioral disorder (e.g., Oppositional-Defiant Disorder), or other possible contributions. These must always be considered when assessing whether one has ADHD. Regardless of the underlying cause of such struggles, the recommendations used for improving structure, time management, and organization are helpful for most children, anyway.

Attention Deficit Hyperactivity Disorder (ADHD) is a condition that can cause disruption in the daily lives of those who are affected by it.  ADHD can impact school performance, interpersonal relationships, and employment, as it affects concentration, activity levels, and impulse control.

An estimated 3 – 5 % of individuals in the U.S. are thought to have ADHD. While it develops in childhood, ADHD can continue throughout life. At least 30% of affected children continue to experience symptoms as adults.

The Nature of ADHD

Attention Deficit Hyperactivity Disorder is characterized by three hallmark symptoms:  inattention, hyperactivity, and/or impulsivity.  While all children demonstrate some degree of these traits due to their immature development, these behaviors are more frequent and severe with ADHD.  To receive a diagnosis, an individual must exhibit symptoms to a greater degree than their peers for at least six months.

Three ADHD subtypes have been identified:

  • Predominantly hyperactive-impulsive — difficulty controlling behavior and over-activity, with few attention problems;
  • Predominantly inattentive – difficulty with inattention, with few problems with hyperactivity or impulse control;
  • Combined hyperactiveimpulsive and inattentive – presence of strong symptoms of hyperactivity, impulsivity, and inattention.  Most children are found to have the combined type of ADHD.

While adult symptoms of ADHD may be similar, they may be expressed differently– for example, restlessness rather than hyperactivity.

Causes of ADHD

As with many other disorders, ADHD is the likely result of a combination of factors.  Researchers have found that levels of certain chemicals or neurotransmitters in the brain tend to be lower in individuals with ADHD.  Known or suspected contributing factors include:

  • Genetics. ADHD often runs in families, and scientists are attempting to isolate genes that may contribute to the development of the disorder.
  • Prenatal problems.  Low birth weight and difficulty pregnancies have been linked to ADHD.
  • Environment.  Studies have found potential links between ADHD and alcohol use or smoking during pregnancy and exposure to high levels of lead and such environmental toxins as PCBs or pesticides.
  • Brain injury.  Head injuries, particularly to the frontal lobe, seem to increase the risk for ADHD.
  • Nutrition.  Much speculation has focused on the possible effects of refined sugar and food additives, but research is inconclusive.

Treatment of ADHD

While there is no known cure, ADHD is a manageable disorder that responds to proper treatment.  Treatments focus on symptom reduction and management.

Medication is the primary treatment mode. Stimulant drugs are often used with children because, unlike with adults, they actually have a calming effect.  A few non-stimulant medications have demonstrated benefits. While parents are understandably cautious about medication, the proper regimen can help a child learn to focus and behave more appropriately.

In addition, treatment may include psychotherapy, education, or specialized training.  For example, behavioral therapy can assist a child in controlling his or her symptoms.  Structured routines can be developed that will assist parents and teachers in managing behaviors.  Social skills training can provide children with tools to interact more appropriately with others.

The good news for many:  most individuals “outgrow” ADHD as they mature into adulthood.  But strides in treatment give hope to all, regardless of age.

When the subject of disabilities surfaces in our thoughts or conversations, it is common to first consider those caused by some type of physical ailment or affliction. Conditions such as arthritis, heart disease and back problems are certainly primary causes of long-term disabilities in our nation. However, mental illness is the leading cause of disability in U.S. citizens ranging in ages from 15 to 44, according to National Institute of Mental Health (NIMH) statistics.

What these numbers show is that many Americans and people around the world are affected by illnesses such as depression, bipolar disorder, schizophrenia and a host of other mood and anxiety disorders in the prime of their working lives. Unfortunately, these numbers show no sign of subsiding anytime soon. In fact, they continue to rise, as do the number of filings with the U.S. Social Security Administration (SSA) for disability benefits due to mental illnesses.

The SSA and Mental Illness Claims

The SSA has established specific criteria that qualify those suffering with mental disorders for disability benefits. Basically, it must be determined that an existing mental condition limits or impairs one’s ability to fulfill their work obligations. In most situations, assessments and evaluations must be performed by mental health professionals. Additionally, evidence must be submitted to the SSA that indicates the individual in question is unable to perform their assigned job duties as a consequence of their condition.

Getting Back on their Feet

It is important for those with mental health issues to make their employers aware of their situation. All too often, workers are hesitant or afraid to address their condition with their employers for fear of negative repercussions. But behavioral or productivity problems could lead to termination, which also often results in the loss of insurance, creating even more problems for these individuals in regard to receiving treatment.

When documented mental health issues are reported to an employer, they are obligated under Americans with Disabilities Act (ADA) regulations to accommodate that employee with whatever they need to successfully perform their job duties, or to make their working situation as comfortable as possible. In lieu of applying for disability benefits, this can allow an employee to continue to work while receiving mental health treatment and take measures that will eventually enable them to effectively manage their condition.


This blog is written and published by Lindner Center of HOPE.

Attention Deficit Hyperactivity Disorder (ADHD) is a complex mental health issue that is not always easy to diagnose. This is often due in part to the existence of signs and symptoms indicative of other conditions such as anxiety and depression.

There are also various classifications of ADHD where either the attention deficit symptoms or the hyperactivity symptoms are more dominant; or where a near equal combination of both is present. Each individual case is unique. Many times an accurate assessment of symptoms requires a rather lengthy diagnostic process.

Those involved in the life of a child or young adult with ADHD struggle along with them in many ways. Parents, teachers and peers at times become frustrated with the ADHD sufferer’s symptoms and behaviors. These include being easily distracted, disruptive, impulsive and an inability to sit still.

A Comprehensive Approach to ADHD Treatment

Incorporating multiple modes of treatment usually produces the best results in those with ADHD. These often include psychotherapy and behavior modification combined with education and medications. Talk therapy and behavioral therapies will help a child better understand their condition and what may trigger certain responses. These will also enable a child with ADHD to be more aware of their behaviors and discover ways to break out of destructive patterns.

Most medications used in ADHD treatments come in the form of stimulants, antidepressants and mood stabilizers. It may take several tries to determine which medication works best for a particular child. But once a medication is settled upon, it will often have a calming effect on the child and will help them significantly improve their focus.

ADHD education programs are recommended for both parents and children as part of the treatment process. Through these programs, goals will be established, progress will be evaluated and strategies outlined in order to help parents recognize and understand ADHD symptoms. These programs also help children with ADHD build self-esteem and develop effective coping mechanisms.

Multimodal treatment plans have a proven track record. This method attacks ADHD from all angles and often helps clear the path for a child to one day live a successful and fulfilling life.



This blog is written and published by Lindner Center of HOPE.

Millions of Americans suffer with mental illness. These come in various forms; from mood disorders and severe addictions to eating disorders. Unfortunately, there is no definitive cure or “silver bullet” for most of these illnesses. However, mental health professionals now have a better understanding than ever before regarding the treatment of mental disorders. As a result, increasingly effective methods of psychotherapy are continually being developed.

Case-by-Case Treatment Plans

When an individual reaches a point where they feel the need to seek help, the realization that there is a problem is a positive first step in the healing process. The next step is for that individual to be thoroughly evaluated and diagnosed by a therapist.

The circumstances surrounding an individual’s mental health issues are as diverse as fingerprints. Each patient is very different and influenced socially by distinct environments and effected biologically by genetic makeup.

Although many therapeutic techniques may fit into categories such as “talk” therapy, behavioral therapy and cognitive therapy, treatments for depression, bipolar disorder treatment, ADHD treatment and addiction treatment are all approached differently. Treatment plans for these and other conditions are constructed in a way that best suit a particular patient.

Unfortunately, many individuals who struggle with mental health problems never pursue treatment. Reasons for this often include a fear of being stigmatized or a lack of convenient access to care. But in this country, numerous mental health centers are located in close proximity to every major city. These facilities offer experienced mental health professionals to patients who require expert care in order to begin their journey toward productive and fulfilling lives.