And why it's now being diagnosed and treated in teenagers

Writer: Caroline Miller

Clinical Experts: Jill Emanuele, PhD , Blaise Aguirre, MD , Alec Miller, PsyD

What You'll Learn

- What is borderline personality disorder (BPD)?

- What are the signs of BPD?

- How is BPD treated?

- Quick Read

- Full Article

- What is BPD?

- Emotional dysregulation

- Self-destructive behavior

- Criteria for diagnosing BPD

- Diagnosing teenagers

- Why early diagnosis is crucial

- Treatment for BPD

People with borderline personality disorder (BPD) experience extreme emotions. Once a powerful emotion is triggered, it is very hard for them to calm down. Because of this, they often have unstable relationships. They also engage in self-destructive behavior, including suicide attempts.

In the past, traditional therapy hasn’t been very effective in helping people with BPD. But there is now new understanding of the disorder and more effective treatments available. With the right support. most people with BPD can learn to manage overwhelming emotions and improve their lives.

Another important change is that BPD is now diagnosed and treated in teenagers. When kids get the right treatment, sooner, they’ll do better in the future.

Some kids with BPD have a history of abuse or neglect. But the disorder can also occur in ordinary, loving families when parents ignore or minimize kids’ big emotional reactions. This might seem like a normal part of parenting, and in most cases, it is. But highly sensitive or emotional kids can end up feeling painfully alone. When these children’s big feelings are brushed off by adults, they often fail to learn the important skills they need to control their emotions.

People with BPD are often overwhelmed by anger and feelings of abandonment, shame and self-loathing. These feelings take a toll on relationships. Small problems easily become big blow-ups, causing fights with friends, parents and partners. Problems with friends or breakups with partners can trigger self-harm or suicide attempts. Other dangerous behaviors can include substance abuse, risky sex, and recklessness.

The gold-standard treatment for BPD is called dialectical behavioral therapy, or DBT. The treatment helps patients practice more effective ways to manage and respond to their feelings, and it is very successful in treating this disorder.

Borderline personality disorder (BPD) is a diagnosis that has historically been difficult to understand and even more difficult to treat successfully. The symptoms associated with it are a painful mix of emotional turmoil, unstable relationships, and self-destructive behavior, including suicide attempts.

But new insights into the disorder, leading to new, more effective treatments, have made the prognosis for someone with BPD much more promising. With the right support, most people with BPD can successfully learn to regulate their overwhelming emotions, stop self-destructive behavior, and improve their lives.

“It used to be that receiving a BPD diagnosis felt like a life sentence of misery,” says Alec Miller, PsyD, an expert in treating adolescents with BPD. “But research now shows that the chances of functioning better and even dropping the diagnostic label are very high.”

Another important change is that BPD is now diagnosed and treated in teenagers. Until recently mental health professionals were reluctant to give the diagnosis to anyone under 18, despite the fact that symptoms become prominent in adolescence or even earlier. Now experts stress that treating BPD as early as possible leads to better long-term outcomes as well as lowering the risk of dangerous or suicidal behavior.

What is BPD?

Experts call BPD a biosocial disorder, meaning that it starts with a biological (or temperamental) inclination that is exacerbated by the social environment. People who develop BPD are by temperament highly emotionally sensitive and reactive, feeling things more immediately and more intensely than most people. And once a powerful emotion is triggered, it takes them longer to return to their emotional baseline.

BPD develops when one of these emotionally vulnerable people is confronted with an environment that doesn’t validate their feelings — that is, acknowledge them, make them feel understood, and help them handle painful emotions. In many cases, kids who develop BPD have been abused or neglected. But the disorder can also come about in children whose loving, well-meaning parents minimize or discount their emotional reactions because they seem exaggerated or inappropriate.

Dismissing what seems like an overreaction is a fairly typical parental response. But for highly reactive kids, thechronic sense of not feeling understood or supported leads them to feel painfully alone and disconnected, explains Blaise Aguirre, MD. Dr. Aguirre is the founding medical director of 3East, a continuum of care using dialectical behavior therapy (DBT) to treat borderline personality disorder at Boston’s McLean Hospital. Friends and family members don’t understand why people with BPD have huge reactions to small things. For Dr. Aguirre, author of Borderline Personality Disorder in Adolescents, BPD is something like a peanut allergy; the reaction may not be typical of most people, but it’s no less real.

Emotional dysregulation

When a child’s powerful feelings aren’t validated by the adults in their life, it becomes difficult for them to learn to manage them in a healthy way. Adults help us name and identify what we’re feeling; by soothing us, they teach us how to soothe and calm ourselves down.

“Take a person with extremely strong, intense emotions who is constantly told that they’re overreacting, they shouldn’t feel the ways they feel,” explains Jill Emanuele, PhD, a clinical psychologist who specializes in mood disorders. “As a result, they don’t learn how to regulate and modulate their emotions. “

People with BPD are often overwhelmed by intense anger and feelings of abandonment, emptiness, shame, and self-loathing.

These feelings tend to destabilize relationships for people with BPD, who are hypersensitive to social cues from others, and more likely than others to interpret things negatively. Minor slights — or things misinterpreted as slights — are taken as evidence of abandonment, and the reaction can be swift and intense, causing rifts with friends, parents, and partners. They go from “I love you” to “I hate you” in a heartbeat, Dr. Aguirre explains. Or they become so frantic asking for reassurance that they are loved — incessant texting, calling, begging, clinging — that they drive partners away.

Rifts with friends or breakups with partners are often the trigger for self-harm or suicide attempts, he notes.

Self-destructive behavior

Why does BPD lead to self-destructive behavior?

Without the skills to manage painful feelings in a more effective way, people with BPD  often find unhealthy alternatives, including substance abuse, risky sex, and reckless thrill-seeking.

Self-injury is very often one of these behaviors: Teenagers use things like cutting, scratching and opening wounds to alleviate emotions they find intolerable. “In fact it can work as an emotional regulation strategy,” notes Dr. Miller, cofounder and clinical director of Cognitive and Behavioral Consultants in Westchester and New York City. “The problem is that if it works, they’re more likely to use it again to cope with negative emotions. To reduce self-harm we need to acknowledge what it’s doing for them, and try to give them some safer replacement strategies.”

One dangerous misunderstanding about BPD is that the emotional drama and the self-destructive behaviors, including suicide attempts, are manipulative pleas for attention.

“Historically, people with BPD have been viewed as purposely manipulative,” explains Dr. Emanuele, “using extreme measures to get things, gaming people around them. But that’s not it at all. These people are in intense pain, and feel they can’t get what they need.”

In fact, Dr. Aguirre notes, suicidal feelings are almost universal in people with BPD and reflect a desperate need to escape extreme emotional distress.

Criteria for diagnosing BPD

These are the criteria mental health professionals use to diagnose borderline personality disorder:

- Frantic efforts to avoid abandonment, real or imagined

- A pattern of unstable and intense relationships

- An unstable self-image or sense of self

- Dangerous impulsivity such as unsafe sexual encounters, substance abuse

- Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior.

- Emotional instability due to high reactivity

- Chronic feelings of emptiness

- Inappropriate, intense anger or difficulty controlling anger

- Transient, stress-relatedparanoia or severe dissociative symptoms

Diagnosing teenagers

In the past, mental health professionals were reluctant to diagnose anyone under 18 with BPD, even though symptoms usually develop during the teen years. That was, in part, because emotional intensity and impulsive risk-taking are to some extent characteristic of adolescence itself. Typical teenage behavior, it was thought, could be confused with BPD.

But even if the behavior looks similar, the reasons for it are different in typical adolescents and those with BPD, Dr. Aguirre notes. Typical teens experiment with alcohol and sex out of curiosity and impulsivity, while people with BPD use them to escape acutely painful feelings. They may seek out sexual encounters, for instance, because they feel abandoned, and crave closeness, rather than sex itself. They may take dangerous risks because “in that moment of desperation the need to change how they feel makes the behaviors feel like the right thing to do.”

Another reason for not diagnosing BPD in teens was to avoid labeling them with a severe illness that didn’t respond well to treatment. But as the treatment picture has changed, so has the aversion to diagnosis in adolescence. One large study called the McLean Study of Adult Development, which followed BPD patients for 12 years, found that 74 percent of participants had no active symptoms after 6 years, and only 6 percent relapsed in the following 6 years.

The lead author of the study, Mary Zanarini, began to call borderline personality disorder a “good-prognosis diagnosis,” and those who are treated while they’re still teenagers have even more optimistic outcomes.

Why early diagnosis is crucial

If BPD is understood as a lack of emotional regulation skills, it’s crucial to get someone who develops symptoms into treatment as soon as possible, Dr. Aguirre says, “before patterns of maladaptive behavior have set in.”

This is particularly important as young people are developing their identity and sense of self, which is difficult for young people with BPD symptoms. “When your environment doesn’t reflect back what your experience is,” Dr. Aguirre says, “it’s hard to know who you are, what your values are.”

Another reason experts urge earlier diagnosis of BPD is to lessen inaccurate diagnosis of more common disorders like ADHD, depression, and bipolar disorder. Sometimes these are co-occurring disorders, but often they are misdiagnoses. As a result, these teenagers are given medications that aren’t effective, including mood stabilizers and antipsychotics.

“I’ve seen kids with BPD who were on extensive drug cocktails because the clinicians didn’t know what was happening,” adds Dr. Emanuele. “They’re just going after the symptoms. And no medication is going to correct the invalidation that these people feel.”

BPD patients who are admitted to Dr. Aguirre’s unit often come in “zombie-like,” he reports, because they are on so many medications. When they are discharged, he says, half are on no meds at all.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Treatment for BPD

There are a number of specialized psychotherapies that have been developed to treat BPD, but the gold standard treatment — the one with the most evidence for its effectiveness — is called dialectical behavioral therapy, or DBT. The reason it’s called “dialectical” is that it involves two things that might seem to be in opposition but are both important: the need for acceptance and the need for change.

First, a patient’s feelings need to be validated, or accepted without judgment, in order for them to learn more effective ways to manage and respond to them.

“It’s basically ‘I’m doing the best I can’ on the one hand,” explains Dr. Miller, “and at the same time ‘I need to do better’ on the other.”

Validation, which is the first step in DBT, means recognition and acceptance of another person’s feelings as being real.  It doesn’t mean agreeing with the thoughts or feelings. When people feel accepted and understood, it has a calming effect and allows them to learn skills to regulate emotions and develop safer, more effective alternatives to the self-destructive behaviors they have been using.

“It’s essentially a skills-based approach which says that if our patients could do better, they would, but they’re lacking skills,” explains Dr. Miller, who is the author of Dialectical Behavioral Therapy with Suicidal Adolescents. “It’s so easy for us to tell people to stop problematic behaviors but it’s better to teach them new skills.”

DBT skills are very effective for getting patients to stop self-injury and suicidality, Dr. Aguirre notes. It’s tougher to change the self-loathing and self-hatred that can become fused with a borderline person’s identity.

He also notes that availability of DBT and other treatment for BPD is limited, which means that a lot of teenagers who should get treatment aren’t getting it. “The number of people with emotion regulation problems is outstripping the number of DBT providers,” he says, “and we know that because suicide rates in adolescents continue to go through the roof.”

Dr. Miller stresses the urgency of getting teens with BPD into treatment: “If you throw yourself into treatment, you can be a very successful, highly functional adult.”

Dr. Emanuele adds that she’s seen many patients dramatically improve their lives. “Over the years, I have repeatedly seen DBT give participants the hope and reality of a ‘life worth living,’ ” adds Dr. Emanuele. “And that’s something they had not been able to imagine or experience before.”

Frequently Asked Questions

At what age does BPD develop?

Symptoms of BPD (borderline personality disorder) usually develop during the teenage years.

How old do you have to be to be diagnosed with BPD? https://standingabovethecrowd.com/?p=16055

James Donaldson on Mental Health - Why Many Autistic Girls Are Overlooked

They often go undiagnosed because they don’t fit autism stereotypes and they mask symptoms better than boys do

Writer: Beth Arky

Clinical Experts: Wendy Nash, MD , Susan F. Epstein, PhD

https://www.youtube.com/watch?v=bPOUMxBnwd8

What You'll Learn

- Why are so many more boys diagnosed with autism than girls?
- How can autism look different in girls?
- Why is it important for girls with autism to be diagnosed early?
- Quick Read
- Full Article
- Autistic girls don’t fit the “model”
- Another problem: misdiagnoses
- Autistic girls “pass”… at least for a while
- The cost of a missed diagnosis
- Safety risks for autistic girls 

Far more boys than girls are diagnosed with autism. But that might not be because more boys have autism. Often, autism in girls just looks different from the stereotype of autistic behavior, so some doctors might not diagnose it.

Repetitive behavior, like flapping their hands, is one sign of autism that most doctors recognize. But girls with autism might not have as many repetitive behaviors as boys, or they might be quieter about them. Having an intense interest in something specific is also common in people with autism. If that interest is something considered “girly,” like horses, a doctor might dismiss it as normal.

Autistic girls are sometimes better at controlling their behavior in public. They might have learned early on to smile or make eye contact. They might also be more interested in making friends than boys with autism are. All of this can make for a more subtle version of autism that a doctor might not recognize. Some girls with autism get diagnosed with ADHD instead, which can look similar on the surface.

When girls with autism don’t get diagnosed, they miss out on support that can help them understand their challenges, build skills and excel in school. They might get exhausted from trying so hard to fit in or be bullied because they miss social cues. That can lead to depression, anxiety, or low self-esteem. Therapists might not see that autism is the underlying cause. Getting diagnosed early on is important so girls can get the support they need as soon as possible.

Many more boys than girls are diagnosed on the autism spectrum: more than four boys for every autistic girl, according to the latest numbers from the Centers for Disease Control. Researchers point to genetic differences. But clinicians and researchers have also come to realize that many “higher functioning” autistic girls are simply missed. They’ve been termed the “lost girls” or “hiding in plain sight” because they’re overlooked or diagnosed late. They don’t fit the stereotypes or their symptoms are misinterpreted as something else. And they may be better at hiding the signs, at least when they’re young.

Even when girls’ presentation is clearer, they can be overlooked. Take Melissa’s two children. Both have an autism diagnosis. But while daughter Lisa’s symptoms were much more obvious than son Justin’s, the girl’s were waved off for three years by a variety of clinicians.

“On paper,” Melissa says, “she seemed to check all the boxes.” Lisa had a significant language delay — she didn’t speak in sentences until she was 4 — did no pretend play, and had several meltdowns each day. There were also other signs, like lining up her stuffed animals, spinning in circles, and constantly seeking sensory input. She was also unable to handle any change in routine.

Though Lisa’s challenges qualified her for Early Intervention at 18 months, it wasn’t until she was 6 that a developmental neurologist would diagnose her with autism.

Melissa’s son was also diagnosed at 6 — but by the first clinician who saw him,  despite the fact that his symptoms were far less obvious.

“The developmental pediatrician who saw Lisa didn’t believe autism was common in girls. He came up with excuses for her behavior and reasons why she couldn’t be on the spectrum,” Melissa says. “At one point, we were even told that my daughter just had low self-esteem and that’s why she didn’t speak. And, of course, that her issues were just a parenting problem. We were never told those things about our son.”

Autistic girls don’t fit the “model”

Autism is a developmental disorder that is marked by two unusual kinds of behaviors: deficits in communication and social skills, and restricted or repetitive behaviors. Children with autism also often have sensory processing issues. But here’s the hitch, according to Susan F. Epstein, PhD, a clinical neuropsychologist. “The model that we have for a classic autism diagnosis has really turned out to be a male model. That’s not to say that girls don’t ever fit it, but girls tend to have a quieter presentation, with not necessarily as much of the repetitive and restricted behavior, or it shows up in a different way.”

Stereo types may get in the way of recognition. “So where the boys are looking at train schedules, girls might have excessive interest in horses or unicorns, which is not unexpected for girls,” Dr. Epstein notes. “But the level of the interest might be missed and the level of oddity can be a little more damped down. It’s not quite as obvious to an untrained eye.” She adds that as the spectrum has grown, it’s gotten harder to diagnose less-affected boys as well.

In fact, according to a 2005 study at Stanford University, autistic girls exhibit less repetitive and restricted behavior than boys do. The study also found brain differences between autistic boys and girls help explain this discrepancy.

Wendy Nash, MD, a child and adolescent psychiatrist, adds that girls are more likely to control their behavior in public, so teachers don’t catch differences. “A lot of autistic girls get ruled out because they may share a smile or may have a bit better eye contact or they’re more socially motivated. It can be a more subtle presentation,” Dr. Nash explains. If girls are socially interested but odd, which is the case with the majority of these girls, she adds, “I think people give them a pass.”

Another problem: misdiagnoses

Dr. Epstein says there’s another reason autistic girls are misdiagnosed, or diagnosed later than boys. Girls struggling with undiagnosed autism often develop depression, anxiety or poor self-esteem, and clinicians may not “really dig underneath to see the social dysfunction” caused by autism.

Dr. Nash adds that these girls can also be misdiagnosed with ADHD. “I see a lot of girls who are diagnosed with ADHD when they’re young who actually meet the criteria for autism,” she says. “There’s hyperactivity without as much social impairment or a different kind of social impairment, so the autism is missed.”

Autistic girls “pass”… at least for a while

Another reason girls may not be diagnosed is because they’re able to “pass.”

“Girls tend to get by,” Dr. Epstein says. “They might not understand what’s going on but they’ll try to just go along and imitate what they see. And they may get away with it to third grade or fifth grade, but once they get to junior high and high school, it shows as a problem.”

This has been the case for Lisa, now 13. Melissa says of her daughter, “She is less mature than her typical peers, and girls are so intricate in how they behave socially. It’s very difficult for her to maintain friendships because of this and, let me tell you, 13-year-old girls are not very accepting of someone different.”

The cost of a missed diagnosis

Dr. Epstein says undiagnosed autistic girls end up wondering “what’s wrong” with them, which can lead to depression, anxiety and loss of self-esteem. They work so hard to fit in that it wears them out. “That’s the thing about imitating,” she says. “You don’t necessarily ‘get’ it so you’re just trying to do what people do. If you’re just trying to mimic and you don’t really understand, it makes it pretty rough.”

Dr. Nash says less severe autism in girls is often first flagged because of these social issues, or the depression they generate. “In people we call mildly autistic, there are adolescent social problems or they’re seeming hyperfocused on a topic and not participating in school to their potential or abilities,” she says. “Depression can be more common among high-functioning kids on the spectrum. So they’ll come in for something like depression or poor school performance. Then it becomes more clear to me that they have a restricted interest and social communication issues.”

Another cost of being overlooked is missing out on early support for skill-building. “We talk about early intervention,” Dr. Epstein says. “When the girls are identified late, they’ve missed out on a lot of social interventions that are much harder later. That’s the danger for anybody who gets a late diagnosis.”

Dr. Nash concurs, adding that they’ve missed opportunities to get the proper support in school as well as socially: “Academically, it’s harder for them to focus on topics that are not of interest. That’s true for people who have ADHD and even to a greater degree for kids who are on the autism spectrum.”

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Safety risks for autistic girls 

Autistic girls may be bullied simply because they’re “different.” Also, Dr. Epstein says, because these girls miss social cues and want to be liked, their autism can leave them more naïve. This makes them easy prey for someone trying to take advantage of them, be it a bully or a sexual predator. “The girls may be wanting the interaction but not understanding what it’s about, what the cues are,” Dr. Epstein says. “It can be very easy for them to follow their hormones without an understanding of what the dangers are. And sometimes even if they have been taught, they need ongoing support to be able to maintain safety.”

Melissa says this has been true with Lisa. “I’ve had to think about female issues at a much earlier age than I expected,” she says. “We’ve already had an incident of her being inappropriately touched by a boy, for whom the excuse was made that because he’s also disabled, he ‘didn’t understand what he was doing was wrong.’”

One of her daughter’s greatest strengths is how accepting she is of others, Melissa adds. “She always finds the good in people, even when they are mean to her,” she says. “But because she is so accepting and kind, others can easily take advantage of her, or bully her, and she won’t say anything.”

Dr. Nash notes that there’s an area of study that’s rethinking how to help girls on the spectrum: “There’s expanding research on how boys and girls present differently and how our treatments may need to be specified a bit more for a girl’s presentation vs. a boy’s presentation.”

But first the girls need to be identified — and accepted. This will require more awareness and sensitivity on the part of parents, teachers and clinicians.

Frequently Asked Questions

How does autism present in girls?

Autism in girls often presents as deficits in social skills and communication. Girls with autism may also have repetitive behaviors, but they tend to be better at boys than hiding them and fitting in with peers. Girls may be hyper-focused on a specific topic and not participate in school to their potential.

Why are so many more boys diagnosed with autism than girls?

https://standingabovethecrowd.com/james-donaldson-on-mental-health-why-many-autistic-girls-are-overlooked/

They often go undiagnosed because they don’t fit autism stereotypes and they mask symptoms better than boys do

Writer: Beth Arky

Clinical Experts: Wendy Nash, MD , Susan F. Epstein, PhD

https://www.youtube.com/watch?v=bPOUMxBnwd8

What You'll Learn

- Why are so many more boys diagnosed with autism than girls?

- How can autism look different in girls?

- Why is it important for girls with autism to be diagnosed early?

- Quick Read

- Full Article

- Autistic girls don’t fit the “model”

- Another problem: misdiagnoses

- Autistic girls “pass”… at least for a while

- The cost of a missed diagnosis

- Safety risks for autistic girls 

Far more boys than girls are diagnosed with autism. But that might not be because more boys have autism. Often, autism in girls just looks different from the stereotype of autistic behavior, so some doctors might not diagnose it.

Repetitive behavior, like flapping their hands, is one sign of autism that most doctors recognize. But girls with autism might not have as many repetitive behaviors as boys, or they might be quieter about them. Having an intense interest in something specific is also common in people with autism. If that interest is something considered “girly,” like horses, a doctor might dismiss it as normal.

Autistic girls are sometimes better at controlling their behavior in public. They might have learned early on to smile or make eye contact. They might also be more interested in making friends than boys with autism are. All of this can make for a more subtle version of autism that a doctor might not recognize. Some girls with autism get diagnosed with ADHD instead, which can look similar on the surface.

When girls with autism don’t get diagnosed, they miss out on support that can help them understand their challenges, build skills and excel in school. They might get exhausted from trying so hard to fit in or be bullied because they miss social cues. That can lead to depression, anxiety, or low self-esteem. Therapists might not see that autism is the underlying cause. Getting diagnosed early on is important so girls can get the support they need as soon as possible.

Many more boys than girls are diagnosed on the autism spectrum: more than four boys for every autistic girl, according to the latest numbers from the Centers for Disease Control. Researchers point to genetic differences. But clinicians and researchers have also come to realize that many “higher functioning” autistic girls are simply missed. They’ve been termed the “lost girls” or “hiding in plain sight” because they’re overlooked or diagnosed late. They don’t fit the stereotypes or their symptoms are misinterpreted as something else. And they may be better at hiding the signs, at least when they’re young.

Even when girls’ presentation is clearer, they can be overlooked. Take Melissa’s two children. Both have an autism diagnosis. But while daughter Lisa’s symptoms were much more obvious than son Justin’s, the girl’s were waved off for three years by a variety of clinicians.

“On paper,” Melissa says, “she seemed to check all the boxes.” Lisa had a significant language delay — she didn’t speak in sentences until she was 4 — did no pretend play, and had several meltdowns each day. There were also other signs, like lining up her stuffed animals, spinning in circles, and constantly seeking sensory input. She was also unable to handle any change in routine.

Though Lisa’s challenges qualified her for Early Intervention at 18 months, it wasn’t until she was 6 that a developmental neurologist would diagnose her with autism.

Melissa’s son was also diagnosed at 6 — but by the first clinician who saw him,  despite the fact that his symptoms were far less obvious.

“The developmental pediatrician who saw Lisa didn’t believe autism was common in girls. He came up with excuses for her behavior and reasons why she couldn’t be on the spectrum,” Melissa says. “At one point, we were even told that my daughter just had low self-esteem and that’s why she didn’t speak. And, of course, that her issues were just a parenting problem. We were never told those things about our son.”

Autistic girls don’t fit the “model”

Autism is a developmental disorder that is marked by two unusual kinds of behaviors: deficits in communication and social skills, and restricted or repetitive behaviors. Children with autism also often have sensory processing issues. But here’s the hitch, according to Susan F. Epstein, PhD, a clinical neuropsychologist. “The model that we have for a classic autism diagnosis has really turned out to be a male model. That’s not to say that girls don’t ever fit it, but girls tend to have a quieter presentation, with not necessarily as much of the repetitive and restricted behavior, or it shows up in a different way.”

Stereo types may get in the way of recognition. “So where the boys are looking at train schedules, girls might have excessive interest in horses or unicorns, which is not unexpected for girls,” Dr. Epstein notes. “But the level of the interest might be missed and the level of oddity can be a little more damped down. It’s not quite as obvious to an untrained eye.” She adds that as the spectrum has grown, it’s gotten harder to diagnose less-affected boys as well.

In fact, according to a 2005 study at Stanford University, autistic girls exhibit less repetitive and restricted behavior than boys do. The study also found brain differences between autistic boys and girls help explain this discrepancy.

Wendy Nash, MD, a child and adolescent psychiatrist, adds that girls are more likely to control their behavior in public, so teachers don’t catch differences. “A lot of autistic girls get ruled out because they may share a smile or may have a bit better eye contact or they’re more socially motivated. It can be a more subtle presentation,” Dr. Nash explains. If girls are socially interested but odd, which is the case with the majority of these girls, she adds, “I think people give them a pass.”

Another problem: misdiagnoses

Dr. Epstein says there’s another reason autistic girls are misdiagnosed, or diagnosed later than boys. Girls struggling with undiagnosed autism often develop depression, anxiety or poor self-esteem, and clinicians may not “really dig underneath to see the social dysfunction” caused by autism.

Dr. Nash adds that these girls can also be misdiagnosed with ADHD. “I see a lot of girls who are diagnosed with ADHD when they’re young who actually meet the criteria for autism,” she says. “There’s hyperactivity without as much social impairment or a different kind of social impairment, so the autism is missed.”

Autistic girls “pass”… at least for a while

Another reason girls may not be diagnosed is because they’re able to “pass.”

“Girls tend to get by,” Dr. Epstein says. “They might not understand what’s going on but they’ll try to just go along and imitate what they see. And they may get away with it to third grade or fifth grade, but once they get to junior high and high school, it shows as a problem.”

This has been the case for Lisa, now 13. Melissa says of her daughter, “She is less mature than her typical peers, and girls are so intricate in how they behave socially. It’s very difficult for her to maintain friendships because of this and, let me tell you, 13-year-old girls are not very accepting of someone different.”

The cost of a missed diagnosis

Dr. Epstein says undiagnosed autistic girls end up wondering “what’s wrong” with them, which can lead to depression, anxiety and loss of self-esteem. They work so hard to fit in that it wears them out. “That’s the thing about imitating,” she says. “You don’t necessarily ‘get’ it so you’re just trying to do what people do. If you’re just trying to mimic and you don’t really understand, it makes it pretty rough.”

Dr. Nash says less severe autism in girls is often first flagged because of these social issues, or the depression they generate. “In people we call mildly autistic, there are adolescent social problems or they’re seeming hyperfocused on a topic and not participating in school to their potential or abilities,” she says. “Depression can be more common among high-functioning kids on the spectrum. So they’ll come in for something like depression or poor school performance. Then it becomes more clear to me that they have a restricted interest and social communication issues.”

Another cost of being overlooked is missing out on early support for skill-building. “We talk about early intervention,” Dr. Epstein says. “When the girls are identified late, they’ve missed out on a lot of social interventions that are much harder later. That’s the danger for anybody who gets a late diagnosis.”

Dr. Nash concurs, adding that they’ve missed opportunities to get the proper support in school as well as socially: “Academically, it’s harder for them to focus on topics that are not of interest. That’s true for people who have ADHD and even to a greater degree for kids who are on the autism spectrum.”

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Safety risks for autistic girls 

Autistic girls may be bullied simply because they’re “different.” Also, Dr. Epstein says, because these girls miss social cues and want to be liked, their autism can leave them more naïve. This makes them easy prey for someone trying to take advantage of them, be it a bully or a sexual predator. “The girls may be wanting the interaction but not understanding what it’s about, what the cues are,” Dr. Epstein says. “It can be very easy for them to follow their hormones without an understanding of what the dangers are. And sometimes even if they have been taught, they need ongoing support to be able to maintain safety.”

Melissa says this has been true with Lisa. “I’ve had to think about female issues at a much earlier age than I expected,” she says. “We’ve already had an incident of her being inappropriately touched by a boy, for whom the excuse was made that because he’s also disabled, he ‘didn’t understand what he was doing was wrong.’”

One of her daughter’s greatest strengths is how accepting she is of others, Melissa adds. “She always finds the good in people, even when they are mean to her,” she says. “But because she is so accepting and kind, others can easily take advantage of her, or bully her, and she won’t say anything.”

Dr. Nash notes that there’s an area of study that’s rethinking how to help girls on the spectrum: “There’s expanding research on how boys and girls present differently and how our treatments may need to be specified a bit more for a girl’s presentation vs. a boy’s presentation.”

But first the girls need to be identified — and accepted. This will require more awareness and sensitivity on the part of parents, teachers and clinicians.

Frequently Asked Questions

How does autism present in girls?

Autism in girls often presents as deficits in social skills and communication. Girls with autism may also have repetitive behaviors, but they tend to be better at boys than hiding them and fitting in with peers. Girls may be hyper-focused on a specific topic and not participate in school to their potential.

Why are so many more boys diagnosed with autism than girls? https://standingabovethecrowd.com/?p=16047

James Donaldson on Mental Health - How Girls With ADHD Are Different

And the emotional costs of being overlooked

Writer: Rae Jacobson, MS

Clinical Experts: Stephen Hinshaw, PhD , Patricia Quinn, MD , Kathleen Nadeau, PhD

What You'll Learn

- How are girls with ADHD different from boys with the disorder?
- Why do girls tend to hide their symptoms and compensate for their weaknesses?
- Why is ADHD hard on girls' self-esteem?
- Hiding in plain sight
- On Wednesdays we wear pink 
- What’s in a name?

I’ve always been a space cadet. Prone to lateness and losing things, brought crashing back from daydreams by people clapping their hands in front of my face. “Earth to Rae,” they’d say, exasperated. As a kid I read for hours but the simplest homework assignments reduced me to a tearful mess.

“You can do this,” my bewildered parents insisted. “You know this stuff!”

“No, I can’t,” I’d bawl. “I’m not normal enough to be a normal person. Something is wrong with me.”

Years later, a few months after my 21st birthday, that “something wrong” finally got a name: attention-deficit hyperactivity disorder.

Why did it take so long?

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Hiding in plain sight

“We were initially taught that ADHD is boys’ phenomenon,” says Stephen Hinshaw, PhD, chair of the psychology department at UC Berkley. “Three decades later we know this is an equal opportunity condition.”

Equal opportunity, maybe, but equally recognized and treated it is not.

According to the CDC boys are far more likely to receive a diagnosis of ADHD — not necessarily because girls are less prone to the disorder but because in girls ADHD presents differently. The symptoms are often more subtle, and they don’t fit the stereotype.

“Girls are not as hyperactive,” says Patricia Quinn, MD, an expert on girls and women with ADHD who has written several books on the subject. “People imagine little boys bouncing off the walls and think: That’s what ADHD looks like and if this girl doesn’t look like that then she doesn’t have ADHD.”

Politely daydreaming underachievers just don’t attract attention the way hyperactive and impulsive boys do. Staring out the window is nothing when the kid next to you is dancing on the sill.

A late or missed diagnosis doesn’t just mean girls don’t get the academic services and accommodations that could help them succeed. Research indicates undiagnosed ADHD can jeopardize girls’ and young women’s self esteem and, in some cases, their mental health. Whereas boys with ADHD tend to externalize their frustration, blaming the “stupid test,” acting up and acting out, girls are more likely to blame themselves, turning their anger and pain inward. Girls with ADHD are significantly more likely to experience major depression, anxiety and eating disorders than girls without.

Dr. Hinshaw and his team published a study showing that girls with combined-type ADHD have significantly higher rates of attempted suicide and self harm, even though 40 percent of them have outgrown their hyperactive and impulsive symptoms inadolescence. “The lack of social and academic skills — the cumulative effect of what they missed when they were younger — take a toll,” says Dr. Hinshaw.

Without proper diagnosis and understanding, failures become evidence, confirmation of self-convicting charges: I’m not smart. I’m a failure. I don’t belong.

Quinn says she asks parents if at a young age their daughters have ever said “I’m stupid.”

“One hundred percent say yes,” she notes. “Even as a kid, as early as 8, you know you can’t do things that other people can do. And that takes a toll.”

A 12-year-old girl with ADHD I know put it best: “If everyone else can do these things and I can’t, it must be me.”

On Wednesdays we wear pink 

Today’s kids have more obligations and opportunities than ever before. The word “overscheduling” is on everyone’s lips and college admission hopes loom large. The pressure to multi-task and succeed has increased tenfold.

One of the consequences of this is that girls who were able to manage their ADHD symptoms before are no longer able to do so. A girl who was fine in grade school can suddenly find herself drowning in the academic, social, and extracurricular intricacies of middle school.

Kathleen Nadeau, director of the Chesapeake Center for ADHD, elaborates. Girls with ADHD often struggle to decode the myriad of social subtleties of girl-world: what to wear, what to say, how to talk, when to be comforting, when to be mean. “Girls are under a lot more pressure to be socially tuned in and self-controlled,” says Dr. Nadeau, who is a clinical psychologist. Being unable to fit in, or perform up to girl-code can make them a target for mean girls and leave them isolated and confused.

Dr. Hinshaw refers to these vice-like pressures as the “Triple Bind.” All girls, he says are subject to a trio of unreasonable expectations:

- Be good at “girl things,” be pretty, empathetic, demure and polite.
- Be good at “guy things,” be competitive, driven, funny and athletic.
- All this and more! Conform to these impossible standards, make it look effortless, and look hot while you’re doing it.

Overwhelming for anyone, says Dr. Hinshaw, but “for girls with ADHD, this is a quadruple bind.” There is no opt out.

And though some girls manage to stay afloat, success comes at a very high price. Sometimes we are our own worst enemies, dissembling and compensating, feverishly working on one thing while other equally, if not more important things languish.

“Girls with ADHD do a lot of hiding because they try very hard to put up this facade of competence,” says Dr. Nadeau. “But what’s behind that facade is ‘Yes, I got a good grade on this paper but I’ve been up for two days and I’m so stressed out I’m about to lose my mind.’ ”

What’s in a name?

The time between declaring my inability to be a normal person and getting diagnosed was turbulent and frustrating. Every failure chipped away at my self-esteem. I began to think of myself as broken, stupid, the one of these things that was not like the others.

But suddenly, as I recognized myself in the symptoms, the baffling discrepancy between what I should be able to do and what I actually seemed capable of was no longer an unseen, unnamed thing. It was something outside of myself, something I could understand, something I could plan for and manage.

“Some girls need glasses, some need ADHD treatment,” says Dr. Hinshaw. “It’s a vulnerability that needs addressing, it doesn’t define you.”

I know firsthand the benefits of having a diagnosis, and I’m hopeful that with advances in research and advocacy, the next generation won’t have to wait so long.

Frequently Asked Questions

Can girls have ADHD?

Yes, girls can have ADHD though boys are far more likely to receive a diagnosis. This is not necessarily because girls are less prone to the disorder but because ADHD presents differently in girls.

How is ADHD different in girls?

What happens when a girl with ADHD goes undiagnosed?

https://standingabovethecrowd.com/james-donaldson-on-mental-health-how-girls-with-adhd-are-different/

And the emotional costs of being overlooked

Writer: Rae Jacobson, MS

Clinical Experts: Stephen Hinshaw, PhD , Patricia Quinn, MD , Kathleen Nadeau, PhD

What You'll Learn

- How are girls with ADHD different from boys with the disorder?

- Why do girls tend to hide their symptoms and compensate for their weaknesses?

- Why is ADHD hard on girls' self-esteem?

- Hiding in plain sight

- On Wednesdays we wear pink 

- What’s in a name?

I’ve always been a space cadet. Prone to lateness and losing things, brought crashing back from daydreams by people clapping their hands in front of my face. “Earth to Rae,” they’d say, exasperated. As a kid I read for hours but the simplest homework assignments reduced me to a tearful mess.

“You can do this,” my bewildered parents insisted. “You know this stuff!”

“No, I can’t,” I’d bawl. “I’m not normal enough to be a normal person. Something is wrong with me.”

Years later, a few months after my 21st birthday, that “something wrong” finally got a name: attention-deficit hyperactivity disorder.

Why did it take so long?

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Hiding in plain sight

“We were initially taught that ADHD is boys’ phenomenon,” says Stephen Hinshaw, PhD, chair of the psychology department at UC Berkley. “Three decades later we know this is an equal opportunity condition.”

Equal opportunity, maybe, but equally recognized and treated it is not.

According to the CDC boys are far more likely to receive a diagnosis of ADHD — not necessarily because girls are less prone to the disorder but because in girls ADHD presents differently. The symptoms are often more subtle, and they don’t fit the stereotype.

“Girls are not as hyperactive,” says Patricia Quinn, MD, an expert on girls and women with ADHD who has written several books on the subject. “People imagine little boys bouncing off the walls and think: That’s what ADHD looks like and if this girl doesn’t look like that then she doesn’t have ADHD.”

Politely daydreaming underachievers just don’t attract attention the way hyperactive and impulsive boys do. Staring out the window is nothing when the kid next to you is dancing on the sill.

A late or missed diagnosis doesn’t just mean girls don’t get the academic services and accommodations that could help them succeed. Research indicates undiagnosed ADHD can jeopardize girls’ and young women’s self esteem and, in some cases, their mental health. Whereas boys with ADHD tend to externalize their frustration, blaming the “stupid test,” acting up and acting out, girls are more likely to blame themselves, turning their anger and pain inward. Girls with ADHD are significantly more likely to experience major depression, anxiety and eating disorders than girls without.

Dr. Hinshaw and his team published a study showing that girls with combined-type ADHD have significantly higher rates of attempted suicide and self harm, even though 40 percent of them have outgrown their hyperactive and impulsive symptoms inadolescence. “The lack of social and academic skills — the cumulative effect of what they missed when they were younger — take a toll,” says Dr. Hinshaw.

Without proper diagnosis and understanding, failures become evidence, confirmation of self-convicting charges: I’m not smart. I’m a failure. I don’t belong.

Quinn says she asks parents if at a young age their daughters have ever said “I’m stupid.”

“One hundred percent say yes,” she notes. “Even as a kid, as early as 8, you know you can’t do things that other people can do. And that takes a toll.”

A 12-year-old girl with ADHD I know put it best: “If everyone else can do these things and I can’t, it must be me.”

On Wednesdays we wear pink 

Today’s kids have more obligations and opportunities than ever before. The word “overscheduling” is on everyone’s lips and college admission hopes loom large. The pressure to multi-task and succeed has increased tenfold.

One of the consequences of this is that girls who were able to manage their ADHD symptoms before are no longer able to do so. A girl who was fine in grade school can suddenly find herself drowning in the academic, social, and extracurricular intricacies of middle school.

Kathleen Nadeau, director of the Chesapeake Center for ADHD, elaborates. Girls with ADHD often struggle to decode the myriad of social subtleties of girl-world: what to wear, what to say, how to talk, when to be comforting, when to be mean. “Girls are under a lot more pressure to be socially tuned in and self-controlled,” says Dr. Nadeau, who is a clinical psychologist. Being unable to fit in, or perform up to girl-code can make them a target for mean girls and leave them isolated and confused.

Dr. Hinshaw refers to these vice-like pressures as the “Triple Bind.” All girls, he says are subject to a trio of unreasonable expectations:

- Be good at “girl things,” be pretty, empathetic, demure and polite.

- Be good at “guy things,” be competitive, driven, funny and athletic.

- All this and more! Conform to these impossible standards, make it look effortless, and look hot while you’re doing it.

Overwhelming for anyone, says Dr. Hinshaw, but “for girls with ADHD, this is a quadruple bind.” There is no opt out.

And though some girls manage to stay afloat, success comes at a very high price. Sometimes we are our own worst enemies, dissembling and compensating, feverishly working on one thing while other equally, if not more important things languish.

“Girls with ADHD do a lot of hiding because they try very hard to put up this facade of competence,” says Dr. Nadeau. “But what’s behind that facade is ‘Yes, I got a good grade on this paper but I’ve been up for two days and I’m so stressed out I’m about to lose my mind.’ ”

What’s in a name?

The time between declaring my inability to be a normal person and getting diagnosed was turbulent and frustrating. Every failure chipped away at my self-esteem. I began to think of myself as broken, stupid, the one of these things that was not like the others.

But suddenly, as I recognized myself in the symptoms, the baffling discrepancy between what I should be able to do and what I actually seemed capable of was no longer an unseen, unnamed thing. It was something outside of myself, something I could understand, something I could plan for and manage.

“Some girls need glasses, some need ADHD treatment,” says Dr. Hinshaw. “It’s a vulnerability that needs addressing, it doesn’t define you.”

I know firsthand the benefits of having a diagnosis, and I’m hopeful that with advances in research and advocacy, the next generation won’t have to wait so long.

Frequently Asked Questions

Can girls have ADHD?

Yes, girls can have ADHD though boys are far more likely to receive a diagnosis. This is not necessarily because girls are less prone to the disorder but because ADHD presents differently in girls.

How is ADHD different in girls?

What happens when a girl with ADHD goes undiagnosed? https://standingabovethecrowd.com/?p=16043

James Donaldson on Mental Health - Disrupted sleep in teens identified as suicide risk factor

Photo by cottonbro studio on Pexels.com

Teenagers who don’t get enough sleep on school nights or have interrupted sleep are at greater risk of suicide, new research from the University of Warwick has found.

Suicide is the one of the leading causes of death among adolescents in the UK. Despite teenagers’ well-known tendency to miss out on sleep—due to both biological and social factors—the long-term impact of this sleep loss on suicide risk has remained unclear.

Now, researchers at the University of Warwick have demonstrated a longitudinal link between disrupted sleep in early adolescence and later suicide attempts, for the first time in the context of risk-taking and decision making.

The new study, published in Sleep Advances, analysed data from more than 8,500 young people in the Millennium Cohort Study. It was found that adolescents who reported a suicide attempt at age 17 were more likely to have had shorter time in bed on school days and disrupted sleep at age 14.

Michaela Pawley, PhD Candidate in the Department of Psychology at University of Warwick said: “Adolescence is a crucial developmental period where both sleep problems and suicide risk tend to emerge. Our findings show that adolescents who experience difficulties maintaining and obtaining sufficient sleep are more likely to report a suicide attempt several years later. Poor sleep is not just a symptom of wider difficulties, but a significant risk factor in its own right. Addressing sleep problems could form a vital part of suicide prevention strategies.”

The key findings from the team at Warwick include:

- Shorter total time in bed on school days and more frequent night awakenings at 14 years of age were associated with an increased likelihood of reporting attempted suicide at 17 years.
- These associations held even after accounting for established suicide risk factors such as socioeconomic status, self-harm history, and mental health difficulties.
- Shorter total time in bed on school days and more frequent night awakenings were stronger risk factors compared to depressive symptoms and other established psychosocial risk factors.

The researchers were the first to explore how cognitive factors may influence the relationship. They found that teenagers with stronger rational decision-making skills appeared protected against the impact of night awakenings on suicide risk —although this protective effect diminished with frequent sleep disruption. This opens the question of what other factors may interplay with sleep to confer adolescent suicide risk.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Senior author Professor Nicole Tang, Director of Warwick Sleep and Pain Lab at the University of Warwick added: “We need to recognise that sleep deprivation and fragmentation are not trivial complaints – they can wear your defences down and drive actions or behaviours that have life-or-death consequences. If we can better identify and support teenagers struggling with sleep, we may be able to reduce suicide attempts.”

The researchers note that while insufficient sleep likely contributes to difficulties in cognitive functioning like decision-making, further studies are needed to fully understand these pathways. Nonetheless, the findings provide a basis for identifying teens most at risk of the poorest outcomes and highlight the potential of increasing sleep time on school nights as a practical target for suicide prevention in young people.

Photo by cottonbro studio on Pexels.com https://standingabovethecrowd.com/james-donaldson-on-mental-health-disrupted-sleep-in-teens-identified-as-suicide-risk-factor/

Photo by cottonbro studio on Pexels.com

Teenagers who don’t get enough sleep on school nights or have interrupted sleep are at greater risk of suicide, new research from the University of Warwick has found.

Suicide is the one of the leading causes of death among adolescents in the UK. Despite teenagers’ well-known tendency to miss out on sleep—due to both biological and social factors—the long-term impact of this sleep loss on suicide risk has remained unclear.

Now, researchers at the University of Warwick have demonstrated a longitudinal link between disrupted sleep in early adolescence and later suicide attempts, for the first time in the context of risk-taking and decision making.

The new study, published in Sleep Advances, analysed data from more than 8,500 young people in the Millennium Cohort Study. It was found that adolescents who reported a suicide attempt at age 17 were more likely to have had shorter time in bed on school days and disrupted sleep at age 14.

Michaela Pawley, PhD Candidate in the Department of Psychology at University of Warwick said: “Adolescence is a crucial developmental period where both sleep problems and suicide risk tend to emerge. Our findings show that adolescents who experience difficulties maintaining and obtaining sufficient sleep are more likely to report a suicide attempt several years later. Poor sleep is not just a symptom of wider difficulties, but a significant risk factor in its own right. Addressing sleep problems could form a vital part of suicide prevention strategies.”

The key findings from the team at Warwick include:

- Shorter total time in bed on school days and more frequent night awakenings at 14 years of age were associated with an increased likelihood of reporting attempted suicide at 17 years.

- These associations held even after accounting for established suicide risk factors such as socioeconomic status, self-harm history, and mental health difficulties.

- Shorter total time in bed on school days and more frequent night awakenings were stronger risk factors compared to depressive symptoms and other established psychosocial risk factors.

The researchers were the first to explore how cognitive factors may influence the relationship. They found that teenagers with stronger rational decision-making skills appeared protected against the impact of night awakenings on suicide risk —although this protective effect diminished with frequent sleep disruption. This opens the question of what other factors may interplay with sleep to confer adolescent suicide risk.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Senior author Professor Nicole Tang, Director of Warwick Sleep and Pain Lab at the University of Warwick added: “We need to recognise that sleep deprivation and fragmentation are not trivial complaints – they can wear your defences down and drive actions or behaviours that have life-or-death consequences. If we can better identify and support teenagers struggling with sleep, we may be able to reduce suicide attempts.”

The researchers note that while insufficient sleep likely contributes to difficulties in cognitive functioning like decision-making, further studies are needed to fully understand these pathways. Nonetheless, the findings provide a basis for identifying teens most at risk of the poorest outcomes and highlight the potential of increasing sleep time on school nights as a practical target for suicide prevention in young people.

Photo by cottonbro studio on Pexels.com https://standingabovethecrowd.com/?p=16039