This type of depression can make you feel so tired that you don’t want to get out of bed.
About 50 years ago, psychiatrists in England described a group of depressed patients as “atypical.” Twenty-five years later, researchers at Columbia University in New York used the term “leaden paralysis” to describe patients who often told doctors that they felt like they had lead weights attached to their legs. Today, this type of depression is called atypical depression, or depression with atypical features.
Despite the word “atypical,” atypical depression is not unusual. In fact, atypical depression may be the most common type of depression seen in outpatients. Studies show that people with atypical depression lose more days from normal activities, have more disability, and use heath care services more than people with other types of depression. If you feel sleepy all the time, are putting on weight, and are overly sensitive to rejection, you could be suffering from atypical depression.
Atypical Depression: Symptoms That Lead to Diagnosis
Atypical depression has different symptoms and responds differently to treatment than other types of depression. Atypical depression can be overwhelming, both physically and mentally. Unlike other types of depression, people with atypical depression can be briefly cheered up by positive events, but they overreact to negative events. A severe depression can be triggered by any feeling of rejection from a friend, boss, or loved one. Symptoms of atypical depression include:
Increased appetite. Unlike other types of depression in which people may lose interest in food, if you have atypical depression you may have a craving for comfort foods. Weight gain is a common sign.
Increased sleep. Unlike other types of depression in which people have trouble getting enough sleep, people with atypical depression feel like sleeping all the time.
Leaden paralysis. This term refers to a sense of heaviness in the arms and legs that people with atypical depression experience. They may feel extremely tired, as though their physical movements have slowed down.
Overly sensitive. People with this type of depression tend to have a personality trait of increased sensitivity. They may expect that other people will not like them or not approve of their behavior.
The diagnosis of atypical depression is made when severe depression is seen along with any two of the above symptoms. However, a study published in the Archives of General Psychiatry that compared 304 patients with atypical depression with 836 patients with major depression found that oversleeping and overeating are the two most important symptoms for diagnosing atypical depression.
Atypical Depression: Treatment One of the earliest clues that atypical depression was a different type of depression was that patients responded better to a type of antidepressant medication called monoamine oxidase inhibitors. Today there are even more options for treating atypical depression:
Monoamine oxidase inhibitors (MAOIs). This older class of antidepressant drugs is still used for atypical depression. However, MAOIs can have dangerous side effects.
Selective serotonin reuptake inhibitors (SSRIs). These newer drugs have fewer side effects than MAOIs. They may be slightly less effective, but their safety makes them a useful drug for atypical depression.
Cognitive therapy. This is a type of talk therapy, or psychotherapy, used to treat many types of depression, including atypical depression. A study published in the Archives of Psychiatry compared cognitive therapy, an MAOI drug, and a placebo in patients with atypical depression. The study found that cognitive therapy was as effective as MAOI, and both were more effective than placebo in treating atypical depression.
Chromium. This is a mineral that plays an important role in blood sugar regulation and may also affect chemical messengers in the brain. A small study published in the Journal of Psychiatric Practice found that taking chromium supplements may relieve symptoms of atypical depression, including the craving for carbohydrates.
If you have any of the symptoms of atypical depression, and especially if you are depressed and find that you are sleeping or eating too much, you need to see your doctor. Atypical depression is a serious illness with higher risks for disability, drug abuse, and suicide than other types of depression. The good news is that atypical depression is also very treatable. With proper treatment, most people get better and can return to normal activities.
Autism can be difficult, but as a parent, there are some things you can do. Interventions are available that may make huge differences, and you won’t even have to pay an expert to do them. By the time you finish this article, you will have some tools to combat a squirrelly kid. (Many of these techniques will work for “normal” kids, too. Shh!)
1. weighted blankets. Weighted blankets cant be used for relaxing or quelling anxiety. Experts will recommend that you not use them for sleep, but monitoring the child and possibly removing the blanket after he is asleep can sidestep that concern. The idea of the weight is that the pressure on the proprioceptive system serves as a calming factor.
2. swinging. Another way of calming, this time with the vestibular system. Swinging helps to balance the system by regulating the inner ear. Any kind of swinging will do: porch swing, playground swing, even swinging around in your arms works, in a pinch.
3. lunges, wall shoves and wheelbarrow rides. Large motor work also helps to give calm the system by giving pressure input to the muscles, sending signals to the brain to calm down.
4. sensory diet: Items such as bean bags, bubbles, feathers, modeling clay, squeezy ball… all serve to help regulate the system and keep balance. Also, gum can help a child concentrate and attend to his homework.
5. Schedule. Many kids with autism need to know what is happening next. Keeping a schedule posted can go a long way towards alleviating anxiety.
6..The Amazing 5 pt scale. This book can be a great help to parents, and others who work with autistic kids. It can be used in many ways. We use it to teach my daughter voice modulation.
1 =silence 2-=whisper/library voice 3= conversational voice 4= playground/outside voice 5= the house is on fire voice
when she is too loud, I remind her what level her voice is at, and what voice works better. It helps.
For my son, it is used as a tool for anger management
1= pretty comfortable, body feeling good, no tension 2 =antsy, but more happy than not 3= tension starting, feeling stressed 4= starting to mouth off, feeling tense, jaw clenched, no violence 5= abusive names, possible hitting ..time for social separation!
Most of these techniques are easy to implement, but as with anything else, there is a bit of a learning curve. Go easy on yourself. Try reading some books, such as The Out of Sync Child, The Out of Sync Child Has Fun, just about any book on Asperger’s Syndrome.
Try googling for information on “sensory diet.” There is a lot of information out there, so don’t get overwhelmed.
Applying Structured Teaching Principles to Toilet Training
Many children with autism are difficult to toilet train. Parents and teachers have tried many approaches to teaching the children to use the toilet independently. Not all children respond to the same teaching techniques. A method that is helpful in one child’s situation may not be useful in another case. TEACCH consultants are often asked for suggestions for successful toilet training. This article is the compilation of several experienced teachers’ and consultants’ suggestions about this area of programming.
In thinking about setting up a program to help a child learn to toilet independently, the first TEACCH recommendation would be to try to look at the problem from the perspective of the student with autism. Another TEACCH recommendation would be to build in many elements of visual structure to help the child understand exactly what is expected. Look at each element of Structured Teaching to decide how visual supports can be added to build positive routines, clarify expectations, and reduce confrontational situations.
The child’s perspective
Even in typically-developing children, toilet training is often a difficult skill to master. While the child may have good awareness and control of his body, there are other factors… social factors… that determine how easily toileting skills are learned. Small children do not feel an intrinsic desire to become toilet trained. Rather, they acquire this skill in order to please their parents and to gain the social status of ” big boy” or “big girl”. This social motivation is a critical factor in determining “readiness” for toilet training.
How might the characteristics of autism contribute to a child’s difficulty in learning to independently use the toilet?
The child’s difficulty with understanding and enjoying reciprocal social relationships would certainly interfere with this process. While other 2- or 3-year-olds might be proud of their “big boy pants” and might be happy to please their parents, this type of motivation is rare in a child with autism.
Given the characteristic difficulties in understanding language or imitating models, a child with autism may not understand what is being expected of him in the toilet.
A child with autism typically has significant difficulty organizing and sequencing information and with attending to relevant information consistently. Therefore following all the steps required in toileting and staying focused on what the task is all about are big challenges.
Further, the child’s difficulty in accepting changes in his routines also makes toileting a difficult skill to master. From the child’s point of view, where is the pressing need to change the familiar routine of wearing and changing a diaper? After 3, or 4, or 6 years of going in the diaper, this routine is very strongly established.
A child with autism may also have difficulty integrating sensory information and establishing the relationship between body sensations and everyday functional activities. Therefore he may not know how to “read” the body cues that tell him he needs to use the toilet. He may also be overly involved in the sensory stimulation of the “product”— smearing feces is not uncommon in young children with autism. The child may also be overwhelmed by the sensory environment of the toilet, with loud flushing noises, echoes, rushing water, and a chair with a big hole in it right over this water! A further consideration is that the removal of clothing for toileting may trigger exaggerated responses to the change in temperature and the tactile feeling of clothes on versus clothes off.
Elements of structured teaching
Structured Teaching is the term given to a set of teaching/support tools designed by TEACCH for people with autism. These tools are responsive to the characteristics of autism using their strong learning modalities (visual and motor skills and enjoyment of routine) to build bridges over some of the gaps in learning caused by their characteristic deficits. Structured Teaching not only increases the learning of new skills but also serves to increase independence and self-esteem, reducing behavior problems that result from confusion, anxiety, and over-stimulation. Structured Teaching combines the use of individualized assessment, establishment of proactive and adaptive routines, and the systematic use of visual supports to support learning.
I. Beginning step: Assessment
When hoping to toilet train a child with autism, one of the first things we must do is define a realistic goal, realizing that independent toileting may be many, many steps down the road. Each of the steps toward independent toileting is a goal itself. It is necessary to observe and assess the child’s understanding of the toileting process in order to choose the correct starting point.
We should begin with establishing a positive and meaningful routine around toileting and collecting data about the child’s readiness for schedule training or for independent toileting.
A simple chart can be used to collect the data needed about the child’s readiness. On a routine basis, the child is taken to the bathroom for a “quick check” every 30 minutes and data is recorded on each occasion. A sample of one format for collecting this basic information is shown below.
Pants column – In the column marked PANTS you will record every hour either: D if he is dry, U if he has urinated in pants, BM if he had a bowel movement, U / BM if he had both
Of course, you don’t have to wait an entire hour. Anytime you think he is wet, check him, write in the time on the chart, and record the results.
Over a period of 1 or 2 weeks, patterns of data begin to emerge.
Is the child dry for significant periods of time?
Is there some regularity in his wetting/soiling?
Does he show any indication that he is aware of being wet or soiled?
Does he pause while wetting or soiling?
A child for whom the answers to all of these questions is “no” is probably not ready for a goal of independent toileting, although a goal of establishing a positive bathroom routine may still be very appropriate.
During the charting phase, we should also be assessing other aspects of the process of toilet training. As the data is being collected,
Is the child beginning to pick up on the routine involved?
How are the child’s dressing skills?
Does he show any particular fears or interests related to the bathroom (reaction to flushing, water, toilet paper roll, or other bathroom fixtures)?
What is his attention span?
At the end of this assessment period, we will have the data needed to establish an appropriate goal to be working toward.
A task analysis of the steps of toileting can give a picture of all the skills needed. Assessing the child’s current skills on each step of a task analysis will help us to choose a realistic goal and remind us not to try to work on several new skills at once. Task analyses can be global or very specific. Each step of a task analysis can be further detailed to determine teaching steps. Examples of a global task analysis and a more detailed analysis of one step are illustrated below.
Task Analysis Further Task Analysis
Enter the bathroom (Does not do fasteners)
Pull clothes down a. Allows Adult to pull b. Pull from calves c. Pull from knees d. Pull from thighs e. Pull from hips f. Pull from waist
Sit on toilet
Get toilet tissue
Wipe with tissue
Throw tissue in toilet
Pull clothes up
II. Physical Structure
One of the principles of Structured Teaching involves structuring the physical environment for success. Our goal is to create a meaningful context for an activity to take place. We accomplish this through the creation of clear boundaries and the reduction of distractions.
When beginning the toilet training of a child with autism, we want to help the child learn that this set of behaviors (elimination) is associated with a particular place (the toilet). Moving all diapering, cleaning, and toileting-related dressing to this setting helps the child realize the purpose of this room. Another way to say this is that we are trying to “isolate the concept” of where toileting-related behaviors take place. Some families assign a half-bath in their homes to toilet-training, since the full bathroom has many objects that are associated with other activities and may be very distracting or confusing (bathtubs and showers, bathing toys, toothbrushes, makeup, laundry hampers, scales, etc.)
A second goal for creating clear physical structure to assist in toilet training is to create an environment that is secure and not over-stimulating. The child will be calmer and more responsive with good physical support for his body. Think about adding foot support, side rails, opening reducers, or other physical supports. Think also about the plumbing noises and echoes of many bathrooms. Many children appreciate soft music playing or the addition of sound-absorbent materials.
III. Establish a Visually Supported Routine
After establishing an appropriate goal for the child, it is important that we teach using visual supports for each step toward this goal. We must create a visual system to let the child know the step or sequence of steps to completing the goal.
At the most basic level, a transition object may be used to let the child know that the toilet routine is beginning. An object that is associated with toileting may be given to the child to serve as the transition object that takes the child to the correct location. Or, this object may be placed in a zip-lock bag that is glued shut. Or, this object may be glued to a card. In any case, it serves to initiate the bathroom routine, helping the child know what is to occur and where. At a more abstract level, a photograph or drawing of the toilet or the printed word on a card may given to the child or placed on his schedule to accomplish this goal.
Once the transition to the toilet area has been made, it is important to continue to visually support each step of the toileting routine. We need to let the child know each step he is to accomplish, when the sequence will be finished, and what will happen when the sequence is finished. Again, using an object sequence, a picture sequence, or a written list are all ways to communicate this information to the child. It is important that the child sees the information, manipulates the system so that he recognizes it’s connection to his behavior, and has a clear way to recognize when each step – and the entire process – is finished.
The inclusion of a concrete, visual “what happens when I’m finished” piece of information is an important part of this system. For some children this may be looked at as a motivator or even a reward. For many children with autism, it is equally or more important as a clear indication of closure. Task completion is a powerful motivator for most people with autism.
IV. Trouble-shooting specific problems
Once a visually supported transition and sequencing system has been established, we continue to use a problem-solving approach to troubleshooting details. Whenever the child has a problem with any step of the process, we think about (1) what his perspective might be and (2) how we can simplify and/or clarify through visual structure. Examples follow:
Resists sitting on the toilet
allow to sit without removing clothes
allow to sit with toilet covered (cardboard under the seat, gradually cutting larger hole, or towel under the seat, gradually removed)
use potty seat on the floor rather than up high
if strategies are helpful for sitting in other places, use in this setting also (timers, screens, picture cues, etc.)
take turns sitting, or use doll for model
add physical support
help him understand how long to sit (sing potty song, length of 1 song on tape player, set timer 1 minute, etc.)
as he gradually begins to tolerate sitting, provide with entertainment
Afraid of flushing
don’t flush until there is something to flush
start flush with child away from toilet, perhaps standing at the door (might mark the spot with a carpetsquare and gradually get closer to the toilet)
give advance warning of flush, setting up flushing cue system, such as “ready, set, go”
allow him to flush
Overly interested in flushing
physically cover toilet handle to remove from sight
give something else to hold and manipulate
use visual sequence to show when to flush (after replacing clothing, for example)
when time to flush, give child a sticker that matches to a sticker on toilet handle
Playing in water
give him a toy with a water feature as distraction, such as a tornado tube, glitter tube, etc.
use a padded lap desk while seated
cover the seat until ready to use
put a visual cue of where to stand
Playing with toilet paper
remove it if a big problem, use Kleenex instead
roll out amount ahead of time
give visual cue for how much, such as putting a clothespin on where to tear, or making a tape line on the wall for where to stop
Resists being cleaned
try different materials (wet wipes, cloth, sponge)
consider temperature of above material
take turns with doll
supply a “target” in the water, such as a Cheerio
larger target as toilet insert (contact papered or laminated cardboard with target drawn on it), gradually moved down
add food coloring in the water to draw attention
Retaining when diaper is removed
cut out bottom of diapers gradually, while allowing child to wear altered diaper to sit on the toilet
use doll to provide visual model
increase fluids and fiber in diet
may need to enlist doctor if serious bowel withholding, may give stool softener
These ideas are not intended to be an inclusive list of steps to take to teach a child to use the toilet. They are, however, illustrative of the problem-solving approach needed and the effort to provide visual cues to increase understanding, cooperation, and motivation.
V. Communication System
Another important step in teaching independent toileting is to plan for a way for the child to initiate the toilet sequence. At first trips to the bathroom may be initiated by an adult directing the child to a transition object or schedule. However, eventually the child will need a way to independently communicate his need to go. Even though he may begin to spontaneously go into a familiar and available bathroom, he needs to learn a concrete way to communicate this need so that he will be able to request when a toilet is not immediately available.
As always, the first step in designing a goal is assessment. Is the child currently signaling in any way that he needs to go to the bathroom, or is he totally reliant on an adult initiating the sequence? If there are behavioral signals that you as an adult observer can “read”, these signals can show you the “teachable moments” when you can help the child learn to use a systematic communication tool. Is he able to use objects, pictures, or words to communicate in other settings?
Many children first learn to use expressively the same tool that the adult has used to teach him about going to the toilet. For example, if Mom has been giving him an empty “baby-wipe” box to mean it is time to transition into the bathroom to be changed, the child might begin to use this same box to let Mom know he needs to be changed. Or, if a photograph of the toilet has been used on the child’s schedule to tell him when it is time to sit on the toilet, the same photograph will make a meaningful expressive communication tool.
A child who is sometimes able to verbally say “bathroom” may not always able to pull this word up at the appropriate time. When he is tired, in a new place, with a new person, with too many people, catching a cold, upset for any reason — his higher-level verbal skills may fail him. A child who shows this inconsistency will also be helped by a visual support that (1) helps cue the word he is looking for and (2) serves as a back-up system when he cannot use verbal language.
Situational depression can be caused by stress or a loss in your life.
Life is full of events that can cause stress. When a source of stress in your life is particularly hard to cope with, you may react with symptoms of sadness, fear, or even hopelessness. This type of reaction is often referred to as situational depression. Unlike major depression, where you are overwhelmed by symptoms of depression for a long time, situational depression usually goes away once you have adapted to your new situation.
Understanding Situational Depression
Situational depression is usually considered an adjustment disorder — because the person affected is having problems adjusting to a situation — rather than true depression. But if situational depression is left untreated, it could develop into a major depression.
“Situational depression means that the symptoms are set off by some set of circumstances or event. It could lead to major depression or simply be a period of grief,” explains Kathleen Franco, MD, professor of medicine and psychiatry at Cleveland Clinic Lerner College of Medicine in Ohio. However, she adds that situational depression may need treatment “if emotional and behavioral symptoms reduce normal functioning in social or occupational arenas.”
Who Gets Situational Depression and Why?
Situational depression is common and can happen to anyone — about 10 percent of adults and up to 30 percent of adolescents experience this condition at some point. Men and women are affected equally.
The most common cause of situational depression is stress. Some typical events that lead to it include:
Loss of a relationship
Loss of a job
Loss of a loved one
Experiencing a traumatic event such as a disaster, crime, or accident
What Are the Symptoms of Situational Depression?
The most common symptoms of situational depression are depressed mood, tearfulness, and feelings of hopelessness. Children or teenagers are more likely to show behavioral symptoms such as fighting or skipping school. Some other symptoms include:
Having body symptoms such as headache, stomachache, or heart palpitations
Missing work, school, or social activities
Changes in sleeping or eating habits
Abusing alcohol or drugs
How Is Situational Depression Diagnosed and Treated?
A diagnosis of situational depression, or adjustment disorder with depressed mood, is made when symptoms of depression occur within three months of a stress-causing event, are more severe than expected, or interfere with normal functioning. Your doctor may do tests to rule out other physical illnesses, and you may need a psychological evaluation to make sure you are not suffering from a more serious condition such as post-traumatic stress disorder or a more serious type of depression.
The best treatment for situational depression is counseling with a mental health professional. The goal of treatment is to help you cope with your stress and get back to normal. Support groups are often helpful. Family therapy may be especially important for children or teenagers. In some cases, you may need medication to help control anxiety or for trouble sleeping.
Situational depression and other types of depression are a common problem today, notes James C. Overholser, PhD, professor of psychology at Case Western Reserve University in Cleveland. “Many people are struggling with social isolation, financial limitations, or chronic health problems,” says Dr. Overholser. “A psychologist is much more likely to view depression as a reaction to negative life events. Many people can overcome their depression by making changes in their attitudes, their daily behaviors, and their interpersonal functioning.”
If you have situational depression, you should know that most people get completely better within about six months after the stressful event. However, it is important to get help, because situational depression can lead to a more severe type of depression or substance abuse if untreated. For many people with situational depression, the coping skills they learn in treatment can become valuable tools to help them face the future.
The link between diet and autism is well debated and The University of Reading leads the way in research. Alison Hepworth talks to Dr Anne McCartney of the food and nutritional sciences department
All around Reading, people have been depositing their poo in the hands of grateful scientists.
Not some kind of plumbing problem, rather, they are handing over their deposits to help studies which could contribute to the way doctors treat people who have autism in future.
The volunteers have been helping with the study that hopes to find a connection between diet and health in people with autism.
It is just one study by The University of Reading’s food and nutritional sciences department that’s often mentioned in the media for its scientific breakthroughs. The last independent assessment concluded 90 per cent of its research output is recognised internationally.
Dr Anne McCartney is the department’s senior research scientist in the microbial and health group and it’s her job to oversee research in graduates’ PhDs –and the logistics of collecting the droppings.
Dr Gillian McKeith-style (kind of, except Dr McCartney is likeable), she and the team study faecal matter in the lab to establish what bacteria is living in the gut.
So what’s the importance of a healthy gut? Well, we’ve all seen the advert for probiotic drinks. When they first emerged around 10 years ago, the ad showed a group of women who, after glugging one daily, seemingly “felt better”.
We were left in the dark as to how this happened – it was all a bit of a mystery. Then, as they rubbed their stomachs appreciatively, a voiceover told us something about probiotics.
The marketing got a bit clever over time and we were then presented with graphics showing good and bad bacteria sitting in our stomachs. Then, there were prebiotics in yoghurts. These clever products helped us keep a good balance and, if we believed the marketing, in turn made us leap around our homes with the kids and tell our friends how marvellous we felt. And for some people, that is the case.
The truth is a bit more complicated than that, says Dr McCartney. Everyone is made differently, so a good balance – which would hopefully lead to good all-round health – depends on your genes, what you were fed as a child, what you eat now and general lifestyle.
Probiotics and prebiotics are both good guys and important: the former are dietary supplements that enhance organisms in the gut; the latter are non-digestible that stimulate growth of bacteria.
“Good digestive health is good gut function which comes down to the whole package,” says Dr McCartney. “The microbiota you have depends on your genetics, childhood diet and lifestyle and it can affect your general health… cause irritable bowel syndrome or colitis.
“A simplistic way of putting it is we should aim for a maintenance of a normal balance [of gut flora]. Your diet can impact that.
“Certainly, types of foods can have an impact. If you eat some badly barbecued food that’s high in charcoal content – that might cause too much gas.
“But also, there are all sorts of bacteria in a gut. Most people walk around carrying clostridium difficile (C-diff) but there are no symptoms because they are neutralised by ‘good’ bacteria.
“But a poor immune system, say, can give them the opportunity to cause trouble. Maybe it’s down to stress, but something that causes a change in conditions can allow these bad bacteria to grow.”
The study of autistic youngsters was born from research that showed those with the condition often had irregular toilet habits. So was there a link between gut health and autism that could, perhaps, be treated with diet changes?
“The idea was that we could link that,” says Dr McCartney. “A lot of autistic children suffer from gut symptoms such as diarrhoea, bleeding. There’s some debate but they seem to have high levels of clostridia (C-diff).
“The impact of that is things are travelling through the gut at a faster rate.
“If I have a problem in that area it makes me bad-tempered and impatient. We are not saying we can cure autism but certainly we may improve quality of life and help them get through life with more ease.”
Studying human droppings in a lab is not exactly an everyday activity for most people, but the studies do require cooperation from volunteers.
Dr McCartney was heartened by the help from parents of autistic children who were very busy anyway. There were a few mishaps though. “We actually found that the parents of autistic children are quite often happy that people are trying to find out how we can maybe improve lives,” says Dr McCartney.
“We had a number of drop-outs though. A lot of autistic children – and children in general for that matter – have a tendency to play with their own faecal matter. One parent had managed to train them not to do it then all of a sudden mummy started collecting it.”
Another child objected to the vessel it was collected in and started holding in their number twos, sometimes not going for three days.
“Sometimes rational thought doesn’t come into these things.”
The research linking diet and autism is in its infancy – it really is an under-researched area. And there is a school of thought in the US that believes autism could be cured with diet.
Meanwhile, Dr McCartney and her students’ study has been passed to scientists at Imperial College London in the hope that it will become one of the milestones in proving a link between diet and improving the well-being of people who have autism.