Twenty Questions To Get You Started, Part 4

Am I Okay?
by Michael B First, M.D., Allen Frances, M.D.

(Page 4 of 4)

Question #16: Does your mind seem to be failing you?

This question addresses problems with a number of different mental functions. Do you have trouble with your memory — learning new things and recalling past events? Do you have times in which you lose touch with what's going on around you and have difficulty focusing your attention? Do you sometimes get disoriented — not knowing where you are, what day it is, and who are the people around you? Do you have trouble understanding others when they talk to you or in making sense when you speak? Do you have trouble carrying out the activities of everyday life — washing yourself, dressing, cooking, planning your day?

Most people are more or less dissatisfied with their mental functioning, especially as it begins to decline with age. The question here is whether you are having problems with your mental functioning that are severe enough to interfere with your work or day-to-day activities.

If the Answer to This Question Is Yes, Please Refer to Chapter 16.

The remaining four questions are for those disorders that always have their onset during childhood or adolescence. In some cases, the child will outgrow the problem or have successful treatment for it. In other cases the symptoms persist into adulthood. You may, therefore, be answering these questions either for yourself or for your child. You should be aware that children and adolescents can be afflicted with virtually any of the problems covered in this book.

If you are going through this chapter with your child's problems in mind, be sure to review the first sixteen questions in this chapter as well.

Question #17: Has your child had delays in development of intellectual, academic, motor, communication, or social skills?

Children vary tremendously in the rate at which they develop intellectual, motor, language, and social skills. This question refers to functioning that is significantly below what is normal for your child's age and which causes marked impairment in school or home. Has your child's IQ been measured to be below 70 and, if so, is he having trouble functioning as a result? Has your child been diagnosed with a specific learning disability in reading, writing, or mathematics? Does your child have a severe problem with coordination, speech, or language? Is your child strange in the way he relates to other people — showing no emotion, not maintaining eye contact, treating other people as if they are pieces of furniture? Is your child's behavior rigid, repetitive, or unusual and are his interests and activities quite restricted?

If the Answer to This Question Is Yes, Please Refer to Chapter 17.

Question #18: Has your child had behavior problems?

We cannot expect, and probably would not want, our children to always be perfect little angels. However, some children display patterns of bad conduct or disruptive behavior that are sufficiently severe and persistent to cause major problems for themselves and for the people around them. Is your child unusually aggressive? Does he destroy property? Does he steal things? Does he lie or consistently cut school, stay out overnight, or run away? Does your child have a pattern of hostile and defiant behavior that goes far beyond the usual and consistently causes problems for him?

If the Answer to This Question Is Yes, Please Refer to Chapter 18.

Question #19: Is your child (or were you) hyperactive or easily distracted?

Is your child so overactive and impulsive that he is hard to contain at school and at home? Is your child always on the go, talking incessantly, fidgeting, jumping out of his seat, interrupting others, and generally seeming to get into everything? Is your child so inattentive that he cannot do homework, play games with other children, organize tasks, follow through on instructions, and hold on to his possessions? Is he forgetful, distracted by unimportant stimuli, and reluctant to do things that require sustained attention?

To some degree, overactivity and distractibility define what it is to be a child. No one, and certainly no child, is perfectly calm or attentive all of the time and in all situations, especially if the task is routine or boring. There is also considerable controversy about a possible overdiagnosis of Attention-Deficit/Hyperactivity Disorder in the school system. You should answer "yes" to this question only if your child's hyperactivity and inattention are persistent, occur in many different situations, and lead to severe problems in school and other tasks.

Although hyperactivity and inattentiveness usually improve with maturation, a fair percentage of affected individuals continue to show some symptoms in adulthood. Most typically, the hyperactivity symptoms mellow out, leaving an inattentive adult who is easily distracted and unfocused.

If the Answer to This Question Is Yes, Please Refer to Chapter 19.

Question #20. Has your child had other problems — difficulty with toilet training, having a hard time separating from you, or having uncontrollable repetitive tic movements or sounds?

This is a miscellaneous question covering a number of unrelated problems that may be seen in children. Does your child continue to have repeated accidents well beyond the time when toilet training is usually completed? Does your child find it so difficult to be away from you that he refuses to go to school or play with other children? Does your child have tics (sudden, rapid, recurrent body movements or vocalizations that he cannot help doing)?

If the Answer to This Question Is Yes, Please Refer to Chapter 20.

Now you have a choice — either read the book straight through for a picture of the full variety of the human psyche — or just go to those sections that are most pertinent to you or your loved ones.

Copyright © 1998 by Allen Frances, M.D. and Michael B. First, M.D.

About the Author

Michael B. First, M.D., is Associate Professor of Clinical Psychiatry at Columbia University College of Physicians and Surgeons and is a research psychiatrist in the Biometrics Research Department at New York State Psychiatric Institute. He was the editor of the DSM-IV text and criteria, and now maintains a private practice in Manhattan.

Allen Frances, M.D., is Professor of Psychiatry and former chairman of the Department of Psychiatry and Behavioral Science at Duke University. Dr. Frances was chairman of the DSM-IV Task Force and is currently leading an effort to develop expert consensus practice guidelines for the different psychiatric disorders.