What is Addiction?

Addiction is a disorder characterized by the uncontrollable edge to continuously use a rewarding substance or to engage in a rewarding activity even when you know and experience adverse effects from your actions.

The brain has a reward mechanism in place to motivate us to do things that ensure and enhance our survival and to help us achieve our goals and live a fulfilling life.  This can be from the smallest things like your decision to eat breakfast to as big a decision as bonding romantically with your lover, having good sex, and or having and caring for your children. For every positive action, the brain transmits something the professionals call dopamine, which gives us a boost, a feel-good factor as reward for the action.

The power of an addiction lies in its ability to “hijack” the reward mechanism. It does this by switching on the brain circuits that make you feel good; prompting you to repeat these behaviours, and hook you into needing more and more of that substance or behaviour to feel good. This creates what is called a tolerance and eventually, the normal hardwiring of the brain begins to work against you. 

Addiction was previously thought to only occur in substance abuse, but it has been proven now, to occur in a variety of activities like gambling; gaming; shopping; internet and social media use; sex; pornography; work; and many other aspects of everyday human activity and the effect, whether to substance abuse or these everyday activities, are similar, and their treatments, same.

Addiction starts with experimental or recreational use, and in social situations. For instance, and an occasional drink out with work colleagues on a Friday night but for some, this becomes more frequent, and soon, an addiction. What the addiction is, and how fast you become addicted, varies with the drug, and behaviour. Some drugs have a higher risk and cause addiction more quickly than others, and soon, you may need larger doses of the habit, to feel good or even find that it's increasingly difficult for you to go without the habit. You may also experience intense cravings, that may make you feel physically ill when you attempt to stop using the drug. This is what the professionals call withdrawal symptoms, and these may increase the chances of you relapsing into the habit. This makes it common for people struggling with addictions to harbour feelings of failure, shame, guilt and a sense of hopelessness, which in turn increases the risk of the onset of other mental health conditions such as depression and anxiety, or worsening already existing mental and physical health problems.

Understanding the Neurobiology of Addiction

The main neurotransmitter responsible in this brain’s reward pathway is called dopamine and the area of the brain responsible is mainly the nucleus accumbens. Addictive substances and behaviours interfere with the normal biology of the brain causing profound changes that affect your ability to derive pleasure from other things apart from the addictive substance/ behaviour. Repeated use of addictive substances can damage the decision-making centre of the brain called the prefrontal cortex, which is responsible for both decision making and helping you recognize the harm the addiction is causing to you, your career and your relationships.

Addiction is complex, chronic mental illness and it is best to speak to one of our qualified health professional to fully understand the significant changes the brain undergoes in addiction and how to work to get it back to its normal state if you or anyone you know is suffering from addiction.

Signs and Symptoms of Addiction

These symptoms may indicate you are experiencing an addiction to a drug or behaviour.

• Feeling that you have to go to a habit regularly, daily or even several times a day- e.g. leaving your office to smoke cigarettes several times a day.
• Having intense urges for the behaviour that block out all other thoughts.
• Needing more of the behaviour to get the same effect e.g. drinking a bottle of wine at dinner when you previously took only one glass a day.
• Indulging in larger amounts of the behaviour over longer periods of time than you intended - e.g. spending all night at the bar drinking when you previously would only spend 2hrs on a Friday night.
• Spending money on the habit even though you can't afford it; and or doing things you normally wouldn't do, to get the drug such as lie, beg, steal or borrow money.
• Not meeting obligations and responsibilities, or cutting back on social or recreational activities because of the habit. e.g. staying home to spend all day and night gaming rather than going to a close friend’s wedding.
• Continuing the habit even though you know it is causing problems in your life, work and relationships. e.g. continuing to drink alcohol heavily despite being diagnosed of liver disease.
• Running risky activities when you're under the influence- e.g. driving or watching pornography at work despite company policy.
• Spending a great deal of time getting the fix, using the drug or recovering from the effects of the drug.
• Failing in your attempts to stop the habit.
• Experiencing withdrawal symptoms when you attempt to stop taking the drug.

How do you recognize unhealthy habits (drug use) in family members?

Possible signs include:

• Frequently missing school or work; a sudden disinterest in school activities or work; or a drop in grades or work performance.
• Lack of energy and motivation; weight loss or gain; red eyes. 
• Neglected appearance; lack of interest in clothing, grooming or looks.
• Major effort to bar family members from entering the (teenager's) room; being secretive about going out with friends; drastic changes in behaviour and in relationships with family and friends; new set of questionable friends and relationships.
• Sudden requests for money without a reasonable explanation; money or valuable items disappearing from your home could indicate they are being used to support a habit.

Who is at risk of Addiction?

• Having a strong family history of substance use creates a link to genetics and the hormones produced by the body in response to stress.
• Previous history of trauma and abuse (especially in childhood), as well growing up with a parent or sibling with substance use also increases the risk of addiction.
• Personality traits especially of impulsivity and sensation seeking have been linked to substance use and gambling.
• Lack of parental supervision and support. Poor parent-child relations and family disruptions such as divorce also add to one's risk, as well as domestic violence, sexual, or emotional abuse.
• Studies show males are more likely to develop substance use disorder than females, however the gender gap may be narrowing for alcohol use disorder.
• Living in an area where there is easy availability of alcohol or other substances in one’s home, at school, work, or in the community increases the risk of repeated use.
• Negative peer group influence, particularly during adolescence may increase risk of substance use and addiction. Positive social relationships, on the other hand, are known to strongly protect against substance use.
• Unemployment. Having a job, and developing the skills for employment, leads to stability and provides financial and psychological rewards that reduce addiction risk.
• Mental health disorders such as depression, anxiety, schizophrenia, attention deficit disorder, and post-traumatic stress disorder (PTSD) increase the risk of drug use and addiction.

What do you do if you or someone close to you has an Addiction?

People struggling with addiction often deny they have a problem and hesitate to seek treatment but addiction is a treatable condition and complete remission is possible.

Addiction recovery is an individualized process that requires lifestyle changes, psychotherapy, sometimes medications and support group meetings.

Recovery is often a long-term process, and may involve multiple attempts which is why relapse is now regarded as part of the process and occurs in 40-60% of people.

Although studies are unclear about its efficacy, an intervention may present a loved one with an opportunity to make changes before an addiction gets worse and may motivate them to seek or accept help.

Family and friends and sometimes co-workers, clergy or others who care about the person gather together to have a direct, heart-to-heart conversation with the person about the consequences of addiction and then ask the person to accept treatment.

Recovery is an individualised process and the first step to overcoming addiction, is for the individual to desire change.

• Set a clear goal on what recovery would look like for you. Once you are clear on your goal, you will need to prepare to change.

• Remove addictive substances from your home and eliminate triggers in your life that may make you more likely to use again.
• You may also find it necessary to change your routine and to avoid the people, places and things which promote the addiction, e.g. changing your route to work to avoid passing your favourite bar or blocking gaming websites on your phone or computer.
• Decide what approach you plan to use to overcome your addiction and get the resources you need to be successful.
• Support groups provide help, while psychologists, psychiatrists and recovery centres provide expertise and medication to treat cravings and the effects of withdrawal.
• Eating healthy and getting exercises play an important role in recovery.
• Recovery is an ongoing process of learning to cope with life without relapse. It requires a constant commitment, which is often difficult to stick to in periods of stress. It is important to seek support when you need it, from family, friends and others in recovery or professionals who understand you and are there to help you.

Talk to any of our therapists, for further information and resources.

Attention Deficit / Hyperactivity Disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral condition first noticed in childhood that is characterized by three core symptoms of inattention, hyperactivity, and impulsivity. Children and adults with this disorder have difficulty paying attention and controlling their behavior.

According to the WHO, 5-8% of all children are estimated to have ADHD and is more common in boys. Studies conducted in Ghana estimate a prevalence of 3-12%, with boys being the most affected. Girls are also affected but they often go undiagnosed and that may account for the perceived low prevalence among girls.

ADHD is a lifelong condition, and although the symptoms evolve overtime, they can still interfere with functioning in adult life and it may affect their work, health, finances and relationships. However, the good news is that, there are treatment options, including medications and therapies, as well as coping strategies that can help people living with ADHD have a productive life.

What causes ADHD?

Although, there is no exact cause known, it has a strong genetic component. 80% of cases are genetically inherited and risk of ADHD among siblings is 2–3 times increased and several genes are involved in the inheritance. Other risk factors include:

• Having a family member with ADHD
• Having a birthing parent of advanced age
• Low birth-weight/ premature birth
• Babies born to mothers who used drugs, alcohol, or tobacco during pregnancy
• Language and motor delays between 3 months and 18 months of age
• Exposure to environmental toxins, such as high levels of lead, at a young age
• Following brain injury from head trauma or infection e.g. meningitis, HIV.
• Experiencing a severe traumatic event in early childhood
• Having other genetic disorders and metabolic disorders.

Clinical Features of ADHD and Symptoms/Signs

There are 3 main clinical features of ADHD, these are:

1. Inattention – not being able to stay focused. They are careless with detail, they fail to sustain attention, appear not to listen, fail to finish tasks, poor self-organization, loses things often, forgetful, easily distracted, and avoids tasks requiring sustained attention.
2. Hyperactivity – excess movement that is not appropriate to the setting or excessive fidgeting, tapping, leaves seat in class, runs/climbs about, cannot play quietly, ‘always on the go’. This is most evident in structured situations like the classroom.
3. Impulsivity – acting hastily without thinking, and in a way that may have high potential for harm. Talks excessively, blurts out answers, cannot wait their turn, interrupts others and intrudes on others.

The symptoms of ADHD in toddlers are similar to behaviors that are normal for active curious toddlers but in toddlers with ADHD, these behaviors are noticeably more intense and disruptive affecting their ability to and focus learn. Many parents of toddlers with ADHD would notice that their child seems less attentive, more impulsive, and more hyperactive than other children their age and this becomes obvious when they are playing with other children in school.

Signs and symptoms differ for boys and girls. Boys may be more disruptive, impulsive and hyperactive while most girls with ADHD tend to struggle with inattention. They may try to mask their symptoms with a coping mechanism called hyper focusing. Because girls often go undiagnosed and untreated it often leads to low self-esteem, guilt, shame and being wrongly labelled as being, “unmotivated,” “stupid,” or “lazy.”

Problems in ADHD

Short term

• Sleep problems
• Low self-esteem
• Problems with family and peer relationship - mislabeled as naughty and receive less care and support from parents, teachers and may be isolated by their peers
• Reduced academic achievement
• Increased risk of accidents especially domestic accidents

Long term

• Development of comorbid problems (specific learning disorders, motor coordination problems, autism spectrum disorder, tic disorders, conduct disorder, oppositional defiant disorder, substance abuse, anxiety, depression, bipolar disorder). These worsen the disorder and make it more difficult to treat.
• Reduced employment success
• Increased rate of engagement in criminal activity
• Antisocial personality disorder

Managing ADHD

Initial assessment is done by a specialist mental health professional. This assessment involves a through history or interview of the parents with collateral history from the school, teachers or any other close person. He would also perform a full physical examination. Its standard practice to observe the child in at least 2 unrelated settings e.g. in the clinic and in school or at home. The doctor may then administer some diagnostic tool/ tests to determine the type and severity and screen for other comorbid problems.

ADHD is managed with medication and behavioral therapy. Medication reduces the severity of the symptoms especially the hyperactivity and inattention. They improve the child’s ability to focus, work and learn and improve their physical coordination. These medications are prescribed ONLY BY A SPECIALIST; AND CAN ONLY BE BOUGHT WITH A PRESCRIPTION.

Behaviour therapy help the child to gain control over their behaviour by establishing clear rules, lists of chores and other structured routines. They also help the child learn social skills, like how to wait their turn, share toys, ask for help, or respond to teasing. Additional therapy like parental training helps parents learn about ADHD, how it affects their family and how to deal effectively with negative feelings that may develop within their home because of their child’s disruptive behaviour. Ensuring that the child gets adequate sleep and physical activity and has a healthy diet and monitoring the child’s symptoms, following up with a physician and teachers will also help identify areas that need attention in managing the child’s diagnosis.

How can parents help children with ADHD?

• Make a schedule for all activities, from wakeup time to bedtime, and try to follow the same routine every day.
• Organize your home so that everything (clothes, toys, school items) has its place, and keep each thing in the right place and encourage your child to follow that pattern.
• Create a structured environment with designated spaces for homework and play can help children with ADHD stay organized and manage their time.
• When you ask your child to do something, give them simple, clear and consistent instructions. Stand near them, look at them and tell them slowly and calmly –do not shout it across the room.
• Break all tasks, e.g. homework, into small timespans such as 15–20 minutes.
• Lookout for good behaviour and praise it. Children with ADHD respond well to positive reinforcement. Rewarding or reinforcing a new good behaviour every time it occurs encourages positive new habits and builds confidence and good self-esteem.
• Be careful about your child’s diet; avoid food high in refined sugars and carbonated drinks which may make their symptoms worse.
• Encouraging physical activity: Exercise can help children with ADHD burn off excess energy and improve their focus and mood.
• Communicating with teachers: Keeping open lines of communication with teachers can help parents stay informed about their child's progress and work together to address any challenges.
• Make sure that you give yourself a break periodically and do not neglect your other children and relationships, especially your relationship with your partner.

How can teachers help children with ADHD?

• Children who have ADHD often also have learning problems, so look out for such problems and give the child the support they need.
• Classroom rules should be clear and concise. These rules should be regularly reviewed and updated when necessary. Rules should be posted in the classroom where they can be easily read.
• Students with ADHD are susceptible to distractions, so it can be beneficial to seat them away from sources of classroom disruption such as doors and windows. Try to limit other distractions in the room, like excessive noise or visual stimuli like clutter. It may be beneficial to seat child near the front of the class close to the teacher.
• Provide simple written information about their tasks and daily schedule, and stick it somewhere that is easily visible to the child.
• Monitor the child’s work closely and give them positive feedback.
• Be flexible and patient.
• Praise and reward the child for every little bit of progress they make.
• Be very clear and specific in any instructions you give. Be clear about what you expect the child to do. Keep your instructions brief, and help the child to follow through the tasks step by step.
• Try to include some physical movement in your lessons. Alternate between seated activities and those that allow some movement, or ask the child to run some errands.
• Give specific consequences immediately after misbehavior. You can discuss and agree the consequences of misbehavior with the child in advance, so they know what to expect. Focus on the behavior, not the child.
•  Help to build the child’s confidence and social skills, e.g., by encouraging them to form positive bonds with peers.

Adults with ADHD

As an adult with ADHD, it can be hard to function in the workplace. Depending on the severity of your disorder, you may find it challenging to stay focused, complete tasks, maintain interest/motivation, or meet deadlines. This may affect your work performance and your overall mental health and well-being.

People with ADHD are known to thrive in areas of work that involve rapidly changing tasks and require problem solving skills such as entrepreneurship, computer programming, creative industries, sales, hospitality, teaching, emergency services, artists, writing, engineering and athletes. Some things you can do to remain motivated include;

• Create a daily routine: Establishing a consistent routine can help you stay organized and focused. Make a schedule for your day and try to stick to it as much as possible.
• Use a planner or calendar: Write down important dates, deadlines, and appointments in a planner or calendar so you don't forget them. Use reminders and alarms on your phone or computer to help you stay on track.
• Break tasks into smaller steps: Large tasks can feel overwhelming, so break them down into smaller, more manageable steps. This can help you stay focused and motivated.
• Use visual aids: Visual aids like diagrams, flowcharts, and mind maps can be helpful for organizing your thoughts and ideas.
• Minimize distractions: Try to minimize distractions in your environment by finding a quiet space to work, wearing noise-cancelling headphones, and turning off notifications on your phone.
• It’s best if possible to have someone at work you do tasks with. It helps you remain focused and accountable.
• Avoid self-blame and forcing yourself to follow certain routines like everyone else. Remember your brain is unique. Be kind to yourself and do things your way, so far as it doesn’t cause harm to others.
• Practice mindfulness: Mindfulness techniques like meditation and deep breathing can help reduce stress and improve focus.
• Exercise regularly: Regular exercise can help improve concentration, reduce hyperactivity, and boost mood.
• Get enough sleep: Adequate sleep is important for overall health and can also help improve focus and concentration.
• Seek support: Consider talking to a therapist or joining a support group for adults with ADHD. A mental health professional can help you develop strategies for managing your symptoms and improving your overall well-being.

Remember, ADHD is a medical condition that can be managed with the right tools and support. With time and practice, you can learn to manage your symptoms and achieve your goals.

What is normal anxiety vs. anxiety disorder?

Anxiety is your body’s natural reaction to the uncertainties of life. It is the normal feeling of tension, worry or fear you’d feel when faced with a potentially threatening or stressful situation and is your body’s way or preparing you for “fight or flight”. Everyone has experienced some symptoms of anxiety one point or another in their life e.g. before an exam or a presentation.  For the purpose of this article let's call this normal experience "nervousness".

This “flight or fight” reaction activates the physical and psychological resources necessary to deal with the potential danger. Although this system works well most of the time, sometimes it can go into overdrive and do more harm than good leading to the illness termed anxiety disorder.

Anxiety disorders are mental illnesses. They cause significant worry or fear that doesn't go away and may even get worse with time. Their symptoms are more severe than just feeling nervous and these symptoms remain fairly constant over time and negatively affect the quality of life of the person. These disorders are the commonest type of mental illness affecting 8.9% of the population at any point in time with a lifetime risk of 14.6%.

There is no definite cause for anxiety disorders, although genetics, brain chemistry, family history, childhood events and parenting styles, certain personality traits, environmental and socio-economic factors, underlying medical conditions, high stress levels and traumatic events all play a role in predisposing a person to the condition.

Types of Anxiety Disorders

Agoraphobia

Agoraphobia is an irrational and extreme fear of being in situations or places where escape might be difficult or that help wouldn't be available if things go wrong. People with agoraphobia would often experience symptoms of panic such as racing heartbeat, fast breathing, sweating and generally feeling ill whenever they find themselves in places they perceive as dangerous. This forces them to avoid any situation where they may feel panicked, helpless, or trapped.

Often these avoidance behaviors are life-limiting, they may avoid taking public transport, go shopping, air travel, etc. In some cases, it becomes so severe they are unable to leave their home alone.

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) can be simply explained as a condition where there is excessive and constant worry about everyday activities, situations and events. These symptoms last 6months or more. This worry is usually non-specific, difficult to control and often shifts from one concern to another and is commonly out of proportion to the impact of the event.

People with GAD will find themselves feeling anxious about everyday daily events, current events in the news, relationships, or potential events that might occur.

Panic Disorder

Panic disorder involves experiencing intense and persistent panic attacks that occur unexpectedly often without warning. A panic attack is characterized by period of intense fear that develops rapidly, reach a peak of intensity in about 10min, and generally does not last longer than 20–30min. Attacks may be either spontaneous (‘out of the blue’) or situational (in places or situations that the person has previously had attacks).

Social Anxiety Disorder

Social anxiety disorder, also known as social phobia, are associated with symptoms of incapacitating anxiety that occur in specific social situations, e.g. public speaking, leading to a desire to escape or avoid such situations. People who have this disorder have an increased sense that others are criticizing or scrutinizing all they do and are often very critical of themselves. They experience both physical and emotional symptoms of fear in social situations including shaking, racing heartbeat, stomach upset, sweating and dry mouth to name a few. This affects their quality of life, relationships and even career progression.

Specific Phobias

Specific phobias are described as recurring symptoms of intense fear in the presence of a specific object or situation that is overwhelming, irrational, and out of proportion to the actual threat. When the source of their fear is encountered, people with a specific phobia experience immediate symptoms such as sweating, crying, shaking and rapid heartbeat. Like other anxiety disorders, people with a phobia may go to great lengths to avoid the source of their fear. Such avoidance behaviors can cause additional stress and limit daily activities. Some broad categories of specific phobia include phobia to animals e.g. insects, aspects of the natural environment e.g., forests, medical procedures e.g., blood, injection, injury, situational e.g. air travel, among others.

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) involves experiencing intrusive thoughts, known as obsessions, and behaviors, known as compulsions. These cause distress and interfere with the person’s social or individual functioning (usually by wasting their time). Obsessions may focus on things such as a fear of germs, a need to have things in a certain order, or disturbing thoughts about taboo topics. Compulsions are behaviors that people often engage in as a way to relieve the anxiety caused by obsessive thoughts. They might involve actions such as counting, ordering, checking, or washing.

Acute Stress Reaction & Disorder

A transient disorder that may occur in an individual as an immediate response to an exceptional stressor e.g. natural catastrophe, major accident, serious assault, rape, multiple bereavement, etc. The stressor usually involves severe threat to the security and life of the individual or of a loved one. Symptoms are mixed and may begin with an initial state of shock/disbelief followed by depression, excessive worry, irritability, anger, or despair. In severe cases there maybe social withdrawal, inattention, disorientation, aggression, hopelessness, over-activity, excessive grief and dissociation. When symptoms are severe, predominantly dissociative and last between 2 days to 4weeks it is termed an acute stress disorder.

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder is a condition that can occur following a traumatic event. It includes symptoms such as changes in mood, arousal, and reactivity. People may have intrusive thoughts, memories, and nightmares related to the trauma. Flashbacks, hypervigilance, anxiety, and avoidance of reminders are other common symptoms.

Other trauma and stressor related anxiety disorders include adjustment disorder, normal and abnormal grief reactions and depersonalization disorder.

Anxiety Symptoms

• Difficulty sleeping
• Dizziness/ light-headedness/ faint
• Dry mouth
• Feelings of nervousness, worry, panic, fear, and unease
• Muscle tightness
• Nausea
• Rapid or irregular heartbeat
• Sweaty or cold hands and/or feet
• Tingling or numbness in the hands or feet
• Unable to be calm /relax
• Trembling or shaking.
• Sense of shortness of breath or smothering.
• Feeling of choking or difficulty swallowing
• Abdominal discomfort
• Feeling detached from oneself or one’s surrounding
• Numbness or tingling sensations

Do I have normal anxiety or an anxiety disorder?

As discussed earlier, most people experience some anxiety from time to time. The difference between normal anxiety and an anxiety disorder involves the amount of distress it causes and how it affects your ability to function normally.

When you experience the physical and psychological signs of fear and anxiety, they frequently signal that something is happening that could be a threat and that you need to deal with it.

Coping with normal anxiety and mild anxiety

Coping strategies often focus on ways to manage anxiety more effectively. These include:

• Lifestyle changes such as limiting caffeine intake, getting enough rest, and regular exercise have been well researched to be effective in preventing and reducing symptoms of anxiety.
• When you feel stressed out, you can do deep breathing exercises, yoga, and progressive muscle relaxation, etc.
• Being well prepared for tasks e.g. presentations, exams, etc. and adequate time management.
• Ask for help when you feel overwhelmed and delegate tasks to others if possible.
• Practice mindfulness, recognize symptoms of nervousness and why you are having them. Understand that these are normal and identify healthy ways to cope with them
• Stay positive. Always try to find and focus on the positive aspects of every situation.
• Take breaks in between tasks and prioritize time for rest and relaxation. Take your annual leave and engage in an interesting recreational activity.
• Speak to a good friend, colleague or counselor. Choose someone who’s patient and a good listener this helps you get things of your chest and they may offer some good advice too.
• Seek professional help. When you’ve tried and still aren’t getting better, it’s good to seek help as soon as you can.

Managing Anxiety Disorders

To diagnose an anxiety disorder, a doctor or mental health professional will ask a series questions and use assessment tools to help determine if you really have a disorder and its severity. There are a variety of options available to treat anxiety disorders. Your doctor on discussion with you would craft a personalized management plan which may include medication, psychotherapy and social support.

If you have an anxiety disorder, there are plenty of treatment options available to help you live your life to the fullest. It’s important to be patient and communicate openly with your mental health provider in order to figure out the plan best tailored to your individual needs.

For further questions or to speak to a therapist....

What is Autism/ Autism Spectrum Disorder?

Autism spectrum disorders (ASD) are a group of lifelong developmental disorders characterized by their effect on social and communication skills as well as by a restricted, stereotyped, repetitive range of interests and activities. It is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave.

Autism is known as a “spectrum” disorder because there is wide variation in the type and severity of symptoms people experience. The spectrum ranges from clear-cut autism, to subtle variants, to traits found in the normal population. Although autism can be diagnosed at any age, it is described as a “developmental disorder” because symptoms generally appear in the first 2 years of life. People of all genders, races, ethnicities, and economic backgrounds can be diagnosed with ASD.

According to the studies conducted by the Centers for Disease Control and Prevention (CDC) in North America, the disorder is four times more likely to affect boys than girls and has become more prevalent now than 10 years ago. In Ghana, there is limited research but available data suggests that 38.7% of children under 14 may have ASD.

Diagnosis of ASD most commonly occurs in the first three years of life. However, in Africa the average age of diagnosis is around 8 years old and most of the children diagnosed had compromised language skills and or severe intellectual disability. The delayed diagnosis could be a result of inadequate healthcare facilities and trained personnel, poor knowledge/awareness about ASD, cultural beliefs and stigma, non-specific pattern of presentation, and delay in seeking medical attention. In a study conducted in urban Ghana, the average age of diagnosis was 37 months.

Symptoms/Signs

As indicated earlier, symptoms are variable, they usually begin to appear before the age of three. Often parents may notice symptoms associated with how the child plays, interact socially, their response to stimuli and their ability to communicate. Because autism is a spectrum condition, symptoms can be classified as mild, moderate, or severe. Some people may have several or many symptoms, but only experience them to a mild degree, in other cases, people might only have a few symptoms but in crucial areas so would have severe difficulties as a result of those symptoms.

People who have milder autism symptoms are often able to function in their daily lives, but they may be more likely to have other mental health concerns including obsessive behaviors, sensory issues, anxiety, depression and difficulty forming relationships.

Some common symptoms to look out for include a child who:

• Avoids eye contact and doesn’t have social smile
• Slow or absent response to people trying to gain their attention e.g. not responding to their name by 1year
• Isolates themselves when playing, does not like to take turns or share
• Not engaging in “pretend” play
• Does not take interest in others or objects around them
• Delayed speech
• Repeats phrases or words often inappropriately
• Difficulty following and engaging in conversations
• Facial expressions that don't match verbal communication
• Intense interest in certain subjects e.g. colors, numbers, etc.
• Shows a lack of enjoyment in fun activities
• Shows a lack of fear e.g. touching hot objects or excessive fear
• Problems expressing feelings or needs in words
• Very sensitive to sensory stimuli including taste, light, and smell
• Repetitive actions such rocking, walking on toes, or flapping hands
• Trouble seeing things from another person’s point of view
• Does not understand jokes, sarcasm, or teasing
• Answers questions with unrelated answers
• Very organized- plays with toys the same way each time, lines toys up in the same way
• Follows certain routines – obsessively and experiences severe distress with minor changes in routine
• Short temper, aggression, self-harm
• Hyperactivity, impulsivity
• Unusual patterns with sleeping and eating

Although every child is unique, if you notice the following in your child, it may point to a need for further evaluation:

• Lack of smiling or happy expressions by six months
• No babbling by age one
• Lack of response when a child's name is called by age one
• Not reaching for objects by age one
• Baby doesn’t use gestures such as waving by age one.
• Baby doesn’t play any back-and-forth games, like “peek-a-boo,” by the age one
• Lack of single-word speech by 16 months
• No two-word phrases by age 2
• Loss of any speech or social skills at any age

Who is at risk?

It’s important to note that there has been no definite cause for autism. However, studies seem to point to a strong genetic component. Some risk factors have been identified, which include:

• Having an older sibling with autism
• Premature birth and low birth weight
• Having elderly parents (>35yrs) especially an older father

Management of ASD

ASD is a lifelong condition, management of it focuses on helping reducing symptoms so child can strengthen their current skills, nurture their cognitive abilities, develop language, communication and social skills and learn adaptive skills that will allow for independent living and help them to function in their environment. Early diagnosis is therefore very important, often the problems are noticed by parents, by professionals at child development clinics (popularly called “weighing”) and by teachers. The child is typically first seen by a child psychiatrist or pediatrician who takes an extensive history and thereafter uses several diagnostic tools to determine the severity of the condition and coordinate further management by other professionals.

Management is by a multidisciplinary team involving child psychiatrists and pediatricians, educators, clinical and educational psychologists, speech therapists, behavioral therapists, sensory integration therapists, and occupational therapists.

There is no one medication for the treatment of autism. There are however some medications given to help manage the symptoms of aggression, anxiety, attention problems, depression, hyperactivity, inappropriate speech, irritability, social withdrawal and poor sleep.

Available resources for ASD diagnosis and management in Ghana are:

• Accra psychiatric hospital
• Pantang hospital
• Mission Pediatrics
• Autism Awareness Care and Training center

In conclusion, Autism spectrum disorder is a multifaceted disorder that affects many aspects of a person's life. Early intervention is important and there are many treatment options and resources available to help. Finding the right treatment for yourself or your loved one can help them function more independently and live a fulfilling life.

Antisocial Personality Disorder

Antisocial Personality Disorder (ASPD) also called dissocial personality disorder is a mental health condition characterized by a consistent pattern of disregard for and violation of the rights of others. Individuals with this disorder often engage in impulsive and irresponsible behavior and have difficulty following social norms and rules.

People with antisocial personality disorder will typically be manipulative, deceitful and reckless, will not care for other people's feelings and may break the law or cause physical or emotional harm to the people around them with cruel indifference. They are antagonistic and often act insensitively or in an unfeeling manner. Individuals with this disorder may lie, engage in aggressive or violent behavior, and participate in criminal activity. They usually lack remorse and do not regret their behavior and disregard the consequences or refuse to take responsibility for their actions.

Like other types of personality disorder, antisocial personality disorder is on a spectrum, which means it can range in severity from occasional bad behaviour to repeatedly breaking the law and committing serious crimes. Psychopathy is associated with antisocial personality disorder however not every person with ASPD is a psychopath. Psychopaths are considered to have a severe form of antisocial personality disorder.

Worldwide, the prevalence of the condition is estimated to be between 0.6% to 3.6% with it being at least 4 times more common in males than in females. Among prisoners, the prevalence of ASPD increases to 1/3 of their population, with some studies estimating a range of as high as 55% among male prisoners and 31% in female prisons. ASPD has been shown to be prevalent in people with substance abuse, low levels of education and lower IQs. Also, studies show a reduction in the prevalence rate with increasing age. This may be explained by changes in personality traits with age and increased mortality among people with ASPD.

Signs and Symptoms

The symptoms of ASPD can be broken down into two categories: behavioral and emotional. These symptoms are pervasive (noticeable throughout all aspects of their lives) and are present in the absence of other mental illnesses (i.e. schizophrenia, bipolar disorder) or the influence of a psychoactive substance (i.e. alcohol, marijuana, etc.)

Behavioral symptoms of ASPD include:

• Frequent lying with the aim of deceiving others for personal gain
• Impulsive behavior and failure to consider the consequences of their actions such as reckless driving, substance abuse, rioting, etc.
• Aggressiveness and irritability that often leads to physical assaults
• History of symptoms during childhood; such as fire setting, stealing, cruelty to animals, and difficulty with authority or juvenile delinquency
• Engaging in criminal activity; so would have had legal problems resulting from failures to conform to social norms and a lack of concern for the rights of others

Emotional symptoms of ASPD include:

• Having difficulty feeling empathy for others
• Displaying a lack of remorse for damaging behavior
• A tendency to manipulate or exploit others for personal gain
• May display a sense of entitlement, and feel that they are above the law or social norms
• Often have poor or abusive relationships with others and are more likely to abuse or neglect their children

Unsurprisingly, people living with ASPD are often described as having no conscience because in many areas of their life, the above behaviors cause significant distress for both the individual and those around them. Their inability to consider the thoughts, feelings, and motivations of other people can lead to a harmful disregard for others and be destructive to both the person living with it and those who come into contact with them. This behaviour usually becomes most extreme and challenging during the late teens and early 20s. It may improve or remit by the time the person reaches between 35- 40 years.

Unfortunately, even in the advanced ages, the condition causes chaos to the patient and their community that the lives of those with ASPD remain negatively impacted even after remission. Most of those who improve with age remain unable to re-claim their lost prospects, including education, family ties i.e., marriage, and employment. Those who show remission were more likely to have spousal or family ties, with better social support.

Problems associated with ASPD

• The condition can result in incarceration, injury, or death due to harmful or criminal actions.
• It affects an individual's ability to work (job loss) and maintain relationships.
• Increased risk of substance abuse
• Increased risk of death from impulse actions e.g. driving under the influence, violence, etc.
• Increased risk of anxiety, depression, mood disorders, self-harm and suicide among those with ASPD.
• It has the potential to cause harm to friends, family members (including their children) co-workers, and strangers who may be harmed by the person's actions.
• Isolation from friends, family and society.

Causes of ASPD

The exact causes of ASPD are not fully understood, but research suggests that a combination of genetic, environmental, and social factors may contribute to the development of this disorder. Studies have shown that people with ASPD often have a family history of antisocial behavior, and may have experienced parental neglect, trauma or abuse in childhood.

The reason for that could be that children who grow up in disorganized, dysfunctional and neglectful homes may lack the opportunities to develop a strong sense of discipline, self-control, and empathy for others or may learn such abusive behaviors from their parents and later display them to others.

Additionally, research has found that individuals with ASPD often have structural and functional differences in certain regions of the brain i.e. the frontal lobe which are related to emotion processing, impulse control, planning and judgement. This suggests that biological factors may also play a role in the development of ASPD. Another study showed an increased risk of the disorder in children whose mothers smoked during pregnancy.

Diagnosis and Treatment of ASPD

Diagnosing ASPD can be challenging, as many individuals with this disorder do not seek help on their own and may not see their behavior as problematic. A mental health professional may be able to diagnose ASPD based on a comprehensive assessment of the individual's behavior and history. Children who display symptoms of ASPD before they are fifteen (i.e. conduct disorder) may with appropriate intensive therapy be prevented from developing ASPD.

It is important to note that although there is no cure for ASPD, evidence suggests behaviour can improve over time with therapy, even if core characteristics such as lack of empathy remain. In the past, antisocial personality disorder was thought to be a lifelong disorder, but that's not always the case and it can sometimes be managed. As individuals with this disorder may be resistant to therapy, they generally receive treatment only after some type of altercation with the legal system or the person's family and friends take an active role in making decisions about their treatment and care.

The recommended treatment for someone with antisocial personality disorder will depend on their circumstances, taking into account factors such as age, offending history and whether there are any associated problems, such as alcohol or drug misuse. Treatment for ASPD typically involves psychotherapy, such as cognitive-behavioral therapy or dialectical behavior therapy, which can help individuals learn coping skills and strategies for managing their behavior. In some cases, medication may be prescribed to treat co-occurring conditions, such as depression or anxiety. Drug rehabilitation may also be required for those with a history of substance abuse.

It takes time and patience to help people with ASPD learn to manage their symptoms but with the right support and treatment, individuals with ASPD can learn to manage their symptoms and improve their relationships with others.

In conclusion:

Antisocial Personality Disorder is a serious condition that has a significant impact on the lives of those affected by it and those related to them. Most people with ASPD do not seek help on their own and intervention likely only happens due to legal problems. Those who have the best outlook are those who have stronger social support and better spousal and family ties. If you or someone you know is experiencing symptoms of ASPD, it's crucial to seek help from a qualified mental health professional who can help you function better in society and cope with living with the condition.

Avoidant Personality Disorder

Avoidant (anxious) personality disorder (AvPD) is a mental health condition characterized by persistent and excessive hypersensitivity to criticism or rejection from others, feelings of social inhibition and extreme self-consciousness and inadequacy. People living with AvPD often experience anxiety and fear in social situations, which can cause them to avoid interactions with others altogether. This can lead to significant impairment in their ability to function in relationships, work, and other areas of life. Like other personality disorders, the disorder ranges from a few traits to the most severe form. It occurs in about 2.4% of the general population and occurs in both males and females in equal proportion.

Often this disorder begins in childhood with shyness and fear of strangers and new situations. Having an actual or perceived disfiguring illness/scar and shyness in childhood can predispose children for this personality especially when they do not outgrow that shyness in adolescence and early adulthood.

People with this disorder often cope by avoiding social and occupational activities that involve significant interpersonal contact they become increasing socially isolated but with accompanying craving of social relations and fantasizing about ideal relationships with others.

People with this disorder are at increased risk of depression and anxiety disorders especially social phobia and generalized anxiety disorder.

Causes of Avoidant Personality Disorder

The causes of AvPD are not fully understood, but it is believed to be a combination of genetic and environmental factors. Some possible causes may include:

• A family history of anxiety or depression
• Traumatic experiences such as abuse, neglect, or bullying especially in early childhood
• Social rejection or criticism in childhood or adolescence
• Overprotective or critical parents
• Biological factors such as a chemical imbalance in the brain or a tendency toward anxiety

Symptoms of Avoidant Personality Disorder

The symptoms of AvPD can vary from person to person, but some common signs include:

• Intense fear of rejection or criticism in social situations
•  Fearful and tense demeanor
• Avoidance of social interactions, even if they are important
• Difficulty making friends or forming close relationships
• Restraint in intimate relationships because of the fear of being shamed or ridiculed
• Unwillingness to be involved with others unless certain of being liked
• Low self-esteem and feelings of inadequacy
• Constant worry about being judged or rejected by others
• Reluctance to take risks or try new things because they may lead to embarrassment
• Self-consciousness and withdrawal in new social situations because of feelings of inadequacy
• Hypersensitivity to criticism or negative feedback e.g. excessive attention to non-verbal cues
• Physical symptoms such as sweating, trembling, or nausea in social situations
• Perfectionism and a tendency to focus on flaws and mistakes
• Self-isolation while still craving social interactions

Diagnosis and Treatment of Avoidant Personality Disorder

Diagnosing AvPD involves a thorough evaluation by a mental health professional, who will assess symptoms, medical history, and other factors. Treatment may include psychotherapy, medication, or a combination of both.

Psychotherapy is a main treatment for AvPD. Cognitive behavioral therapy (CBT) which involves identifying and changing negative thought patterns and behaviors as well as other types of therapy, such as psychodynamic therapy or group therapy are the commonest forms used. Medication may be prescribed to manage symptoms of anxiety or depression but medication alone is not sufficient for treating AvPD.

Living with Avoidant Personality Disorder

Living with AvPD can be challenging, but there are ways to manage symptoms and improve overall quality of life. Some tips for coping with AvPD may include:

• Seeking professional help from a mental health provider
• Participating in social activities, even if they feel uncomfortable at first
• Practicing relaxation techniques, such as deep breathing or meditation
• Building a support system of family and friends who understand the condition
• Challenging negative thoughts and behaviors with the help of a therapist
• Setting small, achievable goals for social interactions or personal growth

In conclusion, AvPD can be a debilitating mental health condition, but with the right treatment and support, it is possible to manage symptoms and lead a fulfilling life. It is important to seek help from a mental health professional if you suspect that you or someone you know may be experiencing symptoms of AvPD.