Dr. Scott Carroll

Yes, online therapy seems to be just as effective as in-person therapy, although many people prefer in-person therapy.

None of them. No psychotherapy has ever been shown to directly help Manic-Depression which is now called Bipolar Disorder. Bipolar Disorder is a purely biochemical disorder that only responds to medication. The only role of psychotherapy in Bipolar Disorder is to help people with Bipolar Disorder cope with having a severe mental illness.

Yes, but cognitive behavioral therapy (CBT) typically works faster. I would recommend starting with CBT for that quick initial improvement, but long term, you may need to do psychodynamic psychotherapy to fully get rid of your anxiety.

Cognitive Behavioral Therapy is the best treatment for social anxiety in an 8yo. Play therapy and certain types of antidepressant medication (selective serotonin re-uptake inhibitors - SSRI's) can also be helpful. Medication only helps while you take it, but psychotherapy has the potential to cure it.

Yes, most types of anxiety can be cured. The main exception is Obsessive Compulsive Disorder (OCD), which can be significantly improved, but usually cannot be cured. All of the other types of anxiety have a type of psychotherapy that is effective at curing it although it can take several years. Medication mostly just relieves the symptoms while you take it, but doesn't directly promote a cure. Traumatic anxiety and phobias are exceptions to the "meds just help symptoms" rule. There are some blood pressure medications that actually seem to promote the cure when used with psychotherapy. A better way to think about medication for anxiety is to think of medication as being able to decrease your anxiety so you are not overwhelmed and can focus on doing the therapy that will eventually cure you.
I hope this helps.

30 mg of Lexapro per day exceeds the FDA maximum recommended dose of 20mg per day. The maximum dose of Lexapro was decreased from 30mg to 20mg per day a few years ago due to concern about causing abnormal electrical activity in the heart (QTc prolongation). While 30mg per day is not illegal, it would be wise to have regular EKG's to ensure that the heart
function is normal.

No, Bipolar Disorder is a complicated disorder that takes an expert to diagnose accurately. He needs to be evaluated by a child psychiatrist, preferably board certified in child psychiatry. If you question the diagnosis for/against Bipolar Disorder, you can get a second opinion.

New onset bedwetting in a 9-year-old male is concerning for medical issues such as a bladder infection, medication side effect, or a change in his sleep quality such as sleeping deeper. You should start with seeing his pediatrician to do a urine test (urinalysis and culture) and to look at what medication he is on. If they are non-revealing, consider an EEG and/or sleep study if the problem persists.

Now is the time to talk to him. He probably already knows a lot and you will be correcting misconceptions more than teaching him something he does know. Don't wait any longer.

The answer to why she doesn't want to be alone depends on her age. Younger children (under 7) have a natural fear of being separated from their parents/caregivers. If the child is 7 or older, then we diagnose them with Separation Anxiety Disorder and treat it, mostly with psychotherapy, but medications can be used in cases when the therapy doesn't work or the anxiety is extreme.

As for being extremely nervous, we will often treat it with play therapy when they are younger (up to 7 or 8 years old) and psychotherapy for older children and adolescents. Medication is generally reserved for severe anxiety in older children and adolescents.

As for why she has these issues it is generally due to either congenital high anxiety (usually genetic that runs in the family) or there was a traumatic event. Young children can be easily traumatized so you many not have realized an event was traumatic for them. Common causes including getting lost in a store or a parent getting sick and having to be hospitalized. Divorce can also trigger it. The child often doesn't know why, but you can usually figure it out through psychotherapy.

She may not have the words to express how she feels yet. Also, strong emotions often "short circuit" their brain so they can't think clearly enough to find the words that they could use if they were calm. Focus on comforting her and helping her calm down so she can then express herself. They generally grow out of this behavior as they get older and better at expressing what they want.

There are rare, but more serious causes of this behavior such as Autism Spectrum Disorder (ASD). However, children with ASD have a host of other difficulties besides self-harming behaviors such as prolonged tantrums that can last an hour or more, delayed language development and difficulty with social interaction and recognizing facial expressions. They also tend to have rigid adherence to patterns or routines and severe tactile sensitivity. If she has any of these issues, please talk to your pediatrician about getting an evaluation for ASD.

We generally don't diagnose Borderline Personality Disorder in children. Instead we would diagnose Reactive Attachment Disorder if there is a history of loss of a parent or being placed in foster care or growing up in an orphanage.

More importantly, there are far more likely causes of severe mood swings and tantrums in an 11 year old boy than from a personality disorder or reactive attachment. The list of possible causes is too long to list here, but I would get him formally evaluated by a child psychiatrist. The psychiatrist should be able to figure out why he's having such severe tantrums and direct you to the appropriate treatment whether it is therapy or medication or both.

She needs to see a counselor. She's probably mad at both of you for the divorce. Kids also need to grieve the loss of a marriage because they are losing the dream of a united family. Counseling can really help them accept a divorce and help them communicate how they feel to their parents.

The answer to your question depends on her age and if anything stressful happened lately. If you are really concerned, you could take her to a counselor.

Having a grandparent a child is close to get dementia can of course affect the child. Common feelings are curiosity, confusion and grief over the changes from the grandparent they remember to the grandparent they now have. Unlike death, dementia produces a more prolonged grieving process. The five stages of grieving by Kubler-Ross is a good model for what your child may experience. You can read more at:
https://grief.com/the-five-stages-of-grief/
Just remember that people cycle through the different stages, back and forth, and that there is no order or sequence.

If he really has Bipolar Disorder, then meds are usually necessary. However, in mild cases, a simple sleeping pill when one has trouble sleeping can be enough.

Many adolescents resist taking medication, but it is usually due to either side effects or not seeing a clear benefit from the medication. His psychiatrist should be talking to him about the medication to help him understand how it helps him and to minimize or prevent any side effects he has.

As last resort, you may need to use consequences and/or rewards to get him to take them, but this should only be done at your psychiatrist's direction.