Parenting Matters

Identifying Depression in Children and Youth

By Alicke Grobler

There are many stereotypes and misconceptions about clinical depression perpetuated by media and pop culture. Although there are some common signs and symptoms of depression that occur in most cases, depression can look very different in everyone. The presentation of depression can also vary significantly across different ages and genders.

Depression is not an uncommon occurrence in adults. Recent research indicates that about 16% of adults experience depression in their lifetime. Depression is significantly more common among women and the elderly. Additionally, approximately 65-75% of people with depression are initially diagnosed in adolescence. This indicates that depression is a chronic disorder and most often develops in the teenage years. Because of this, it is essential to know and be able to identify the signs of depression as early as possible, in order to ensure that your child has access to resources and support and develops coping skills early on in the course of the disorder.

Although rare, it is possible for children younger than adolescence to be diagnosed with depression; according to the National Institute of Health (NIH), approximately 2.5% of young children in the US suffer from depression. Under the age of 12, depression is slightly more common in young boys than young girls. However, once children hit adolescence, the rate of depression jumps up to 11%. This rate is the average for all adolescents between 12-18, but the risk of depression increases substantially for older adolescents. Adolescent girls are 2-3 times more likely to develop depression than boys.

This article is not meant to scare parents, but rather to provide them with information and resources to best help their children who may be struggling. However, because depression can manifest differently in everyone, it can be hard to identify it in teens and children, and to distinguish it from the typical and developmentally normative angst of the teen years. As such, the following information will include ways to recognize depression in children and teens, risk factors to look out for, ways to help your child cope with depression, and resources available to parents and children.

Depression most often presents, across ages, as persistently low mood, hopelessness, fatigue, and lack of enjoyment. However, in children, other symptoms may be more obvious including:

  • Irritability or anger
  • Social withdrawal
  • Changes in appetite – eating too much or too little
  • Changes in sleep pattern – sleeping too much, not sleeping enough or at all
  • Difficulty concentrating or thinking
  • Difficulty functioning and completing day to day tasks at school, with friends, or at home.
  • Physical complaints such as stomach or headache that do not respond to treatment
  • Increased sensitivity to rejection or failure
  • Lack of motivation
  • Vocal outbursts or crying
  • Feelings of guilt or worthlessness

In children under 12 years old, irritability or anger, changes in sleep pattern or appetite, vocal outbursts, and physical complaints may be the easiest to identify and the most strongly expressed symptoms. In adolescents, depression looks more like adults, with major changes in mood and functionality. However, all of the symptoms listed above could apply to a child or adolescent suffering from depression, so it is important to be aware of your child’s mood and behaviors. Children will likely display different symptoms in different settings, and most with significant depression will display a noticeable change in academic performance, social activities, and even appearance.

Some children may be at greater risk for depression than others. This is especially true for children who have a parent with depression. Depression has been linked to a genetic predisposition, and tends to run in families. Children whose parents have depression are also more likely to develop depression earlier than children whose parents do not. Other risk factors include substance use. Depression may also lead to substance abuse in older children and adolescents, which is likely to worsen the symptoms. Children may also develop depression based on major life events, loss of loved ones, or biochemical disturbances.
If you notice some of these behaviors in your child, especially if they are persistent for more than two weeks, do not be afraid to consult a mental health professional.

Depression is a cyclic disorder. This means that those who have depression typically go through periods of feeling healthy and functioning well, and periods or episodes of depression. Major Depressive Disorder is diagnosed if an individual has a depressive episode lasting two weeks or more that significantly interferes with their daily functioning. However, depressive episodes often end on their own after a period of time. The end of a depressive episode does not mean that depression has been cured and is no longer a cause for concern; rather, it is highly likely that a depressive episode will recur in the future. Therefore, even if your child is not currently exhibiting the symptoms or signs described, or if the symptoms stop or improve naturally, it is still essential to seek resources and support for your child.

There are a variety of effective treatment options for depression, including psychopharmacology and psychotherapy. Mindfulness and cognitive behavioral therapy have both been shown to be effective in reducing depressive symptoms, and Mindfulness Based Cognitive Therapy has been shown to be effective in reducing the risk of relapse of a depressive episode. If you are concerned that your child is depressed, you have a number of options to seek support.

Your pediatrician may be able to help you find suitable antidepressants for your child, and can likely refer you to a psychiatrist and/or therapist.

Your child’s school counselor can connect you to resources both in and out of school.

The Youth and Family Services Social Worker, Kristie Demirev, at the Community Center can work with families on an individual basis to assess their needs and connect them to supports they need. She can be reached at 781 698 4843 and is free to all residents.

The following articles are also helpful for educating yourself about depression in children and adolescents. If you are concerned about your child, please reach out and find support for yourself and your family:

Hankin, B. L., Young, J. F., Abela, J. R., Smolen, A., Jenness, J. L., Gulley, L. D., … & Oppenheimer, C. W. (2015). Depression from childhood into late adolescence: Influence of gender, development, genetic susceptibility, and peer stress. Journal of abnormal psychology, 124(4), 803.

Avenevoli, S., Swendsen, J., He, J. P., Burstein, M., & Merikangas, K. R. (2015). Major depression in the National Comorbidity Survey–Adolescent Supplement: prevalence, correlates, and treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 37-44.


 

Alicke Grobler is a Master of Social Work candidate at Boston College, studying clinical social work with a focus in mental health. She is currently an intern with the Lexington Human Services Department, and aspires to help increase access to and awareness of mental health care for low income families and military families. She can be reached by calling the Human Services Department at (781) 698-4840.

 


Parenting Matters columns are presented to the Lexington community through a collaboration with the Lexington Human Services Department of Youth Services. Information provided in these columns is general in nature and not intended to be a substitute for a personalized clinical evaluation. Please see a professional for any concerns you may have about this topic or any others in a Parenting Matters column. LEXINGTON COMMUNITY CENTER 39 Marrett Road, Lexington, MA 02421. Open Monday – Friday 8:30 AM to 4:30 PM

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PARENTING MATTERS: Launching Creative Kids

Shawn M. McGivern, LMHC

 

“Imagination is the beginning of creation. You imagine what you desire, you will what you imagine, and at, last, you create what you will” -George Bernard Shaw

With more than 100 theories of creativity in disciplines ranging from neuroscience to psychology, economics, and philosophy, it can be dizzying to land on the best way to invoke, evoke and sustain our children’s innate creative drive.

What is creativity?

Perhaps the late Steve Jobs put it best: “Creativity is the ability to make connections”.

Therefore, whether it’s inventing a new product, playing an instrument, or planting crops to ameliorate world hunger, children’s future ability to offer their creative gifts to the world may, in part, depend on mastering certain developmental tasks their first 18 years.

Polish psychologist Dabrowski’s 1960s research on the characteristics of highly creative students turned up some savory food for thought. Specifically, while we sometimes assume the child prodigy is destined for great things, Dabrowski’s findings suggest that inherited talent, temperament and IQ do not necessarily guarantee success.

Given a problem to solve, creative students will arrange and re-arrange their thinking so as to offer multiple solutions. They daydream; they fantasize. To the delight of some and the chagrin of others, they see the humor where others do not. They don’t like non-acceptance, but aren’t especially bothered by being “different” either.

With a passion that can border on pesky, these are the kids who ask questions until they get a thorough answer. As Dabrowski points out, they can surprise us with their original, silly, or even bizarre representations of what originated in the imaginal realm.

What sets these students apart from others? They possess a rare ability to concentrate and across the board work hard to achieve their personal goals.

“Creativity is contagious, pass it on” -Albert Einstein.

Having counseled scores of creative adolescents and adults over the past 20 years, I’m often asked, “How can I nurture my child’s creativity?”

The fact is, some adults who have survived trauma will continue to create as if their next and last breath depends on it. Optimally, however, kids will benefit from parents who find value in the words of a seasoned reading specialist.

“Give me a child whose been read to her whole life infancy and I’ll show you a kid who can imagine her own possibilities. Give me a curious, connected parent and I’ll show you a child who has a thirst for knowledge. Give me a parent who, when their kid shows hem a drawing, focuses more on the thoughts and feelings that inspired it, and I’ll show you the kid who is most likely to draw as an adult.”

When it comes to encouraging our children’s creativity, Swiss Psychologist Erik Erikson’s sequential 8-stage Theory of Psychosocial Development may be worth consideration.

In general, creativity arises when we are invited to trust. According to Psychosocial Theory, if children are consistently fed during their first year, they will develop trust and, by extension, the virtue of hope.

If at age 2, they are allowed to exercise control over their personal skills (especially toilet training) they will emerge from this stage having achieved Autonomy. (Note: when children say NO to us, they are often saying “Yes to ME”)

Age 3-5 constitutes the Play Stage. Kids live in the body. Their explorations  will invariably result in messy experiments involving taste, touch, sight, sound, and smell. If, however, we can hold off on teaching that Neatness Counts, they will emerge from this stage possessing Initiative and will.

From age 6-8, children are becoming industrious. In order to become competent, the task is to obtain the knowledge and skills required to move half-baked ideas to fruition. Doing things together helps them become relational. In addition, these are times when, if we actively listen, they will let us in on how they think, feel, and perceive their world.

Ideally, adolescents move from being able to form lasting friendships to having the capacity for intimacy and love as they enter young adulthood at 18. As an example of a young man who evidences a sense of individuality and belonging in the larger world, here follows an excerpt from “T’s” college admissions essay.

“My parents gave me every possible advantage in terms of honing my skills as a sculpture. I grew up with teachers and adults who valued self expression and gave me the tools I need to be my own person.

Looking back, what I value the most are the talks my dad and I have had while making things in his woodshop. We’ve talked about his life, my life, what makes life good vs. disappointing. My mom and I have always gone hiking together. When I was a kid she’d take a picture of something and then have me take a picture of the same thing just so we could talk about how we saw things in the same way and how we saw them differently. My sculptures show how people relate to themselves, to each other, and to nature. I have a lot to learn but I have a lot to contribute too.”

Leading By Example

Theories on creativity abound but as a means by which to model what works with creative kids, this tale of a mom whose 7-year old son hopes to one day be a marine biologist is worth passing on.

Most Saturday mornings, Collette looks forward to seeing what Matthew has created in an area of the family room he calls “MY INNOVENTIONS”.

This particular Saturday, however, she registers horror when she enters the den. With clear intent, Matt has cut into pieces not only a large, very expensive stuffed pig (with piglets attached to her belly) but also a hefty stuffed elephant.

OMG! I’ve given birth to Young Frankenstein, shouts a voice inside her head.

“Hey Mom!” Matt smiles.

Colette grew up with parents who adhered to the Victorian saw, children are meant to be seen and not heard.

“Hey Matt. What’s up?”

With the focus of a heart surgeon, Matt keeps cutting.

“Sea Monster, His name is Borgo.”

Collette is not only an animal rights activities; she’s on an ethics committee that’s protesting the use of animals for scientific experiments. Matt is oblivious. He is now waving her onto the floor next to him, holding out the lacquer-sewing box.

“Mom, I need you to sew the pig’s head to this side of the octopus’s head and the elephant’s head to the other side.”

Collette sits down, says gently, “You know, honey, I just don’t feel up to doing this right now.”

“Don’t worry, Mom, he says, ” If you put your mind to it, you can do ANYTHING!!!! “

“But what I’m telling you, Matt, is I just don’t feel like doing this right now”.

The mix of Matthews’s faith in her and the disappointment in his eyes is poignant.

Colette meditates. Breathe in Love; Breathe out Fear.

“Tell you what, Matt, how about instead of me doing it, I teach you how to sew?”

“Can’t you do it?”

“Hey, everybody knows you can do ANYTHING too, remember?”

One hour later, Borgo, in all his tentacled, Platapyzmic splendor is presented to Collette next to the fruit bowl on the kitchen counter.

Cool, huh? Matt is beaming with pride.

“Wow! Matt! You did it!”

“You think it’s good?

Sticky Wicket. Collette knows that if she has the power to say Matt’s piece is good, she also has the power to say it’s bad.

Alternative: “ What I love, Matt is that you saw something in your mind’s eye and then you spent time making something new – something that has never until now existed in the history of history!”

“I’m bringing him to school Monday” says Matt, “ I’m going to tell everyone the story of Borgo.”

“Cool! So how about I take notes while you tell me the story of Borgo?”

The Story of Borgo by Matt

The Octopus is a busy guy. He gets really hungry looking for food. He’s having a hard time finding lunch, though, because the fish are getting trapped in all the plastic people are dumping into the ocean. Pigs are really smart.

Did you know they can find food even when it’s buried in the earth?

So the pig will help the octopus find food. Also, the elephant can use his trunk like a vacuum cleaner to suck fish who aren’t getting chocked by plastic out of the coral reefs.”

“Now that’s what I call an Innovation!” Colette claps.

“But Matt, can I ask you one question?

“Sure”.

“How come you sewed the piglets to the elephant’s trunk?

Matt grabs an apple out of the fruit bowl. Takes a big bite.

“I don’t know, Mom. That’s for the future to figure out.”

 

Shawn M. McGivern, LMHC

Shawn M. McGivern, LMHC

Shawn M. McGivern, LMHC, is a psychotherapist in private practice who specializes in the integration of creativity and mental health. She is an Adjunct Psychology Professor at Lesley University and a former freelance art critic for The Boston Globe. In addition, she is the inventor of a creative writing/storytelling process called My Legacy in Words and Images Email he at: shawnmcgivern@yahoo.com.

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Parenting Matters: The Importance of Feelings…Really

By Danielle DeTora, Psy.D.Photo for Colonial Times

“How does that make you feel?”  This is the quintessential therapist’s line that is often mocked in movies, television, books, and everyday life.  It’s unfortunate that feelings get such a bad rap because they are more important than people realize.  In fact, I believe that learning to understand and appropriately express one’s emotions is the single most important skill to promote mental health wellbeing.

DEFINING FEELINGS

People have a hard time identifying feelings.  Often when I ask how someone is feeling (yes, I do ask that question of my clients), I get answers that describe something else.   Statements such as, “I’m just stressed!” or “I’m overwhelmed” or “I’m anxious” actually describe a physiological state of being but they are not feelings.   For example, if a person is “stressed,” then they are likely experiencing a heightened state of arousal.  Maybe the person’s muscles are tense or his/her thoughts are racing or s/he has no appetite.  These are all examples of bodily reactions to some stressor(s).  They are important to attend to, but they are not emotions.  Examples of emotions are:  sadness, hurt, anger, frustration, fear, happiness, love, disgust, surprise, etc.  The difference between physiological states and emotions may seem subtle and insignificant but it’s key in helping manage stressors in our lives.

Everyday, our bodies have hundreds of emotional reactions.  Hard to believe?  Watch a group of preschoolers.  Because they are fully connected to their bodies, you’ll see them get sad (tears in eyes, shoulders hunched, frown on face), mad (knitted eyebrows, clenched fists, red cheeks), delighted (smiles, open arms, skipping), etc.  Typically, they experience whatever emotion arises in their bodies.  Then, often a teacher or parent helps them express it with words.  Afterwards, they move on to the next thing that catches their interest.  They gracefully allow feelings to come and go.  As we grow up, we shift our focus away from our bodies and into our thoughts.   Just because we’re not paying attention to our bodies as acutely as a preschooler, does not mean that we aren’t having those emotional reactions.  But how do you attend to all of these reactions as an adult and still manage all your daily tasks?  You don’t.  You learn how to recognize them, manage your access to them and most importantly, not disregard their existence.

RECOGNIZING FEELINGS

Recognizing an emotional reaction requires paying attention to sensations in your body.  Often, we spend so much of our day thinking of things to do, people to contact, places to be, etc. that we are not aware of our body.  A good example of this disconnection is when people are so busy that they ignore hunger signals and forego eating a meal.  The same process is true for emotions.  For example, if you see an elderly person struggle to walk across the street, are you aware of the emotional reaction you are possibly having?  Or are you so focused on where you have to go or the next thing on your “to do” list that you are unaware of any physical sensations that may be emotions?  If you pay attention to this moment and discover that it is sadness, you may then relate it to your own parents’ current struggles with aging or your deceased grandparent whom you adored and miss.  Allowing yourself to feel this sadness, even if only for a few seconds, validates your emotional self and keeps you connected to your body.

If paid attention to, an emotion is something that comes and goes, like a wave passing over you.  Too often, people will not allow themselves to feel an emotion for fear that they will get completely overwhelmed by it.  If they feel sad, for example, they will plunge into a deep black hole of sadness and not be able to stop crying.  Unfortunately, this thought is the result of not perceiving an emotion as something that occurs in our bodies and is temporary.  When we stop a feeling before it’s been fully felt, it reinforces the idea that feelings are “bad” or that they shouldn’t exist.  Feelings are just feelings – they are neither bad nor good.  If repeatedly ignored, however, emotions have a tendency to build up over time and cause symptoms of stress, anxiety, depression, and more.

RESPONDING TO FEELINGS

In addition to attending to our own emotions, it is important to recognize them with others.  As parents, it is crucial to validate our children’s feelings.  When we validate their feelings, we validate their existence.  In other words, what they feel in their bodies is just as important as their thoughts.  Regrettably, we often do the exact opposite.  For example, if your child says, “I’m really bummed that we lost that soccer game” (translation, “I’m really sad”), how often do we respond with, “Oh, but you won all your other games.  It’ll be fine.”  Or “It doesn’t matter, you still have a spot in the playoffs.”  These statements are well intended to make the child feel better about losing the game but instead, they are invalidating the child’s emotional reaction.  In essence, we are telling the child, “You’re feeling sad and it is wrong or bad.” What we should be saying is, “Yes, I understand it’s difficult to lose.” Or even better, “Tell me more.” This latter statement creates a unique opportunity for the child to try and connect with the sadness and communicate it.  No matter what the child says, it is crucial for the parent to make it clear that being sad is a perfectly acceptable emotion to have in response to losing a game.  After a feeling is validated, then a parent can add, “Can I share some of my opinions about the loss?” or “Would it be helpful if I offered some ways to think about the loss?”  Asking, instead of launching into a series of statements, is yet another way for your child to focus on what s/he wants and needs in that moment.

Being able to identify our emotions in our bodies and express them appropriately is a skill that we all had when we were young children.  With practice and patience, that skill can be relearned and help us live more emotionally connected lives.

REFERENCE:

Frederick, Ronald J. (2009).  Living Like You Mean It.  San Francisco, California:  Jossey-Bass.

 

Danielle DeTora, Psy.D. is a licensed psychologist with a practice in Lexington.  She works with adolescents, young adults, adults, couples and families on various issues related to emot
ional health and well-being.  Dr. DeTora helps people achieve and live more satisfying and meaningful lives.  Dr. DeTora can be reached at 781-862-6772, or email – danielledetora@gmail.com.

 

 

Parenting Matters is a collaboration between the Colonial Times Magazine and the Town of Lexington Human Services Department. This column is not intended as a substitute for therapy and the contents are do not necessarily reflect the views of the CTM editorial staff. The information contained in Parenting Matters is for general information purposes only and should not be considered a substitute for the advice of a mental health professional.

 

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Winning the Worry Wars

Stephanie M. Kriesberg, Psy.D.

Stephanie M. Kriesberg, Psy.D.

By Stephanie M. Kriesberg, Psy.D. , Licensed Psychologist

Recently I was driving to work and realized I forgot my iPad. Since I had some extra time, I decided to turn around, go home, and get it.   On the return trip, I saw the line of traffic that had backed up. Construction!    An accident!  “Don’t do it!”  said a worried voice in my head. “If you keep going, you will get stuck in that snarl of traffic on your way back to the office.  You will be late.”  That worried voice made a lot of sense, I thought. It was trying to help me.  So I turned the car around again and got to the office on time.  And really, I managed just fine without my iPad that day.

Sometimes, the worry voices we hear in our heads can really help us out.  Worry can help us make good decisions, stay safe, and encourage us to work hard and do our best. But for many children and teens, worry stops being a helpful signal, a sign to slow down and think things through.  Instead, the worry voice becomes a screeching tyrant, convincing kids that disaster lurks at life’s every corner.

For example: Since the summer’s thunderstorms, 10-year-old Lily is afraid to sleep in her own bed at night.  She worries:  “What if it thunders again? What if it wakes me up?  What if something bad happens?”  Lily’s parents have taken to standing guard by her bed until she falls asleep.  Most nights, she winds up in her parents’ room anyway, asleep on the floor.

For Colin, age 8 (not to mention his parents) homework time is torture.  Colin is an endearing, industrious boy who wants to get everything just right. If he stumbles on a math problem, tears are sure to follow.  He wants to please his teacher and is certain she will be upset if his homework isn’t perfect.

Fifteen-year-old Nicole, rising star softball player, feels so sick to her stomach the night before every game her parents are starting to wonder if she should keep playing, as much as she loves the sport. “If I strike out, everyone will laugh at me. Coach wants us to make it to the play-offs.  I need to make every hit a homerun,” Nicole laments.

Each of these young people has a worry voice that has taken residence in their heads and does not want to vacate.  Each of them could benefit from being taught several basic principles about worry and its management.   Worry is part of life.  We have to expect it.  However, we have to figure out when our worry voice is helping us, providing useful information, and when that worry voice is full of hot air and doesn’t know what it’s talking about.

In their book Anxious Kids Anxious Parents Reid Wilson and Lynn Lyons describe steps parents can take to help their anxious children.  Parents, like the ones described above, often feel powerless in the face of their children’s worry.  They spend their evenings hovering by their children’s beds or talking their frantic kids through every possible calamity.  No one feels better.  Worry wins every time.

Worry can be brought down to size when children and teens are taught that anxiety is expected and predictable.  Reid and Lyons (p. 59)  write that for most kids anxiety shows up in the same five types of situations over and over.  Anxiety tends to show up when kids are:

  1. Trying something new

  2. Unsure about plans

  3. Have lots of “what if” questions

  4. Have to perform

  5. Anticipating something scary

If your child or teen is struggling with worry, try the following exercise.   First, divide a piece of paper into two columns.  On one side, write the five conditions that tend to create anxiety.  Ask your child to think about which of these situations tend to create anxiety, and write them in the other column. Try to get as specific as possible. Your child will probably see that she does not get anxious in all types of situations.  There are plenty of times when she feels calm and brave. That realization itself is empowering and reassuring.

Second, go back to the situations in which your child experiences anxiety, when his worry voice is chattering in his ear.  Teach your child to picture his worry voice as something outside of himself.  Teach him that he can talk back to that worry voice and let it know what’s really true.  Have fun with this step!  Kids can be kind to their worry voices.  Lily might say: “Thanks for warning me that there might be a thunderstorm tonight.  It’s true,  I hate the loud noise, especially when I’m sleeping!  But I know it’s not dangerous, and I can handle it.”  Colin could reassure his worry voice:  “Listen, worry, I know you are trying to help me with my homework.  But my teacher is really nice.  If I can’t get this math problem, she wants to know so she can help me.  Trust me, nobody expects me to be perfect.”   Kids can also talk tough:  “Listen, worry.  I have had it with you,” Nicole can inform her worry.” Making mistakes is part of being an athlete.   My job is to play the best I can, not listen to your nonsense. So take a hike.”

Finally, when your child begins to worry again, before immediately reassuring, tell her:  “That sounds like worry talking to me!  What can you say to it?”   Over time, your child or teen can learn that worry is part of life, but it doesn’t have to run the show.

 

Stephanie M. Kriesberg, Psy.D. Is a licensed psychologist who practices in Lexington.  She has twenty years’ experience treating children, adolescents and adults.  Her areas of specialty include parent guidance, anxiety disorders, and treatment of adult daughters of narcissistic mothers.

 

Parenting Matters is a collaboration between the Colonial Times Magazine and the Town of Lexington Human Services Department. This column is not intended as a substitute for therapy and the contents are do not necessarily reflect the views of the CTM editorial staff. The information contained in Parenting Matters is for general information purposes only and should not be considered a substitute for the advice of a mental health professional.

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“Parenting Is Not Art”

Kimberly Hackett, LMHC, is a Family-Focused Therapist, Parent Coach and writer.

Kimberly Hackett, LMHC, is a Family-Focused Therapist, Parent Coach and writer.

By Kimberly Hackett, LMHC

Parenting is not art. It’s not a roster of must learn skills. It’s not something to conquer or something you can completely ignore. It’s not a vocation or way of life, a movement, mission or religion. You don’t need training or schooling or even the best possible childhood to “parent.”
And when it happens, there is no turning back but there is turning away and turning towards or standing stock still. Parenting is a happening that permanently changes you – no matter which direction you choose – or don’t.

To parent is to choose, however cavalierly or intensely, or somewhere in between, to let your child belong to you and for you to belong to your child, to commit to the unfolding before you. And in you. It is the only relationship that never ends.

Any adult can attest to the challenges of being an adolescent. Because we’ve all been there. We might remember or choose to forget the intense highs and lows, the awesome curiosity and the constant state of high alert. We might remember the feeling of not knowing who we were, what we were about, or how to get where we thought we should be going.

Adolescence is chaotic but it is also the definition of creativity. “Creativity takes courage,” says Henri Matisse. It’s not a stretch to say, adolescence takes courage. There’s nothing more creative than giving form and meaning to the blank canvas of adolescence, that starting point of defining and shaping identity.

When children enter puberty, they begin leaving the protective cloak of their family identity to seek their own. They leave the sureness of childhood bodies and the security of imaginary play to ponder, explore and experiment with the greatest question of all – “Who am I?” This mighty question ignites the flame inspiring each of us to become artists of our own lives.

Each stage of development presents a crisis which demands resolution. Psychologist Erik Erikson identified the psychosocial work of the adolescent stage as Role Confusion and Identity Formation. The work of adolescence is to trial test new selves while negotiating a rapidly expanding inner world. If adolescents resolve the “crisis” of identity, they develop fidelity, the ability to attach themselves faithfully through intimacy and connection to ones self and to another. If unable to successfully do the work of adolescence, we might feel lost, confused, unmoored.

Adolescence is primarily social and emotional. And so, teens need social and emotional mentors and teachers. This is a challenge since our children spend most of their days in schools that are decidedly left brain and tend to throw their hands up when it comes to the inner lives of their students.
As a result, parents carry the weight of their child’s social and emotional education, the “heart” work of their development. And all that at a time when adolescents are trying to create their own identity separate from their parents.

Social and emotional development and learning is the conscious building of interpersonal (awareness of other’s feelings) and intrapersonal (self-awareness) intelligences necessary for living an connected, engaged life.

Parents can support their child’s social and emotional growth in many ways. Here are eight tips for parents to support their child’s social emotional development.

1. Active Listening – How a parent listens to an adolescent child can positively aid in the work of identity formation. Parents help their children explore the “who am I?” question of adolescence by listening without judgment or fear. Listening with an open heart helps adolescents make sense of their world and their changing selves as they begin the process of taking responsibility for who they are at that moment and who they want to be.
2. Self-Reflection – Where does self-reflection, the foundation of self-knowledge, fit into an adolescent’s busy schedule? Parents can promote this critical developmental need at home in creative ways – conversation around the dinner table or even watching a movie together. Self-reflection needs time to develop and practice to come naturally.

3. Model Authenticity – Adolescents are keen observers of human behavior, especially of their parent’s behavior. They constantly question truth and reality as they experiment with new ways of being. Parents support their child’s search for emotional courage and honesty by living it themselves – or at least by putting ones best effort forward. A good starting place for parents is to not pretend to have all the answers.

4. Promote Creativity – The adolescent work of creating an identity means stepping into the unknown. Like artists, adolescents enter an empty canvas and experiment with colors and materials as a way to accept or reject new ways of being. Creativity gives adolescents freedom to experiment and create themselves in safe and constructive ways. This can be achieved through art, writing, dance, sports, clothing, theatre and music. Parents validate their child’s creative endeavors when expressing their own curiosity with real questions and interest.

5. Celebrate Mistakes – Mistakes mean your child is taking risks and ultimately learning from their experiences. Mistakes are an essential part of growing. Physicist David Bohm writes: “From early childhood, one is taught to maintain the image of “self” or “ego” as essentially perfect. Each mistake seems to reveal that one is an inferior sort of being, who will therefore, in some way, not be fully accepted by others.” This is unfortunate because “all learning is trying something and seeing what happens.”

6. Parallel Process – Parallel process is learning and growing alongside your child. With each moment of your child’s growth, parents are reminded of their own experiences at that age. Simultaneously, perspective is necessary for parents even when they feel there is none. Adolescence joins parent and child in the human journey of self-discovery.

7. The Struggle is Important – Parents often want to pick their child up after they fall down. It is important to recognize that resilience is linked to learned self-reliance. Adolescents need to learn and accept difficulty as part of life and living. They learn what they are made of when they go through something on their own. Parents need to support the important work of struggle as a developmental imperative.

8. Integrating The Dark Side – It can be frightening to witness a once sunny, “problem-free” child transform overnight into a gloomy, irritable adolescent. Some parents find the emerging darker side (self-doubt, anger, fear, self-consciousness) difficult to accept and send the message that the harder stuff of growing up is not accepted. Parents need to integrate the highs and lows, the good and the bad, to support balance and self-acceptance.

Parenting is not art. It’s a relationship that is social and emotional in nature. It is is constant and changing, and demands that we grow alongside our children.


Kimberly Hackett, LMHC, is a Family-Focused Therapist, Parent Coach and writer. She specializes in struggling adolescents and their families. She helps parents focus on relationship, attachment and connection and helps teens achieve greater developmental well-being.
She is writing a book that explores 21st century parenting. Kimberly is married with four kids and divides her time between her private practice in Arlington and Vermont.
Find out more and read her blog at KimberlyHackett.com. Kimberly can be reached at Hackett.kimberly@gmail.com.

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Relationship Parenting – A 21st Century Requirement

By Kimberly Hackett, LMHC

Kimberly Hackett, LMHC

Kimberly Hackett, LMHC

“She doesn’t need me. She tells me a thousand ways everyday.”

Don’t believe it. She does need you. Now more than ever.

The parent/child connection is our most precious and enduring relationship. Like Yin and Yang, the sun and moon, Laurel and Hardy, one cannot exist without the other. We belong together. We balance one another. When it works, it feeds our soul. When it doesn’t, it is demoralizing and destabilizing – for both parent and child.

Cultivating relational health in your parent/adolescent relationship, even when your teen is actively blocking you, takes reinvention, persistence and a willingness to look inward. It can be a difficult transition moving from parenting an adoring, pretty-perfect, pre-adolescent child to parenting a teen, whose developmental job is to differentiate from her parents.

Differentiation is that growing space between you and your adolescent, where too much space becomes disconnection and too little space hinders growth. The parent/child relationship from birth onward is all about negotiating that precious space.

One way of thinking about and measuring the health of your parent/adolescent relationship is to take a closer look at the quality of the space between you and your child. This can be measured by how reactive you are around your child. Space brings calm, the ability to see more clearly. It is where the relationship thrives.

The parent/adolescent relationship demands flexibility simply because a teen’s changing needs and sense of self is dynamic and in constant flux. Understanding your teen is much like reading a book where crucial plot points are redacted. Teens are literally hard to read. And because communication changes so drastically during adolescence, it’s critical that parents adjust their expectations and perceptions along the way – not only of their child but also of themselves.

This means, quite simply, that parents must grow alongside their teen. It is a parallel process of mutual growth. It is as much internal work as it is external.

Relying solely on grades, friends or other external factors to gauge the well-being of our adolescent children can be misleading. It takes the parent out of the relational space, making them judge and juror, someone who is watching their life, not part of their life. This leads to a power dynamic where both parent and adolescent struggle with who holds the power between them, creating a match of wills.

A relationship is not one of power, but of connection, that includes mutual respect and self-respect.

Because teens want to keep parents at bay, to insure their social-emotional freedom, kids become expert actors, transforming themselves into who their parents want them to be. When parents attune to the relationship, they see beyond the “act.” Because relational parents work at being curious and engaged, teens are less likely to hide in plain sight.

In an age where cyber friending passes as relationship currency, parents are called upon as an antidote to heightening social and emotional alienation.

Real time connection is fast becoming a 21st century parenting requirement. Our children need parents to ground them, to daily sit across from them, face to face, to talk, to listen, to work through the discomfitures of this most important relationship, and to not cave in to the scowl but insist upon what’s beneath.

Only seven percent of communication is verbal, the rest is vocal, facial, gesture and posture. Parents who zero in on their child’s non-verbal language tune into their teen in a more comprehensive way. Kids need to be seen. All the cyber visibility in the world will never replace what it feels like to be seen in real time.

The 21st century parent/adolescent relationship is much like turning the radio on. When there is static, you automatically adjust the dial for clearer reception. Static is important. Static lets parents know something is up, something needs attention. Static catches your attention. It’s the red blinking light. You know to slow down and focus in, to both yourself and your child.

In 1953, pediatrician Donald Winnicott coined the term, “good enough mother.” The good enough parent is someone who works at it, but is not always successful, someone who doesn’t give up, someone who accepts the messiness and work of relationship.

The success of the parent/adolescent relationship must start with the parent. Many parents don’t like to hear this. Old school parenting thinking creeps in – “do as I say, not as I do.” “How dare she talk to me that way? She needs to change.” But the parent/adolescent relationship must remain an inherently unequal relationship. Parents must be in charge. They must set the relational standard. Your efforts now will be repaid hundredfold in your child’s future relationships, both personal and professional.

Our 21st century teens consider themselves relationship savvy and cooly cynical about connection, especially when it comes to their parents. Yet they are craving authentic connection. Teens today have instant access to escaping any relationship that hints at awkward or scary. This is where relational parenting comes in.

Our children are fast becoming the Disconnect Generation. Whenever they are the least bit relationally uncomfortable, they can block, delete, or un-friend anyone in an instant. Sitting in their room pondering life, sitting with “awkward” or “scary,” without screen escapism, is fast becoming ancient history. Parents are beginning to truly grasp the stark reality that we have no control over what worlds our children enter behind their bedroom door.

All the more reason then, that relational parenting is needed more than ever. Solid, firm and loving connection is the antidote to silence behind closed doors. Our 21st century children are in need of their parents’ presence in their everyday lives. Tenacity is at the top of the list of parenting traits we must all acquire. We must stick to our children with a different kind of glue, a glue that binds parent and child in real time connection.

Finally, parenting takes courage. A lot. It asks a lot of parents to stay connected to children who send strong messages they are no longer needed. But please don’t believe them. You are needed now more than ever.

Everyone benefits when parents commit to relational parenting, to insisting on connection with their child. Our children need us in a new kind of way. They need our presence, our conversation, our ability to be firm and loving and calm. They need us to keep trying, to not forget how important we are to them. They need us to insist on relationship and to remind them that life is all about cultivating those relationships, those real relationships.

 

Kimberly Hackett, LMHC, is a Family-Focused Therapist, Parent Coach and writer. She specializes in struggling adolescents and their families. She helps parents focus on relationship, attachment and connection and helps teens achieve greater developmental well-being.
She is writing a book that explores 21st century parenting.Kimberly is married with four kids and divides her time between her private practice in Arlington and Vermont.
Find out more and read her blog at KimberlyHackett.com. Kimberly can be reached at 617-475-0942, or email – Hackett.kimberly@gmail.com.

 

Parenting Matters is a collaboration between the Colonial Times Magazine and the Town of Lexington Human Services Department. This column is not intended as a substitute for therapy and the contents are do not necessarily reflect the views of CTM’s editorial staff. The information contained in Parenting Matters is for general information purposes only and should not be considered a substitute for the advice of a mental health professional, diagnosis or treatment.

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Getting Your Partner to (Really) Listen

Robyn Vogel, MA, LMHC

Do you wish you could tell your partner what you are feeling more easily? Are you looking for a way to have a productive conversation without playing the blame and shame game? Do your “discussions” sometimes last into the wee hours of the night leaving you exhausted the next day?

When you have something important to share with your sweetie, you will need these 4 simple steps:

1. Choose the right time for ‘you’ to have the conversation (consider your time & your energy level)

2. Ask your partner if s/he is willing to talk at that time

3. Be willing to hear ‘no’ and ask for a better time

4. Schedule the conversation and agree to an ending time

Getting your partner to listen when s/he is not truly available can feel very frustrating — which only adds to an already charged situation.

If your experience is anything like mine used to be, your life is busy and it’s hard to fit time in for anything extra! It’s “easier” to avoid difficult conversations than approach them. You are frustrated because you often have to sift your way through the fog of blame and shame to get to clarity. You don’t feel deeply heard.

Several years ago, I learned there was a different way. Thank goodness! And I teach it to all of my clients!

You and your partner are going to love how easy this is for you both.

PRACTICE TIP: Sit together facing each other. Close your eyes and take some deep breaths together. Synchronize your breath for a few minutes (feel silly? keep going…trust the process, it works!) When you feel connected via your breath, open your eyes and look deeply at each other.

Make an agreement: one person will share at a time and the listener will reflect back what s/he heard…bit by bi

Slowly….switching speakers as needed. Use “I” statements. If you find yourself saying “YOU”, take a breath and start over! A do-over is a powerful tool to use! I recommend you limit your conversation to 1 hour max.

Now, what if you have something important to share with your partner, but feel like all you want to do is blame him (or her)? Here is exactly what you need to move forward and avoid a screaming match.

Take 5-10 minutes to journal what you are upset about (don’t skip this very important step!)

Re-read what you wrote and highlight every “you” or “s/he” and change them to “I” (this is called “the turn-a-round” according to Byron Katie’s The Work)

Look over the “I” statements and find nuggets of truth (leave the rest)

Now choose the right time for ‘you’ to have a conversation. Ask your partner if s/he is willing to talk at that time. Be willing to hear ‘no’ and ask for a better time. Schedule the conversation and agree to an ending time no more than 1 hour later.

You’ll want to take the steps above to heart and please share them with your partner. The idea here is that you don’t blame or shame your partner and s/he doesn’t do that to you!

It feels terrible to be on the receiving end of someone else’s blaming! “Well everything’s ruined and I’m upset because of YOU!” “I’m disappointed because you did this and you did that…and you made me feel this way or that way…and on and on and on.” We’ve all heard those words before. Sadly. And have those conversations been productive? Are they loving?

There’s more but I don’t want to give you too much at once. So begin with the invitation above (the steps) – and practice as often as you can.

You and your partner are on your way to deeper love already! Congratulations!

Robyn Vogel, MA, LMHC

Robyn Vogel, MA, LMHC

 

Robyn Vogel, MA, LMHC, is a psychotherapist and intimacy coach who serves the community by offering counseling to couples. For 20+ years, she has been supporting others in creating more love in their lives. Robyn has been trained in several body-oriented modalities which support her spiritual approach to healing and her deep connection to this work.  Some of those include: Conscious Communication, Family Mediation, Internal Family Systems, Sex Coaching and Yoga Therapy. To contact Robyn Vogel, please call 508-380-9254 to schedule a free consultation.

 

Parenting Matters is a collaboration between the Colonial Times Magazine and the Town of Lexington Human Services Department. This column is not intended as a substitute for therapy and the contents are do not necessarily reflect the views of CTM’s editorial staff. The information contained in Parenting Matters is for general information purposes only and should not be considered a substitute for the advice of a mental health professional, diagnosis or treatment.

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Complex Sibling Relationships

If sibling rivalry is an issue that affects your household, you may understand how stressful it can be for everyone in the house to bear. You may be at a loss to know how to stop the fighting, or question whether they shouldn’t just, “work things out.” Let’s first take a look at the basis for sibling rivalry.

Tension between siblings can run in a few different forms. One form that is most common is that siblings tend to look at each other as equal even if their age is not. This may come out as, “Why does she get to have a phone?” or, “Why can’t I stay out that late?” School-age kids especially may be very black and white in their thinking about fairness, such as when they see parents giving preferential treatment to a younger sibling (such as greater physical affection).

A second form of tension stems from individual temperaments. These temperaments, including mood, disposition and flexibility, as well as their unique personalities play a large role in how well siblings get along. For example, if one child’s disposition is to be okay with close proximity, but another child delineates their personal space, it c

Patti Grant, LICSW

Patti Grant, LICSW

an lead to conflict. “But that’s my side of the couch!” Does this sound familiar?

Another form of tension can stem from kids that have special needs, either emotionally or medically. The child who isn’t sick may resent the amount of the parent’s attention that this sibling needs. This child may also not be able to verbalize this feeling well, and it may come out in a way that makes it hard to address, such as, “Why does he always get everything he wants?” Maybe this is a phrase you tend to hear that leads to tension for everyone.

The final form of tension that can impact siblings is their role models. The way that parents-and other close family members-resolve problems and conflict sets a strong example for their kids. If family members tend to yell, call names and isolate themselves, siblings are likely to do the same. However, if family members can work through conflict in a way that’s healthy and respectful, it increases the chance that the children will adopt the same tactics.

So what do you do when the fighting starts? Whenever possible, don’t get involved. If the siblings can work things through in a productive way without your help, that will be the best for their self-esteem and problem solving development. You also risk been seen as taking sides whenever you step in, based on past experiences of the children or simply even the timing of when you step in. However, always intervene in a situation where you feel they might become violent with each other.

If and when you do decide to step in, try to resolve problems with your kids, not for them. Following are some suggestions to follow when stepping in.

Separate kids until they’re calm (as well as yourself). Unless everyone is calm, fighting can resume and the problem solving cannot.

Take the focus off blame, as focusing on who’s to blame only exacerbates fighting. This can be done by encouraging each child verbalize their concerns, one at a time.

Voice your own concerns for their fighting, such as how you feel like family life could improve, or how you’re concerned they’re going to hurt each other.

Ask them to come up with a mutually agreeable and feasible solution that addresses all the concerns. Be careful to throw out solutions that won’t be likely to have follow through, or ones that don’t consider all of the concerns.

Support solutions that children come up with, check their follow through and come back to the table to talk if the solution is attempted and it doesn’t help resolve the original concerns.

There are also some simple techniques that can be used every day to help kids get along. An important one to use is to explain to the child that, “equal is not always fair, and fair does not always mean equal,” in that each child gets what he or she needs, and sometimes one child may need more than another. Another important technique is to set ground rules for behavior. Tell the kids that if an argument starts, they must keep their hands to themselves, and yelling, cursing or name-calling, as well as abuse to objects (slamming doors or throwing things) are not allowed. Explain to kids that they are not responsible for getting angry, but they are responsible for their behavior.

You can also be proactive in getting involved in each of your children’s interests, and make sure you give each child some one-to-one time on a consistent basis. Make sure each child has their own space to do their own thing, either to take space quietly, go outside, or enjoy activities with peers without their sibling tagging along. Tell your kids that you love them both, without limits.

It’s also important to have fun as a family as well. It can be as simple as throwing a ball together or playing a board game, something that establishes a peaceful time that you can all relate as a time that everyone got along well. Also keep in mind that the fighting may be for attention, and if you leave the situation, it may remove the incentive for fighting.

If fighting is occurring daily, you can hold family meetings weekly or daily to review the ground rules and work on solutions to resolve conflicts, as outlined in the bullets above. If children frequently fight about the same issue, it’s a sign that a collaborative approach is needed, with parents modeling problem-solving behavior.

In a small percentage of families, the conflict between siblings is so severe that it disrupts daily functioning, such as the children’s ability to go to school on time or attend extra-curricular activities. Fighting can be so severe that it can affect kids emotionally or psychologically. In these cases, please do seek help from a mental health professional. If you have any questions about your children, you can also speak to their pediatrician, who can help you assess whether you and your family might benefit from seeking out professional help or refer you to local behavioral health specialists.

 

Patti Grant, LICSW (617) 606-7450

grant@copernican.us

Private Practice:

Newton: 44 Thornton Street, Newton,

Lexington: The Liberties, Suite #11, 33 Bedford Street, Lexington, MA 02420

Copernican Clinical Services: www.Copernican.us  “We Help People Change”

Phone: (617) 606-7450

 

 

Parenting Matters is a collaboration between the Colonial Times Magazine and the Town of Lexington Human Services Department. This column is not intended as a substitute for therapy and the contents are do not necessarily reflect the views of CTM’s editorial staff. The information contained in Parenting Matters is for general information purposes only and should not be considered a substitute for the advice of a mental health professional, diagnosis or treatment.

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Anger Outbursts: Common Myths About Anger Management and Thought Based Interventions that Actually Work

Dr. David Perna

If you are a parent who is struggling with your child’s anger outbursts stop blaming yourself. Instead, join the crowd. I work with a multitude of educators and mental health professionals who are equally stymied by kids who display anger outbursts. And they are professionals. They typically use outdated solutions that do not work like, “I just have them hit a pillow,” or “I tell them to count to ten.” These interventions typically don’t work. How do I know that these interventions do not work? I simply ask my patients. They have said, “That is the dumbest thing I ever heard-count to ten.” Or, “I am getting really good at hitting my pillow, and my brother.”

Research shows that if you want kids to punch someone when he/she is angry then simply have him/her practice punching something on a regular basis, such as a pillow. Remember, practice make perfect. I help teach kids that angry oubursts are a choice. These behavioral choices are influenced by the thoughts that precede them. By working to understand their unhealthy thoughts they can avoid poor choices. It might sound complicated but it is pretty simple. Here are three examples.

1. Poor Reality Testing: We commonly think that everyone shares a common sense of reality when an event occurs. However, kids who struggle with their anger have a difficult time with shared reality whether they are participating in a sporting event, a birthday party, or a board game. Younger children are more prone to these kinds of challenges given their age and limited ability to understand many cultural/societal/group rules. Kids with anger challenges commonly maintain a more regressed view of the world. In essence they are not tracking the same information that most kids are paying attention to. In the end they make behavioral decisions that cause tension and then lash-out when other people challenge their perspectives.

Example #1: An example of Poor Reality Testing would include a child who “throws a nutty” while hitting during a baseball game. In this situation he is likely to think that the umpire’s call was wrong, quickly feel embarrassed and humiliated, and then start to throw his bat and helmet to the ground. Reviewing with him over and over again, “Take a deep breath,” will not work. He believes he was wronged. A better foundational intervention would be to talk with him about how people see things differently. How umpires sometimes make mistakes. And how although he has a right to an opinion in the end the umpire has the final say. Reminding him before he steps up to hit that he should try his best, but abide by the umpire’s feedback is most critical. After he bats you can encourage him to tell you his opinion of the umpire’s calls whether or not he gets on base. This will allow him to anticipate a difference of opinion and provide him with an outlet for discussion. Increased language usage leads to increased reality testing.

2. Pseudo-Paranoia: Pseudo-paranoia is evidenced by the extent to which certain kids seem to always start off with a negative view of others. No one is trusted until they “prove” themselves, and the proof required is tremendous. These kids are not fully paranoid in the sense that they do not think that the government is planting transmitters in their teeth, however, they tend to focus on what is wrong with others rather than what is right about them. Pseudo-Paranoid thoughts commonly piggyback on top of poor reality testing and enhance it.

Example #2: Sometimes kids will think that their schoolteacher does not like them. Despite any practical proof they think that other children in their class are favored. Many times they will erupt in class and lash out yelling that the teacher is not fair, cares more about the boys than the girls, or specifically chose a writing activity since the teacher knew that she “hates writing.” In such circumstances it is important for the teacher to articulate to the student why certain activities are important.

I will frequently tell teachers that they need to catch my patients “doing things right.” By balancing out one situation where a limit is set with five situations where they offer praise I have found that my patients will typically settle down and feel at ease. Parents will commonly comment to me, “I don’t want my kid to feel indulged or to become spoiled.” I will typically respond by saying that without such balancing their child will be so overwhelmed each day in school that he/she will not make progress. The first step is always balance and calming. During this phase the emphasis is on providing firm examples that substantiate that the teacher is fair. The second step is to offer better reality testing.

3. Rumination: Cognitive rumination is based upon the rather distasteful notion of actual “rumination” which is exemplified by a cow chewing and re-chewing its cud. Unlike most people who are impacted by an event, digest it, and let it go, kids with anger disorders are marked by an inability to let things go and cognitively move on. These issues keep coming back up again and again in their thoughts. When angry kids recirculate these “stuck thoughts” they display a limited ability to show restraint. Like a snowball that gathers energy and weight as it rolls down hill, ruminating thoughts generally gather steam and lead to an explosive release.

Example #3: Adolescents tend to struggle with ruminating thoughts. It is common for them to arrive home, go to their room and start to brew about an earlier conflict. When an unsuspecting parent knocks on their door to tell them it is time for dinner, he/she is typically bombarded with an emotional barrage that throws them for a whirl. Parents commonly start to scream in response, which in turn provokes a verbal trench war. And let’s be clear, trench warfare never really ends pleasantly. In contrast it would be better for parents to remain calm, note their surprise in not knowing that their child was upset, assume that their child has some legitimate reason to be upset and ask him/her to simply put his/her frustration into words. Be patient. Remember, verbal mediation is the “Holy Grail” of anger management. Good luck! Better yet, Good Skills!

 

Dr. David Perna

Dr. David Perna

Dr. Perna is a licensed psychologist who has an expertise in the treatment of child/adolescent anger management and its relationship to learning challenges. He is the owner of Copernican Clinical Services, a group practice with offices in Lexington and Newton, MA. He works with families, schools, and various professionals in addition to running specialized anger management groups. He maintains an academic appointment at Harvard Medical School and is a Clinical Associate at McLean Hospital, the medical school’s largest psychiatric teaching facility. He is the former Director of the Child/Adolescent Anger Management Program at McLean Hospital. Feel free to follow his newsletter/postings/ramblings about anger management, learning, adolescent psychology, and family therapy on the web: www.copernican.us, or visit his personal website: www.davidperna.com.

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Pop Quiz: Which Mouse has ADHD?

By Henry David Abraham MD

If you harbored any doubt that ADHD is real, take a look at the time-lapsed photo below. It comes from Duke University where they are trying to define ADHD on a molecular level. The mouse in the left test-tube is normal. The one in the middle is missing a certain gene. The one in the right tube is missing a pair of those genes. The blurred image tells the story. Hyperactivity is for real, at least in mice.

But if you or your child has suffered from attention deficit-hyperactivity disorder you don’t need evidence from a lab. The classroom tells the story well enough. The ADHD child is the one who can’t keep his seat, who runs and climbs at the wrong times, who can’t wait his turn or keep from talking. A more subtle form is found in the kid who can’t pay attention, can’t organize, is forgetful, distractible, and forever losing things. This is the inattentive type of ADHD. Kids with poor attention have trouble reading. Kids with hyperactivity have trouble listening. Some kids have both types.

We even know where it comes from, sort of. Genes have been identified. Smoking in pregnancy increases the chances a baby will have ADHD. Even Tylenol in pregnancy increases the odds somewhat. The problem is that there is no simple test that clinches the diagnosis. It’s more a matter of a consensus between parents, teachers and doctors that seals the deal. Knock one of those out of the discussion, and you open the door to years of error.

Consider a short list of some of the other problems that can cause hyperactivity without ever being ADHD: learning disabilities, autism, mood disorders, drug abuse, caffeine, thyroid disease, asthma medication, to say nothing of a new sibling, new school, divorce, or death of a parent or grandparent. If there is one take home lesson, it’s that diagnosis should drive treatment, not the other way around.

When people agree on the diagnosis, treatment should follow two principles. The first is to create a state in the child of what AJ Martin calls “academic buoyancy.” That’s when a student develops the capacity to overcome setbacks that are typical of ordinary life at school. In severe cases medication is nearly always essential, since a strictly behavioral program is not likely to succeed alone. But behavioral steps in class and at home are essential. These children are not simply going to be cured by a pill. Needed as well are getting classroom accommodations, building classroom citizenship, making and keeping friends, and seeking schoolhouse victories in class and after school.

This brings up a second principle. Treatment must protect the children from us- the swarm of well-meaning parents, teachers, counselors and doctors who all want to do something about this whirling dervish of a child. Too often an overly aggressive treatment plan labels the child as trouble, a poor learner, not normal. The result is stigma, social isolation, and the continual drumbeat of inadequacy that the child hears and comes to believe. It’s not that you should do nothing. But whatever is done has to be done carefully. Note that on the average, symptoms diminish by about 50% every 5 years between the ages of 10 and 25. It’s fair to ask if a child’s problems are likely to disappear by adulthood, why treat in the first place? Because they may not, and without treatment she is in for a childhood surrounded by handwringing adults. This is not good for anyone.

What about the child with mild or moderate ADHD? They look OK for the most part, like the mouse in test-tube 2, but they still stand out by being inattentive rather than hyperactive, girls rather than boys. They are also annoying, irritable, friendless, indifferent to school work, anxious, or depressed. They may be helped by classroom accommodations, tutoring in tough subjects, and a little more parental involvement. Medications may be an option if behavioral approaches don’t do the job.

Medication is a big stick, and there are risks as well as benefits. Medications for the most part are stimulants. They are abusable, addictive, and with unpleasant side effects like insomnia, anxiety, and weight loss. In large doses they cause paranoia and psychosis. On tests and papers they can result in blithering. Worse, in a Dutch study of heroin addicts, fully one quarter of them had ADHD. And among ADHD patients, the risk for drug abuse was increased seven times.

So why has the sales of stimulants for ADHD quintupled in the last ten years? The answer is vividly described by Alan Schwarz’s recent piece in the New York Times, “The Selling of Attention Deficit Disorder.” The sale of stimulant drugs is big business. Shire, the world’s biggest producer of ADHD drugs, just recorded some of its highest profits, largely based on sales of its stimulant Vyvanse. Shire even supports an on-line six question self-quiz to tell you if you suffer from their favorite disease. Nearly half the people who took the quiz for the Times were classified as possible ADHD cases. (Trouble wrapping up a project? Sounds serious. Call your doctor!) Stimulants have a ready market among desperate parents, hurried doctors, and students willing to divert their drug supply to friends who want to pull an all-nighter. The medications also have a thriving after-market among addicts. Heroin may have killed Philip Seymour Hoffman, but stimulants helped. A reporter for Al Jazeera asked me recently if normal college kids should use stimulants to enhance their school performance. Brave new world, that has such questions in it.

 

Henry David Abraham, M.D.

Henry David Abraham, M.D.

Dr. Henry David Abraham is a psychiatrist in Lexington, MA. He is the author of several books on drug education, including What’s a Parent to Do: Straight Talk on Drugs and Alcohol, and the e-book for teens, The No Nonsense Book on Drugs and Alcohol, available on Amazon.com and BN.com.

 

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