Category: mental illness

Unsettling: What psychosis looks like in children and young people

Unsettling: What psychosis looks like in children and young people

kill him street
This eerie painting is by a young woman of 22 diagnosed with schizophrenia. She is encountering a threat, real or imagined, and her paranoia is compounded by being watched from the window above. Note the symbolic references to communications links and satellites.

Odd, eccentric, a little weird:  people experiencing psychosis are living in dream space.  If you haven’t experienced psychosis yourself, it’s a little like the period just before you awake, when you’re in a dream but also aware of your surroundings.  Your dream and emerging consciousness weave together in a wonderful or horrible or simply odd narrative.  If you try to explain it someone, you realize it makes no sense, yet it made a lot of sense while you were dreaming.

To a parent watching a psychotic child, you may observe that they see, feel, hear, move about, and respond to you as if fully conscious, but it’s important to know that they simultaneously inhabit the subconscious. As a result, they don’t notice that what they do and think is any different from anyone else.  The term “anosognosia” refers to their inability to recognize this, and it explains why so many resent being told they have a problem and need treatment.  They simply aren’t aware that anything is different about them.

Evidence of psychotic behavior

Parents of a child who was eventually diagnosed with a psychotic disorder often report that their child was always a bit different from their peers–slightly eccentric, a unique individual who had an interesting way of looking at the world. Parents have also reported the following behaviors when their child was exhibiting psychosis.  (Not all of these are present in each child.)

  • A belief in something that isn’t rational, and the belief is unusual or unreal or impossible.  The person cannot be talked out of the belief.  And rational, logical reason only increases resistance to reason.
    • If the psychotic episode is positive or magical, the person may have powerful religious feelings and a sense of omnipotence or clairvoyance. They may believe they have been instructed to give a message to save the world, for example.
    • If the episode is negative and paranoid, they can become very agitated, fearful, or they may panic.  They may act negatively on irrational beliefs.  They are attracted to paranoid or extremist views, especially those with high emotional content.
  • Smiling or laughing at nothing in particular and for no apparent reason. It’s as if someone has just told them a joke.
  • Yelling or ranting, this could be at an object or at someone or at nothing apparent. The ranting can happen online.  The ranting has repeated themes, and the themes are unique to each person.
  • Intense, crushing anxiety, irritability, accusations, and obsessive troubling thoughts.
  • Talking and gesturing as if they’re in a conversation with an invisible someone. (Normal people also gesture they think, but they are aware they are not literally communicating with someone.)
  • Wandering eyes and shifting body language as if they are seeing or feeling things that aren’t there.
  • Abrupt personality change from seemingly normal behavior.  Often, a child’s eyes will have a disquieting faraway ‘look’, as if the child is not in their body, and a they’ve been overtaken by a demon.
  • Fear, anxiety, and paranoia–they feel watched, trapped, and controlled in some way. They stop trusting people.  They hide or try to block experiences to protect themselves.
  • Intense obsessions with ideas, things, or events (even if they occurred long past). Themes emerge which often refer to actual events that elicited strong emotions.
  • Seeing patterns and connections in events that aren’t connected.
  • Unusual and confusing responses when communicating with others—a comment that doesn’t seem to apply, or a a string of words that defy interpretation.
  • A preference for solitude and closing themselves off from others.  This is for self-protection.
  • Loss of interest in self-care: not wearing clean clothes, bathing, or organizing their surroundings.

The most common diagnoses that have psychotic features are schizophrenia, schizoaffective disorder, bipolar disorder, and depression.  This story about schizoaffective disorder gives some real world examples of psychosis:  “Life with a Schizoaffective Teen.”

Psychotic behavior can have a long slow onset

brain degeneration in schizophrenia
The image on the left is of a 15-year-old boy with early onset schizophrenia. The purple regions have normal neuron density, red regions have low neuron density. In the 2nd image, the red area at the top of the brain is in the cerebral cortex, the region of executive function and rational thought.

It’s easy to miss signs of early psychosis!  Sometimes a child or young person starts showing eccentric behaviors that aren’t serious or are easy to interpret as something else: creativity and imagination; immaturity; puberty; influences from immature friends; too much video gaming…  Your child may have been experiencing mild visual or aural hallucinations for some time, even a couple of years, and just assumed it happened to everyone so they never reported it.  As psychosis emerges in the early teens, their thoughts and behaviors start affecting friendships or school work.  The child stops doing things they once enjoyed.  Someone might assume they’re experimenting with drugs.  They seem so much like other difficult, distracted, or defiant teens that a parent can be lulled into thinking they are not seriously mentally ill… but psychosis is very serious.

If this describes your child, immediately (and I mean immediately) find a psychiatrist and get an assessment.  The earlier you can treat psychosis, the better the outcome for your child.  Psychosis is degenerative.  The longer a brain stays in a state of psychosis, the more neurons it loses.  Early treatment via therapies, medication, diet, and other physical supports can literally prevent neuron loss and future psychotic breaks that require hospitalization.

Psychosis can emerge abruptly

For disorders on the schizophrenic spectrum, this is common in young men in the late teens and early 20’s.  However, adults in their 30’s and 40’s have also been known to have sudden onset of psychosis.  It’s tragic, you witness this young person launching into adulthood, studying in college or starting employment, and suddenly his or her personality changes.  Their behavior worsens, and it becomes evident they’ll never be able to have the future they planned.  They need immediate treatment, possibly hospitalization if the psychotic break reaches a crisis point.  If this is your child and they are past age 18, use every means possible to get help for them!

Kendall art
Self-portrait by a 24-year-old woman diagnosed with schizoaffective disorder. Her image is a modified mug shot photo taken of her after an arrest.

What worsens psychosis and what you can do to relieve it

  • Poor sleep and reduced sleep.

Help your child get enough hours of sound sleep. The best sleep environment is a cool very dark room.  Once my child became unable to attend high school, I allowed her to nap any time of the day.

  • Closing themselves off from the world.

Your child needs mental and sensory stimulation to keep their mind from spinning out on their obsessions, hallucinations, and paranoia, but the amount must be tolerable.   Stimulus must come from the tangible, sensory world (e.g. not screen time, videos, books).  Concrete interaction with reality diverts their attention from obsessive thoughts or voices.  They will benefit from regular (perhaps limited) social interaction*, an undemanding therapy animal, creative work (such as art and music), and being out in nature.

  • Marijuana use–specifically the THC in marijuana

CBD in marijuana has many medical benefits and is considered safe, but the THC is not.  THC is also addictive, and available in very highly concentrated oils… extremely dangerous.  Like THC, any addictive substance, from alcohol to methamphetamine, will interfere with treatment for psychosis.  The drug’s influence trumps everything.  Drugs are literally self-induced psychosis.  See:  “Marijuana is Uniquely Harmful to Troubled Teens”;  “Marijuana is Dangerous.”

  • Continual exposure to things they already obsess on or that make them paranoid, angry, or anxious.

In every way possible, keep your child away from any material, people, or messages that upsets them.  These only add gasoline to the fire and increase the likelihood of future psychotic breaks.  They may obsess on the same things for the rest of their lives.  If someone who’s psychotic is exposed to intense emotional experiences that feed their obsessions and paranoia, people have been known to do to horrible things to themselves or others.  An example at the time of this writing is of a young woman with psychotic bipolar mania who tragically pulled out her own eyes.

Find ways to redirect your child’s attention elsewhere and help them get a grasp on the reality.  Help them calm down (“deescalate” them) and help them learn ways to calm themselves down.

A diagnosis of an illness that includes psychosis is devastating

Face to facePsychosis and/or a psychotic crisis in a child who previously led a normal healthy life blindsides everyone, especially the family.  Allow yourself to go through the stages of grief as you would after any death…  because it can feel like the ‘death’ of your child and their future and your hopes for them.  Get help from others as you would after any death.  Here you are, grieving, but your child needs you to be strong!  Get help for your own mental health.

Reason for hope

Children who receive regular social support from family and loved ones do well over the decades.  They can avoid homelessness, hospitalizations, harm.  They can get advanced education, keep strong relationships, maintain employment.  They get a life of wellbeing.  This has happened with my adult child after years of horrendous experiences.

Cognitive Enhancement Therapy

A relatively new therapy has been developed and tested that meaningfully helps people with chronic psychotic disorders.  “CET attempts to increase mental stamina, active information processing, and the spontaneous negotiation of unrehearsed social challenges. It does so with a focus on enhancing perspective taking, social context appraisal, and other components of social cognition… CET has been shown to have remarkable and enduring effects in a study of persons with schizophrenia or schizoaffective disorder…”
–CET Training LLC, “approved and recognized by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) as an evidence-based practice.

What are your experiences?  Have you found anything that helps?

–Margaret

 

*Social Interaction Increases Survival by 50%
Psychiatric Times. July 30, 2010

Theoretical models have suggested that social relationships influence health through stress reduction and by more direct protective effects that promote healthy behavior. A recent study confirms this concept.  Findings from a meta-analysis published in PLoS Medicine indicate that social interaction is a key to living longer. Julianne Holt-Lunstadt, PhD of Brigham Young University and colleagues analyzed data from 148 published studies (1979 through 2006) that comprised more than 300,000 individuals who had been followed for an average of 7.5 years. Not all the interactions in the reports were positive, yet the researchers found that the benefits of social contact are comparable to quitting smoking, and exceed those of losing weight or increasing physical activity.

Results of studies that showed increased rates of mortality in infants in custodial care who lacked human contact were the impetus for changes in social and medical practice and policy. Once the changes were in place, there was a significant decrease in mortality rates. Holt-Lundstadt and colleagues conclude that similar benefits would be seen in the health outcomes of adults: Social relationship-based interventions represent a major opportunity to enhance not only the quality of life but also of survival.”


If you would like to get ongoing updates on the latest news and research in child & adolescent mental health, follow my Facebook Page.

Welcome to the 911 Club for Parents of Troubled Kids

Welcome to the 911 Club for Parents of Troubled Kids

Let’s start a 911 Club, a community for parents who depend on emergency services for managing their mentally ill child. Our T-shirts would be black and blue like bruises. Only people raising a mentally ill child or young adult could join. Club rules would be simple:  1. No one is ever judged. 2. We keep things confidential. 3. Everyone is made to feel like a hero. 4. Everyone accepts that they are not guilty or failures, and neither are their children.

Every day, an emergency is just around the corner.

Parents with troubled children, no matter the age or diagnosis, are forced to make difficult decisions and take extreme actions… like calling 911.  It’s not something they choose, and they’ll avoid it if possible.  They are like any other parent with a severely disabled or physically ill child—they will do anything to help their child, but instead of wheelchairs or chemotherapy, they need emergency responders.

Most parents with normal children will never need to do the following 10 things that parents of troubled children often do:

  1. Call police
  2. Call an ambulance
  3. Or call a crisis line repeatedly
  4. Search a child’s room, especially if the child is a teenager or may be suicidal
  5. Spy on their child: read their email, texts, social media or search histories, read their journals
  6. File criminal charges or get a restraining order
  7. Lock up common household items (matches, knives, scissors, fuel, and anything conceivably dangerous in the wrong hands)
  8. Participate in endless meetings, appointments, and therapy sessions. Complete dozens of forms and continually pursue financial or community mental health resources
  9. Block out people who used to be friends
  10. Never share our stories with ‘normal’ people lest we get bombarded with uninformed and unsolicited opinions.


Parents can see an emergency coming, but can do little to prevent it.

All parents of troubled children have barriers to getting help, even when it’s blatantly obvious that the child needs it.  Why?  The aftermath of a recent high school shooting in Florida by provides details:

  1. The tragedy has to happen first: “A neighbor warned the sheriff’s office …and begged them to intervene. She was told there was nothing deputies could do until Cruz actually did something.”
  2. Mental health professionals don’t take history into account; and they are ignorant that children can behave well in their presence: “An investigator … spoke to Cruz, and advised that he was “not currently a threat to himself or others” and did not need to be committed.
  3. Family and other eyewitnesses are ignored by the people and institutions they depend on. “Lynda Cruz’s cousin warned deputies Cruz had rifles and pleaded for them to “recover these weapons.”


Policymakers, mental health professionals, and emergency responders out there:  fix this!

Part of the reason parents or family of the mentally ill person can’t get timely help is because of civil rights laws.  To those in the mental health community, start talking about how to handle this.  The present situation is unacceptable!  Stop protecting an acknowledged dangerous person’s rights over those of innocent victims.  It’s not OK.  This is just like some gun advocates who think it’s more important to sell assault rifles to protect their personal rights over those of innocent victims.

True Story

An upsetting thing happened in my city about 10 years ago that could have been my story. A man took his grown son to the emergency room because the son had been insisting he was going to stab someone—he suffered from untreated schizophrenia. When there, the staff found no reason to hold the son despite his history of violence and his father’s testimony. The father pleaded with them to put his son in a 72-hour hold and they refused.

Within minutes, the son ran off into the surrounding neighborhood, and within an hour, had stolen a steak knife from a restaurant, and ran out and stabbed a man walking on the sidewalk. (The victim lived, fortunately.) The father told the reporter that he’d been trying every possible means to stop this from happening in the hours before the event. Getting the son to go with him to the ER was an extraordinary feat in and of itself. He was beside himself with frustration and sadness and anger.  Now his son had aggravated assault and attempted homicide charges, and faced prison instead of a hospital.

–Margaret

 

U.K. needs to be a “999 Club”; Germany needs a “112” Club; a “110 Club” in China…

Your child’s ADHD diagnosis could be wrong, leaving other issues untreated

Your child’s ADHD diagnosis could be wrong, leaving other issues untreated

Inattention and distractibility are caused by many medical conditions and life situations.  You child may not have ADHD or ADD if they didn’t show signs when they were young.

Children don’t just catch ADHD or ADD

If your child has a behavioral change you haven’t seen before, there may be an underlying medical or co-occurring mental disorder that’s causing ADHD symptoms… especially if they’re on ADHD-ADD medications which are not working well.

“It is vital not to mistake another medical or psychiatric condition as ADHD.”
Richa Bhatia, MD, Fellow of the American Psychiatric Association

The medical conditions listed below produce ADHD and/or ADD symptoms such as slow processing speed, impulsive behavior, and limited attention and focus.

  • Epileptic seizures: some types cause a brief freeze in thinking–the child’s brain goes blank for a few moments (“absence seizures”)
  • Diseases of the brain: Lyme disease, HIV infection, parasitic and viral infections, brain tumors
  • Brain damage from head injury or toxins (e.g. narcotics)
  • Chemotherapy side-effects, “stupor”
  • Hypothyroidism.  Too little thyroid hormone results in memory, attention, and concentration problems. It decreases blood flow in brain regions that mediate attention and executive functioning (the hippocampus and cerebral cortexes).
  • Hyperthyroidism. At the other extreme, too much thyroid hormone causes anxiety and tension, irritability and impatience, and hyperactivity and distraction.
  • Sleep apnea. A condition where a child stops breathing during sleep, for a few seconds to a few minutes several times per night.  The following day, the child can’t pay attention, remember, or follow a sequence of steps.  It also causes hyperactivity and belligerence.


Mental health disorders with ADHD-like symptoms:

Anxiety disorders are common to most other mental health conditions, and create problems with concentration.  The chronic stress from anxiety affects the brain regions responsible for memory and cognitive functions.   If a child does not have a history of ADHD symptoms, than significant and pervasive anxiety may be the cause of inattention and distraction.

Abuse or trauma. Difficulty concentrating is one of the core symptoms of post-traumatic stress disorder (PTSD), and recent abuse or trauma can cause agitation, restlessness, and behavioral disturbance—symptoms that mimic ADHD.

Depression – Difficulty concentrating also is a criterion for major depressive disorder.

Bipolar disorder – ADHD symptoms are apparent in children with suspected bipolar disorder. Both disorders can cause distractibility, increased energy, and instant mood swings. (Some children are eventually diagnosed with both disorders.)

Drug abuse using marijuana, cocaine, ecstasy, produce similar symptoms of ADHD because they affect the same brain regions affected by anxiety.  MRI scans of the brain were taken of young children who were exposed to cocaine in the womb. The scans revealed frontal lobe malformations which predicted long-term problems with attention and impulse control.

Common stimulant foods and beverages with excess caffeine or sugar

Insomnia from medical conditions. Sleep plays a huge role in memory and attention. Sleep disorders (e.g., sleep apnea, restless legs syndrome) can produce chronic tiredness and significantly reduce attention, concentration, and cognitive functioning in children, adolescents, and adults.

Plain old lack of sleep in healthy children can cause inattention and reduce academic achievement.  There are many causes of sleep loss:  early school hours; screen time at least an hour before bed (because the blue light suppresses sleepiness); or allowing the use of technology in the bedroom at nighttime.  What helps getting to sleep and staying asleep:

  • A cool, dark room
  • Thirty minutes of reading or drawing on paper before lights out.
  • Removing phones, laptops, or desktops from the bedroom at night.


Learning disorders:
Children with an undiagnosed learning disorder often present with ADHD symptoms. An undiagnosed reading or mathematics disorder (dyslexia), or an autism spectrum disorder that’s not yet diagnosed, can have a significant impact on classroom behavior.  The child might not be paying attention because of his (her) restricted ability to grasp the subject matter, or because they are frustrated and irritated with the struggle to keep up.

Caution:  Teachers often report a student’s inattention and confused thinking to parents, and suggest a diagnosis of ADHD when the real problem may be lack of sleep or something else.  It’s useful to hear classroom observations of your child, but teachers are not trained in mental health diagnosis—get a second opinion from a professional!

More on the consequences of untreated ADHD or another underlying disorder is in this article:  “ADHD kids become troubled adults.”

–Margaret


Subject matter was drawn from this article by psychiatrist Dr. Richa Bhatia.

“Rule out these causes of inattention before diagnosing ADHD”
Richa Bhatia, MD, FAPA, Current Psychiatry. 2016 October; 15(10):32-C3

How to pick the ideal therapy pet for your child or teen

How to pick the ideal therapy pet for your child or teen

“A pet is an island of sanity in what appears to be an insane world. Whether a dog, cat, bird, fish, turtle, or what have you, one can rely upon the fact that one’s pet will always remain a faithful, intimate, non-competitive friend, regardless of the good or ill fortune life brings us.”
–Boris Levinson, PsyD, Child Psychologist

Any animal can be a therapy pet, but put thought into finding the ideal pet

It depends on your child’s individual needs and his or her innate appreciation of or connection with the creature.  Parents often think of furry animals like dogs or cats or “pocket pets” as the best therapy animals.  Dogs and cats are the most common, but they are not the only effective options.  (And some are problematic:  perhaps a family dog or cat is of no interest to your child, or is stressful because its behavior–easily agitated cats and chronically fussy dogs aren’t therapeutic!

What fascinates your child? What do they want–what creature(s) are they drawn to?  And are you willing to take care of this pet?  Your child’s therapy pet is not a lesson in responsibility… though that may be an outcome someday.  The pet is a therapist first, not a teaching tool.  Since you may be the responsible one, the pet must work for your needs and household too.

The right creature will reduce your child’s stress and continually delight them in some way.

Dogs and cats

Under the best circumstances, the right dog or cat will choose your child, calming them down or drawing them out of their shell. Dogs and cats are ideal for symptoms of anxiety, autism spectrum disorders, or depression. The right dog or cat is calm, loyal, and patient, and helps an insecure child or one who can’t handle emotional demands. Dogs also support physical exercise, and provide opportunities for significant life lessons.

True story – Some juvenile prison systems have dog programs, where the inmate is assigned a troubled shelter dog to train and teach appropriate dog behavior. Young inmates often empathize with a dog’s abuse history, and training the dog helps them learn patience, forbearance, and anger management.  The trained dogs are them adopted out to the community.  A program I personally know about has had very positive outcomes.

Pocket pets

Pocket pets help children who like touch, and bring out a child’s nurturing side. Small animals can also be playful and amusing–ferrets have especially silly antics.  It’s important the pet likes to be held, but it’s also important to prevent it from escaping and hiding. Their small size and habitat needs are better for small living spaces, and they can go anywhere with the child in a small carrier.  A concern may be their shorter lifespans. Is your child able to handle loss and learn from it?

Birds

Birds are smart ‘pocket pets’ and very loyal to the person they bond with.  A bird that’s purchased young or been hand-fed as a chick is tame and will readily perch on a child’s shoulder or finger… or happily hide out in a pocket.  Most birds can be taught words, whistles, or even songs in human language.  They are pretty, charming, highly interactive, and long-lived.  Birds are good for depressed children who need energy and stimulation, and children with ADHD who need attention and interaction.  Like a pocket pet, a bird can also travel with a child in a small carrier.

Reptiles

Reptiles aren’t often considered as therapy pets, but reptile lovers will tell you that they are indeed therapeutic and have inidividual personalities. Most are quite beautiful. Many like to be held and carried.

“She fell asleep in my shirt and nobody saw her. I noticed I was able to communicate with other people without problems. When I started to feel anxiety I put my hand over her and it calmed me downI was able to go in [a store], do what I needed to do and get out without a panic attack.”
–Teen with social anxiety disorder speaking about her Bearded Dragon.

Ask if a pet store will allow your child to hold one of their reptiles for sale.  Common pet store lizards that are good for children are:  leopard geckos, bearded dragons, and iguanas (which need lots of handling at first).  Like other small animals, reptiles can escape. Turtles are usually easy to find, but not lizards or snakes.  There are lizard leashes on the market for this reason.  Most snakes available on the market like to be held, or will accept it if handled often.

Fish

Beautiful calming aquariums are excellent sources of visual delight and serenity. There is a reason aquariums are placed in waiting rooms and in psychiatric hospital settings.  They provide gentle entrancing movement in a miniature natural world—they are healing like Nature is healing.  An aquarium is good for children with intense anxiety they can’t express, often with schizophrenic or autistic symptoms.  The soft bubbling sound can be calming because it is steady and hides noises that may overstimulate a child who’s grappling with a stream of upsetting thoughts.  Read more about “calming rooms” and how visual and audio environments help children with tantrums, “Calming room ideas to prevent tantrums in autism and other disorders.”

Insects (yes, insects)

I have two stories about therapy with insects

True story – A depressed 9-year-old boy was regularly teased at school, then came home to a single mother who was always too distracted by dating concerns to spend time with him. His father found a second wife and started a new family and showed little interest in him.  The boy was smart and very interested in science.  He befriended a neighbor who kept hissing cockroaches to feed her lizards, and he would visit often and ask to hold a roach and pet it to make it hiss.  The neighbor allowed the boy to borrow one to take to school for show-and-tell, which he brought along in a plastic container.  The students were both fearful and intensely curious about this giant roach.  Except for the squeamish, everyone wanted to pet it to make it hiss.  He became the coolest kid in class.  His teacher was impressed because he told the story about hissing cockroaches, where they were from, and how they were part of a forest ecosystem.  He stopped being teased, and his teacher gave him more attention with science studies… all thanks to a lowly roach.

True story – An 11–year-old boy with ADHD found a praying mantis in his backyard and picked it up. He knew from school it wouldn’t bite, and that it caught and ate other insects.  He wandered around nearby homes looking for bugs to feed it.  When he caught something, he enjoyed watching the mantis snatch the bug from his finger and eat it with gross crunching sounds and goo…. awesome for a kid like him. He was allowed to keep the mantis in an empty aquarium. As Nature has it, it died in the Fall. His parents, however, purchased mantis eggs from a nursery to populate the yard the next summer. When they hatched, the boy spent hours amusing himself by finding and feeding the baby mantis population,and watching them grow to adulthood.  It reduced the hours he’d spend indoors on video games,and connected him with nature outdoors.

 

–Margaret

The Brain Diet for Troubled Kids

The Brain Diet for Troubled Kids

Kids with brain disorders need a whole body/whole life approach to treatment–no one medical practice is sufficient. Neither mainstream psychiatry or naturopathy have all the answers for mental health, but both provide important treatments:  diet, medication, therapy, exercise, gut health, and sleep, etc. This article is about brain diet specifically–foods which support or improve brain health.

These are some general rules for this food:

  • Food should be raw or as close raw as possible. Cooking removes some of the essential nutrients.
  • In the case of fish, raw may not be appropriate except for sushi or pickled herring.  For fish that’s canned, choose fish packed in oil, not water.  Omega-3’s are in the oil, but washed away in water.
  • Variety is important.  Concentrating on a few foods exclusively is not helpful because you and your child still need additional nutrients that are important for your overall health.
  • Food is better than supplements because food nutrients are properly absorbed in the body in the right ‘dosages.’  This is especially true of Kava kava–supplements and tinctures provide tiny amounts of kavalcones!  Kava should be prepared as a tea from dried ground root–at least a cup or more.  (Methods are available on the internet.)  It is very bitter, but from personal experience, very worth it!

Be aware of food fads.  There are no miracle foods.

Over the decades, people bombarded by some dietary research, and immediately demand foods that fit the limited knowledge at the time.  Food producers then label and provide whatever the public wants.

  • A good example of a fad years ago was fat-free and oil-free foods.  As it turns out, additional studies proved this was actually harmful–people need fats in their diet, but just a selection of fats.
  • For decades, coffee and chocolate were once considered harmful, but this has since been proven wrong for most people.
  • Diet sodas were supposed to be better than sugary sodas, but as medical research and understanding advanced, this was disproven.  Sugar-free sodas are actually more harmful.
  • There’s been an antioxidant craze. Yes, antioxidants are important, but these nutrients alone are insufficient for brain health.
  • The “paleo diet” was big for a while.  It was the great idea of someone who was not a paleontologist.  Paleontologists themselves aren’t comfortable with it because they are still finding evidence of what early humans actually ate.
  • Lately, everyone wants gluten-free foods. Gluten is very bad for a small segment of the population, but not most people. What’s funny as that even water is labeled gluten-free.  This is from a dish detergent label:
Seriously? Gluten free dish detergent?Labels like this are for marketing, not your health. They also reinforce a fad which is misleading.

 

High consumption of a single brain food does not improve your brain unless a test confirms you have a deficiency. 

Vitamin D deficiency is serious for mental health:  In the case of psychiatric health, severe Vitamin D deficiency was discovered in 72% of adults tested in a psychiatric hospital.  Other studies have shown that those with mental illness tend to have abnormally low levels of Vitamin D.

“Vitamin D’s effect on mental health extends beyond depression. Schizophrenia has also been linked with abnormal levels of vitamin D.”

“..vitamin D activates genes that regulate the immune system and release neurotransmitters (e.g., dopamine, serotonin) that effect brain function and development. Researchers have found vitamin D receptors on a handful of cells in regions in the same brain regions linked with depression.”

 

Take the time to learn how to prepare these foods in ways that your and your kids like!

–Margaret

 

Resources:

The Psychological Consequences of Vitamin D Deficiency

These Foods for Anxiety Are the Good Kind of Stress Eating

Should you get your nutrients from food or from supplements? – Supplements can plug dietary gaps, but nutrients from food are most important

Survey Results – How parents managed a crisis

Survey Results – How parents managed a crisis

In a small survey a couple of years ago, I asked parents how they handled their child’s mental health crisis.  It was completed by 16 people in one city–too few to get a broad picture.  Can you help learn what works and what doesn’t work by sharing your story?  Wherever you live in the world, your information can also help crisis responders, law enforcement officials, and schools to do a better job in a crisis. We need ideas, and “dos” and “don’ts”, for handling our really serious situations.

Please take this new survey about your experiences with your child’s mental health crises. Thank you.

Click the button below. The survey will take approximately 10 minutes.  It is completely anonymous.  The survey closes December 31, 2017, and results will be analyzed and published on this site and its Facebook page by January 15, 2018. (“Follow” to ensure you see results.)


Here’s what the first survey found:

Demographics (16 respondents from the greater Portland, Oregon region)

Child’s age range:  9 to 24 years of age
Child’s gender:   67% male, 33% female
Child’s diagnosis:  Everything!

Autism, ADD and ADHD, depression and bipolar disorder, schizoaffective disorder, brain injury, severe anxiety, PTSD, obsessive compulsive disorder, borderline personality disorder, oppositional defiant disorder, Tourette’s, reactive attachment disorder, and sensory processing disorders including PDD (pervasive developmental disorder).

This is a general summary of the results.  If you’re a geeky type, graphs of raw results are at the end of this article.

When your child had a mental health crisis, what did you do?

Parents had a variety of responses, with the most seeking help from mental health providers (hospital, crisis line, etc.).  Many tried to handle a crisis themselves, either by themselves or with the support of others.  Since many crises happen at school, the parents’ only option was taking their child home.  Many called the police at least once for a crisis, but a few called multiple times.

Of those who called the law enforcement:

Those parents who responded said the law enforcement officers mostly did a great job, and if the child was arrested, they agreed that the arrest was appropriate (these were parents who faced severe behavior: physical violence, psychotic rage, property damage, and credible threats of harm).  A few parents experienced criticism from the police, or their child was arrested and they did not agree with this.  A few also indicated their child had calmed down by the time the police arrived.

What kinds of help did parents seek?

Most parents sought help from other people (such as family members, friends, and neighbors) and from a mental health crisis line for information, emergency response, and support.  This was followed by seeking psychiatric care, or help from a school counselor if the child was at school.  A few didn’t seek help.

What worked best for managing a crisis?

By far, when parents had the help of friends and family, the crisis outcome was the best.  They also experience good results when they called a crisis line, which includes both for law enforcement police or mental health.   A few found hospitalization and other crisis responders helpful.

Comments:
“We implemented a crisis plan we’d made that included all options.”
“My child is 18 and I don’t know the adult system. Nothing’s worked thus far.”

What was the quality of the crisis resolution with each of these services available?

  • Most often, temporary improvement was the result of using the crisis support options available.
  • Also most often, crises worsened if a school was involved or a parent tried to manage it alone.
  • Next most often, the crisis results were good but the parents still had concerns. The police and psychiatric facilities were best at getting good results.
  • A “best possible outcome” was uncommon; only a 1 in 5 had this result.

Comments:
“The staff at the school made things much worse for my son. We had to find a different school.”
“My daughter did well after inpatient care, but there was no discharge plan.”
“The school counselor was useless, insisting that everything my daughter was acting normal for her age.”
“My ex played me as the “bad” guy.”
“Family and friends were clueless.”
“The police were helpful but temporary because they couldn’t help with underlying issues.”
“Hospitalization for a week helped her eventually get insight into her illness, but it took a long time.”

What have you done for self-care?

By far, parents took time off, and received therapy or medication for themselves.  This was followed by including the family in time off or in family therapy.  Half got help by attending a support group, followed by classes or involvement in a mental health organization.  Some sought respite care.

This is what we want: happy healthy children. Is that too much to ask?

What do you wish for the most?

This was an open-ended question and survey takers were encouraged to put down a sentence or two.  There were 29 comments for this question. Here is a general summary of the responses ranked from most to least, followed by a selection of quotes.

1. More, better, and affordable mental health treatment
2. A better life for my child
3. A break and rest
4. Emotional support
5. Better skills and knowledge for helping my child

Selected comments:

“Fewer financial barriers to health and wellness services”
“Easier access to the right care at the right time”
“For my daughter to feel safe and loved and at peace in her soul”
“For my son to feel better and participate in more everyday activities”
“More and restful sleep”
“People understanding us, including mental health professionals”
“Support group for spiritual development”
“Mentoring and positive community activities for teens”
“A cleaning lady (or man)”
“Knowledge of what to do and who to call”
“More understanding by my family members instead of judgment”
“To be more patient and calm”


RAW RESULTS

When you handled a mental health crisis, what did you do?  (% who responded, multiple responses possible)

Comments:
–We’ve responded in all of these ways.

If you’ve ever called law enforcement, how many times?   (% who responded)

What happened when you called law enforcement?  (% who responded, multiple responses possible)

Comments:
–Police took my child to a mental health facility.
–My son came home later, calmed down.

Did you seek help from other services?  (% responding, multiple responses possible)

Comments:
–If he wasn’t a danger to himself or others they could do nothing.
–Definitely have thought about who to call

What worked best to handle a mental health crisis?  (% who responded, multiple responses possible)

Comments:
–We implemented a crisis plan we’d made that included all options.
–My child is 18 and I don’t know the adult system. Nothing’s worked thus far.

What were the results?  (number who responded, multiple responses possible)

Comments:
–The staff at the school made things much worse for my son. We had to find a different school.
–My daughter did well after inpatient care, but then tanked and there was no discharge plan. I pushed hard to get her in a step-down facility, and then we got a good discharge plan.
–The school counselor was useless, insisting that everything my daughter was acting normal for her age. My ex played me as the “bad” guy. Family and Friends were clueless. The police were helpful but temporary because they couldn’t help with underlying issues. Hospitalization for a week helped her eventually get insight into her illness, but it took a long time.

Have you taken any action for self care?  (% who responded, multiple responses possible)

Comments:
–We got a companion pet.
–I built a support network of friends and colleagues with expertise in meditation and self-care.
–I got respite when my son was placed with his father temporarily.

As a parent of a troubled child, what do you wish for most?  (number responding, up to 3 choices possible)

 

–Margaret

How to Handle a Child’s Mental Health Crisis

How to Handle a Child’s Mental Health Crisis

You can sense there will be a crisis long before it happens. You have days when you’re so concerned about your child and family (and work and responsibilities) that you can’t think straight.  You can’t even spend time on little things like chatting with a friend or reading a magazine.  Your intuition says it’s only a matter of time and you won’t be able to handle it.

Before this happens, make a Crisis Plan with these priorities in order:

  1. Safety for everyone comes first
  2. Stabilization and treatment for your child
  3. Stress reduction for the family afterwards
  4. Lessons learned

What constitutes a mental health crisis?

  • When something dangerous has happened or is likely to happen because of a child’s behavior, words, plans, or triggering events that they experience.
  • Anytime a child’s behavior leads to harm or imminent harm to the child or someone else (including pets), or significant damage to property. Harm also includes emotional harm, threats, running away to unsafe places or doing unsafe things.

Trust your gut and trust your intuition.

Examples of a crisis when you must act

  • Watch. Pay attention to evidence your child has plans for suicide, which may include seeking dangerous items; or making multiple references to hating life; or they have a worsening mental state, or there’s been a prior suicide attempt.  Try this: “Use the “S” word: talk openly with your child about suicide.”
  • Look for increasingly troubled behavior over time that leads to extreme behavior:  non-stop raging, assault, repeated running away, threatening, talking about strange things, or spending too much time alone.
  • Pay attention following a traumatic event, such as someone else’s suicide or a newsworthy major tragedy. These can trigger a child to act dangerously on thoughts they already have.
  • The child runs away while psychotic, or depressed, or with a dangerous person–perhaps another troubled child–or under the influence of drugs or alcohol.
  • Psychosis of any kind including hallucinating or hearing voices; odd ideas; extreme agitation, anxiety, or paranoia; or a belief they have special powers.

The Crisis Plan

Have a crisis plan for home, school, and any other place where the child spends time.  For some, it’s also the parents’ workplace.  If a child is in college, a student adviser or someone in the campus health clinic needs to be a contact for checking in on your child.

Plan A:  call 911. You will not be bothering the police or emergency responders!

Plan B:  Answer these questions

For a runaway.  Who gets on the phone to call 911, and who goes out to look for the child and bring him or her back without mutual endangerment?  Both should know how to work with police and other community members.  There is no waiting period in a missing person’s report.  Check this article for what to say in call and do when police arrive. “How to work with police once you’ve called 911.”

Note: children have been known to behave perfectly once the police arrive, and police sometimes implicate the parents as having the problem. Don’t let this bother you.  You have demonstrated to your child that you are willing to call the police, and you’ve asserted your authority.  You might point this out to them–another episode of extreme behavior will be countered with significant action on your part. Use a neutral tone and avoid making this sound like a threat!

Who else knows your child and is trustworthy: others parents, businesses, teachers, their friends?  Are any of them able to assist you with talking to your child or keeping them safe?  Can any them help you “hold the fort” while waiting for an emergency responder?  Build a support network in advance:

Who gets on the phone and calls for extra assistance?  And is there a list of phone numbers?  Does your town or city have a crisis response team for kids?  What about a crisis line run by the mental health authority?  Check.  They are there to help.

Who should be appointed to communicate with the child?  This should be a family member or friend or teacher that the child trusts.  Communication with the right person can solve things fast, but with the wrong person can backfire, even from a parent… perhaps especially from a parent.

Who should step in and break up a fight, physical or emotional?  And what specifically should they do or say to de-escalate a situation spinning out of control?  Think about this:  your troubled child can often tell you exactly what works best and what makes things worse.  Listen to them.  It doesn’t have to sound rational to you as long as it works.

How should a time-out work?  Who counts to 10, or who can leave the house and go out for a walk?  Where can someone run to to feel safe and be left alone for a while?  What are the emotional safety rules for when the time out ends?  How can you and your child trust each other enough not to upset a fragile stability?

What should teachers or co-workers or others do to calm down a situation and get their classroom or office back to normal as quickly as possible?

Can a sibling stay at someone else’s house until things cool down at home?  Which house?  Sibling(s) can benefit from an escape to a friend’s house to protect them emotionally until a crisis has passed.  Ask them.

Teamwork

Think of your family and support network as a team that springs into action when someone sounds the Red Alert that your child is in danger.  Talk to family members and friends or neighbors ahead of time and give them an assigned role.  Let each should know they will be backed up.  This will be tremendously reassuring.  Your child’s crisis will be an upsetting event, but reasonable people will pull together when they know what’s going on and what they should do.  “Gang up on your kids:  Parent networks for tracking runaway children

Experiences and evidence shows that a rapid reduction of stress is effective at reducing the emotional wounds of a crisis.  Rapid cooling down of emotions, or “de-escalation,” is what prevents or limits the fallout from a crises.  You and your family can develop de-escalation techniques for bouncing back in tough situations.  The goal is “resilience.”  More than anyone, families with troubled children need resilience.

After the crisis

Everyone gets a mental health break.  This could be anything:  a day off, eating out, ice cream, going out for a movie…  Do something to get everyone back to an OK place and on their feet.  There should always be a reward for bravery, team work, and a job well done.

Next time it happens

There will be a next time.  A troubled child will be fine for many months and you’ll be so relieved, and then WHAM.  Use a previous crisis as a learning experience.  What can be done better next time?

Your long-term goal is to reduce crisis frequency over time, or prevent them from happening in the first place. 

Many parents have taken these steps to prevent a crisis or limit its severity.

  • Communicate directly with a police officer or precinct, school counselor, or juvenile justice official to explain your child’s legitimate mental health disability and your willingness to cooperate. Build a working relationship with them.
  • Locks on doors: a sibling can protect him or herself and their belongings; a parent can protect belongings, prescriptions, valuables, and money.
  • Track via technology – Track where your child goes and what they see online, and let them know you are doing this. This is legal.
  • Track via eyes and ears on the street – Befriend or build trust with your child’s friends, their parents, their teachers, neighbors, and businesses where they hang out.  Ask for a report if they see or hear something of concern. They may not be able to do anything but just report.
  • Search the child’s room for evidence of unsafe behavior, anything from razors for cutting themselves, harmful substances, porn, weapons, unusual ‘stockpiles’ of stuff (lengthy explanation goes here… just trust your gut if something is out of place). Room searches in your home are legal, but keep them secret and avoid acting on other things you find that aren’t 100% related to danger
  • Lock up dangerous items even though it’s inconvenient for you–kitchen knives, weapons, alcohol, drugs and prescriptions, matches, etc.
  • Lock up money, credit cards, and valuables. With money in hand, your child is on a path to victim-hood or association with people with criminal behavior. For example, they can buy drugs and alcohol from inappropriate people who then rob or assault them.
  • Confront people who undermine your authority. This is often a friend’s parents or other person who thinks you are abusing your child (because your child has told them so). They ‘rescue’ your child and offer safe harbor, and actively help them run away.  This is completely against the law, and they are subject to police action and criminal charges.  People who do this do not have your child’s safety in mind.

Extreme measures

There may be times when, for reasons of safety, you may to do things you are uncomfortable with while you wait for police, ambulance, or friends to arrive.  These are things parents have done in a crisis:  tackle a child and hold them down; or trick a child to get in a car and then have someone hold them down until they arrive at an emergency room (commonly needed in rural areas).  The way to avoid the risk of being charged by your child with abuse or assault is to have those open relationships with the authorities, teachers, and other parents who know your situation.  A letter from a doctor can be really important here.  I was glad I had one.

There will be fallout if you use force or trickery. Your child will not accept your reasoning or the necessity for your actions.  You can truly apologize for upsetting your child but without admitting guilt. Instead, ask what they want to happen next time they are in a crisis.  You should also honestly reassure them you will never use extreme methods again unless there is a safety issue.

To recap:

  • Trust your gut
  • Act immediately
  • Follow a plan that includes others working as a team
  • Take care of everyone afterwards
  • Prepare for extreme measures
  • Retain your authority as a parent by establishing supportive relationships.

You can handle this!

 

–Margaret