Category: parenting

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

therapy catIt 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 may not noticeably 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

Mental Health Medications for Children ages 3 – 12

Mental Health Medications for Children ages 3 – 12

This is an excerpt from an article contributed by Drugwatch, an organization devoted to informing the public about the uses and risks of drugs and medications, and the use of medical devices.

Doctors may prescribe the use of medications to treat the health effects of bullying.

For example, children who suffer from depression or anxiety disorders (two health effects of bullying) may be prescribed selective serotonin reuptake inhibitors (SSRIs), such as Prozac. It’s important for parents to be aware that all SSRIs carry risks.

Childhood Bullying & Its Health Effects

Research shows that bullying behavior can start as early as age 3. Both children who are bullied and those who bully others may have serious lasting health problems as a result of these actions.

Bullying may cause lasting health issues for both parties involved.

A 2017 study by University of Pittsburgh researchers, for example, found that children who are bullied experience mental and physical health issues that can last well into adulthood. The study shows that bullied children are more likely to have trouble with finances and to be treated unfairly by others. They are also more pessimistic about their futures, according to the study.

On the other hand, the study revealed bullies are more likely to be stressed, hostile and aggressive, and to smoke cigarettes and marijuana. Both bullies and their victims are at a higher risk of heart disease, which is the leading cause of death for both men and women.

Doctors may prescribe Cymbalta to treat generalized anxiety disorder in children ages 7 to 17.Childhood developmental or learning disorders are often diagnosed when a child is of school-age. Mental illnesses, however, can be hard for a parent to identify. Although children can develop the same mental health conditions as adults, they sometimes express them in different ways. In 2013 alone, more than 8.3 million children were taking psychiatric medications. About half of the medicated children were between the ages of 6 and 12.

ANXIETY DISORDERS

Anxiety disorders are a group of mental disorders branded by feelings of anxiety and fear. Children may have more than one anxiety disorder. More than 2 million children were on anti-anxiety medications in 2013. The age group with the largest number of medicated children was ages 6 to 12 years.

Generalized Anxiety Disorder (GAD)

It’s perfectly normal for your child to stress about grades or an upcoming sporting event. However, if your child worries excessively or if anxiety and fear affect your child’s ability to perform daily activities, your child may be suffering from GAD. Doctors may prescribe Cymbalta, a serotonin-norepinephrine reuptake inhibitor (SNRI) as treatment. In 2014, the FDA approved Cymbalta for the treatment of generalized anxiety disorder in children ages 7 to 17. SNRI medications carry serious risks, including birth defects, skin disease, suicidal thoughts and liver toxicity. The FDA also warns of Cymbalta discontinuation syndrome, which is when a person experiences withdrawal side effects after stopping Cymbalta. Effexor, another SNRI, has not been approved by the FDA for use in children, but some doctors prescribe it for older teens as an off-label treatment for depression and anxiety.

Obsessive Compulsive Disorder (OCD)

Prozac, Zoloft and Luvox are among the drugs used to treat OCD in children.

Children with OCD experience unwanted and intrusive thoughts — or obsessions. They feel compelled to repeat rituals and routines to try to lessen their anxiety. OCD can affect children as young as 2 or 3, though most children with OCD are diagnosed around age 10. The FDA has approved several drugs to help control the symptoms of OCD in children, including Prozac, Zoloft and Luvox.

The FDA has approved haloperidol, pimozide and aripiprazole to treat tics.

Tourette Syndrome

Children with Tourette syndrome may make unusual movements or sounds known as tics. The FDA has approved haloperidol, pimozide and aripiprazole to treat tics.  All three medications have the potential to cause unwanted side effects, so most doctors prescribe the blood pressure medications guanfacine or clonidine. This is known as “off-label” use because the FDA has not approved either drug for treatment of tics.

MOOD DISORDERS

Every child can feel sad or depressed at times, but mood disorders are more extreme and harder to manage than typical sadness. Doctors may prescribe antidepressants or antipsychotics to treat mood disorders in children. SSRIs are popular antidepressants, despite an increased risk of suicidal thoughts in children. Prozac is the only SSRI approved for use in children older than 8 years of age. Antipsychotics prescribed to children include Abilify (aripiprazole), Thorazine (chlorpromazine), Risperdal (risperidone) and Invega (paliperidone).

These new kinds of drugs called atypical antipsychotics can have serious side effects in children like drastic weight gain, sedation and movement disorders. Risperdal and Invega also include a side effect called gynecomastia, a condition where boys develop breasts.

Nearly 2.2 million children were on antidepressants in 2013, and more than 830,000 were taking antipsychotics. In addition, doctors often prescribe the anti-seizure drug Depakote for children with bipolar disorder, a use not approved by the FDA. The medication has a black box warning for increased risk of liver failure and pancreatitis in children and adults.

(Blog owner’s note: Antidepressants are sometimes mistakenly prescribed to depressed children who are actually experiencing the depressed phase of bipolar disorder. The risk is that antidepressants can bump a child’s mood way too high, into mania.)

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Doctors use stimulants like Ritalin and Adderall to treat ADHD.

Doctors have been diagnosing children as young as 4 with ADHD. In the past nearly 30 years, the number of children diagnosed with ADHD has grown six-fold. Scientists estimate about 5 percent of children actually have ADHD, but the CDC shows that 15 percent are diagnosed.

Doctors usually treat children with ADHD with stimulants such as Ritalin (methylphenidate) and Adderall (amphetamine and dextroamphetamine). Side effects of these drugs include decreased appetite, sleeping problems and headaches. Less common but more severe side effects include the development of tics and personality changes. Data from 2013 showed more than 4.4 million children were on ADHD drugs.

Children with a history of heart conditions may have a higher risk of strokes, heart attacks and sudden death when taking stimulants. Studies have also found rare cases of children developing hallucinations – such as hearing voices and increased suspicion without reason – or becoming manic.

Children & Medications

Children are particularly vulnerable to the potentially harmful side effects of drugs during important stages of physical and mental development. The amount of mental health drugs prescribed to youth has increased at an alarming rate, and each comes with its own risk.

AUTHOR

Emily Miller
emiller@drugwatch.com
407-955-4198

 

This is the full article from which the above post is excerpted:
“Children’s Comprehensive Health Guide – From Newborn to Preteen”

 

The Dysfunctional Family and the “Black Hole” Child

The Dysfunctional Family and the “Black Hole” Child

Many families living with the proverbial “black hole” child start to cope in unhealthy ways. Everyone gradually alters their normal behavior to avoid stress, frustration, anxiety, or anger, but these behavioral accommodations actually make things more chaotic. It’s unintentional, but parents, siblings, extended family and friends take on psychological roles, and the resulting dynamics are harmful. This is the “dysfunctional family,” and these are some common roles:

    • Protector is the emotional caregiver and defends the child regardless.
    • Rulemaker wants Protector to stop enabling the child and set boundaries.
    • Helper smooths over conflict, calms others, and sacrifices for others.  They become “parentified,” and miss important childhood experiences, like play.
    • Escapee stays under the radar for safety, and finds ways to stay away from home to avoid the stress.
    • The Neglected shows a brave face but hurts. They need nurturing but don’t ask for help because the parents are so distracted.  They become depressed.
    • Fixer has all the answers and keeps trying to make everyone do things ‘right’.  They repeatedly jump into everyone’s lives and stir up chaos.
    • Black Hole Child devours everyone’s energy, and gets trapped in their own black drama. For complex psychological reasons, they learn to manipulate, split family members against each other, and blame their disorder for behaviors they can control. Due to insecurity, they act out repeatedly to test if those they depend on still care.

If this is your family, it’s not your fault. Forgive yourself and everyone else. Families living with an alcoholic or addict behave similarly, but they have specialized 12 Step programs like Al Anon and Narc Anon to help them become functional again.  Their 12 Steps would help you too!  I’m not aware of a similar 12-Step approach specifically for families living with mental illness, but I strongly recommend a support group.  Look for one near you (in the US or Canada) at the National Alliance on Mental Illness (www.nami.org) or the Federation of Families for Children’s Mental Health (www.ffcmh.org).

For a child to be well, each person around the child must be well.

First:  A stress relief meeting.  Meet together without the “black hole” child present… now is not the time to include them.  Meetings might be held with the guidance of a family therapist or support group to keep emotions safe. The goal is to ease everyone’s fears by bringing them out into the open. Each member vents their true feelings.  Brace yourself.  You may hear upsetting things, but once feelings are out in the open people will feel better.  There will be more problems to solve, but now everyone knows what they are.  No more secrets.  All everyone needs is to feel heard and understood.  Clearing the air helps people move on.

It is a relief to tell your story and have someone listen and understand.

Check in with family members (perhaps not the troubled child yet… use your best judgment).  Ask everyone how they‘re doing. What is working well? and what isn’t?  Be prepared to hear more complaints and venting.  Just listen and ask clarifying questions until they get it out of their system. (It’s like vomiting, and feeling so much better afterward.)  Brainstorm solutions together.  Ask for ideas on what needs to happen differently.  You don’t need to agree or comply, just listen.

At some point, the troubled child’s own opinions and needs need to be woven into the new family system.  This can be very tricky.  If you feel things will get out of control, get help from a therapist or counselor for yourself or for your family.  The methods for doing this are too lengthy for covering in this article, but you can find out more by exploring books or websites on family interventions for an alcoholic or addict.

Warning:  Once family teamwork improves, prepare everyone for an explosive defiant backlash. This is actually a good sign, so plan for it in advance.  It is a sign you are regaining your authority.  Visualize standing shoulder-to-shoulder to keep everyone safe while the child explodes.  Stick together.  The child may blow-up multiple times, but stick together.  The explosions fall off over time.  This article explains the reasons for these explosions, called “Extinction Bursts” by psychologists. They are the  final act of defiance when limits are firmly enforced and the child loses power.

Ultimate goal:  The child’s behavior improves!  The child stabilizes; they are surrounded by a caring but firm team that locks arms and won’t be shaken by chaos. Surprisingly, this actually helps the child feel more secure and less likely to cause distress.

How it might unfold:

  • Protector steps back; cares for themselves; and accepts that Rulemaker has some legitimate reasons for boundaries.
  • Rulemaker steps in to help Protector as needed and gives them a break. Rulemaker and Protector work out acceptable structure and make two to three simple house rules for everyone that are fair and easily enforced.

Rulemaker and Protector also make two to three simple agreements between themselves.  Number one:  no fighting or disagreements in front of the child.  Next, checking in with each other and agreeing on a plan or strategy.  Ideally, their relationship improves, and trust and safety is reestablished.  This can happen between parents who are divorced too.

  • Helper gets a life of their own, accepts they are not responsible for everyone, and is encouraged to spend time with supportive friends or doing activities they really like.
  • Escapee and The Neglected need lots of support and comfort and emotional connection to a nurturing adult. They are at risk of mental health problems in the future, especially depression and addiction.  They may suffer from PTSD as adults, from enduring years of emotional distress or neglect. Both may need mental health treatment such as therapy and relaxation skills.
  • Fixer: withholds judgement and realizes there are no simple answers. Their education or experience does not necessarily apply to this family. They should ask how to help instead of trying to make people change, and they should be gracious and supportive.

Helping a troubled child means helping the family first, and family teams are the best way.  As each member strives for a healthier role, each gets support from other family members and hears things like, “Atta girl!”, “You rock!”, “Go Mom!”. Teamwork creates therapeutic homes and strong families. Research proves that strong families lead to better lifetime outcomes for the child.

–Margaret

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