Category Archives: depression

Defying ODD: what it is, and ways to manage.

Defying ODD: what it is, and ways to manage.
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Parenting a defiant ODD child or teen could be your hardest job ever. 

Not only is it exhausting, but you must continually find the compassion and forgiveness to be nurturing, and the energy and doggedness to be consistent.

ODD is caused by abnormal electrical activity in the brain, it is not in the character or ‘soul’ of your child or teen, and not something they can control.  If your child could do better on their own, they would.  You are the one who can make the most difference.

If you think your child or teen’s defiance is oppositional defiant disorder, you have practical ways to manage your child’s exasperating condition.  This information comes from psychiatric, psychological, and child behavior resources– information to help you work effectively with mental health providers or teachers.  You’ll need to ask them focused questions to learn everything they know about ODD.  Professionals pay better attention to knowledgeable parents (which shouldn’t be the case, all parents deserve attention).  Go in armed with knowledge.

This is what ODD looks like.  The pinkish curving region in the center of the 3-D brain image below represents hyper-charged electrical activity in a 13-year-old boy with severe oppositional defiant disorder.  This feature is typical of ODD, but also typical in individuals with obsessive compulsive disorder (OCD), “Road Rage,” pathological gambling, chronic pain, and severe PMS.

The name of this region is anterior cingulate gyrus (ACG), and scientists believe this area is responsible for enabling a person to shift attention and think flexibly, traits which are deficient in ODD kids.  It is also the brain region known to regulate emotions.  Children with a hyper-charged ACG have “a pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which 4 or more of the following are present:

  • Often loses temper
  • Often argues with adults.
  • Often actively defies or refuses to comply with adults’ requests or rules.
  • Often deliberately annoys people.
  • Often blames others for his or her mistakes or misbehavior.
  • Is often touchy or easily annoyed by others.
  • Is often angry and resentful.
  • Is often spiteful and vindictive.” 

–From the “Diagnostic and Statistical Manual of Mental Disorders, 4th Edition,” published by the American Psychiatric Association, 2000.

There are two different medication approaches to ODD:

  • treat it as a form of attention deficit disorder;
  • treat it as form of depression and obsessive-compulsive disorder.

–         The attention deficit approach may use Straterra (chemical name is atomoxetine), Ritalin (methylphenidate), Risperdal or risperidone (for patients with low IQ), and Depakote or divalproex (a mood stabilizer).

–         The depression & obsessive-compulsive approach may use serotonin-based antidepressants such as Prozac (fluoxetine), and Anafranil or clomipramine (used to treat OCD).

At the end of this article are a list of other medical conditions that can cause disruptive behavior.

Unfortunately, oppositional defiant disorder usually includes other disorders, so you may be coping with more than defiance.  Below are common disorders that combine with ODD:

  • 50-65% of these children also have ADD or ADHD
  • 35% of these children develop some form of depressive disorder
  • 20% have some form of mood disorder, such as bipolar disorder or anxiety
  • 15% develop some form of personality disorder
  • Many of these children have learning disorders

–From http://addadhdadvances.com/ODD.htmlAnthony Kane, MD 

Other medical conditions that can cause disruptive behavior like ODD:

  1. Neurological disorders from brain injuries, left temporal lobe seizures (these do not cause convulsions, no one can tell these are happening), tumors, and vascular abnormalities
  2. Endocrine system problems such as a hyperactive thyroid
  3. Infections such as encephalitis and post-encephalitis syndromes
  4. Inability to regulate sugar, rapid increases and decreases of blood sugar
  5. Systemic lupus erythematosus, Wilson’s disease
  6. Some prescription medications:  Corticosteroids (anti-inflammatory and arthritis drugs such as Prednisone);  Beta-agonists (asthma drugs such as Advair and Symbicort)

–From Peters and Josephson.  Psychiatric Times, 2009.

ODD is a disability.  It isn’t easy to manage, but you can do it.  Your child may need multiple medications and a large variety of approaches to therapy and behavior modification.  You will need patience as teachers, doctors, or specialists try different approaches until they discover one that improves your child’s behavior, so hang in there!

Some good news, if your child has these traits, it will be easier to improve or overcome ODD behaviors:

  • A normal IQ
  • A first born child
  • An affectionate temperament
  • Positive interactions with friends their age
  • Nurturing parents who can consistently set clear behavioral limits

–From the Journal of American Academic Child and Adolescent Psychiatry, 2002.  Author J.D. Burke.

You try everything but nothing works.  People’s natural instincts for parenting do not work with an ODD kid—they need completely different techniques than ‘normal’ children.

How to reduce ODD behaviors

First, prepare yourself for the intensity of parenting a defiant kid because you are about to run a marathon.  Get enough sleep, maintain your other important relationships (spouse or partner, children, friends), schedule breaks or getaways, and guard your physical and emotional health.  Don’t expect quick results with these techniques; it may take weeks or months.

Parent Management Training – PMT refers to intensive educational programs that are “evidenced based,” proven to help parents gain the skills they need for extremely difficult children, especially those with ODD.  These programs are intensive, but substantiated interventions in child mental health.  PMTs help parents assert consistency and predictability, and promote pro-social behavior in their child.  A good explanation can be found at the Encyclopedia of Mental Disorders.  Examples include:  the Total Transformation and the Incredible Years.

Find something positive to do together.  Your child has normal needs for closeness and appreciation and joy.  Ask your child about their interests, and if their ideas don’t work for you, try new activities until one brings about a good chemistry between you and your child.

Praise is one of the most powerful tools for managing disruptive behavior.  Take responsibility to inject much-needed positive energy into your relationship with your child or teen.  It’s likely that this relationship has been almost 100% negative, yes?

Set limits – “Consistent limit setting and predictable responses from parents help give children a sense of stability and security.  Children and teens who feel a sense of security regarding the limits of their environment have less need to constantly test it.”  (Webster-Stratton and Hancock)

More praise – ‘Catch’ them doing something good.  Offer praise and make it sound genuine even if they respond in anger, then let it drop.  Spend as much time praising as disciplining!  And don’t expect thanks, it’s not about you.

Active ignoring – This works for best with children between the ages of 2 and 12.  It involves purposefully withdrawing your attention away from your child when they are misbehaving, such as in a temper tantrum, or when whining or sulking, or when making continuous demands or loud complaints, etc.  Pretend you don’t care and even turn your back if possible.  Give attention only after the behavior is over.

–Find out more at http://www.sosprograms.com/chapters/p_eng_chapters/EngParents03.pdf.

Make the behavior uncomfortable for the child/teen.  Example:  If your kid swears, test them, “C’mon, you can do better than that, be creative, I’ve heard all those things before.  Don’t be a copy cat.”  They can become frustrated when they aren’t getting the reaction they want from you, and give up.  Example:  your teen refuses to get out of bed for school.  Don’t nag or repeat, repeat, repeat.  Remove the blanket and set them far enough away that your child has to get out of bed to retrieve them.  (“Managing Resistance,” John W. Maag, jmaag1@unl.edu)

Give multiple instructions at once, where at least one of the instructions is what they want to do, and one is what you want them to do.  “Close the door while you’re yelling at your sister and don’t forget the light.”  Your child will be overloaded as they try to figure out which thing they’re supposed to defy.  Kids tend to get flustered by the mental effort and comply without knowing they’re doing it. (“Managing Resistance,” see above)

Reverse psychology:  Yes, this works, and it’s OK when important.  Example:  your child is bouncing on the furniture.  You turn on music and say “hey, try this, see if you can bounce to the beat, but I bet it’s harder to do on the floor.”  This is a good kind of manipulation.

Surprise rewards – Reward appropriate behavior with something they already like (that is acceptable to you).  They are more likely to do a desired behavior if they expect something they want and aren’t sure when it will be offered.

At the end of this article is a list of things to do to make ODD worse.  Avoid these!

“Why should I have to do this when it’s my kid’s responsibility to behave?”

It’s your responsibility as a parent to do what you can to help your child be successful.  ODD is a genuine disability that negatively affects their life and future.  I’ve seen highly intelligent ODD kids experience academic failure, or enough suspensions and expulsions to hold them back a grade, a can’t-win-for-losing consequence that worsens their behavior.  Wouldn’t this suck?

Warning, once you start consistent enforcement, things get worse at first – Defiant behavior tends to increase once your family system is changing.  This as a good sign—you are regaining your authority!  Your child’s backlash is a common human psychological response, and it’s called an “extinction burst.”  (see diagram below)  As parents change their approach to handling inappropriate behavior, the child becomes more defiant to test their resolve.  View this as predictable and plan ahead.  It won’t last and they will begin to comply with this one rule.  They then find another rule to defy and ramp up their defiance.  As you enforce it, they back off again, and the pattern continues until it’s just not worth it to defy rules anymore.

 

–From “Behavioral Interventions for Children with ADHD,” by Daniel T. Moore, Ph.D., © 2001, http://www.yourfamilyclinic.com/shareware/addbehavior.html .  The author requests a $2 donation through PayPal to distribute his article or receive printed copies.


How to make ODD worse -or- DON’T TRY THESE AT HOME

Don’t treat your child like another adult who has an equal say in how things are done.  Don’t treat your home as a democracy, where everything must be fair and equal.  Don’t answer your child’s accusations by offering reasonable, rational explanations.

Don’t keep finding fault with your child and let them know about it over and over and over.  If they do something positive, let them know it’s not enough.

Don’t ignore your child’s unique needs or the challenges they face everyday, such as bullying at school, or fear of abandonment, or stress from a chaotic home.  Just pretend they have no reasons for their behavior.

Only enforce rules once in a while, or have the consequence come later (Famous example: “I’ll tell your father when he gets home.”).  Don’t get angry about something, then direct your anger to your child and let them know it’s because of the stress they’ve caused you.

Don’t treat your child appropriately for his or her age.  Don’t make long explanations to a three-year-old about why you’ve set a certain rule.

Stop making rational justifications for your rules and stop expecting your child to logically, rationally accept them.  What’s interesting to me when I see parents doing this is that their children can be quite young (4 or 5), too young to be reasonable in the first place, or they can be young adults (early 20’s) who have a long track record of being unreasonable.

Don’t keep trying the same things that still don’t work.  Like making excuses; like screaming.  (Don’t be embarrassed; we’ve all done this.)

Don’t jump to conclusions that demonize the child.  I often hear parents say:  “Why does he keep doing this?, or, “Why doesn’t she stop after I’ve told her not to, over and over again.”  Then they answer their own questions:  “It’s because he always wants his way,” or, “She’s doing this to get back at me.”  As they tell their story, I hear them taking things personally:  “He does this just to make me mad;” “She manipulates the situation because she wants more (something) and I won’t give it to her.”

Good luck with your defiant ODD child.   I WISH YOU THE BEST!

–Margaret   How am I doing?  Please rate this article at the top, thanks.


 

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Filed under ADHD, bipolar disorder, defiant, defiant children, depression, discipline, mental illness, oppositional defiant disorder, oppositional defiant disorder, parenting

Teachers and stigma – judging and blaming families

Teachers and stigma – judging and blaming families
1 votes

Troubled kids' families also want improved classroom behaviorAs parents of troubled children, we already know that our child’s disorder or behavior will not work in most classrooms.  No one needs to tell us this or explain why our child needs to change in order to learn–we already stay up at night worrying how our child or teen will make it in the world.  Most parents have tried everything:  we’ve looked for other educational options (which almost never exist or we don’t qualify), we’ve asked or pleaded for help, we’ve read books and scoured the internet for advice…  When nothing works, some parents and caregivers just give up and try to muddle through.

When it comes to working with schools, it feels like you can’t win for losing

Those parents who’ve tried everything become deeply frustrated and take it out on school staff.  This reaction makes sense when you’ve been there like I have.  I probably looked bad at meetings, angry, stressed, anxious, and confused—and that’s how I was treated.  I could sense staff assumed I was this way all the time and thus the cause of my child’s disorder.

Those parents who give up don’t show up.  They can’t face another school meeting to listen to the litany of their child’s problems, feeling nagged with advice given in a tone of impatience, never getting help, hope, or heard.  Not showing up also makes perfect sense.  Who wants another downer?  It’s best to stay home and conserve precious emotional energy.  These parents look apathetic and neglectful at best–I personally know a couple like this.  I’ve heard school staff wondering aloud if the parents were using drugs, abusive, or criminally neglectful.  They weren’t.

Teachers have the same paradoxical attitudes held by the public at large when it comes to troubled children.  They may try to be neutral when they work with parents, but underlying attitudes and feelings still come out:

–  We sympathize but you’re still to blame;

–  You can change things if you want to, but you don’t really care;

–  We know what your child needs, you don’t.

I truly believe teachers care about children and teens which is why they are teachers.  Their professional education centers on children’s development and learning, but not on the intricacies and psychology of family relationships or children’s mental health!  Their qualifications and license are for giving their students a quality education, not for doing social work with families.  Even if teachers recognize that families struggle with their child, there is still a sense that the cause of a student’s lack of achievement “sits squarely on the shoulders of parents”  who simply “don’t care.” *

* Taliaferro, JD; DeCuir-Gunby, J; Allen-Eckard, K (2009).  ‘I can see parents being reluctant’: Perceptions of parental involvement using child and family teams in schools.  Child & Family Social Work, 14, 278-288

> Find out more about this research at the Research and Training Center http://www.rtc.pdx.edu/ – “School Staff Perceptions of Parental Involvement,” August 2009, Issue #164 <

Mixed messages from schools

Teachers and schools give mixed signals to families, on the one hand encouraging parents to work with their child’s teacher, and on the other hand becoming “offended when… parents would take the side of their children or question a teacher’s assessment.” *  When it comes to mental health, teachers simply aren’t trained to recognize or diagnose disorders.

Parents with troubled kids in school have additional responsibilities, but their energy and time reserves are the lowest:  there are Child and Family Team (CFT) meetings, Individual Education Plan (IEP) meetings, waivers, Releases of Information (ROIs), and many communication attempts to follow through on these.

Teachers need to believe in the ability of parents to contribute to their child’s well being and understand parents’ need for support when children have mental or emotional disorders.  And “…schools must change practices so that information can be shared with a socially just approach.  Schools must meet families where they are rather than embracing misperceptions and stereotypes…” *

Let’s change this situation, and here’s how you can help Boys fighting

If you are a teacher, parent, or other education advocate, there’s a program available from the National Alliance on Mental Illness (NAMI) to develop understanding and partnership between schools and parents with troubled children.  It’s called Parents and Teachers as Allies.

This is an in-service mental health education program designed for teachers, administrators, school health professionals, families, and others in the school community.  The curriculum focuses on helping everyone better understand the early warning signs of mental illnesses in children and adolescents and how best to intervene, and how best schools can communicate with families about mental health-related concerns.

The program is also designed to target schools in urban, suburban, rural, and culturally-diverse communities.  The toolkit is being developed to be culturally sensitive and will include a Spanish language version.

For more information about this program, please contact: Bianca Ruffin, Program Assistant, Child & Adolescent Action Center, Email: biancar@nami.org, Phone:  703.516.0698

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Filed under depression, mental illness, oppositional defiant disorder, parenting

For fathers who raise troubled kids

For fathers who raise troubled kids
2 votes

Where are the men?

Every year, I attend several conferences around the nation that focus on the families, children, and policies associated with children’s mental health.  The majority in attendance are women.  As part of my job, I also attend many meetings on children’s mental health in social services organizations and advocacy groups where, again, the majority in attendance are women (often 100%).  I’ve facilitated family support groups for 11 years, open to the public, mostly attended by woman:  bio mothers, adoptive mothers, girlfriends, stepmothers, grandmothers, aunts, and sisters involved in caring for a troubled child.  Anyone else notice this?

<At the end of this post are studies and articles on the many benefits caring men provide to troubled children and teens.>

We need the men.  I know they are out there.  I know they are engaged in raising a troubled child and probably alone with their concerns.  They are not just biological fathers, they are stepfathers, boyfriends, adoptive fathers, foster fathers, uncles, and brothers, but I’ll call them all “dads” here.

The recent national “Building on Family Strengths” conference in Portland, Oregon, had a presentation on the subject of dads helping dads.  It was the first time I attended a seminar where mostly men attended.  I asked the panel, founders of Washington Dads, www.wadads.org, “why hasn’t there been a gathering like this before?”  Apparently, panel members tried to find help and it wasn’t there, so they started a support organization for themselves.  They believe it’s the only one like it in the nation.

The messages – One panel member said men feel they are supposed to fix the problem, but they can’t and feel like failures.  Another said that “dads are often not the main caregivers, and perhaps they lack experience,” and after trying what they think will work, are at a loss when it doesn’t.  Another, “we want a quick fix, but a clear concrete fix will do… we want to know how to problem solve.”  That’s a big one, men fix things, they want to get together and hash out solutions.  “Men talk solutions right away instead of talking through emotions.”  They said men like rules or instructions such as Collaborative Problem Solving techniques, the use of technology, and carefully considered plans such as IEPs.

In general, moms tend to feel guilty, but dads tend to be resentful:

  • Of the public nature of the family’s problems
  • Of mom’s leniency towards the child
  • Of the over-the-top attention given to the child
  • Of the loss of quality relationships with all family members

“We’ve been down on our knees in pain for our kids, and we’ve been trying to bring them into society, and it’s a long road.”

Dad’s emotions are there but expressed very differently.  “Some men need to vent aggressively… blow a gasket, but only other men are OK with this.”  Some want to reveal things to each other they wouldn’t share with their wife or partner; “men need to bond without women present” and with personal face-to-face contact.  Men tend to have custody issues too, and often face challenges to their rights to visit their children or maintain relationships with them.

Gentlemen, trust me, moms want you to have support.  Form a group and get yourself some buddies.

Below are previously published articles on the influence of fathers on children’s mental health.  I could not find any articles about issues faced by many fathers, such as custody of the children, disagreements with mom, the influence of their decisions about treatment, or placement, or educational issues, or the need for support in tune with men’s particular cultural and social needs.

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Involvement of nonresident fathers may protect low-income teens from delinquency January/February 2007 issue of the journal Child Development

Many American children live without their biological fathers. A substantial proportion of fathers who live apart from their children have lost touch with them and therefore don’t provide consistent parenting. A new study has found that when nonresident fathers are involved with their adolescent children, the youths are less likely to take part in delinquent behavior such as drug and alcohol use, violence, property crime, and school problems such as truancy and cheating.

The study, by researchers at Boston College, is published in the January/February 2007 issue of the journal Child Development. The research was funded, in part, by the W.T. Grant Foundation, the National Institute of Child Health and Human Development, Office of the Assistant Secretary of Planning and Evaluation, Administration on Developmental Disabilities, Administration for Children and Families, Social Security Administration, and the National Institute of Mental Health.

Researchers looked at a representative sample of 647 youths who were 10 to 14 years old at the start of the study and their families over a 16-month period, gathering information from the adolescents and their mothers. The families were primarily African-American and Hispanic, and most lived in poverty.

Taking into consideration adolescents’ demographic and family characteristics, the researchers found that when nonresident fathers were involved with their children, adolescents reported lower levels of delinquency, particularly among youth who showed an early tendency toward such behavior.

They also found that adolescent delinquency did not lead fathers to change their involvement over the long-term. But in the short-term, as teens engaged in more problem behaviors, fathers increased their involvement, suggesting that nonresident fathers may be getting more involved in an effort to stem their children’s delinquency. This finding was most prevalent in African-American families and contrasts with the pattern in two-parent, middle-class, white families, where parents often pull away and become less involved in the face of adolescent delinquency.

“Nonresident fathers in low-income, minority families appear to be an important protective factor for adolescents,” said Rebekah Levine Coley, professor of applied development and educational psychology at Boston College and the study’s lead author. “Greater involvement from fathers may help adolescents develop self control and self competence, and may decrease the opportunities adolescents have to engage in problem behaviors.”

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Early Father Involvement Moderates Biobehavioral Susceptibility to Mental Health Problems in Middle Childhood

Boyce, W. Thomas; Essex, Marilyn J.; Alkon, Abbey; Goldsmith, H. Hill; Kraemer, Helena C.; Kupfer, David J.;  Journal of the American Academy of Child and Adolescent Psychiatry, v45 n12 p1510-1520 Dec 2006

[my summary in everyday English:  When fathers are engaged in nurturing and parenting a child from infancy, the child develops healthy responses to social situations when they reach the middle childhood years ~age 9.  The father’s engagement actually improves brain function on the emotional level and reduces activity in the stress area of the brain.  If a father is not involved, the child is at a high risk of behavioral problems.  Also, if a mother is depressed in their child’s early years, the child is at an ever higher risk of behavioral problems.]

Objective:  To study how early father involvement and children’s biobehavioral sensitivity to social contexts interactively predict mental health symptoms in middle childhood. Method: Fathers’ involvement in infant care and maternal symptoms of depression were prospectively ascertained in a community-based study of child health and development in Madison and Milwaukee, WI. In a subsample of 120 children, behavioral, autonomic, and adrenocortical reactivity to standardized challenges were measured as indicators of biobehavioral sensitivity to social context during a 4-hour home assessment in 1998, when the children were 7 years of age. Mental health symptoms were evaluated at age 9 years using parent, child, and teacher reports. Results: Early father involvement and children’s biobehavioral sensitivity to context significantly and interactively predicted symptom severity. Among children experiencing low father involvement in infancy, behavioral, autonomic, and adrenocortical reactivity became risk factors for later mental health symptoms. The highest symptom severity scores were found for children with high autonomic reactivity that, as infants, had experienced low father involvement and mothers with symptoms of depression. Conclusions: Among children experiencing minimal paternal care taking in infancy, heightened biobehavioral sensitivity to social contexts may be an important predisposing factor for the emergence of mental health symptoms in middle childhood. Such predispositions may be exacerbated by the presence of maternal depression.

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Devoted dad key to reducing risky teen behavior – Moms help, but an involved father has twice the influence, new study finds  [EXCERPT],  By Linda Carroll, June 5, 2009

Teenagers whose fathers are more involved in their lives are less likely to engage in risky sexual activities such as unprotected intercourse, according to a new study.  The more attentive the dad — and the more he knows about his teenage child’s friends — the bigger the impact on the teen’s sexual behavior, the researchers found.  While an involved mother can also help stave off a teen’s activity, dads have twice the influence.

“Maybe there’s something different about the way fathers and adolescents interact,” said the study’s lead author Rebekah Levine Coley, an associate professor at Boston College. “It could be because it’s less expected for fathers to be so involved, so it packs more punch when they are.”

Dad’s positive effect
Parental knowledge of a teen’s friends and activities was rated on a five point scale.  When it came to the dads, each point higher in parental knowledge translated into a 7 percent lower rate of sexual activity in the teen.  For the moms, one point higher in knowledge translated to only a 3 percent lower rate.  The impact of family time overall was even more striking. One additional family activity per week predicted a 9 percent drop in sexual activity.

Child development experts said the study was carefully done and important. “It’s praiseworthy by any measure,” said Alan E. Kazdin, a professor of psychology and child psychiatry at Yale University.

Why would dads have a more powerful influence?

“Dads vary markedly in their roles as caretakers from not there at all to really helping moms,” Kazdin said. “The greater impact of dads might be that moms are more of a constant and when dads are there their impact is magnified.”  Also, Kazdin said “when dads are involved with families, the stress on the mom is usually reduced because of the diffusion of child-rearing or the support for the mom.”

In other words, dad’s positive effect on mom makes life better for the child, Kazdin explains.

The study underscores the importance of parental engagement overall, said Patrick Tolan, a professor of psychiatry and director of the Institute for Juvenile Research at the University of Illinois in Chicago.  “For one thing, the more time you spend with them, they’re going to get your values and they’re more likely to think things through rather than acting impulsively.”

Coley hopes that the study will encourage both moms and dads to keep trying to connect with their teenage children, even as their kids are pushing them away.  “…it’s normal for teens to want to pull away from the family, [but] that doesn’t mean they don’t want to engage at all,”

Linda Carroll is a health and science writer living in New Jersey. Her work has appeared in The New York Times, Newsday, Health magazine and SmartMoney.

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The Father-Daughter Relationship During the Teen Years – Ways to strengthen the bond  [EXCERPT],  by Linda Nielsen

According to recent research and my own 30 years of experience as a psychologist, most fathers and teenage daughters never get to know one another as well, or spend as much time together, or talk as comfortably to one another, as mothers and daughters.  Why is this bad news?  Because a father has as much or more impact as a mother does on their daughter’s school achievement, future job and income, relationships with men, self-confidence, and mental health.

When I ask young adult daughters why they aren’t as comfortable sharing personal things or getting to know their fathers as they are with their mothers, most make negative comments about men.

  • “Because he’s a man, he doesn’t want to talk about serious or personal things.”
  • “Because men aren’t capable of being as sensitive or as understanding as women.”
  • “Because fathers aren’t interested in getting to know their daughters very well.”

If a daughter grows up with these kinds of negative assumptions about fathers, she will not give her father the same opportunities she gives her mother to develop a comfortable, meaningful relationship. As parents, we strengthen father-daughter relationships by teaching our daughters how to give their fathers the opportunities to be understanding, communicative and personal.

Creating more father-daughter time alone – Regardless of a daughter’s age, the most important thing we can do is to make sure fathers and daughters spend more time alone with one another.  Since most fathers and daughters haven’t spent much time together without other people around, they might feel a little uncomfortable at first.  If so, they can start by taking turns participating in activities that each enjoys.  One idea:  The father could choose 15 or 20 of his favorite photographs from various times of his life — as a little boy, a teenager or a young man — and then use the pictures to tell his daughter stories about his life.  The key to the success of this father-daughter time is that they alone are sharing this experience.

Staying involved during dad’s absence – Teenage daughters and fathers can strengthen their relationship during dad’s absence through e-mails, letters, pictures and a touch of silliness.  Before dad departs, for one example, father and daughter can talk about how much their relationship means to each of them and agree to write or e-mail at least twice a week.

Linda Nielsen is a psychology professor at Wake Forest University in Winston-Salem, N.C. Her most recent book is Embracing your Father: How to Create the Relationship You Always Wanted With Your Dad. For more information on father-daughter relationships visit www.wfu.edu/~nielsen/.

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Filed under ADHD, anger, bipolar disorder, borderline personality disorder, depression, discipline, mental illness, oppositional defiant disorder, parent rights, parenting

Yoga – Safe and effective for depression and anxiety

Yoga – Safe and effective for depression and anxiety
3 votes
"Meditating, it makes you calm, and calm. Om."  Andre, 7

"Meditating, it makes you calm, and calm. Om." Andre, 7

Yoga is being taught to and practiced by adults with mental and emotional disorders, including those who are developmentally disabled.  And relatively recently, it is being taught to children and teens with similar challenges.  According to people who suffer brain disorders, a session of yoga has more than physical benefits:

  • Improving mood, and increasing self-esteem and energy
  • Reducing anger and hostility, reducing tension and anxiety, and reducing confusion or bewilderment in developmentally disabled people

Yoga is simple:  a series of gentle poses, postures, stretches, and breathing and physical exercises that can be practiced by most people.  Yoga is safe and anyone can benefit for free.  And from 65% to 73%  report they have been genuinely helped by yoga practice.  Types of yoga used in treatment settings are Iyengar and Hatha yoga (poses and exercise), and Pranayamas (breathing exercises).  The specifics of these types of yoga are best explained in the articloes at the end of this article.

There are a number of research studies showing that yoga qualitatively improves mood as self-reported by adult psychiatric patients (on evidence-based survey instruments, see below).  But yoga has also been shown to help children and teens with serious mental and behavioral disorders.  It is currently being taught in schools for special needs children (ex: Pioneer School in Portland, Oregon) and in psychiatric residential treatment programs for children.

At the end of this post are excerpts from articles on the benefits of yoga for calming, easing anxiety, and reducing depression in children and adults.

For more information on the practice of yoga specifically for troubled and traumatized children and teenagers, there are two organizations that provide yoga classes to help young people feel better, function better, and support their recovery.

The Flawless Foundation – “Creates and supports programs that enrich the lives of children who courageously face challenges of neurodevelopmental and psychiatric disorders on a daily basis.”  http://www.flawlessfoundation.org/

Street Yoga – Street Yoga teaches yoga, mindfulness and compassionate communication to youth and families struggling with homelessness, poverty, abuse, addiction, trauma,  and neurological and psychiatric issues, so that they can grow stronger, heal from past traumas, and create for themselves a life that is inspired, safe, and joyful.   http://www.streetyoga.org/

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Study: Yoga Enhances Mood

Journal of Alternative and Complementary Medicine, August 20, 2010

Research confirms what many have suspected—that yoga has positive effects on mood over other physical activities. In a recent study of 2 randomized groups of healthy participants, it was found that the group that practiced yoga 3 times a week for an hour increased brain gamma aminobutyric (GABA) levels over the other group that walked 3 times a week for an hour.

Boston University School of Medicine (BUSM) researchers compared participants’ GABA levels on the first and final day of the 12-week study through magnetic resonance spectroscopic (MRS) imaging. With his colleagues, lead author Chris Streeter, MD, an associate professor of psychiatry and neurology at BUSM

Details available at: Streeter CC, Jensen JE, Perlmutter RM, et al. Yoga Asana sessions increase brain GABA levels: a pilot study. J Altern Complement Med. 2007;13:419-426.

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The effects of yoga on mood in psychiatric inpatients

Roberta Lavey, Tom Sherman, Kim T. Mueser, Donna D. Osborne, Melinda Currier, Rosemarie Wolfe

Psychiatric Rehabilitation Journal, Volume 28, Number 4 / Spring 2005

Abstract

The effects of yoga on mood were examined in 113 psychiatric inpatients at New Hampshire Hospital.  Participants completed the Profile of Mood States (POMS) prior to and following participation in a yoga class.  Analyses indicated that participants reported significant improvements on all five of the negative emotion factors on the POMS, including tension-anxiety, depression-dejection, anger-hostility, fatigue-inertia, and confusion-bewilderment.  There was no significant change on the sixth POMS factor: vigor-activity.  Improvements in mood were not related to gender or diagnosis.  The results suggest that yoga was associated with improved mood, and may be a useful way of reducing stress during inpatient psychiatric treatment.

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Practitioners using yoga therapy to mend bodies and spirits (excerpt)

By Michelle Goodman, The Seattle Times, January 11, 2006

As Tisha Satow stretches into the standing yoga pose known as Warrior II, she encourages her student Shaun, clad in sneakers, jeans and a Seahawks T-shirt, to adjust his feet.  Across from Shaun, fellow yogi Susan, who travels with a baby stroller occupied by three teddy bears, grips a metal folding chair for balance.

Welcome to yoga therapy, one of the newer recreational activities available to clients of Seattle Mental Health on Capitol Hill. Shaun and Susan, adults who live in group homes and are diagnosed as both developmentally disabled and mentally ill, are regulars in this class, taught weekly by Satow or one of her co-workers at the Samarya Center, a Seattle nonprofit organization devoted to providing yoga to everyone it can, regardless of health issues or finances.

What is yoga therapy? Simply put, it’s the adaptation of yoga breathing, stretching, even chanting techniques to help people with health issues alleviate pain, gain energy and basically feel a heck of a lot better. Who can benefit from it? Anyone from typical backache sufferers to the terminally ill.

“Science is beginning to catch up to this, is beginning to validate this,” says John Kepner, director of the International Association of Yoga Therapists, which has about 1,400 members worldwide.

For the Seattle Mental Health clients, who often attend less glamorous classes such as anger management and checkbook balancing, yoga seems a breath of fresh air. Shaun, who’s shy yet quick to share a laugh with his classmates, says he likes the stretching best. And Susan, who calls yoga “fun” and likes that it gives her a chance to “see people,” shows off her biceps after class so instructor Satow can feel how strong she’s getting.

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Yoga as a Complementary Treatment of Depression:  Effects of Traits and Moods on Treatment Outcome  (excerpt)

David Shapiro; Ian A. Cook; Dmitry M. Davydov; Cristina Ottaviani; Andrew F. Leuchter; Michelle Abrams

Abstract

Our preliminary research findings support the potential of yoga as a complementary treatment of depressed patients who are taking anti-depressant medications but who are only in partial remission.  In this study, participants were diagnosed with unipolar major depression in partial remission.  They took classes led by senior Iyengar yoga teachers.  Significant reductions were shown for depression, anger, anxiety, neurotic symptoms and low frequency heart rate variability.  Of those in the study, 65% achieved remission levels post-intervention.  Yoga is cost-effective and easy to implement.  It produces many beneficial emotional, psychological and biological effects, as supported by observations in this study.

Iyengar yoga classes typically involve sitting and standing poses, inversions (head stand, shoulder stand), breathing exercises (pranayama) and short periods of relaxation at the end of each class (savasana–corpse pose).  An important feature of participation in Iyengar yoga is sustained attention and concentration.  Iyengar theory and practice specifies asanas (poses, postures, positions), and certain asanas have been found to enhance positive mood in healthy (non-depressed) participants.

Previous research on the effects of yoga on mood in non-depressed healthy subjects, suggests the potential of yoga for use in the management of clinical major depression.  In a form of yoga (Hatha Yoga) that has a strong exercise dimension much like Iyengar yoga, subjects reported being less anxious, tense, angry, fatigued and confused after classes than just before class.

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How Hatha Yoga saved the life of one manic depressive.  (excerpt)

By: Amy Weintraub ; Psychology Today Magazine, Nov/Dec 2000

When Jenny Smith was 41 years old, her mental illness became so severe that she could barely walk or speak.  After days of feeling wonderful one moment and hallucinating that spiders and bugs were crawling on her skin the next, she landed in the hospital.

Smith is a victim of bipolar disorder, an illness characterized by oscillating feelings of elation and utter depression.  And though she had tried 11 different medications for relief, some in combination, nothing seemed to work.  Upon leaving the hospital, Smith was told that she could expect to be in and out of psychiatric hospitals for the rest of her life.  Soon after her release, Smith decided to learn Hatha yoga, which incorporates specific postures, meditation and Pranayamas, deep abdominal breathing techniques that relax the body.  As she practiced daily, Smith noticed that her panic attacks—were subsiding.  She has since become a certified hatha yoga instructor, and with the help of only Paxil, Smith’s pattern of severe mood swings seems to have ended.

Key to reaping Hatha yoga’s mental benefits is reducing stress and anxiety.  To that end, Jon Cabot-Zinn, Ph.D., of the University of Massachusetts, developed the Stress Reduction and Relaxation Program (SRRP), a system that emphasizes mindfulness, a meditation technique where practitioners observe their own mental process.  In the last 20 years, SRRP has been shown to significantly reduce anxiety and depression, and thus alleviate mental illness.

Research conducted by the National Institute of Mental Health and Neuroscience in India has shown a high success rate—up to 73 percent—for treating depression with sudharshan kriya, a pranayama technique taught in the U.S. as “The Healing Breath Technique.”  It involves breathing naturally through the nose, mouth closed, in three distinct rhythms.

According to Stephen Cope, a psychotherapist and author of Yoga and the Quest for the True Self, “Hatha yoga is an accessible form of learning self-soothing,” he says.”  Yoga students may also benefit from their relationship with the yoga instructor, Cope said, which can provide a “container” or a safe place for investigating, expressing and resolving emotional issues.

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Filed under borderline personality disorder, depression, mental illness, parenting, teens, therapy, yoga

Stigma is prejudice, and harmful to children

Stigma is prejudice, and harmful to children
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Stigma victimizes the victimes

Stigmatization, blame, judgment… It only takes a few individuals to harm a child or family with their words, but it takes a whole society to allow it.  In this article, I’m going to present recent research on the negative stereotyping of families and children with mental disorders, and share stories from families I know.  I hope readers will be empowered to speak out against this form of prejudice and mobilized into changing our society’s attitudes.

Have you ever heard of a bake sale to help a child get treatment for a mental disorder or addiction?
Have you ever heard of a bake sale to help a child get treatment for a mental disorder or addiction?

Puckette©2008

Stigma takes many forms.

The most common scenario of stigma is when you are seen as a bad parent, perhaps even an abusive one, or your child is seen as stupid, spoiled, attention-getting, or manipulative.  Another form of stigma is having others show disrespect to parents who seek help from the mental health profession.  Psychologists are “flakes,” and families  who see them are “wackos.”  “Where’s your faith?”, some say, or “why don’t you quit making excuses for your child and give them real consequences?”

One of the more destructive forms of stigma is the condemnation parents receive when they “drug their child to fix them.”  Too many believe drugs turn children into “zombies” (see research study below).  Because of the stigma of treatment, I’ve seen many parents try every alternative treatment possible to help their child, only to have their child struggle year after year in school, fall farther behind their peers, make no progress in therapy, and other setbacks that medicines can prevent.  These parents cling to the belief that they are doing the right thing, yet some children really need medicines, and the drugs don’t turn them into zombies.  [In today’s treatment approaches, drugs are always considered a piece of the treatment puzzle, never the complete answer.]

A mother’s story about her experience with stigmatization:

This mother lost her best friend of 20 years because the friend got tired of hearing the mom talk about her very troubled 10-year-old son.  In frustration, the friend wrote her a letter saying the mom was neurotic, and that she should quit trying to control her son, that her son’s behavior was a cry for help.  The friend said she needed to set her son free and get help for her emotional problems, and that she wasn’t going to “enable” this mom anymore by being her friend.  The mom was stunned and hurt by the letter.  She intellectualized that she didn’t need a friend like this, but her heart was nonetheless broken by the betrayal.  The son turned out to have brain damage from a genetic disorder and it was getting worse.

What you can do when someone makes thoughtless remarks, lectures you, or avoids you because of your child

From my blog post November 2008:

http://raisingtroubledkids.wordpress.com/2008/11/25/ideas-for-what-to-do-when-youre-blamed-and-judged/

First, resist defending yourself; it can attract more unwanted attention and disagreement.  You don’t have the time or emotional energy to explain or teach someone who will challenge everything you say.  Do everything you can to avoid people like this—many have had to cut off some family members and friends, and even their clergy or religious communities.

My story:  when my child was diagnosed with a serious mental disorder, I stood up in front of my church congregation, explained what was happening, and asked for prayers for my family.  At the end of that service, people started avoiding me.  There were no more hello’s.  There wasn’t even eye contact.  The abrupt isolation from people I knew was devastating and I stopped attending.  What did I say?  Why did this happen?  I thought if my child had a ‘socially-acceptable’ cancer others would know what to do or say to ease the isolation and grief.

Second, actively seek out supportive people who just listen.  You need as large as possible a network of compassionate people around you.  You may be surprised how many people have a loved one with a mental or emotional disorder, and how many are willing to help because they completely understand what you’re going through.

Third, politely and assertively say thanks but no thanks.  Try something like this:  “Thanks for showing interest, but we are getting the help we need from doctors we trust.” Or simply, “please don’t offer me advice I didn’t ask for.”  No apologies.

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Public Perceptions Harsh of Kids, Mental Health (excerpt)

May 1, 2007   (USA TODAY)

Though the subject has been analyzed in adults, until now there has been limited research illuminating how the public perceives children with mental disorders such as depression and attention deficit disorders, according to experts from Indiana University, the University of Virginia and Columbia University.  The findings are published in the May 2007 issue of Psychiatric Services.

The study, based on in-person interviews with more than 1,300 adults, indicates that people are highly skeptical about the use of psychiatric medications in children.  Results also show that Americans believe children with depression are more prone to violence and that if a child receives help for a mental disorder, rejection at school is likely.

“The results show that people believe children will be affected negatively if they receive treatment for mental health problems,” says study author Bernice Pescosolido, director of the Indiana Consortium for Mental Health Services Research, in Bloomington.  “Nothing could be further from the truth.  These misconceptions are a serious impediment to the welfare of these children.

According to the study:

  • those interviewed believed that doctors overmedicate children with depression and ADHD and that drugs have long-term harm on a child’s development.  More than half believed that psychiatric medications “turn kids into zombies.”
  • respondents thought children with depression would be dangerous to others; 31% believed children with ADHD would pose a danger.
  • Respondents said rejection at school is likely if a child goes for treatment, and 43% believe that the stigma associated with seeking treatment would follow them into adulthood.

Pescosolido and her colleagues say such stigma surrounding mental illness — misconceptions based on perception rather than fact — have been shown to be devastating to children’s emotional and social well-being.

Population studies show that, at any point in time, 10% to 15% of children and adolescents have some symptoms of depression.  About 4 million children, or 6.5%, have been diagnosed with ADHD, only 2% less than the number of children with asthma.

“People really need to understand that these are not rare conditions,” says Patricia Quinn, a developmental pediatrician in Washington, D.C.

To banish the stigma linked to mental health problems in children, the public has to get past labels and misconceptions, Pescosolido says.   Normalizing these conditions would help too, Quinn says.  “We need to view depression and ADHD like we do allergies,” she says. “They are very treatable.”

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Filed under bipolar disorder, borderline personality disorder, depression, mental illness, oppositional defiant disorder, parenting, schizoaffective disorder, schizophrenia, teens