Category Archives: teens

Life at home is a war zone

Life at home is a war zone
2 votes

Homes with troubled children are war zones–very different from those with physically-disabled kids.   We can’t make things better for our child with wheelchairs or ramps or other specialized equipment.  We need serious fire power.  This story tells what it’s like to live with our child, seek mental health treatment, and find social and emotional support for ourselves.  It is inspired by, and much quoted from, Emily Perl Kingsley’s “Welcome to Holland,” about having with a son with cerebral palsy.  The original is at the end of this article.

Welcome to the War Zone

I try hard, often unsuccessfully, to describe the experience of raising a child with a brain disorder – to try to help people who have not shared that difficult experience to understand it, to imagine how it would feel.  It’s like this… When you’re going to have a baby, it’s like planning a fabulous vacation trip – to Italy.  You buy a bunch of guide books and make your wonderful plans.  The Coliseum, the Michelangelo David, the gondolas in Venice.  You may learn some handy phrases in Italian.  It’s all very exciting.  After months of eager anticipation, the day finally arrives.  You pack your bags and off you go.

Several hours later, the plane lands.  The stewardess comes in and says, “Welcome to Afghanistan.”  “Afghanistan?!?” you say.  “What do you mean Afghanistan??  I signed up for Italy!  I’m supposed to be in Italy.  All my life I’ve dreamed of going to Italy.”  But there’s been a change in the flight plan.  They’ve landed in Afghanistan and there you must stay.

They’ve taken you to a dangerous unstable place full of fear.  You have no way to leave, so you ask for help, and citizens offer to help but you must pay in cash.  Instead of help, they lead you down one blind alley after another.  You are afraid because you are different, you are a target because you stand out.  After spending most of your cash, you can’t ignore it any more–you are in very serious trouble–completely alone in a strange country, surrounded by people who don’t like you.  You won’t be rescued.  You can only think about hiding and praying and holding yourself together.

After a few years of ‘round-the-clock stress and isolation, you make a couple of connections, and arrange an escape across the border.  There are dangers in the next country, but your connections help.  Your escape seems to take forever, yet you finally make it home!  But everyone you know has been busy coming and going to Italy… and they’re all bragging about what a wonderful time they had there. And for the rest of your life, you will say “Yes, that’s where I was supposed to go. That’s what I had planned.” And the pain of that will never, ever,  go away… because the loss of that dream is a very, very significant loss.  But… if you spend your life mourning the fact that you didn’t get to Italy, you may never feel the fulfillment of using your character-building experience to help others escape Afghanistan.

Margaret

– – – – –

“Welcome to Holland” by Emily Perl Kingsley – http://ourlifeinholland.blogspot.com

“I am often asked to describe the experience of raising a child with a disability – to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. It’s like this….When you’re going to have a baby, it’s like planning a fabulous vacation trip – to Italy. You buy a bunch of guide books and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may learn some handy phrases in Italian. It’s all very exciting. After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The stewardess comes in and says, “Welcome to Holland.” “Holland?!?” you say. “What do you mean Holland?? I signed up for Italy! I’m supposed to be in Italy. All my life I’ve dreamed of going to Italy.” But there’s been a change in the flight plan. They’ve landed in Holland and there you must stay. The important thing is that they haven’t taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It’s just a different place. So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a whole new group of people you would never have met. It’s just a different place. It’s slower-paced than Italy, less flashy than Italy. But after you’ve been there for a while and you catch your breath, you look around…. and you begin to notice that Holland has windmills….and Holland has tulips. Holland even has Rembrandts. But everyone you know is busy coming and going from Italy… and they’re all bragging about what a wonderful time they had there. And for the rest of your life, you will say “Yes, that’s where I was supposed to go. That’s what I had planned.” And the pain of that will never, ever, ever, ever go away… because the loss of that dream is a very very significant loss. But… if you spend your life mourning the fact that you didn’t get to Italy, you may never be free to enjoy the very special, the very lovely things … about Holland.”

The Holland story has been used widely by organizations such as NAMI (National Alliance of Mental Illness), as a way to help parents with troubled kids accept their situation when their child is identified as having a brain disorder.  Holland just seems too nice, too peaceful, to relate to our situations.

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Filed under Grief, mental illness, parenting, teens, troubled children, troubled children

Managing resistance: tips and advice

Managing resistance: tips and advice
3 votes


For those who raise resistant, defiant children or teens, this is the single most important piece of advice:  take care of yourself, your primary relationships, and the rest of your family.  Your child cannot take everyone down.  You have a life and so do the rest of the family members.  Protect your other children from PTSD – Post Traumatic SIBLING Disorder.  Schedule regular times for you and the others to relieve tension, and do something that takes you out of the home and brings you joy.  The time or expense is worth every bit as much as psychotherapy.

Before we get to the practical “how to” advice, make note of these facts about defiant and resistant children:

  • Physical age is not emotional age.  They act younger than they are.
  • The child lives in the here and now; they don’t think about the past or future.  They don’t see how their original actions result in a series of consequences.
  • The child does not notice their effect on others.
  • Their brain is easily overloaded, which explains their problems, but you can use this overloading problem to your advantage (see below)
  • They are inherently irrational and cannot follow your reasoning, so don’t try.
  • Believe it or not, you want your child to be resistant to the negative things they’ll face in life.  It is a strength to cultivate because it takes a strong will to face challenges.  YOU need to be resistant.

Managing resistant children is a balancing act.  If you go too far asserting authority you can draw more resistance, especially if you become emotional, so STAY COOL.  You’ll have to stand rooted and calm many times before they reduce their behavior, so embrace patience.  Patience is good medicine for stress.  Don’t get stuck believing you’ve lost patience… because you haven’t!

Practice ahead of time

Before you set a boundary on your recalcitrant child, practice what you will say in advance.  Play the dialogue out in your head—imagine their reaction to your request or rule, and plan a neutral-toned response.  Remind yourself that you are the authority, and you are more resolved and persistent than they are.  Your message doesn’t have to be rational, e.g. “Because I’m the mommy (or daddy) and I say so.”

THESE ARE PRACTICAL IDEAS, BUT NOT IRONCLAD RULES.  USE YOUR BEST JUDGEMENT.

Be a benevolent dictator

Since your home is not a democracy and your child does not run the household, they are not entitled to have all their needs fulfilled or opinions considered.  When they make a demand, thank them for letting you know their opinion, and explain how you will weigh their needs with those of everyone else.  Your child will find your decision completely unfair, but remind yourself that “fair” is not “equal.”   (It’s not desirable to treat everyone and every situation equally.)  Say it’s the best you can do for now.  As their accusations fly, dial back your interest, get busy with something else, and become distracted.

Allow some aggression

When it’s appropriate and safe, ask your child to do more of what they’re already doing so that they turn it around and defy you by stopping the behavior.  Example: your child refuses to take a direction and throws a book on the floor in anger.

Parent:  “There’s only one book on the floor. Here is another one, now throw this on the floor.”  (Child throws book down.)

“Here’s another one. Throw this down too.”  (Child throws book down.)

“And here’s another book, throw this one down, too.”  (Child becomes frustrated and angry, but stops throwing books down in defiance.)

Be a marshmallow

Show no resistance, instead, listen and respond to how they feel, not what they say.  Show them you are open to genuine talk later when the stress dies down.

Teen:  “I hate you, you f- -king b- -ch!”

Parent:  “Sounds like you’re really angry.”

Teen:  “Shut up you stupid wh- -e!  You c – -t!”

Parent:  “Can you tell why me you’re angry so I can do something about it?”

Teen:  “Leave me alone f- -k face!  Stop patronizing me!”

Parent:  “OK, I hear you don’t want me to patronize you, so I won’t.  I feel this is stressful for both of us, so I’d like to take a break and maybe talk about it later.”

Call their bluff

Child:  “I’m going to run away!”

Parent:  “OK, I’ll give you 50 cents to call me and tell me where you are, and I’ll bring you your stuff.”  (then walk away)

Reverse psychology

Parent:  “Oh my God, I can’t believe what you’ve done to your hair, that’s horrible!  What are people going to think?  That’s worse than tattoos.  You have to stop this nonsense!”

(One mother used this technique to get her daughter to stop her plans to make a homemade tattoo on her face.  After all, hair grows out, but facial tattoos can be forever.)

Overload their brain circuits

Give your child or teen multiple instructions quickly, and include things they do and don’t want to do.  It becomes too much work for them to sort out what to defy.

Parent:  “Keep up the yelling and close the door on your way out.  And be sure to get louder out there so all the neighbors can hear.  Dinner is at 5:30.”

(What happens?  The door is slammed maybe, but the kid is home at 5:30 for dinner.)

Actively ignore

As mentioned in a previous post* this works best with children 2 through 12.  They try to get a reaction by annoying you or threatening to do something you don’t want them to do.  Stay in the vicinity but don’t respond, look away, and act like you don’t care or can’t hear them.  Go into another room or outside, for example, and the annoying child will follow you to continue to get your attention with annoying behavior.  If they flip the lights on and off, or ring the doorbell repeatedly, or turn up the volume too loud, maybe you can switch a circuit breaker off and walk away… or if driving, you can pull over, stop the car, and get out and wait.   * Defying ODD: What it is and ways to manage

Mix it up

Be unpredictable.  Give a reward sometimes but not all the time, so the child keeps trying the good behavior to get the reward.  Instead of a consequence, use bribes to stop a behavior.  Allow them to do something they like to do, only with appropriate boundaries.  In my personal opinion, I think it’s also OK to manipulate a situation and allow the child to think they’ve “won.”  Choose your battles.  Let some things go if you’re too stressed.

Have realistic expectations

It’s easy to get stuck in rut—it happens to everyone—but you can climb out.  Remember,  it’s not the child’s fault and it’s not your fault.  Your child may not go through life the same as others, they may always have problems, but your job is to help them bounce back and learn from their mistakes.  If you can do that, you’ve wildly succeeded.  The best you can is the best you can do.

Bottom line

One must be a saint for sticking it out for their troubled child or teen, whether a bio parent, foster parent, grandparent, adoptive parent, or other family member.  If the child’s condition is serious, they may never make it in the world because of their disability, but you’ll know you’ll have honored them, lived your values, and loved unconditionally.

Hope

  • They have the ability to do better.
  • With treatment, children improve (e.g. therapy, exercise, medication…).
  • Things usually work out.
  • Help is out there.

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Filed under bipolar disorder, defiant children, mental illness, oppositional defiant disorder, parenting, teenagers, teens

Marijuana and psychosis in teens

Marijuana and psychosis in teens
5 votes

Underside of normal brain. Shown area has blood flow.

 

It’s a myth that marijuana is safe.  While it has clear, proven benefits for certain physical ailments, the drug’s effect on those with psychiatric vulnerabilities, especially adolescents, can lead to psychosis and debilitating long-term cognitive impairment.  Marijuana should not be political or partisan, yet it is.  The research is international, which tends to refute the argument that concerns are political instead of medical.  Advocates use the term “safe herbal medicine,” but avoid mention of its horribly unsafe effects.  Like any psychoactive drug, there is serious risk of harm.

16-year old with 2 years regular marijuana use.

 

I was at a fundraising event once, chatting with a biochemist about brain chemistry.  At one point he turned and asked a friend passing by about his party the night before, and the friend said that everyone was so stoned they could hardly stand up.  This man then said he was sorry he missed it.  I asked the scientist if he was aware of the negative effect marijuana had on the neurotransmitter serotonin, and how it causes psychosis. “You’re joking!” he said sarcastically.  “What are you, some uptight ultra right reactionary?”  A person nearby overheard us and chuckled and said to me, “Where have YOU been?”  I’m just a parent who cares about kids, who is not buying the story out there.  And I’ve read the peer-reviewed research on marijuana going back 20 years.

18-year-old with 3 year history of marijuana use, 4 times per week

 

I share this story because I assumed that an expert in the biological chemistry would know we don’t fully understand the astonishing complexities of brain chemistry, nor the compounding effect of genetics on a person’s reaction to substances.  Why didn’t this man question his belief that marijuana is perfectly safe?

At the end of this article are summaries of  research studies that have been conducted worldwide since 2004.  All found negative effects of marijuana use on teens.

 “When THC (tetrahydrocannabinol) was administered in one trial, it caused both patients and controls to experience transient increases in cognitive impairments and schizophrenia-like… symptoms.”

 There are side effects.  We know some people cannot stop using alcohol once they start, and that serious addiction runs in families.  We now know that pharmaceuticals help some people, but have deadly side effects in others.  Why isn’t marijuana, with proven negative side effects, also considered a risky substance like antipsychotics or arthritis medications or statins?  Because it’s a plant, and not made by a giant corporation?  Because it’s popular?

I work with adolescents in the juvenile justice system.  A young man on my caseload grew noticeably depressed after starting regular marijuana use—this was tracked by weekly urinalysis.  He said that smoking helped him feel better.  I asked if he got depressed afterwards, and he shrugged.  I asked if he thought it was safe, and he said, “Sure, because it’s natural.  Everyone knows that.”

Pay attention, this is what teens think:  marijuana is natural and therefore safe. That’s what sellers tell them and that’s what they tell each other.  Advocates use the comforting term “safe natural herb.”  Did you know that commonly used herbs are NOT safe?

  • Comfrey is used in tea for arthritis pain, but causes liver damage.
  • Arnica is used for pain, but causes kidney damage.
  • Cinnamon bark is smoked by teens, and it causes disorientation, unconsciousness, and kidney damage.
  • Ephedra (ma huang) causes heart attacks.

Research into smoked or consumed marijuana is repeatedly linked to the onset of psychotic symptoms such as hallucinations, cognitive impairments, and schizophrenic-like symptoms, regardless of a person’s age, even if they don’t use other narcotic substances.  The risk is especially high for adolescents because they start using marijuana early.

A note on medical marijuana – The plant Cannabis sativa has two substances of interest:

  1. cannabidiol (CBD) – the molecule considered safe for a variety of treatments, and even approved by the upstanding American Medical Association;
  2. tetrahydrocannabinol (THC) – the molecule responsible for the high and the one that can produce psychotic symptoms.

Safe medical marijuana should not be the smoked leaf and buds, but as a dosed aerosol, and available by prescription, just as all other medications with possible negative side-effects.  Legalizing only this form makes sense. Otherwise, legalization is not about medical need but recreational use.

“Increasing levels of cannabis use at ages 14-21 resulted in lower levels of degree attainment by age 25, lower income at age 25, higher levels of welfare dependence, higher unemployment, lower levels of relationship satisfaction, and lower levels of life satisfaction.” (read more below)

 More than half the young people on my caseload have diagnosable disorders, or a history of addictions and disorders in their families.  They’re already in trouble with the law. The last thing they need is the means to self-induce psychosis.

Share this information with other parents.  This isn’t about keeping  medicine away from people who need it, nor is it a “righteous” ploy to pick on people who like to get high.  The danger for children is real.

–Margaret

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


Early Marijuana Use Heightens Psychosis Risk in Young Adults (summary)
John McGrath MD, Rosa Alati MD Archives of General Psychiatry, published online March 1, 2010,
MedscapeCME: Psychiatry and Mental Health

“Early cannabis use increases the risk of psychosis in young adults,” reports lead investigator John McGrath, MD, of Queensland Centre for Mental Health Research in Brisbane, Australia.  “Apart from having an increased risk of having a disorder like schizophrenia, the longer the young adults reported since their first cannabis use, the more likely they were to report isolated symptoms of psychosis.”

Investigators assessed 3801 study participants at ages 18-23 years, identifying first marijuana use and three psychosis-related outcomes:  non-affective disease, hallucinations, and the Peters et al Delusions Inventory Score.  “Psychotic disorders are common and typically affect 1 or 2 people of every 100” Dr. McGrath said, “…(I) was surprised that the results were so strong and so consistent…  We need to think about prevention.”

Results mirror those of another study conducted by Michael Compton MD, published in the American Journal of Psychiatry (November 2009), where investigators looked at 109 patients in a psychiatric unit and found that daily marijuana and tobacco use was common.  Of those who abused cannabis, almost 88% were classified as weekly or daily users before the onset of psychosis.

Emma Barkus, PhD, from the University of Wollongong in New South Wales, Australia, says other studies suggest that those who are engaging in risk behaviors about the age of 14 years are more likely to persist as they get older, adding further support to the role of cannabis use in predicting earlier psychoses.
– – – – –

Evidence Accumulates for Links Between Marijuana and Psychosis (summary)
Michael T. Compton, MD, MPH – Assistant Professor, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, 2008

Cannabis is the most abused illicit substance in the general US population, and the most abused illegal drug among individuals with schizophrenia.This literature reviewed studies that examined (1) associations between cannabis use and clinical manifestations of psychosis, and (2) the biologic plausibility of the observed links.

The initiation of cannabis use among those with psychotic disorders often precedes the onset of psychosis by several years.Cannabis use in adolescence is increasingly recognized as an independent risk factor for psychosis and schizophrenia.  Progression to daily cannabis use was associated with age at onset.

Study evidence also supported biological links between cannabis use and psychosis.  In the brains of heavy users, interactions with specific cannabinoid receptors are distributed in brain regions implicated in schizophrenia.  Other studies report elevated levels of endogenous cannabinoids in the blood and cerebrospinal fluid of patients with schizophrenia.  When THC (tetrahydrocannabinol) was administered in one trial, it caused both patients and controls to experience transient increases in cognitive impairments and schizophrenia-like positive and negative symptoms. – – – – –

Chronic toxicology of cannabis.  (summary)
Reece, Albert Stuart; Clinical Toxicology (Philadelphia, PA.)   vol. 47  issue 6, Jul  2009 . Medical School, University of Queensland, Highgate Hill, Brisbane, QLD, Australia.

 Findings: There is evidence of psychiatric, respiratory, cardiovascular, and bone toxicity associated with chronic cannabis use.  Cannabis is implicated:

  • In major long-term psychiatric conditions including depression, anxiety, psychosis, bipolar disorder;
  • Respiratory conditions include reduced lung density, lung cysts, and chronic bronchitis;
  • elevated rates of myocardial infarction and cardiac arrythmias;
  • linked to cancers at eight sites, including children after in utero maternal exposure.- – – – –

Marijuana Use, Withdrawal, and Craving in Adolescents (summary)
Kevin M. Gray, MD, Assistant Professor in the youth division of the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina in Charleston.

Findings in the literature survey:  Initiation of marijuana use typically occurs during adolescence.  Recent data indicate that in the United States, 42% of high school seniors have tried marijuana; 18% have used it in the past 30 days; and 5% use it daily.  Among adolescents aged 12 to 17, 3.6% met criteria for cannabis use disorder (abuse or dependence) and 2% met criteria for cannabis dependence.

More than half (51%) of adolescents reported that marijuana is fairly or very easy to obtain.  Ironically, this ready availability may be a “reverse gateway” from marijuana use to cigarette use to nicotine dependence.  Earlier initiation is associated with problem-related marijuana use: “hard” drug use, poly-drug use, and academic failure.  Using marijuana once per week or more during adolescence is associated with a 7-fold increase in the rate of daily marijuana use in young adulthood.  Cannabis dependence increases the risk factors for impaired driving and delinquent behavior.  Chronic use is associated with impaired immune function, respiratory illnesses, cognitive problems, and motivational impairment. 

There is a debate whether marijuana use begins as “self-medication” for psychiatric disorders, or whether habitual marijuana use can predispose some individuals to psychiatric symptoms.

Social anxiety disorder in adolescence is associated with 6.5-times greater odds of subsequent cannabis dependence, and vice versa, frequent marijuana use during adolescence appears to increase the risk of subsequent development of anxiety and depressive disorders.  The prevalence of cannabis abuse is 2 to 3 times greater among adolescents who have major depression.  Also linked in both directions: conduct disorder predicts marijuana and other substance use, while early-onset marijuana use predicts conduct disorder.

Five treatment regimes were studied: motivational enhancement/cognitive-behavioral therapy (MET/CBT), family education and therapy intervention, a community reinforcement approach, and multidimensional family therapy.  All resulted in positive but modest outcomes, with MET/CBT and community reinforcement treatments being most cost-effective.

Emerging evidence indicates rewards for marijuana abstinence may be positive.  Multi-systemic therapy, an intensive approach that incorporates individual, family, and community components, has demonstrated effectiveness among delinquent adolescents.

Withdrawal: Marijuana withdrawal symptoms are a constellation of emotional, behavioral, and physical symptoms that include anger and aggression, anxiety, decreased appetite and weight loss, irritability, restlessness, and sleep difficulty, which result specifically from withdrawal of marijuana’s psychoactive ingredient, THC.  Less frequent but sometimes present symptoms are depressed mood, stomach pain and physical discomfort, shakiness, and sweating.  Onset of withdrawal symptoms typically occurs within 24 hours of cessation of THC, and symptoms may last days to approximately 1 to 2 weeks.

Craving: Patients’ craving of marijuana is evidenced after presenting them with cues associated with marijuana (e.g. sight or smell of the substance, films of drug-taking locations, and drug-related paraphernalia).   Exposure to cues leads to robust increases in craving, along with modest increases in perspiration and heart rate.  Cue reactivity can predict drug relapse.

Craving and withdrawal symptoms interfere with successful cessation of use and sustained abstinence.  In addition, medications are often used to target withdrawal from substances, such as benzodiazepines for alcohol dependence and clonidine and buprenorphine for opioid dependence. These medications could be combined with psychosocial interventions, or developed to complement concurrent psychosocial treatments. – – – – –

Legalization of Marijuana: Potential Impact on Youth (summary)
Alain Joffe, MD, MPH, W. Samuel Yancy, MD the Committee on Substance Abuse and Committee on Adolescence – PEDIATRICS Vol. 113 No. 6 June 2004, pp. e632-e638

Scientists have demonstrated that the emotional stress causedby withdrawal from marijuana is linked to the same brain chemical that has been linked to anxietyand stress during opiate, alcohol, and cocaine withdrawal.  THC stimulates the same neurochemical process that reinforcesdependence on other addictive drugs.  Current, well known, scientific informationabout marijuana shows the cognitive, behavioral,and somatic consequences of acute and long-term use, which include negative effects on short-term memory,concentration, attention span, motivation, and problem solving.  These clearly interfere with learning, and have adverse effects on coordination,judgment, reaction time, and tracking ability.  http://pediatrics.aappublications.org/cgi/content/full/113/6/e632 – – – – –

The Past, Present, and Future of Medical Marijuana in the United States (summary)
By John Thomas, JD, LLM, MPH, Professor of advanced law and medicine, civil procedure, and commercial law at the Quinnipiac University College of Law, Hamdon, Connecticut, January 6, 2010

Cannabidiol (CBD) is considered safe and has a variety of positive benefits, and this component should be legalized.  However, the other narcotic component in marijuana, tetrahydrocannabinol (THC), is responsible for the high, and too much may not be a good thing because it can produce psychotic symptoms in people. – – – – –

 Medical Marijuana:  The Institute of Medicine Report (summary)
Ronald Pies, MD, Editor in Chief – Psychiatric Times. Vol. 27 No. 2 , January 6, 2010

Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects.  However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other prescription medications. Cannabinoids can induce acute transient psychotic symptoms or an acute psychosis in some individuals… (but it is unclear) what makes some individuals vulnerable to cannabinoid-related psychosis.  There is a pressing need for more high-quality research in the area of medical marijuana and cannabinoid use. – – – – –
 
Link Between Cannabis Use and Psychosis Onset at a Younger Age (summary)
Ana Gonzales MD, Santiago Apostol Hospital in Vitoria, Spain, Journal of Clinical Psychiatry. August 2008

Researchers found a strong and independent link between cannabis use and the onset of psychosis at a younger age, regardless of gender or the use of other drugs.  The link is related to the amount of cannabis used.  “The clinical importance of this finding is potentially high,” Dr. Gonzalez-Pinto given that cannabis use is extremely prevalent among young people… estimates of the attributable risk suggest that the use of cannabis accounts for about 10 percent of cases of psychosis.”The findings showed a significant gradual reduction in the age at which psychosis began that correlated with an increased dependence on cannabis. Compared with nonusers, age at onset was reduced by 7, 8.5, and 12 years among users, abusers, and dependents, respectively, the researchers report. – – – –
Cannabis use and later life outcomes. (summary)
Fergusson DM, Boden JM, Addiction;  Pages: 969-76;  Volume(Issue): 103(6), June 2008

A longitudinal study of a New Zealand birth cohort tracked subjects to age 25 years.  Cannabis use at from ages 14-25 was measured by:  university degree attainment to age 25; income at age 25, welfare dependence during the period 21-25 years, unemployment 21-25 years, relationship quality, and life satisfaction.  Other indices were measured to adjust for confounding factors:  childhood socio-economic disadvantage, family adversity, childhood and early adolescent behavioral adjustment and cognitive ability, and adolescent and young adult mental health and substance use.The findings were statistically significant.  Increasing levels of cannabis use at ages 14-21 resulted in lower levels of degree attainment by age 25, lower income at age 25, higher levels of welfare dependence, higher unemployment, lower levels of relationship satisfaction, and lower levels of life satisfaction. – – – – –

Doctors:  Pot Triggers Psychotic Symptoms (summary)
May 1, 2007
Aetna Intelihealth – Mental Health

 LONDON — New findings show physical evidence of the drug’s damaging influence on the human brain.  In some people, it triggers temporary psychotic symptoms including hallucinations and paranoid delusions. Two of the active ingredients of cannabis: cannabidiol (CBD) made people more relaxed.  But second ingredient: tetrahydrocannabinol (THC) in small doses produced temporary psychotic symptoms in people, including hallucinations and paranoid delusions. According to Dr. Philip McGuire, a professor of psychiatry at King’s College, London, THC interfered with activity in the inferior frontal cortex, a region of the brain associated with paranoia. “THC is switching off (a chemical) regulator,” McGuire said, “effectively unleashing the paranoia usually kept under control by the frontal cortex.”In another study, Dr. Deepak Cyril D’Souza, an associate professor at Yale University School of Medicine, and colleagues tested THC on 150 healthy volunteers and 13 people with stable schizophrenia. Nearly half of the healthy subjects experienced psychotic symptoms when given the drug.  Unfortunately, the results for the schizophrenic subjects was so much worse that researchers scrapped adding additional schizophrenic subjects to the study.  The negative impact was so pronounced that it would have been unethical to test it on more schizophrenic people.”One of the great puzzles is why people with schizophrenia keep taking the stuff when it makes the paranoia worse,” said Dr. Robin Murray, a professor of psychiatry at King’s College in UK.  She theorized that schizophrenics may mistakenly judge the drug’s pleasurable effects as outweighing any negatives. – – – – – 

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Filed under depression, mental illness, parenting, schizoaffective disorder, schizophrenia, teens

Parenting mistakes – 9 ways to make things worse

Parenting mistakes – 9 ways to make things worse
1 votes

Knowing what NOT to do as a parent can sometimes be as informative as knowing what to do.

1…Treat your child or teen like another adult who has an equal say in how things are done.  Treat your home as a democracy, where everything must be fair and equal.  Answer your child’s accusations by offering explanations that show how reasonable you are.

2…Find fault with your child and let them know about it over and over and over again.  If they do something positive, let them know it’s not enough.  Let your tone of voice reveal how frustrated, angry, stressed or resigned you feel because of them.

3…Pretend your child has no reason for their behavior.  Ignore his or her unique needs or the challenges they may face everyday.  Are they being picked on at school or by a sibling?  Do they fear abandonment?  Are they stressed about an upcoming event?  Is your home too chaotic?

4…Make rules and only enforce them once in a while, or have the consequence come much later than the misbehavior (“I’ll tell your father when he gets home.”).

5…Don’t treat your child appropriately for his or her age.  Make long explanations to a three year old about why you’ve set a certain rule.  Assume a teen wants to be just like you.

6…Expect your child to logically, rationally accept your reasonable rules.  Parents expect common sense from children who are quite young (4 or 5), too young in the first place, or from young adults (up to early 20’s) who have a long track record of doing things that don’t make sense.

7…Keep trying the same things that still don’t work.  Like repeating yourself over and over , talking at them rather than with them, or screaming.  (Don’t be embarrassed; we’ve all done this.)

8…Jump to conclusions that demonize the child.  “You’ll do anything to get your way,” or “You are manipulative and deceitful,” or “You don’t listen to me on purpose,”  “I’m tired of your selfishness…”

9…Make them responsible for your feelings.  If you lose your cool and blow out over something they did (stress pushes parents over the edge sometimes), insist they do the apologizing.

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Filed under mental illness, parenting, teens

ADHD kids become troubled adults

ADHD kids become troubled adults
4 votes

I have been so wrong about ADHD.  I confess I used to think attention disorders were not as serious as other disorders.  Sure, these kids had big problems, but they didn’t seem to compare with the disabling, even dangerous, symptoms of disorders like bipolar or schizophrenia.  ADHD kids just seemed more ‘functional’ to me, and the treatments seemed to work better.  While other families talked about psychotic breaks, suicide, and uncontrollable rages, I heard parents of ADHD kids talk about intense frustration and daily calls from school.  Heck, ADHD kids could attend school!  When I attended children’s mental health conferences, the ‘youth-talk-back’ workshops were all led by young people with ADHD.  They were articulate about their experiences and needs, answered questions, and interacted appropriately with audiences.  So many strengths!  Youth with other disorders are challenged by all of these tasks.

I confess, I also found ADHD funny…

…but my perception changed radically when I found recently published research on children with ADHD who were followed from childhood to adulthood.  These studies revealed deeply unsettling news—the long-term effects of ADHD can be serious.  Adults with ADHD have a higher risk of developing other psychiatric problems, being victimized and incarcerated, and facing lifetime struggles with education and employment.  Summaries from 10 research studies on the long term prognoses of ADHD are found at the end of this post.

Children and teens with ADHD deserve the chance to reach adulthood with skills that keep them from sliding inexorably downhill, which studies show is common.

Treatment is imperative, not optional!  ADHD hits hardest in adulthood, but starts in childhood when parents have an opportunity to change it’s course.  Parents and caregivers should aggressively and persistently seek an appropriate treatment for their ADHD child that improves functioning:  behavior at school and home, school attendance and educational attainment, self-esteem, and self-actualization.  In addition to medical/medication treatment as recommended, the child must learn self-management and self-calming skills so they can control impulses when they reach adulthood.

Little things start adding up – Without skills (and/or medication), a person with ADHD slips up on life’s daily little challenges–losing, forgetting, neglecting, overreacting, disappointing others, and undermining themselves in a thousand different ways.
Needing others and resenting it – I’ve noticed that those with ADHD seem to find or attract others they can depend on.  They seek and get support to be functional, but the effort can weigh heavily on their “caretakers” (spouse, friends, co-workers) and family.  They lose opportunities to practice self-reliance when this happens, and they resent their dependence on others.  Who wants to be stuck within other’s limits, and on the receiving end of their frustration and impatience?

 
Unfinished business – Those with ADHD drag unfinished projects with them indefinitely, keeping them in an actual or metaphorical garage full of costly but unfinished projects.  Little repairs become big expensive repairs through lack of maintenance.  Bills don’t get paid, licenses don’t get renewed, debtors get away with never paying them back.
 
Guide your child to his or her gifts –
From personal experience with ADHD children and adults, I know they can love, be affectionate, funny, generous, and show empathy for others.  They strive to be better.  Think of careers your child or teen might pursue that require creativity, energy, and enthusiasm.  Introduce them to experiences that challenge them, and ignore the myth that they can’t focus or that they mess things up, not true.  ADHD kids readily focus on projects they enjoy, demonstrate mental nimbleness with complexities, multitask with accuracy, and shine in emergencies, whether debugging software, making music, or even doing surgery.

Writer’s commentary: To medicate or not to medicate?  Two extremes, neither appropriate. I’ve read articles that question the existence of ADHD, or vilify the families that treat with medications. Prejudice against this disorder and parents is common. Even uninformed people think they understand ADHD, and comfortably spread personal opinions about the use of medications or consequences for ADHD behaviors. This is unhelpful. Public controversy over ADHD negatively influences parents’ decisions regarding diagnosis and their choice of a child’s treatment.

At one extreme: some think medications turn children into zombies, and that ADHD is a fake diagnosis or treatable with natural substances or meditation, etc. Non-drug options may help, but what if the results are marginal and short-lived? What if a parent stubbornly sticks with a treatment that fits a personal goal and refuses to notice that it’s not working? If a non-drug remedy is effective, there will be hard proof: the child will keep up with school, maintain grade level, exhibit behaviors appropriate for their age, and show signs of self-control. These are more important to a child’s future than a parent’s loyalty to a belief.

Ironically, the choice of drugs for those of us with children with severe disorders may be easier than for parents of ADHD kids. Drugs keep psychotic kids safe and alive, here and now. Worrying about side effects is a luxury.

At the other extreme: some parents want a “quick fix” with pills, but chemical control also makes it easier for these parents to avoid hard parenting work like teaching their child to check impulses and set boundaries. And if parents are happy with the drug, might they overlook their child’s discomfort with side effects and ignore this child’s need for an adjustment? Might they also overlook how their home environment promotes distraction and chaos? A pill will compensate for bad parenting and a crazy-making lifestyle until the child reaches adulthood, having never been taught to make choices that promote their gift of creativity and reduce their risk of addiction, or having never been taught self-discipline.

Margaret

 
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High School Students With ADHD: The Group Most Likely to…Fizzle

 Breslau J, Miller E, Joanie Chung WJ, Schweitzer JB.Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time. Journal of Psychiatric Research.  Jul 15 2010

 Adolescents with attention deficit/hyperactivity disorder (ADHD), conduct disorder, or who smoke cigarettes are least likely to finish high school (HS) on time or most likely to drop out altogether, researchers at the University of California, Davis, School of Medicine (UC Davis) have found.

Lead investigator Joshua Breslau, PhD, ScD, medical anthropologist and psychiatric epidemiologist reported that of a total of 29,662 respondents, about one third (32.3%) of students with combined-type ADHD were more likely to drop out of high school than students with other psychiatric disorders. This figure was twice that of teens with no reported mental health problems (15%) who did not graduate. Students with conduct disorder were the second at-risk group (31%) to drop out or not finish on time. Cigarette smokers were third in line, with a staggering 29% who did not finish high school in a timely manner.

Educational achievement squelched in children with ADHD
Newsletter – NYU Child Study Center, New York, NY, February 2009
Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common disorders in childhood and adolescence, with prevalence estimates ranging from five to ten percent.  Children with untreated ADHD drop out of high school 10 times more often than other children.

Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder
American Journal of Psychiatry, January 2010
Researchers studied age 6 to 18-year-old girls with diagnosed ADHD and followed up after 11 years.  Conclusions:  By young adulthood, girls with ADHD were at high risk for antisocial, addictive, mood, anxiety, and eating disorders. However, ADHD medications appear to reduce the prevalence of multiple disorders at least in the short term.  These findings, also documented in boys with ADHD, provide further evidence for negative long-term impacts ADHD across the life cycle.

Brain abnormality found in boys with attention deficit hyperactivity disorder
Journal of Abnormal Psychology, March 2009
Researchers trying to uncover the mechanisms that cause ADHD and conduct disorder found an abnormality in the brains of adolescent boys suffering from the conditions. The research focused on two brain areas, the “mid brain” striatal, and cerebral cortex.  The mid brain motivates people to engage in pleasurable or rewarding behavior.  The cortex notices if an expected reward stops and considers options. However, this doesn’t occur as quickly in boys with ADHD or conduct disorders.  Instead, the mid brain region keeps trying for rewards, which is a quality of addictive behavior.

Kids with ADHD more likely to bully, and those pushed around tend to exhibit attention problems
Developmental Medicine & Child Neurology, February 2008
Children with attention deficit hyperactivity disorder are almost four times as likely as others to be bullies. And, in an intriguing corollary, the children with ADHD symptoms were almost 10 times as likely as others to have been regular targets of bullies prior to the onset of those symptoms.  Bullies were the kids in class who couldn’t sit still and listen, didn’t do their homework and were almost constantly in motion.  Children with ADHD symptoms make life miserable for their fellow students, and they too can develop attention problems related to the stress of being bullied.

Girls’ hyperactivity and physical aggression during childhood and adjustment problems in early adulthood:  A 15-year longitudinal study.
Archives of General Psychiatry, March 2008
Girls with hyperactive behavior such as restlessness, jumping up and down, and difficulty keeping still or fidgety, and girls exhibiting physical aggression such as fighting, bullying, kicking, biting or hitting, all signs of ADHD, were found to have a high risk of developing adjustment problems in adulthood.

Teen’s inattentive symptoms may determine how long they stay in school
Forum for Health Economic & Policy, November 2009
Poor mental health of children and teenagers has a large impact on the length of time they will stay in school, based on the fact that at conception there are differences in genetic inheritance among siblings. This study provides strong evidence that inattentive symptoms of ADHD in childhood and depression in adolescents are linked to the number of years of completed schooling.

Children with ADHD more likely to participate in crimes
Yale School of Public Health and University of Wisconsin at Madison, October 2009
Children with ADHD are more likely to participate in crimes such as burglary, theft and drug dealing as adults.  Those who had attention deficit hyperactivity disorder as children were at increased risk of developing criminal behaviors.  Researchers said one reason is that children with ADHD tend to have lower amounts of schooling.

ADHD may affect adults’ occupational and educational attainments
Journal of Clinical Psychiatry September 2008
Adults who have ADHD generally have lower occupational and educational attainments as adults than they might have reached if they didn’t have the disorder, at least compared to what attainments would have been expected given their intellect.  “Educational and occupational deficits… are a consequence of ADHD and not IQ,” lead researchers Dr. Joseph Biederman said. The finding strongly underscores the need for “diagnosing and treating ADHD to avert these serious consequences,” he said.

Attention-deficit/hyperactivity disorder (ADHD) in the course of life.
European Archives of Psychiatry and Clinical Neuroscience, September 2006.
ADHD is a pervasive disorder that extensively impairs  quality of life and that can lead to serious secondary problems.  Long-term studies have demonstrated that the disorder is not limited to childhood and adolescence. The clinical experience indicates substantial difficulties for adults whose ADHD is not diagnosed and treated, and they often create extensive costs for the welfare system. The evidence-based psychiatric treatment available is highly effective and inexpensive.

70% of crystal meth (methamphetamine) inpatients had ADHD
Journal of  Addiction Disorders. 2005, and the blog: Adult ADHD Strengths.
Methamphetamine-dependent inpatients were screened for childhood attention deficit hyperactivity disorder (ADHD), and of the participants, 70.6% screened positive for ADHD and reported significantly more frequent methamphetamine use prior to baseline.  ADHD participants exhibited significantly worse psychiatric symptomatology.  At a three-week follow- up, all who didn’t complete treatment screened positive for ADHD.

 

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Teen rights vs. parent rights when the teen has a mental disorder

Teen rights vs. parent rights when the teen has a mental disorder
3 votes

 If you’re a parent of a troubled teen, how much decision making power should your child have?

How can your teenager possibly make decisions for themselves if they’re brains aren’t functioning normally?  They hate you, or they say and do crazy things for unfathomable reasons.  You want to guide them with incentives and consequences but these haven’t worked.  You’re traumatized by their history of unstable behavior and it affects your thinking.  Perhaps you get stuck in a power struggle, or you give up power because asserting your authority just puts gasoline on their fire.  You know they can make good on serious threats, such as running or causing serious personal or material damage.  Or they may completely fall apart.

Decent, caring parents, who aren’t out to “fix” or punish their child, often feel their teen has too many rights:

Problem – A teen’s statements to treatment providers are completely confidential after age 14.  Privacy is important, and the therapist needs the young person’s trust to help them with therapy, but some information could be shared with parents on a case-by-case, “need to know” basis.  A parent should be able to partner with the therapist, so they can structure interactions at home that support therapeutic goals.  For example, if the teen talks about dangerous activities with a best friend that the parent doesn’t know about, I think the parent could be coached to appropriately reduce contact with this friend or defuse the dangerous influence they have over the teen.  If a therapist can’t reveal this much, can’t they at least tell a parent what to watch for, what to set boundaries on?  How to respond?

 Problem – A teenager has the right to refuse medication or therapy at age 14 (in practice, most providers are reluctant to force treatment at any age).  But if their refusal leads to a serious crisis, I know from experience that most parents have no option but calling 911 or using force to keep themselves and others safe.  Yet force undermines the parent-child relationship, and has lead to undeserved charges of child abuse.

Problem – A young person has the right to refuse school attendance even when there are consequences, and the parent can be held liable for neglect.  This is of special concern to a parent who risks losing custody to the state or to a vindictive ex.

Problem – A teenager can commit a crime and a parent can lose custody.  Sometimes crime is the only way for a young person to get the help they need, but sometimes this means they descend, step-by-step, into a justice system that presumes bad parents create bad kids.

Parents of troubled teens need greater control over their situation, and lots of outside support, to prevent losing too much to the Black Hole of their child’s disability.   The emotional, physical, and financial costs to all family members are exceptionally high.  If a parent’s authority is undermined by a society that thinks they are the kid’s problem, and an education and health care system that focuses only on the child’s needs, the parent and family see their own rights being trampled.

What about a Parent Bill of Rights?

  1. Parents and families have a right to personal safety including the safety of pets, and the right to protect themselves, their belongings, and personal space.
  2. Parents have a right to ensure and sustain their financial, social, and job stability, even if it means periodically putting aside the teen’s needs.
  3. They have the authority to create house rules based on respect, safety, and shared responsibility.
  4. And they have the right to enforce houserules and expect them to be followed.
  5. Parents and families members have the right to be human and make mistakes.
  6. Parents and families have the right to take time out for their own well being and self-care.

When does a youth’s rights supersede a parent’s rights?

The youth, because of their disability, has a right to make progress at their own pace, and choose their own path of learning.  They also have the right to reasonable family accommodations because of their different needs.  Like any human being, especially one’s child, they have the right to respect and support regardless of inconvenience.  They also have the right to negotiate for what they want, and to expect earnest efforts towards compromise.  The last, and this is very important, they have the right to choose incentives and consequences that work best for them.

You know your teen will reach adulthood and independence whether they are ready or not.  They will do what they want, perhaps suffer serious consequences, and there’s nothing anyone can do about it.  So do something about it now.

Look at the future from their perspective. Young people in the mental health system face life needs and challenges different from peers. They often don’t reach 18 without experiencing significant setbacks due to their disorders.  They have missed opportunities for the education and life skills needed for adulthood, and lack of youthful achievements that boost confidence and self-esteem. Teens and young adults with disorders may have to manage these the rest of their lives!  Once age 18 is reached, supports they’ve depended on are abruptly dropped.  They are exported to an adult system where they must start from scratch to establish a new support network that will assist them towards an independent life.  Your job is to change from parent to mentor as these new supports are developed.

What are parent responsibilities?

Acceptance:  this is the nature of your child and it’s OK.  They will still be part of the family and get your support.  Your child would function better if they could.

Positive attitude:  yours is not a lost child, there are resources out there to help them, and you really do have the energy to find and use these resources.

Realistic expectations:  brain disorders are termed “disabilities” for a reason.  You cannot expect their lives to unfold like yours did, or even like others their age.  They will redefine what progress means for them.

Support without strings attached:  your teen doesn’t owe you for the life you’ve given them, nor must they pay you back for your extra sacrifices.

Take good care of yourself so you can handle your situation.

Access and use information on the disorder and it’s treatment regime.

Learn and practice an entirely different approach to parenting.

What about youth responsibilities?

My previous post, “Youth with mental disorders demand rights!” presents a document created by members or Youth M.O.V.E (Motivating Others through Voices of Experience), a peer-to-peer organization for teens and young adults http://youthmove.us.  I have a suggestion for M.O.V.E.:  consider developing a youth Responsibilities document.  I believe young people are also responsible for acceptance and realistic expectations, like their parents, as well as being accountable for themselves.

The following list is a good place to look for other ideas.  It was developed by adult mental health consumers (part of this list has been de-emphasized because it does not yet apply to youth).  Everyone, regardless of their medical and mental health situation, should do what they can to take responsibility for their health treatment.

Adult responsibilities that could be applied to youth and young adults:

“In a health care system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume reasonable responsibilities. Greater individual involvement by consumers in their care increases the likelihood of achieving the best outcomes and helps support a quality improvement, cost-conscious environment. Such responsibilities include:

  1. Take responsibility for maximizing healthy habits, such as exercising, not smoking, and eating a healthy diet.
  2. Become involved in specific health care decisions.
  3. Work collaboratively with health care providers (teachers, parents) in developing and carrying out agreed-upon treatment plans.
  4. Disclose relevant information and clearly communicate wants and needs.
  5. Show respect for other patients and health workers (students, coworkers, neighbors, siblings).
  6. Use the health plan’s internal complaint and appeal processes to address concerns that may arise.
  7. Recognize the reality of risks and limits of the science of medical care and the human fallibility of the health care professional.
  8. Be aware of a health care provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
  9. Become knowledgeable about your health plan coverage and health plan options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
  10. Make a good-faith effort to meet financial obligations.
  11. Abide by administrative and operational procedures of health plans, health care providers, and Government health benefit programs.
  12. Report wrongdoing and fraud to appropriate resources or legal authorities.”

 


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Youth with mental disorders demand rights!

Youth with mental disorders demand rights!
1 votes

Youth M.O.V.E. (Motivating Others through Voices of Experience) offers peer support, social and educational support, and advocacy for youth with brain disorders.  The Oregon Chapterin  partnership with Portland State University, wrote  a Youth Bill or Rights for teens to young adults between ~13 to about 30.  As you can see in the Rights document below, they believe youth should be allowed to guide their mental health treatment, and receive respectful, humane care.

“YOUTH BILL of RIGHTS  –  We believe that all youth should have the following rights in their mental health care:

1) Youth have the right to be leaders of their psychiatric treatment plans.

Youth should be informed of the possible side effects of medications, how long recommended medications take to go into effect, and the possible long-term effects of recommended medication. Service providers should work with youth to explore possible alternatives to using psychiatric medication before medication is given. Communication between youth and all medical providers should be collaborative, clear, and with limited use of medical terminology.

2) Youth have the right to evaluate their mental health services.

Mental health counselors, social workers, psychologists, and other service providers should provide opportunities for youth to evaluate the satisfaction of their services throughout the duration of care in a respectful and non-threatening manner. This includes evaluation of the relationship with the provider, counseling plans, and implemented treatment models.

3) Youth have the right to service transitions that are as non invasive as possible.

When youth are transitioning into new services, mental health programs should strive to make the transition as accommodating as possible for the youth. Youth should be consulted on the ways they would like to end their relationship with the current provider and whether they would like the current provider to share their file with their new provider. Providers should share if there will be any changes in the costs of services and/or insurance coverage.

4) Youth have the right to trained, sensitive treatment providers.

Youth should have access to mental health professionals that are familiar with the unique needs and challenges of youth with mental health needs. All mental health professionals should have specialized training that fosters positive youth development and support. Youth mental health service consumers should be included in the creation and implementation of these trainings.”

This document was created and signed in 2009 by 30 mental health service-experienced youth gathered in Portland, OR, from the following states: California, Hawaii, Idaho, Illinois, Kentucky, Maine, Massachusetts, Missouri, Michigan, New York, North Carolina, Oregon, Texas, and Washington.  http://youthmove.us

 This list of rights is similar to the “Mental Health Consumer Rights” developed by adult mental health consumers, which is appended at the end of this article.

What do you think?  I say “bravo,” these are appropriate and necessary–anyone receiving treatment must be comfortable and safe with care providers, and treated with dignity and respect, period  But I’d like to see something similar for parents and caregivers, too, who also participate in treatment and need to feel respected and heard.

What does your teen or young adult child think?  Tell them about an opinion survey where they can comment and read other’s comments, http://mentalhealthyouthbillofrights.blogspot.com .

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Adult Consumer Bill of Rights – for adults in mental health service systems

  1. Information Disclosure:  Consumers have the right to receive accurate, easily understood information and may require assistance in making informed health care decisions about their health plans, professionals, and facilities.
  2. Choice of Providers and Plans:  Consumers have the right to a choice of health care providers that is sufficient to ensure access to appropriate high-quality health care.
  3. Access to Emergency Services:  Consumers have the right to access emergency health care services when and where the need arises.
  4. Participation in Treatment Decisions:  Consumers have the right and responsibility to fully participate in all decisions related to their health care.
  5. Respect and Nondiscrimination:  Consumers have the right to considerate, respectful care from all members of the health care system at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality health care system.
  6. Confidentiality of Health Information:  Consumers have the right to communicate with health care providers in confidence and to have the confidentiality of their individually identifiable health care information protected.
  7. Complaints and Appeals:  All consumers have the right to a fair and efficient process for resolving differences with their health plans, health care providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review.
  8. Consumer Responsibilities:  In a health care system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume reasonable responsibilities.

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) established the Consumer Bill of Rights Workgroup to promote and implement the Presidential Advisory Commission’s Consumer Bill of Rights and Responsibilities in health care. http://mentalhealth.samhsa.gov/consumersurvivor/billofrights.asp

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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.

– – – – – – –

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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Things that protect troubled girls from delinquency

Things that protect troubled girls from delinquency
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Both boys and girls get in trouble with the law.  Boys are in the majority for arrests for crime, but statistics indicate that girls’ arrests are increasing:  “…between 1996 and 2005, girls’ arrest for simple assault increased 24%.”  Of 1528 girls studied over a period from 1992 and 2008, 22% committed serious property offenses and 17 % committed serious assaults.  (Girls Study Group, U.S. Department of Justice, 2008. www.ojp.usdoj.gov).

  

Troubled girls easily become criminal, but also risk being a victim

 

Girls who have behavioral disorders, from addictions or past trauma or emotional disorders, begin to have delinquent or criminal behaviors as early as middle school.  What makes a girl’s criminal activities different from boys is that girls put themselves at high risk of being victimized themselves.  How can a parent or caregiver prevent their daughter from engaging in criminal behavior, and trapping themselves in a social world where their stresses and disorders can worsen?

 

The Girls Study Group quoted above studied which factors protected girls from becoming criminal, or helped them stop and reengage in activities that improve and stabilize their lives.  Protective factors did not prevent all criminal activity however, yet the first one has been shown to be the most effective.

 

  • Support from a caring adult.  THIS IS THE SINGLE MOST IMPORTANT FACTOR in preventing girls from criminal activities of any kind.
  • Success in school helped prevent aggression against people, but not property crimes.
  • “Religiousity,” or how important religion was to troubled girls, meant they were less likely to be involved with drugs.

Risks to girls that are different from boys: 

    

Early puberty is a risk if the girl has a difficult family and comes from a disadvantaged neighborhood.  Biological maturity before social maturity causes more conflicts with parents and more negative associations with older boys or men.

 

Sexual abuse, which girls experience much more than boys, including sexual assault, rape, and harassment.  But abuse of any kind affects both boys and girls equally.

 

Depression and anxiety, which girls tend to suffer more from than boys.

 

Romantic partners.  Girls who commit less serious crimes are influenced by their boyfriends.  But for serious offenses, both boys and girls are equally influenced by a romantic partner.

 

Once she’s regularly breaking rules, it’s not easy to turn things around for a troubled girl.  It requires constant, persistent efforts to:

  • Keep her away from risky associates.
  • Keep her in school and up with studies. 
  • Keep telling her what’s great about her, what’s special, what’s powerful and good.

If you are a parent or caregiver, and you are lucky enough to have a strong mentoring relationship with your troubled daughter, keep it up despite any occasional law-breaking activities.  She’ll need consequences, but they should be obstacles to overcome rather than punishments—such as earning back privileges by having good behavior for a period of weeks or months.

 

If you don’t or can’t have a mentoring relationship, find out who can (or already does).  Admit you might not be the sole support for her success, and work in partnership with a caring adult.  Find out who believes in her already.  Find out who she asks for help if she’s feeling fearful or down about herself.  Listen to her if she talks about someone she’s grateful for for helping her through difficulties.  Girls respond really well to someone who believes in them.

 


Teen girls can be turned around and it’s always worth the effort.  She might be hard to take sometimes, but find something, anything, that’s good about her and let her know.  Over time, you’ll start noticing more and more great things about her, and then she’ll start noticing them too.

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Filed under bipolar disorder, borderline personality disorder, depression, law enforcement, mental illness, oppositional defiant disorder, parenting, teens