Tag: depression

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

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

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

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).  This is not a complete list because new compounds may come into the market.

–         The depression & obsessive-compulsive approach may use serotonin-based antidepressants such as Prozac (fluoxetine), and Anafranil or clomipramine (used to treat OCD).  Again, this is not a complete list.

Oppositional defiant disorder often includes symptoms from 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

Anthony 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. Side-effects of 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 his or her 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 of 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.  Make an effort to inject as much positive energy into your relationship with your child or teen.  It’s likely that this relationship has been close to 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.  Caution: don’t expect thanks or joy from your child once they’re praised; 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.

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.”  They can get frustrated when they aren’t getting the reaction they want from you, and give up.
  • Another example:  Your teen refuses to get out of bed for school.  Don’t nag or repeat, repeat, repeat.  Remove the bed covers 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. (from “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, it’s harder to do on the floor.”  This is a good kind of manipulation.

Unexpected rewards – Occasionally reward appropriate behavior with something they like.  They are more likely to do a desired behavior if they expect something they want and aren’t sure when it will be offered.

“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.  This is a can’t-win-for-losing path sucks, doesn’t it?

Warning, once you start consistent enforcement, things get worse at first – Defiant behavior will 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 eventually 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 these particular 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.   Hang in there.  I WISH YOU THE BEST!

–Margaret

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Yoga – Safe and effective for depression and anxiety

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

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/

– – – – – – –

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.

– – – – – – –

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.

– – – – – – –

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.

– – – – – – –

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.

– – – – – – –

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.

Mental illness is more deadly than cancer for teens, young adults

Mental illness is more deadly than cancer for teens, young adults

Mental illness is more deadly than cancer for teens, young adults
3 votes

Why isn’t everyone more upset?  A disease is killing our children and it’s more deadly than cancer and leukemia!  Did you know it was mental illness?

Out of curiosity, I did some research on child mortality rates from various causes because I wanted to know how death from mental illnesses compared with other fatal illnesses of childhood and adolescence. The results were astonishing, unexpected, and disturbing.

Look at the highest bars in this graph. They are 3-4 times the height of average cancer and diabetes rates in children. There are gaps in the available data, but this simple comparison is disturbing.

* The starting point for the mortality rates of medical illnesses was the website for the Center for Disease Control and Prevention www.cdcp.gov  in Atlanta; the starting point for the mental illnesses was the website for the National Institute for Mental Health, www.nimh.gov.

** The suicide data was from those with depression, bipolar disorder, schizophrenia, and psychotic disorders-unspecified.  (Suicide from other mental health causes, such as borderline personality disorder and co-morbid substance abuse is also prevalent, but I could not find data for children to young adult age ranges.)

On suicide:

  • It’s often normal for children and young people to think about suicide, but just in their imagination. They might consider it during some painful time in their lives, but there are no plans made or steps taken.  When the difficult times are over, they don’t think about it any more.
  • Young people with early onset mental illness can’t endure much stress; thoughts of suicide recur over time, starting as early as age 6 or 7.  These children are vulnerable to repeated intrusive suicidal thoughts because they live with a combination biological, psychological, and social/relationship causes (called “biopsychosocial”).  More about this is explained here: “Use the “S” Word: Talk with your Child about Suicide.”
  • There are ‘fast’ and ‘slow’ suicides in young people.
    • The ‘fast’ ones are 1) direct self-harm that has been planned, or 2) spur-of-the-moment suicide due to an extreme emotional reaction to a single intolerable event (examples: a boyfriend/girlfriend or best friend dies; a teen has a serious fight with a parent and (without planning) wants to ‘get back’).
    • The ‘slow’ suicides result from a persistent pattern of harmful behaviors that eventually lead to death.  Young people struggling with anorexia can die by heart failure or other causes due to their weakened body.  Others abuse substances and/or participate in extremely risky activities that expose them to multiple lethal situations:  overdose, criminal environments, disease.

This graph screams out for a changes in attitude, policy, and investment in children’s mental health treatment and suicide prevention.  I had no idea that death rates from mental illness could be 3 to 4 times higher than most cancers and leukemia.  It is imperative that young people with mental health issues receive as aggressive and sensitive treatment as is expected and demanded of medical systems that treat cancer in children.

Parents: talk about this. Talk to your child; share it on social media; and talk to mental health organizations about what you can do.

The data on mortality rates for mental illnesses was difficult to find, and it required searches in many different medical journals and websites.  I chose to use the data on cancer, leukemia, and diabetes because the mortality rates from these are high and because deaths from all other causes were insignificant by comparison (motor vehicle accidents are the one exception).  In this graph, the death rates for cancer and leukemia are averages for the different forms of each, and in the medical journals they were presented together.

I welcome additions or corrections of this data from any other sources, and encourage readers to investigate this for themselves.

–Margaret

 

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