ADHD Treated!

Sorry for the massive delay in getting this post out. Anyway, here it is:

The truth be told, ADHD is a complex and multifaceted diagnosis. The treatment of which causes extreme controversy almost instantly. It is very hard to find good, accurate information regarding the treatment of ADHD and its even harder to know what information to believe.

Officially, research shows that a combination of medication and psychotherapy is the best type of treatment for the diagnosis of ADHD. However, in my work with people diagnosed with ADHD, most have been given the impression that the only treatment is medication. Since I'm not a medical doctor I won't spend my time with this post talking about medicated treatment for ADHD. I just wanted to point out that both the American Medical Association and the American Academy of Pediatrics recommend that a multi-modal (many methods - medication, individual or family therapy, educational guidance) approach be used in the treatment of ADHD. Below is a breakdown of some therapeutic treatments for ADHD.

ADHD - Diagnosed!

So what does it take to be diagnosed with ADHD? Actually, diagnosing ADHD is as complicated and controversial as the actual diagnosis. To be clear, there are specific symptoms that point mental health and medical professionals to this particular diagnosis, however there are various ways of documenting and verifying those symptoms as an actual diagnosis of ADHD.

NEW ADHD Diagnosis and Treatment Guidelines!

The American Academy of Pediatrics just released new guidelines for the treatment and diagnosis ADHD. This change has the potential to be a great blessing to many families if parents are aware of what the guidelines actually say and mean. Below is a quick overview of the important changes, followed by a few suggestions every parent and family should know regarding these changes.

National Family Day!

Mark your calendars, the CASA National Family Day is coming soon. The National Center on Addiction and Substance Abuse (CASA) has declared Monday, September 26, 2011 as a National Family Day - A day to eat dinner with your children. CASA has been conducting studies on the effects of eating meals together since 2003. Each report has concluded with generally the same findings - eating dinner with your children at a dinner table decreases risky childhood behavior (i.e. alcohol and drug experimentation). Below is a quick recap of some of the most recent findings in their September 2011 report.

Relationship Communication

I often spend so much time focusing on improving actual parenting I tend to forget another piece of good parenting - A strong couple relationship. Research shows that children are comforted and feel secure when their parents' relationship is strong. One aspect of a strong couple relationship is positive communication. A research study found that on the average couples spend about 13 minutes a day exchanging affection (i.e. hugs, kisses, sharing feelings) and only 20 minutes a day in conversation (Dainton, 1998). They further broke down the types of conversation into four categories: catching up (6 minutes), planning (6.2 minutes), openness (1 minute), other (7 minutes). Openness and catching up were defined as checking on each others day and connecting with each other emotionally. That's a total of about 7 minutes each day that average couples spend trying to connect with each other. If we add in the 13 minutes of affection we have a total of 20 minutes each day that couples spend connecting in a meaningful way.

Forbidden Parenting Phrases...

This article gives some pretty good advice regarding parental "Forbidden Phrases". The information is amazingly stated, so please visit the original site, but here is a list of phrase parents should not use on their children, just to pique your interest:

1. "Leave me alone..."
2. "You're so..."
3. "Don't cry..."
4. "Why can't you be more like..."
5. "You know better than that..."
6. "Stop or I'll give you something to cry about!"
7. "Just wait until Daddy (Mommy) gets home!"
8. "Hurry up!"
9. "Good boy/girl"

A Thousand Small Moments: Session 7

In conjunction with the parenting booster classes offered at the Michigan State University, Couple and Family Therapy Clinic additional material for the latest class is below:

Session 7 - Responding with Flexibility

Now that you are familiar with and using love and limits consistently, and have a good understanding of where your parenting techniques stem from, it is time to really become flexible. An important formula to remember is: Inflexible Children + Inflexible Parents = Explosive Behavior. 
There will be times when your child will be too tired, too hungry, too upset, or too overwhelmed to be able to comply with your requests. Imagine a time in your life when you were too overwhelmed (either with stress, emotion, or exhaustion) to be able to respond appropriately to a request you otherwise would have had no problem doing so. The difference between you and your child (and the main reason you don't typically throw yourself on the ground and scream) is that you have learned over your lifetime how to properly handle your emotions so that even when you respond inappropriately is doesn't look like a full blown temper tantrum. Here are a few tips on responding with flexibility:

A Thousand Small Moments: Session 6

In conjunction with the parenting booster classes offered at the Michigan State University, Couple and Family Therapy Clinic additional material for the latest class is below:

Session 6 - Understanding Yourself as a Parent
Having learned how to show love to your children and how to set limits, it is time to learn about granting latitude to your children. Latitude means being flexible and adjusting your expectations to fit your child's individual personality. This is especially important for parents with more than one child. No two children are 100% the same and all children need to have flexibility tailored to themselves. Latitude starts with self understanding. So often we as parents said to ourselves when we were growing up, "I will do things differently with my children." And yet when things get tough and demanding we often repeat the patterns of parenting we learned from our parents. Each of us have three aspects of ourselves that, if understood, could help us became our own masters and allow us to decide how we want to parent. These aspects are:

A Thousand Small Moments: Session 5

In conjunction with the parenting booster classes offered at the Michigan State University, Couple and Family Therapy Clinic additional material for the latest class is below:

Session 5 - Effective Consequences & Time-Out
Remember, applying consequences and using time-out are withdrawals from the emotional bank account. Use as many other techniques as possible before branching into applying consequences. Consequences can be seen as simply the result of particular behavior. For instance, the consequence for going to work and doing your job is a paycheck.
Every behavior we do has an inevitable consequence attached to it. Teaching children that negative behaviors result in negative consequences helps them to stop doing the negative behaviors. Some effective consequences are as follows:

A Thousand Small Moments: Session 4

In conjunction with the parenting booster classes offered at the Michigan State University, Couple and Family Therapy Clinic additional material for the latest class is below:

Session 4 - Effective Commands and Rewards
This week using effective commands and rewards was discussed as a way to enforce limits. It is important to remember that your family values should be taken into account when giving children commands and using rewards to motivate behavior. Effective commands are commands that are:

• Clear - Clear commands explain the expectation as well as the family value that is related to the command. For instance, "We don't yell in our family, I want you to use a calm voice." The parent should remain calm, assertive, and polite when giving the command. 
• Positive - Another characteristic of a good command is that you tell the child exactly what you expect of them. Don't tell them what not to do, rather tell them what to do. Giving positive commands, the child is not left guessing what you are asking them to do. 
• Consistent - Make sure you are consistent with your commands. When you give a command that requires the child to do something, make sure the behavior is completed. Watching your child in order to ensure compliance is a helpful thing. It lets them know you are going to be consistent with all of your other commands or expectations.  

A Thousand Small Moments: Session 3

In conjunction with the parenting booster classes offered at the Michigan State University, Couple and Family Therapy Clinic additional material for the latest class is below:

Session 3: Values and Freedom

This week we discussed the first way to step toward setting limits. As a reminder, we believe that the best way to start setting limits with children is to start expressing love toward our children. To review the first two sessions click here (for emotion coaching and child-directed play) and here (for attention, praise and routines). Once you have established "routines of love" you are able to start setting limits. 

The first step in setting limits is establishing family values. Family values influence the rules that parents set for their children and the expectations they place on their children. Values also influence how parents show and express love toward their children. An important way to discover the values you are currently teaching your children is to do the following exercise in your mind: 

A Martian came from her planet and asked if she could follow you around for a day so that she could understand what was important to you. She said she was not interested in knowing your history, culture, or any justification, she simply wanted to watch. She said that she would make herself invisible as to not get in your way. As you go throughout your day, what observations would the Martian Observer make? What would she say you spent most of your time on (you valued the most)?

A Thousand Small Moments: Session 2

The MSU CFT clinic recently started a parenting booster class. In conjunction with that class I will be posting additional material related to the topics discussed for each class. For those who can't join us we hope this will be of some help.

Session 2: Attention and Praise and Family Routines
In this session we discussed ways to show love and change behavior by using positive Attention and Praise as well as by instituting Family Routines.
First, as a result of our continuously busier lives, parents and children rarely spend much quality time with each other. Often the time that is spent with each other is spent where the parents give half-hearted attention to their children, or are giving orders for their children to do something. As with the first session (Child-Centered Play and Emotion Coaching) giving positive attention and praise to your children becomes a great way to reduce negative behaviors displayed by children. When giving attention to your children it is important that you give them your undivided attention so they know that you really care about their concerns and their ideas. Try to provide a ratio of five positive interactions to every negative interaction with your child in order to improve behavior.

A Thousand Small Moments: Session 1

The MSU CFT clinic recently started a parenting booster class. In conjunction with that class I will be posting additional material related to the topics discussed for each class. For those who can't join us we hope this will be of some help.

Session 1: Emotion Coaching and Child Directed Play
In the first session we discussed some of the best first lines of action to try when your children are experiencing behavior problems. The fist topic is Emotion Coaching (Gottman, 1998). Emotion coaching is the idea that parents validate the emotions their children express through problem behaviors. When parents validate the emotions before disciplining the behavior, children feel more accepted and their behaviors decrease. The steps in Emotion Coaching are as follows:

1. Emotional Awareness:
• Be aware of your own emotions. What does it feel like to be angry, sad, frustrated, happy, excited, etc. If you are aware of your own emotions you are more likely able to recognize those emotions in your children.

Parents or Friends?

Some parents want so much to be 'friends' with their children that they sometimes forget that children need structure, limits, and monitoring. I saw this video and thought it discussed a potential problem with many parents today. What are your thoughts?

Parenting to Your Child

Thought: The more intense the child, the more intense the intervention. Small and subtle changes might work when a child is feeling calm, but when emotions run high (or for children who generally have stronger emotions) something with a little more “umph” is needed.

Try This!
Most interventions can be beefed up. Take some time today to think about some of your parenting strategies and figure out different levels for them. Example: a walking time out – the child is informed that communication is suspended for the next minute; a sitting time out – the child is excluded from communication and activities for 10 minutes; a working time out – the child is excluded from communication and activities, and must complete some kind of assignment (write an apology, memorize a quote, clean, etc.)

New Parenting Class Being Offered

For those who live in Michigan, I am co-facilitating a parenting class that will be starting Friday, April 29 2011. This group will be held in the Michigan State University Couple and Family Therapy Clinic. This class will use the Love, Limits and Latitude curriculum that uses research based parenting techniques. The information for this class is below:

What - Parenting Booster Class

When - Friday's 5:00PM to 6:30PM (April 29 - June 24)

Where - MSU CFT Clinic

How Much - $5/session per couple

Call 517-432-2272 to register (space is limited, so registration is required)

Free Child Care is Available

Hope to see you there on April 29th.

The Facebook Depression?

The American Academy of Pediatrics just released a clinical report on the use of social media by teenagers. It is worth a good look over, but can be quite dense. Here is a quick summary of the clinical report for those with little time on their hands:

• Seventy five percent of adolescents have cell phones - 
• 25% use them for social media
• 54% use them for texting
• 24% use them for Instant Messaging
• Internet (social media) addiction is increasing - 
• Sleep deprivation is increasing along with internet addiction
• Benefits of using social media for teens include - 
• Community engagement
• Creativity
• Development of ideas (i.e. blogs, podcasts, videos)
• Expansion of diversity exposure (i.e. getting connected with others around the world)
• Developing personality and social skills
• Enhancement of learning skills
• Risks of using social media for teens include - 
• Cyber-bullying is increasing
• Sexting (approximately 20% of teens admitted to sexting).
• "Facebook Depression" (spending too much time on social media leads to typical depressive symptoms)
• What goes online stays online

Ways to help decrease the negative affects of social media on teens:

• Talk with children about their internet use. Specifically address: Cyber-bullying, Sexting, Time Management.
• Become better acquainted with technologies used around the home. 
• Develop a family online use plan, emphasizing appropriate online behavior.
• Become involved in your teens online use (get your own social media account) in addition to using computer monitoring software.

Children and Electronics

Today is the age of electronics. Most children are familiar with the internet, computers, video games, cell phones, texting, and a variety of other electronic devices. With each device come challenges, opportunities and responsibilities. Each family needs to decide what is an appropriate use of each particular technological device. Some guidelines to keep in mind when setting appropriate boundaries around technology include:

1. Technology is a privilege, which means parents have the right to restrict it's use when children begin to use it outside the families individual values.
2. Technology can be used to harm individuals. Children who use technology to harm others need to have their usage restricted. 
3. Filtering software is available for most computers and some handheld devices, but many handheld devices that access the internet don't have filtering available. Parents need to be wise in their choice of allowing particular handheld devices. 

If you have any other suggestions about helping children and families appropriately use technology, feel free to comment below. 

March: The Month of Technology

From the time my wife and I have been married we have tried to be consistent in celebrating March 14 by enjoying a nice apple pie (for those non-geeks, March 14 is also 3.14, which is the abbreviated value of Pi in math). I thought it would be fitting to discuss technology throughout this month. Each week I will post information regarding how technology has changed the way we parent children and discuss a few issues that technology poses to parents. I know that this topic can be divisive, so fill free to post your thoughts regarding each topic.

Let me start off with a story. When my wife and I were on a date, I took the time to look around at the other couples at the restaurant we were eating at. I noticed that almost 70% of the individuals in the restaurant were distracted in one way or another on their phone or smart phone. It reminded me of a video I saw about parents doing the same thing.

Take a few minutes to watch this video and try the following experiment:

• Count how many minutes you are present with your children but doing something on your phone.
• Try to reduce that time in the following week.

Emotional Nurturing

Emotional Nutrition - When children misbehave, the attention they receive is tied to a message of failure and rejection, it therefore brings no sense of accomplishment, intrinsic worth, or real connection. Children become “addicted” to negative behaviors even though the attention they gain is not satisfying, even when the level of negative energy escalates.

Try This! Work on introducing more ways of connecting in small moments (waiting in line, leave-taking and reunions, meals, bed time, etc.) so that emotional hunger is satisfied.

Comments - Please post comments about your experiences for other parents to learn and grow from.


Posted in behalf of Anne Brown

Safety from Limits

Thought: Children need safety and security. Their inability to set internal limits means that external limits are necessary so things won’t get out of control. Safety comes from their emotions and behaviors being “handled” by the adult(s) in charge. Acting out is a way of asking for more structure.

Try This!
Then next time your child misbehaves, think about your response as a way of increasing structure rather than punishing the behavior out of them. Example: Not doing homework doesn’t require punishment, simply finding a time and place where homework can be done and a system for checking to see if it is finished may be enough.

Comments - Please post comments about your experiences for other parents to learn and grow from.


Posted in behalf of Anne Brown

Q and A: Telling Children About Divorce

The following is for informational purposes only. Every situation is different and if you feel that your situation needs further exploration and explanation, please seek help from a licensed mental health professional. If you are having difficulty finding one in your area please visit the following website: http://therapistlocator.net/


Question:


My friend and her husband have recently decided to divorce, and they plan on breaking the news to their 6 yr. old daughter the day after Valentines. Any tips I can pass along to her how to handle the inevitable situation?


Answer:


First of all, sorry to hear of this situation. It is very difficult to answer the question without visualizing those involved. My heart goes out to the mother, father and especially the 6 year old little girl. 
Second, research has shown time and again that the best predictor of how a child will react (adjust) to divorce is how well the parents each react (adjust) to the divorce. For instance, if the parents react (adjust) poorly, i.e. being uncooperative with their ex-spouse, saying bad things about their ex-spouse; then children will react (adjust) poorly, most often blaming themselves for the divorce. 
If I had five minutes to talk to your friend (and by extension her current spouse) I would want them to know the following:

1. Before talking to your child, establish a common story (explanation) about why you are getting divorced. This needs to be a united front. Both of you need to agree on the reasons and not change the story when you are alone with your daughter. Each time she asks, you need to reiterate what you have already stated.
2. Be honest about the reasons, and be sure to emphasize that she was not the reason for the divorce. Children often take on the responsibility for their parents' marriage. Make sure she knows that this is an adult decision and has nothing to do with her.
3. Be developmentally appropriate. Share enough details that she will understand, but not too much that will cause her 'trauma.' For instance, if the reason for the divorce is an affair, I would tell a six year old that "Mommy/Daddy made choices that made Daddy/Mommy very sad. We have talked about the choices and have decided it is better for all of us (you, mommy and daddy) if mommy and daddy are no longer married." If she asks what it was that happened, tell her that you will give her more details when she is older and able to understand. Again, you need to have a united front so that when she is older both mom and dad know what they will say to her regarding the reasons for the divorce. 
4. Don't "use" her to hurt the other in any way. Some common ways parents do this are asking the child to speak to your ex-spouse about child support, visitation, or their dating lives. This is not appropriate and harms the child more than the ex-spouse.
5. Be emotionally supportive. Your child will likely be experiencing a lot of emotions as a result of this announcement. Be there for her and listen to her. However, do not ask her to emotionally support you. She will likely try to do this naturally and though at first it may seem cute and helpful, it plays into the belief that she is responsible for you (or your marriage) which will reinforce her belief that she caused (or could have prevented) the divorce. 
6. Lastly, they need to get into "Co-Parenting Therapy." This is critical so they can learn how to communicate more effectively and be parents for the child. 

I know this was more than what your question was, but they are all important points. For additional resources regarding this topic please visit this great website:

http://www.divorceinfo.com/children.htm

Thanks again for your question. I hope this was helpful. 

Positive Parenting

Thought: Traditional parenting approaches give much more energy to negative behaviors than to positive behaviors, sending the message that:

• Negativity is a quick and easy (think fast-food) way to connect (meet emotional needs)
• Positive behaviors are not very important
• “Pushing buttons” is a way to gain power over parents

Try This! Set aside an hour today to focus on positive behavior.

Comments - Please post comments about your experiences for other parents to learn and grow from.


Posted in behalf of Anne Brown

February: The Month of Love

Just a few days after Christmas I noticed that The Valentines Day decorations went up quickly in almost every store I shopped in. Naturally when I think of Valentines Day I think of February. When I think of February I think pink (probably all of the elementary school conditioning). And when I think of pink I think love. Today I would like to talk about Parenting Love. In one of the parenting classes I teach, I tell my parents that, "True love between parent and child grows toward separation." Often parents are shocked and somewhat saddened to hear this. I have had people ask me, "You mean if I truly loved my child I would want to be away from them? That doesn't make sense!"

Let me explain what this statement means. First think of your child (I have two little boys, so I will use them as an example). As I think of my four year old boy, all I can think of is how fast he is growing up. It seemed like just yesterday he was an infant relying totally on my (and his mothers) mercy and help for everything. Now it seems that he can dress himself, pick his own clothes, feed himself, get in the car and buckle up by himself. He has even started to write his own name. When we visit the doctor he wants to speak for himself and tell the doctor what is happening, and believe me, if I say something that isn't right, he makes a point to correct me in front of the doctor. He has become very independent. Yet still he can't do some things. He can't cook his own food, fill his own bath water, tie his own shoes, drive to school, go to the store by himself, etc. Someday he will be able to do those things, and me and my wife will be the ones to teach him those things. Someday, he will even be big enough to go to college and live by himself. Even though thinking of that day scares me and makes me sad, I am delighted and can't wait to see my little boy being so grown up. My love for him urges me to teach him how to do those things. My love for him wants me to make sure he will be okay when he is alone. My love for him demands that I let him be his own person. This is what the statement, "True love between parent and child grows toward separation." Even after he is an adult, I will still want to see him. I will still expect for him to visit every once in awhile, but mainly to report to me about his accomplishments, and to give him counsel in hard times. I would be very selfish if I expected or wanted him to rely on me for everything (or almost everything) for the rest of his life.

Think about the statement, do you agree or disagree? Regardless of whether you agree or not, what are you going to do during this Month of Love to show your child that you love them?

For the Month of February, Michael and Anne are combining to bring a weekly update with small parenting thoughts and interventions. Check back at the beginning of each week for the updates from Anne. Also feel free to ask any question you might have about parenting or child behavior. Since this is in a blog format, we will answer in general terms.

Why This Blog?

I wasn't always a Marriage and Family Therapist. I have worked in many different occupations. For instance I was a Janitor for a small town store, a store clerk for 7-11, a door to door salesman, a telemarketer (only for a week), a construction worker (again only for a week), and a Technical Support Representative for three different companies. What was most common among all of those occupations was training. In all of the workplaces I was hired there was a period of training for each. Even when I had experience in Technical Support, or Janitorial services I was always mandated to training whenever I switched employers. Most of the time the training was similar, but some of the time it was more specialized. At one job I was required to attend MONTHLY trainings, just to make sure I was "Up to Date." The most training for a job I have ever recieved was for my career as a Marriage and Family Therapist (MFT). As a matter of fact, after almost four years I'm still in training. I have no complaints about my training as an MFT, I have really enjoyed the experience and education I have received. However, there is one occupation for which I have received the least training in. That is of a Father/Parent to my children.

Throughout both of my wife's pregnancies we attended classes on the birthing process, what it takes to register in the hospital, and a tiny bit on the differences between bottle feeding and nursing. We were told nothing about how to properly nurture, play with, care for, or otherwise raise our children. We had to seek that information out. And even seeking out information on parenting we were bombarded by conflicting and confusing advice on raising children. Being a father myself and knowing the frustrations and struggles of parenting I wanted to help parents find accurate and consistent information on child development and child rearing. Being an MFT I wanted to provide easy access to the vast amount of training I have, to those who may be not need therapy, but still want to know good and up to date information on parenting. I'm sure you have experienced some similar struggles either as a new parent or as a parenting veteran, with inconsistent and conflicting information.

This blog will contain contributions from a variety of therapists who work with parents and children. Feel free to view our profiles for additional information about our experience and individual practices. We hope that this blog will help answer some of your questions and be a great help to you in your time of need. Please feel free to ask questions and we will try to answer them to the best of our ability. Thank you for your interest in this blog and please check back often for updates.