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Aug 25

By Mary Elizabeth Dallas, Healthday News — Positive airway pressure, which is used to treat obstructive sleep apnea, may also help ease symptoms of depression among people with the sleep-related breathing disorder, a new study suggests.

Although depression is common among people with sleep apnea, researchers from the Cleveland Clinic Sleep Disorders Center found that patients who used positive airway pressure therapy had fewer depressive symptoms — even if they didn’t follow the treatment exactly as prescribed.

Obstructive sleep apnea occurs when the tissue in the back of the throat blocks the airway, which causes people to stop breathing while they are sleeping. The condition disrupts sleep and can increase the risk of other health problems such as heart disease and stroke. Positive airway pressure therapy helps correct this problem by keeping the airway open with a stream of air. CPAP, or continuous positive airway pressure, is the term commonly used to describe a form of the therapy that is delivered through a mask worn during sleep.

In conducting the study, researchers asked 779 sleep apnea patients to complete a questionnaire, known as PHQ-9, which assessed and scored their symptoms of depression. Following positive airway pressure treatment, the patients repeated the questionnaire. The study revealed that all of the participants reported improvements in their depression symptoms.

Patients using positive airway pressure for more than four hours each night showed more improvement than those who did not adhere to their treatment regimen as strictly.

“The score improvements remained significant even after taking into account whether a patient had a prior diagnosis of depression or was taking an antidepressant,” lead investigator Dr. Charles Bae said in a news release from the American Academy of Sleep Medicine.

“The improvements were greatest in sleepy, adherent patients but even non-adherent patients had better PHQ-9 scores. Another interesting finding was that among patients treated with [positive airway pressure], married patients had a greater decrease in PHQ-9 scores compared to single or divorced patients,” Bae added.

Aug 24

Right Brain Parenting


Do you or you spouse ever feel this journey of parenthood is not exactly what you thought it would be? In many entertainment magazines and tabloids, parenthood has been a cause de célèbre, especially when movie stars make being a parent the new “in” thing. You see pictures of celebrities taking their young children to the park or on other outings looking blissful and beautiful. You wonder why these stars look so happy and you are not, right?

The truth is parenthood is the most challenging yet rewarding “job” we will ever have. There are moments of pure joy mixed in with times of sheer frustration and terror. The question is: Can we realistically expand more times of joy being a parent? Practicing right brain parenting might be the answer.

Right brain parenting is defined as the ability to use that part of the brain that is emotional, creative, playful, and intuitive while parenting. This approach came to me while asking a good friend of mine how he came up with an incredible creative game with his son. It was not only fun for him and his child to partake in, but it also had a learning component to it. I realized that the joy he got doing this came from using his right brain.

The brain is divided into two hemispheres that control different functions, yet are connected to one another. Left-brain functions include analytical and mathematical thinking. When you are being creative, allowing yourself to daydream, or using your intuition, the right side of the brain takes over. Often while parenting children, we are constantly in a state of questioning our actions, with thoughts like, “Is this the right way to handle this situation?” or “What if he/she can’t do this task and what should or can I do about it?”

These thoughtful questions allow our left-brain to take over to come up with logical answers. There is nothing wrong with these left- brain induced thoughts, but it begins to become tiresome when there is no balance of right brain parental action. You know when this happens when you feel more stressed, less joy out of parenting, and overwhelmed.

Here are three ways to activate the right brain while parenting and get more fun and joy out of being a parent:

1. Allow a creative flow of ideas in the form of games or projects to play with children. Start off with an idea of what could be a fun way to teach or explain something to your children. It could also be some way you want to spend time and interact with them. Don’t over analyze the idea and enjoy having fun playing around with the creative aspects of it. You can include your children in this right brain idea formation and ask for their suggestions. The how to’s of putting it into action will be the left -brain’s job to do.

2. Tune in to that intuitive voice when you’re not sure how to handle a situation with your child. Instead of immediately reacting to a situation, take a few deep breaths and then ask yourself, “What would be the best way in my child’s highest interest to handle this particular situation?”

Listen for the answer that sounds like a voice talking to you. It’s our right brain tuning in to the wisdom that comes from our intuition that is usually correct. The stress in parenting comes from the not knowing how to handle a child’s problem or issue.

3. Create more right brain parenting thoughts. For every “I should do this for my child” thought, counter it with “What would I enjoy doing with my child?” thought. Too often the “shoulds” of what to do make parenting tiresome. Also when you switch the thoughts around, this allows you to see different perspectives and gives you more choices while parenting.

You do not have to react to every right brain thought or even do them at that moment, but it alleviates the stress of too much logic in parenting and not enough fun—and fun in parenting leads to more joy!

Dr. Andrea Weiner is the founder of Emotionally Smart Beginnings

Aug 23

By Stephen C. Webster A Yale study published Tuesday in the Journal of Adolescent Health found that people who used alcohol or tobacco in their youth are almost twice as likely to abuse prescription opiate drugs than those who only used marijuana.

Researchers were careful to specify that any youth substance abuse, including just marijuana use, makes people more than twice as likely to abuse prescription opiate drugs in young adulthood. However, the study’s authors noted that clinical data from the National Survey on Drug Use and Health revealed that of the 12 percent of young adults who said they’d abused prescription opiates, “prevalence of previous substance use was 57% for alcohol, 56% for cigarettes, and 34% for marijuana.”

The Centers for Disease Control said in January that prescription opiate overdoses kill more Americans every year than cocaine and heroin overdoses combined.

Interestingly, the Yale study also found a bit of a gender skew that may indicate boys are naturally more inclined than girls to engage in risk-taking behaviors. “We found that among young boys, all previous substance use (alcohol, cigarettes, and marijuana), but only previous marijuana use in young girls, was associated with an increased likelihood of subsequent abuse of prescription opioids during young adulthood,” researchers wrote.

The findings seem to confirm a study published last month in The Journal of School Health, which fleshed out several misconceptions about the so-called “gateway drug” theory and pinpointed alcohol, instead of marijuana, as the most commonly abused substance for first-time drug users.

Researchers used the University of Michigan’s Monitoring the Future survey to prove that marijuana use is not the primary indicator of whether an individual will abuse other more dangerous substances. In doing so, the School Health study proved that there is data which correlates to a so-called “gateway effect,” showing that the largest gateway is actually alcohol.

“If you take [our findings] and apply them to a school health setting, we believe that you are going to get the best bang for your buck by focusing on alcohol,” study co-author Adam E. Barry told Raw Story. Public health officials have been making similar efforts with tobacco, saying they’re encouraged by the success of educational ad campaigns that show the true health effects experienced by many life-long smokers.

Yale researchers reached a similar conclusion, saying: “Prevention efforts targeting early substance abuse may help to curb the abuse of prescription opioids.”

A study published in 2010 in the medical journal Lancet ranked alcohol as the most harmful drug known to man, with more than double the potential harms of heroin use.

Aug 22

By Jessica Minahan, M.Ed, BCBA
The Anxiety Disorders Association of America reports one in eight children suffer from anxiety disorders. Without intervention, they’re at risk for poor performance, diminished learning and social/behavior problems in school. Because anxiety disorders show up differently in children, parents and teachers can’t always identify them until the child hits the breaking point.

When a student acts out—throws a book, yells, storms out of the room—or has difficulty learning to read or grasping new math concepts, teachers often don’t suspect anxiety as the underlying cause, which means the problems may persist or worsen. This fall, I consulted with Mr. Lee, an exasperated third grade teacher. “I want to give up,” he said, slumping in his chair. Mr. Lee is one of the most thoughtful, talented teachers I’ve worked with. It’s unusual to see him so defeated. He related an incident from that morning’s math class.

Mark was in a great mood. He loves math, especially math fact bingo, which was on the agenda for the day. As always, Mr. Lee asked Mark if he would like to pass out the pencils. Mark asks to do this almost daily because he says he “likes to get up and move.” Today Mr. Lee had barely finished the question when Mark jumped out of his seat, swiped the contents of his desk on the floor, screamed, “I hate this school!” and ran from the room. “It came out of the blue!” Mr. Lee said.

“Out of the blue” behavior

When I hear a teacher report a student’s challenging behavior “comes out of nowhere” or is “totally unpredictable,” I begin to suspect anxiety. Teachers are trained to recognize behavior patterns (“Carl always gets frustrated during math.”, or “Maria often cries when asked to read aloud.”), but some students with anxiety don’t show clear patterns. Anxiety levels fluctuate throughout the day, based on many variables, making the student’s behavior seem erratic. Think of an unopened soda can. You can’t know if it’s been shaken until you open it and it explodes. Similarly, it’s difficult to see how shaken a student is in any given moment until he acts out.

When Mark was asked to pass out pencils on Monday he did it with a smile on his face. On Tuesday, he said “Great!” when asked. But on Wednesday he totally blows up. The outburst has little to do with distributing pencils. It’s due to the high level of anxiety Mark was experiencing at the moment he was asked. On that day the request was the last straw.

Effects on Academics

This invisible disability can greatly affect academic performance as well. Anxiety impacts a student’s working memory, making it difficult to learn and retain information. The anxious student works and thinks less efficiently, which significantly affects the student’s learning capability. One study showed children who were the most anxious in the autumn of first grade were almost eight times more likely to be in the lowest quartile of reading achievement and almost 2½ times more likely to be in the lowest quartile in math achievement by spring of first grade.

What’s worse, academic performance can be hindered in an inconsistent way due to the student’s fluctuating level of anxiety. This leaves teachers befuddled and left to make their own conclusions.
Mr. Lee expressed his confusion. “Yesterday Mark wrote three exceptional paragraphs and today he didn’t finish a single sentence. Is he tired? Is he lazy today?”

This inconsistent presentation is unique to anxiety. Other disabilities, such as a reading disability, are much more predictable. A student with dyslexia doesn’t read a chapter flawlessly one day and then struggle over a sentence in the same book the next day. Teachers aren’t accustomed to thinking of disabilities as affecting kids only some of the time.

Recognizable Effects on Behavior

Without obvious signs, like sweating, shaking or blushing, anxiety is difficult to detect. The good news is that anxiety isn’t always totally invisible. A teacher can learn to recognize the more elusive behavior signs—increased inflexibility, over-reactivity, emotional intensity, and impulsivity. Many anxious students try to escape or avoid something through behavior, for instance going to the nurse to avoid a math quiz or acting up to be kicked out of chorus. Just as with a child who has oppositional behavior disorder, reactions may be tantrums, constant arguments or angry and disruptive acting-out. The form the behavior takes isn’t particularly distinctive – the only difference between oppositional and anxiety-related behavior is the underlying cause.

Educating teachers about anxiety and the behavioral signs they may see in the classroom makes this invisible disability easier to detect and understand. Mr. Lee learned to expect the unexpected while gaining an understanding of anxiety. The trained teacher is on the way to intervening effectively, turning the tide for the student’s academic and behavioral performance.

Jessica Minahan, M.Ed, BCBA, is a board-certified behavior analyst and special educator in the Newton, Massachusetts public school system. She is the co-author of The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students, written with Nancy Rappaport, M.D. (

Aug 22

50 Best Back-to-School Articles for Parents


50 Best Back-to-School Articles for Parents

1. Teaching Beyond The Transmission of Knowledge by Miguel Angel Escotet, Ph.D. Parents are teachers too! Understand the educational philosophy of teaching to the test vs. teaching to the heart. Twitter

2. The Developmental Psychologists’ Back-to-School Shopping List by Gabrielle Principe, Ph.D. at Psychology Today. Five ways to improve children’s learning at all ages, grounded in scientific research.

3. Kindergarten Academics: What To Expect by Patti Ghezzi at SchoolFamily. Learn how kindergarten has changed and how new academic standards will affect your child. Twitter; Facebook Page

4. A Link Between Relatedness and Academic Achievement by Ugo Uche, LPC, at Psychology Today. The key to student success relies not just with teacher’s attitudes toward students but also with the student’s attitude towards the teacher. Parents help develop these attitudes! Twitter

5. Happiness in the Classroom by Jessica Lahey. A middle-school teacher’s tips for classroom happiness apply beautifully to parents too! Pass this one onto your child’s teacher! Twitter

6. Seven Ways to Encourage Reluctant Readers by Steve Reifman, M.Ed. A teacher’s strategies can turn your child from a reluctant to a willing reader. Try them out! Twitter; Facebook Page

7. Boys and Girls Learn Differently by Patti Ghezzi at SchoolFamily. Get insights on how to help your son or daughter at home and in the classroom. Twitter; Facebook Page

8. The Success Myth by Heidi Grant Halvorson, Ph.D., at Psychology Today. Rethink your ideas of what makes us succeed. Then apply them to your parenting. Twitter
Family Well-Being

9. It Isn’t Easy Being a Parent by the Search Institute. Nine strategies every parent should know based on fostering developmental assets in children. Twitter; Facebook Page

10. The Happy Teen: A Primer on the Positives in Youth Development by Stephen Gray Wallace, M.S.Ed. at Psychology Today. Read some good news about adolescent development.

11. Growing Empathy by Jody McVittie, M.D. at SoundDiscipline. How to see the world through children’s eyes, without judgement. Twitter; Facebook Page

12. Resisting Raising Children Who Feel Entitled by Jan Faull, M.Ed. at ParentNet Unplugged. How NOT to indulge your child’s every want. Twitter; Facebook Page

13. Four Tips for Having a Happier Family, by Joe Wilner at PsychCentral. How to deepen family bonds. Twitter; Facebook Page

14. The Seven Best Gratitude Quotes by Melanie A. Greenberg, Ph.D., at Psychology Today. How to bring gratitude into your family’s life. Twitter; Facebook Page

15. Are Parents Setting Kids Up for Failure by Pushing Too Hard for Success? By Lylah M. Alphonse at Yahoo Shine. Tips from Madeline Levine’s new book, “Teach Your Children Well: Parenting for Authentic Success.” Twitter; Facebook Page

16. Five Lessons Our Kids Don’t Learn in School For Success in Life by Jennifer Owens at HuffPost Parents. Parents play a big role in teaching children how to succeed in life! Learn how. Twitter

17. Six Ways to Let Your Child’s Genius Out by Marjie Knudsen at The Oregonian. Learn how to support your child’s learning – for a lifetime! Twitter

18. Healthy Parenting after the Marriage Ends by Kevin D. Arnold, Ph.D., at Psychology Today. How to support your children’s social, emotional and intellectual health after divorce. Twitter
Parent-Readiness and Engagement

19. Parent Involvement: The Missing Key to Student Achievement by James Norwood, Ph.D. at Teaching in the Middle. Learn why developing a partnership with school is one of the most important things you can do to help your child. Twitter

20. Are You Ready for the First Day of School? by Meryl Ain, Ed.D. at Your Education Doctor. An important back-to-school list for parents. Twitter; Facebook Page

21. Twenty-Five Education Blogs Perfect for Parents (And Just About Anyone Else) by Jeff Dunn at Edudemic. Excellent blogs to follow to keep abreast of what’s going on in education. Twitter Facebook Page

22. Two Questions Heard Around the World by Steve Constantino, Ed.D., at ParentNet Unplugged. When your children come home from school, replace the most common two questions asked by parents with a few well-placed statements! Twitter

23. Developing Belief Systems About Education: It Takes a Village by Nicole Rivera, Ed.D., at Psychology Today. Children develop beliefs about education through what their parents believe.

24. Top 10 Pinterest Boards for Parents by Cathy James at the NurtureStore. If you are looking for educational projects to do with preschool and elementary school-age children at home, Pinterest is the place to be! Twitter; Facebook Page
Back-to-School Anxiety

25. Back-To-School Worries by Eileen Kennedy-Moore, Ph.D., at Psychology Today. How to help children cope with starting a new school year. Twitter; Facebook Page

26. Ease Back-to-School Stress by Christine McLaughlin at SchoolFamily. How to help your child switch from laid-back fun of summer to homework and routine. Twitter; Facebook Page
Children with Special Needs, Abilities & Personalities

27. Ten Tips for Parenting an Introverted Child by Susan Cain at The Power of Introverts. Learn how introverted children are special and how to cultivate their passions. Twitter; Facebook Page

28. Five Strategies for Smooth Operating for the New School Year by Cindy Goldrich, Ed.M. at PTSCoaching. Good advice on getting organized, managing time, and using low-tech strategies to support children with ADHD. Twitter; Facebook Page

29. Five Ways to Help Your Child Transition Back to School by Chynna Laird at Special-lsm. Mom with child with Sensory Processing Disorder (SPD) talks about creating a transition plan for supporting special needs children. Twitter; Facebook Page

30. The Need to Believe in the Ability of Disability by Scott Barry Kaufman, Ph.D. and Kevin McGrew at HuffPost Education. How our beliefs help or hinder children with disabilities. Twitter

31. The 200 Best Special Education Apps by Eric Sailers at Edudemic. Great apps for teachers and parents who work with special needs children. Twitter

32. From Perfection to Personal Bests: 7 Ways to Nurture Your Gifted Child by Signe Whitson at HuffPost Parents. How to develop a growth mindset in your high-ability child. Twitter; Facebook Page

33. Reducing Homework Stress by Lori Lite at Stress Free Kids. Ten tips to help parents, teens, and children with the daily homework routine. Twitter; Facebook Page

34. Who Takes Responsibility for Homework? What is the Parent’s Role? By Rick Ackerly at The Genius in Children. Helping kids understand the consequences and rewards of homework. Twitter

35. Keep Your Middle Schooler Organized by Nancy Darling, Ph.D., at Psychology Today. How to help kids develop organizational skills and relieve the homework struggle. Twitter
Youth Sports

36. Soccer, Baseball or Karate? Top 10 Reasons to Involve Your Kids in Sports by Signe Whitson at Psychology Today. Reasons why being a sports chauffer can pay big rewards. Twitter; Facebook Page

37. Emphasize the Internal Rewards by Jeffrey Rhoads at Inside Youth Sports. How to help your child experience the internal rewards of playing sports. Twitter; Facebook Page

38. How to Help Kids Be “Winning” Losers in Youth Sports by Patrick Cohn, Ph.D., at The Ultimate Sports Parent Blog. Learn how losing in sports develops internal skills perseverance, determination, and the ability to adapt to adversity. Twitter; Facebook Page

39. Heads Up Concussion In Youth Sports by Shannon Henrici at Stress Free Kids. Learn about concussions and what you can do as a parent. Twitter; Facebook Page

40. Mean Girls: Why Teenage Girls Can Be So Cruel by Chris Hudson at Understanding Teenagers. Learn how gender influences adolescent behavior in friendship groups and why girls have a natural tendency toward social aggression. Twitter; Facebook Page

41. Bully Proof Your Child by Lori Lite at Stress Free Kids. What parents can do to protect children from bullying. Twitter; Facebook Page

42. How to Protect Kids from Cyber-Bullying by Michele Borba, Ed.D. How to keep an electronic leash on your child! Twitter

43. Bullying Runs Deep: Breaking the Code of Silence that Protects Bullies by Michelle Baker at HuffPost Education. A poignant and personal story with deep insights for parents. Twitter
Media & Technology

44. Parenting: Who is More Powerful: Technology or Parents? By Jim Jaylor, Ph.D., at Psychology Today. How are you flexing your parenting muscles against the strength of today’s media? Twitter; Facebook Page

45. How Much Television is Too Much? Science Weights In by Todd B. Kashdan, Ph.D., at Psychology Today. Science vs. common-sense parenting. Twitter

46. Will Watching Violent Video Games Affect Your Teen’s Behavior? By Dennis E. Coates, Ph.D., at How to Raise a Teenager. Get both sides of the story about violent video games. Twitter

47. The Dangers of Teen Sexting by Raychelle Cassada Lohmann, M.S., L.P.C., at Psychology Today. Learn about sexting and how to protect your teen. Twitter; Facebook Page

48. What is in Your Discipline Toolbox? By Jody McVittie, M.D., at ParentNet Unplugged. How to use kindness and firmness when disciplining children. Twitter; Facebook Page

49. Why Punishment Does Not Make Good Neurological Sense by Meredith White-McMahon, Ed.D., at Development in the Digital Age. How punishment differs from discipline. Twitter

50. Connection before Correction by Jane Nelsen, Ed.D., at Positive Discipline. How positive discipline creates respectful connections with children. Twitter; Facebook Page

©2012 Marilyn Price-Mitchell, Ph.D. Marilyn is the author of Roots of Action: How Families, Schools, and Communities Help Kids Thrive. Find her on Twitter and Facebook. Subscribe to new articles by email.

Aug 18

How well do you know your spouse?


Written on April 7, 2011 by Barbara Peters in relationship advice for couples
“Oh, you like chocolate ice cream best! Imagine that, you love the Beach Boys as much as I do! I can’t believe you love Primitive art too!”

When we first begin to learn about the people who are destined to become our significant others or spouses, the gates of knowledge fling open and a rush of trivia, some good, some bad and some downright ugly, floods our heads. We just can’t learn enough about the person we find so attractive.

Somehow we tend to assume nothing changes as years pass, until one day we overhear our spouse telling an acquaintance, “My favorite ice cream is strawberry.” What in blazes is going on here?

How well do you really know your spouse?

Turn off the TV for an evening and try an experiment I often suggest to couples having a difficult time communicating with each other. All it takes is a pad of paper, pen and a good dose of reality.

Each should jot down at least ten questions to ask the other, but both must answer to spread the wealth of knowledge sure to be discovered. Start with easy questions like “What’s your favorite song, vacation, dessert,” and so on.

Then begin probing a little deeper . . . What are you passionate about? What do you fear the most? Who is your hero? All these questions will require thought and may take some time to answer. No rush, this should be a work in progress.

There is no score to tally; the goal is to learn more about your partner, possibly discovering things and thoughts which might surprise you. It’s fun to do, and you could uncover interests you never knew you shared.

Aug 17

Breast Implants Linked to Suicides


An epidemic has been steadily growing in the U.S. and has reached its peak: Body Image Disorder. Not officially of course, but the idea is that we must do whatever it takes to look like everyone else. Implicit among the need to diet, exercise and surgically “improve” our bodies is the belief that you, as you are, is simply not good enough.

Plastic Surgery is a popular trend in the United States. Breast augmentation surgery in particular is the second most popular surgical cosmetic procedure next to liposuction, according to the American Society for Aesthetic Plastic Surgery. Even girls as young as 7-years-old go under the knife, pandering to the images of beauty fed to them and their peers through the media.

Cosmetic surgery can be danerous. According to Forbes, it can lead to Hematomas, infections, necrosis, or even death.

Discovery Health reported that even after a 14-year ban of silicone implants in the U.S. because of potential health risks, it is back by popular demand and has since grown to be more frequently produced than plastic–But hey, anything to be, feel and look like Kim Kardashian right? (because she has SO much going for her).

If that is not enough, studies have also shown that among the risks posed by breast implants are raised rates of suicides among women. A study published in the Annals of Plastic surgery revealed that “increased risk of suicide was not apparent until 10 years after implantation.”

The August 2007 study looked at 3,527 Swedish women who had breast enhancement procedures between 1965 and 1993 considering only women who got implants for purely cosmetic. Tracked for at least a decade, the study found that of these 3,527 women, 24 committed suicide, representing a suicide rate three times higher than among the general population.

Ten to 19 years after surgery, the suicide rate became 4.5 times that of women in the general population. Twenty years or more after surgery, it was six times. The suicide rate was also higher for women 45 years or older, and on average the suicides occurred 19 years after surgery.

Five other studies confirmed that women with breast implants were two to three times more likely to commit suicide. Furthermore, researchers found that women with breast implants more often had problems with alcohol and drugs and were more likely to be divorced, all of which are risk factors for suicide.

Researchers believe that the link between suicides and plastic surgery is a combination of medication received post-op and the fact that up to 15 percent of patients who undergo plastic surgery suffer from body dysmorphic disorder (BDD), which causes people to obsess over small or even nonexistent imperfections, Los Angeles Times reports.

Many clinics are beginning to implement psychiatric and physical screenings for patients who want to undergo the surgery to ensure that they are both mentally and physically fit enough to do so.


Aug 17

Is It ADHD or Dyslexia – or Both?


By Madeline Vann, MPH For many children, attention deficit hyperactivity disorder (ADHD) and the learning disorder dyslexia go hand-in-hand. As many as one in four children with ADHD also have dyslexia, while between 15 and 40 percent of children with dyslexia have ADHD. In those cases, children and their families must work to manage both conditions.

Distinguishing between ADHD and dyslexia may at first seem difficult, especially for a parent who has no experience with either disorder. Is your child skipping words when reading because he cannot read them or because he is just speeding ahead? With ADHD making headlines, your first thought might go toward attention problems rather than reading difficulties. But it is important to look at the whole picture when assessing your child’s performance.

“With ADHD there are more behavioral kinds of problems,” says special education expert Nancy Mather, PhD, associate professor in the department of special education, rehabilitation, and school psychology at the University of Arizona in Tucson. “Dyslexia is limited to reading and writing.”

Despite these distinctions, experts have observed a link between ADHD and dyslexia. “Similar areas of the brain are involved in both disorders,” explains Mather. They both appear to lead to problems with executive function, memory, and processing symbols quickly. Another similarity is that children with these disorders often have normal to high intelligence and high creativity, but are frustrated academically. What’s different is how these disorders play out — with dyslexia, it’s in terms of reading and writing difficulties, and with ADHD, it involves behavior.

ADHD and Dyslexia: Reaching a Diagnosis

The process of finding out what is causing your child’s problems could be lengthy. Because girls with ADHD tend to quietly tune out rather than act out, figuring out your child’s learning challenges could be a bit more difficult with a daughter. “You need neuropsychological testing to tease that out,” says ADHD specialist Eugene Arnold, MD, professor emeritus of psychiatry at the Ohio State University in Sunbury.

In order to figure out which disorder your child has — or if it’s both — you will need:
Teacher input. Talking to teachers about your child’s behavior in class and performance on schoolwork can be revealing. Children with ADHD may have trouble paying attention, remembering and following verbal directions, or sitting still, but if they don’t have dyslexia, their ability to read and write is often just fine — indeed, many children with ADHD are avid readers. As they get older, they tend to do better with written instructions than verbal ones. On the other hand, children with dyslexia may try to avoid reading and writing, or mix up letters when learning to write, but do well with oral testing and comprehension.
A learning ability evaluation. If you suspect a learning disability such as dyslexia, you have the right to ask for an evaluation through your public school system. This is also true for homeschooled children, points out Mather. Testing can help identify dyslexia.
ADHD evaluation. In order to get an ADHD diagnosis and begin treatment, you will need a psychiatric assessment from an ADHD expert.

Succeeding With ADHD and Dyslexia

Just as the conditions are related but different, so are the solutions. The first step is to work with your child’s school.

“A lot of information is collected by the team at the school,” says Mather. The team may include a special education teacher or counselor, your child’s teachers, and any experts you want to include. If you suspect dyslexia, Mather advises including a dyslexia expert in team meetings. Based on test results, you and the team can develop a plan, usually called an IEP (Individualized Education Plan), for helping your child succeed in school.

Children with ADHD and dyslexia often require:
ADHD medication. With the right medical treatment, children with ADHD learn better. This is especially true for children who also have dyslexia — they need to be able to focus in order to learn how to read and write in a more intensive way. Specialized reading and writing training. If your school system has teachers trained in dyslexia on staff, your child may be able to get this additional help during the school day. However, many families find that their child requires tutoring after school. For children with ADHD, this can be especially challenging after a long day when ADHD medication may be wearing off. Talk to your doctor about using additional smaller doses of medication to keep your child’s attention focused until dinner time.
Classroom accommodations. When you put together the classroom plan for your child with ADHD, you may need to include such things as taking breaks during long work periods, being able to get up and move around the classroom frequently, or being seated away from distractions. Be cautious about being overly reliant on audiobooks or verbal instruction for children with dyslexia, however. Mather points out that learning to read and write is still essential. Specialized tutoring may be necessary.

Though challenges are ahead, there is also great potential. With hard work and structure, children with ADHD and dyslexia can be successful in school.

Aug 17

Two studies have shown that medications used to treat ADHD do not increase the risk of future drug and alcohol abuse as the patients who take them grow into early adulthood.

Attention-Deficit/Hyperactivity Disorder (ADHD) is often treated with stimulant medications such as methylphenidate. Ritalin is the best known brand name of methylphenidate. Because these medications belong to a class of drugs often abused on the streets, the fear was that those who took them medicinally as children or adolescents might be more susceptible to drug abuse as young adults.

“These studies say [ADHD medications] don’t have an impact,” says Dr. Alice Charach, head of the neuropsychiatry team in the Department of Psychiatry at Toronto’s SickKids Hospital (SickKids), refering to a child’s future risk of drug abuse. At the same time, parents whose children are taking any medication on a daily basis are right to be concerned and should become informed about the potential long-term impact that medication will have, she says. The first study, published in the American Journal of Psychiatry, shows these fears to be unfounded. Researchers followed up on 112 males ten years after they had first been diagnosed with ADHD and prescribed medications, including Ritalin. At this ten-year mark, the study found no significant increased risk of abuse of drugs, alcohol, or nicotine.

The second study, also published in the American Journal of Psychiatry, also found no link with substance abuse and further concluded that it did not matter when a child was first prescribed stimulants for ADHD, nor how long the child remained on the medication: no association with future drug abuse existed.

“This information is reassuring because it is the first study of its kind to follow young people right through their age of risk,” namely, the late adolescent and early adult years when people are most likely to abuse drugs or alcohol, says Dr. Charach. Previous studies had not tracked patients for such an extended period of time.

“That these medications are linked to drug abuse is a common belief,” Dr. Charach says, adding these beliefs persist due to inaccurate information disseminated through alternative media. At the same time, “[Ritalin] does have some street value for teens and college students,” she admits, which no doubt contributes the negative public perception of these stimulant medications.

Newer, longer- and slower-acting forms of methylphenidates, which are now more commonly prescribed and were included in these studies, make the drug less attractive for those taking it for non-medicinal purposes.

Conduct disorder and future drug abuse
Dr. Charach says while there is no connection between ADHD medication and future drug abuse, the same cannot be said for conduct disorder, the psychological term for chronic bad behaviour. “Many studies have noted that if the child with ADHD has a history of breaking rules, getting into trouble, and hanging out with others who do these things as a group, there is a higher risk for future drug abuse,” she says. “Thankfully, most children with ADHD are not like this. They try very hard and are very motivated to do as they are told. They may be impulsive and have trouble paying attention, but these are now considered separate and distinct difficulties from rule-breaking and other bad behavior.”

Biederman J, Monuteaux MC, Spencer T, Wilens TE, MacPherson HA, Faraone SV. Stimulant therapy and risk for subsequent substance use disorders in male adults with ADHD: A naturalistic controlled 10-year follow-up study. American Journal of Psychiatry. 2008; 165: 597-603

Mannuzza S, Klein RG, Truong NL, Moulton JL 3rd, Roizen ER, Howell KH, Castellanos FX. Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: Prospective follow-up into adulthood. American Journal of Psychiatry. 2008; 165: 604-609

By Amy Solomon, Senior Editor TUESDAY, April 10, 2012 — Excruciating, throbbing head pain; nausea and vomiting; sensitivity to light and sound. These classic signs of migraine can make daily life difficult for the estimated 36 million Americans who experience these chronic, debilitating headaches. Although there are medications and other migraine treatments available, they don’t work for everyone and may come with unwanted side effects.

But a surgical procedure performed by plastic surgeons may do the trick — and as a bonus, you may end up looking younger. That’s because it’s based on forehead rejuvenation surgery, otherwise known as a forehead lift.

Known as nerve decompression surgery, the procedure was pioneered by Bahman Guyuron, MD, who heads the department of plastic surgery at University Hospitals Case Medical Center in Cleveland, Ohio. Dr. Guyuron noticed that in some of his patients, migraine symptoms disappeared after he performed forehead lifts. Regarding one patient, Guyuron told ABC News, “[S]he was not only happy with the way she looked, but she hadn’t had a migraine for the previous six months.”

Based on these results, Guyuron developed a surgical technique designed to deactivate migraine trigger sites, specific areas in the muscles or nerves of the head that when irritated are thought to lead to migraine pain. Guyuron has been performing the procedure for the past 12 years and has published several reports on his results. One paper co-authored by Guyuron and published last year in Plastic and Reconstructive Surgery found that after five years, 61 of 69 patients who underwent the surgery (88 percent) had at least partial relief from migraine symptoms. About 30 percent said their migraines went away completely, and 60 percent said they decreased significantly.

Botox injections are also thought to help migraines by paralyzing muscles and nerves at trigger points. Before undergoing surgery, Guyuron’s patients receive Botox to determine the correct trigger site; if they respond, it’s more likely that they’ll have a good outcome.

Who Should Get Nerve Decompression Surgery?

If you’re interested in nerve decompression surgery for migraines, there are some caveats to keep in mind:

Although the results so far are encouraging, the studies have been performed in a very small, select number of patients, Cathy Glaser, founder of the Migraine Research Foundation, told ABC News. “Surgical interventions are…not something you are going to do when you are first diagnosed.”
W.G. Austen, MD, chief of plastic and reconstructive surgery at Massachusetts General Hospital, told the Boston Globe that only about five percent of migraine sufferers are good candidates for nerve decompression surgery. Criteria include being under a neurologist’s treatment, having severe migraines more than once a week, and failing to see improvement with standard migraine treatments. Dr. Austen is one of about 250 plastic surgeons trained by Guyuron to perform the procedure.
Some headache specialists believe that it’s “inappropriate” for plastic surgeons to treat headache patients, according to Alexander Mauskop, MD, a board-certified neurologist and head of the New York Headache Center in New York City. Speaking to Medscape Medical News, Dr. Mauskop also noted that “the issue with surgery is that it is permanent and there are potential side effects, including risk of infection.” Other side effects can include bleeding, numbness, or hair loss around the incision site.
Insurance may not cover the treatment, and out-of-pocket costs can run between $5000 and $10,000, Austen told the Globe.

But if nothing seems to work for your migraine pain, you may want to talk to your doctor or neurologist what other treatment options, including surgery, may be right for you.

Aug 15

Is It Bipolar Disorder or ADHD?


by William Dodson, M.D.
It can be difficult enough to obtain a diagnosis of attention deficit disorder (ADD ADHD), but to complicate matters further, ADHD commonly co-exists with other mental and physical disorders. One review of ADHD adults demonstrated that 42 percent had one other major psychiatric disorder. Therefore, the diagnostic question is not “Is it one or the other?” but rather “Is it both?”

Perhaps the most difficult differential diagnosis to make is between ADHD and Bipolar Mood Disorder (BMD), since they share many symptoms, including mood instability, bursts of energy and restlessness, talkativeness, and impatience. It’s estimated that as many as 20 percent of those diagnosed with ADHD also suffer from a mood disorder on the bipolar spectrum — and correct diagnosis is critical in treating bipolar disorder and ADHD together.

ADHD is characterized by significantly higher levels of inattention, distractibility, impulsivity, and/or physical restlessness than would be expected in a person of similar age and development. For a diagnosis of ADHD, such symptoms must be consistently present and impairing. ADHD is about 10 times more common than BMD in the general population.
Bipolar Mood Disorder (BMD)

By diagnostic definition, mood disorders are “disorders of the level or intensity of mood in which the mood has taken on a life of its own, separate from the events of a person’s life and outside of [his] conscious will and control.” In people with BMD, intense feelings of happiness or sadness, high energy (called “mania”), or low energy (called “depression”) shift for no apparent reason over a period of days to weeks, and may persist for weeks or months. Commonly, there are periods of months to years during which the individual experiences no impairment.
Making a diagnosis

Because of the many shared characteristics, there is a substantial risk of either a misdiagnosis or a missed diagnosis. Nonetheless, ADHD and BMD can be distinguished from each other on the basis of these six factors:

1. Age of onset: ADHD is a lifelong condition, with symptoms apparent (although not necessarily impairing) by age seven. While we now recognize that children can develop BMD, this is still considered rare. The majority of people who develop BMD have their first episode of affective illness after age 18, with a mean age of 26 years at diagnosis.

2. Consistency of impairment: ADHD is chronic and always present. BMD comes in episodes that alternate with more or less normal mood levels.

3. Mood triggers: People with ADHD are passionate, and have strong emotional reactions to events, or triggers, in their lives. Happy events result in intensely happy, excited moods. Unhappy events — especially the experience of being rejected, criticized, or teased — elicit intensely sad feelings. With BMD, mood shifts come and go without any connection to life events.

4. Rapidity of mood shift: Because ADHD mood shifts are almost always triggered by life events, the shifts feel instantaneous. They are normal moods in every way, except in their intensity. They’re often called “crashes” or “snaps,” because of the sudden onset. By contrast, the untriggered mood shifts of BMD take hours or days to move from one state to another.

5. Duration of moods: Although responses to severe losses and rejections may last weeks, ADHD mood shifts are usually measured in hours. The mood shifts of BMD, by DSM-IV definition, must be sustained for at least two weeks. For instance, to present “rapid-cycling” bipolar disorder, a person needs to experience only four shifts of mood, from high to low or low to high, in a 12-month period. Many people with ADHD experience that many mood shifts in a single day.

6. Family history: Both disorders run in families, but individuals with ADHD almost always have a family tree with multiple cases of ADHD. Those with BMD are likely to have fewer genetic connections.

Treatment of combined ADHD and BMD

Few articles have been published about the treatment of people who have ADHD and BMD. My clinical experience, having seen more than 100 patients with both disorders, shows that coexisting ADHD and BMD can be treated very well. It’s important to always diagnose and treat the BMD first, as ADHD treatment may precipitate mania or otherwise worsen BMD.

Outcomes for my patients treated for both ADHD and BMD have thus far been good. The majority have been able to return to work. Perhaps more importantly, they report that they feel more “normal” in their moods and in their ability to fulfill their roles as spouses, parents, and employees. It is impossible to determine whether these significantly improved outcomes are due to enhanced mood stability, or whether treatment of ADHD makes for better medication compliance. The key lies in the recognition that both diagnoses are present and that the disorders will respond to independent, but coordinated, treatment.

Aug 15

By Rick Nauert PhD Senior News Editor
Couples Therapy Reduces PTSD, Improves Relationship As an individual recovers from posttraumatic stress disorder (PTSD), his or her partner often confronts significant caregiver burden and psychological distress.

A new study discovers that participation in disorder-specific couples therapy resulted in decreased PTSD symptom severity and increased patient relationship satisfaction, compared with couples who were placed on a wait list for therapy. The study is discussed in the Journal of the American Medical Association (JAMA). Experts all agree that there are well-documented associations between PTSD and intimate relationship problems, including relationship distress and aggression.

“Although currently available individual psychotherapies for PTSD produce overall improvements in psychosocial functioning, these improvements are not specifically found in intimate relationship functioning. “Moreover, it has been shown that even when patients receive state-of-the-art individual psychotherapy for the disorder, negative interpersonal relations predict worse treatment outcomes,” study authors said.

In the study, Candice M. Monson, Ph.D., and colleagues examined the effect of a cognitive-behavioral conjoint therapy (CBCT) for PTSD, designed to treat PTSD and its symptoms and enhance intimate relationships in couples. Researchers conducted the randomized controlled trial from 2008 to 2012, and included heterosexual and same-sex couples (n = 40 couples; n = 80 individuals) in which one partner met criteria for PTSD.

Symptoms of PTSD, co-existing conditions, and relationship satisfaction were collected by assessors at the beginning of the study, at mid treatment (median [midpoint], 8 weeks after baseline), and at post-treatment (median, 16 weeks after baseline). An uncontrolled 3-month follow-up was also completed. Couples were randomly assigned to take part in the 15-session cognitive-behavioral conjoint therapy for PTSD protocol immediately (n = 20) or were placed on a wait list for the therapy (n = 20).

Researchers studied if the intervention helped reduce PTSD symptom severity (as a primary outcome); and if intimate relationship satisfaction, patient- and partner-rated PTSD symptoms, and co-existing symptoms were also improved (secondary outcomes).

The researchers found that PTSD symptom severity and patients’ intimate relationship satisfaction were significantly more improved in couple therapy than in the wait-list condition. Additionally, PTSD symptom severity decreased almost 3 times more in CBCT from pretreatment to post-treatment compared with the wait list; and patient-reported relationship satisfaction increased more than 4 times more in CBCT compared with the wait list.

The secondary outcomes of depression, general anxiety, and anger expression symptoms also improved more in CBCT relative to the wait list. Treatment effects were maintained at three-month follow-up. “This randomized controlled trial provides evidence for the efficacy of a couple therapy for the treatment of PTSD and comorbid symptoms, as well as enhancements in intimate relationship satisfaction,” said researchers.

Notably, improvements occurred in a sample of couples in which the patients varied with regard to sex, type of trauma experienced, and sexual orientation. Researchers discovered the treatment outcomes for PTSD and related symptoms were comparable with or better than effects found for individual psychotherapies for PTSD.

In addition, patients reported enhancements in relationship satisfaction consistent with or better than prior trials of couple therapy with distressed couples and stronger than those found for interventions designed to enhance relationship functioning in nondistressed couples, report the authors.

In summary, researchers believe cognitive-behavioral conjoint therapy can be an effective strategy to address individual and relational dimensions of traumatization. The therapy technique may be of benefit to individuals with PTSD who have stable relationships, and partners willing to engage in treatment with them.

Aug 15

by Thilaka Ravi Girls with Attention Deficit Hyperactivity Disorder (ADHD) and their families wait for a likely decline in visible symptoms such as fidgety or disruptive behavior as they mature into young women, but a new study reveals girls with ADHD are prone to self harm as they grow into young adults.

New findings from UC Berkeley caution that, as they enter adulthood, girls with histories of ADHD are more prone to internalize their struggles and feelings of failure – a development that can manifest itself in self-injury and even attempted suicide. “Like boys with ADHD, girls continue to have problems with academic achievement and relationships, and need special services as they enter early adulthood,” said Stephen Hinshaw, UC Berkeley professor of psychology and lead author of a study that reports after 10 years on the largest-ever sample of girls whose ADHD was first diagnosed in childhood.

“Our findings of extremely high rates of cutting and other forms of self-injury, along with suicide attempts, show us that the long-term consequences of ADHD females are profound,” he added.

The study is published today (Tuesday, August 14) in the Journal of Consulting and Clinical Psychology. Its results are consistent with earlier findings by the UC Berkeley team that, as girls with ADHD grow older, they show fewer visible symptoms of the disorder, but continue to suffer in hidden ways. The findings challenge assumptions that girls can “outgrow” ADHD, and underscore the need for long-term monitoring and treatment of the disorder, Hinshaw said.

The longitudinal study, which began when the girls were ages 6 to 12, is funded by grants from the National Institute of Mental Health. Since 1997, Hinshaw and his team have tracked a racially and socio-economically diverse group of girls with ADHD in the San Francisco Bay Area through early childhood summer camps, adolescence and now early adulthood. In addition to this new study, many others have been published by the team about the girls every five years.

In the United States, more than 5 million children ages 3-17 – approximately one in 11 – have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. ADHD is characterized by poor concentration, distractibility, hyperactivity, impulsiveness and other symptoms that are inappropriate for the child’s age. Evidence-based treatment includes stimulant medications and various forms of behavior therapy.

The new UC Berkeley study, assessing the girls 10 years after it began, examined 140 of them, ages 17-24, comparing their behavioral, emotional and academic development to that of a demographically similar group of 88 girls without ADHD. It also gauged the symptoms of two major ADHD subtypes: Those who entered the study with poor attention alone versus those who had a combination of inattention plus high rates of hyperactivity and impulsivity.

The study’s major finding was that the group with combined inattention and hyperactivity-impulsivity during childhood was by far the most likely to manifest self-injury and suicide attempts in early adulthood. In fact, the study pointed out, more than half of the members of this subgroup were reported to have engaged in self-injurious behavior, and more than one-fifth had attempted suicide, Hinshaw said.

“A key question is why, by young adulthood, young women with ADHD would show a markedly high risk for self-harm … Impulse control problems appear to be a central factor,” the study said.

In the first study on this group, published in 2002, the 6- to- 12-year old girls attended five-week camps where they were closely monitored as they partook in art and drama classes and outdoor activities. Those taking ADHD medication volunteered to go off the drug treatment for much of the summer camp study. The counselors and staff observing all the participants did not know which of them had been diagnosed with ADHD.

That study found that girls with ADHD were more likely to struggle academically and to be rejected by their peers, compared to the comparison peer group. The five-year follow-up study, when the girls were 12 to 17 and experiencing early to mid-adolescence, found that the fidgety and impulsive symptoms tended to subside in the early teen years, but that the learning gap between girls with ADHD and their non-ADHD peers had widened, and eating disorders and substance abuse had surfaced.

For the latest study, in which 95 percent of the original sample of girls participated, the researchers conducted intensive interviews with the subjects and their families. Those interviews include personal reports on behaviors such as self-harm and suicide attempts, drug use, eating habits and driving behavior.

Researchers also measured key cognitive functions such as executive planning skills, which include goal-setting and monitoring, planning and keeping on task despite distractions. While many girls in the study showed improvement in ADHD symptoms during the 10-year period, certain problems persisted and new ones emerged, suggesting that careful monitoring and treatment are essential, Hinshaw said.

“The overarching conclusion is that ADHD in girls portends continuing problems, through early adulthood,” the study concluded. “Our findings argue for the clinical impact of ADHD in female samples, the public health importance of this condition on girls and women, and the need for ongoing examination of underlying mechanisms, especially regarding the high risk of self-harm in young adulthood.”

That said, Hinshaw added, “ADHD is a treatable condition, as long as interventions are monitored carefully and pursued over a number of years.” Read more: Teenage Girls With ADHD Prone to Self-injury, Suicide | Medindia

Aug 14

Unconscious Conditioning


A psychologist at a girl’s college asked the members of his class to compliment any girl wearing red. Within a week the cafeteria was a blaze of red. None of the girls were aware of being influenced, although they did notice that the atmosphere was more friendly. A class at the University of Minnesota is reported to have conditioned their psychology professor a week after he told them about learning without awareness. Every time he moved toward the right side of the room, they paid more attention and laughed more uproariously at his jokes, until apparently they were able to condition him right out the door.

– W. Lambert Gardiner, Psychology: A Story of a Search, 1970

Aug 9

The Benefits of Positive Behavior Support


By Amy Van Wynsberghe, PhD

The Benefits of Positive Behavior SupportAll individuals have the right to aspire toward their own personal goals and desires. At times, mental health conditions and problem behaviors, such as aggression or property destruction, can create barriers to reaching those goals.

Fortunately, a number of treatment practices exist that can assist an individual in adopting positive behaviors. If you or a loved one has been diagnosed with a mental health condition and has problem behaviors, consider talking to a mental health provider about the benefits of Positive Behavior Support (PBS).
What is PBS?

Positive Behavior Support (PBS) is a philosophy for helping individuals whose problem behaviors are barriers to reaching their goals. It is based on the well-researched science of Applied Behavior Analysis (ABA). A key component is understanding that behaviors occur for a reason and can be predicted by knowing what happens before and after those behaviors.

PBS interventions are designed both to reduce problem behaviors and increase adaptive, socially appropriate behaviors. These outcomes are achieved through teaching new skills and changing environments that might trigger problem behavior. Prevention of problem behaviors is the focus, rather than waiting to respond after a behavior occurs. PBS strategies and interventions are appropriate for children and adults diagnosed with a variety of mental health conditions such as schizophrenia, depression, autism, and intellectual disability.
Who is Trained in PBS? What Do They Do?

Mental health professionals, such as psychologists and behavior analysts, are trained to complete assessments and design PBS interventions. They conduct assessments, called structural and functional behavioral assessments, to determine when, where and why problem behaviors occur. For example, a mental health professional may conduct an assessment of a student who is identified at risk for expulsion and alternative school placement due to profanity and disruptive behavior in the classroom. The goal would be to learn what the student is achieving by using those behaviors.

A typical assessment would include several observations in different locations to determine which behaviors are problematic. It then would identify the environmental triggers that predict when those behaviors will and will not happen. The mental health professional would talk with the student, his or her family, teachers, other treatment providers and friends to answer questions about the problem behaviors.

From there, the professional would develop treatments that match the reason that the student is using the problem behaviors. These treatments include developing strategies to replace problem behaviors with appropriate behavior.

By learning and using new skills, an individual can stop using problem behaviors. For example, an individual diagnosed with schizophrenia may break the ceiling fan in her home because she believes that the fan is yelling at her. The mental health professional will teach her coping skills such as mindfulness, deep breathing, journaling, asking for help, or muscle relaxation. This gives her other, more acceptable behavior options to use the next time she believes that the fan is yelling at her.

While the mental health professional may lead the development of PBS treatments, the individual leads the implementation by learning and using these new skills or replacement behaviors. Additionally, key people in the individual’s life such as family, friends and co-workers learn how to implement PBS treatments to change the environment to support the individual.
Why use a PBS Approach?

PBS emerged in the 1980s to understand and address problem behaviors. As a holistic approach to treatment of mental health conditions, PBS has many attributes:

It is person-centered. Using a person-centered approach, PBS addresses the individual and respects his or her dignity. This includes listening to the individual, recognizing the individual’s skills, strengths, and goals, and the belief that the individual can accomplish his or her goals. Treatments are developed to fit the specific individual rather than a “cookbook” approach.

It causes positive changes. Through environmental changes and reinforcement of adaptive behaviors, individuals can reduce problem behaviors. Coping mechanisms such as relaxation can take the place of the problem behaviors. PBS minimizes the need for punishment or restrictiveness such as restraint, seclusion, or removal of privileges.
It is outcome-focused. PBS places an emphasis on outcomes important to the individual and to society. These behavioral outcomes, such as fewer aggressive incidents, have the ability to make homes, communities, hospitals, and schools safer.
It provides collaborative support. PBS involves collaboration with those who support an individual, including caregivers, support providers, doctors, nurses, teachers, aides, nurses, social workers, and team leaders. This collaborative process keeps everyone involved in the individual’s treatment and allows for new behaviors and skills to be supported in all settings.

Does PBS Work with Other Treatments?

PBS may be practiced alongside other treatment interventions as part of a multidisciplinary approach to mental health treatment. For example, an individual who is prescribed medication by a physician or psychiatrist for mental health conditions such as schizophrenia, autism or impulse control disorder could benefit from PBS. An individual who sees a dietician to help with specific nutritional needs such as in Prader-Willi Syndrome, or receives occupational, speech, or physician therapy, may also benefit from PBS techniques.

PBS is consistent with other treatment approaches that are person-centered or recovery-based. This means that they can work well when used together. PBS interventions are inconsistent with restrictive or punishment-based interventions. PBS interventions are used instead of these approaches.

Since PBS is a holistic approach, and clinicians consider all aspects of an individual when assessing and developing interventions, it is helpful for a PBS clinician to become a member of an individual’s interdisciplinary team. PBS-trained professionals have experience working directly with other health care professionals to design treatments. For example, a PBS-trained professional may work with speech therapists to develop communication boards for non-verbal individuals who engage in self-injurious behaviors such as head-banging or skin-picking.

Without treatment, the consequences of mental illness are astounding: disability, unemployment, substance abuse, homelessness, incarceration, and suicide. While medication and other interventions have proven to be beneficial in many mental health conditions, a multidisciplinary approach that includes a behavioral component can offer support mechanisms critical in the treatment process.

Talk to a mental health professional about the benefits of PBS.

Aug 8

The Sleep-Symptom Connection in Bipolar


Psychological conditions can be intensified by life stressors, traumatic experiences, and interpersonal conflicts. Lack of sleep can also increase the symptoms of mental health problems. Additionally, sleep problems can indicate the presence of psychological illnesses such as depression and anxiety. Researchers have studied the effects of poor sleep patterns on mental and physical health for many years. But there have been few studies that have focused on how sleep fluctuates during nonsymptomatic periods. For instance, individuals with bipolar experience episodes of positive and negative affect but also go through periods when their moods are relatively stable. Although sleep patterns may be quite volatile in the presence of symptoms, few studies have looked at how interepisode sleep cycles affect symptom severity and the onset of future episodes.

To address this gap in research, Anda Gershon of the Department of Psychiatry and Behavioral Sciences at Stanford University recently conducted a study that examined the sleep patterns of 32 individuals with bipolar for 8 weeks. The participants were classified as interepisode at the time of the study and were assessed daily for affect, symptom severity, and sleep behaviors. Gershon looked specifically at how particular aspects of sleep, such as sleep onset and sleep quality, differed from a sample of 36 individuals with no history of bipolar.

Gershon found that the individuals with bipolar had more sleep disturbances than the controls. The clinical participants had more difficulty falling asleep and woke more during the night. They also stayed awake longer when they woke and had more trouble going back to sleep. The bipolar group demonstrated higher rates of negative affect than the controls. However, when affect was analyzed on the basis of sleep cycles, it was found that sleep impairment led to negative affect equally in both groups. Gershon believes that sleep is critical to the management of symptoms of bipolar during symptom flare ups and even interepisode. Gershon added, “Ongoing monitoring of sleep-affect coupling may provide an important target for intervention in bipolar disorder.”

Aug 8

What is Executive Function?


Executive Function (EF) refers to brain functions that activate, organize, integrate and manage other functions. It enables individuals to account for short and long term consequences of their actions and to plan for those results. It also allows individuals to make real time evaluations of their actions, and make necessary adjustments if those actions are not achieving the desired result.

There are differing models of executive function put forth by different researchers, but the above statements cover the basics that are common to most. Two of the major ADHD researchers involved in studying EF are Russell Barkley, PhD, and Tom Brown, PhD.

Barkley breaks executive functions down into four areas:

Nonverbal working memory
Internalization of Speech (verbal working memory)
Self-regulation of affect/motivation/arousal
Reconstitution (planning and generativity)

Barkley’s model is based on the idea that inabilities to self-regulate lie at the root of many challenges faced by individuals with ADHD. He puts forth that they are unable to delay responses, thus acting impulsively, and without adequate consideration of future consequences — beneficial or negative.1

Brown breaks executive functions down into six different “clusters.”

Organizing, prioritizing and activating for tasks
Focusing, sustaining and shifting attention to task
Regulating alertness, sustaining effort and processing speed
Managing frustration and modulating emotions
Utilizing working memory and accessing recall
Monitoring and self-regulating action

According to Brown, these clusters operate in an integrated way, and people with ADHD tend to suffer impairments in at least some aspects of each cluster. Because these impairments seem to show up together much of the time, Brown believes they are clinically related.

Under Brown’s model, difficulties in these clusters lead to attentional deficits, as individuals have difficulty organizing tasks, getting started, remaining engaged, remaining alert, maintaining a level emotional state, applying working memory and recall, and self-monitoring and regulating actions.2

It is clear that executive function impairments have an adverse effect on an individual’s ability to begin, work on and complete tasks. It is also commonly thought that deficits in executive functions are highly interrelated to symptoms associated with ADHD.

(CBS News) What makes hoarders feel the compulsive need to hang onto everything?

About 5 percent of the world’s population are clinical hoarders, according to the International OCD Foundation, saving objects ranging from food wrappers, old newspapers to animals because they simply can’t let go of them.

New research examines the brains of people with compulsive hoarding to find out what leads them to this behavior which can often lead to unsanitary and dangerous living conditions.

In a new study published in the August 6 issue of the Archives of General Psychiatry, researchers at the Institute of Living at Hartford Hospital in Conn., used fMRI machines to measure the brain activity of people when they made decisions about whether to keep or throw away a possession.

The researchers compared the scans of 43 people diagnosed with hoarding disorder, 31 people with obsessive-compulsive disorder (OCD) and 33 healthy individuals. According to the Mayo Clinic, hoarding may be a symptom of OCD but many people who hoard don’t have other OCD-like symptoms.

Compared with healthy people and those with OCD, the researchers found distinct patterns of abnormal activity in the anterior cingulated cortex (ACC) and insula in the brains of people who had a hoarding disorder. Those areas of the brain are tied to decision-making processes. When the researchers presented subjects with an object that did not belong to them, the hoarders showed lower activity in those brain regions than their counterparts’ brains revealed on the fMRI scans.

However, when they were presented with an object that they owned, the hoarders’ brains showed “excessive” signals on the scan, unlike the other two groups. The other subjects’ brains showed no such activity when confronted with a decision to throw out a personal item. The researchers say their findings emphasize the problems in the decision-making process that contribute to hoarders’ inability to throw items away.

“That brain network goes into hyperdrive, starts freaking out,” study author Dr. David Tolin, a psychologist at the Institute of Living in Hartford, Conn., told WebMD. “The task seems to overload the network.”

As such, the study showed that the group of subjects with hoarding disorders discarded significantly fewer items that belonged to them than subjects in the other two groups. The authors say the links between excessive functions of these brain regions in people with hoarding disorder should be researched further.

“This illumination is important because although it is fairly uncommon and probably affects less than 1 percent of the population, we’re talking about a serious problem,” Dr. Joseph Coyle, a professor of psychiatry and neuroscience at Harvard Medical School in Boston who was not involved in the new research, said to HealthDay. “This is not about keeping a few extra newspapers in the house. This is about filling your house up with things to the point when you can no longer even live in it. And this study goes a long way towards helping us better understand how and why this happens.”

Aug 7

Anxiety symptoms fall into 5 categories


Alice Boyes, Ph.D.

Anxiety symptoms fall into five categories. Different types of anxiety symptoms are characteristically associated with different anxiety disorders, but there is overlap.

1. Physical anxiety symptoms

Most common anxiety symptoms are part of our evolved fight/flight/freeze response. For example, increased heart rate for running and fighting. Blood flow increases to your large muscles. It also moves away from your extremities so you’re less likely to bleed out if you lose a finger in a fight, and this can result in tingling or numbness in hands and feet. Goosebumps are related to making hair stand on end to make animals look larger and scarier, and thereby discourage predators (think: cats). Sweating is part of cooling and making animals more slippery. People with panic disorder, health anxiety, and social anxiety tend to over-monitor their physical sensations.

One type of social anxiety involves fear of blushing. Paradoxically, blushing is often associated with more positive evaluations rather than more negative. It’s thought blushing evolved because it helped with social cohesion e.g., when we communicate embarrassment or shame it most often provokes caring in others. High worriers often have problems with muscle aches and tension (shoulders, wrists, jaw etc.). People often have “catastrophic cognitions” about their physical symptoms of anxiety. They worry that physical symptoms of anxiety are signs of illness (“Have I got M.S?”) or “going crazy.”

2. Cognitive anxiety symptoms (thoughts)

People with social anxiety often worry that their anxiety will be obvious to others or that people will judge them as boring, stupid, or unattractive. People often worry about being incapacitated by anxiety or losing control due to anxiety. There is a form of Obsessive Compulsive Disorder in which the sufferer fears they will become a pedophile, despite no evidence for this. People with Generalized Anxiety Disorder often worry that their frequent worrying will harm them. Paradoxically, they often also believe that worry is necessary for being prepared / not making mistakes.

People with anxiety tend to overestimate the likelihood of negative things happening, but most importantly they underestimate their ability to cope if something negative did happen. For example, they underestimate their ability to cope if they did get “dumped” by a friend. Anxiety often causes people to lose confidence in themselves. People’s thinking tends to become more all-or-nothing when they’re anxious. You might find you can’t see the wood for the trees or that your thinking feels rigid and that thoughts seem to get stuck.

3. Behavioral symptoms of anxiety

Avoidance is the number 1 behavioral symptom of anxiety. People avoid situations and actions they fear will trigger anxiety or where they’ll be unable to escape. People might avoid situations in which they fear they will not be able to perform as perfectly as they would like. People may overcompensate for anxiety by working extra hard. Many types of anxiety involve both over-checking and under-checking. For example, someone with an eating disorder who is anxious about their weight might sometimes weigh themselves very frequently or sometimes avoid weighing themselves, or check their appearance in mirrors a lot or avoid this.

4. Affective anxiety symptoms (emotions)

Affect is the felt experience of an emotion. Anxiety obviously feels like anxiety, but other emotions are commonly felt by people who are anxious. For example, irritability and hopelessness.

5. Interpersonal Anxiety Symptoms

There are lots of interpersonal symptoms of anxiety. People with panic disorder, generalized anxiety, health anxiety, eating disorders, obsessive-compulsive disorder, or social anxiety may do a lot of reassurance seeking, especially with their romantic partners. People who are anxious might avoid sex because the physical sensations (e.g., increased heart rate and body temperature) feel too similar to symptoms of anxiety. People with anxiety sometimes fear being dependent or incompetent and this has relationship implications. People may snap at partners or other family due to anxiety-induced irritability.

Cognitive Behavioral Therapy (CBT) is generally considered the best treatment for anxiety. You can try some Cognitive Behavioral Therapy exercises yourself. on my therapy website

About the author

You can find @DrAliceBoyes on Twitter or join my Facebook page where I ask happiness questions, do 30 day projects, and talk about how I use psychology in my own life.

Aug 7

Creatine for Depression?


By Rick Nauert PhDSenior News Editor

Creatine is a naturally occurring amino acid typically associated with providing fuel for intense bursts of energy during high-intensity, short-duration exercises, such as lifting weights or sprinting. A new study finds the dietary supplement may also help women overcome major depression.

In a new study, researchers found that women with major depressive disorder (MDD) — also known as clinical depression — who augmented their daily antidepressant with 5 grams of creatine responded twice as fast and experienced remission of the illness at twice the rate of women who took the antidepressant alone. Researchers say that taking creatine under a doctor’s supervision could provide a relatively inexpensive way for women who haven’t responded well to SSRI (selective serotonin reuptake inhibitor) antidepressants to improve their treatment outcomes.

“If we can get people to feel better more quickly, they’re more likely to stay with treatment and, ultimately, have better outcomes,” said psychiatrist Perry F. Renshaw, M.D., Ph.D., M.B.A, senior author on the study. Although researchers are quick to point out that the findings need to be replicated in larger trials, the benefits of taking creatine could help many Americans battling major depression.

Improving treatment of depression will not only help individuals, but will also provide significant savings in both hospital and ambulatory based care settings. Experts say the economic windfall would bring a significant boost to state and federal coffers. In Utah alone, the state paid an estimated $214 million in depression-related Medicaid and disability insurance in 2008. Add the costs of inpatient and outpatient treatment, medication, and lost productivity in the workplace, and the total price of depression in Utah reached $1.3 billion in 2008, according to the U estimate.

The mechanism by which creatine works against depression is not precisely known, but Renshaw and his colleagues suggest that the pro-energetic effect of creatine supplementation, including the making of more phosphocreatine, may contribute to the earlier and greater response to antidepressants.

The eight-week study included 52 South Korean women, ages 19-65, with major depressive disorder. All the women took the antidepressant Lexapro (escitalopram) during the trial. Twenty-five of the women received creatine with the Lexapro and 27 were given a placebo. Neither the study participants nor the researchers knew who received creatine or placebo.

Eight women in the creatine group and five in the placebo group did not finish the trial, leaving a total of 39 participants. Participants were interviewed at the start of the trial to establish baselines for their depression, and then were checked at two, four, and eight weeks. In the study, researchers used three measures to check the severity of depression, with the primary outcomes being measured by the Hamilton Depression Rating Scale (HDRS), a well-accepted tool.

Investigators discovered that the group that received creatine showed significantly higher improvement rates on the HDRS at two and four weeks (32 percent and 68 percent) compared to the placebo group (3.7 percent and 29 percent). Remarkably, at the end of eight weeks, half of those in the creatine group showed no signs of depression compared with one-quarter in the placebo group. There were no significant adverse side effects associated with creatine.

The findings are important because antidepressants typically don’t start to work until four to six weeks. Still, research suggests that the sooner an antidepressant begins to work, the better the treatment outcome. As a result, Renshaw and his colleagues are excited about the outcomes in this first study. “Getting people to feel better faster is the Holy Grail of treating depression,” he says. Researchers say that future research efforts will test creatine supplements in both men and women. The South Korean University and University of Utah study is published in the American Journal of Psychiatry online.

Source: University of Utah
APA Reference
Nauert PhD, R. (2012). Creatine for Depression?. Psych Central. Retrieved on August 7, 2012, from

SUNDAY, Aug. 5 (HealthDay News)By By Barbara Bronson Gray
— For anyone raising teenagers, the idea of helping them feel grateful for everyday things may seem like a long shot; just getting them to mumble a “thank you” every now and then can be a monumental accomplishment.

But a new study suggests that helping teens learn to count their blessings can actually play an important role in positive mental health. As gratitude increases, so do life satisfaction, happiness, positive attitudes, hope and even academic performance.

Giacomo Bono, study author and a professor of psychology at California State University, Dominguez Hills, said it seems there’s not much time these days for teens to pause and consider their appreciation of their friendships, activities they enjoy or even the food on the table.

But among those kids who say they feel grateful for a variety of things in their lives, Bono found an association with critical life skills such as cooperation, a sense of purpose, creativity and persistence.

“Gratefulness allows us to understand what matters most to us and translate that to a broader goal,” said Bono. He is expected to present his research Sunday at the American Psychological Association annual meeting in Orlando, Fla.

The study involved 700 students living in New York, aged 10 to 14. The participants were white (67 percent), Asian American (11 percent), black (10 percent) and Hispanic (1.4 percent), and about 11 percent were other ethnicities or did not identify their race. The researchers took into account for socioeconomic factors and parental educational attainment, but not for religious beliefs.

The study authors defined grateful teens as having a disposition and moods that enabled them to respond positively to the good people and things in their lives, Bono said.

Students completed questionnaires in school at the beginning of the study and then four years later. Bono compared the results from the least grateful to the most grateful. He found those who were among the most grateful gained 15 percent more of a sense of meaning in their lives, became 15 percent more satisfied with their lives overall and became 17 percent more happy and hopeful about their lives. That group also had a 13 percent drop in negative emotions and a 15 percent decrease in symptoms of depression.

Bono said there’s a strong link between having a sense of satisfaction with life and feeling grateful. “People who are grateful are more optimistic and hopeful, feeling they have the resources to be successful in their future,” said Bono.

An expert involved in working with teens said it makes sense that gratitude would increase a teenager’s sense of purpose in life. “I help kids become more aware of what they’re grateful for, not just in treating depression, but in materialistic, busy, media-driven lives,” said Alec Miller, chief of child and adolescent psychology at Montefiore Medical Center in New York City.

Interestingly, socioeconomic status doesn’t appear to be linked to gratefulness. “You don’t have to be rich to feel grateful,” said Bono. “We’ve found poor kids are very appreciative when other people help them out.”

Miller agreed. “I see Medicaid kids and children from wealthy homes in Westchester County, and I don’t see any greater or lesser sense of gratitude from one group or another. It’s fairly low in both groups,” he said. “Unfortunately, our society isn’t focused much on gratefulness; it’s become out of vogue to talk about it,” said Miller. “But I give these researchers credit for reviving interest in the topic.”

Miller said he often asks kids what they’re grateful for. When they can’t identify anything much at all, he sees it as a danger sign of increased risk of severe depression and suicide. But developing a sense of gratitude in kids can help prevent the gradual erosion of self-esteem and build their sense of purpose and ability, he noted.

How can parents help instill a sense of gratitude in their children? Bono suggested parents start paying attention to their own sense of gratefulness and model it. “Talk about what you’re grateful for, and ask your kids what they appreciate,” he said. He also advised mentioning people who have helped in their lives: a teacher who stayed after class, a coach who made a difference. “Talking about gratitude helps guide us all to the things that matter most,” he noted.

Aug 7

Working Memory Linked to Analytical Skills


By Rick Nauert PhDSenior News Editor
Reviewed by John M. Grohol, Psy.D. on August 7, 2012

Using a computer analogy, the amount of working memory that we can hold in our brain at any one time is similar to RAM — a capability that is limited yet critical for analytical skills.

Scientists say working memory capacity reflects the ability to focus and control attention and strongly influences our ability to solve problems. However, new research finds that working memory may limit creative problem-solving. A new article in journal Current Directions in Psychological Science discusses the role of working memory capacity in both mathematical and creative problem-solving.

Emerging research from a variety of psychological science studies suggests that high working memory capacity is associated with better performance at mathematical problem-solving. In fact, researchers now believe that decreased working memory capacity may be one reason why math anxiety leads to poor math performance.

In general, studies show that working memory capacity seems to help analytical problem-solvers focus their attention and resist distraction. Nevertheless, researchers are discovering that working memory capacity may impair creative problem-solving. With creative problems, reaching a solution may require an original approach or a novel combination of diverse pieces of information. This need for a big-picture, unencumbered view may be stifled by too much working memory. Practically, real-world problems may require either analytic or creative solutions. Successful problem-solving matches the approach to the needs of a given situation.

Source: Association for Psychological Science

By Patrick Barkham
One has acquired more Olympic medals than any other athlete in history. The other was knocked out of the Games after just 250 seconds. But Michael Phelps and Ashley McKenzie, the 23-year-old British No 1 judoka, have one thing in common: both have attention deficit hyperactivity disorder (ADHD), as does another high-profile Olympian, British gymnast Louis Smith, who this week helped win the first British men’s gymnastics team medal for a century.

Suddenly, a condition that is hugely stigmatised and still controversial, is unexpectedly in the spotlight. It raises several interesting questions. Does ADHD hinder or help sporting success? And can the Olympics offer a positive legacy for people suffering from it?

Phelps, the American swimmer with a record-breaking 19 Olympic medals to his name, is probably the most famous person in the world with ADHD, the top behavioural disorder in Britain, which is estimated to affect 2-5% of children and young people. For Phelps, a gangly, hyperactive child who was diagnosed with the condition aged nine, the swimming pool was a sanctuary, a place to burn off excess energy. His mother, Debbie, once recalled being told by a teacher: “Your son will never be able to focus on anything.” It’s interesting that the boy who was unable to concentrate at school would sit for four hours at swimming meets waiting to compete in five minutes of races.

Louis Smith has spoken of how gymnastics was an outlet for his tremendous energy, and taught him discipline and manners. But Ashley McKenzie’s story is perhaps most dramatic of all. Expelled from three schools and placed in a psychiatric unit aged 11 because his mother was unable to cope, McKenzie also served time in a young offenders’ institute. He credits judo with saving him from prison, and in a recent BBC documentary called it a “mad booster” to his life, giving him “a pavement instead of walking on the road”.

“I don’t want to be looked at as, ‘He’s got ADHD and he’s the bad person.’ I’ve changed now,” he said.

But it is not as simple as sport rescuing him. McKenzie served three bans from judo for drinking and fighting, and on the last night of the Team GB training camp before the Olympics, he went out to celebrate his 23rd birthday and told a stranger at a bar: “I’m gonna smash your face in.” His ADHD may bequeath him energy but his sporting career is actually a hindrance to tackling his condition: he cannot take the medication he needs to treat his ADHD because it contains substances banned by the sporting authorities – hence his struggle to control his behaviour.

More athletes will almost certainly be undiagnosed or keeping it quiet, such as Adam Kreek, a Canadian rower who won gold in Beijing, and two years later began talking openly about his condition. “I found that the disorder isn’t a negative infliction, but it gives positive energy as well,” Kreek, who is now a motivational speaker, said in 2010. Diagnosed aged six, he believes anyone with ADHD can train their mind to channel their “incredible” energy. As well as a good diet and family support, he found “rowing to be an outlet to control my ADHD”.

ADHD can be a confusing condition because people may be fidgety and unable to focus and yet – as Phelps so spectacularly proved – are capable of concentrating intently on an activity they find rewarding. Children with the disorder, says Andrea Bilbow, founder and chief executive of ADDISS, a charity and support service for ADHD, are often brilliant at computer games. Psychiatrists say that this “hyperfocusing” is a relatively common feature in individuals with ADHD.

Athletes like Phelps and McKenzie do not, however, have special powers via their condition. Bilbow believes it is actually significantly harder for people with ADHD to become elite athletes. “Having ADHD doesn’t mean you’re going to be a great sportsperson,” she says. “Your ADHD isn’t going to get you there, it’s hard work that will. ADHD is not a contributor towards success but equally it is not a barrier to success.”

People with ADHD, which is a developmental disorder, may find they have poor problem-solving skills, and struggle with timekeeping, and organising and motivating themselves, explains Bilbow. This may suggest that adapting to the discipline demanded by athletic training is tough for those with ADHD and yet Bilbow believes many with the condition find sport gives them the kind of immediate rewards and sense of achievement they need to build confidence and resilience.

After his early exit in the judo, McKenzie has vowed to come back stronger in Rio in 2016. Bilbow hopes McKenzie can get the extra help he will need in the coming years. She works with parents with children with ADHD and believes more could find sport a constructive way of managing the condition, rather than being preoccupied with academic success. Her two sons, Max and Joe, both have ADHD: Max, who is 29, finds an outlet for his energy in elite kayaking while Joe, who is 25, is currently an Olympic volunteer. Her advice to parents? “Find your child’s island of competence and invest in it heavily.”

Bilbow has noticed that children with ADHD may have their sporting opportunities curtailed as punishment for their behaviour, as McKenzie found. Bilbow knows of a brilliant young footballer with ADHD who was barred from representing his school because of his conduct in lessons.

Many teachers and schools, she believes, still scoff at the disorder, believing there are only naughty children – and bad parents. The concept of role models can seem an overused cliche but the Olympians with ADHD may really inspire a generation of athletes who once would have been written off. “Parents can be saying to kids who are having a miserable time in school, ‘Look, Michael Phelps had ADHD and he worked really hard. Ashley McKenzie has been in a young offenders’ institute but he didn’t give up,'” says Bilbo. “That’s the message we’ve got to give kids.”

Aug 4

Hyperactivity or Impulsivity


Children with symptoms of hyperactivity and impulsivity are often diagnosed with ADHD when they are younger. Their behaviour often needs to be redirected by adults more often than their peers’

Hyperactivity and impulsivity in context
At school
Children with symptoms of hyperactivity/impulsivity, especially boys, often act like the “class clown.” They may talk too much when they are not supposed to, but then fall silent when the teacher asks a question. Alternatively, they may blurt out answers before they hear the whole question. Sometimes they have trouble slowing down enough to hear or follow directions, which can create problems at school.

After school
After school can be an especially challenging time for families of children with symptoms of hyperactivity/impulsivity. These children may experience more conflicts with siblings while parents are busy with household tasks during this time.

Bedtime routines

Children with symptoms of hyperactivity/impulsivity often have problems falling asleep, even when they are very tired. This may make bedtime routines especially challenging.

Leisure and recreation
Hyperactive and impulsive children may put themselves at risk of injury by acting too quickly without considering the consequences. As a result, they may need more supervision than typical children.

Normal levels of hyperactivity and impulsivity
It is normal for children to be hyperactive and impulsive sometimes. For example:

Toddlers and preschoolers are normally very active and impulsive and need constant supervision.
Children often become more active and impulsive when they are tired or hungry.
Children may become more active in new situations or when they are anxious.
Older children and teenagers sometimes act on impulse, especially when they are excited or when peer pressure is involved.
These symptoms do not necessarily mean that a child has ADHD. ADHD would only be diagnosed if:

the child is much more hyperactive and impulsive than other children of the same age, sex, and stage of development
the symptoms are causing problems for the child at home, at school, or in social situations

Aug 2

By Allison Cohen, M.A., MFT for

We’ve all heard the dauntingly horrible statistic: 50 percent of marriages end in divorce. No one wants to be a cliché, and everyone wants to find themselves amongst the 50 percent that beat the odds.

What if you could identify the biggest indicators before it was too late? What if you had the chance to turn it all around? Would you seize the moment, even if it meant taking an unpleasant look at the reality of your relationship and digging in to repair the damage?

Look at the indicators below to see where you fall on the spectrum of marital turmoil:

1. You become a one-woman consulting firm. You used to ask your partner for their opinions on a variety of subjects. Everything from what you should do about your difficult boss to what plans you’ll make for the weekend. Those days are gone, and you find yourself making decisions without consideration for your spouse’s feelings or how it might affect him.

2. You pull out your scorecard and start tallying. The ease of give and take has been replaced with playing “Tit for Tat”, and you actively keep mental notes on how much you are contributing versus how much your partner isn’t.

3. You anoint yourself king/queen of the castle. In a successful relationship, no one person’s needs are more important. Your desires are equally considered and equal attempts are made to bring them to fruition. However, now that there is stress, resentment and tension, you make your needs priority one.

4. You move from teammates to roommates. Teammates work in tandem to accomplish goals. They share ideas for how to succeed and envision home and life plans together. Roommates take on singular projects with no respect or thought towards the other person in the house. They clean their space. They do their laundry. Their separate plans become your separate lives.

5. You pull out your needle and start jabbing. Anyone in a long-term relationship knows their partner well enough to have a keen awareness of their hot buttons. In days past, you accidentally pressed them, learned from your mistakes and vowed not to repeat them. Today, you press them with full awareness, and you like it.

6. You stop dating. When you two were happy and in love, you “dated” each other. You did all the little things that kept the romance alive. You sent the sweet text in the middle of the day. You brought home the dessert from that little café you know they love. You made an effort to keep up your appearance. Now, you see your mate as a ball and chain instead of the hot date you used to roll out the red carpet for.

7. You move your love tank to someone else’s truck. Whether it’s emotional or physical, you are reaching out to anyone and everyone other than your mate to connect with and feel connected to.

8. You kidnapped cupid and you’re holding him for ransom. People joke that you stop having sex when you get married because you no longer “have to.” But the truth is that often times, people stop having sex when they start losing the positive feelings towards their mate. No one wants to have sex with the person they see as an impediment to their happiness. Even if you still have sexual feelings, you stop pursuing them to punish, play games or make a point to your partner.

9. Words are saved for scrabble. Gone are the days of staying up late, talking. Conversations with your mate seem futile and exhausting. Instead, you use as few words as possible to convey your sentiments and conversations devolve into what needs to get done around the house or who is running carpool tomorrow.

10. You checked out of your relationship and into your mental hotel. In happier times, your partner was your refuge because they were your best friend, your comfort and your joy. As tension sets in, you blindly interact with your mate without giving them your presence of mind. Your mindfulness has been replaced with fantasies of your new life, away from your partner.

If you’re determinedly shaking your head in agreeance, that’s a flashing yellow light that trouble is brewing. No one said it would be a snap, but then again, nothing worth having comes easy. You have a finite opportunity to get your marriage out of trouble before that yellow light turns red.

If you’re debating and looking for the motivation you’ve been missing, remember that no fantasy holds up to the reality and complexities of a relationship. Even the best partnerships are messy, challenging and can often send you to the brink. They all require effort, diligence and consistency. Be part of the solution and defy those nasty odds.

Aug 2

Anxiety, Depression, And Sleep


By Richard Zwolinski, LMHC, CASAC & C.R. Zwolinski
How’re you sleeping?

If you can’t sleep, or if you can but you wake up every so often choking or gasping for breath, or if you snore loudly and often, you probably have a sleep disorder.

You also might be at risk of developing anxiety or depression or might already be struggling with one or both of these mental health issues.

Amir Sharafkhaneh, MD, PhD and Max Hirshkowitz, PhD, recently discussed the correlation between one sleep disorder, called sleep-disordered breathing (SBD) and anxiety disorders and depression in Psychiatric Times. Any observant therapist (those who do thorough evaluations) will tell you that many, if not most of their patients, actually have some kind of sleep disorder, possibly including sleep-disordered breathing.

Whether the sleep disorder precedes the mental illness or the mental illness precedes the sleep disorder appears to vary on your point of view, as much as your psychosocial history. As for causality, well clinicians and researchers come down on both sides of the issue.

Years ago clinicians believed that symptoms of mental illness included various types of sleep disorders. Today research seems to indicate that many of them precede mental illness. Sleep disorders appear to indicate that you might have a higher risk of mental illness and some research does indeed show that they actually contribute to psychiatric problems.

We don’t have to construct complicated studies to recognize that withholding sleep from someone causes mental dysfunction (such as memory problems or problems concentrating). We know that at a certain point, sleep deprivation causes serious problems including hallucinations and psychosis, or even death.

For example, we can look at world history and current events for some answers.

Sleep deprivation has been used in interrogation as a method of torture. In the former Soviet Union, the NKVD (which the KGB branched from), Menachem Begin former prime minister of Israel was famously a victim of sleep-deprivation torture. In White nights: The Story Of A Prisoner in Russia, we read “In the head of the interrogated prisoner, a haze begins to form. His spirit is wearied to death, his legs are unsteady, and he has one sole desire: to sleep… Anyone who has experienced this desire knows that not even hunger and thirst are comparable with it.”

Other countries, both tyrannical dictatorships and democracies, have used sleep deprivation during interrogation. China is well-known for using it, not only with Chinese dissidents but also with Tibetan political prisoners. Recently a young Chinese man sadly lost his life, not from interrogation and torture but from staying up to watch every game in the European soccer championship.

History, current events, clinical research (and ordinary observation and clinical experience) show that lack of sleep (including sleep disorders) may not only contribute to serious health problems, anxiety, and depression, but also bipolar disorder and other mental illnesses and cognitive dysfunction.

Whether you have a mental illness or not, (or an addiction, by the way; our program often sees people who became addicted to the medication they were prescribed for insomnia or pain-related insomnia), getting a good night’s sleep is essential to functioning well and living a meaningful life.

Make a good night’s sleep, nutritious diet, exercise and other good physical health habits a priority in your life—your mental health will definitely get a boost.

See C.R.’s recipe for a good night’s sleep.

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