February 25, 2013 by Sucheta Kamath

Unmotivated, unaware, scattered and disorganized children are often thought to be lazy (and unintelligent). In fact, they typically struggle with symptoms of Executive Dysfunction.

It’s hard to like people who are unreliable or unaccountable. It’s even harder when those same people don’t change their ways in response to suggestions, guidance or advice. That’s the plight of a person with Executive Dysfunction.

I want to offer parents a framework to clearly understand Executive Dysfunction (also known as poor Executive Functions or Executive Function disorder). With an understanding of the challenges faced by an ADHD underachiever, you can approach the ‘appearance’ of laziness differently, improving your child’s ability to manage his/herself, and strengthening relationships within the family.

Get to Know the Beast

The main symptoms of ADHD include inattention, impulsivity and hyperactivity. They reflect dysfunctions in a wide range of “executive” abilities – cognitive, communicative, social, behavioral and emotional.

To simplify Executive Dysfunction, it helps to understand what well-developed executive abilities look like. Among other things, Executive Functions allow individuals to:

Constantly adapt or change

Shift focus or behavior, as necessary, when there is a slight interruption
Tweak familiar ways to handle unfamiliar situations
Make changes without being prompted by outside forces

Sustain focus on personal or group intentions

Pay attention, and maintain attention
Handle tempting distractions without wavering from task
Put effort into actions that move towards a final goal
Help others by helping yourself stay on joined goals

DO what needs to be done

Understand personal challenges and how they interfere with success
Use critical thinking to understand why goal-directedness matters
Solve problems to promote SELF goals

Executive Functions were once known as street smarts or common sense. When a child lacks these skills, it may appear lazy, rude, obnoxious, annoying or lacking in personal responsibility. Historically, discipline for children with Executive Dysfunction treats a child with ADHD like s/he has “character flaws”:

– Rule with iron fist: be tough on the child.
– Punish the child. Create a “fear of god” so s/he will stop.
– Ignore it because getting the child to cooperate is tedious.
– Just give up because nothing seems to help.

Parents can inadvertently blame the child with ADHD as intentionally difficult or purposefully oppositional. However, deeper understanding can lead to greater respect for the suffering of the children with ADHD and subsequent Executive Dysfunction.

4 Tricks To Shift your Thinking

1. Make Family Values Transparent: Trouble with concrete thinking, working memory and self-awareness makes it harder for kids with ADHD to accept a parent’s advice. Family values can foster loving relationships:

Listen more respectfully
Keep an open mind to ideas that may not make sense at first
Work hard on a suggestion before giving it up
Thank those who are patiently helping

2. Show More and Lecture Less: Trouble with self-awareness and self-judgment leads to a tendency for kids with ADHD to stall, procrastinate, or lose interest in their work. S/he may argue, annoy or show insensitivity towards those who are trying to help, leading to parenting “lectures” that often make the parent feel better, but does not necessarily reach the child. Think differently about the guidance you offer:

Show the first step. “Walk” your child through how to get started.
Email your concerns so your child can slowly process and not miss any details.
Emphasize your “feelings” using “I” language, and keep them brief.
Keep it simple — do not bombard with suggestions.
Avoid spilling out your fears of “impending doom” if your child doesn’t do what s/he is expected to do.
Keep words to a minimum when you are upset. Bring your child’s attention to the nuances of the emotional state of others.

3. Tools Are needed AND They Require Practice: Children with ADHD who present themselves as disorganized, inefficient and inconsistent are often offered help and support. However, if a parent comes up with the solutions, the child’s Executive Functions are not trained. Children must be educated about the WHY and the HOW of the Tools offered (such as planners, timers, Apps, recorders, organized binders, color-coded drawers).

Take time to explain why it is important to use a tool
Do not invent new tool each time the previous tool fails
Don’t be bedazzled by technology. A tool is valuable if it works and is easy to use, not because of its bells and whistles.

4. Bring Mindfulness Practice to the forefront: While children with ADHD have many needs, they tend to resist addressing them. The symptoms of Executive Dysfunction can create enormous amounts of stress on the family, especially when a child’s day is so full of glitches and faux pas that s/he doubts his/her ability to succeed. Managing these challenges takes resilience and optimism! This mysterious balance can be achieved through the practice of Mindfulness!

Involve the whole family in learning mindfulness tools.
Bring intentionality in healthy eating habits and exercise.
Learn deep breathing techniques through Yoga, Tai Chi etc.
Create bed-time routines that include no electronics, fresh set of clean clothes, calm lighting, and inspirational reading material.
Learn meditative practice that emphasize using visual imagery and body relaxation.
Use CDs for guided relaxation.
Bring some type of spiritual elements to your daily life.

Parenting has never been easy. Modeling good citizenship is even harder. People who suffer from ADHD and Executive Dysfunction have an added burden of compensating for impulsivity, lack of awareness and inability to take different perspectives. Shifting the mindset from “how to handle this problem” to “how to lead a meaningful life in spite of it” will bring a sense of calm, certainty and hope. ADHD and Executive Dysfunction CAN be managed!

by Cindy Goldrich, Ed.M., ACAC
Oppositional Defiant Disorder (ODD) is characterized by excessive anger, frustration, arguing, stubbornness and defiance. The correlation rate for being diagnosed with ADHD and ODD is staggering, ranging between 60% and 80%. It is the most common co-existing condition associated with ADHD and people with ADHD are 11 times more likely to be diagnosed with ODD than the general population. Anyone familiar with ADHD knows that its core components are Inattentiveness, Hyperactivity and Impulsivity. Yet, very often I receive calls from parents who are confused and concerned that the behavior of their child with ADHD is becoming combative and rebellious. Is there a connection between ADHD traits and the development of oppositional behavior?

According to Dr. Russell Barkley, world-renowned Clinical Scientist and Researcher in the field of ADHD, there absolutely is a link between having ADHD and developing ODD. In fact, Dr. Barkley believes that if you have ADHD you have a propensity for developing Oppositional Defiant Disorder from the start. Why? Because, he believes that ADHD involves one more vital component that has been left out of the Clinical diagnosis for ADHD – Emotional Dysregulation: deficits in inhibiting and regulating emotions.

During his Keynote Address at the recent National CHADD (Children and Adults with Attention Deficit Disorder) Conference, Dr. Barkley provided compelling evidence to suggest that, overwhelmingly, the difficulties people with ADHD have in both suppressing and regulating their emotions are not co-existing conditions of ADHD such as ODD or Bipolar Disorder … they are characteristics of ADHD itself. Simply stated, Emotional Dysregulation is as much a part of ADHD as are hyperactivity, impulsivity, and inattentiveness.

With the work being done now to rewrite the DSM-V, the manual physicians and clinicians use to diagnosis Mental Health Disorders and Insurers use to determine coverage, this vital and exciting new insight by Dr. Barkley could change the way ADHD is defined and treated. More importantly for most of us, it may change the way we understand and parent our children.

The Connection Between ADHD and Emotional Self-Regulation

Emotional Self-Regulation is the ability to manage your behavior in relation to the events that happen in your life. This can involve suppressing or inhibiting your response, self-soothing to calm or comfort yourself, prolonging your pleasurable experience, or refocusing your attention to a more positive goal directed activity. By providing compelling evidence where he analyzed neuro-anatomy, psychological evidence, and clinical research, Dr. Barkley found that children diagnosed with ADHD also exhibited difficulties in Emotional Self-Regulation.* He found that every rating scale that is given to children who have been diagnosed with ADHD that measures symptoms of emotions is elevated dramatically for hostility, anger, frustration and impatience. These children exhibited much stronger emotional reactions and had much greater difficulty in controlling their reactions once elicited.

What does this mean for Parenting the Child with ADHD?

So, if part of the experience of having ADHD for a child is having difficulty suppressing and regulating their emotions, how does this impact the way we parent these children? First and foremost, as I always say, you must Parent the Child You Have. If your child is having difficulty managing their emotions, you must understand, without judgment, that this is an inherent part of their disability. The tremendous social roll that the Emotional Dysregulation part of their ADHD plays cannot be understated. Dr. Barkley states: “The single biggest predictor of social rejection among children and adults with ADHD is not distractibility, inattentiveness, not completing their goals, [nor] their hyperactivity – it is their inability to regulate their frustration, impatience, hostility and anger.”

Dr. Barkley explains that the capacity to Self-Regulate is limited like a fuel. Teaching children what depletes their ability to Self-Regulate and the steps they can take to refuel their willpower can go a long way in helping them cope with the stressors they face in life. It is also important for parents to recognize and intervene when their children’s fuel may be tapped out, perhaps after a long and stressful day at school, rather than being surprised or agitated with them. Just as with hyperactivity, impulsivity and inattentiveness, you will need to learn the specific ADHD parenting skills needed to help your child develop the tools needed to manage their emotions.

In addition to helping children learn to regulate their emotions, there is a second implication in Dr. Barkley’s findings related to the strong link between ADHD and the development of Oppositional Defiant Disorder. He states, “The single best predictor of who will develop diagnosable ODD is parenting.” What does this mean for parents? We must recognize the tremendous stakes involved in how we parent our ADHD children. ODD has two main components: Emotional Regulation and Social Conflict. The Social Conflict component has to do with being argumentative, defiant, and stubborn. It seems that the Social Conflict component of oppositional behavior is a learned behavior. Dr. Barkley states: “The way parents manage the emotional gambits of the child may make the emotions of the child better or worse and may teach the child that emotions are a tool to use on others. This is known as coercion theory.” By being inconsistent, both emotionally and actionably, in how we react to a child’s emotions and actions, we leave the door open for children to use negative emotions to coerce others into doing conforming to the child’s desires.

It is not easy parenting a challenging child. More than with other children, you must gain clarity on your rules and expectations, strengthen your resolve when you are secure in your decisions, and be consistent in your parenting. This must at all times be adjusted as your child matures and seeks greater need for independence and inclusion in decision-making.

* For more information on Dr. Barkley’s research and evidence discussed in this article, please refer to: Deficient Emotional Self-Regulation: A Core Component of Attention-Deficit/ Hyperactivity Disorder, Journal of ADHD & Related Disorders, Vol. 1, No. 2

Written by Cindy Goldrich, Ed.M., ACAC ADHD Parent Coach

Everyone feels anxious from time to time. Stressful situations such as meeting tight deadlines or important social obligations often make us nervous or fearful. Experiencing mild anxiety may help a person become more alert and focused on facing challenging or threatening circumstances.

But individuals who experience extreme fear and worry that does not subside may be suffering from an anxiety disorder. The frequency and intensity of anxiety can be overwhelming and interfere with daily functioning. Fortunately, the majority of people with an anxiety disorder improve considerably by getting effective psychological treatment.

What are the major kinds of anxiety disorders?

There are several major types of anxiety disorders, each with its own characteristics.

People with generalized anxiety disorder have recurring fears or worries, such as about health or finances, and they often have a persistent sense that something bad is just about to happen. The reason for the intense feelings of anxiety may be difficult to identify. But the fears and worries are very real and often keep individuals from concentrating on daily tasks.

Panic disorder involves sudden, intense and unprovoked feelings of terror and dread. People who suffer from this disorder generally develop strong fears about when and where their next panic attack will occur, and they often restrict their activities as a result.

A related disorder involves phobias, or intense fears, about certain objects or situations. Specific phobias may involve things such as encountering certain animals or flying in airplanes, while social phobias involve fear of social settings or public places.

Obsessive-compulsive disorder is characterized by persistent, uncontrollable and unwanted feelings or thoughts (obsessions) and routines or rituals (compulsions) in which individuals engage to try to prevent or rid themselves of these thoughts. Examples of common compulsions include washing hands or cleaning house excessively for fear of germs, or checking work repeatedly for errors.

Someone who suffers severe physical or emotional trauma such as from a natural disaster or serious accident or crime may experience post-traumatic stress disorder. Thoughts, feelings and behavior patterns become seriously affected by reminders of the event, sometimes months or even years after the traumatic experience.

Symptoms such as extreme fear, shortness of breath, racing heartbeat, insomnia, nausea, trembling and dizziness are common in these anxiety disorders. Although they may begin at any time, anxiety disorders often surface in adolescence or early adulthood. There is some evidence that anxiety disorders run in families; genes as well as early learning experiences within families seem to make some people more likely than others to experience these disorders.

Why is it important to seek treatment for these disorders?

If left untreated, anxiety disorders can have severe consequences. For example, some people who suffer from recurring panic attacks avoid any situation that they fear may trigger an attack. Such avoidance behavior may create problems by conflicting with job requirements, family obligations or other basic activities of daily living.

People who suffer from an untreated anxiety disorder often also suffer from other psychological disorders, such as depression, and they have a greater tendency to abuse alcohol and other drugs. Their relationships with family members, friends and coworkers may become very strained. And their job performance may decline.

Are there effective treatments available for anxiety disorders?

Absolutely. Most cases of anxiety disorder can be treated successfully by appropriately trained mental health professionals such as licensed psychologists. Research has demonstrated that a form of psychotherapy known as “cognitive-behavioral therapy” (CBT) can be highly effective in treating anxiety disorders. Psychologists use CBT to help people identify and learn to manage the factors that contribute to their anxiety.

Behavioral therapy involves using techniques to reduce or stop the undesired behaviors associated with these disorders. For example, one approach involves training patients in relaxation and deep breathing techniques to counteract the agitation and rapid, shallow breathing that accompany certain anxiety disorders.

Through cognitive therapy, patients learn to understand how their thoughts contribute to the symptoms of anxiety disorders, and how to change those thought patterns to reduce the likelihood of occurrence and the intensity of reaction. The patient’s increased cognitive awareness is often combined with behavioral techniques to help the individual gradually confront and tolerate fearful situations in a controlled, safe environment.

Along with psychotherapy, appropriate medications may have a role in treatment. In cases where medications are used, the patient’s care may be managed collaboratively by more than one provider of treatment. It is important for patients to realize that there are side effects to any drugs, which must be monitored closely by the provider who prescribed the medication.

How can licensed psychologists help someone suffering from an anxiety disorder?

Licensed psychologists are highly trained and qualified to diagnose and treat people with anxiety disorders using techniques based on best available research. Psychologists’ extensive training includes understanding and using a variety of psychotherapies, including CBT.

Psychologists sometimes use other approaches to effective treatment in addition to individual psychotherapy. Group psychotherapy, typically involving unrelated individuals who all have anxiety disorders, can be an effective approach to delivering treatment and providing support. Further, family psychotherapy can help family members better understand their loved one’s anxiety and learn new ways of interacting that do not reinforce the anxiety and associated dysfunctional behaviors.

Individuals suffering from anxiety disorders may also want to consider mental health clinics or other specialized treatment programs dealing with specific anxiety disorders such as panic or phobias that may be available in their local area.

How long does psychological treatment take?

The large majority of people who suffer from an anxiety disorder are able to reduce or eliminate their anxiety symptoms and return to normal functioning after several months of appropriate psychotherapy. Indeed, many people notice improvement in symptoms and functioning within a few treatment sessions. The patient should be comfortable from the outset with the psychotherapist. Together the patient and psychotherapist should develop an appropriate treatment plan. The patient’s cooperation is crucial, and there must be a strong sense that the patient and therapist are collaborating well as a team to treat the anxiety disorder.

No one plan works well for all patients. Treatment needs to be tailored to the needs of the patient and to the type of disorder, or disorders, from which the individual suffers. The psychotherapist and patient should work together to assess whether a treatment plan seems to be on track. Patients respond differently to treatment, and adjustments to the plan sometimes are necessary. Anxiety disorders can severely impair a person’s functioning in work, family and social environments. But the prospects for long-term recovery are good for most individuals who seek appropriate professional treatment. People who suffer from anxiety disorders can work with a qualified and experienced mental health professional such as a licensed psychologist to help them regain control of their feelings and thoughts — and their lives.

Printable version of this article (PDF, 455KB)

By CATHERINE SAINT LOUIS
Victims of bullying at school, and bullies themselves, are more likely to experience psychiatric problems in childhood, studies have shown. Now researchers have found that elevated risk of psychiatric trouble extends into adulthood, sometimes even a decade after the intimidation has ended.

The new study, published in the journal JAMA Psychiatry on Wednesday, is the most comprehensive effort to date to establish the long-term consequences of childhood bullying, experts said.

“It documents the elevated risk across a wide range of mental health outcomes and over a long period of time,” said Catherine Bradshaw, an expert on bullying and a deputy director of the Center for the Prevention of Youth Violence at Johns Hopkins University, which was not involved in the study.

“The experience of bullying in childhood can have profound effects on mental health in adulthood, particularly among youths involved in bullying as both a perpetuator and a victim,” she added.

The study followed 1,420 subjects from Western North Carolina who were assessed four to six times between the ages of 9 and 16. Researchers asked both the children and their primary caregivers if they had been bullied or had bullied others in the three months before each assessment. Participants were divided into four groups: bullies, victims, bullies who also were victims, and children who were not exposed to bullying at all.

Participants were assessed again in young adulthood — at 19, 21 and between 24 and 26 — using structured diagnostic interviews.

Researchers found that victims of bullying in childhood were 4.3 times more likely to have an anxiety disorder as adults, compared to those with no history of bullying or being bullied.

Bullies who were also victims were particularly troubled: they were 14.5 times more likely to develop panic disorder as adults, compared to those who did not experience bullying, and 4.8 times more likely to experience depression. Men who were both bullies and victims were 18.5 times more likely to have had suicidal thoughts in adulthood, compared to the participants who had not been bullied or perpetuators. Their female counterparts were 26.7 times more likely to have developed agoraphobia, compared to children not exposed to bullying.

Bullies who were not victims of bullying were 4.1 times more likely to have antisocial personality disorder as adults than those never exposed to bullying in their youth.

The effects persisted even after the researchers accounted for pre-existing psychiatric problems or other factors that might have contributed to psychiatric disorders, like physical or sexual abuse, poverty and family instability.

“We were actually able to say being a victim of bullying is having an effect a decade later, above and beyond other psychiatric problems in childhood and other adversities,” said William E. Copeland, lead author of the study and an associate professor of psychiatry and behavioral sciences at Duke University Medical Center.

Bullying is not a harmless rite of passage, but inflicts lasting psychiatric damage on a par with certain family dysfunctions, Dr. Copeland said. “The pattern we are seeing is similar to patterns we see when a child is abused or maltreated or treated very harshly within the family setting,” he said.

One limitation of the study is that bullying was not analyzed for frequency, and the researchers’ assessment did not distinguish between interpersonal and overt bullying. It only addressed bullying at school, not in other settings.

Most of what experts know about the effects of bullying comes from observational studies, not studies of children followed over time.

Previous research from Finland, based on questionnaires completed on a single occasion or on military registries, used a sample of 2,540 boys to see if being a bully or a victim at 8 predicted a psychiatric disorder 10 to 15 years later. The researchers found frequent bully-victims were at particular risk of adverse long-term outcomes, specifically anxiety and antisocial personality disorders. Victims were at greater risk for anxiety disorders, while bullies were at increased risk for antisocial personality disorder.

A version of this article appeared in print on 02/21/2013, on page A15 of the NewYork edition with the headline: Effects of Bullying Last Into Adulthood, Study Says.

By David Palmiter
The large majority of adults and kids who might benefit from psychotherapy do not receive it. For example 14-22% of U.S. children meet criteria for a diagnosable psychological disorder, but only about 20% of these kids get effective care. And, even when kids get effective care they usually suffer for years before getting it. Similar statistics are available for adults. This is beneath us as a culture and often yields dramatically painful and unnecessary outcomes (e.g., suicide is the third leading cause of death among people aged 15-24, depression has a higher mortality rate than cardiac disease, etc.). This post reviews some of the common myths I’ve found that serve as barriers to understanding and healing.

If I enter therapy I might become too dependent on the therapist. Therapy will never end.

The goal of psychotherapy is to foster healthy independence, not unhealthy dependence. So, the aim of evidence-based psychotherapy is to reach measurable treatment goals as fast as possible. Indeed, the chief job of the competent therapist is to make her services obsolete. While some problems require longer treatment, many do not.

Counseling costs too much money.

Most health insurance polices cover the lion’s portion of psychotherapy. Clients end up being out of pocket only for the part not covered by the insurance company. In addition, the costs are considered a medical expense and may be deductible from taxes. Studies also suggest that trips to a counselor can dramatically reduce trips to the medical doctor, sick days and an assortment of other expensive problems (e.g., divorce, addiction, etc.). Plus, think what it would be like to be rid of any significant psychological pains that inflict you or a loved one. What would that be worth? Finally, there are options for low fee services all across the country; for example, if your local university has a graduate program in the mental health professions they may have a low fee training clinic (the average fee in the clinic I direct is $10/visit), community mental health centers exist across the country, etc.

Only crazy people are in therapy.

This is really a bunch of nonsense. Putting aside the meaning of the word “crazy” for a moment, choosing to be in therapy is often a very rational act. It seems much more irrational to avoid therapy, because of silly myths, when therapy might be helpful in important ways. Effective therapy helps people to identify new methods for overcoming emotional pain and solving life’s problems. What is crazy about the pursuit of such learning?

People who spend significant time and resources on therapy are being self indulgent and selfish.

If effective therapy does anything, it increases a person’s freedom to love. Did you ever try to give to others when you have a sharp toothache? The same thing applies with psychological pain. Those who have been healed in counseling are in a position to be able to love others more and better. How can this be considered selfish?

I’ll get better eventually anyway.

According to studies on counseling, effective psychotherapy promotes healing and recovery. It may not be helpful to wait years for change. Even if change does come, the same problem may resurface later if the central issues have not been sufficiently resolved. Psychotherapy provides a way to confront and resolve problems at their source. It also provides tools for dealing with future problems. Moreover, a competent therapist can direct you to the evidence that supports the methods that he or she is prescribing.

Being in therapy is a sign of weakness. Strong, effective people don’t need help solving their problems.

Maybe in a Rambo movie. In the real world more vulnerability is often found in the person who fears acknowledging human limitations and faults and is unwilling to take the steps necessary to overcome them. Counseling is no panacea and not everybody is a candidate for counseling. However, those who can acknowledge the possible need for counseling may be stronger, and more secure in themselves, than those who cannot.

If I take my kid in for an evaluation, he’ll get the idea that there is something seriously wrong with him.

Experienced child therapists both know that parents are concerned about this and have developed procedures that minimize this risk (e.g., making sure to assess for your child’s and family’s strengths). Besides, a child or teen with a legitimate behavioral or emotional problem is much more likely to think that there is something wrong with him/her, and to have that reflected in others’ eyes, if she/he does not get help. Also keep in mind, as is the case in medicine, that behavioral and emotional problems are much more easily understood and resolved sooner rather than later.

If you are wondering if counseling might be of benefit to you or a loved one, why not look into it? A competent therapist will be able to evaluate whether or not counseling is advisable and, if advisable, what it might be able to accomplish and how long it might take to complete. What do you have to loose, really? (If you’d like a referral in your community, click here.)

Children with ADHD may have reading problems because of:

inattention
slower information processing
problems with working memory and executive function
reading disability
Inattention and reading problems
Children who are inattentive in kindergarten often read poorly later on. This is true even when allowing for:

other behaviour problems
early reading skills
intelligence
Behaviour problems make it less likely that a child with early reading problems will improve in the first few grades. These children should be monitored so any problems can be addressed early.

ADHD and orthographic processing
Some children with ADHD have poor orthographic processing, which is the ability to code written words into short-term memory. This means that they may have trouble with:

spelling
deciding whether words are correctly spelled, for example, blame/blaim or streat/street
Text recall and comprehension in children with ADHD
Children with ADHD may have trouble remembering and understanding what they read.

Studies have found that children with ADHD may:

read single words and non-words (nonsense words that are used to test a child’s ability to connect letters to sounds) more slowly
have trouble remembering and repeating information from stories
have trouble retelling stories in a well-organized way
have trouble identifying cause and effect in stories
have trouble following spoken information
read more slowly and less accurately
ADHD and reading disability
Between 15% and 40% of children with ADHD also have a reading disability such as dyslexia. This means that they have reading weaknesses from both ADHD and the reading disability. Children who have both ADHD and a reading disability generally get lower grades, have weaker academic skills, and are more likely to need special education services than children with only ADHD or only a reading disability. These children may also have more social challenges than children with ADHD alone.

Helping children with ADHD and reading problems
In the classroom, the following may help children with ADHD and reading problems:

direct instruction on reading-related skills. Direct instruction is a type of instruction that is given individually or to a small group of children. It involves breaking down tasks into smaller steps, using diagrams, having the teacher model skills for the children, allowing independent practice, and providing frequent feedback.
helping the child focus on the letters and combinations of letters that represent sounds and words in written text
teaching strategies the child can use to become an independent reader
giving the child many chances to participate and be involved with lessons, such as small group learning or peer tutoring
frequent, clear feedback on their performance
These are discussed in detail on the TeachADHD web site.
http://www.aboutkidshealth.ca/En/ResourceCentres/ADHD/AtSchool/ADHDandLearningProblems/Pages/ADHDandReading.aspx

Dr. Peggy Drexler.Author, research psychologist and gender scholar

Jill remembers the very first time Ben got called to the principal’s office. The kindergarteners were standing in line waiting for the bus home when Ben pushed a classmate to the ground. Then he encouraged a few of the other kids to start kicking. The boy wasn’t down for long before a teacher, who had witnessed the whole thing, came over to intervene. Ben, the teacher later told Jill, seemed to think it was funny. Jill was horrified.

Ben and his collaborators were sentenced to five hours each of community service around the school during recess: cleaning dry erase boards, packing up balls in the gym. At home, Jill talked to Ben about what it means to act appropriately at school and to be kind to others, and continued to talk to him in the months following. He was a smart boy; he understood, she thought. After all, at home, he was generally well behaved.

And yet, three years later, Ben remains the undisputed class troublemaker. Teachers almost seem to assume that he’ll act out. Often, Jill suspects, this is precisely the reason he does. He knows what’s expected of him.

During the elementary school years, boys tend to misbehave more than girls, though girls catch up later during adolescence, in other ways. We used to say that boys were more “active,” as if to excuse, or at least explain, misbehavior. But the truth is that the line between “active” and “disruptive” is thin, kids aren’t particularly skilled at walking it, and disruptive is a problem. Parents of kids like Ben know that once a boy has been labeled a troublemaker at school, it can be very difficult for him to shake the label. Often, that’s because he becomes the label; he, like Ben, lives up to the expectations other have laid out for him.

It’s not easy for parents to admit their son is the one causing trouble, and can be even harder to reconcile when the child is well behaved at home. It’s a natural impulse to defend kids, especially when you didn’t actually see what happened, and want to help them argue their way out of trouble — whether that’s after-school detention or a speeding ticket. It’s also natural for parents to want to intervene when their troublemaker finds himself an outcast among friends, as many often do. “Many of the boys stopped wanting to play with Ben at recess because it often meant they’d get into trouble, too,” remembers Jill. “It was heartbreaking, but in a way I couldn’t really blame them. It wasn’t untrue.”

If your child is the troublemaker, it’s important to help set him straight sooner rather than later — ideally before he gets labeled and before he finds himself losing friends. A few ideas to keep in mind:

Practice tough love (on yourself, too). Be honest with yourself about your son’s behavior. Your job is to be his champion, but not his defender when he’s behaved inappropriately. If he’s the class clown, even if he’s not “hurting anyone,” you need to acknowledge that, and respect the consequences. Learning to develop the skills needed to be part of a group is a critical part of growing up, and something your son needs to learn. Maybe even the hard way.

Cooperate. The best results come when parents can work with, and not against, teachers. When you argue with the school, his coach, or the staff at the daycare, you’re letting your son off the hook. You can support him without letting him avoid the consequences of his actions. The more you help him skirt the issue, the less likely he is to change. And if you do disagree with the way a teacher is handling your child, never discuss it in front of him. That will only further undermine her authority in his eyes. Take your concern directly to the teacher, way out of earshot of your son.

Be specific. When your son acts out at home or in school, don’t just tell him what he did wrong. Have him tell you — and then talk together about why that behavior was unacceptable. Teach him strategies to act better. One way to do this is to present specific scenarios. Set up micro-scenes and have him act out responses: What to do when he’s bored in class, angry with a friend, feeling the urge to tell a joke during quiet time. Then remind him of all his positive qualities and point out when he does something right, like helping a friend or making his bed without being asked. Being labeled a troublemaker can be difficult on a child’s self-esteem, so remember to give it a gentle boost now and again. If he thinks he only does wrong, he’ll continue to do wrong.

Let things go… If your son is losing friends because of his behavior, don’t try to intervene, no matter how difficult it is to watch. Children have the right to decide if they’re not comfortable playing with other children. Respect their decision and know that it will be a learning tool for your son, then talk to him about why his friends may be turning away. Learning how to get along with others is an important part of becoming independent, and while you can help him understand what it means to be a good friend, you can’t force other children to overlook your son’s problematic behavior. In fact, the less you help, the quicker he’ll figure it out himself.

…But don’t give up. If the pattern continues or gets worse, you may want to consider enlisting the help of your pediatrician or a counselor. Some kids have trouble adjusting to change, at school or at home. But if his behavior has been consistent over months or even years, something may be bothering him that he’s unable to articulate.

By Janice Wood Associate News Editor
Reviewed by John M. Grohol, Psy.D. on February 17, 2013

Adults undergoing bariatric surgery who are more physically active are less likely to be depressed, according to a new study, which found that being active for as little as eight minutes a day made a difference.

Obese adults are nearly twice as likely to have a major depressive disorder (13.3 percent) or anxiety disorder (19.6 percent) compared to the general population (7.2 and 10.2 percent), according to Wendy C. King, Ph.D., an epidemiologist at the University of Pittsburgh Graduate School of Public Health.

“Typically, clinical professionals manage their patients’ depression and anxiety with counseling and/or antidepressant or anti-anxiety medication,” she said. “Recent research has focused on physical activity as an alternative or adjunct treatment.”

Just one hour of moderate-intensity physical activity a week — or eight minutes a day — was associated with 92 percent lower odds of treatment for depression or anxiety among adults with severe obesity.

Similarly, just 4,750 steps a day — less than half the 10,000 steps recommended for a healthy adult — reduced the odds of depression or anxiety treatment by 81 percent.

“It could be that, in this population, important mental health benefits can be gained by simply not being sedentary,” said King, who also was the lead author of the study.

The researcher notes it is important to treat depression and anxiety prior to bariatric surgery. Preoperative depression and anxiety increase the risk of these conditions occurring after surgery — and have been shown to have a negative impact on long-term surgically induced weight loss.

As part of the Longitudinal Assessment of Bariatric Surgery-2, an observational study designed to assess the risks and benefits of bariatric surgery, King and her colleagues assessed participants’ physical activity for a week prior to undergoing bariatric surgery using a small electronic device worn above the ankle. Participants also completed surveys to assess mental health, symptoms of depression, and treatment for psychiatric and emotional problems, including depression and anxiety.

The study included 850 adults who were seeking bariatric surgery between 2006 and 2009 from one of 10 different hospitals throughout the United States.

Approximately one-third of the participants reported symptoms of depression, while two in five reported taking medication or receiving counseling for depression or anxiety.

The researchers noted that the link between physical activity and less depression was strongest when only moderate intensity physical activity was considered. However, the number of steps a person walked each day, no matter the pace, also was related.

“Another goal of this study was to determine physical activity thresholds that best differentiated mental health status,” said King. “We were surprised that the thresholds were really low.”

Because this was an observational, cross-sectional study — meaning patients’ regular physical activity and symptoms of depression were measured at the same time — the study could not prove that a patient’s physical activity influenced mental health.

“Results of the study are provocative, but we would need further research to verify that physical activity was responsible for lower levels of depressive symptoms in this patient population,” said study co-author Melissa A. Kalarchian, Ph.D., associate professor at Western Psychiatric Institute and Clinic, part of University of Pittsburgh Medical Center (UPMC). “Nonetheless, physical activity is a key component of behavioral weight management, and it is encouraging to consider that it may have a favorable impact on mental health as well.”

The study is published in the Journal of Psychosomatic Research.

Source: University of Pittsburgh Schools of the Health Sciences

Doctors, nurses, and other health-care professionals need to communicate with each other quickly and effectively. They also have a sense of humor, as you’ll notice in the following list of slang terms used in hospitals.
1.Appy: a person’s appendix or a patient with appendicitis
2.Baby Catcher: an obstetrician
3.Bagging: manually helping a patient breathe using a squeeze bag attached to a mask that covers the face
4.Banana: a person with jaundice (yellowing of the skin and eyes)
5.Blood Suckers/Leeches: those who take blood samples, such as laboratory technicians
6.Bounceback: a patient who returns to the emergency department with the same complaints shortly after being released
7.Bury the Hatchet: accidentally leaving a surgical instrument inside a patient
8.CBC: complete blood count; an all-purpose blood test used to diagnose different illnesses and conditions
9.Code Brown: a patient who has lost control of his or her bowels
10.Code Yellow: a patient who has lost control of his or her bladder
11.Crook-U: similar to the ICU or PICU, but referring to a prison ward in the hospital
12.DNR: do not resuscitate; a written request made by terminally ill or elderly patients who do not want extraordinary efforts made if they go into cardiac arrest, a coma, etc.
13.Doc in a Box: a small health-care center, usually with high staff turnover
14.FLK: funny-looking kid
15.Foley: a catheter used to drain the bladder of urine
16.Freud Squad: the psychiatry department
17.Gas Passer: an anesthesiologist
18.GSW: gunshot wound
19.MI: myocardial infarction; a heart attack
20.M & Ms: mortality and morbidity conferences where doctors and other health-care professionals discuss mistakes and patient deaths
21.MVA: motor vehicle accident
22.O Sign: an unconscious patient whose mouth is open
23.Q Sign: an unconscious patient whose mouth is open and tongue is hanging out
24.Rear Admiral: a proctologist
25.Shotgunning: ordering a wide variety of tests in the hope that one will show what’s wrong with a patient
26.Stat: from the Latin statinum, meaning immediately
27.Tox Screen: testing the blood for the level and type of drugs in a patient’s system
28.UBI: unexplained beer injury; a patient who appears in the ER with an injury sustained while intoxicated that he or she can’t explain

By Traci PedersenAssociate News Editor
Reviewed by John M. Grohol, Psy.D. on February 10, 2013

Children who eat breakfast on a near-daily basis have significantly higher scores in verbal and performance IQ tests, according to new research from the University of Pennsylvania School of Nursing.

For the study, researchers looked at data from 1,269 six-year-old children in China, where breakfast is highly valued.

The scientists concluded that children who did not eat breakfast regularly had, on average, 4.6 points lower total IQ scores than children who often or always ate breakfast.

The two components of overall IQ also saw similar deficits. Kids who skipped breakfast scored, on average, 5.58 points lower on their verbal test and 2.50 points lower on their performance test.

The study also adjusted for other variables in the childrens’ lives that may have offered alternative explanations for the differences, such as income and schooling.

IQ stands for intelligence quotient. An IQ test is a psychological test designed to test a person’s overall intelligence. It is comprised of two sub-scores — one measuring a person’s verbal abilities and one measuring a person’s performance skills.

One standard deviation — 15 points — is considered significant in IQ testing. So none of the current study’s findings would be considered a significant difference.

“Childhood is a critical period in which dietary and lifestyle patterns are initiated, and these habits can have important immediate and long-term implications,” said lead author Jianghong-Liu, Ph.D., R.N., F.A.A.N., associate professor at Penn Nursing.

“Breakfast habits appear to be no exception, and irregular breakfast eating has already been associated with a number of unhealthy behaviors, such as smoking, frequent alcohol use, and infrequent exercise.”

At age 6, a child’s cognitive ability — the ability to think and reason things through — is rapidly developing.

Both the nutritional and social aspects of breakfast play an important role. After a whole night of fasting, breakfast serves as a means to supply “fuel” to the brain.

The authors noted that mealtime discussions may also promote cognitive development by offering children the opportunity to expand their vocabulary, practice synthesizing and comprehending stories, and acquire general knowledge.

“Because adequate nutrition in early childhood has been linked to increased IQ through childhood, which is related to decreased childhood behavioral disorders, better career satisfaction, and socioeconomic success in adults, breakfast consumption could ultimately benefit long-term physical and mental health outcomes as well a quality of life,” said Liu.

“These findings may reflect nutritional as well as social benefits of breakfast consumption on children and hold important public health implications regarding regular breakfast consumption in early young children.”

Source: University of Pennsylvania School of Nursing

They’re small things, but each has the power to dramatically change someone’s day. Including yours.
Want to make a huge difference in someone’s life? Here are things you should say every day to your employees, colleagues, family members, friends, and everyone you care about:

“Here’s what I’m thinking.”

You’re in charge, but that doesn’t mean you’re smarter, savvier, or more insightful than everyone else. Back up your statements and decisions. Give reasons. Justify with logic, not with position or authority.
Though taking the time to explain your decisions opens those decisions up to discussion or criticism, it also opens up your decisions to improvement.
Authority can make you “right,” but collaboration makes everyone right–and makes everyone pull together.

“I was wrong.”

I once came up with what I thought was an awesome plan to improve overall productivity by moving a crew to a different shift on an open production line. The inconvenience to the crew was considerable, but the payoff seemed worth it. On paper, it was perfect.
In practice, it wasn’t.
So, a few weeks later, I met with the crew and said, “I know you didn’t think this would work, and you were right. I was wrong. Let’s move you back to your original shift.”
I felt terrible. I felt stupid. I was sure I’d lost any respect they had for me.
It turns out I was wrong about that, too. Later one employee said, “I didn’t really know you, but the fact you were willing to admit you were wrong told me everything I needed to know.”
When you’re wrong, say you’re wrong. You won’t lose respect–you’ll gain it.

“That was awesome.”

No one gets enough praise. No one. Pick someone–pick anyone–who does or did something well and say, “Wow, that was great how you…”
And feel free to go back in time. Saying “Earlier, I was thinking about how you handled that employee issue last month…” can make just as positive an impact today as it would have then. (It could even make a bigger impact, because it shows you still remember what happened last month, and you still think about it.)
Praise is a gift that costs the giver nothing but is priceless to the recipient. Start praising. The people around you will love you for it–and you’ll like yourself a little better, too.

“You’re welcome.”

Think about a time you gave a gift and the recipient seemed uncomfortable or awkward. Their reaction took away a little of the fun for you, right?
The same thing can happen when you are thanked or complimented or praised. Don’t spoil the moment or the fun for the other person. The spotlight may make you feel uneasy or insecure, but all you have to do is make eye contact and say, “Thank you.” Or make eye contact and say, “You’re welcome. I was glad to do it.”
Don’t let thanks, congratulations, or praise be all about you. Make it about the other person, too.

“Can you help me?”

When you need help, regardless of the type of help you need or the person you need it from, just say, sincerely and humbly, “Can you help me?”
I promise you’ll get help. And in the process you’ll show vulnerability, respect, and a willingness to listen–which, by the way, are all qualities of a great leader.
And are all qualities of a great friend.

“I’m sorry.”

We all make mistakes, so we all have things we need to apologize for: words, actions, omissions, failing to step up, step in, show support…
Say you’re sorry.
But never follow an apology with a disclaimer like “But I was really mad, because…” or “But I did think you were…” or any statement that in any way places even the smallest amount of blame back on the other person.
Say you’re sorry, say why you’re sorry, and take all the blame. No less. No more.
Then you both get to make the freshest of fresh starts.

“Can you show me?”

Advice is temporary; knowledge is forever. Knowing what to do helps, but knowing how or why to do it means everything.
When you ask to be taught or shown, several things happen: You implicitly show you respect the person giving the advice; you show you trust his or her experience, skill, and insight; and you get to better assess the value of the advice.
Don’t just ask for input. Ask to be taught or trained or shown.
Then you both win.
“Let me give you a hand.”
Many people see asking for help as a sign of weakness. So, many people hesitate to ask for help.

But everyone needs help.

Don’t just say, “Is there anything I can help you with?” Most people will give you a version of the reflexive “No, I’m just looking” reply to sales clerks and say, “No, I’m all right.”
Be specific. Find something you can help with. Say “I’ve got a few minutes. Can I help you finish that?” Offer in a way that feels collaborative, not patronizing or gratuitous. Model the behavior you want your employees to display.
Then actually roll up your sleeves and help.
“I love you.”
No, not at work, but everywhere you mean it–and every time you feel it.

Nothing.

Sometimes the best thing to say is nothing. If you’re upset, frustrated, or angry, stay quiet. You may think venting will make you feel better, but it never does.
That’s especially true where your employees are concerned. Results come and go, but feelings are forever. Criticize an employee in a group setting and it will seem like he eventually got over it, but inside, he never will.
Before you speak, spend more time considering how employees will think and feel than you do evaluating whether the decision makes objective sense. You can easily recover from a mistake made because of faulty data or inaccurate projections.
You’ll never recover from the damage you inflict on an employee’s self-esteem.
Be quiet until you know exactly what to say–and exactly what affect your words will have.

7 major health issues that regular sexual activity helps to cure.
BY DR. JONI FRATER AND ESTHER LASTIQUEThe old saying that, “An apple a day keeps the doctor away” is true, but having an orgasm a day works just as well and has extra benefits! This is by far the ultimate health stimulus plan. If you want to live a long, vibrant life with your spouse filled with excitement that keeps your sexual appetite into your golden years then read on.

Medical research has revealed enormous data proving that sexual climax (orgasm) has resulted in as many as 55 reasons to have sex on a regular basis. We’re focusing on just the top seven major health crises that are helped by climaxing regularly for both men and women. In order for the optimal health benefits, having an orgasm every 24 hours keeps the health benefits at their maximum and the levels of oxytocin, estrogen and testosterone consistently flowing. Any increase in sexual frequency is beneficial, and for those who are alone, masturbation with orgasm is a perfect substitute—so love yourself!

1. Increases Immunity to Infection
Good sexual health may mean better physical health. Healthier people usually are happier as well, which also means that we are taking better care of ourselves. Science has proven that having sex once or twice a week has been linked with higher levels of an antibody called immunoglobulin A or IgA, which can protect you from getting colds and other infections. This includes reducing the possibility of getting the H1N1 infection in addition to the flu!

2. Improve Cardiovascular Health
Getting your blood flowing through sexual activity keeps blood flowing to all of the right spots, starting with your heart. Starting as young married, increasing the frequency of sexual activity, directly correlates to healthier blood vessels and heart function. Researchers also found that having sex twice or more a week reduced the risk of fatal heart attack by half for men, compared with those who had sex less than once a month. Reducing heart disease also reduces erectile dysfunction, which causes the penis to not maintain an erection.

3. Reduce Risks of Prostate Cancer
Frequent ejaculations, especially in 20-something men, may reduce the risk of prostate cancer later in life. Research reported in the British Journal of Urological Health found men who had five or more ejaculations weekly while in their 20s reduced their risk of getting prostate cancer later in life by a third. Another study, reported in the Journal of the American Medical Association, found that frequent ejaculations, 21 or more a month, were linked to lower prostate cancer risk in older men, as well, compared with less frequent ejaculations of four to seven times monthly.

4. Decrease Incontinence for Men and Women
Who wants to be wearing adult diapers if it can be avoided? The muscles used while having sex are called the PC muscles. Both men and women have them and women are often advised to do Kegel exercises to strengthen them in order to keep incontinence at bay. But these are the same muscles used during orgasm in both men and women. Squeezing these muscles together during climax strengthens them the same way, but is way more fun! To start strengthening them, men and women need to find where the PC muscles are located. To do this, try to stop the flow of urine several times during urination. The muscles you’re squeezing are the PC muscles and are the ones you should focus on during intercourse. The squeezing motion gives more sensation to the penis and vagina and will intensify the sexual experience and keep away the diapers!

5. Reduce the Possibility of Osteoporosis
Bone loss during our elder years can be devastating with increased chances of hip or bone fractures. Both testosterone and estrogen levels experience a boost through regular sexual activity. Testosterone does more than just boost your sex drive. Testosterone helps fortify bones and muscles. Since men and women both have testosterone, turn up the heat and get sexy! Nobody wants to be an invalid as we age. Keep doing those pelvic thrusts and push-ups while having sexual activity and let your body keep those bones healthy and strong.

6. Increase Longevity
Who doesn’t want to live longer and look younger as we age? Well, research shows that maintaining a healthy sex life can add three to seven years to your life and keeps your skin looking younger. Throw away the Botox and stay healthier the sexy way. Surveys show that happy couples live longer. Every time you reach orgasm, the hormone DHEA (Dehydroepiandrosterone) increases in response to sexual excitement and ejaculation. DHEA can boost your immune system, repair tissue, and even work as an antidepressant. Meaning, a health benefit of sex, if you keep the orgasms coming, is potentially a longer life.

7. Burns Calories
Would you rather run on the treadmill or have sex? Just 30 minutes of sexual activity (that results in orgasm) burns an average of 150 calories. Sex, like exercise, releases endorphins—your feel good hormones. It gives you the same runner’s high that exercise provides. If you have sex for an hour, that is 300 calories per session at three to seven times a week, you will lose weight while having fun with your intimate erotic friend, your spouse!

The health benefits of regular orgasmic sex are bountiful and our bodies naturally want to stay healthy. In order to accomplish this you have to use it or lose it. Staying sexually connected isn’t the key to happiness, but it is a great way to increase the emotional part of your relationship, keep healthier and live longer. Your life and your marriage will flourish as a result and your kids will learn that a passionate connection is a happier family as well.

by Sheila McCann
The truth is that your left brain is probably playing tricks on you and robbing you of creative ideas.

Most feel comfortable going from point A to point B, systematically building on the previous step.

They love control and organization.

Logic rules in their world and they are uncomfortable with randomness.

They think stepping outside tried and true paradigms is counterproductive and a waste of time.

If you’re in this group, this mode of thinking has probably served you well in many areas except in terms of creativity.

As a matter of fact, you’re so comfortable with the left brain linear approach that it has probably tricked you into believing you’re not creative.

Before we talk about ways your left brain is tricking you, let’s take a moment to talk about the right brain left brain theory.

The Right Brain Left Brain Theory

The right brain left brain dominance theory goes something like this: each side of the brain controls different types of thinking and people usually prefer one to the other.

If you’re left brain dominant, your style of thinking is logical, focused and analytical. You tend to think in a linear fashion.

If you’re right brain dominant, you’re intuitive, holistic and creative. You tend to think in a nonlinear fashion.

Both sides or modes of thinking are equally important and when combined can be powerful. The truth is, the brain is much more complicated than this and works in a more interconnected way.

However, this theory is still a great way to refer to the two modes of thinking because it is so widely known and the labels are now synonymous with linear and nonlinear styles of thinking. It’s a simple and effective way to refer to and visualize how we use our brains.

Why Creativity is Crucial

How we use our brains is not only crucial to our survival, it also determines whether we succeed or fail.

Our world is changing at a rapid rate and this makes it necessary to be able to think in a nonlinear fashion as well as a linear fashion.

We need use our right brains to get the “big picture,” generate creative ideas and novel approaches to think strategically.

We have to improve our brain power.

On that note, let’s take a look at how our “left brain” tricks us into thinking we are not creative.

5 Tricks Your Left Brain Plays on You

Here are five sneaky ways your left brain tricks you.

Once you know what they are, you’ll have a much better chance at avoiding them.

1. Limited View

The view from inside the left brain linear approach is limiting. Think of a straight line (the line represents your thinking).

You start at a specific point (the points represent your ideas) and you build step by step on that point. This way of thinking is organized, controlled and works well in specific situations, albeit limiting.

Now think of a circle (the circle represents your mode of thinking) with many random points (the points represent ideas) inside that circle that can be connected in novel ways.

Not as logical but many more unique connections. If you picture nonlinear in terms of a circle you can see that it opens up the possibility of unlimited creative ideas.

This type of thinking is crucial in an environment that is changing rapidly.

2. Linear = Safe

We tend to feel a certain amount of control and safety in a tried and true structure. In this case, left brain thinking provides that organized structure. We go from one step to the next.

We are very focused. The outcome is fairly predictable. It’s a safe approach. The only problem is that it’s not safe to be stuck in this mode of thinking.

Quite the contrary, it appears nonlinear thinking is becoming safer in terms of survival and being able to succeed in today’s world. Thinking outside paradigms and thinking in creative ways is proving to be a powerful skill to have.

3. Logic

Logic is powerful. However, when we step outside of logic we can utilize the power of intuition.

Intuition pulls its information from seemingly invisible sources that we can’t point to but that we are in tune with.

When you think in a nonlinear creative fashion, intuition is your guide.

4. Part to Whole

Putting parts together to get a whole is necessary for building things. You take pieces, line them up, make a whole and then draw conclusions.

However, sometimes it is more advantageous to look at the whole first and break it down into parts.

Right brain thinking looks at the whole first. In this ever-changing world we need to get the “big picture” view first in order to maneuver life.

5. You’re Not Creative

The left brain tricks you into thinking you’re not creative and can’t generate new ideas. When we get used to something, we get stuck in a pattern.

This makes it difficult to break out of a limited mode of thinking. In this case, you may identify with being logical and analytical and may be disconnected from your creative right brain.

If you’re left brain dominant, don’t fall for its tricks.

Try opening up to activities that will help you prime your creative right brain pump.

Adding creative thinking to the strength of your left brain may be the secret weapon you’re looking for to succeed in today’s world.
[Sheila]

Written on 2/1/2013 by Sheila McCann. Sheila McCann is the creator of the Rainbow Framework. She blogs about creativity and personal development in the context of the Rainbow Framework. One look and you’ll get life in a big way. Pop on over and get your free rainbow framework e-book and visual.