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Apr 27

Top 10 Reasons People Avoid Counseling


By Jennine Estes, MFT 47653 .
If you recognize any of these excuses, here’s why you should go to counseling anyway.
Going to counseling can be a scary concept, so if you’re avoiding it — you’re not alone. You might wonder if counseling will work, what it means about your relationship that you want a mediator, and if the financial investment is really worth it. People put off finding counseling for plenty of reasons, but the truth is that you don’t have to be ashamed about wanting help, and putting it off can likely make your situation worse. Here are some of the main reasons people avoid counseling.

10. The Financial Aspect: Yes, coming to counseling will cost money. Think of counseling as an investment in your life, whether it’s individual counseling or couples counseling. It’s OK to put yourself first and spend money getting back on track — it’s worth it in the long run.

9. Horror Stories: Sometimes you might a story from a friend or other loved one about counseling gone bad. Maybe your friend left counseling feeling that it didn’t work, or your sister says she had a therapist who wouldn’t really listen to her. It can be hard to be motivated to go to counseling yourself when you’ve heard a bad story. Counseling is different for each person, and it’s important not to let someone else’s bad experience steer you clear of counseling.

8. Bad Previous Experience: Maybe you haven’t hear horror stories from others, but you yourself have gone to counseling before and didn’t think it helped you. Remember that each counselor is different, and many use entirely different styles and theories. Instead of writing off all counseling, look for a counselor who uses a different approach than your previous counselor.

7. It’s Only for “Crazy” People: No, counseling isn’t just for crazy people, or couples who are totally dysfunctional. Counseling can address so many issues, and is really just a safe space to talk freely about what you’re going through and get help moving forward. It can benefit almost anyone who needs to figure out the reason behind bad feelings or troubled communication.

6. Privacy Concerns: If you’re a private or reserved person, it seems intimidating to open up in front of a complete stranger, it’s true. You might also have reservations about repeating personal conversations. However, a good counselor will make you feel comfortable, and over time you can actually feel quite safe about being honest in counseling. And, of course, any thing you say in counseling is completely confidential and won’t be repeated.

5. Other Peoples’ Opinions: Even if you don’t announce that you’re going to counseling, at some point your friends and family may find out you are going to counseling, and it’s easy to be anxious about what they’ll think. In reality, counseling is about your personal development, and you might be surprised that people who love you are totally supportive about you wanting to improve yourself. Even if other people judge you in a negative way, the benefits of counseling outweigh listening to a negative opinion about it.

4. Asking For Help is Hard: If you pride yourself on being self-sufficient, stepping into a counselor’s office might feel like you’re letting yourself down. You might think you can handle your problems on your own, and asking for help means you’re weak. On the contrary — counseling helps you build a stronger self-esteem and learn new tools for handling whatever life throws at you. You’re not weak for reaching out!

3. It’s Overwhelming: The thought of tackling a big problem is overwhelming, so you might procrastinate going to counseling or avoid it altogether. This won’t make your problems disappear, however, and things might get a whole lot worse. Your counselor will help you tackle issues piece by piece, and give you realistic goals so you won’t be overwhelmed.

2. Drudging Up the Past is Scary: Bringing up past hurt isn’t fun, and the thought of going as far back as childhood might be a deal breaker for people considering counseling. Yes, you will probably have to bring up some past issues in counseling. But keep in mind that these issues will be there whether you enter counseling or not — at least when you go to counseling you can start to work through them. Pretending that past hurt doesn’t matter anymore won’t make it go away.

1. Small Problems Don’t Require Counseling: Many people think your problems must be HUGE before you go to counseling. So, they put off seeking help because it seems silly to go to counseling over what they conceive to be a minor issue. The thing is, small problems can snowball into big ones. It often makes sense to get counseling if you have a problem that is haunting you or your relationship, no matter how minor, so you can prevent it from getting bigger.

Apr 27

Understanding Dyslexia — the Basics


What Is Dyslexia?
Dyslexia is a chronic reading problem. It is a very common learning difficulty, affecting a large percentage of those labeled “learning disabled.” According to the National Institutes of Health, up to 15% of the U.S. population has significant difficulty learning to read. People with a learning difference like dyslexia may have trouble with reading, writing, spelling, math, and sometimes, music. Three times as many boys as girls have dyslexia.

Most people think dyslexia is a condition that involves reading from right to left and reversing words and letters. While some people with dyslexia do have these problems, they are not the most common or most important characteristics of dyslexia. Experts say dyslexia has little to do with recognizing the visual form of words; rather, the brains of people with dyslexia are wired differently, making it difficult for them to break the letters of written words into the distinct sounds (or phonemes) of their language, a capability called phonological awareness.

Diagnosis and Treatment

Dyslexia can occur at any level of intellectual ability. Sometimes children with dyslexia appear to their teachers and parents to lack motivation or not to be trying hard enough. Dyslexia may be accompanied by — but is not a result of — lack of motivation, emotional or behavioral problems, and sensory impairment.

A more positive view of dyslexia describes people with dyslexia as visual, multidimensional thinkers who are intuitive, highly creative, and excel at hands-on learning. Many dyslexic people shine in the arts, creativity, design, computing, and lateral thinking.

What Causes Dyslexia?
Dyslexia tends to run in families, and researchers have identified the genes that may be responsible for the condition.

Scientists have also found specific brain differences involved in dyslexia. Brain images show that dyslexia results from certain structural differences in the brain, particularly in the left hemisphere.

Brains of people with dyslexia show very little activity in areas known to be highly important in linking the written form of words with their phonetic components. So in order to read, people with dyslexia must develop alternative neurological pathways. They compensate by making more use of a front-brain section called Broca’s area, traditionally associated with other aspects of language processing and speech.

Apr 27

8 Tips for Talking With Your Child About ADHD


By Heather Hatfield
WebMD FeatureReviewed by Hansa D. Bhargava, MDTalking with your child about his ADHD isn’t always easy. But it’s important to do, and it goes better if you keep it productive and positive.

“I have two children with ADHD, so I can speak from experience here,” says Terry Dickson, MD, director of the Behavioral Medicine Clinic of NW Michigan, and an ADHD coach. “The reason why you need to talk about your child’s ADHD with him directly is because you want them to be involved, to understand, and to be on board.”

These eight tips will help you talk about it.

ADHD in Children
Start Talking
When you find out your child has ADHD, that’s the time to start communicating with them about it.

“It’s never too early to start talking with your child about his ADHD,” says Patricia Collins, PhD, director of the Psychoeducational Clinic at North Carolina State University.

You’ll talk about it many times as your child grows and develops. Start having those talks as early as possible.

A good approach is to help your child understand what ADHD means, what it doesn’t mean, and how to be successful at school and in life. What you say should be appropriate for their age.

“You need to help your child feel special, and like he is part of the plan,” Dickinson says. “He should feel like he is involved.”

1. DO make sure your child feels loved and accepted.
Help him understand that ADHD has nothing to do with his intelligence or his ability, and it’s not a flaw, Dickson says.

2. DO pick the discussion time wisely.
“It should be a time when you are unlikely to be interrupted,” Collins says.

Try to pick a time when your child isn’t eager to do something else, like playing outside or before dinner or bed.

Leave some time for follow-up, so you’re available to the child after the conversation is over if he has extra questions.

3. DO let them know they’re not alone.
Many other people have ADHD, too, and everyone with ADHD can be successful.

Give your child examples of people who have or had ADHD that they might know, like Walt Disney, Michael Phelps, and designer Tommy Hilfiger.

Let your child know they are special and they can succeed as well as anyone else.

4. DO learn more about ADHD.
Talk to your doctor, reach out to advocacy groups, and find support groups in your area.

“One of the best things you can do is talk to other parents who already have experience with ADHD about what they’ve learned,” Collins says.

5. DON’T focus on the negative.
“Focus on their strengths, what they do well, and praise their accomplishments,” Dickinson says.

“Whether its sports, arts, or dance, they can pursue their interests and do well with your support.”

6. DON’T let your kids use their ADHD as an excuse.
“Kids can’t take the easy way out by blaming their setbacks on their ADHD,” Collins says.

“Parents need to help their child understand that ADHD is not a reason to not turn in homework, to not try their hardest, or to give up.”

7. DON’T expect instant interest.
Don’t be surprised if your child doesn’t respond immediately or seems uninterested, Collins says.

It takes some children, particularly younger ones, some time for new information to make sense, or for them to know what questions to ask.

8. DO maintain open communication.
“One conversation is just the beginning,” Dickinson says.

“Keep the dialogue going, talk about school, their friends, homework, extracurricular activities, and keep a positive attitude.”

Apr 9

All day long we’re surrounded by faces. We see them on the subway sitting two by two, pass them on the sidewalk as we make our way to work, then nod to them in the elevator.

But most of those faces don’t tell us much about the emotional life of the person behind the face.

“People don’t just go around the world smiling or grimacing or frowning,” says psychologist Marcus Munafo of the University of Bristol. “The majority of the facial expressions that you come into contact with — people walking past you in the street, for example — will be ambiguous to some extent.” And because most of the faces we encounter are emotionally ambiguous, we’re forced into interpretations. Does the expression of that man coming toward you have the smallest tinge of threat around the eyes. Or is that just surprise?

“When you see someone just looking relatively neutral,” Munafo explains, “then it’s really down to you which of those interpretations you choose, and different groups of people see different things.” Research has shown that when depressed people look out at the ambiguous faces around them, they see sadness in those faces more often than people who are not depressed. People with anxiety see fear. But it’s people with aggression that particularly interested Munafo and a group of his colleagues in the U.K.

“People with aggression show a tendency to interpret ambiguity as reflecting hostility,” Munafo says.

Which makes sense. “If you’ve grown up in a tough environment where actually a lot of the time people are out to get you, then that default assumption is probably a relatively safe assumption to make,” Munafo points out. “The problem is when you take that assumption into a more benign environment, into the wider world, if you like, and start responding inappropriately to people who have no hostile intent.”

Then the strategy that you developed to help you survive becomes a kind of prison. You see aggression everywhere and respond aggressively, which causes the people around you to actually be aggressive, even if they didn’t begin that way. It’s a vicious cycle. So is there some way to alter the cycle? To retune the perceptual biases that aggressive people carry into the world?

Munafo and his colleagues designed an experiment to find out. The results were published in a recent issue of the journal Psychological Science. Their experiment took place in a youth program for troubled teens, two-thirds of whom already had some kind of criminal conviction.

There they set up an intervention that attempted to retrain the way those kids interpreted faces. To begin, the kids were placed at computers and asked to identify the emotions in a series of faces that flashed on the screen. Some of the faces were clearly happy, and some were clearly angry; but most were somewhere in the middle. “There were 15 faces along the continuum,” Munafo says, “and people were simply asked to judge whether that face was happy or angry.”

In the first round, the goal was simply to identify the point on the continuum where each teen stopped seeing happiness in an ambiguous face and started seeing anger — in other words, their set point. Next the teens were divided into two groups. One group essentially got no treatment; in the other, the researchers attempted to shift the point on the continuum where they started seeing angry faces.

To try to retrain troubled teens to reinterpret facial expressions, researchers showed them images of happy, angry and neutral faces, and then gave them feedback on how they described them. To try to retrain troubled teens to reinterpret facial expressions, researchers showed them images of happy, angry and neutral faces, and then gave them feedback on how they described them. To try to retrain troubled teens to reinterpret facial expressions, researchers showed them images of happy, angry and neutral faces, and then gave them feedback on how they described them. They did this by showing the kids the same faces in the same way, only after each face, they were given feedback.

Here’s the trick: For two of the faces that they previously described as angry, if they called them angry again, the feedback informed them that they were mistaken: It wasn’t an angry face, it was a happy face.

For a week, day after day, the kids looked at the faces again and again, relearning which faces were angry and which were happy. Then the researchers tracked the number of aggressive incidents the kids were involved in. For weeks, they followed both the kids who got the treatment and the kids who didn’t. The staff at the program evaluated each teen without knowing whether or not they had been retrained. What they found surprised them.

The kids who had been trained to visually see differently interacted with the world in a different way: They came at the world with less aggression. “There was a 30 percent difference between the two groups,” Munafo says.

In fact, researchers have been trying this approach — of modifying visual biases — in people with anxiety and depression, and have gotten similar results. Ian Penton-Voak, another psychologist, says the value of the work is clear. “It demonstrates that the way you see the emotional world around you affects your behavior in a kind of causal way,” he says. That’s an insight the researchers hope might ultimately lead to new interventions.

In case you missed it, Rock Center with Brian Williams did a fantastic story on Adult ADHD this past Friday. The piece focused on what it’s like for an adult with undiagnosed ADHD, and also touched on how things can change for the better with treatment.

It’s rare to see a story in the media (especially one on a popular network program) take such a personal approach to ADHD and the adults who have been diagnosed with it. I was pleasantly surprised to see that no one was villianized in this story; not the adults with ADHD, not the doctors who diagnose it, and not the pharmaceutical companies who make the medicines that treat it. Instead, we got a glimpse into the lives of real people, and that is refreshing.

I highly recommend taking the time to view this video, and taking the time to pass it along, too!

Apr 9

Tools for parents with ADHD


So, should ADHD kids be made to sit still?

I would say probably not; however, that doesn’t mean just letting them bounce off the walls. I encourage parents to find strategies that fit these two categories. It definitely requires more creativity, but there are so many ways available now to help kids learn and focus better, without requiring them to sit still during boring tasks. Here are three of my favorite products. (Note: I am not affiliated with any of these companies, nor have I received any sort of compensation whatsoever for mentioning these products. I just think they are really cool!)

The Safco AlphaBetter® Desk is standing desk with a swinging foot bar. This combines several great ideas. First, standing helps many people focus better on their work. The foot bar incorporates a movement strategy, that is much less annoying that foot tapping. Third, there is a chair as well so kids can sit and stand alternatively. It’s not cheap ($300-450), compared to regular school desks ($100-150), but I think many parents and teachers can see the advantages of a standing desk like this one.

The Time Tracker from Learning Resources is a visual timer that helps kids see how much time is left. The visual aspect can help them remain on task better, and fidget less, especially if they know that the end of a boring task is coming soon. I’ve seen this priced around $35 usually. Learning Resources also makes a Time Tracker “mini” version that is only $14.

The Sunrise System Alarm Clock is probably one of the best things I’ve ever bought myself. This clock hooks up to a bedside lamp and mimics the sunrise in the morning over 45 minutes or so, and comes with a back up buzzer alarm as well. Adding more light in the morning, gradually, will help the ADHDer who struggles to wake up in the morning. It’s a little pricey ($99), but provides much more light via a lamp than other sunrise clocks that have a built in light.
– See more at:

Apr 8

ADD Often Is Undiagnosed In Adults


Disorder often goes undiagnosed in adults, but it’s quite common and can cause big lifestyle problems

By Linda Lewis Griffith — Special to The Tribune

A recent study published in the journal Pediatrics reports that two-thirds of children diagnosed with ADHD continue to have symptoms into adulthood. A problem that was once thought to disappear with maturity not only interferes with adult sufferers’ functioning but is often accompanied by other serious psychiatric illnesses.

This information may be startling to the general public. But it’s old news to the estimated 8 million men and women already grappling with the disorder.

Adult ADHD often flies under the diagnostic radar because it presents itself differently at different stages of life. For instance, children diagnosed with ADHD may be easily distracted or have difficulty following directions. They may have trouble sitting still, find it hard to wait their turn or blurt out answers in the classroom. On the other hand, adults with ADHD might put things off until the last minute or fail to follow through on work or family commitments. They report feeling restless and impatient, always needing to be on the go, even when they’re on vacation. They frequently interrupt others’ sentences and have problems maintaining relationships.

Other symptoms of adult ADHD include poor listening skills, difficulty starting a task, chronic lateness, angry outbursts and an inability to establish priorities. Adults with ADHD are also apt to have problems managing money, be involved in frequent traffic violations and impulsively change jobs.

Research conducted by Dr. William Barbaresi, director of the Developmental Medicine Center at Boston Children’s Hospital, found that adults with ADHD were five times more likely to commit suicide. More than 25 percent of those who had ADHD and another mental disorder abused alcohol; 16 percent abused other substances. Personality disorders and mood disorders, such as anxiety and depression, were also common.

Treatment for adult ADHD involves a multifaceted approach. Stimulant medications, such Ritalin, Adderal and Vyvanse, are commonly prescribed. Anti-depressants such as Wellbutrin and Effexor are also used. Equally important are behavioral and environmental changes as well as counseling and marital therapy.

Linda Lewis Griffith is a local marriage and family therapist. For information or to contact her, visit


• Follow a routine. Your life is inherently chaotic. You need to impose structure and control from the outside. Eat meals at regular times. Develop a regular sleep routine. Exercise at set times throughout the week.

• Purchase a date book. Write down every activity you perform during your week. Carry it with you wherever you go so you can add and refer to it often.

• Make lists. Write down everything you need to accomplish each day. Put the most important items at the top. Check tasks off as they’re completed.

• Keep a notepad handy. Details are apt to slip your mind. So it’s helpful to jot notes to jog your memory. For instance, write down where you parked your car or that you drive the carpool at 2:45.

• Avoid clutter. Prevent clutter by throwing away items you’re not using and tidying your desk at the end of each day. If clutter is already a problem, designate time to tackle one specific area. Or ask help from a friend or loved one to help you stay on track.

• Put things in the same place. Avoid the stress of looking for lost items by creating a home in which everything lives. Put your keys in a bowl on your dresser. Hang your purse on the back of the chair.

• Break tasks down to a manageable size. It’s easy to feel overwhelmed and then avoid those chores that feel daunting. Instead, decide on a first step that you can accomplish. When that’s completed, move on to step two.

• Use an alarm clock, watch or timer. Punctuality is not your strong suit. Timers ensure you’re always on time or don’t get distracted. Set your alarm clock to get up in the morning. Program your cellphone to alert you of impending meetings. Set a timer to ring when you’ve spent 20 minutes on the Internet.

• Avoid credit card debt. Credit cards can entice you to spend money that you don’t have. If you do use credit cards, pay your full balance every month. If you’re frequently in financial trouble because of your cards, pay off your debt as quickly as possible, then cut up the cards and pay cash.

• Exercise. Exercise decreases stress and anxiety and enhances your mood. It improves impulse control and reduces compulsive behavior.

• Get counseling. Knowledgeable therapists can help you create personal structure and devise strategies for decreasing your symptoms. They’ll also hold you accountable for the changes you’ve committed to making.

Read more here:

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on April 9, 2013

Autistic Kids Tend to Imitate ‘Efficiently,’ Not ‘Socially’ Normally, kids copying adult behavior will go out of their way to repeat each and every element of the behavior even if they realize parts of it don’t make any sense.

But a new study shows that when a child with autism copies the actions of an adult, he or she is likely to omit anything “silly” about what they’ve just seen.

Researcher say the findings, reported in the journal Current Biology, are the first to show that the social nature of imitation is very important — and challenging for children with autism. They also emphasize just how important it is for most children to be like other people.

“The data suggest that children with autism do things efficiently rather than socially, whereas typical children do things socially rather than efficiently,” said Antonia Hamilton, Ph.D., of the University of Nottingham.

“We find that typical children copy everything an adult does, whereas autistic children only do the actions they really need to do.”

The researchers made the discovery after testing 31 children with autism spectrum conditions and 30 typically developing children who were matched for verbal mental age.

On each of five trials, each child was asked to watch carefully as a demonstrator showed how to retrieve a toy from a box or build a simple object. Importantly, each demonstration included two necessary actions (e.g. unclipping and removing the box lid) and one unnecessary action (e.g. tapping the top of the box twice).

The box was then reset behind a screen and handed to the child, who was instructed to “get or make the toy as fast as you can.” They were not specifically told to copy the behavior they’d just seen.

Investigators discovered almost all of the children successfully reached the goal of getting or making the toy, but typically developing children were much more likely to include the unnecessary step as they did so, a behavior known as overimitation.

Those children copied 43 to 57 percent of the unnecessary actions, compared to 22 percent in the children with autism. That’s despite the fact that the children correctly identified the tapping action as “silly,” not “sensible.”

Researchers now plan to investigate precisely what kind of actions children copy, and how that tendency to copy everything might contribute to human cultural transmission of knowledge.

Hamilton said parents and teachers should be aware of the social value in going beyond the successful completion of such tasks.

Apr 6

Risk Factors for Gambling Addiction Tied to Age


By Rick Nauert PhD Senior News Editor
Age appears to play a critical factor for the development of pathological gambling, and the clinical course the addiction may follow.

In a new study, researchers reviewed more than 2,300 patients aged from 17 to 86 years and discovered that some personality traits associated with age are risk factors in different stages of life.

For example, younger patients (from 17 to 35 years) are more likely to be impulsive and seek new sensations that act as precipitating factors of gambling.

In contrast, older patients (from 55 to 86 years) are less impulsive and thrill-seeking yet more likely to have risk factors such as anxiety and excessive worrying.

“Older people do not gamble to seek awards or for the challenge of winning or for competitiveness as young people do, but they gamble to modulate negative emotional states,” said Susana Jiménez-Murcia, Ph.D., lead researcher.

“Older patients try to flee from loneliness, dissatisfaction or even physical discomfort.”

“The only personality factor that does not vary with age is self-direction, the ability to take control of our lives, to be persistent with a goal,” said Jiménez-Murcia.

Researchers believe the current study confirms that self-direction “is low at all stages and that could be one of the keys to the treatment and prevention of the disorder.”

Investigators discovered young patients are associated with a higher severity in their gambling conduct. “Early intervention in these patients allows us to understand the causes of the problem in the early stages and we can give to patients tools to control it.”

A key finding from the study is that pathological gambling is a temporary and episodic condition in patient’s life.

“We observe,” Jimenez said, “that at certain times of the life, some social, environmental and personal factors can ease to control this behavior but in other moments it is not so easy, and the psychopathology could be more serious. But the good news is that it is not a chronic disorder for life.”

For individuals aged from 55 to 86 years, the gambling addiction is associated with health problems, while in middle age the disorder is associated with economic problems.

Gender also is a variable in the presentation of the addiction as researchers detected a later gambling onset in women, from 35 to 40 years, while men begin to gamble younger.

Gambling has also changed with the times as recent profiles reflect online gambling opportunities.

“We see younger, college-educated and higher socioeconomic level patients. We must continue working to promote responsible gaming and also to inform of the potential risk of gambling.”

Source: IDIBELL-Bellvitge Biomedical Research Institute

Apr 5

Tobacco Use with ADD and ADHD


Individuals with ADD and ADHD have a tendency towards addictive behavior. As I wrote in an earlier piece on gambling, addictive and impulsive behaviors are common place for people with ADD/ADHD. Last October, scientists from McGill University in Canada released a study suggesting that there’s a genetic link between childhood ADHD and heavy tobacco consumption as an adult (McGill University Study). The study also goes on to explain how it is important for people with ADD/ADHD to identify programs that are catered to the individual if he or she is looking to quit.

So does this mean that a child with ADD/ADHD is going to run to his or her local store and buy cigarettes the rest of his or her life? Obviously not, but what it does tell us and helps us to understand is that there’s a little more to this than just being addicted to nicotine. We need to look at this from a bigger-picture standpoint. If individuals with ADD/ADHD are more-likely to smoke when he or she gets older (from a genetic and scientific perspective), than the problem goes much deeper than just saying no. But at the same time, just because one’s genetically more likely to take on an activity doesn’t mean he or she is going to do it.

With my clients that have expressed an interest in quitting tobacco use, I always suggest he or she starts slow. Instead of stopping, cut down. Set short-term and achievable goals aimed at eventually stopping the activity. For example, if an individual smokes a pack-a-day, start by smoking three less cigarettes a day for one week. If that is successful, make it six less for the next week. And so on and so forth. If a goal is set to quit smoking with no real plan, it is almost-always going to fail. Approach quitting smoking gradually and with achievable goals. There will be slip-ups, but try to hold to your goal as well as you can.

For more information on my ADD, ADHD and Executive Functioning coaching, please visit To learn more information about some of the other services I provide, please visit and I can be found on Twitter at ADHDEFCoach. You can also find me on Facebook, Google Plus and Tumblr. My good friend and fellow ADD/ADHD Coach Tara McGillicuddy invites me as a regular guest on ADD/ADHD Support Talk Radio. Tara does many wonderful things and you should check out her website here. Feel free to email me at or call 773.888.ADHD (2343) with any additional questions.

Apr 4

By Maureen Salamon, HealthDay ReporterTHURSDAY, Oct. 27, 2011 (HealthDay News) — While smoking has long been linked to cancer, its frequent companion, drinking, may be as well, a new study suggests. Research also found extra pounds, black tea and fruit might all shield against the disease.

Three new studies presented at a medical meeting this week find a link between heavy boozing and a rise in risk for the number one cancer killer.

On the other hand, studies also suggest that heavier people are less likely to develop lung cancer than smaller folk, and black tea might help ward of the disease, as well.

The findings were to be presented at the annual meeting of the American College of Chest Physicians, Oct. 22-26, in Honolulu.

More Americans die from lung cancer than any other form, according to the U.S. Centers for Disease Control and Prevention (CDC). In 2007, the most recent year for which statistics are available, more than 203,000 people in the United States were diagnosed with lung cancer, and nearly 159,000 died.

In one study presented at the meeting, Dr. Stanton Siu and colleagues at Kaiser Permanente in Oakland, Calif., looked at the diets and lifestyles of more than 126,000 people first surveyed between 1978 and 1985. They then tracked their incidence of lung cancer through 2008.

The team found that having more than three alcoholic drinks per day upped lung cancer risk, with a slightly higher risk ascribed to beer consumption versus wine or liquor. Specifically, compared to teetotalers, people who had three or more drinks daily were 30 percent more likely to develop lung cancer, with a 70 percent rise in risk if the drink of preference was beer.

One expert stressed, however, that it’s tough to tease out drinking from another, even more carcinogenic habit, smoking, since the two often go together.

“Smoking remains an overwhelming factor, but . . . heavy drinking, whether it’s the alcohol itself, or that heavy drinking is a surrogate for hanging out in smoky bars and getting more smoke, I don’t know,” said Dr. Norman Edelman, chief medical officer of the American Lung Association, who was not involved in any of the studies.

In another intriguing finding from the study, a higher body mass index (BMI), which indicates overweight or obesity, was linked to a reduction in the odds for lung malignancies.

The finding may not mean that packing on extra pounds insulates one against lung cancer, however. Edelman noted that being overweight or obese is typically associated with poorer health, while “people who are sick weigh little,” he said. So, the results may just mean that the heavier study participants haven’t suffered the ill effects of their lifestyle — yet.

In a separate study also slated for presentation at the meeting, researchers from the Czech Republic found that among non-smoking women, regular black tea consumption appeared to lower lung cancer risk by about 31 percent, and higher amounts of fruit in the diet was also linked to lowered lung cancer risk for both genders.

Edelman and Dr. Mark Rosen, chief of the division of pulmonary/critical care and sleep medicine at the North Shore-LIJ Health System in New Hyde Park, N.Y., cautioned that all of the study results need to be replicated before being taken seriously.

“They show some interesting associations, but that doesn’t mean they’re necessarily factual,” Rosen said. “If you put a lot of data into a computer, you’re going to find some things come out [linked] just by chance. Associations are interesting, but they all require further studies.”

Experts also note that research presented at scientific meetings is considered preliminary and has not been peer-reviewed.

Posted on Wednesday, April 11, 2012 9:58 AM

Earlier this week I blogged about a practical alternative which I regularly offer to individuals and families who have questions about ADHD and related disorders, but aren’t sure they’re ready to spring for a full neuropsychological evaluation. The next post here at this blog was a consideration of how to determine when such evaluation is in fact right for you or your family member.

So what happens after a neuropsychological evaluation? After all the testing and scoring and writing up the results…what next?

The Feedback Session

As much as I enjoy (I really do!) administering the various tests which make up the neuropsychological battery, and as interesting as it is to score these tests and look at the pattern of strengths and weaknesses, the real heart of the neuropsychological evaluation is the Feedback Session.

Usually scheduled a week or two after the evaluation is complete (you’ll need a chance to breathe!), the feedback session offers the client and his spouse or parents a chance to review the test scores with the neuropsychologist and “make sense of the scores” together.

In the Feedback Session, I’ll explain how a neuropsychologist thinks about these tests and scores and how I pull this data together to answer referral questions. In the Feedback Session we’ll connect the dots – I’ll relate your chief concerns to my own mental status exam observations and to the test scores. We’ll identify patterns of strengths and weaknesses among test scores and relate those patterns to know patterns of brain-behavior relationships in the scientific literature. (There are identifiable patterns among neuropsychological test data which suggest, for example, ADHD or dementia or brain injury or depression-related concentration problems.)

Feedback Session data typically fall into three categories:

1.It confirms what the client already knew or suspected about him/herself;
2.It challenges the client to see him/herself in a new way, but seems reasonable or acceptable or “true”;
3.It just doesn’t seem to fit – the client says “nope, I don’t think that fits the picture for me, doesn’t seem consistent with my experience of myself.”

When my clients reject feedback data, I assume that maybe they’re right or maybe they’re not ready to hear that feedback about themselves just yet. Either way, we don’t focus on feedback data that falls into category #3. We focus on that second category – feedback which the client can accept, but which “pushes” him/her a bit, and offers a new way of seeing himself or moving towards treatment or rehabilitation or supports.We typically consider two or three next steps. As a result of this feedback, what are you going to do next? What are you going to do differently? What will help? We set specific behavioral goals and agree to meet again for the Followup Feedback Session.

The Followup Feedback Session

A unique feature (as far as I know) of my own evaluations is the Followup Feedback Session scheduled for 6-8 weeks after the first feedback meeting. This second feedback session allows the client, his family, and I to “check in” and see what they might have missed from the first feedback hour, and what they need to review.

The Followup Feedback Session builds in a bit of accountability. Did the client do what he said he/she was going to do as a result of the first feedback visit? If so – how is it working out? And if not – why not, what obstacles have prevented that follow-through? At the Followup Feedback Session the client and her spouse or parents have had a chance to review my report and offer any comments or feedback to me, or to clarify any remaining questions.

What recommendations might follow a neuropsychological evaluation for attentional or learning problems?

Speaking with a mom who was considering neuropsychological evaluation for her son, I indicated that I try to write jargon-free reports which are user-friendly for parents, doctors, teachers, and therapists. I also let her know that I don’t presume to tell pediatricians how to do medicine, or to suggest to occupational therapists how to plan OT interventions. And I don’t tell educators how to do curriculum planning or how to teach. At this point, mom asked, “Hmmm, what do you recommend then, David, after your evaluation?” It was a good question, and the answer depends on the type and severity of neurocognitive deficit identified in the evaluation. But some interventions which might follow my evaluation include:

•preferential seating for the distracted student
•frequent checks for understanding (by the teacher) for a student with auditory processing problems
•use of multi-sensory teaching styles for students with auditory processing problems or easy distractibility
•reduced homework assignments (as permitted by classroom objectives) for a student with speed of information processing challenges
•”buddy system” with either younger students (to give the child the experience of teaching) or older students (to give a child the experience of learning from a slightly more mature student who has mastered navigating lockers and hallways and other “executive” challenges outside the classroom)
•considering special education services (for students with adhd, learning disability, or general developmental delay)
•considering Section 504 services (for the same students noted above)
•considering state agency support (for students with documented head injury or students with developmental delay)
•involvement of occupational therapy (for students with sensory overload, or students who need more sensory input throughout the day)
•involvement of speech/language services (for students with developmental articulation problems or with “language pragmatics” problems associated with autistic spectrum disorder)
•allowing alternate ways of turning in homework (google docs, memory sticks, faxing at start of day, etc).
•use of FM system (lapel microphone) for students with central or peripheral hearing/auditory impairment
•regular teacher-family communication re: homework details (for students who “lie” or “forget” about homework assignements as a way of avoiding hard work)

None of these recommendations is appropriate for every student with a particular diagnosis, and some of them might even be a bad idea for a particular student. That’s why any recommendation should flow logically from the findings of neuropsychological evaluation. For each recommendation, I ought to be able to answer a question like “why do you think this strategy would work for this student?”

Apr 3

By Margarita Tartakovsky, M.S.
Associate Editor

3 Handy Ways to Help Your Child Overcome Negative Thinking Negative thinking isn’t something that just plagues adults. It also plagues kids.

In the book Freeing Your Child From Negative Thinking: Powerful Practical Strategies to Build a Lifetime of Resilience, Flexibility and Happiness, child psychologist Tamar E. Chansky, Ph.D, writes that for kids with a “negative thinking bias,” negative thoughts become “the default, the first, last and final word.”

Kids simply don’t realize that they have a choice in whether they internalize these thoughts. Instead, they start to see these inaccurate beliefs as absolute truths.

Fortunately, Chansky says that parents can help! Whether your child expresses negative thoughts occasionally or on a regular basis, you can help them overcome these harmful patterns of thinking. Below are three activities to try with your kids.

Spotting Negative Thoughts

But first, in order to tackle negative thoughts, you have to be able to spot them. Chansky provides this list of red flags.
•Exaggerating and extending the importance of an adverse event
•Blaming self for something that was caused by external circumstances; blaming big for small things
•Generalizing that whatever happened always happens
•Becoming easily angry with self
•Not trying activities unless sure can excel
•Thinking bad things always happen, good things never happen
•Trouble tolerating mistakes, disappointment or losing
•Shutting down in the face of any obstacle


1. Distinguishing between negative and accurate thoughts

For kids, telling the difference between negative and more accurate thoughts is tough. (It’s tough enough for adults!)

One simple way to help young kids make the distinction is by using stuffed animals to represent each line of thinking. Chansky says: “The cranky puppy and the happy bear can both be looking at the same situation—spilling the milk—and have two very different versions of the story.”

If your child is older, take a piece of paper and draw a line down the middle. On one side, write “Negative Thoughts or “Meany Brain Thoughts.” On the other side, write “My Good Thoughts” or “Smart Thoughts.”

2. Becoming an optimistic thinker

Cultivating optimism in kids also is key in addressing negative thinking. Chansky gives a good example in her book. Say two kids are at an ice cream shop and their rocky road slips off the cone. One exclaims, “It wasn’t on right, so it fell. I want another one.” The other child says, “Why does this always happen to me? This store always does it wrong. Everything’s ruined. This is the worst day of my life.”

In the first example, the optimistic child relays the facts and sees a solution for the problem. However, the pessimistic child “inserts extraneous material from outside the script, attributing intention, permanency and a global quality to something that was a small accident, plain and simple.” (Which might sound familiar to many of us adults!)

Parents can play the “Unfortunately, Fortunately” game with their kids. Together with your child, come up with “five sticky situations,” which you write down on cards and put in a hat. Each person then pulls out a card and says the unfortunate situation (Chansky uses the example: “Unfortunately, the movie I wanted to see was sold out”). The other person responds with a fortunate perspective (“But fortunately, I went to see another movie”). Then you go back and forth, each mentioning unfortunate and fortunate circumstances.

The next time your child is going through a difficult situation, you might say, according to Chansky, “There are a lot of ‘unfortunatelys’ stacking up. Can we see if there are any ‘fortunatelys’ in this situation?”

3. Building distance from negative thoughts

It’s also important to help your child get “some distance and perspective” on a situation. To do so, avoid saying that they’re being negative. Instead, blame the “negative brain.” (This also makes you an ally, Chansky says, in helping defend your child against this “troublesome third party of Mr. No—the real bad guy ruining her day.”)

According to Chansky, this relabeling “begins to demote the validity of negative thinking, encouraging the child to not trust it as the ‘truth,’ but as the annoying, upsetting, overprotective or just sort of ill-informed voice that it is.”

Ask your child to pick a name for their negative brain. Chansky gives the following examples: Mr. Sad, Meany Mouse, Fun Blocker. Have them draw the character and create a voice, too. Plus, they can brainstorm ways to talk back to that negative brain: “You’re not the boss of me; you make me feel bad; I’m not listening to you; you see everything as awful; you need new glasses!”

Chansky also has a suggestion on how to initiate the chat with your child about creating the negative brain character. You might say: “Remember when you said you were ‘stupid’ because you drew on the table by accident? You don’t feel that way now, right? But what would you call that voice in your head that made you feel that way then?”

In general, the goal isn’t to halt, deny or fight negative thoughts, Chansky says. Instead, she writes (by the way, an important lesson not just for kids!):

New research suggests that drinking soda, especially diet soda, is associated with an increased risk of depression.
WEDNESDAY, Jan. 9, 2013 — Just under half of all Americans reported drinking at least one glass of soda per day, while two-thirds said they drink at least one cup of coffee daily, according to a 2012 Gallup poll. Despite popular opinion about soda and weight gain, the same poll found that frequent soda drinkers do not weigh more than non-soda drinkers.

But health experts still say that even one glass of soda a day is too much, as it has been linked to a variety of health problems, including a relatively new one, clinical depression.

Preliminary data from a National Institutes of Health report that will be released in March at the American Academy of Neurology’s 65th Annual Meeting in San Diego show that regular soda drinkers, particularly those who drink diet soda, are more likely to be diagnosed with depression. The data showed that coffee drinkers, on the other hand, have a slightly lower risk of a depression diagnosis.

The researchers do not say that soda causes depression — they did not determine whether people who are likely to become depressed are also simply more likely to drink soda in the first place, and the study did not control for all relevant factors, such as socioeconomic status. What they did find was that people who drank more than four cans or cups of soda per day were 30 percent more likely to develop depression over the course of the 10-year study than people who drank no soda. Fruit punch drinkers were 38 percent more likely to develop depression than those who did not drink sweetened drinks. Depression risk appeared to be even greater for people who drank diet soda rather than regular soda, and diet rather than regular fruit punches and iced tea.

Meanwhile, heavy coffee drinkers in the study experienced more than a caffeine buzz: They were also about 10 percent less likely to develop depression than those who drank no coffee.

This most recent finding doesn’t necessarily mean you should quit Diet Coke cold turkey and run out for a cup of joe instead. But it’s not the first time researchers have found a link between soda consumption and mood. One study of teens in Boston found that those who drank six or more cans of soda per week were more likely to be violent with family and friends and even carry weapons. Researchers associated heavy soda consumption with a 9 percent to 15 percent increase in the risk for aggressive behavior, and suggested that sugar or caffeine may be to blame.

Because past studies have linked poor emotional health to the sugar in soda, this most recent finding is a little more ambiguous. It either indicates that both sugar and the artificial sweeteners in diet drinks may be related to depression, or that other factors contribute to the link between soda drinking and clinical depression. Still, cutting down on both regular and diet soda can help your health in a number of ways.

“Our research suggests that cutting out or down on sweetened diet drinks or replacing them with unsweetened coffee may naturally help lower your depression risk,” said study author Honglei Chen, MD, PhD, in a release. “More research is needed to confirm these findings, and people with depression should continue to take depression medications prescribed by their doctors.”

Apr 1

How Anxiety Leads to Disruptive Behavior


Caroline Miller

Editorial Director
Child Mind Institute
Kids who seem oppositional are often severely anxious
A 10-year-old boy named James has an outburst in school. Upset by something a classmate says to him, he pushes the other boy, and a shoving-match ensues. When the teacher steps in to break it up, James goes ballistic, throwing papers and books around the classroom and bolting out of the room and down the hall. He is finally contained in the vice principal’s office, where staff members try to calm him down. Instead, he kicks the vice principal in a frenzied effort to escape. The staff calls 911, and James ends up in the Emergency Room.

To the uninitiated, James looks like a boy with serious anger issues. It’s not the first time he’s flown out of control. The school insists that his parents pick him up and take him home for lunch every day because he’s been banned from the cafeteria.

But what’s really going on? “It turns out, after an evaluation, that he is off the charts for social anxiety,” reports Dr. Jerry Bubrick, director of the Anxiety & Mood Disorders Center at the Child Mind Institute. “He can’t tolerate any—even constructive—criticism. He just will shut down altogether. James is terrified of being embarrassed, so when a boy says something that makes him uncomfortable, he has no skills to deal with it, and he freaks out. Flight or fight.”

James’s story illustrates something that parents and teachers may not realize—that disruptive behavior is often generated by unrecognized anxiety. A child who appears to be oppositional or aggressive may be reacting to anxiety—anxiety he may, depending on his age, not be able to articulate effectively, or not even fully recognize that he’s feeling.

“Especially in younger kids with anxiety you might see freezing and clinging kind of behavior,” says Dr. Rachel Busman, a clinical psychologist at the Child Mind Institute, “but you can also see tantrums and complete meltdowns.”

A great masquerader

Anxiety manifests in a surprising variety of ways in part because it is based on a physiological response to a threat in the environment, a response that maximizes the body’s ability to either face danger or escape danger. So while some children exhibit anxiety by shrinking from situations or objects that trigger fears, some react with overwhelming need to break out of an uncomfortable situation. That behavior, which can be unmanageable, is often misread as anger or opposition.

“Anxiety is one of those diagnoses that is a great masquerader,” explains Dr. Laura Prager, director of the Child Psychiatry Emergency Service at Massachusetts General Hospital. “It can look like a lot of things. Particularly with kids who may not have words to express their feelings, or because no one is listening to them, they might manifest their anxiety with behavioral dysregulation.”

The more commonly recognized symptoms of anxiety in a child are things like trouble sleeping in his own room or separating from his parents, avoidance of certain activities, a behaviorally inhibited temperament. “Anyone would recognize those symptoms,” notes Dr. Prager, who is also an assistant professor at the Harvard Medical School, and co-author of Suicide by Security Blanket, and Other Stories from the Child Psychiatry Emergency Service. But in other cases the anxiety can be hidden.

“When the chief complaint is temper tantrums, or disruption in school, or throwing themselves on the floor while shopping at the mall, it’s hard to know what that means,” she explains, “but it’s not uncommon, when kids like that come in to the ER, for the diagnosis to end up being a pretty profound anxiety disorder.”

To demonstrate the surprising range of ways young children express anxiety, Dr. Prager mentions a case she had just seen of a young child who presented with hallucinations, but whose diagnosis she predicted will end up being somewhere on the anxiety spectrum. “Little kids who say they’re hearing things or seeing things, for example, may or may not be doing that. These may not be the frank hallucinations we see in older patients who are schizophrenic, for example. They might be a manifestation of anxiety and this is the way the child expresses it.”

Problems at school

It’s not uncommon for children with serious undiagnosed anxiety to be disruptive at school, where demands and expectations put pressure on them that they can’t handle. And it can be very confusing to teachers and other staff members to “read” that behavior, which can seem to come out of nowhere.

Dr. Nancy Rappaport, a Harvard Medical School professor who specializes in mental health care in school settings, sees anxiety as one of the causes of disruptive behavior that makes classroom teaching so challenging. “The trouble is that when kids who are anxious become disruptive they push away the very adults who they need to help them feel secure,” notes Dr. Rappaport. “And instead of learning to manage their anxiety, they end up spending half the day in the principal’s office.”

Dr. Rappaport sees a lot of acting out in school as the result of trauma at home. “Kids who are struggling, not feeling safe at home,” she notes, “can act like terrorists at school, with fairly intimidating kinds of behavior.” Most at risk, she says, are kids with ADHD who’ve also experienced trauma. “They’re hyper-vigilant, they have no executive functioning, they misread cues and go into combat.”

When a teacher is able to build a relationship with a child, to find out what’s really going on with him, what’s provoking the behavior, she can often give him tools to handle anxiety and prevent meltdowns. In her book, The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students, Dr. Rappaport offers strategies kids can be taught to use to calm themselves down, from breathing exercises to techniques for distracting themselves.

“When a teacher understands the anxiety underlying the opposition, rather than making the assumption that the child is actively trying to make her miserable, it changes her approach,” says Dr. Rappaport, “The teacher is able to join forces with the child himself and the school counselor, to come up with strategies for preventing these situations.” If it sounds labor-intensive for the teacher, it is, she notes, but so is dealing with the aftermath of the same child having a meltdown.

Anxiety also drives a lot of symptoms in a school setting that are easily misconstrued as ADHD or oppositionality.

“I’ll see a child who’s having difficulty in school: not paying attention, getting up out of his seat all the time, asking a lot of questions, going to the bathroom a lot, getting in other kids’ spaces,” explains Dr. Busman. “His behavior is disrupting other kids, and is frustrating to the teacher, who’s wondering why she has to answer so many questions, and why he’s so wrapped up in what other kids are doing, whether they’re following the rules.”

People tend to assume what’s happening with this child is ADHD inattentive type, but it’s commonly anxiety. Kids with OCD, mislabeled as inattentive, are actually not asking all those questions because they’re not listening, but rather because they need a lot of reassurance.

How to identify anxiety

“It probably occurs more than we think, either anxiety that looks disruptive or anxiety coexisting with disruptive behaviors,” Dr. Busman adds. “It all goes back to the fact that kids are complicated and symptoms can overlap diagnostic categories, which is why we need to have really comprehensive and good diagnostic assessment.”

First of all, good assessment needs to gather data from multiple sources, not just parents. “We want to talk to teachers and other people involved with the kid’s life,” she adds, “because sometimes kids that we see are exactly the same at home and at school, sometimes they are like two different children.”

And it needs to use rating scales on a full spectrum of behaviors, not just the area that looks the most obvious, to avoid missing things.

Dr. Busman also notes that a child with severe anxiety who’s struggling in school might also have attentional or learning issues, but she might need to be treated for the anxiety before she can really be evaluated for those. She uses the example of a teenager with OCD who she’s “doing terribly” in school. “She’s ritualizing three to four hours a day, and having constant intrusive thoughts—so we need to treat that, to get the anxiety under control before we ask, how is she learning?”

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