By MARIA BOGDANOS

Emotional abuse is elusive. Unlike physical abuse, the people doing it and receiving it may not even know it’s happening.

It can be more harmful than physical abuse because it can undermine what we think about ourselves. It can cripple all we are meant to be as we allow something untrue to define us. Emotional abuse can happen between parent and child, husband and wife, among relatives and between friends.

The abuser projects their words, attitudes or actions onto an unsuspecting victim usually because they themselves have not dealt with childhood wounds that are now causing them to harm others.

In the following areas, ask these questions to see if you are abusing or being abused:

Humiliation, degradation, discounting, negating. judging, criticizing:
Does anyone make fun of you or put you down in front of others?
Do they tease you, use sarcasm as a way to put you down or degrade you?
When you complain do they say that “it was just a joke” and that you are too sensitive?
Do they tell you that your opinion or feelings are “wrong?”
Does anyone regularly ridicule, dismiss, disregard your opinions, thoughts, suggestions, and feelings?
Domination, control, and shame:
Do you feel that the person treats you like a child?
Do they constantly correct or chastise you because your behavior is “inappropriate?”
Do you feel you must “get permission” before going somewhere or before making even small decisions?
Do they control your spending?
Do they treat you as though you are inferior to them?
Do they make you feel as though they are always right?
Do they remind you of your shortcomings?
Do they belittle your accomplishments, your aspirations, your plans or even who you are?
Do they give disapproving, dismissive, contemptuous, or condescending looks, comments, and behavior?
Accusing and blaming, trivial and unreasonable demands or expectations, denies own shortcomings:
Do they accuse you of something contrived in their own minds when you know it isn’t true?
Are they unable to laugh at themselves?
Are they extremely sensitive when it comes to others making fun of them or making any kind of comment that seems to show a lack of respect?
Do they have trouble apologizing?
Do they make excuses for their behavior or tend to blame others or circumstances for their mistakes?
Do they call you names or label you?
Do they blame you for their problems or unhappiness?
Do they continually have “boundary violations” and disrespect your valid requests?
Emotional distancing and the “silent treatment,” isolation, emotional abandonment or neglect:
Do they use pouting, withdrawal or withholding attention or affection?
Do they not want to meet the basic needs or use neglect or abandonment as punishment?
Do they play the victim to deflect blame onto you instead of taking responsibility for their actions and attitudes?
Do they not notice or care how you feel?
Do they not show empathy or ask questions to gather information?
Codependence and enmeshment:
Does anyone treat you not as a separate person but instead as an extension of themselves?
Do they not protect your personal boundaries and share information that you have not approved?
Do they disrespect your requests and do what they think is best for you?
Do they require continual contact and haven’t developed a healthy support network among their own peers?

By RICK NAUERT PHD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on November 26, 2013

A new review on the positive effects of playing video games finds that the interaction may boost children’s learning, health and social skills.

The American Psychological Association (APA) study comes out as debate continues among psychologists and other health professionals regarding the effects of violent media on youth.

An APA task force is conducting a comprehensive review of research on violence in video games and interactive media and will release its findings in 2014.

“Important research has already been conducted for decades on the negative effects of gaming, including addiction, depression and aggression, and we are certainly not suggesting that this should be ignored,” said lead author Isabela Granic, Ph.D.

“However, to understand the impact of video games on children’s and adolescents’ development, a more balanced perspective is needed.”

The article will be published in the journal American Psychologist.

A common viewpoint is that playing video games is intellectually lazy. New research however, suggests such play actually may strengthen a range of cognitive skills such as spatial navigation, reasoning, memory and perception.

This is particularly true for shooter video games that are often violent, the authors said.

A 2013 review of published studies found that playing shooter video games improved a player’s capacity to think about objects in three dimensions, just as well as academic courses to enhance these same skills, according to the study.

“This has critical implications for education and career development, as previous research has established the power of spatial skills for achievement in science, technology, engineering and mathematics,” Granic said.

This enhanced thinking was not found with playing other types of video games, such as puzzles or role-playing games.

Playing video games may also help children develop problem-solving skills, the authors said.

The more adolescents reported playing strategic video games, such as role-playing games, the more they improved in problem solving and school grades the following year, according to a long-term study published in 2013.

Children’s creativity was also enhanced by playing any kind of video game, including violent games, but not when the children used other forms of technology, such as a computer or cell phone, other research revealed.

Simple games that are easy to access and can be played quickly, such as “Angry Birds,” can improve players’ moods, promote relaxation and ward off anxiety, the study said.

“If playing video games simply makes people happier, this seems to be a fundamental emotional benefit to consider,” said Granic.

The authors also highlighted the possibility that video games are effective tools to learn resilience in the face of failure.

By learning to cope with ongoing failures in games, the authors suggest that children build emotional resilience they can rely upon in their everyday lives.

Another stereotype the research challenges is the socially isolated gamer.

More than 70 percent of gamers play with a friend and millions of people worldwide participate in massive virtual worlds through video games such as “Farmville” and “World of Warcraft,” the article noted.

Multiplayer games become virtual social communities, where decisions need to be made quickly about whom to trust or reject and how to lead a group, the authors said.

People who play video games, even if they are violent, that encourage cooperation are more likely to be helpful to others while gaming than those who play the same games competitively, a 2011 study found.

The article emphasized that educators are currently redesigning classroom experiences, integrating video games that can shift the way the next generation of teachers and students approach learning.

Likewise, physicians have begun to use video games to motivate patients to improve their health, the authors said.

In the video game “Re-Mission,” for instance, child cancer patients can control a tiny robot that shoots cancer cells, overcomes bacterial infections and manages nausea and other barriers to adhering to treatments.

A 2008 international study in 34 medical centers found significantly greater adherence to treatment and cancer-related knowledge among children who played “Re-Mission” compared to children who played a different computer game.

“It is this same kind of transformation, based on the foundational principle of play, that we suggest has the potential to transform the field of mental health,” Granic said.

“This is especially true because engaging children and youth is one of the most challenging tasks clinicians face.”

The authors recommended that teams of psychologists, clinicians and game designers work together to develop approaches to mental health care that integrate video game playing with traditional therapy.

Source: American Psychological Association

by TRACI PEDERSEN Associate News Editor
Reviewed by John M. Grohol, Psy.D. on August 18, 2013

Children who have frequent stomach aches are more likely to suffer from anxiety and depression as adults, according to a new study.

Researchers evaluated about 330 children with functional abdominal pain syndrome (FAPS) — abdominal pain with no specific cause — and compared them with 150 children without stomachaches.

Later psychiatric evaluations (conducted an average of nine years later) revealed that the risk of developing an anxiety disorder was about four to five times higher in individuals who suffered from abdominal pain as a child.

The findings also suggest that children with abdominal pain have a greater risk of adult depression. In the study, 40 percent of adults who had abdominal pain as children had depression during their lifetime, compared with 16 percent of adults in the control group.

Approximately 50 percent of those who had FAPS as kids had social anxiety, phobias or other anxiety disorders while growing up or in adulthood, compared with about 20 percent of people without FAPS.

The findings suggest that anxiety should be taken into account when treating children who get frequent stomach aches, the researchers said.

“It’s not just that they are anxious because of the pain. We saw that once the abdominal pain went away, they still had clinically significant anxiety,” said study researcher Dr. Lynn Walker, professor of pediatrics at Vanderbilt University in Nashville.

“We need to address the pain and anxiety together, and help kids cope better with their discomfort,” Walker said.

Stomach aches are common in children, but some children who are otherwise healthy get “medically unexplained” stomach aches, sometimes several times a day. As children grow up, the pain usually diminishes, but it can still interfere with their normal lives, making it difficult to attend school or play with other kids.

“The children might be more likely to stay home, get behind school work and be no longer connected with their friends, which over time may create a lot of stress for them,” Walker said.

The unexplained stomach aches can be a source of stress for parents too, who may become too protective, triggering even more worry in the child that something may be wrong.

“Once the physician has done the proper evaluation, and says there’s really nothing seriously wrong here, then the parents should start behaving more like a coach, and encourage the children to continue their activities, instead of keeping them at home.”

The cause of FAPS is still unknown, but it is thought that the nervous system might play a role.

“It’s not that the pain is not real,” Walker said, but it might be that the brain doesn’t properly respond to the sensations coming from the gut.

“We have a natural ability to turn down the pain signal once whatever is wrong has healed, or if there’s nothing wrong. People who are anxious have more difficulty turning off the alarm system,” she said.

Study participants experienced both anxiety and abdominal pain early in childhood, and the researchers could not identify which came first. Perhaps some children are genetically predisposed to have both anxiety and a hypersensitivity to pain, they said.

Another possibility is that a stomachache could trigger stress in some children, which in turn makes them more observant and attentive to minor discomforts, therefore feeding into a vicious cycle, Walker said.

“We think that chronic pain is better treated in a multidisciplinary fashion, in which you not only have to look for a disease, but you also look at emotional and psychological aspects of it, and address all of those together in an integrated fashion,” she said.

Source: Pediatrics

By RICK NAUERT PHD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on November 25, 2013
Spanking apparently can have an unintended effect from what a parent has in mind; in fact, just the opposite.

Emerging research suggests university students who were spanked as children are more likely to engage in criminal behavior.

University of New Hampshire’s Murray Straus, Ph.D., considered one of the foremost researchers on corporal punishment, also found that even young adults whose parents were generally loving and helpful as they were growing up, showed higher rates of criminal behavior.

“The results show that spanking is associated with an increase in subsequent misbehavior, which is the opposite of what almost everyone believes.

“These results are consistent with a large number of high quality peer-reviewed studies,” Straus said.

Straus looked at criminality trends of university students in 15 countries using nine measures of criminality.

The measures are criminal beliefs, antisocial personality, father assaulted by child in previous year, mother assaulted by child in previous year, physical assault of partner in previous year, severe physical assault of partner in previous year, physically injured partner in previous year, attacked someone intending to seriously injure them, and stolen money from anyone, including family.

The 15 countries in the study are Hong Kong, Taiwan, Belgium, Greece, Italy, Norway, Poland, Russia, Scotland, Slovenia, Spain, Switzerland, Israel, Canada and the United States. Straus took into account the influence of such factors as parental education, misbehavior as a child, loving and positive approach to correcting misbehavior, student gender, student age, and nation.

One of the most interesting findings was related to the effect of parents who took a loving and positive approach but who also spanked their children.

“So many parents and child psychologists believe that if spanking is done by loving and helpful parents, it has no harmful effect,” Straus said.

“This study and only one other study I know of that empirically investigated this belief found that it is not true. Spanking seems to be associated with an increased probability of subsequent child behavior problems regardless of culture and, regardless of whether it done by loving and helpful parents.”

“Children need lots guidance and correction, but not by being physically attacked under the euphemism of ‘spanking,’ ” Straus said.

Straus found that positive parenting decreased the probability of subsequent crime but mainly for nonfamily crime. And even though positive parenting was associated with less crime by students, the relation of spanking to crime remained for all nine aspects of crime.

“Most people will find these results hard to understand because parents spank to correct misbehavior and to teach the child to be law-abiding citizens,” Straus said.

Straus also investigated the criminal behavior of university students who were spanked just by their fathers, just by their mothers, or by both parents.

He found that university students who were spanked by both parents are associated with the greatest increase in criminality for eight of the nine criminality measures.

In most of the 15 nations, two-thirds of university students said they were hit when they were age 10, and among those who were hit, they said it typically was between once and twice a week. If university students were hit by only one parent, more often than not the mother was the parent carrying out the punishment.

Straus’ findings are based on data from the International Parenting Study of 15 nations and 11,408 university students.

Source: University of New Hampshire

By SAMUEL LÓPEZ DE VICTORIA, PH.D.

At the core of extreme narcissism is egotistical preoccupation with self, personal preferences, aspirations, needs, success, and how he/she is perceived by others. Some amount of basic narcissism is healthy, of course, but this type of narcissism is better termed as responsibly taking care of oneself. It is what I would call “normal” or “healthy” narcissism.

Extreme narcissists tend to be persons who move towards eventually cutting others off and becoming emotionally isolated. There are all types of levels on that road to isolation. Narcissists come in all shapes, sizes, and degrees. I would like to address how a person becomes an extreme narcissist.

Narcissism, in lay terms, basically means that a person is totally absorbed in self. The extreme narcissist is the center of his own universe. To an extreme narcissist, people are things to be used. It usually starts with a significant emotional wound or a series of them culminating in a major trauma of separation/attachment. No matter how socially skilled an extreme narcissist is, he has a major attachment dysfunction. The extreme narcissist is frozen in childhood. He became emotionally stuck at the time of his major trauma of separation/attachment.

In my work with extreme narcissist patients I have found that their emotional age and maturity corresponds to the age they experienced their major trauma. This trauma was devastating to the point it almost killed that person emotionally. The pain never was totally gone and the bleeding was continuous. In order to survive, this child had to construct a protective barrier that insulates him/her from the external world of people. He generalized that all people are harmful and cannot be trusted.

The protective insulation barrier he constructed is called a false persona. He created a false identity. This identity is not the true person inside. The many types of false personas or identities that an extreme narcissist creates can vary.

Some narcissists may have the ability to change into a variety of identities according to the situation. The wounded child inside may choose to present a front as a “bad ass” and tough individual. He may look, by appearance, intimidating and scary to the average person. He could also play the “nice guy/person” whom everyone likes. A corporate type version can be one that is diplomatic, proper, and appearing to care but in reality does not. Another very likeable extreme narcissist can be the one that chooses the comedian role. He is the life of the party and has everyone in stitches, making them laugh constantly. Everyone wants to include this person because they are a lot of fun.

Try to get close or ask personal questions as to how he is internally doing and feeling and you will find is that he will quickly distract you. They will sidestep the question with another joke, making you suddenly forget what you were asking. Narcissists can be very skilled at dodging and ducking personal questions. If you press them, they will then slot you as “unsafe” and will begin to avoid you and exclude you from their life.

There is also the success oriented narcissist. She will be your friend and keep you close to her as long as you are useful. Once you do not have anything more to offer and she has taken all they wanted from you, you are history. You are no longer desired, wanted, or sought.

I remember a significant half dozen of these in my life. One narcissist in particular avoids me like the plague because he knows that I do not ultimately plan my life around whether people like me or not. Hence my behavior cannot be controlled by him. He is threatened by my self-assuredness. I’m not safe to him. It does not matter that I have helped him in critical moments of his life. When he realized that he could not control me to make him look good when I was with him, he dropped me like a heavy weight. I received no more phone calls and was taken off his radar screen.

Another extreme narcissist stopped calling me when I got my Ph.D. I believe that, in his insecurity, he could no longer look “better” than me and be the focal person. As a result, he felt threatened that I had a more powerful image than he did. I think it is silly because I do not care about whether people have degrees to validate their intrinsic value as a human being.

In my ministerial past, I have had several colleagues that I considered to be like blood brothers. We had sworn honesty and loyalty to each other. Once I opened up my weaknesses to them and then asked them to reciprocate, they looked for excuses to label me and reject me. The more I pressed them about their lack of being forthcoming and failing at their own promise of commitment to the friendship, the more vehement they became at avoiding disclosure of their warts to me. Of course, I already knew many of their flaws and already had no problem accepting them. Now it was their turn and they shut down and put up the thick wall.

This is what genuine narcissists do. This is sad but it happens all the time with individuals that are scared to go down the road to becoming whole and healthy. It is like going under the knife of a surgeon. When there is a legitimate organic threat as with a malignant tumor, it can be hard to submit to the truth and then the treatment. This, however, is a door to a better life.

Is there hope for an extreme narcissist living in an emotional and relational fort of isolation. Is a narcissist able to have a healthy life? Definitely! I’ve seen many extreme narcissists become extremely healthy in their emotional and relational life. The first step is to find competent and safe help that knows how to heal emotional traumas. Just because a counselor may have all kinds of credentials it does not mean they are competent in dealing effectively with trauma issues. Because extreme narcissists tend to have an early history of emotional wounds they are full of distrust. If they can get past this hurdle then they can begin to find help to heal.

Second, extreme narcissists have to be willing to enter the realm of their feelings again. They have been the masters of covering and hiding, even to themselves. They now have to start uncovering painful wounds. They have taught themselves to stuff and disconnect their own feelings for years. Because of this, they tend to live inside their heads, in the realm of so called reason. They are likely to live in the world of rational principles, laws, rules, which are all linear. This domain is a realm they feel they can control. It is devoid of feelings. The realm of the heart or feelings is very intimidating and unsafe to them because it is non-linear and there is very little control of the outcomes. If extreme narcissists can overcome these two hurdles then there is much hope for them. They are on their road to healing.

Sitcoms, as well as movies, poke fun at PMS (Premenstrual Syndrome) and female moodiness, but PMDD is not a laughing matter.

PMDD (Premenstrual Dysphoric Disorder) is a major depressive disorder gaining more attention since its official inclusion in the latest version of the Diagnostic and Statistic Manual of Mental Disorders (it had previously been listed as a disorder needing further research).

PMDD is a mental illness that involves mood changes occurring exclusively during the two weeks prior to menses.

Over 80 percent of women experience some level of physical and emotional problems during this time, but only 3 to 8 percent meet the definition of PMDD. It is most commonly seen in women who are in their late 30s through their mid 40s.

PMDD symptoms mimic symptoms of major depression with the most common feeling reported being irritability, but unlike depression they are accompanied with breast pain and bloating. Women suffering from PMDD also have an increased risk of suicide during the two weeks they are affected. Also, unlike major depression, it is relieved once menses begins. During this two-week period other symptoms are experienced as well, including the following:

Anxiety and a feeling of being on edge.
Severe mood swings up and down with tears, extreme sensitivity to abandonment, and rejection.
Anger and increased conflict.
Decreased interest in usual activities.
Feelings of being overwhelmed as well as feeling out of control.
Physical symptoms, including joint and muscle pain, as well as weight gain and headaches.
Diagnosing PMDD requires a complete history from the patient. The symptoms must occur only during the two weeks prior to menses for at least two consecutive cycles. It does not classify as PMDD when it happens in conjunction with another illness. Risks and prognostic factors in the DSM V lists two main areas:

Environmental: situations that accompany PMDD are stress, a history of interpersonal trauma, seasonal changes, and socio-cultural; meaning women are affected, not men.

Genetic: It is unknown if PMDD is hereditary, but we do know that premenstrual symptoms are. Between 30%-80% of women who suffered from PMS said other women in their family suffered as well.

If you or someone you love suffers from PMDD, the following suggestions may help relieve the symptoms of depression.

Exercise helps to relieve the anxiety and depression.
Dietary changes may help as well, especially eliminating caffeine, alcohol and consuming less salty foods.
Anti-depressants, as well as anti-anxiety medications prescribed by your doctor; help minimize the depression and anxiety.
Cognitive behavioral therapy can help by teaching healthy ways to manage anger, frustration, stress, and irritability.
Seeing your health care provider is important if you suffer from this disease. They help validate that what you have is a real condition, and also will help you feel better with medications and referrals to other health care professionals to improve your quality of life. Suffering in silence or telling yourself what you’re feeling is all in your head is never the best way to advocate for yourself.
PMDD is a mental health issue that women and the men who love them should be aware of. Hormones affect many body functions, and if you’ve noticed that your personality changes two weeks prior to your menses making life and your relationships deteriorate, it’s time to make an appointment with your doctor. Allowing two weeks of each month of your life (and those who love you or work with you) to be chaotic and traumatized by how you feel is not acceptable.

A marriage succeeds when each of us realizes that our spouse’s needs are at least as important as our own….

Joey is a seven year old referred by his pediatrician because he has difficulty paying attention in school. His mind wanders, he responds to his teacher’s questions in class with “What, I don’t know,” and he is a bit self-conscious about his declining grades. Joey is a super sweet little boy, he does not squirm in his seat, bother other kids or anger the teacher. She simply wonders, “Why is he always day-dreaming?”

The answer, as pediatric neuropsychologist Dr. Paul Beljan may be, “Joey’s boss is out.” Here’s a useful audio ADHD and Executive Function: When the boss is out on the boss in Joey’s brain.

Joey’s boss resides in the frontal lobes of the brain. His boss is in charge of the executive functions that help him to preview, plan, think, inhibit, organize and execute tasks of daily living. I call this area of the brain “The Thinker.” You can read all about The Caveman and The Thinker here The Family Coach Method.

Another helpful book on EF is Executive Skills in Children and Adolescents, Second Edition: A Practical Guide to Assessment and Intervention.

It’s also possible that day-dreaming may be beneficial.
1. Daydreaming may be a sign of creativity.

2. Daydreaming may be a signal that your child is looking for more stimulating or interesting things to think about.

3. Both inward reflection and outward attention are important, the skill is when to use which one.

4. The brain gets tired and occasionally needs a break for refueling, daydreaming can be like a little cat-nap for the brain.

5. Daydreaming may be the moment before a burst of cognitive energy is expended.

What do you observe in your children? Is daydreaming a sign of lack of attention or focus or might it actually be useful? Let us know @drlynnekenney

By Dr. Jennifer Howard

If we will be quiet and ready enough, we shall find compensation in every disappointment. -Henry David Thoreau

Have you ever noticed that before spring arrives, a few gorgeous days trick us into thinking it’s finally here? Blue skies and higher temperatures lure us into believing winter is finally over, until dismal, gray weather descends upon us again. We feel fooled every time, and for some of us it’s always a little disappointing, but we know eventually those spring days will roll us right into summer.

Disappointment is a part of life, although people may express it differently and for different reasons. We all have moments of feeling bummed about something, from an incident as small as missing dinner with a friend to very serious loss. Some of us try to avoid it, and by doing that we can miss some of the richness of life. Yes, we have a say in how our lives go, but whether we like it or not, people die, jobs don’t work out and relationships end.

We run into trouble when we don’t identify the ways we avoid disappointment. We might be afraid to face what’s there, or we just don’t have the skills to deal with our feelings when life hands us something we don’t want. In our efforts to avoid disappointment, we might deny some of our feelings; avoid pursuing our goals, or falling in love.

I’ve noticed lately that many parents try to shield children from any disappointment. Some sports teams for young kids make sure that both sides “win,” and no one loses. It’s great to participate in sports as in life, but we do them a grave disservice if they don’t learn to deal with disappointment. One day their boss might give a promotion to the person in the next cubicle, and then what? Learning how to manage these early experiences of disappointment allows us to develop inner strength. It helps us build resilience helping us deal with the bigger disappointments down the road.

Even though we know we can’t eliminate disappointment altogether, we can learn to manage it and see the possibilities on the other side. Here are 7 ways to deal with disappointing experiences:

1. Remember, disappointment is inherent in life. It’s a natural aspect of living. If you believe you shouldn’t feel disappointed, you’re not being realistic and you’re creating unnecessary stress.
2. Allow yourself to experience it. Rather than avoiding or trying to bypass your disappointment, allow yourself to experience it. When you embrace the experience, you can move beyond it faster and more completely. Sit with it a while or talk it out with a friend. Write down your thoughts about the entire experience.
3. Look for the feelings underneath it. Many feelings will accompany the disappointing experience. There might be sadness, anger, embarrassment, or grief. You might worry you’re missing out on something. Identifying, acknowledging, and experiencing the other emotions you have allows you to process and move through whatever’s there. Remember, once you’ve accepted and allowed them to pass, you’ll feel much happier and lighter.
4. See it as your teacher. Sometimes we aren’t clear about our desires until we’re blasted with disappointment. If that job didn’t pan out, for example, was it really the work you wanted most? What qualities would you want in the next one? Disappointment can help us hone in on what we really want to create in our lives. Use the difficulties as a support to help you grow.
5. Sometimes one door closes, and another opens. Rather than viewing your disappointment as a firm ‘no’ and rejection by the world, remember another, better avenue may reveal itself to you. Sometimes not getting what you want leads to something you want more.
6. Look at your expectations. You may have limiting ideas and beliefs operating as unconscious expectations. When something runs counter to this unconscious belief, you’re disappointed. Look at what you were expecting to happen or not happen. Was it realistic? It’s fine to have desires, but they need to be flexible. If we hold life rigidly, believing it has to be a certain way, we’re ripe for disappointment.
7. This, too, will pass. Life isn’t linear; it’s not an orderly sequence of events. Rather, it spirals and it’s not tidy. Sometimes it doesn’t seem to make any sense. As you release your need for life to go a certain way, it becomes much easier. When you’re aligned with your True Self, life gives you more green lights.

How have you experienced disappointment in your life? What did you do?

http://www.drjenniferhoward.com/blog/Happiness/Seven-Good-Ways-to-Manage-Disappointment.asp

I am an educator and I’m currently working with a kindergartner with what could best be described as extreme ADHD. She is currently on Ritalin, which has allowed her to increase her attention span. However, it seems the medication makes her moody, tired and melancholy. Ritalin also seems to greatly alter her personality. She seems almost depressed when she is on the drug. Are there any interventions that would be helpful in such a case? Her parents seem receptive to advice and would really love to help this little girl.

We certainly can’t offer diagnoses or treatment recommendations from such a distance, but can offer some general information in response to your observations, questions and concerns that will no doubt resonate with educators and parents across the country.

Because there still is no definitive objective test for diagnosing Attention Deficit Hyperactivity Disorder (ADHD), doctors making this diagnosis must rely on careful observation of children’s behavior in their offices as well as thorough reports from teachers and parents.

ADHD is probably over-diagnosed in some settings, and under-diagnosed in others, but either way, there is clearly room for error. There is good evidence that stimulant medication is an effective treatment for ADHD, but when it is not, it is important to go back to the drawing board to be sure that ADHD is the correct diagnosis, and whether or not it is the only one.

Many children are very, very active without tipping over into hyperactivity. This distinction can be difficult to make unless the hyperactivity is truly extreme.

In young children, there is a wide range in the ability to sit still and concentrate in the classroom setting, and indeed, we are asking more and more compliance with traditional academic demands at earlier and earlier ages, despite the fact that there is no reason to believe that children’s capacities to handle these have started developing at earlier ages. (In fact, there may be some conditions in our world today that make it harder for some children to attend and focus. For example, one study found a correlation between long hours of television watching in children under age 3 with symptoms of attention difficulties at age 7, although a cause and effect link could not be made by the researchers.)

Excessive physical activity, fidgeting and restlessness, trouble concentrating, being easily distracted and impulsive behavior all are symptoms of ADHD. Yet they also can be more general signs of distress in young children. Just as fever suggests an infection without telling us what the cause of the infection is, these behaviors in young children may signal a range of other conditions, including anxiety, a mood disorder or even post traumatic stress in a child who has been abused or traumatized in some other way.

Stimulants such as Ritalin (methylphenidate) can bring about clear improvements, noticeably increasing attention and concentration, and decreasing hyperactivity. Sometimes, though, a child does begin to appear down, or even depressed when taking these medications. They can interfere with sleep, which might also be a cause for sleepiness and moodiness during the day. A switch to a different preparation (short or long-acting, for example) or kind of stimulant (dexedrine, for example, rather than methylphenidate) sometimes can help with either of these side effects, although there are some children who just won’t be able to tolerate these medications. If the Ritalin is stopped and the melancholy moodiness continues, there may be another problem that needs careful assessment. If parents express concerns that line up with yours, they may accept your suggestion to turn to a child psychiatrist, if they haven’t done so already, to address these specific questions about possible side effects, other treatment options and diagnostic reassessment.

While there now are studies that show that medication alone can be more effective than cognitive-behavioral treatments alone for ADHD, there are also a number of other measures to try that may be helpful. In the classroom, a child who is easily distracted and has trouble attending should be seated close to the teacher, and positioned so that all of the other children wiggling and jiggling are out of her line of sight. This must be done without making her feel singled out or humiliated – self-esteem all too often suffers in children with ADHD. It is also helpful to give such children regular, gentle reminders to tune back in again: The teacher can work out a private signal with the child that helps the child to feel special and valued rather than to stand out as the “trouble” child.

Reminders and disciplines should be framed positively and with hope, since these children often need so many that they will soon tune out anything that sounds like nagging to protect themselves from feeling worse and worse about themselves.

Special chores that allow them to work off steam, like getting up to sharpen the pencils, or pass out supplies, or to deliver the attendance list to the principal’s office can also help honor such children’s need for extra activity. These children often need frequent encouragement, praise and rewards, as it can be as hard for them to sustain their own motivation and keep themselves on track independently.

Careful and respectful back and forth sharing between parents and teachers can help create a more seamless experience of rewards and reminders for the child as she adapts each day to transitions between school and home. The long-term goal is for the child to understand and accept herself so that she can become increasingly independent in coping with and overcoming her challenges. For parents and teachers to help with this, they too will need to understand and accept.

For more information:

Children and Adults with Attention Deficit/Hyperactivity Disorder www.chadd.org

The American Academy of Child and Adolescent Psychiatry’s website at www.aacap.org

– See more at: http://families.naeyc.org/families-today/whats-best-kindergartner-adhd#sthash.t3aIM5wz.dpuf

By ALEXANDRA KATEHAKIS, MFT, CST, CSAT

In my work with partners of sex addicts, I always want to look at the role that anger has played for the partner.

Anger is a normal response to the traumatic experience of having been betrayed by your mate.

But it can also be a feeling that is difficult to tolerate. Some people dive into anger fully, while others avoid experiencing feelings of rage, and sometimes, people are afraid of their own angry feelings.

As a force, anger can be put to positive and constructive uses, and it can also be very destructive.

An important piece regarding anger is the acknowledgement of the emotion. Being in touch with your feelings and identifying that you are angry is crucial toward this process of releasing the anger. This is followed by an examination of the underlying issues.

Some have an easier time expressing anger. But the anger can become out of control, and we may find ourselves engaging in explosive, irrational behaviors that we later may regret.

Others fear expressing anger and avoid it. Perhaps they fear losing control. Regardless, if anger is not appropriately acknowledged and expressed, it can be turned inward, and there is a risk of engaging in self-defeating or self-destructive behaviors, such as blaming oneself for others’ inappropriate or hurtful behaviors or actions.

Anger in and of itself often is a coverup for other painful feelings, such as embarrassment, shame, humiliation, fear and sadness. When not expressed in a healthy way, anger can come out “sideways” as being distant, expressing sarcasm, or creating ruminative thoughts and fantasies about the object of one’s anger having bad things happen to them.

Sideways anger often simmers just beneath the surface and can be very vengeful and destructive. While the revenge may provide fleeting moments of satisfaction, indirectly expressing anger can lessen one’s self-esteem and self-worth.

Some helpful techniques to deal with anger are: journaling or writing down emotions; engaging in exercise or physical activity; calling a trusted friend; and talking about the feelings of anger openly. It’s important to be able to sit with the anger, and not brush it under the rug or ignore it.

At the same time, healthful expression of anger means knowing we are angry. Make the choice to examine what the consequences of acting out in anger are prior to engaging in hurtful behaviors that could potentially damage our relationships and self-esteem.

Anger can be positive. It can protect us from threats, and mobilize us to act. Anger also can be negative. It can create more chaos and destruction, and keep us in toxic cycles of retaliatory behaviors. Learning how to harness our feelings of anger through acknowledgment, validation, and integration of positive coping tools is crucial to keeping our lives in balance.

Even as the rate of diagnosis has reached 11 percent among American children aged 4 to 17, neuroscientists are still trying to understand attention deficit hyperactivity disorder (ADHD). One classic symptom is impulsivity – the tendency to act before thinking.

Scientifically, impulsivity can appear as a choice for a small but immediate reward over a larger one that requires some delay. Choosing between present and future rewards is a fundamental need in schooling, says Luis Populin, associate professor of neuroscience at University of Wisconsin-Madison. “If you say to an impulsive child, ‘Do your homework so you will get a good grade at the end of the quarter,’ that has less appeal than ‘Let’s play baseball this afternoon instead of studying chemistry.'”

To study impulsive behavior, Populin and graduate student Abigail Zdrale Rajala selected two rhesus macaque monkeys with opposite behaviors. One was extremely calm, while the other was nervous, fidgety and impulsive. The monkeys were trained to stare at a dot on a screen and, when it went dark, to choose between two pictures placed to the side. Their choice of picture determined whether they got a small but immediate sip of water, or a larger sip, after a delay ranging up to 16 seconds.

As expected, the calm monkey, but not the impulsive one, quickly figured out that waiting would bring the sweeter result.

This willingness to take a smaller reward right away rather than a larger, delayed reward, called “temporal discounting,” is a common feature of “combined type” ADHD, which specifically lists impulsivity among its diagnostic criteria, Populin says.

When the monkeys were given a dose of methylphenidate, the active ingredient of the common ADHD drug Ritalin, they chose the delayed reward more frequently. The impulsive monkey actually showed the same preference for delayed rewards as the unmedicated, calm monkey. However, identifiable differences in their performance mean that methylphenidate improved the condition, but did not eliminate it.

“There is no perfect animal model of ADHD,” says Rajala, “but many studies are performed on rodents; this one was done in a non-human primate, which is much closer to humans.” The Society for Neuroscience adjudged the paper valuable enough to support Rajala’s travel to the conference in San Diego.

Methylphenidate changes the elimination of dopamine, a “reward” neurotransmitter that is elevated by drugs like cocaine and amphetamine. The result is that more dopamine remains in the brain, which is the most likely explanation for the altered reward processing in the medicated monkeys.

Some scientists have thought that temporal discounting in ADHD may result from cognitive processing, which relies on the highly evolved frontal cortex in the brain. The new results support an alternative, but less common, hypothesis: that temporal discounting is linked to the reward-processing mechanism, which is governed by more primitive parts of the brain.

By teasing apart one characteristic of ADHD, the study could help refine drug or behavioral treatments of a disability that has grown 16 percent more common just since 2007, Populin says.

Sexting, bullying and getting round security settings… young people tell Olivia Gordon what really happens on the internet

Cal Davies, 16: ‘Most of my friends who have had ask.fm have received a question saying, “Why are you so ugly?” or, “When are you going to kill yourself?”‘ Photograph: Laura Pannack for the Guardian
Thirty years ago, children were taught never to accept sweets from strangers, but the equivalent modern message, about staying safe online, doesn’t seem to be getting through. For all its positives, the online world is full of potential hazards to young people. Sexting, bullying and sexual approaches from strangers are online dangers modern teenagers routinely face. And adults’ knowledge of what young people are doing online is often vague and complacent.

Nearly half of British children now have online access in their bedrooms, while a quarter of 12- to 15-year-olds owns a tablet of their own. The number of this age group using smartphones to send, receive and post photos online has risen significantly in the past year, and Ofcom points out that children’s online safety skills have failed to rise at the same rate, with particular risks coming from the lack of privacy on social networking sites. Most parents of five- to 15-year-olds believe they know enough about the internet to keep their children safe, but, according to research by internet security system McAfee in 2012, four-fifths of teenagers say they know how to hide their online behaviour from parents.

Some parents feel their only recourse is to restrict internet access, but James Diamond, of parenting and technology website Quib.ly, says: “A big reason that children don’t tell parents about abuse is that the default reaction of parents is to take the internet away from them.”

Internet safety needs to be taught, with specific ground rules and open communication between generations. Parents need to know that the dark side of the online world can’t be avoided – if they have teenage children, it is almost certainly already in their lives.

Now let the kids tell you what they really do online:
http://www.theguardian.com/society/2013/nov/09/children-online-sexting-bullying-security-settings?CMP=twt_gu

Published on March 20, 2013 by Peggy Drexler, Ph.D. in Our Gender, Ourselves

Eight-year-old Henry lied about everything. It absolutely infuriated his mother, Sophie, if mostly because she couldn’t figure out why he was doing it. Some of the lies she understood, as they’d clearly been issued to avoid mild trouble or reprimand, like the lies about whether he’d made his bed or eaten his lunch. But he’d also tell very obvious lies from which he had nothing to gain, like that it was sunny outside when it wasn’t, or that 2 plus 2 was 5. What bothered Sophie most about the lies was how adamantly Henry would insist they weren’t lies, even as Sophie pointed out the rain pouring down outside. “It’s not like I’d have preferred if he was a good liar,” Sophie told me, “but it was confusing that he chose to lie about things he a) didn’t need to lie about and b) that were so easy to call him out on. I’d be like, you’re eight. You know that 2 plus 2 is 4. You can see it’s raining outside. You can’t even defend these lies a little bit. Why are you telling them?”

It’s entirely normal for kids to experiment with lying, starting at an early age — sometimes as early as two — and escalating until 12, the age of greatest deceit, according to various studies conducted by Canadian researcher Kang Lee. Some lying is “healthy” lying — fantasy and imagination at work, like a four-year-old’s lie about her teddy bear telling her a secret. Other lies are “white lies” told to benefit another or to avoid hurting someone’s feelings, and which tend to start around age six. Most lies kids — and, for that matter, adults — tell are more self-serving, however, and told to avoid trouble or punishment, look better in the eyes of others, or get (or get away with) something. This sort of lie from a three-year-old might come out as “someone else” spilling the apple juice on the living room rug. A 10-year-old who’s insecure about his math abilities might lie about having already done his math homework.

This sort of lie can also show up, especially in boys, as mischief making. Seven-year-old Bobby always wanted to know “what would happen” if he threw a tennis ball against the house. He waited until his parents were out to tell the babysitter that “Mom lets me do it.” He was so insistent, and confident, that the babysitter acquiesced. Later that day, Bobby’s mom, Kathy, returned home to find the garage door window shattered in pieces on the driveway. “I suppose now he knew what would happen if you throw a ball against the house,” said Kathy. “But then again, he probably always knew.” What Bobby had done was use lying to get what he wanted, while also, in his mind, having the ability to “blame” the babysitter for allowing him to do it.

And then there are those kids who tell lies just for kicks, seemingly without anything to gain. In the case of Henry, for instance, insisting that 2 plus 2 was 5 was something he said just because he could; just, Sophie suspected, to see what might happen. Some studies suggest that children with better cognitive abilities tend to lie more, since lying requires first keeping the truth in mind and then manipulating that information. The ability to lie successfully — something that Henry had not yet learned how to do, though Sophie got the sense he was definitely working his way up to that — requires even more in the way of thinking and reasoning. Lying proficiency has also been linked to good social skills later on, in adolescence.

That doesn’t mean such lies, or any lies kids tell, should go unacknowledged. It’s important to raise children to value honesty, and to prevent lying from becoming frequent and consistent, the point at which lying is most troublesome. The first step in figuring out how to address a lie is to consider why your child is telling it. Is the child trying to avoid trouble? Save face? Is he old enough to understand that lying is wrong? A three-year-old who won’t cop to coloring on the wall knows that wall coloring is bad, but may not quite understand that lying about it isn’t. In such a case, instead of threatening him with punishment, teach him about the value of things.

Gently point out that you think he may know more than he is letting on, and then thank and praise him if he comes clean. This can foster more truth-telling in the future. What’s more, in younger and older kids, don’t set them up to lie. If you know a child has spilled milk on the living room rug because you saw it happen, don’t ask her if she spilled milk on the rug. Instead, ask her why it happened. If you know your 16-year-old has been smoking because you found cigarettes in his car, don’t ask him if he’s smoking. Ask him when he started.

In all cases, when talking to kids about lying, express your displeasure. Be explicit that it’s wrong to lie, and explain why. Make it clear that lying diminishes trust, and that the more frequently he lies, the harder it becomes to believe him when he’s telling the truth. Establish, and stick with, consequences for lying; the more a child has gotten away with lying, the more likely he is to continue. Try to head lying off at the pass: If you sense a lie is coming, say, “It makes me happy when you tell me the truth.” And keep in mind yourself that lying is different from not sharing. This is particularly relevant as kids approach adolescence, when kids may be more reluctant to share information with you, but without necessarily lying. Allowing them to develop their own sense of independence — that is, resisting the need to know everything — and being confident in their decision-making will reduce the likelihood that they’ll lie to you about the things that really matter.

And above all, with kids of any age, help encourage the notion of truth telling by practicing it yourself. Most adults issue “harmless” lies all day long, within earshot of children. Maybe that’s a lie about a kid’s age to get a break on tickets to a soccer game. Or telling someone who calls that you can’t talk because you’re running out the door, when you’re about to sit down to watch a movie. Keep in mind that kids, especially those under 10, often can’t tell the difference between small lies and big ones. They just know it’s happening. And that lying is a learned — but changeable — behavior. The more they’re conditioned to hearing lies, the more they’ll think they’re a normal part of behavior, and vice versa. Which means the biggest truth of all is that raising honest kids starts with you.

Peggy Drexler, Ph.D. is a research psychologist, Assistant Professor of Psychology at Weill Medical College, Cornell University and author of two books about modern families and the children they produce. Follow Peggy on Twitter and Facebook and learn more about Peggy at www.peggydrexler.com

By JANICE WOOD Associate News Editor
Reviewed by John M. Grohol, Psy.D. on November 9, 2013
A new study has found that people experiencing a depressive episode process information about themselves differently than people who are not depressed.

Using functional magnetic resonance imaging (fMRI), researchers at the University of Liverpool scanned the brains of people in major depressive episodes and those who weren’t. The task subjects were given while in the fMRI machine was to choose adjectives to describe themselves or the British Queen — a figure significantly removed from their daily lives that all but one of the participants were familiar with.

“We found that participants who were experiencing depressed mood chose significantly fewer positive words and more negative and neutral words to describe themselves, in comparison to participants who were not depressed,” said Professor Peter Kinderman, head of the university’s Institute of Psychology, Health and Society.

“That’s not too surprising, but the brain scans also revealed significantly greater blood oxygen levels in the medial superior frontal cortex — the area associated with processing self-related information — when the depressed participants were making judgments about themselves.”

The research leads the way for further studies into the psychological and neural processes that accompany depressed mood, he continued.

“Understanding more about how people evaluate themselves when they are depressed and how neural processes are involved could lead to improved understanding and care,” he said.

“This study explored ways to consolidate some of the differences between medical and psychological models of depression,” added Dr. May Sarsam, from the Mersey Care NHS Trust.

“It showed that brain activity only differed when depressed people thought about themselves, not when they thought about the Queen or when they made other types of judgments, which fits very well with the current psychological theory.”

“Thought and neurochemistry should be considered as equally important in our understanding of mental health difficulties such as depression,” she added.

The research, in collaboration with the Mersey Care NHS Trust and the Universities of Manchester, Edinburgh and Lancaster, was published in PLOS One.

Feb. 12, 2013 — Understanding the relationship between narcissism and envy may provide some insight into sudden outbursts of aggressive behavior. Narcissism has long been associated with envy in the field of psychology, but an Iowa State study provides new evidence about that connection.

Zlatan Krizan, assistant professor of psychology at Iowa State University, said his research shows most narcissists, because of their inflated sense of superiority, are not likely to feel envy.
“They really buy into their own fantasy,” Krizan said. “If you think you’re the greatest, it makes sense that you wouldn’t envy others because everybody is beneath you, so there’s nothing to envy. It’s really the vulnerability that predicts envy and it predicts it very, very strongly.”
The study, published in the Journal of Personality, disputes existing theories that suggest envy is a core characteristic for those who are self-absorbed, arrogant and exploitive. Krizan said his work helps to better define the different dimensions of narcissism — what psychologists refer to as grandiose and vulnerable narcissism. Those who are more vulnerable show stronger feelings of envy.
“Narcissism is a more multi-faceted construct than we believe,” Krizan said. “I think that’s an important point, because this public image of narcissism that most people have of this grandiose, dramatic individual is only one side of the coin.”
Krizan and Omesh Johar, a graduate student at Iowa State, surveyed nearly 200 undergraduate students and more than 150 adults to identify their feelings of envy and the frequency. Those identified as vulnerable had low self-esteem, were often distraught, anxious and depressed.
“These individuals still think they’re special, entitled, and they want to be great, but they just can’t do it,” Krizan said. “As a result they’re vulnerable, their self-esteem fluctuates a lot, they tend to be self-conscious and not very proactive, but passive, shy, and introverted.”
When the feeling of envy is added to the mix, Krizan said it can be a potentially dangerous combination. Though vulnerable narcissists are not as overt in their behavior, they may be more prone to unexpected outbursts of aggression.
“It’s these vulnerable individuals who are in some sense more worrisome because they are quiet, sort of festering in anger out there in a corner. And it’s just a matter of time before they get frustrated and lash out and verbally assault somebody, maybe even an innocent party, because of some provocation that they felt,” Krizan said.
This becomes a concern when that anger turns to violence. Krizan said the Columbine school shooting in 1999 is an example in which narcissism and envy were possible motivating factors. He points to the videotapes left behind by the two shooters as evidence.
“If you look at evidence that is often left over, in Columbine for example you had those videos, these shooting escapades seem to be a kind of power grab by these individuals,” Krizan said. “The tapes are also narratives, in which they are the person taking control, they’re the one in charge and they will determine how things will go.”
It is important to note that there is always a combination of factors that contribute to the violence in these extreme cases. However, Krizan said understanding how envy and narcissism are related will help in the diagnosis and definition of narcissistic personality disorder and its antisocial consequences.

By Aurora Winter

Grief is the loss of hopes and dreams. It can be triggered by a death, divorce, breakup, job loss, special needs child, a parent with dementia, or other heartbreaking challenges. After my husband died suddenly, many people reassured me, “It just takes time.”

But the truth is, if you wait for time alone to heal you, healing grief can take years.

After coaching many people through grief, and training coaches at the Grief Coach Academy, I have seen that there are 3 keys to healing grief more rapidly and easily. Here’s what turns grief into growth:

Commitment
Action
Coaching
STEP 1: COMMITMENT

If your life is like a beautiful car, your commitment is the ignition. Without it, nothing happens. Will you choose to become bitter – or better? When you make a commitment to becoming better, you start the engine.

John F. Kennedy said, “The Chinese use two brush strokes to write the word crisis. One brush stroke stands for danger; the other for opportunity. In a crisis, be aware of the danger—but recognize the opportunity.”

Grief is a crisis. It is also an opportunity to grow, discover what truly matters, and contribute to the world.

Your life is a hero’s journey. Will you choose to be heroic and grow? A hero does not say at home in bed pitying himself or herself. A hero has grit and courage. A hero chooses to face his or her challenges.

Will you choose to be heroic and grow? Or become bitter and shrink? Make a commitment now.

STEP 2: ACTION

Your car is running—but it is still parked in the driveway. You need to put it in gear, and go somewhere. But where? And why?

These are important questions. Powerful questions help you discover what really matters to you, and why it matters. With that deeper understanding, you can drive to a meaningful destination. You can see the right actions to take, the right decisions to make, the right journey to take.

An action might be physical or mental. For example, it is an active choice to forgive. It is an active choice to contribute to others. It is an active choice to be here now. The right actions will transform your happiness, relationships, health, and life.

Growth is an ongoing process. It’s not something you do once, then never revisit. Growth is like a muscle. Use it or lose it. Take some action every day towards creating your life by design. That’s the key to success.

STEP 3: COACHING

No one can pull themselves out of a well. A good coach is like someone who shines a flashlight into the well. She lets you know you are not alone. She throws down a rope ladder and helps you climb out of grief step by step.

No one can see their own blind spots. As they say in AA, “your best thinking got you here.” Coaching can help you have breakthroughs you would not achieve on your own.

The word “coach” originally comes from “kosci,”which means “carriage” in Hungarian. A coach is someone you take a journey with. A coach is your expert companion. A good coach will ask you powerful questions, help you avoid the top 5 death-bed regrets, and help you heal and build a new life.

A good coach is solid, someone you can trust. A good coach is interested in understanding you—what motivates and inspires you, what you care about, your history, your challenges, your opportunities. A good coach is action-oriented, and will jump into coaching exercises that will shift or clarify your thinking and your actions. A good coach will challenge and stretch you with honesty and by holding you accountable to follow through on your commitments. A good coach is devoted to excellence and is continually growing and learning. A good coach is someone you respect and admire.

The difference between good and great is having a coach. Studies show that coaching dramatically improves your results, tripling the speed of your progress.

With the support of a properly-trained coach, people release heartbreak and grief with greater grace, speed, and ease.

In summary, don’t wait for time alone to heal your heartbreak or grief. Make a commitment, take action, and work with a coach or expert companion for optimal results.

By Elizabeth Shimer Bowers
Medically reviewed by Niya Jones MD, MPH

For many people, finding the right depression treatment is a trial-and-error process. “The largest study that looked at effectiveness of antidepressants, the STAR*D Report, found that only 37 percent of people experienced relief of their depression symptoms [known as remission] after trying one antidepressant,” says board-certified psychiatrist Joseph Hullett, MD, senior medical director for OptumHealth Behavioral Solutions in Minnesota. “And even after trying four different depression treatments, only 67 percent of people experienced remission.”

The odds can seem somewhat stacked against you as you search for the right depression medication. To improve your chances of finding the treatment that works best for you, look for these nine signs your antidepressant isn’t working, isn’t working well enough, or is no longer working like it should:

1. You feel better right away. “If you respond to an antidepressant very quickly, that’s actually a bad sign,” Dr. Hullett says . Antidepressants work by increasing and balancing feel-good neurochemicals in your brain, including serotonin, dopamine, and norepinephrine, a process that takes some time. Depression relief from an antidepressant usually takes two to 12 weeks to set in, with a peak at six to eight weeks . “So if you feel different immediately after starting a depression treatment, it’s either a side effect of the depression medication or a placebo effect,” Hullett says.

2. You experience no relief from depression symptoms after a few months. “You should see some improvement within three months of starting an antidepressant,” explains Zinia Thomas, MD, a psychiatrist at Spectrum Psychiatry in St. Louis, Mo. “If you have been on an adequate dose of a depression medication for three months, and you don’t get results, it’s probably time to try something new.”

3. You feel a sudden surge of energy — along with the blues. “If you feel more physical energy after starting an antidepressant, but you still have depression, that’s good and bad news,” says Gabriela Cora, MD, MBA, a psychiatrist in Miami. “It means the depression medication is starting to work, but not in the right way.” She says that increased physical energy combined with depression is a bad combination that can make you act out or increase your risk for suicide. “So report these symptoms to your doctor right away,” urges Cora.

4. You’re experiencing unpleasant side effects. “The largest study that looked at the effectiveness of antidepressants found that there are no marked differences — they all pretty much work the same,” Hullett says. That means deciding which depression medication to take may come down to side effects. If you gain weight or have sexual problems on one antidepressant, for example, you may want to switch to one without those side effects, he advises.

5. Your antidepressant doesn’t pack the punch it used to. “If you’ve been on an antidepressant for a long time, your body may develop a tolerance,” notes Hullett. So while your medication may have worked well as a depression treatment at first, now you may be feeling that its power has faded. Hullett suggests talking to your doctor about increasing the dosage.

6. Your depression gets deeper. “If your depression symptoms get worse as soon as you start taking an antidepressant, or they get better and then very suddenly get worse, it’s a sign that the depression medication isn’t working properly, and you should see your health care professional right away,” Hullett says. Specific warning signs to look out for include feeling agitated or restless, pacing or constant movement, hand wringing, or feeling generally out of control.

7. Your depression symptoms have improved, but you’re still not yourself. If you experience some relief on an antidepressant, but it’s not the relief you hoped for, it may be time to try something new, Dr. Thomas says. That may include trying another depression medication or adding counseling, psychotherapy, mood-boosting cardio exercise, or even light therapy to your treatment regimen. The combination of medication and other depression treatments can speed up the time to recovery and reduce your overall time on antidepressants, she says.

8. You’re having violent mood swings. “Depression medications can sometimes cause mood swings, especially in people who have a tendency toward bipolar disorder — depression and mania,” Hullett says. If you feel unusually elated or you become very terse with your spouse, break furniture, or have an uncharacteristic bout of road rage, you probably need to change your antidepressant, he advises.

9. After an extended period on an antidepressant, your depression is gone. “If you’ve been taking an antidepressant for at least 6 months and you’ve achieved remission, then it may be time to stop altogether,” notes Hullett. He stresses the importance of slowly tapering off depression medications, however. “Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), can produce physical symptoms of withdrawal if you stop taking them suddenly,” he says. “So you need to reduce the dosage of depression medication slowly, usually over a few weeks.”

Antidepressants can be very helpful, but they’re not like taking aspirin for a headache. If you feel your medication isn’t working up to your expectations, call your doctor, and he or she can help you get back on track to feeling better.

Many health insurers must treat coverage of mental health and substance abuse in the same way they handle treatments for physical illness, according to a new rule issued Friday by the Obama administration.

The rule “breaks down barriers that stand in the way of treatment and recovery services for millions of Americans,” Health and Human Services Secretary Kathleen Sebelius said Friday. “Building on these rules, the Affordable Care Act is expanding mental health and substance use disorder benefits and parity protections to 62 million Americans.”

The goal of the new rule is to ensure people who need treatment for mental health and substance abuse problems are subjected to the same copays, deductibles and other benefits that apply to patients who need medical or surgical treatments.

The law has limits. For instance, it applies only to group health plans that cover more than 100 workers. Smaller group insurance plans are covered by the Affordable Care Act, which includes similar requirements for parity.

A more complete analysis comes from NPR’s Julie Rovner, who will discuss the changes on Friday’s All Things Considered. She says the rule “means insurers can’t charge someone more for mental health services than for other services. It used to be that plans could, and would, pay 80 percent for medical care but only 50 percent for mental health care.”

Julie adds that “under the new rules, plans can’t cover fewer inpatient hospital days for mental health or substance abuse treatment than for a physical illness.”

By Therese Borchard
Recently I described symptoms of panic:

Indecision: sorting the laundry is excruciating. My God! I don’t know if these plaid shorts go into pastels or darks. They include both light and dark colors!
Guilt: I’ve given my husband a rash because I’m causing him stress and stress does evil things, shame on me. I’ve also caused my son’s hyperactivity and my daughter’s vision problems.
Lack of confidence: There is no way in God’s name I will be able to write a blog post by the end of the day. So far I’m at one word, THE.
Insecurity: People think I’m insane and weak and pathetic. Why post anything on Facebook when they will make fun of me behind my back.
Overwhelmsion (noun for overwhelm?): Procrastinating on fetching the mail from the mailbox because you don’t know if you can handle it right now.
And lots of other wonderful warm fuzzies.
Like I said earlier, I am experiencing all of that right now, so I thought I would give you one of those lists I swore against of things I’m doing to starve my panic. I am not going to lie and say they are working. Some of them do some of the time. And that is good enough for me. Today.

Trust my friends. When my self-image and self-confidence are at sea level, which they always are when I’m in the state of panic, I MUST trust my friend’s perception of me, which tends to be higher and, I’m hoping, more realistic. I try to believe the nice things they tell me even as I think they are lying to help me feel better.
Just do it. I imagine myself blindfolded and repeat Eleanor Roosevelt’s quote: “You must do the thing you cannot do.” This means sitting down at the computer and pretending I’m a writer even when I’m convinced I won’t be able to squeeze out one word.
Identify the little men. That’s what my friend Michelle calls the voices and noises of the amygdala, the almond-shaped structure inside our brains responsible for most of our fear. When I hear, “You can’t do it, moron,” I try to imagine a little man with an inferiority complex yelling lies into my ear in order to pump up himself, and then I visualize slapping him.
Do the minimum. I go through my to-do list and cross off every single thing that is not necessary for my survival, eliminating as many things as I can without upsetting too many people. I get an extension when I can, which makes me feel guilty and weak and pathetic, but allows me the space to cry and practice long sessions of deep breathing if I have to.
Avoid people who make me feel insecure. As I said in another blog post, this takes effort. I have to rearrange my whole day. But when I’m in a fragile state, I can’t risk being brought down lower. Better to protect myself and stick around the folks who like and admire me until I form a stronger shell.
Drink a Diet Dr. Pepper. I know it’s bad for me. Recent research says that diet soft drinks are linked with depression. But desperate times call for desperate measures. Identify your crutch, your treat, and splurge. Go ahead and be bad when you feel bad.
Repeat a mantra. I keep on repeating, “ I WILL get better.” I don’t believe it, but I say it, and sometimes it soaks in.

By SARAH WHEELER

Shane Victorino has it all. He is a member of a Boston Red Sox team that is two victories away from a World Series title. He has a championship ring (won with the Philadelphia Phillies in 2008), three Gold Glove awards, and a yearly income of over $6 million. He has a beautiful wife and two insanely adorable children. He has the undying love of Boston sports fans, after hitting a pennant-clinching grand slam that sent the Red Sox to the World Series against the St. Louis Cardinals.

And he has attention deficit hyperactivity disorder, or A.D.H.D.

I have worked with children with A.D.H.D. for almost a decade, and I have been a Red Sox fan for as long as I can remember. So the sight of Victorino, the Red Sox right fielder, basking in the glory (and the Gatorade) after his performance in the final game of the American League Championship Series against the Detroit Tigers made me think about all of the children I have known with A.D.H.D., and what his story might mean for them.

In the mid-1980s, when Victorino first learned he had the disorder, an estimated 3 to 7 percent of children were thought to have A.D.H.D. (then called attention deficit disorder “with or without hyperactivity”). Today, the national average is estimated to be around 11 percent, with rates as high as 16 in every 100 children in some states.

The appalling rises in A.D.H.D. diagnoses in the United States have been getting a lot of attention lately, and the issue is certainly worthy of debate. Working in schools, it sometimes feels like pediatricians are handing out A.D.H.D. diagnoses, and an accompanying prescription for stimulants, like candy. The fact that there is no definitive lab test for A.D.H.D. makes these issues even murkier, and leads to all sorts of comments about how children are just too used to being overstimulated every second in this digital age, or how they are being turned into zombies by the pharmaceutical companies.

But for every student who has a little bit of trouble sitting still and following instructions, there are also children like Shane Victorino. Like many children with A.D.H.D. (PDF), Victorino had significant problems in school, repeatedly got into accidents, and became a constant source of concern to the adults around him. He reminds me of many athletically talented boys with A.D.H.D. I have known who are not just impulsive or energetic, but also perpetually one incident away from being asked politely — or not so politely — to skip Little League tryouts next year.

Jumbled in the conversation about the validity of A.D.H.D. is the fascinating and timely discussion of whether medical or manufactured “enhancements” to an athlete’s body or mind should be seen as breakthroughs or dangers.

Some may find it arbitrary that H.G.H. is considered illicit, while stimulants are not. Victorino is one of a number of professional athletes who are “out” about their A.D.H.D., so he is allowed to take stimulants, under a doctor’s care.

While many agree that social and behavioral interventions are a crucial component of any treatment plan for A.D.H.D., children who also use stimulant medications have been found to have the most promising outcomes over time. Would all baseball players be better on stimulants? Possibly. Would Shane Victorino be playing in the World Series right now — even though lower back tightness kept him out of Game 4 on Sunday night, and his status for Monday night’s Game 5 in St. Louis and any other remaining games in Boston is uncertain — if those early assessments had concluded that he was a “spirited” child who only needed an exploratory curriculum and a gluten-free diet? Not likely. Does Shane Victorino have an advantage? It’s unlikely that we’ll get clear answers to that question soon. It’s much more likely, however, that in Victorino’s case, giving his challenges a name and treating them chemically is not unreasonable.

Russell Barkley, one of the world’s leading experts on A.D.H.D., prefers that we not use the word “attention” to discuss issues related to the disorder. Instead, he sees A.D.H.D. as an “intention” deficit — meaning that those who have it are constantly unable to accomplish things they intended to do. Even on medication, Shane Victorino visibly struggles to inhibit what are called his “prepotent responses” — something he immediately, instinctively, wants to do, like approaching the mound to talk to a pitcher about a wild pitch (that one started a benches-clearing fight and led to a three-game suspension) or
flipping off an opposing team member’s family during a high school soccer game.

Like many people with A.D.H.D., Victorino also struggles with emotional regulation, or as he has been quoted as saying, “letting my emotions get the best of me.” We’re not talking about being “sensitive” or getting upset every once in a while, we’re talking about a lifetime of disruptive, embarrassing and emotional displays that have had very negative consequences.

It’s quite apt that the song that plays every time Victorino walks up to the plate in Fenway Park is “Three Little Birds” by Bob Marley. As the Boston fans wail out the lines, “Don’t worry about a thing, ’cause every little thing is gonna be all right,” you have to wonder how many times in the last 33 years Victorino has desperately recited this mantra, or something like it, to himself.

Sarah Wheeler is a former special education teacher and now a school psychologist in the San Francisco Bay Area. She is a doctoral candidate in education at the University of California, Berkeley.

By Carolyn Gregoire
Sigmund Freud, the father of modern psychology, was obsessed with guilt. In his psychological framework, the painful emotion (a tension between the super-ego, or conscience, and the acting ego) played a critical role in the development of depression — and it was as a major roadblock in the pursuit of happiness.

“The price we pay for our advance in civilization is a loss of happiness through the heightening of the sense of guilt,” Freud wrote in his 1930 sociological masterpiece, Civilization and its Discontents, arguing that modern societies reinforce our sense of internal-stemming guilt.

While our modern understanding of human behavior has moved beyond many elements of the Freudian psychological framework, his analysis of guilt remains significant, and has been supported by some recent research.

Anyone who’s experienced guilt — which is to say, everyone — knows that it can cause a great deal of suffering, and can easily keep you from enjoying your life. Without question, guilt can be useful and essential; it can prompt us to evaluate our thoughts and actions, and function as a moral checks-and-balances system. But when guilt takes over, any misstep can become a catalyst for self-doubt, shame, and even depression.

Here are six things you should know about guilt — and how to keep it from controlling your life.

It can (literally) weigh you down.

According to new research from University of Waterloo and Princeton University, a heightened sense of guilt can actually correspond with feelings of increased weight. The researchers wanted to see if there was any truth to the popular notions of “carrying guilt” and of guilt “weighing” on one’s conscience. And what they found was fascinating.

“We found that recalling personal unethical acts led participants to report increased subjective body weight as compared to recalling ethical acts, unethical acts of others or no recall,” Princeton researcher Martin Day said in a statement. “We also found that this increased sense of weight was related to participants’ heightened feelings of guilt, and not other negative emotions, such as sadness or disgust.”

It contributes to depression.

A 2012 brain scanning study found that those who are or have been depressed have a heightened guilt response. For those who have suffered from depression, feeling guilt is less associated with a knowledge of socially acceptable behavior than it is for non-depressed individuals — meaning that those who are depressed may engage in excessive self-blame in a way that is not solution-oriented.

“The scans revealed that the people with a history of depression did not ‘couple’ the brain regions associated with guilt and knowledge of appropriate behavior together as strongly as the never depressed control group do,” the University of Manchester’s Roland Zahn said. “This could reflect a lack of access to details about what exactly was inappropriate about their behavior when feeling guilty, thereby extending guilt to things they are not responsible for and feeling guilty for everything.”

It might be the reason you’re procrastinating.

Many studies have found that guilt is a key factor in procrastination. We feel bad about something we’ve done, and so we hesitate to start a new task, perhaps for fear of making another error. And in turn, procrastinating causes us to feel guilty, which often undermines the good feeling we may have gotten from avoiding the task in the first place.

Need to finally get something done? Research has found that by forgiving yourself for procrastinating, you can actually prevent future procrastination.

Women really are more prone to guilt.

Research supports the cultural stereotype of women as the more guilt-prone sex. A 2010 Spanish study found that women experience guilt more frequently and more intensely than men, and also score higher on measures of interpersonal sensitivity than men. The difference in guilt levels between men and women in the 40-50-year-old age group was particularly stark. The researchers noted that lack of interpersonal sensitivity could be a central contributing factor to low levels of guilt among men.

It’s not a very good motivator.

Many psychologists believe guilt can prompt us to self-correct after doing something wrong — or thinking we’ve done something wrong — whether it’s eating one too many slices of cake or canceling plans with a friend at the last minute. Modest amounts of guilt have been shown deter bad behavior. But runaway guilt can actually keep you stuck in patterns of bad behavior — studies have shown that guilt can dip into (and deplete) our reserves of willpower.

“Feeling guilty is a cop-out. You feel guilty so you don’t have to take responsibility,” Cara Paiuk wrote in a Huffington Post blog. “Instead of actually taking action and fixing the situation, you choose to just feel ‘guilty’ about it. It appears as “Shoulda coulda woulda,” but the point is, you didn’t. Instead of moving on, guilt lets you live in the past and avoid the present.”

So next time you get caught in a guilt spiral, remember: it may not be the most effective way to motivate you to lose those last five pounds, become a better mother, or accomplish any other goal that’s important to you.

It’s not the same as shame — but the two feelings are intertwined.

While shame relates to the self, guilt has more to do with others, according to psychologist Joseph Burgo. Guilt generally involves feeling bad about a particular wrong action and the way it may have affected others, while shame is the painful feeling that there is something wrong or bad about who you are.

“The difference between shame and guilt is the difference between ‘I am bad’ and ‘I did something bad,'” “Daring Greatly” author Brene Brown told Oprah, explaining that shame is the more harmful emotion.

But the two feelings often go hand in hand, and what they do have in common is that they keep us stuck in the past, ruminating about our wrongdoings and perceived shortcomings. And in excess, neither gets us closer to truly coming to terms with the things we’ve done wrong or changing the parts of ourselves that we’re uncomfortable with.