Archive for August, 2009

PostHeaderIcon Obstacles for parents in teaching boundaries

One of the biggest difficulties for parents in teaching children boundaries is putting up with your child’s whining about the boundaries.  The child will push you and push you in order to test the limits in order to get their way!  That is their job, of course they want what they want and when they want it.  Your job as a parent is to put up with this testing of the limits, the whining, anger, temper tantrums, and pouting until the boundary lines between you as a parent and your child are clear and defined.  Teaching a child appropriate boundaries with you as a parent as well as at school and with their friends is a very difficult job, however if you teach these boundaries, your child will be much more successful at relating to others as well as being more successful in all of their relationships in life.  The obstacles to developing boundaries in your child are as follows:

1.) When a parent depends on their child to meet their own needs.  You want your child to develop their own friendships and relationships .  When you as the parent need your child to be close to you and require their constant affection to meet your own needs, this interferes with your child’s ability to establish their own boundaries with you and with others.  This causes problems for children later in life because they are too dependent upon you and you have now made your child your “friend” in order to have everything between you flow smoothly in order to not lose their “friendship.”  Children are our children and the appropriate boundary is for them to be our kids and not our “friends.”  Their friends are at school and not at home.

2.) Another common obstacle to establishing appropriate boundaries with our kids is when we overidentify with our child’s feelings.  This usually occurs as a result of a parent’s own unresolved issues from their childhood.  We as parents often are unable to delay our child’s gratification as result of trying to avoid having our child experience any pain, guilt, anger, or fear.  This is impossible!!  We as parents need to empathize with our children when they are scared or feel pain, however we as parents can not avoid having our children feel these feelings.  Children need to learn how to experience and handle their emotions.

3.) Children require consequences in order to learn boundaries.  A common mistake made by parents is when they believe that their children will not love them if they give them consequences for their behavior.  Children need structure and many parents fear that if they confront their child or or disagree with their child that they will lose their relationship with their child.  The reality is that when you set clear boundaries for your child, they will feel more secure, not less.

4.) A common obstacle also seen is when parents ignore their children when they are misbehaving and then later start ranting and raving at them.  For example, your child is in a store and complains and carries on about having you as the parent buy them something and you ignore their behavior while you are in the store.  You are really hoping that they will stop their temper tantrum in the store and they will simply stop.  Then, when you get in the car you let them have it!  Of course, your child starts crying or is very angry at you and you as the parent feel guilty.  This is an obstacle that will clearly not help you establish boundaries with your child.  That behavior your child was displaying in the store should have been addressed immediately, even if you had to leave the store.  Nobody and I mean nobody gets their way all the time, don’t set your child up for a reality shock later on in their life. 

5.) Lastly, and the most popular  obstacle to setting clear boundaries for our kids is when we let our children wear us down and we simply give in to whatever they are asking us.  We have all done this as parents.  They go on and on and on and finally we say, “alright go ahead, just stop your whining.”  Kids do not give up easily and they will work you to death until you give in and they get their way, even if you don’t agree as a parent to what you gave in to.  Don’t simply say boundaries to your child, you have to enforce the boundaries and this needs to be done consistently. 

Children without boundaries are usually children that are out of control and have little to no ability to delay gratification.  As a parent, have supportive relationships of your own, this will help you stay focused and allows you to have an outlet.  In addition, parents that have their own life are teaching their kids that they are truly not the center of the universe.  This teaches children that they must interact and relate to those around them and everyone is important and has their own wants and needs.

PostHeaderIcon How is ADHD diagnosed?

The most important component at arriving at an accurate diagnosis of ADHD is to complete a thorough and comprehensive evaluation.  Many times, I have seen children and they have have been brought in by their parents and diagnosed by their pediatrician after being seen for five to ten minutes.  In addition, parents will often tell me that either their child’s pediatrician or a child psychiatrist, prescribed their child medication after being seen and the parent is uncertain as to whether or not their child received an accurate diagnosis.  Unfortunately, this happens all too often and the steps to arrive at a diagnosis of ADHD should take more than 5-10 minutes in a doctor’s office. 

First and foremost,  a clinical interview should be completed with the parents to obtain a thorough background history.  This should include developmental history, medical problems or complications, school and home issues, any behavioral problems, social/interpersonal skills, etc… In other words, everything else should be ruled out before a diagnosis of ADHD is given.  ADHD is a diagnosis of exclusion.  We need to rule out that their is not another issue or problem before we arrive at a diagnosis of ADHD.  A medical evaluation may also be needed to determine that the behavior or symptoms are not caused by a medical issue.

Both a child’s parents and the child’s teacher should complete a behavior rating scale in order to determine the child’s behavior in both settings.  In addition, this is a good method to compare if their are any discrepancies between the parent’s report of behavior and the child’s teacher’s report.  If there is a huge difference between what the parents are saying and what the teacher is saying, this might strictly be a behavioral issue in one of the settings and we should be looking at a discipline problem and not an attentional issue.

The child should also be interviewed and behavioral observations should be made by the psychiatrist, psychologist, or a mental health professional that is conducting the evaluation.  Direct behavioral observation of the child are often very helpful, however this is not a necessary component to reach a diagnosis of ADHD. 

Also, intelligence and/or achievement testing is also beneficial to determine if their is a learning difficulty.  Children who are struggling in school, often act out or are inattentive as a result of extreme frustration with their school work.  A learning disability evaluation is often beneficial to rule out that the child is not struggling academically, which affects their behavior at school.  Before any child can be diagnosed as having ADHD, a complete and thorough evaluation needs to be completed and all information obtained should be scrutinized carefully and all issues/problems ruled out that may be causing attentional difficulties.  Most evaluations completed by a psychologist or psychiatrist to diagnosis ADHD last at least 2-3 hours in order to obtain the necessary clinical information.  If your child has been diagnosed with ADHD after a 5-10 minute session with your child’s pediatrician than a comprehensive evaluation should now be completed.

PostHeaderIcon Signs that your child may be depressed

For parents to know whether or not their child is depressed, they must first understand the symptoms to look for.  Many parents have told me that they do not believe that their child is depressed and will comment, “what do they have to be depressed about, they don’t have any stress in their life.”  Wrong!  Children and adults alike often do not realize the signs and symptoms of depression, but both know that something is wrong by how the child is functioning.   Children that are depressed often have changes in their physical health, they often display behavioral problems, they have difficulty concentrating or focusing, and their are of course the emotional problems that accompany depression.  The emotional signs such as loss of pleasure, sadness, anxiety, and anger or irritability are the easiest for parents to recognize.  The problem often comes in for parents as to what is “normal” childhood development and what is not.  All children, especially teenagers are “moody” at one time or another and this is to be expected.  The signs/symptoms of depression can be organized into four main areas:

1.) Behavioral Symptoms: These include their withdrawal from activities that they usually enjoy, difficulty controlling their behaviors such as restlessness or even self-harm.  They seem to want to isolate themselves to solitary activities such as watching television, staying in their room reading for hours, or playing video games.  In addition, depressed children spend increased amounts of time on activities that do not require alot of brain power such as video games or television.  Lastly, depressed kids often become very irritable, demanding, or clingy and their behavior is often out of their ordinary character.

2.) Physical Symptoms or Complaints: Children that are depressed also seem to have a variety of physical complaints.  They often have little to no appetite and just do not seem to want to eat anything.  They complain of having little energy and want to sit around the house do nothing and avoid being around their friends.  Children that suffer with depression also seem to be agitated or restless and do not sleep well at night.  A good indicator is if your child is falling asleep at school and they seem to be very sluggish.

3.) Cognitive Symptoms: More simply stated, this is a change in their thought patterns.  Signs to look for are if your child has very negative and self-defeating thoughts.  These children make self-deprecating statements and never seem to find anything good or positive to say about themselves.  Depressed children seem to be guilt ridden and they go over and over faults with themselves and others.  Nothing anyone seems to say about them or those around them seems to cheer them up or brighten their day.   

4.) Emotional Signs/Symptoms: These signs are often the easiest for parents to recognize in their child.  The emotional signs of depression are when a child is often irritable and seems to be mad at everyone all the time.  Some children may be sad and cry alot and others seems to lose interest in everything and isolate themselves in their room. 

While no child will display all of the signs/symptoms of depression listed, these are some clues to look for as to whether or not your child may be suffering from depression.  If your child is depressed, then professional treatment is highly recommended.  Many parents try psychological treatment prior to placing their children on medications, however this is up to the discretion of the child’s parents.

PostHeaderIcon Managing social problems with ADHD children

Children that have been diagnosed with ADHD often have severe problems getting along with other children.  The child with ADHD tends to be very impulsive, has problems sharing, and they tend to be overactive.  Other children may find this child’s behaviors aversive and they often will not want to play with the ADHD child.  Other children may not like when the ADHD child blurts out whatever they are thinking, as ADHD children often have problems showing restraint in what they do or in what they say to others.  In addition, ADHD children often fail to consider how their behaviors or actions will affect those around them and they usually do not consider that there are consequences to all of their actions. 

These children often do not see an immediate reward for playing well with other children, with sharing, cooperating, or taking turns with other children and other children usually perceive the child to be very selfish and self-centered.  As a result of their poor social skills, children with ADHD often have few friends and the school year can be a very harrowing and difficult one as a result of poor peer relationships.  How often has it been said by the ADHD child, “I have no friends, no one wants to play with me.”  Another common comment is, “everyone seems to make fun of me” and parents will often hear, “I don’t want your son playing over at our house, he misbehaves and hits my son.”  How can we as parents teach our children better social skills in order to improve their relationships.  There are a number of steps that can be taken in order to improve social skills:

1.) First and foremost, establish a reward or behavior management program in which tokens or a chip program are used in order to improve social behaviors.  Choose only one or two social behaviors that you would like to see improved such as sharing or say your child keeping their hands to themselves and not hitting or touching another child.  Only pick one or two behaviors, more than that and your child will most likely not be successful.  Choose the unwanted behaviors that you see your child doing the most and work on these such as being bossy, not speak loudly, or taking turns.

2.) Post the social behaviors that you want to see changed in a prominent place that you want your child to see.  I usually advise parents to post a chart on the refrigerator, in the child’s bathroom, and possibly on the mirror in your child’s bedroom.  The chart does not have to be too detailed, simply post the unwanted social behaviors that you want to see changed in your child.  If your child’s friends are coming over take the charts down, they will probably embarrass your child otherwise.

3.) When you observe your child playing with other children and your child is displaying appropriate social behaviors, make sure to tell them they are acting appropriately.  This should be done in a discrete manner and not to embarrass your child or take them away from an activity with their friends that they are enjoying.  When you see your child acting in an inappropriate fashion (ie… bossing their friends around or not taking turns) remind them that they lose tokens for their behavior.  Also, before your child has friends over or goes over to play with friends or at the beginning of a school day, remind them of the unwanted social behaviors that you want them to change.  Observe your child more frequently when they are playing with their friends to ensure that that their social skills are appropriate.  Reward or punish according to the behaviors that they are displaying.

4.) A few times each week, you and your child should set aside time to go over the positive behaviors that you have observed and the negative behaviors that you have observed while they were with their friends.  Make sure to point out the positive aspects so your child does not become discouraged. 

5.) Role playing appropriate social behaviors can also be a very useful tool.  As a parent, you pretend to be your child and model the negative behavior you see them displaying and then model the appropriate more positive social skill such as taking turns and then have your child try the positive new skill.  Encourage your child to display this new, more appropriate skill the next time they are playing with their friends and they will more likely get a more positive result from their friends.  Remind your child every time they go off to play with friends or if friends come over to the house, that they need to use their new social skills when they are playing with them. 

The main areas of concern that children with ADHD may have problems with are: starting or maintaining a conversation with another child, listening to other children when they are speaking and not interrupting, resolving conflicts when everything is not going their way, and sharing and taking turns with other children.  Be patient with your child when trying to teach them these new skills and focus on only one or two behaviors at a time in order to improve their social skills.  Peer relationships are such an important part of a child’s life, whereby teaching them these skills will make them alot more comfortable in their social interactions.

PostHeaderIcon How to help your ADHD child cope with the stigma

Are you saying, does a stigma still exist for kids that have ADHD?  Absolutely!  Many kids are still ashamed to tell anyone that they have ADHD and even more embarrassed if they have to take medications at school!  Older children and teenagers that I have seen in therapy often quit taking medications for ADHD because they do not want their friends to find out that they have ADHD or even worse that they have to take medications for it.  How can we help our children overcome the stigma that still exists among adults and kids alike when a child or teenager has ADHD.  Of course for children, parents, caregivers, and teachers, the best way to cope with the symptoms of ADHD are often a struggle, however a good starting point is how to overcome the stigma of a label or diagnosis of ADHD.  There are several steps that can be taken to combat the stigma:

1.) As a parent, the first thing you need to do to reduce the stigma of ADHD, is to not make a big deal about it.  Watch and control your reaction about the symptoms of ADHD when they rear their ugly head.  You making a big deal about having ADHD or that they have to take medications or an alternative treatment (natural vitamins or therapy) will only increase the challenge that they are already fighting.

2.) Don’t tell your child not to tell anyone!  This definitely sends the message that having ADHD is something to be embarrassed or ashamed of.

3.) If your child is embarrassed to take medications for ADHD at school then work with your child’s pediatrician or psychiatrist on finding a way for your child to take medicines before or right after school.  Many children and especially older children and teenagers are embarrassed in front of their friends no matter what you say to them about taking medication.

4.) Remind your child regularly that ADHD is merely a different way of thinking about things and that their brain works differently.  Don’t treat ADHD as something awful, I have found that ADHD has many positive aspects and treat it as a gift.  Do not treat your child differently because they have ADHD and expect less of them, they will act accordingly and will lower their own expectations of themselves.

5.) Determine as a parent whether or not you plan to share a diagnosis of ADHD with your child or teen’s school.  Parents often differ in this regard on whether or not they want their child’s teacher and school to know of an ADHD diagnosis.  I highly recommend to parents that they share their child’s diagnosis of ADHD with the school and discuss strategies that need to be implemented for your child in the classroom.  Your teacher should also not lower his/her expectations for your child.  Yes, the ADHD child may have to have a modified curriculum, but it does not mean that they can not learn like everyone else.

6.) Talk openly with your child about an ADHD diagnosis in order to take away the stigma of the diagnosis.  Boost their self-confidence and explain how those around them may perceive their ADHD behaviors.  Unfortunately, many children at your child’s school will discriminate against a child that has ADHD and often because ADHD children struggle socially, they have difficulty making and keeping friends.  Encourage your child to particpate in activities that will raise their self-esteem and emphasize their positive attributes.  When you see your child doing something good or helpful, point it out.

7.)  Encourage your child to be around other children that have similar strengths and weaknesses.  ADHD is a common problem and your child may benefit from attending a social skills or an ADHD group with children that are experiencing similar struggles.  Psychological treatment is also another option, where your child can learn self-confidence, coping skills, social skills, and parents can learn about how to manage negative behaviors associated with ADHD.

8.) Children and parents need to surround themselves with individuals that are positive and supportive of  ADHD.  The last thing a child needs to hear is that, “ADHD is not a real diagnosis, it’s just an excuse to misbehave.”  This a very common misconception among the general public and many parents will experience this very thing as will their children. 

9.)  Lastly, use the resources that are available to you.  Discuss with other parents, teachers, family members, or a local or national support group about your child’s ADHD.  Information for parents and educating those around you about what ADHD is and how it affects your child and adults is the best weapon against the stigma of ADHD.  Get your child the help they need at school so that they are NOT discriminated against. 

Let’s start off this school year the right way and give your child every opportunity to learn and be successful!

PostHeaderIcon To Spank or Not to Spank?

To Spank or Not to Spank.  That is the question?  I am writing about this particular subject today as a result of an argument that took place in my office this past week between two parents.  They brought in their child to see me due to discipline problems they are experiencing with him at home.  The parents proceeded to argue in front of me about how to discipline their son and how to get his behavior problems under control.  You see, this child had completely taken over the house and the parents were no longer in control of their own home.  The child was running the show!  The father told me that he believes that corporal punishment or spanking him is a most effective way to discipline and the mother prefers to send him to time out or to reward him when his behavior is appropriate.  I proceeded to watch this couple argue for about 15 minutes in order to observe how they interact with each other and finally asked them, “is this how the two of you talk to each other at home?”  They proceeded to tell me that they try to argue about these types of things in their bedroom away from their son.  The problem with that folks, is that children tell me all the time that they either know that their parents are arguing or that they can actually hear their parents yelling in the bedroom.

So back to my question, to spank or not to spank.  The problem that I just outlined for you above is an all too common one that myself and other therapists hear.  If parents are not even in agreement, how do they expect their child to react to conflicting and/or inconsistent discipline in the home.  Spanking, in my opinion is not an effective tool to change a child’s behaviors/actions in the long run.  The problem with spanking is that it will stop a behavior or an action immediately following the punishment, however children usually do not even really know what they are in trouble for and it will most likely not change the behavior for the long-term.  Yes, I know that alot of parents will not agree with that statement, however controlling someone’s behavior through negative means is never a good thing.  In addition, spanking is a punitive measure and is a negative means to control behavior, not a positive one.  If you really want to change a child’s behavior, a more effective means of doing so would be to reward positive behaviors consistently and set up a behavior management plan for your child in order to change unwanted behavior.  If parents are not successful in doing so by themselves, they should consult a mental health professional for assistance.

PostHeaderIcon Does TV and Video Games really cause ADHD?

A common misconception among parents, caregivers and the general public is that ADHD is caused by TV or by too much time playing video games.  When I see parents or family members in therapy that have brought their ADHD child in to see me, I commonly hear, “should we take away his video games, I hear that this can cause ADHD.”  I also have heard repeatedly as many other mental health professionals have that the more time a child watches TV or plays video games, the worse their ADHD symptoms will be.  This is definitely not true!  Yes, children that have been diagnosed with ADHD prefer to watch television or play video games, because these activities require very little effort and a shorter attention span than say reading a book or completing their homework. 

Up to this point in time, there has been no scientific study or any empirical research that has been completed that links TV or playing too many video games to a diagnosis of ADHD.  However, should a child that has ADHD or a child that does not have ADHD spend hours upon hours watching television or playing video games? Of course not!  Parents need to find a balance between TV time, video games and other leisure pursuits that is balanced with school, homework, and a social life.  Too much of anything is never a good thing!  Remember that moderation is king.

PostHeaderIcon When do we complete homework with the ADHD child?

Parents often tell me that completing homework with their ADHD child is often a great challenge and causes a lot of frustration. Children usually by the time they get home are tired and simply want a “break” from their work and want to play or “chill out” and watch television. However, homework still has to be done and parents usually wait until late afternoon or night to complete homework. Inevitably, children procrastinate and “fight” their parents every inch of the way in completing their homework. By the time the homework is completed, everyone including the child are usually angry and frustrated and homework took a very long time as the parent tries to cajole their child to complete the work.

As a rule, children with ADHD seem to do better on schoolwork in the mornings, more often than children without ADHD. What this means exactly is that school work and/or homework should be completed earlier in the day or even some of the homework should be completed in the morning if possible. Tasks for children that are boring, repetitive, or that take sustained attention/concentration should be done earlier if possible. By the end of the day, children are usually tired; fatigued and if parents decide to complete homework late in the day, problems are sure to ensue and the work will most likely not be completed.

Therefore, a homework schedule should be implemented that includes part or the entire school work load to be completed in the morning.   Also, when homework is completed with your child, it should be done in a quiet setting with no distractions.  This means that the radio, television, and the noise from video games must be turned off.  Children with ADHD are easily distracted and the less distractors for them when they are trying to complete their schoolwork the better.  In addition, homework should be completed on a 1:1 basis.  Children with ADHD do not do well in group situations where they are able to become over-stimulated and if possible homework should be done alone, just you and your child where individualized attention can be given.

PostHeaderIcon When do we reward positive behaviors in children?

Many parents that I have seen over the years have told me that they like to reward their children for a “good job.”  Now exactly what does that mean, “a good job.”  Parents have told me that they give their child a reward such as money, going out to dinner, or buying them something every single time they do something they are told to do.  So when do we reward a positive behavior in our children?  We do this when they have performed above and beyond the call of duty.  Children should be rewarded when they have diligently worked at something and have learned something new and also when they have performed exceptionally well, whether this is at home, school, or at an extra-curricular activity.  If we reward our children every single time they do something they are told to do, we create a sense of entitlement in our children and they are not grateful or thankful when we do reward them.  They simply come to expect that they are going to get a reward for easy; menial jobs around the house or at school. 

Children should complete their homework, schoolwork, housework, and do age-appropriate things.  However, rewards such as money, buying them a new game, a trip to their favorite place, can be very powerful tools but they need to be used appropriately.  Rewards are good when your child surpasses what is “normally” expected of them and when they finally do receive a reward it will be special and mean something to them.  Once children learn a new skill that is required in life to be a responsible adult, we do not continue to reward this behavior.  For example, you as a parent decide to reward your child for learning to tie his/her shoes and you give them a reward for having done so.  You reward them once and do not continue to reward them forever for having learned an age-appropriate skill. 

Also, be careful to not instill in your child the attitude that they will only do something if they are rewarded for it.  I see this all the time!!  If a child does not perform at school or at home and they should be doing so, then a consequence should be enforced for them.  (your child does not get to go out with a friend over the weekend because they did not clean up their room.)  Having done this, you have avoided the sense of entitlement that has become so prevalent in the U.S., the attitude of getting something for having done nothing!  Everyone is required to do their part, whether it is a family unit, at work, at school, everybody has to work and  rewards are only given when your child does something “extra” above what is normally expected. 

Remember this, in today’s society no one is given a reward as an adult for doing the bare minimum and having everyone else do things for them.  We need to as parents teach our children how to be productive and responsible adults that are able to take care of themselves.