Interview with High Schoolers

Several bright and insightful St. Charles High School students recently visited Plum Tree. They’re finishing Psychology courses and had great questions for a clinical psychologist. Here’s what they wanted to know:

1. How many years of experience have you had in being a therapist?

About 10 years.

2. What are your areas of expertise?

Psychological Assessment, IQ Testing, Attention-Deficit/Hyperactivity Disorder (ADHD), and Suicidal/Self-Injury Behaviors

3. How would you describe your treatment style?

Solutions-focused, collaborative, evidence-based, and genuine.

4. What type of therapeutic strategies do you think work most effectively?

• For ADHD: Coaching strategies, where the focus is on developing organization, improving attention, managing restlessness, improving time-management, and establishing priorities
• For Self-injury/Suicide: Dialectical Behavior Therapy (DBT)
• For children’s mental illness: play therapy, behavioral parenting, and cognitive-behavioral therapy

5. Do you think our society overemphasizes happiness?

No, but society isn’t clear about how to achieve happiness. Particularly teens are bombarded by social media emphasizing fame, fortune, and beauty. In fact, none of these are linked directly to happiness.

6. What made you want to be a psychologist?

I enjoy a challenge. No science seems as complicated and nuanced as that of human thoughts, feelings, and behaviors.

7. Why did you pick to work with children and adolescents?

I’ve always “spoke their language.” This population of people is easily misunderstood. There’s nothing so fulfilling as being the interpreter between a child and his/her caregivers, teachers, and other important adults.

8. How do you decide which approach is best for the patient?

I weigh a combination of patient (or parent) goals, treatment history, symptomology, research, and clinical experience.

6. What has to happen during a session for therapy to be successful?

The patient should feel validated and also supported to change.

7. What are the measurable criteria you use to assess how well treatment is working?

It varies per person. Every patient has a treatment plan with measurable goals and timelines. I also conduct intermittent screenings with psychological tests to monitor progress. Of course, patient (and parent) feedback is an important part of assessing the effects of treatment.

8. Do you believe the effects of labeling are true? In the way that when a patient is diagnosed with a certain disorder they act in that labeled way and also the people around them treat them differently according to their diagnosis?

A diagnosis is not a judgment; it’s a fact. Just as there are criteria and scientific evidence to medical diagnoses (e.g., diabetes, colds, cancer) mental illnesses have criteria and scientific evidence. So, just as it’s appropriate and effective to label someone with flu symptoms as having the flu, it’s appropriate and effective to label someone with anxiety symptoms as having anxiety.

Diagnoses (or, labels) are tied to evidence-based treatments, scientific literature, and clinical outcomes. So, when a patient is accurately diagnosed, then treatment pathways become clear. It also allows for different treatment providers to speak the same language about what issues/treatment goals are.

Overwhelmingly, patients can be relieved by learning about their diagnoses. They may have felt “different” all along. The knowledge that there is a name, a treatment, and a community of people with similar issues can be—in itself—an effective therapeutic experience.

Of course, there’s still a lot of public stigma around mental illness. People who have it can be embarrassed or feel inept. Since the idea of mental illness can make others uneasy, patients may experience some ostracizing. Public education is needed.

9. In your opinion, what is the most common diagnosis? Has that changed in the last several years, if so, how?

Trending shows that—for pediatric populations—Bipolar Disorder and Autism Spectrum Disorders, are on the rise. ADHD has been on the rise for at least a decade now, too.

10. Do you think that therapy is the best choice for all who may need it?

Yes.

 

Self-Esteem (“I got this, Mom”)

Good self-esteem is the ultimate buffer in kids’ lives. It bolsters them during failure. It navigates them through social pressures. It weathers their emotional (and hormonal) storms. It keeps their negative self-statements in check. Good self-esteem encourages kids to try new things. It helps them understand other people, and treat them well. It makes life more enjoyable. Self-esteem is not something kids build on their own. In fact, building self-esteem can have more to do with others than it does with the self.

Parents, your role in your child’s self-esteem is critical. From your child’s birth onward, you get more and more jobs in helping her develop positive self-esteem.

Birth to 1 Year: Good self-esteem starts when babies learn to fulfill their basic needs (love, hunger, comfort) by manipulating parents and caregivers. (“When I cry, Dad hugs me.”) There are 3 jobs for parents.

  1. Love, adore, and cuddle your baby.
  2. Give her everything she demands. There is no such thing as spoiling a child who is 0-6 months old. It takes a newborn a few months to realize he’s actually a separate person from his primary caregiver. (Can you imagine that a-ha moment?) After age 6 months, parents usually notice their child’s manipulation strategies are developing remarkably. You feel like a sucker. Still, meet her needs. But also start to teach effective communication skills. Children between 6-12 months are usually still in the pre-verbal stage; they cannot say what they want. For example, suppose a toy is not working and your son screams and shoves it in your face to fix it. First, validate his frustration (i.e., “Oh, it’s not working? That’s a bummer!”) Second, have him practice handing it to you nicely (i.e., “When you hand it to me without screaming, I’ll help you buddy.”) Third, think out loud as you fix the toy (i.e., “See this thing here. It’s not turning right. If I do this, it will work, see? Here, you try it.”)
  3. Be a model for calm effort in working through problems…and checking the stupid batteries

1 Year to 3 Years: Good self-esteem means feeling brave and secure enough to explore and try new things. There are 4 more jobs for parents:

  1. Avoid “helicopter parenting” by smothering children. Nothing is so sweet as a safe moment to oneself. Encourage her unaccompanied excursions into the next room. Introduce him to the arts (i.e., banging on kitchen pans for drums). Praise her efforts, and the products of them (i.e., hang up her drawings on the fridge). Kids develop bravery by understanding that caregivers will keep them safe, and will be there if anything gets scary.
  2. Don’t neglect your child. Make sure he is in supervised, child-proofed environments that will not punish exploration with injury. When accidents happen (…do coffee-table manufacturers have toddlers?), validate the injury (“Ouch!”) and explain how it can be avoided in the future.
  3. Tell your child multiple times a day what INTRINSIC qualities you admire in her: sustained effort, working through frustration, showing care for others, athletic ability, smart reasoning, bravery, sense of humor, etc. When your child misbehaves, make a point to discourage the behavior, not the child. (“In our house, we don’t hit. You are not the kind of person who hits. Please take a time out.”) Do not under any circumstances apply negative labels to your child. Labels like “lazy,” “dramatic,” “babyish,” “worry wart,” and other unpleasant character appraisals shame your child, and have no positive impacts. Remember: Attribute good behaviors to your child’s character and bad behaviors to your child’s choices. (Behavior charts are a good way to get kids to behave without harming their self-esteem).
  4. Model good self-esteem. Normalize mistakes. Don’t talk down about yourself. Don’t talk down about your spouse. Toddlers are using your skills to build their own. To children, parents are the most attractive, important, effective, and powerful people in the world. (Feeling better about yourself now?)

3-6 Years: Good self-esteem is being able to do stuff for oneself. There are 3 more jobs for parents:

  1. Encourage and expect your child to take more and more responsibility for his Activities of Daily Living (ADL). These include: showering/bathing, brushing hair/teeth, getting dressed, using the toilet independently, feeding oneself appropriately, using the telephone/computer, taking care of pets, cleaning up after oneself, using safe behaviors (buckling self into the car seat), organizing school materials, and so on.
  2. Expect more from your child. It’s OK if kids don’t get ADLs perfect. In fact, they won’t. But it is important that parents have reasonable expectations for children to try their best at each job. High demandingness is one very important part of good parenting. Mandate good effort in a matter-of-fact way. We all have to do things we don’t want to; that’s part of life.
  3. Praise your child. Give warm support and even over-the-top, exaggerated cheers for jobs well done. Be sure to emphasize how proud you are of your child’s efforts, even if the outcome is not great. It’s not your imagination: your child IS incredibly unique, gifted, wonderful, and a genius at being himself. Let him know that.

6-11 Years: Good self-esteem means comparing oneself realistically to others and, in doing so, seeing self-worth. There are 3 more jobs for parents:

  1. The focus for kids this age turns increasingly away from parents to other people (particularly peers). Kids compare themselves to others and see that there are often major differences. For most kids, differences will be both positive and negative. Your child realizes that he is not the best student in math. She sees that she is a great basketball player. He understands that others are more popular. She gets that other kids have family troubles. He sees that other people have more expensive clothes and gadgets. Parents should verbalize values for intrinsic skills and character, and not necessarily for achievements. Be realistic and positive in appraisals of your child. (“Yes, I suppose he is a better pitcher than you. He has spent a lot of time practicing and he’s sure talented. If you work hard, you may be as good as him. If not, no biggie. You’re great at understanding technology.”) Introduce your child to (books about) heroes of character and effort, not heroes whose only attributes are beauty, fame, or fortune (as they see on TV and other media).
  2. Love the child you have, not the child you wanted to have. It’s time to come to terms with possible disappointments, and with, perhaps, your own childhood “failures.” Focus on the things you admire in your child, not on the ways you see her as falling short of your ideals. Strike the balance between pushing your child to do better and recognizing that she may be doing her very best. Indulge his passions, if they’re safe and appropriate.
  3. Keep close ties with your child’s school. Teachers have valuable information about how your child relates to others. Good schools help teachers structure the classroom in ways that help all children feel accepted. Good teachers ensure that children do not feel inferior.

12-20 Years: Good self-esteem is knowing who you are, and who you are not. There are 3 more jobs for parents:

  1. Teenagers have critical questions to answer about themselves, like “Who am I?,” “How do I fit in?,” and “What am I going to do in life?” Questions of identity relate to everything from hair color to religious views. Parents should permit this exploration, and support it. When you push too hard for your child to conform to your views, trouble happens. He may become confused about what’s important to him. Of course, there are family and societal values to be enforced: safe and ethical behaviors. Allowing your child to experiment with substances is not the thing to do. Permitting your child to dress provocatively is not the thing to do. But you may consider letting your child dye his hair. She should be able to select (safe) friends. He may wonder aloud (appropriately) about his sexual, religious, or political orientations.
  2. Forming an identity can take a while. Be patient. This stage spans several years of awkward fashions, silly fads, and important work on the self. Continue to love and support your child through this sometimes difficult stage. Support especially the times when she sticks to her values, while peers do not. For example, praise your son when he elects not to drink alcohol at a teen party.
  3. Avoid being defensive. For kids this age, everything is grist for the mill. Your child may call your rules too strict. She may accuse you of invading her privacy on Facebook or Twitter. He will say things at home aren’t fair. She may say your religious or political views are wrong. While taking into consideration your child’s view (she may have a good point!), remember that her accusations have more to do with her questions about herself. Matter-of-factly state your views, don’t attack his, and show your child how to communicate differences with respect.

An important, final note: mental illness is the arch enemy of good self-esteem. It ruthlessly attacks self-esteem. This can and does happen even for kids who have great parents. Mental illness can interfere with the development of good self-esteem from toddlerhood and up. When a child has poor self-esteem, particularly within the context of a supportive home environment, it’s a red flag for mental illness. The usual culprits are depression, anxiety, and attention problems. Signs of low self-esteem include:

  • Recurrent, unjustified shame and guilt
  • Hopelessness about the future
  • Feeling unlucky, punished, or “waiting for the other shoe to drop”
  • Suicidal ideas or behavior
  • Self-harm ideas or behavior

Children with good self-esteem have experiences–often provided to them by parents–that prepare them well for their future. They expect to succeed in what matters most to them.

 

 

Are ADHD Stimulants Working?

A common ADHD treatment is stimulant medication. Methylphenidate is popular, with trade names of Ritalin, Concerta, Daytrana, and Metadate. An amphetamine salt (trade name Adderall) is also used quite a bit.

Dosages are typically prescribed based on a child’s size. It is not uncommon for these dosages to be too high. Parents may notice a trade-off in symptoms, for example, when their child’s attention is improved but he is more physically agitated. This is one clue that the dosage may not be appropriate. Or, an “over-medicated” child might be sluggish, less creative, and (while medications are active in his system) lose his spunky personality. In other words, too much medication can smother the best parts of ADHD.

Stimulant medications take effect quickly. Within about 30 minutes, medication impacts thinking and behavior. Measuring the impact of stimulant medication has historically been difficult. Parents are left to their own observations, the hard-to-read self reports of their child, and input from teachers. With detailed behavior observations (such as how long a medication takes to act on the child, and what happens as the medication wears off), some gains can be made.

But, there is a better way to determine if a stimulant medication is effective. It’s called the Test of Variables of Attention (TOVA). It’s simple, short (about 20 minutes), and accurate. This test can be repeated time and again. A recommended use of TOVA is to compare a child’s “baseline” (performance without medication) against a medication trial. For example, baseline results can be compared for how a child does with 5mg methylphenidate. Since results are ready as soon as the test is finished, physicians and parents have real-time information to consider dosage or prescription adjustments.

A common finding from the TOVA test is that dosages are too high–meaning that unnecessary side effects can be reduced with the lessening of medication, while positive effects can remain. Test results can be very helpful for prescribing doctors. They also give parents clear directions on next steps in treatment and help with peace of mind.

The TOVA is also used as a standard part of ADHD assessments. From 2003 to 2007, there was a 22% increase in kids with parent-reported ADHD, according to the CDC. Research continues to find higher rates of ADHD. There is no single cause of ADHD, but some factors are known to contribute to it.

 

 

4% of Teens on Antidepressants

The Centers for Disease Control reported recently that about 1 in 25 teenagers take antidepressant medications, writes the Huffington Post. Depressive episodes in adolescents can look different from adult depression. For one, teens tend to show more irritability than sadness. Another difference is that teens are not as adept as adults in articulating issues associated with depression. Teens who meet criteria for a diagnosis of depression also usually have at least 4 of the following symptoms: (1) loss of interest in activities that used to be pleasurable to them, (2) changes in appetite or weight–either increases or decreases, (3) sleep problems, including troubles falling or staying asleep, or sleeping too much, (4) seeming either physically slowed-down or physically agitated and restless, (5) feeling fatigued or out of energy often, (6) feelings of guilt or worthlessness, (7) problems concentrating or making decisions, (8) recurrent thoughts of death or suicide. Depression is more likely to affect females. It also runs in families. Children who have not yet reached puberty are more likely to have depression in conjunction with other disorders–such as ADHD, Anxiety, or Disruptive Behavior Disorders.

If you suspect a teenager you know may be depressed, you should take action. Schedule an evaluation with a child psychologist. There are evidence-based treatments for depression, most of which are based in cogntive-behavioral therapies. You should notice symptom improvement after 12-16 weeks of treatment. If improvement is slow or nil, consider making an appointment with a child psychiatrist to discuss medication that may be appropriate as an adjunct to therapy.

No TV for Toddlers

Mental health professionals have long urged parents to limit kids’ TV time. Excessive TV watching has been linked to ADHD symptoms, and other concerns. Now, the American Academy of Pediatrics has recommended even stricter measures on TV. As in, no TV for children two years old or younger. Young children who watch TV have higher chances of developing sleep problems and speech delays. Beyond the speed of the frames (which seem to train young brains to attend only to super-fast stimuli), the content of programs is impossible for most babies to understand. In fact, according to Rachel Rettner’s new article, studies have shown that 18-month-olds “have the same reaction to a TV program regardless of whether it’s going forward or backward.” Yes parents, this would even be true for “educational programs” like Sesame Street. Likewise, the Baby Einstein shows have not been shown to help IQ.

What’s more, toddlers who watch TV  miss out on an ultra-serious, critical event: play! Good, old-fashioned play is the developmental task for small children. It helps them build interpersonal skills, problem-solving techniques, and enhances creativity. Even having TV on “in the background” appears to have negative effects on children. Parents who watch TV while young children are around don’t interact with children as often. Solid development in speech, social skills, and emotion regulation happens when children engage in real-life dialogue with people around them. Play-dates, sports, clubs, social activities, and especially one-to-one time with parents are the best ways for children to learn and grow, and to develop into smart, effective, and well-adjusted adults.

Pesticides Linked to ADHD Symptoms

Pesticides Linked to ADHD Symptoms

The “organic movement” has roots (pardon the pun) in studies about harmful effects of pesticides. Pesticides Linked to ADHD Symptoms. A new study (conducted by Canadian researchers used data collected from nearly 1,140 children participating in the United States Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey) suggests more bad news about pesticides. There seems to be a link between level of exposure to pesticides and the development of ADHD symptoms. This MSN Childhood Health article (by Leah Zerbe Rodale) states that “this study is the first to look at everyday exposure levels in children from around the country. And as it turns out, U.S. kids are exposed to harmful levels of pesticides in their food, day in and day out.” The take-home message is: avoid using pesticides around your own lawn, and–if possible–try to buy organic foods.

According to a 2007 Columbia University study, about 1 in 70 preschoolers take psychiatric medications

Toddlers on Psychiatric Medications

According to a 2007 Columbia University study, about 1 in 70 preschoolers take psychiatric medications—including stimulants, antidepressants, mood stabilizers, antipsychotics, and antianxiety drugs. It is not possible to say—without knowing these children personally—if medications are appropriate. But we do know that psychiatric drugs are not approved by the FDA for children under 6. There is simply not enough information to know how very young brains and body will respond—over time—to these medications.

As a child psychologist, I have worked with hundreds of children on psychiatric medications. In many cases, medications were necessary for the children’s safety and well-being. Almost every parent I’ve worked with has agreed to their child’s taking medication because they really believed it was the best way to get back on track. Few parents are excited about medications, but look instead to outweigh the downsides of out-of-control behaviors, moods, and urges.

But, here’s the thing. Medication is not the only option. It should never be the first option. The fields of child psychiatry and child psychology have solid, evidence-based research that shows the effectiveness of non-invasive treatments—therapy, sensory integration, parent/teacher education, and coaching.

If you’re wondering if your toddler is “abnormal,” see a child psychologist. This doctor should spend time with your child, you, and get a detailed history of the problem. Child psychologists can conduct standardized measures that have been validated to use on very young children. Mental illness is hard to characterize in preschoolers. You need an expert. There’s a national shortage of child psychologists and child psychiatrists, but it is worth the wait to see one. There is nothing less at stake than the health and welfare of the one you love most—your child.

This CNN article by Kelley King Heyworth is a thorough dialogue about the dilemma of putting toddlers on psychiatric medications.

 

 

ADHD on the Rise

ADHD on the Rise

The Centers for Disease Control reports a rise in the number of children diagnosed with ADHD.

Their report indicates a 10% rise in pediatric ADHD in the Midwest in the past 10 years. The looming question—to which no one can provide a definitive answer—is this: Does the increase mean more kids with “real” ADHD, or just more kids with the ADHD label? The difference is critical.

ADHD is considered a “mental disorder,” and as such is defined by the American Psychiatric Association (APA). It is believed to affect, according to APA’s most recent diagnostic manual, 3%-7% of school-aged children. If prevalence rates are said to be significantly higher (and they are, according to this article by the CDC), it is fair to use the term “epidemic” to describe the rise in ADHD.

ADHD symptoms can be “caused” by numerous triggers: vision problems, hearing problems, spinal misalignments, poor sleep and/or diet, underdeveloped prefrontal lobes in the brain, and structural “abnormalities” in other brain parts. Environmental triggers such as television, video games, and busy schedules can add to a child’s propensity to develop ADHD symptoms.

Are symptoms the same thing as the diagnosis? No. A psychiatric diagnosis confers that that the caues of “problems” are known. It is not simply confirming that a variety of symptoms are present. When a mental health professional diagnoses ADHD, she confirms that she KNOWS, for example, that hearing problems are not the primary cause of a child’s inattention. An ADHD diagnosis confirms that food allergies are not the primary cause of hyperactivity. An ADHD diagnosis proposes that ADHD problems do not stem from an untreated sleep disorder. The problem with the current ways in which children get diagnosed is that many (competent and well-meaning) care providers simply do not have the time, information, or other resources to properly evaluate a child for ADHD. Is it any wonder that ADHD is so easily and so often misdiagnosed and, thus, mistreated?

To get an accurate ADHD diagnosis, Plum Tree evaluates a child with a series of interviews, observations, and tests to determine if ADHD is the appropriate diagnosis. An ADHD diagnosis should only be applied after the mental health provider has:

  • Spent lots of time with your child (more than 15 minutes)
  • Obtained a detailed and structured history of your child’s health, behavior, and functioning from you AND others, including school professionals, babysitters, etc.
  • Administered a computer test (TOVA) to measure objectively your child’s inattention and impulsivity rates
  • Ruled out other mental health conditions and the possibilities of other health conditions

 

Social Media Effects on Children

Social Media Effects on Children

A CNN article reviews the role of electronic media in children’s lives—the good, the bad, and the narcissistic. The research was conducted by Larry D. Rosen, Ph.D., professor of psychology at California State University, Dominguez Hills, and technology researcher. Below is a summary of the major trends observed by Dr. Rosen. Social Media Effects on Children.

Positive Results

– Social media is a great tool for engaging and captivating children
– Online networking can teach socialization
– Online users show more “virtual empathy”
– Social Media can help children establish a sense of self

Negative Results

– Students using social media during study breaks received lower grades
– Children who use social media tend to be more narcissistic
– Research suggests social media can increase anxiety and depression in children

Dr. Weller suggests that parents stay up-to-date on social media trends. Become familiar with what sites your child uses. (St. Charles school district has recently offered teen-led classes to parents for help with this). Like anything done in mindful moderation, social media can play a role in a well-balanced life.

Coaching Can Improve Performance

Coaching Can Improve Performance

I recently read an article written by Cari Nierenberg. In the article, psychologists review why people “choke” under pressure. Nierenberg writes, “There are two main theories about why people choke: One is that thoughts and worries distract your attention from the task at hand, and you don’t access your talents. A second explanation suggests that pressure causes individuals to think too much about all the skills involved and this messes up their execution.” Click to read Nierenberg’s article: Don’t choke! Why we buckle under pressure

We know that preparing and practicing for high-stress situations can improve performance. Coaching is a good way to do this. Everyone is familiar with the idea of athletic coaches. Some people have heard of life coaches–and maybe this brings up an image of a swami or some other existentially-focused person. At Plum Tree, coaching is none of these things. Instead, Dr. Weller uses action-oriented, straightforward, practical, and solutions-focused approaches to help adolescents meet their goals.

Coaching is an appropriate alternative to individual therapy for adolescents who are functioning well overall, but have problems in one area (e.g., poor academic progress, test anxiety, ADHD, low self-esteem). Coaching targets are usually smaller and step-oriented than in therapy. There is a narrower scope in dialogue and topics, reserved for things directly related to goal-completion. Solution-focused conversations and activities are common. While therapy has some homework, coaching has lots of homework. Coaching is usually not indicated for children under 12. Plum Tree offers two kinds of coaching: ADHD Coaching and Individual Coaching.