Category: Parenting

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Russian Adoption Laws Leave Children Warehoused and Unwanted

10Attachment, Child Development, Ethics and Morality, Featured news, Health, Law and Crime, Parenting June, 16

Source: John Manuel Sommerfeld on Flickr

It is a life of deafening silence, colourless walls, and empty corridors, a life of intense longing and disappointment. For over 600,000 children living in Russian orphanages waiting to be adopted, it is the only life they know.

In 2013, Russia passed a law to ban the adoption of orphaned children by American citizens, in part because of tense political relations between the two countries. In 2014, Russia also banned the adoption of orphans into any country that acknowledges same-sex marriage in order to “protect children’s psyche from the undesirable effects of exposure to unconventional sexual relationships.”

With these measures in place, finding homes for orphans outside the country has become very difficult.

Meanwhile, adoption within the borders of Russia faces its own set of barriers. Cultural prejudice against adoption perpetuates feelings of rejection among orphaned children and contributes to fears amongst potential adoptive parents that orphans have inherited undesirable traits and tendencies from their biological parents.

As one adoptive parent, Vera Dobrinskaya, stated in a BBC interview, many orphanage staff members discourage adoption when meeting with prospective parents. She quoted a nurse as saying to her, “Their parents abandoned them, and you want to take care of them?”

Unlike orphans in other countries, 95% of Russian orphans have at least one living parent. Often, they are taken forcibly into state custody because of family illness, disability, or poverty.

While institutions manage to provide for children’s basic physical needs, most Russian orphanages fail to take mental health into consideration. Research has shown that mass institutionalization and the absence of regular adoption practices harm children’s health and development.

To make matters worse, the interaction of staff members and children in these facilities is minimal and conducted in a formal manner, with little warmth or emotion. Daily activities like waking up, showering, dressing, and feeding are carried out in a militaristic way.

As the BBC explains, the problem of Russian orphanages is mainly in their self-identification as warehouses for unwanted children.

Georgette Mulheir, an advocate in the movement to end child abuse, explains why mental health neglect is a problem for these children in a recent TED Talk. While visiting a Russian orphanage, Mulheir reported seeing rooms lined with rows of barred beds, with children quietly gazing up at the ceiling. Newborns also lay in silence, often wearing soiled diapers but not crying, unfamiliar with the help that comes from attentive caregiving. And the head nurse proudly told Mulheir, “You see, our children are very well-behaved.”

Lacking proper stimulation and without secure attachment, many children develop odd and often self-injurious behaviours, such as rocking back and forth or banging their heads into walls. Just as healthy attachment between children and caregivers provides a sense of security for psychological, emotional, and physical development, lacking appropriate caregiving can seriously damage mental health.

As Stephen Bavolek, in the field of child abuse suggests, some of the problems these children can expect as they grow up include poor impulse control, impaired foresight, and a lack of trust in and affection for others.

Several months after the Russian adoption bans were implemented, the United Nations held a meeting to develop alternate childcare programs. Local governments within Russia were instructed to begin transferring children from orphanages to foster families.

This process, however, has encountered resistance from the institutional staff. As child rights protection activist, Maria Ostrovskaya, explains, “Institutions reject sending children into families, as state funding brings jobs and paychecks.”

The situation remains unresolved while many thousands of children wait for politicians to decide their fate. The stakes are high, as many of the children grow up with a risk of being sold into slavery, committing crimes, entering prostitution, or taking their own lives.

– Sara Benceković, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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RUSH Prevention Program Helping Children of Bipolar Parents

20Bipolar Disorder, Emotion Regulation, Environment, Featured news, Health, Parenting, Stress, Therapy May, 16

Source: Rolands Lakis on Flickr

“It was just kind of not knowing what you were going to get every time. Emotionally when I was younger, I always cared about her. She was my mom. As I grew up, I kind of became disconnected because I didn’t know the real her. I only knew her from her diagnosis. I only knew her emotions. I didn’t know the real her.”

– Steven, child of a bipolar mother.

In 2004, the World Health Organization named Bipolar Disorder (BD) the seventh-leading cause of ‘disease burden’ for women between 15 and 44, a measure that combines years of life lost to early death and years lost to living in subpar health. Public Health Agency of Canada reports that BD occurs in one percent of Canadians, and their reported mortality rates are two to three times greater than the general population.

The disorder is marked by alternating periods of manic euphoria and intense depression. In a manic state, people experience elevated moods, racing thoughts, and sleeplessness, in addition to overspending and engaging in risky sex. The depressive phases make for overwhelming feelings of sadness, withdrawal, and thoughts of death and suicide.

Research has related BD to aggressive behaviour, substance abuse, hypersexuality, and suicide. But more recently, studies have been showing the kinds of challenges faced by children of those diagnosed with the disorder.

The Pittsburgh Bipolar Offspring Study reports that children of bipolar parents are 14 times more likely to develop bipolar spectrum disorder. Children of two bipolar parents are at an even higher risk.

And these children are also more vulnerable to psychosocial problems. A study by Mark Ellenbogen at Concordia University finds them at greater risk for problems with emotional regulation and behavioral control.

Ellenbogen and colleagues have explained how stressful home environments can alter biology to influence mood disorders in adolescents and adults.

In an interview with the Trauma and Mental Health Report, Ellenbogen stated that OBD individuals (that is, offspring of parents with bipolar disorder) show higher levels of daytime cortisol, a hormone that is released during times of stress. OBD are psychologically more sensitive to stresses in their natural environments.

“We have found that high cortisol levels in offspring may represent a biomarker of risk for affective disorders, particularly in vulnerable populations like the OBD. We believe that these changes in cortisol levels can be linked to stress, inconsistent parenting practices and disorganization in the family environment.”

Reducing the stressors in early childhood may help decrease elevated levels of cortisol, and ward off the development of BD and other problems.

Recognizing the need for early intervention, Ellenbogen initiated a pilot prevention program, Reducing Unwanted Stress in the Home (RUSH), which targets bipolar parents and their vulnerable children between six and eleven.

An assessment measures salivary cortisol, looks at the family environment, and evaluates the child’s behaviour. Then parents and children participate in weekly sessions.

With parents, the focus is on improving communication and problem-solving skills, and increasing structure and consistency in the home. With children, they teach skills for understanding and coping with stress through age–appropriate exercises and educational games.

“The goal of the RUSH program is to prevent the development of affective disorders and other mental disorders by intervening in families well before these serious mental disorders begin. That is, this is a prevention program for children at high risk of developing debilitating mental disorders.”

To date, children and parents have been responding well, but the research is ongoing.

Programs like RUSH aim to prevent the development of mental illness in vulnerable youth. And an ounce of prevention can mean a whole lot to quality of life down the road.

– Eleenor Abraham, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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When Adolescents Claim the Right to Refuse Treatment

20Child Development, Decision-Making, Family Dynamics, Featured news, Parenting, Therapy April, 16

Source: UnitedNotions Film, Used with permission

In a personal essay in the Hartford Courant, 17-year old Cassandra C. recalls her legal battle when she refused to undergo chemotherapy after being diagnosed with Hodgkin Lymphoma, a cancer of the lymphatic system.

The Connecticut Superior Court ruled that as a minor, Cassandra did not understand the severity of her condition. She was taken to Connecticut Children’s Medical Center in Hartford, where she was forced to undergo chemotherapy.

In her essay, Cassandra wrote:

“I should have had the right to say no, but I didn’t. I was strapped to a bed by my wrists and ankles and sedated. I woke up in the recovery room with a port surgically placed in my chest. I was outraged and felt completely violated.”

When Cassandra’s mother did not bring her to medical appointments, the Department of Children and Families took Cassandra into custody. She was medically examined and placed into foster care.

A month later, Cassandra was allowed to return home once she agreed to continue chemotherapy. After reluctantly undergoing two days of treatment, Cassandra claimed that it was beginning to take a toll. Feeling trapped, she decided to run away to evade treatment, only returning home out of fear her disappearance would land her mother in jail.

It is common for cancer patients to experience adverse side effects while undergoing chemotherapy. In addition to physical side effects, patients often experience a range of psychopathologies, including depression, fear, anxiety, and hopelessness.

In court, Cassandra argued that she cared more about the quality of her life than the duration. Yet she was told that undergoing chemotherapy would increase her chance of survival by 85 percent. Without it, doctors said there would be a near certainty of death within two years. Although Cassandra acknowledged this risk, she maintained that she had the right to make decisions about her own life and body.

In an interview with the New York Times, Cassandra’s mother supported her daughter’s decision to refuse chemotherapy:

“She knows the long-term effects of having chemo, what it does to your organs, what it does to your body. She may not be able to have children after this because it affects everything in your body, it not only kills cancer, it kills everything in your body.”

Both Cassandra and her mother denied that Cassandra’s decision was anyone’s but her own. But there is some concern that Cassandra’s opinion on medical treatment could have been influenced by her parents. This issue is especially important given the far greater chance of survival offered by treatment.

A study by psychiatrist Paola Carbone in the Journal of Child Psychotherapy describes how young cancer patients may have trouble accepting treatment because of its severe effects on their developing bodies. Adolescent girls often express dissatisfaction with their bodies and lower self-esteem. The side effects of chemotherapy, such as weight loss, may negatively affect their fragile self-confidence.

The right to independent decision-making at this age is also a factor. In her essay, Cassandra writes:

“I am a human—I should be able to decide if I do or don’t want chemotherapy, whether I live 17 years or 100 years should not be anyone’s choice but mine.”

Researchers, Coralie Wilson and Frank Deane, suggest that it is important to teach adolescents’ that part of being more independent and autonomous is being aware of when and how to seek the support of others.

An extreme need for independence can result in self-imposed isolation, which is why Carbone maintains that adolescents are particularly in need of familial support. Other studies have also found that family involvement in discussions about the side effects of chemotherapy improves social support and decision making, lowers physical and mental distress, and increases emotional wellbeing.

Carbone explains:

“Chemotherapy refusal by adolescent patients should not be considered an obstacle to be eliminated at all costs, but rather a message to be welcomed and worked on.”

Cassandra was discharged from hospital last April, after completing treatment. Prior to being released, she wrote on Facebook, “I have less than 48 hours left in this hospital and I couldn’t be happier!”

She reported that she was grateful that she responded positively to the drugs and was predicted to survive cancer-free. But she also added:

“I stood up and fought for my rights, and I don’t regret it.”

– Khadija Bint Misbah, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Overpraising May Reduce Self-Esteem in Children

Overpraising May Reduce Self-Esteem in Children

10Confidence, Family Dynamics, Featured news, Parenting, Personality, Self-Esteem December, 15

Source: Vinicius Zeronian Mattoso on Flickr

Spend five minutes at a park, and soon you’ll hear enthusiastic parents reinforcing their kids with, “you did so amazing” and other statements as a means of encouragement.  To the nurturing parent or guardian, praising a child for performance seems like a no-brainer.

But recent research suggests that overpraising may not be such a confidence booster for some children, particularly those with low self-esteem.

Developmental psychology researcher Eddie Brummelman at Ohio State University says that using inflated praise can actually backfire.  In his research, children were asked to draw a famous painting, Wild Rose by Vincent van Gough.  One group of children received inflated praise such as “you made an incredibly beautiful drawing,” while a second group received non-inflated praise like “you made a beautiful drawing,” and a third group received no praise.

In a later task, children were asked to copy a picture of their own choice.  For example, they could choose to copy a simple picture, where the child would likely make few errors, or a difficult picture with more detail.

The results showed that children with low esteem were more likely to choose easier drawing tasks after receiving inflated statements of admiration.  In an interview with Research and Innovation Communications at Ohio State University, Brummelman said, “if you tell a child with low self-esteem that they did incredibly well, they may think they always need to do incredibly well.  They may worry about meeting those high standards and decide not to take on any new challenges.”

Children with low self-esteem may interpret high praise as expectation, making them afraid of failure and disappointment, and consequently, afraid to take on novel tasks.

Elizabeth Gunderson and colleagues at the University of Chicago found that parents who praised with a focus on the child’s personal characteristics (e.g. “you’re so smart”) implied to the child that their ability was fixed and unchangeable, resulting in a lack of motivation to tackle challenging tasks.  But when parents highlighted their child’s efforts (e.g. “you worked hard”), children often used positive approaches for problem solving, and believed that their abilities could be improved with effort.

Researchers often refer to this constructive encouragement as process praise.

Psychology professor, Lisa Marie Tully, from the University of California states that process praise might be especially beneficial for children who are generally more motivated and persistent.  Those children are more likely to ask for help when faced with experiences of failure after attempting challenging tasks.

Interestingly, Gunderson also found that the amount of praise that the child received from the parent had no apparent effect on motivation or self-esteem.

Consistent with these findings, Michigan State University Extension (MSUE) suggests ways to give constructive encouragement to children, to promote self-confidence and competence.

MSUE advises that supporting the child’s effort, whether or not they are successful in accomplishing a task, is important.  So instead of using personal and exaggerated praise in an attempt to boost esteem, let the child know that you recognize their determination.

Letting the child know exactly what they are doing well and noticing the detail of their work is critical.  Trading ambiguous praise for detail-oriented questions lets the child know that their work is interest-worthy.  When children are explicitly told what they are doing right (e.g. “good job at cleaning up the blocks”), it’s more effective in changing future behaviours and promoting improved effort.

– Khadija Bint-Misbah, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Parental Pressure Takes a Toll on Young Athletes

Parental Pressure Takes a Toll on Young Athletes

00Child Development, Family Dynamics, Featured news, Parenting, Resilience, Self-Esteem November, 15

Source: Jim Larrison on Flickr

Two young Jiu Jitsu fighters battle for position, and all I hear are the parents, “Ref, you missed those last two points!” “Jeffery, you’re doing it wrong!” Jeffery gets caught in a dangerous hold, and I end the match to spare him risk of a broken arm.  Afterward the parents approach me, angry I ended it so soon.

As a Brazilian Jiu Jitsu referee, many parents appreciate my concern for the welfare of trainees, but all too often, I’m forced to address those parents who try to motivate their children through put downs.  They call them names, yell, compare them to others, and stress the importance of being number one.  The pressure has a detrimental effect on child health, and leaves them feeling distressed and deflated.

According to Frank Smoll, Professor of Psychology at the University of Washington, parents play a pivotal role in determining whether sport is a fun learning experience or a nightmare. Smoll calls it frustrated jock-syndrome for parents who attempt to re-live their own past successes.

Smoll’s research found that children respond most favourably, not to coaches and parents who punish undesirable behaviours, but to those who sincerely reinforce behaviours that are desirable. For example, instead of yelling at a child for fumbling a ball, a parent or coach should congratulate the young athlete for the assist they made earlier in the game.  This encourages the child to try their best.

The money that parents spend can be a factor too.  Financial investment in sport has been associated with parental expectations. Travis Dorsche, a Utah State University professor and former football player, recently told The Wall Street Journal that “when parental sport spending goes up, it increases the likelihood that either the child will feel more pressure or the parent will exert it.”

As parents spend more on private coaching, equipment and travel expenses, the sport becomes less enjoyable for the child, and the child’s sense of personal ownership over their athletic career weakens.

Parent support is necessary for child success, but there is a fine line between supportiveness and pushiness.

Long term negative effects of overbearing sports parents are seen in two of the most successful athletes of all time, tennis player Andre Agassi, and baseball player Mickey Mantle.  In his international best seller, Open: An Autobiography, Agassi writes that he hates tennis with a “dark and secret passion” because of his overbearing father, and that when he won his first Grand Slam title, his father responded with, “You had no business losing that fourth set.”

Throughout their professional careers, both Agassi and Mantle developed problems with substance abuse.

Agassi turned to methamphetamine because it “swept away every negative thought in [his] head.”  Mantle, who had also been under intense pressure from his father, struggled with alcoholism and contemplated suicide.

According to Northern Illinois’ department of education, pressuring children too much in athletics can result in low self-esteem. These children are also at risk for physical injury, often pushed to perform regardless of pain complaints; they return to the field before fully healing.

For parents with children who play sports, about.com suggests encouraging your child to play the sport he or she enjoys, and supporting your child’s desire not to play a particular sport. Paediatrician and youth sports medicine specialist, Paul Stricker, argues that emphasis should be placed on a child’s effort.  Additionally, this should be modeled by parents and coaches, so children can learn the positivity of competition and effort, regardless of winning or losing.

As a coach and referee, safety is imperative.  Standing by my decisions and explaining that I’m not willing to risk safety may help some parents realize that there are things more important than being number one.

– Andrew McColl, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Sensory Sensitivity Can Strain Parent-Child Relations

Sensory Sensitivity Can Strain Parent-Child Relations

00Attachment, Child Development, Featured news, Parenting, Relationships, Stress, Trauma November, 15

Source: Camp ASCCA/Flickr

“For a child that has sensory hypersensitivity, every touch is painful. A hug is perceived as a painful gesture.”

So says Yael Ohri, a preschool teacher who specializes in identifying and alerting parents to potential issues their children may have with sensory sensitivity.

Sensory sensitivity is an important concern for some children and their parents. Low sensory thresholds characterize sensory hypersensitivity, in which any touch or experience can overwhelm the child, while sensory hyposensitivity occurs when a child is “under-sensitive” to stimuli.

Ohri was trained by clinical-developmental psychologist Rami Katz at Tel Aviv University, who trains professionals who work with children, in the Neuro-Developmental & Functional Approach (NDFA). Developed by Katz, NDFA aims to address early developmental issues by targeting the underlying source of the problem, rather than the external manifestations like the behavioural and learning difficulties resulting from sensory sensitivity.

Sensory hypersensitivity comes in various forms as it may be experienced through any of the five senses: sight, hearing, touch, smell, or taste. Ohri states that “a child’s skin may be so sensitive that she might complain that the tag in the back of the shirt, or the stitching in the socks is bothersome. Every little thing is experienced so intensely in a way that a child with normal sensitivity would not feel at all.”

Also of concern, over- or under- sensitivity in children can negatively affect the formation of attachment between parent and child.

As Ohri explains, “imagine a new mother who gives her baby a bath, and throughout the duration of the bath, the baby does not stop screaming, it can be very frustrating. The mom may blame herself and say, ‘I’m such a terrible mother, I can’t even bathe my baby,’ or worse, she may get angry with her baby for acting up and proclaim, ‘my baby hates me,’ causing an attachment issue right off the bat.”

To help young children struggling with average intensity stimuli, occupational therapists may stimulate the child’s skin with different brushes that allow the body to moderate the sensory input.

This, as well as other techniques, is designed to help sensory sensitivity. Still, Ohri believes that a critical element of treatment is simple awareness.

“It is essential that parents understand their child’s hyper- or hypo- sensitivity, and that it’s not something that the child is doing to them on purpose.” By raising early awareness, the issue is addressed when it is still relatively easy to treat. Ohri views it as much worse when the issue is not targeted early, leading to fights and stress in the family, as well as parents labelling the child as having a personality problem.

A sensory hyper-sensitive child may be labelled as irritable or whiny. Similarly, a hypo-sensitive child, who tends to be rougher, does so “not because he’s doing it on purpose, but instead, because he needs to hold and feel you and in order to do that, he does so more strongly. This kind of child is often labelled as violent.”

The problem is that this type of labelling can result in a self-fulfilling prophecy where the child ends up thinking of himself as difficult or rude, identity characteristics that become difficult to break free of later on.

Ohri argues that awareness helps. “Once parents become aware that the child has a sensory sensitivity, and begin asking themselves the right questions about the child’s day-to-day behaviours, they learn to alter their interaction with their child in order to avoid conflicts.”

Does simply being aware solve the problem altogether? No, but it’s a start.

“It doesn’t necessarily mean that the child stops being sensitive, but it helps moderate the difficulties and makes the child’s environment more understanding. This applies to both the child and the family. As both sides become more aware, living with sensory sensitivity becomes more tolerable. Mothers are amazing, if they are made aware, they find the solution.”

But what about parents who struggle with their own mental health? Parents dealing with personal trauma may find it harder to perceive signals coming from their child and may interpret them inaccurately.

According to developmental psychologist, Sarah Landy, at the Hincks-Dellcrest Centre in Toronto, parents who don’t have their personal needs met due to past trauma, find it difficult to emotionally connect with their children and respond sensitively to their needs. “When parents are unavailable due to trauma,” says Ohri, “awareness alone won’t do the trick, since the parents might not be able to get there on their own.”

So, parents who work toward resolving their own struggles with mental health will likely become better attuned to their children’s cues and respond to them more sensitively.

Sensory hyper- and hypo-sensitivity can be resolved relatively easily when targeted early, but can become a more complex issue when ignored or treated incorrectly, or when parents are not emotionally available to notice the problem.

Through the difficulties, Ohri emphasizes, “awareness is key.”

– Noam Bin-Noon, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

After a Stillbirth, Interpersonal Support Facilitates Coping

After a Stillbirth, Interpersonal Support Facilitates Coping

00Caregiving, Depression, Featured news, Grief, Health, Parenting, Resilience October, 15

Source: Judit Klein on Flickr

Over 2 million babies are stillborn every year worldwide, resulting from a genetic or physical defect, an illness suffered by the mother, or problems with the umbilical cord. In more than one quarter of cases, no cause can be determined.

In a recent interview with The Trauma & Mental Health Report, Heather, a mother and mature student shared her experiences surrounding stillbirth and commented on the services provided for families.

I chose to name my baby Benjamin.  I didn’t return to work after I got the ultrasound results and eventually I resigned.  I didn’t want to face the office, or their sympathy.

Immediately after a stillbirth, parents are offered various services to help manage their grief.

I was given a private room for the induction – an artificially stimulated labour – and received options for grief counselling and the services of priests and rabbis at the hospital.  We had him cremated, and the tiny basket of ashes was buried on my grandmother’s grave.  My husband and I also received genetic counselling to try to find the cause of the loss.

Parents of stillborn children have the option to see, touch, or hold their baby.  Memories that validate their experiences as parents can be created through handprints or footprints, pictures, or keeping locks of hair.  It can be overwhelming to make these decisions while coping with the reality that your child is gone, but these options may help parents make sense of their grief.

I was 21 weeks pregnant, so I was already making plans, thinking of names, and my daughter was looking forward to having a sibling.  I also looked physically pregnant… I was ready to have a baby, and in a fleeting moment he was gone.  It was so hard to move forward after that, and it was hard to reach out for help.

Interactions with hospital staff following the death of the child may influence how parents cope.  A 2013 study by Soo Downe, an associate professor at the University of Central Lancashire, found that parents believed there was only one chance to create an environment conducive to coping.  This means that positive memories and outcomes following a stillbirth depend as much on caring attitudes and behaviors of staff as on high-quality clinical procedures.

When interactions with hospital staff did not create a supportive environment, parents became distressed, which added to their grief and affected their ability to manage their jobs, family life, and mental health.  This additional stress can ultimately impact couples’ willingness to seek help.  When these interactions were more compassionate, parents were more likely to have positive, healing memories that aided their psychosocial recovery.

It is also common for parents to develop poor coping strategies, and to adjust differently after the loss of a child. Those who do not seek out services because of shame, fear, or anger tend to suffer in silence. A study by social worker Joanne Cacciatore, Faculty Associate at Arizona State University, shows that women who attend a support group develop fewer post-traumatic stress symptoms than those who do not.

Opening up to other bereaved mothers is helpful for reducing grief and other mental health difficulties.  Partners may also find reaching out to religious or spiritual leaders, funeral homes, and support groups helpful.  Online resources like blogging can also be useful for parents looking to connect in an anonymous way.

Heather was lucky to have the support and experience of the women in her family, which played a critical role in how she managed her grief.

I was grateful that my mother came out to stay with me during the termination.  Talking with her helped.  Other family members also began opening up for the first time about their experiences with miscarriage and stillbirth.  I didn’t feel so alone.

Some organizations are working to educate marital partners on coping styles and seeking out support.  The International Stillbirth Alliance works to improve stillbirth prevention and bereavement care for those who have lost a child.  Although they do not provide individual services, they work with other organizations to connect locally and globally to improve standards of care.

Women who have had a stillbirth can benefit from bereavement services and support of their loved ones.  Those who suffer in silence will likely do so much longer than they have to.

– Danielle Tremblay, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright: Robert T. Muller

This article was originally published on Psychology Today

Book Review: “Drop the Worry Ball”

Book Review: “Drop the Worry Ball”

10Anxiety, Attachment, Featured news, Parenting, Perfectionism, Resilience July, 15

Source: Stephan Hochhaus/Flickr

Parents are inundated with conflicting advice on how to raise their children. Pediatrician William Sears’ attachment parenting couldn’t be more different from the approach taken by “tiger mother” Amy Chua.  The range of “how-to” styles can leave parents scratching their heads about what’s best.

Research tends to support an authoritative parenting style, a balance of clear guidelines and expectations paired with warmth and attentiveness.  But in this age of perfected parenting, we are seeingan increase in anxiety and depression in children. Some think that caregivers are overparenting, and that this over-attentiveness may be causing problems.

In his latest book Drop the Worry Ball (2012, Wiley),clinical psychologist Alex Russell says that children no longer grow up; nowadays we raise them, placing all responsibility on the parents.  This results in caretaking that is too protective, too involved.  At the extreme, this becomes helicopter parenting.  Parents “hover” nearby, hyper-aware of the risks and needs of their child before the child is able to evaluate a situation or make decisions on their own.

Russell’s observation of the two outcomes of over-parenting:  too little or too much anxiety in children, parallel research of Ellen Sandester, professor at Queen Maud University College of Early Childhood Education in Norway.  Sandester argues that it is through risk that children expose themselves to fearful situations, and the thrill experienced from coping with anxiety helps develop the child’s evaluation of their ability to cope with future challenges.  When children are prevented from engaging in these non-catastrophic risks, they become either hypo-anxious or hyper-anxious.  With the first, there is too little realistic perception of consequences, so the child seeks greater thrill or tries out more dangerous situations.  With hyper-anxiety, the lack of experience leads the child to become phobic of novel situations.

Similar, but not identical to Sandester, Russell argues that we are seeing two kinds of children develop as a result of over-parenting.  First, there are those who become disengaged or avoidant of stress and anxiety and don’t want to take on the adult world. And second, there is the hyper-anxious child, the pleaser and perfectionist.  The imbalance of anxiety is created by anxious parents who hold the worry for their children –essentially shielding them from normal developmental experiences.  Similar to Sandester’s analysis, these children are deprived of the opportunity to cope with healthy, necessary levels of stress and anxiety.

That anxious parents could produce anxious children is not surprising, but that over-attentive parenting leads to hypo-anxious, disengaged children seems counterintuitive.  A lot of media attention has been given to the increasing numbers of children who are disengaged.  Russell argues however, that the same parenting style can create this avoidance of anxiety.  The parents make the adult world appear stressful and unmanageable, so why grow up?

Russell acknowledges that there is no quick fix, and that all parents make mistakes.  He recommends a mindful approach to parenting.  That is, a shift back to listening and reflecting on what the child says and does, instead of giving advice or actively taking over.

Parents need to appreciate that the child has the ability to cope with everyday risks, and need to give the child the space he or she needs to solve problems.

This book is a worthwhile read for parents.  Sometimes we need to remind ourselves that raising kids is about being “good-enough,” not perfect.

After all, children do grow up, and seem to do this best with a little space to explore and learn from mistakes.

– By Heather Carter-Simmons, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Dysregulation: A New DSM Label for Childhood Rages

Dysregulation: A New DSM Label for Childhood Rages

00Anger, Child Development, Cognition, Featured news, Health, Parenting, Self-Control, Stress July, 15

Source: Mary Anne Enriquez/Flickr

With the many changes in the newest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), among the most significant has been the inclusion of Disruptive Mood Dysregulation Disorder (DMDD)—a direct response to the dramatic increase in the diagnosis of bipolar disorder in children and adolescents during the 1990s.

Diagnosing bipolar illness in children is considered elusive at best.  Characterized by extreme and distinct changes in mood, bipolar illness ranges from depressive symptoms to manic “highs.”  In younger populations, the shift between manic and depressive episodes is not so clear.

Children often experience abrupt mood swings, explosive and lengthy rages, impairment in judgment, impulsivity, and defiant behavior.  Such parent-reported symptoms became a popular basis for childhood bipolar disorder diagnoses.

In recent years, Ellen Leibenluft, a senior investigator at the National Institute of Mental Health and an associate professor at Georgetown University, developed the concept of “severe mood dysregulation” as distinct from bipolar disorder.  Her research highlights the difference between unusual intense rages, and the distinct mood swings in bipolar disorder.

Anchored in her research, the DSM-5 task force attempted to develop a new classification for a disorder that shared some characteristics with bipolar disorder but did not include the abrupt shifts in mood.  By doing so, the task force hopes the rate of diagnoses for bipolar disorder in children will decline.

The DSM-5 characterizes DMDD as severe recurrent temper outbursts that are “grossly out of proportion in intensity or duration” to the situation.  Temper outbursts occur at least 3 times per week and the mood between outbursts remains negative.  To separate DMDD from bipolar disorder, children must not experience manic symptoms such as feelings of grandiosity, and reduced need for sleep.

Differentiating between bipolar disorder symptoms and rages unrelated to mood swings may very well be a step in the right direction.

But some studies suggest that DMDD may not be all that distinct or useful as a diagnostic entity different from those already in use, such as oppositional defiant disorder or conduct disorder.  It may be that DMDD is not a condition of its own, but rather a primary symptom of a larger issue.  Irritability and rages may be an indication of a disorder already established in previous versions of the DSM.

Aside from diagnostic labels, taking social situations into account may lead to a sharper understanding of rages in children.

While the role of biology cannot be discounted in the development of mental disorders, childhood behavioral problems may be affected by social and economic circumstances. Financial hardships and other parental stresses have an effect on children’s mental well-being, and stress may be detrimental to the communication between the parent and child.

Along with biological conditions, the DSM task force should consider the impact of the child’s social experience.  Helena Hansen, assistant professor of psychiatry at the New York University School of Medicine, argues that the recent revisions in the DSM-5 have missed key social factors that trigger certain biological responses.  Her article, published in the journal Health Affair, emphasizes the importance of understanding how social and institutional circumstances influence the epidemiological distribution of disorders.

For example, differing temperaments can explain why some children appear to cope well with life stresses while others develop problem behaviors.  Lashing out in the form of rages and tantrums may be a natural response to intolerable anxiety and stress for some children.

As new terms for disorders are coined, such as DMDD, we need to ask if the development of another category is the best alternative.  Is substituting one label of childhood behavioral problems for another really our best option?

Due to the many possible causes for temper outbursts, giving the child a single label may not be all that helpful.  Instead, determining the core issues surrounding the rages may be more useful in providing the patient with an effective treatment plan.

Also, let’s keep in mind that mental disordersare simply constructs, not unique disease states.  They are developed to allow better understanding of a group of behavioral, emotional, and cognitive symptoms, and are regularly revised based on new research and changing cultural values.  While the DSM is useful for the purpose of understanding the challenges faced by patients, it should not be given “bible” status.

Along with mental health care providers, it is important for parents to get informed about DMDD, to ask questions, and to get involved in discussions when considering treatment options for their child.

– Khadija Bint Misbah, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Distinct ADHD Symptoms in Girls Result in Under-Diagnosis

Distinct ADHD Symptoms in Girls Result in Under-Diagnosis

00ADHD, Adolescence, Education, Featured news, Gender, Parenting June, 15

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When my daughter was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) in the first grade, I was devastated. I didn’t see a hyperactive, impulsive child or one with behavioural issues. I apparently missed the symptoms, now making me wonder how many other parents also don’t know what ADHD looks like in girls.

It’s common to hear stories of young boys being overmedicated and over-diagnosed with ADHD. What we don’t hear is that for every boy diagnosed, there is a girl whose symptoms are being missed.

Patricia Quinn, developmental pediatrician and director of the National Center for Gender Issues and ADHD, says that girls with the disorder often exhibit symptoms in less physical and disruptive ways compared to boys. Girls are raised to internalize their emotions in North American culture, this is likely why they are more commonly diagnosed as having the ADHD inattentive subtype. Quinn notes that even girls with the ADHD hyperactive subtype do not show the same physical energy as boys do with the same subtype, but instead, exhibit symptoms like incessant talking, chewing on hair or clothes, being emotionally reactive or displaying hypersensitivity.

Similar to my experience, Katie, a mother of two girls living in Arkansas, found her daughter Katelyn’s diagnosis surprising. After Katelyn’s second grade teacher noticed her difficulty focusing and staying on task, a psychologist diagnosed Katelyn with the inattentive subtype of ADHD and mild anxiety.

“I thought Katelyn was just a little over-sensitive. She never acted too fidgety or anything. The most she did was talk incessantly, but that wasn’t a big deal,” says Katie.

Katie’s younger daughter, Violet, demonstrated intense and sometimes aggressive behavior. She was diagnosed at age six with combined type ADHD with aggression. The impulsive behavior showed up in Violet as being “mean” and sometimes acting like a bully.

Michelle, a single parent from Toronto, is currently in the process of having her eight-year-old daughter Lisa assessed. Having already been through the assessment process with Lisa’s older brother Nick, Michelle explains, “With Nick we were doing damage control whereas with Lisa, her behavior was more covert and not as extreme.”

Lisa, Katelyn, and Violet are fortunate to have been diagnosed early.

Most girls are not diagnosed until puberty, and even then, their symptoms can be mistaken for other disorders like depression, anxiety, and bipolar disorder. Quinn highlights that in a 2002 nationwide survey by Harris International, 14% of adolescent girls who had ADHD were [improperly] treated with antidepressants before their ADHD treatment, compared to only 5% of males with ADHD.

Even once a diagnosis is made, parents can go through various stages of denial, grief, and blame. Child psychologists, Alexandra Harborne and Miranda Wolpert at CAMHS in England, and neuropsychologist, Linda Clare, at the University of Wales Bangor say that it is common for parents to blame themselves for their children’s bad behaviour. In addition to dealing with self-blame, parents may unintentionally delay an assessment for their child.

In Katie’s situation, she says Katelyn’s grandfather did not believe that there was anything wrong with her, causing Katie to question her decision to have her daughter assessed as well as her choice of a medication based treatment plan. So too, Violet’s daycare initially attributed her misbehaviour to poor parenting, rather than an inability to regulate her emotions and behavior.

Receiving a diagnosis can bring relief to parents as it provides an explanation for the behaviors they’ve experienced. But, it can also cause grief as parents deal with the loss of a “normal” child and anxiety over what the future holds for the family.

A key part of the assessment process should include some support for the parents. But this is sometimes hard for parents to find. CHADD, Children and Adults with ADHD is a network throughout the U.S. and Canada that provides support groups and parenting classes. ADDitude magazine is another helpful resource. These networks allow parents to share the process of understanding the diagnosis and learning new parenting skills.

Michelle says that after researching ADHD she has come to see her children as simply being wired differently. She refers to the reactions and behaviours of ADHD as her child’s “guidance system”. She believes triggers occur when the environment or situation is a poor fit for the child, but that they can find what they need, and learn what to avoid.

Katie thinks that ADHD is not a problem per se, but part of who her children are. She considers her girls’ different ways of thinking as leading to creativity and innovation, underscoring the idea that a diagnosis of ADHD is not necessarily a negative label. As Michelle and Katie demonstrate, just being able to accept and understand the differences created by ADHD can be empowering. It’s neither a curse, nor a gift, just a different way of thinking.

Quinn notes that ADHD is highly treatable regardless of whether it is present in girls or boys.

What we need now is a better understanding of gender differences so we don’t miss early signs, and can better treat ADHD in girls.

– Heather Carter-Simmons, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today