More than Meds

thoughts of a child psychiatrist

Saying “NO!” or letting go; when to set limits

When does good parenting turn into over-protection? What is neglectful parenting?  What’s so bad about being a “helicopter parent” (ready to swoop in to rescue at any sign of trouble)?

These questions are important to most parents, but become especially meaningful after a child has had trauma or illness.  I see this in my practice frequently, and try to help parents determine how their actions and attitude can best help in their child’s recovery.

It is important to know that feeling vulnerable is hard, uncomfortable and even threatening to many children.  Teens especially hate feeling like a victim or feeling that others see them as less than competent. That’s one reason why the experience of trauma at this age is so difficult to manage.

But kids and teens count on the adults in their life to help them manage — they just don’t want to make this dependence obvious!

What is best for a parent to do, then? There is no easy “one size fits all” answer. Being aware of a young person’s developmental stage helps the adults in his or her life shape strategy for assistance. Often the best answer is to try to walk the thin and often rambling line between helping too much (and eroding self-confidence) and helping too little (leading to a feeling of loneliness and abandonment.) Frequent re-evaluation and good communication helps!

Healthy Eating: Does it matter?

Galapagos tortoise (RJB; 2011; Galapagos)

Yes.

FACT: Eating well helps mood, sleep, and concentration, as well as general health.

It really does not make a lot of sense to take medication for any of these while continuing a pattern of unhealthy eating.  It often is that improving eating (and then getting better sleep) helps mood, sleep and concentration enough to stop or lower doses of medication. But how to convince children of this?

There is no great trick or secret to helping children eat well.  Model healthy eating habits at home, have plenty of fruit and vegetables available for snacks and look for a good source of protein for each meal – especially school-day breakfasts.  Get rid of as much junk food as possible (best not to keep it in the house.)

As children reach early elementary age involve them in shopping and meal decisions.  Don’t be afraid to break patterns;  pizza, spaghetti or soup  for breakfast or even fruit and yogurt smoothies for supper can add interest to the day and make picky eaters more enthusiastic.

Older children and teens have more opportunities to make choices regarding food.  Planning ahead for family meals and snack food options help open discussions about health and good choices.  Try to resist  fast food  for supper (hard on those rushed days with multiple activities) but if it is necessary look for options with  good protein and vitamin sources.

Eating healthy and feeling healthy often go hand-in-hand.  There is much we can’t control or change  for our children, but having good choices of  food available and modeling healthy eating habits is a profound way to influence children and promote life-long benefits.

 

Sleep — key to behavior

Sleep like a ...sea lion? (R. Brockman, 07/2011, Galapagos)

Sleep. I get calls every day about sleep problems. And for good reason; unregulated sleep often goes hand- in -hand with behavior problems.

Sometimes it is hard to know which came first.  The upset and angry teen may not be able to settle down and self- soothe enough to get to sleep, the depressed child may naturally have a poor sleep cycle, and the youngster on medication for ADHD may not sleep well because of medication side effects. But even if we do not know the “chicken or egg” answer (which came first?) we do know that establishing and maintaining a consistent sleep and awake pattern helps almost every behavior and emotional problem.

But how can we get a child or teen to adopt such a pattern?  Not easily!  Here are some ideas – these won’t fit or work for every sleep disordered youth, but the basic idea works for most.

1. Get electronics (other than a basic radio) out of the room.  No cell phone, TV, computer, game system.  Consider having books and maybe soothing music available.

This is sometimes the most difficult step and is easiest if established at a young age.  But even for older teens it is doable if you are clear that this is not negotiable.

2. Set regular sleep and awake times and be prepared to enforce them.

3. Cut out or drastically reduce sources of caffeine.

4. If there is a medication issue that may be contributing, consider changing timing of the med (talk with the child’s doctor about this.)

5. Think about bedtime routines that make sense and help implement.

And most importantly, try to enlist your child or teen into the effort.  Help them understand your concerns about their sleep and try to make a shared effort to get sleep back on track.  Celebrate with them when gains are made and help them try again if sleep remains difficult at first.

There are some medications that are used to help children restore sleep cycles, but most practitioners will ask that you try some of these other steps first. Good luck and let me know if there are other ideas about sleep out there!

 

 

Developing a “hard shell”

Sally Lightfoot Crabs (R.Brockman, Galapagos; 07/2011)

I was glad to read this article about cyber-bullying and the efforts of the Grand Forks community to combat this growing problem. As a psychiatrist, I am acutely aware of the prevalence of  hurtful and hateful comments among the school-aged  crowd on social media sites;  it would be difficult to not be aware as patients bring this to my attention daily!

And while I am all for attacking (and hopefully eliminating) the problem directly, I also believe that it is useful and important to to address the flip side of the issue.  That is, to work with kids who feel pushed around, teased and mistreated by peers and help them find strategies to strengthen their own voice and thereby mount a response on their own behalf. This is never an easy task, but certainly is an important one with long reaching consequences.

As parents and other caring adults, we all walk the fine line between wanting to shelter and protect children and wanting to prepare them to be self-reliant . I remind parents that children generally takes cues from adults; we do best when we help kids identify and develop tools and strategies that are usable across many situations, rather than trying to step in and save them from disappointment and hurt.

 

 

 

ADD? ADHD? or… TT (typical teen)

Which way? (Andes Mountains, 08/2011; R. Brockman)

15 year old Shana and her mother come into my office. They explain that since beginning high school last fall, Shana’s grades have dropped, she is forgetful and having trouble keeping track of class assignments, and last week received her first-ever detention after returning to campus late from lunch. Both Shana and her mother are concerned – Shana because she has been getting in trouble at home due to the school issues and her mother because she feels, ” I know Shana can do better; could she have ADD or ADHD?”

As a psychiatrist it is my job to help Shana and others like her sort out situations like this one. Could she have a disorder of attention such as ADD? Sure! But it is equally likely that she is simply having difficulty adjusting to the demands of her new school situation and the relative freedom of high school life with an open campus and less oversight. Of course, there may be other factors at work here as well; I would want to screen for any symptoms suggestive of depression, substance use, or medical problems that could be contributing to these changes in functioning.

One of the most important diagnostic tools I employ as a psychiatrist is the ability to take a good history and place the history into context. Understanding Shana’s emotional, social and educational progression and development will most likely provide the key I need to help Shana and her family, and to decide if further testing or treatment is needed.

ADD and ADHD do not suddenly appear in teenage years; these are disorders that are present from early childhood. However, it is always possible (especially in bright children who do not have behavior problems) that the diagnosis could have been overlooked early on, and this is another reason why a careful history is so important.

Take-home message? A lack of attention, distractibility, and poor control of impulses are hallmarks of attentional disorders but the presence of these characteristics alone are not enough. It takes a careful history, screening tests and typically other diagnostic evaluations to make a definitive diagnosis. And then comes treatment…topic for another day!