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Understanding ADHD…For Parents

Posted on: December 3rd, 2019

I’ve been working as a therapist with people for over 20 years.  For many years I worked with children having ADHD in a school setting.  Then I became a parent to children having ADHD as well.  So not only have I experienced it first hand as a professional, but live the experience at home as well.

ADHD is a neurodevelopmental disorder affecting millions of children, though more often in boys.  It affects focus, concentration, and task completion.  Often children can appear easily distracted or forgetful. They may have trouble sitting still or may interrupt frequently.  These children may struggle academically, in social settings, and at home.  Some may also have learning disabilities or other mental health conditions in combination with ADHD.

ADHD takes different forms, so it’s important to differentiate.  There are three forms: Inattentive-type, Hyperactive-impulsive type, and Combined type.  Inattentive-type is most common in girls and is identified by a more pronounced difficulty with focusing, finishing tasks, and following directions.  Girls may also day dream and talk a lot more than boys.  Hyperactive-impulsive type is identified by fidgeting, interrupting others when talking, and not being able to wait one’s turn.  Combined type is the most common.  Children with this type have both inattention, hyperactivity, and impulsivity.

Children with ADHD have an immature frontal lobe and less grey matter in the brain as compared to typical peers without ADHD.  This means that the parts of the brain responsible for stopping and thinking, organizing, planning, and regulating emotions, is not as developed.  Children with ADHD may struggle with speech, self-control, decision-making, and muscle control.

There are numerous resources on the web about ADHD to find information about recognizing symptoms, the prevalence of ADHD, how to advocate for your child with ADHD, as well as treatment options.  Here are a few things I have come to learn both professionally and personally that have made me a more informed therapist and parent.

  • When in doubt, get your child tested.  A common inventory used by pediatricians is the Vanderbilt.  It is  designed to compare your child’s symptoms at home and in school.  Another option is going through a psychologist, either at your child’s school, or an outside resource specializing in ADHD testing.  Testing is helpful and can provide you and your child with additional recommendations for next steps, such as  school accommodations, a 504 plan, or therapy resources.
  • Get informed.  Learn about ADHD…things that work and don’t work.  Attend trainings or workshops.  Read about it.  Join an online forum.  
  • Advocate for your child at school.  Teachers are busy.  You are the best expert on your child at home.  Develop a working relationship with your child’s team.  Consider meeting with your team early in the school year, and following up with the team on a regular basis.
  • Employ checklists and routines at home.  If your child is not yet independent with routines, start with one-step, check to see it gets done.  If it isn’t getting done, break the task down into smaller steps, and do the task together.  
  • Keep it together.  Yelling really doesn’t help.  It escalates you and your child.  Nine times out of 10, the child isn’t trying to make you frustrated when they fail to follow through.  Instead, think about what is the one thing you could do to make this task easier and more successful for my child.  
  • Be compassionate towards your child.  Think of your child in a positive light.  There will be hard days.  Check in with yourself often when you feel your buttons are being pressed.
  • Consider a good therapist specializing in ADHD.  Therapists have additional clinical experience and resources that can set your child up for success.  Perhaps your child needs a behavior chart or plan at school, or behavioral services that can come to the home or school.  Sometimes families need therapy too to cope with a child having ADHD.
  • Medications can help.  Non-pharmacological approaches are a great first step.  But if everything has been tried and your child is not finding success in multiple environments, it’s time to consider medication.  Your doctor will work with you to find the right medicine for your child. Sometimes this can be a bit of trial and error.  Be patient.  Take good data and observe your child.  Communicate regularly with your child’s doctor.  If the medication and therapies are working, grades get better, friendships are healthier, your child appears happier, and homelife is more stable.  

Our journey at home continues and involves all of these aspects.  If you have concerns about your child’s ADHD, or think you have ADHD yourself, or need more information about the therapy process, contact me at SHCS.

Building up your Coping Muscles

Posted on: November 3rd, 2019

Relaxation, self-care, soothing your mind and body, thought-changing, mindfulness…

No matter what we face in life, we do have to develop reasonable ways to manage our thoughts, feelings, and behavior.  We cannot control other people, only ourselves.  Whether it’s coping with a difficult personality, facing a fear, or working through traumatic memories, how we learn to handle distress can have lasting changes in our brain and impact those around us.

Coping muscles are the muscles in our brain that we cannot see.  It gives us the ability to move past “hurdles,” see a problem differently, walk away from a heightened situation, and make informed choices.  Getting there though takes work.  Physical activity and relaxation need to be practiced.  This requires time, effort, routine, and consistency built into the day.  How long is required to be effective?  That depends…for mindfulness, only 7 minutes/day for lasting results.  

Next time you are finding it difficult to focus, having racing thoughts, or are feeling overwhelmed, try a few of these mindful techniques to slow yourself down.

  • “Clear a Space”- Check in with your mind and body.  Create a safe image in your mind.  Set aside thoughts of the past, present, and future.  Or use a backpack image…leave behind judgement and self-doubt.  Pack courage or inspiration.  Look at the experience with kindness and curiosity.  Focus on clearing a space in your mind.
  • “Safe Place Imagery”- Imagine a real or imagined scene your mind using all of your senses.  Focus on the sensation of each sense and provide as much detail as possible.  (Your brain will not know the difference between you being there or merely thinking about it!)
  • 7/11 breath- breathing in for seven seconds and exhaling for eleven.  Repeat…
  • Take a breath before answering the phone, while you are on hold, replying to a text, or email.
  • Breathing Retraining- For early signs of panic.  Hold the breath for 10 seconds.  Breathe in for 3 seconds and out for 3 seconds 10x (about 1 minute).  Repeat both steps until symptoms are gone.
  • 4-Square breath- Using your finger as if to trace a square, breath in as you move up, hold for 4 as you move across, breath out as you move down, and hold for 4 as you return to start.  Repeat.
  • Figure 8 breath- Using your finger as if to trace a figure 8, inhale for the first half, and exhale for the second half.  Repeat.
  • Focus on your footsteps.  Breathe with your steps…in for 4, out for 4.  Gradually slow your pace.
  • Focus on a particular sound (single instrument, nature sounds, etc) How far away can you hear it?  What is the next closest sound?  Can you hear anything nearby, your own breath?    
  • Yoga poses (try holding a pose that is comfortable to you, like “Mountain Pose” and focus on the stability of the pose, the connection with the floor, the emphasis on posture, and the breath that gives you strength.

The key to any mindful technique is consistency.  Try it first thing in the morning, during lunch, in between work tasks, or at the end of the day before sleeping.  Need support building your coping muscles.  Connect with me at SHCS.

Trying to cope but repeating old patterns?

Posted on: October 15th, 2019

I know of a child who regularly has meltdowns when asked to do something he or she does not want to do.  Instead of using words, the child escalates to the point of disrupting property, slams doors, yells, and makes poor statements about his or herself.  The child’s coping skill….going to sleep.  Is it effective?  Maybe.  Can it be generalized to other settings?  Unlikely.  You can’t go to sleep at school if things aren’t going your way or when a teacher asks you to follow directions. “Use your coping skills,” I hear from others, time and time again.  Not only have I said these very words to my own kids, but to clients, too.

What are coping skills anyway?  According to UCLA, coping skills/strategies are “the behaviors, thoughts, and emotions that one uses to adjust to the changes that occur in life.  Some are more effective than others depending on the stressful situation and the person employing them.”  How one copes can be good for you or not so good for you.  

For example, if you think to yourself, “I’ve got to take a break before I lose it” then go for a run, this can be good for you.  Running releases endorphins drives out stored up muscle tension, and can benefit your body physically and mentally.   The pros are that you are coping in a healthy way and are not giving into the distress you feel.  On the other hand, if a person thinks that nothing will ever get better and he or she needs to release the pain, self-harming behavior, such as cutting, may occur.  This, too, can also release endorphins, yet can leave permanent scarring, resulting in hospitalization, or even death.   Both sets of coping skills can become habits.

What I do know is that coping strategies require practice to become a habit.  Timing is important too.  Being aware of what causes stress, anxiety or frustration is also important.  We call these triggers, the things that “set us off.”  Ignoring the signs and waiting too long before using a coping strategy can worsen the experience.

When the intensity of one’s thoughts and emotions become too big, tantrums happen, or the individual may give into distress by self-harming.  Sometimes the escalation is so quick that there isn’t time to intervene, such as in ADHD or autism, where thoughts become stuck or inflexible, quickly leading to the behavior.  (It’s also important to note that in children with these conditions, the frontal lobe of the brain, responsible for self-regulation and executive functioning, is still immature, making it harder to access coping skills.)

Healthy coping skills can include:

  • exercise, 
  • writing in a journal
  • drawing/coloring
  • listening to music
  • playing an instrument
  • taking a shower/bath
  • playing with a pet
  • spending time outdoors in nature
  • organizing or cleaning activities

In regards to DBT (dialectical behavior therapy), coping skills can include mindful distractions and ways to soothe yourself.  They can improve the moment when you can’t make things better right away.  They can help you make more informed decisions so that you are not giving into distress.  For kids, parents/teacher/counselors can model and teach expected responses and practice calming skills with kids to assist them in the learning of new habits and behaviors.  

Being a musician, music is meaningful to me.  I sing, strum guitar, and play the piano for self-expression and to self-soothe.  If I don’t do it, I miss it.  It’s a release that I’ve come to require in my life for my own self-care.  In addition, I walk my dog daily.  It’s a time to think quietly and focus on my steps, a mindful moment.  These have become habits and routines that have made my life more balanced.  

If you are having trouble learning coping skills or would like to improve on the ones you have, contact me at SHCS!

A Parent’s Guide to Separation Anxiety

Posted on: August 15th, 2019

Does your child cling, cry, or melt down when you attempt to leave the room, leave the house, or when he or she goes to school?  Does your child attempt to spend the night, only to call, crying, saying they need to be picked up?

You’re not alone.  I’ve been there.  When my son was five, he started kindergarten and began riding the bus for the first time.  The school was close by and could be seen from our house.  For about six months, the mornings began with tears, prolonged hugs, and questions like, “Will I ever see you again?”  It’s heartbreaking to see your child stressed, but more specifically when you know it’s the idea of being apart from you that drives it.  

What is separation anxiety?

Separation anxiety is a form of anxiety in which the fear of separation is so great, it’s all the person can think about.  Some individuals may have nightmares and physical complaints, are reluctant to go to school, or other places.  Symptoms can last for six months or more and interfere with daily life. 

The DSM-V classifies separation anxiety in the following ways:

  • Unusual distress about being separated from a person or pet
  • Excessive worry that another person will be harmed if they leave them alone
  • Heightened fear/worry surrounding being alone
  • Physical symptoms when they know they will be separated from another person soon
  • Needing to know where a loved one is at all times

Who can have separation anxiety?

Separation anxiety is common, with more than 200,000 cases per year, affecting children 13 and under.  While it’s rarer among teens, adults can also be affected by it.  

What causes separation anxiety?

In children, separation anxiety is a normal part of childhood development, with the timing of it varying. Some children might go through it between 18months and 2 and1/2 years of age, while others may never experience it.

Kids with separation anxiety disorder fear being lost from their family members and are often convinced something bad will happen to them.  Physical symptoms may include:

  • Panic symptoms (nausea, vomiting, shortness of breath), or panic attacks before a parent leaves
  • Nightmares about separating
  • Fear of sleeping alone
  • Excessive worry about being lost, kidnapped, or going places without a parent

Life stressors can also be a factor, such as a new sibling, moving to a new place, loss of a caregiver, or a parent’s divorce.  

In adults, it can stem from a parent, partner, or child moving away (leaving home, going to college), or a significant life change, such as divorce.  It may also be related to another underlying mental health condition.  Controlling or overprotective tendencies are often ways an adult may express fears of separating.

Other risk factors for separation anxiety are having OCD (obsessive compulsive disorder), being female, childhood adversity (such as the death of a family member), or a history of childhood traumatic events (abuse).  

How is it treated?

Separation anxiety is largely treated with cognitive-behavioral therapy (CBT), and in some cases, in combination with medication.  CBT aims to identify and change the person’s thoughts and behaviors that are making the anxiety worse.  

Parenting strategies, group therapy, family therapy, as well as support groups are also avenues where folks can gain help in learning techniques to reduce anxiety.  In children, this may involve play techniques, therapeutic stories, and coping tools incorporating breathing games and expressive arts activities.

Making Transitions Easier

For Parents:

  • Timing matters.  Be wary of starting daycare or childcare with an unfamiliar person if your child is between 8-12 months.  Also, do not try to leave when your child is hungry, tired, or restless.  Schedule your leaving for after naps and meals.
  • Practice being apart.  Introduce new people and places slowly.  Visit daycare or school a few times before staring a full program.  Practice leaving your child with a caregiver for short periods so your child can get used to being away from you.
  • Stay calm.  Have an exit ritual.  Keep it pleasant, loving, and firm.  Show confidence in your child.  Let your child know you’ll be back.  Give your full attention to your child during goodbyes.  Leave when you say you’re leaving.  (Coming back in again makes things worse).
  • Be consistent.  Follow through on promises and return when you say you will.  

How Parents may feel:

  • Guilty.  It’s okay to take time out for yourself, leave your child with a caregiver, or go to work.  Your child’s unwillingness to leave you is a good sign of a healthy attachment.  Over time your child will learn that you consistently return after being away.  
  • Overwhelmed.  Your child my need a lot of attention and time from you.  By practicing being apart, your child gets a chance to develop coping skills and become a little more independent.

For the Caregiver:

  • Distract the child.  Have an activity, toy, song, game that will shift the child’s attention.  Keep trying until you find something that works.
  • Use clear language.  Answer the child’s questions in a simple, straightforward way.  If you need to mention Mom and Dad, do so like this, “Mommy and Daddy will be back as soon as they get home from work.  Let’s play with some toys.”

For both:

  • Trust your instincts.  Is your child refusing to go to a certain sitter, day care, or displaying other signs of stress?  Is your child having trouble sleeping or eating?  There could be a problem with the child care situation.

When should I see a mental health professional?

For most kids, the natural phase of separation anxiety passes without a need for further attention.  But, if you are unsure whether you or your child’s fears are related to separation, contacting a counselor is a great start.

If intense separation anxiety lasts into pre-school, elementary school, or beyond and is interfering with you or your child’s daily life, it’s time to see a mental health professional or talk to your doctor.

Need support with your child’s separation anxiety?  Contact me at Sound Health Counseling Solutions.