I remember my mother telling me that she read all of the parenting books when she had us, and still, she wasn’t sure what to do.  One would say spanking was good; another would say “bad.”  Given the conflicting information, she did the best she could.

In a culture where research has become the Touchstone of Truth, we still swing with the pendulum.  Data directs us first one direction then another in terms of nutrition, hormone replacement therapy, and parenting.  Recently, L. Alan Sroufe, a nationally recognized psychologist, wrote an opinion piece about ADHD for the New York Times.  In it, he charted the history of our understanding vis a vis treatment outcomes with medication.  Initially, research studies suggested that therapeutic drugs like Ritalin and Adderall provided tremendous benefit to children, but then with further study, these improvements in children’s behavior began to diminish over time.  With no clearly better alternative, pediatricians and psychiatrists have continued to use medication as a first-line treatment.

A researcher himself, Sroufe described how we rely on study findings for our answers and how our scientific knowledge depends in part on funding trends.  He pointed to how NIH tends to reward proposals pertaining to genetics, neuroscience, and biochemistry– factors which seem to have objective measures of normality and pathology.  As a result, we are more likely to read articles which document the genetic and biochemical anomalies associated with our problems.  It then makes sense that drug interventions would become the treatment of choice because they so obviously target brain chemistry.   What’s missing, Sroufe argues is that our environment also plays a role in the development of problems.  In the same way that diet and exercise can stave off Type II Diabetes, perhaps the environment can shape the way a child interacts with the world.

Having studied the same group of 180 children for the past 35 years, Dr. Sroufe and his fellow researchers have identified a variety of socioeconomic and family factors that affect emotional and intellectual development over time.  Yet, these are the only aspects of the environment he measures, and so these are the only causal factors he finds.  What about time spent watching TV, surfing the internet, or the amount of sugar and junk food consumed?  How might these influence biochemistry and behavior?  What’s a parent to do?  How do you help your children?

Having an ADHD child can be exhausting, and moms and dads have multiple responsibilities.  They want to help their children but also need to ease their own stress levels.  By the time parents seek help, they typically feel overwhelmed by their child’s behavior and teachers’ frustrations.  Medication can provide quick, essential relief, and yet, it may not last if used alone.  Adding short-term behavior therapy can help the family.  A psychologist can work with moms and dads to identify the negative influences and problematic behaviors and then develop strategies to manage these.  It may take time, but along the way, each parent and child can learn skills that will add to his or her coping repertoire.

Unfortunately, our diagnostic system focuses on the unique and negative aspects of functioning, but psychologists are trained to help individuals find their strengths as well. Ultimately, this may lead everyone in the family to view the constellation of ADHD symptoms simply as a collection of mutable, manageable acts, which frees the child to be appreciated for his or her energy, playfulness, humor, and creativity.

(This article is the second in a series of five blog entries that address common myths and misconceptions about ADHD.)    

Myth #2:  “It seems like everyone has ADHD.  ADHD wasn’t even around when I was a kid.”

Another common misconception about ADHD is that the disorder is a relatively new phenomenon and did not exist in previous decades.  This is an understandable assumption to make given recent data compiled by the U.S. Centers for Disease Control and Prevention that suggested that the number of children diagnosed with ADHD increased a staggering 22-percent from 2003-2007.  This means that roughly 1 in 10 children is diagnosed with ADHD in the United States.  These numbers would seem to indicate that: a) ADHD is relatively new disorder; and b) that the problem is getting worse.

It is important to note that it is unclear just how much current and previous reported rates of ADHD reflect actual cases of ADHD.  While it is certainly possible that there are more actual cases of ADHD currently than there were in past decades, this increase in reported cases could also be influenced by: a) an under-recognition of the disorder in past decades and an over-diagnoses of the disorder currently.  In the past, less was known about ADHD, and many cases of the disorder may have gone undiagnosed or mislabeled.  Now that more is known about ADHD, professionals may be able to better recognize and accurately diagnose it, hence the rising rates.  In addition, increased diagnosis of ADHD may represent an increased cultural acceptance of the disorder and willingness for parents to seek mental health services for ADHD symptoms.  However, it is also possible that there are current factors that may have led to an over-diagnosis of the disorder in the past decade.  Some have argued that ADHD is a “fad” that can be accounted for, in large part, by increased pressure parents feel to have their children to perform at a high level in school or due to professionals mislabeling symptoms as ADHD without sufficient evidence.  It is not clear if either one of these assumptions is true, but it is important to be aware of these possible influencing factors when evaluating true prevalence rate and trends related to ADHD.

Given these possible influencing factors, it is natural for parents to be somewhat skeptical about AHDH diagnosis.  It is important for parents to keep an open but wise mind when exploring the possibility of ADHD in their child. They can take steps to try and increase the probability of an accurate diagnosis.  For example, it is a good idea for parents to seek out services from professionals with experience in evaluation and treating ADHD.  Such professionals should take into account multiple individual and environment factors when determining a diagnosis and use a variety of measures to assess symptoms.  Following this step can help parents feel more comfortable about the diagnosis that is given to their child.

Use resilience to follow through with your 2012 resolutions!

2012 is quickly approaching and many of us will start thinking of resolutions for the New Year. It can actually feel uplifting to begin a new plan such as joining a gym to get fit, writing one page a day for the next Great American novel, or more prosaically, keeping up with your inbox).

But, as most of us know, the novelty wears off as we get bored and discouraged. We’re suddenly confronted with the day to day challenge of sustaining our goals. Unexpected events throw us off course. We need to stay late at work, we can’t leave our smart phone or a relative gets sick. Disappointingly, one day of missing the goal then leads to missing the next and next day, until we feel defeated and our goal is abandoned.

In this article, I’m going to start at the phase where resolutions begin to unravel. Most articles about New Year’s resolutions talk about setting practical goals and getting started, I’m going to jump ahead and anticipate your first failure. Just as important as setting realistic and important goals is having a plan for how to keep going despite the inevitable setbacks you will encounter.

Disillusionment Stage

Helen has been very excited about her New Year’s resolutions to lose weight, be kinder to her husband, and implement a reward chart for with her 5 year old son. She’s discovering the dance class at the gym is lots of fun and she has even lost a few pounds. Her son loves the stickers he gets for keeping his room tidy. She’s also been enjoying her alone time with her husband more since she’s made an effort to be less critical and more supportive.

Then, in mid-January there’s ice on the windshield and she has to shovel out her driveway. She cannot find the stickers and leaves home without following through on the program she planned with her son. Helen arrives late for the gym to find the parking lot is full. After circling for fifteen minutes, she leaves feeling very annoyed. She gets to work and feels awkward that she still has her gym clothes on and she has to explain the situation.

Starving and frustrated, Helen furtively grabs a chocolate-covered donut from the break room. Helen’s husband calls during work to say hi and she snaps at him for something random, as she’s meanwhile harboring resentment that he didn’t help clear the car of ice.

We all have such days. No one succeeds in accomplishing his or her goals without facing some unexpected setbacks. What, then, differentiates those who can pick themselves up and keep going from those who become just give up?

What Went Wrong?

As human beings, we constantly strive to understand our circumstances and, our purpose. When something unpleasant happens to us, we often demand to know why. This explanation stage is crucial to understanding how we respond to setbacks. Most of us look for a way to make sense of setbacks. We look to blame someone (oneself, a partner, the situation) and start feeling hopeless. If we believe the setback is something beyond our control, then we’ll feel helpless, frustrated and discouraged.

Those who are resilient persevere in face of adversity. In fact, some individuals even use setbacks to become even more determined to accomplish their goals. The large body of research on resilience demonstrates that those who can get back on track quickly after setbacks enjoy better moods which leads to more productivity, and overall better health.

How can we use this information to help us overcome those rough days and stick to our New Year’s Resolutions?

In the mental health field, we know that some individuals are born with more resilient temperaments, even as infants, showing the capacity to soothe themselves quickly. Even if you weren’t born as one of these fortunate individuals, know that it’s not too late for you to develop your own resiliency capabilities. Here is a mindset to help you become more resilient.

1. Develop realistic expectations.

Recognize that the unexpected (e.g., a sick child, power outage, miscommunication) is a part of life. Also, acknowledge that making changes takes time and that there is a steep learning curve at the beginning. At times, it will take longer to accomplish our goals than we had originally anticipated. However, this time doesn’t need to be a “waste of time.” Instead of saying “this shouldn’t happen,” or “I should already know how to do this,” recognize that setbacks are part of life that lead to progress.

2. Develop a mindset of curiosity and openness.

Ask yourself what did you miss? What considerations might be important to factor into future plans and goals? With an open, curious mind, we can explore how to make improvements in the future. Keep a list of each of your main goals, with notes about setbacks and what these are teaching you. Challenge yourself to identify one or two ways to approach the goal differently in the future. This will not only make you a better problem-solver but will also help you develop resilience.

3. Appreciate that setbacks may even bring unexpected surprises.

Helen might decide to talk to her husband about chores and discover he welcomes a heart-to heart with her; he’s been frustrated with her silent treatments and is relieved to know what’s bothering her. Or maybe Helen will talk to her HR department at work about having healthier options in the break room.

Perhaps she’ll realize that she just had a slip with her son and his reward stickers and can talk to him tomorrow to explain the plan and get back on track. There are lots of options. The beauty is that each day offers new opportunities to approach things just a bit differently, adding a process for efficiency, cultivating kindness and patience, or just having “one of those days.

In fact, you might even consider making your New Year’s “Resolution” to become more resilient, to better able to find solutions and maintain your overall determination in all that you do. Resolve not to let small setbacks – or even large ones – throw you off your game. Once you resolve to find a healthy determination and mindset to tackle problems one by one, you’ll be mentally and spiritually re-charged. Go ahead, set realistic goals, but also set one extra one – the goal of sticking with your plan when the going gets tough.

(This article is the first in a series of five blog entries that address common myths and misconceptions about ADHD.)

Myth #1:  “Children with ADHD can’t pay attention to anything … except for video games.”

A common misconception regarding ADHD is that children and teens with ADHD can’t pay attention to anything.  It turns out that the opposite is actually true; they pay attention to almost everything.  This is what makes it so difficult for them to focus on one solitary activity, especially when that activity is not fun or exciting – homework for example.  This phenomenon ultimately is the result of a central processing issue in the brains of children with ADHD.  Their brains struggle to filter out distracting stimulation or inhibit behavioral responses to it.  This results in poor focus and frequent activity shifting.  In essence, children with ADHD are akin to race horses without blinders on.  They can perform very well yet are easily distracted by things around them.

Often parents of children with ADHD notice their kids struggling to complete tasks such as homework or chores while spending hours upon hours focused on other activities.  These activities often include things they enjoy such as video games, watching “trashy TV,” reading magazines, texting with friends, or even reading for fun.  Many parents assume that their children are willfully putting off harder tasks or shirking their responsibility, because they don’t have a full understanding of why their children can focus on one activity and not another.  The process of choosing to focus on some activities and not others, or “selective attention” as it is commonly referred to, is somewhat misleading as is relates to ADHD.

In reality, children with ADHD can focus more easily on activities that they enjoy because they provide more stimulation for their brains.  Video games, for example, provide frequent auditory and visual stimulation and frequent shifts in context.  These elements are attractive to the ADHD child, because their brains are getting all needs for stimulation met.  In contrast, activities such as homework or chores may provide little stimulation, so the brain continues to search for other ways to stimulate itself.  In fact, children with ADHD may have such a difficult time with these “boring” tasks that they will avoid them altogether in order to prevent frustration and a sense of failure.  This is often when parents start to notice tasks not being completed or being missed altogether.  Therefore, children with ADHD may indeed be “selecting” stimulating tasks over less stimulating ones.  However, this most likely represents their attempts to avoid high levels of frustration rather than to intentionally shirk responsibility.

So what’s a parent to do?  Let’s face it; playing video games, sports, texting and watching “trashy TV,” etc. will always be more “stimulating” than doing homework or chores for a child or teen with ADHD, or for any child for that matter.  However, there are things parents can do to make mundane activities more stimulating, and therefore increase the chance that they will get done.  For example, by turning homework into a game or by introducing media elements, teachers and parents can make these tasks more stimulating.  In addition, when parents provide their children with multiple breaks (during which they can briefly engage in more stimulating activities), homework or chores can become less arduous or daunting.

By Daniel Sheras, Psy.D.  

The reported long-term sexual abuse of children by former Penn State assistant football coach Jerry Sandusky has resulted in a strong emotional response from the public.  For many, the most disturbing element of this case is the reported lack of action taken by those who could have put a stop to this abuse.  Many have questioned why no one who was aware of the reported abuse called the police.  In this case, it appears that those in charge may have lost sight of the moral and legal obligation to protect children or may have felt that they had done their part by simply reporting these incidents to their superiors.

This disheartening unfolding of events may be explained, in part, by a psychological phenomenon called “diffusion of responsibility.”  This states that people will be less likely to take action or feel a sense of responsibility to take action when they are part of a large group of people.  Research on diffusion of responsibility (and the related “bystander effect”) was spurred by the 1964 case of a woman named Kitty Genovese who was murdered in New York City as onlookers observed from a nearby apartment but did not intervene (presumably because they felt others would) until it was too late.  Penn State administrators and others who suspected or witnessed the abuse may have felt less responsibility to take action, because they knew others were aware of it and felt that these others would report it to the police.   This, as in the Kitty Genovese case, had a tragic outcome.

While this phenomenon certainly does not excuse the inaction of those involved, it does provide valuable information about how to keep things like this from happening in the future.  Children, and especially underprivileged children, are vulnerable and need to be protected and advocated for.  State child abuse reporting policies are in place to ensure protection of children.  But, ultimately (and as the Penn State case illustrates), the responsibility falls on the individual to make the decision to report suspected abuse to the authorities.  There are important lessons for parents to be taken from this tragedy.

•  “Stranger danger” is misleading. While many parents fear their children being abducted or abused by strangers, most children are abused at the hands of adults who they know or trust.   Therefore, in addition to teaching your children how to respond to strangers, it is also important to talk with them about ways to respond if a trusted adult is not respecting their personal boundaries.

• Observe warning signs and educate.  If a child does not want to talk about her/his interactions with an adult or seems to respond negatively when asked about this, this may indicate that something they are uncomfortable with is taking place.  It is important for parents not to assume that their children are being abused or hurt, but rather to use this as opportunity to gather information, educate their children about staying safe and encourage them to come to you if anything happens.

• Know that you can report suspected abuse to authorities.   In addition to protecting their own children, it is important for parents to know that they can report suspected abuse of any child.  The Penn State incident taught us the importance of this.  Adults in some professions (such as teaching or mental health) are mandated to report suspected abuse in North Carolina.  However, not all adults are “mandated” reporters.  This does not mean that parents cannot report abuse to the police or Child Protective Services if they suspect or hear about it.  By reporting suspected abuse, adults can help to stop future abuse from occurring.

For many parents, it may be difficult to ensure the safety their children without feeling that they are being paranoid or overly protective.  The events at Penn State show that children are indeed vulnerable and illustrate the harm that can be done when abuse is not reported by adults.  However, by following certain steps and by reporting suspected abuse, parents can take an active role in protecting children from incidents such as this.

Thanks A Lot

When parents are sent to war, how can children cope?

In this blog post, clinical psychologist, Dr. Daniel Sheras, provides suggestions to kids and teens to enhance their enjoyment of sports.  Dan recently joined Orenstein Solutions, and offers testing and counseling to help children thrive at school and at home.

1. Surround yourself with positive teammates.  When you’re thinking of joining a team or finding a group of people to practice or train with, look for people with positive attitudes who have a similar level of commitment to the sport that you do.  When members of a close-knit group support and challenge one another, it very often leads to better performance from you and your team as a whole.  Good teammates will motivate you to do your best and will support you when you are struggling.  Go Team!

2. Find the right fit.  Not every athlete is great at everything.  Different sports require different sets of skills.  Try out several sports to see which ones are best for your specific set of physical skills.  Peak performance is mostly likely to occur when your skills match the task in front of you.  This match is even more important than your overall level of skill and effort.  A bad match can lead to feelings of frustration and poor self-esteem.  Therefore, an awareness of what you’re good at and what you’re not so good at will make sports more enjoyable.

3. Preparation leads to confidence.  Being confident in your skills is important.  But in order to gain confidence you must put yourself in a position to succeed by following a plan of preparation.  Many athletes comfort in knowing that they have done everything in their power to succeed.  This reduces feelings of doubt and performance anxiety, both of which can hurt your performance.  If you know you can do something because you have prepared well, you will usually perform better on game day!

4. Find the right balance between excitement and relaxation.  Athletes have been shown to perform at their best when they are neither too “amped-up” nor too calm.  You will most likely perform at your best if you are somewhere in the middle.  If you are too pumped up or anxious, try calming yourself down with some slow deep breaths, progressive muscle relaxation, positive self-talk or by imagining a calm place.  If you need more energy, you can imagine an energizing or motivational scene, listen to motivational music, or move your body (i.e. jump up and down or pace).

5. Visualize Success.  “Seeing is believing.” If you can see yourself achieving goal, there is a better chance that you will make it happen.  At least that’s what research with athletes has suggested —that “mental practicing” through visualization can actually improve performance.  Visualization is simple:  Just close your eyes, try and tune out distractions and imagine yourself touching the wall first in a race, sinking the winning free-throw, or scoring the winning touchdown or goal.  Do this is as many times as you can both in the days and weeks leading up to the event and right before you are about to perform.  This will also help you to calm down and focus.                

written by child psychologist, Dr. Daniel Sheras.  Dan enjoys counseling children, teens and their families at Orenstein Solutions in both our Cary and Chapel Hill offices.

Dr. Orenstein’s offers some suggestions for the outing:

• Go somewhere without interruptions.
• Leave plenty of time so you’re not rushed.
• Make it simple and pleasant.
• If you invite your parent, offer to treat.
• Get your parent’s input about where he or she would like to go.
• Offer a choice between a couple of places so that you’re not dictating, yet you have some control.
• Enjoy the dignity and independence you each have as adults.

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