Teens enter my office for many different reasons. Most times, parents initiate the contact. Other times, it’s schools. Adults’ concerns are usually—and correctly—about the teen’s safety. So, teens who have problems with self-injury, suicidal thoughts, and aggression are often identified and sent to someone like me. Other behaviors that prompt such action include defiance, oppositional […]
Our bodies are made up of traits that are good for our survival and the survival of our species. Every part of us has a function, a purpose. For example, the function of eyes is to see. The function of taste buds is to determine the nutritional value of food and avoid eating poisons.
Our emotions evolved right alongside our bodies. What is the function of emotions? To answer this, think about good ol’ Uncle Caveman. How did fear keep him alive? That’s easy, when he saw a Sabertooth tiger, Uncle Caveman got scared and ran away! Fear gave him the adrenaline, energy, and focus he needed to stay alive.
How did anger keep Uncle Caveman alive? It helped him bargain for his interests better. When another tribe tried to move into his cave, anger created the right motivation for Uncle Caveman to keep his cave (good thing too, what with all those Sabertooth tigers running around). Anger helped Uncle Caveman protect his interests.
What about shame? Shame is a very social emotion, more so than other feelings. When Uncle Caveman did something that disgusted, disappointed, or angered his tribe, he felt shame. Being part of a tribe was critical to Uncle Caveman’s staying alive. The formula is: Alone = Death, Part of Tribe = Survival. Shame helped Uncle Caveman act in pro-social ways so his tribe would not kick him out. (So he had to stop tagging the wooly mammoths).
Sadness for Uncle Caveman was caused by a loss of some sort. I hope one of his children wasn’t eaten by a Sabretooth tiger, but I can’t promise that. Say it happened. Well, sadness did two important things for Uncle Caveman’s survival, and the survival of his tribe. 1) He never forgot that Sabertooth tigers can kill. He told everyone he knew. And he never again asked a Sabertooth tiger to babysit his kids. 2) It made him yearn for his child, and for connection to others. Guess what, this story ends well. Uncle Caveman’s baby actually was hiding that whole time, and since sadness had motivated Uncle Caveman to search for his kid…they lived happily ever after.
Emotions helped Uncle Caveman make decisions that helped him stay alive. The function of emotions is to help us make good decisions, so we don’t get hurt, used, ignored, or run down.
Evolution is a SLOW process. In fact, our bodies are very alike to our cavemen ancestors. Sure, we know a lot more. And we use Facebook and soap. But our bodies—and our brains—are not so different from good old Uncle Caveman!
Emotions evolved in humans like everything else; what was adaptive to the species remained. Emotions are critical to our decision making! That’s why therapists tell people to “understand your emotions.” If you did that better, you’d made better decisions. I promise.
If we all had perfectly tuned emotions, life would be good. But, we are individuals within a species, and we each have different characteristics. That applies to our eye color, height, IQ, athletic ability, and—of course—emotional experiences.
Many mental disorders are characterized by too much—or not enough—of certain emotions. Depression is too much sadness. Anxiety Disorders are too much fear. Personality Disorders may be too much shame and anger. When you notice your feelings remain far beyond their function (remember, they help you make good decisions), they can seriously interfere with your life. If your emotions have outlived their usefulness, talk to a trusted adult (p.s., Sabertooth tigers are not good confidantes). It’s time you had some help.
Stress is how you respond to “stressors.” And stressors are most of the things in your life: parents, grades, personal appearance, falling in love, friends, prom, teachers, jobs, clubs, college applications, break-ups, mid-terms. It can seem like stress is just a natural part of teen life.
People have different thresholds for stress. You probably know people who are quite happily busy for 18 hours a day. You also know folks who seem overwhelmed with just the idea of a to-do list. If you’re like most teens, you’re somewhere in the middle: working to balance the parts of your life, effectively. You are probably doing the best you can. And, still, you’re feeling stressed out.
Stress is a mean relative of anxiety. Anxiety has lots of relatives, and not all of them are bad. Many people who achieve at high levels have a drive to do well that can cause anxiety. So, goal-achievement is a nicer relative of anxiety. Conscientiousness—how aware we are of ourselves and others—is also related to normal anxiety: another nice relative. But, stress…he’s a mean one.
Stress is the unwanted, vague, suffocating, terrorizing relative that tends to overstay his welcome. When stress stays too long, it is bad for you. You’ve probably heard: chronic stress is associated with poor sleep, lowered immune deficiency, inflammation that damages your body’s cells, acne, high blood pressure, aches, weight gain, and gastrointestinal problems. Stress makes you feel inept. In a world of problems, it blocks every potential solution from your view. Like I said: mean.
So how do you manage stress effectively? Dialectal Behavior Therapy (DBT) would tell us to try reducing our emotional vulnerability. Use the P.L.E.A.S.E. skill. Stress really is in your body, not just in your mind. So, the first step in countering stress is to take care of your body. The P.L.E.A.S.E. skill is a guide for this. When your body is healthy, it’s better prepared to manage the daily stressors that are part of life. And, should a big stressor present itself (finals!), you’ll be ready to take them on, too.
P: Physical and L: HeaLth. (L fits, see?)Take care of your body. If you’re sick, treat the illness, first and foremost. Your body is telling you something: “take care of me.” So, rest. Take medications as prescribed by your doctor. These may be your vitamins, antibiotics, psychotropics, blood thinners, inhalers…whatever your doctor and parents both agree is right for you, take those medications as prescribed.
E: Eating. Balance your eating. Don’t eat too much. Don’t eat too little. Both can make you feel ridiculously tired. Over-and under-eating can cause clinically significant levels of inattention. They lead to moodiness, including especially irritability. Both over-eating and under-eating can become all-consuming, where the thing you think about most is food. That makes it hard to be effective in life.
Eat good foods. They really make a difference. Whole grains. Fruit and vegetables. Lots of water. If you love carbohydrates, try to move those into the evening hours. Your best concentration/energy foods are the proteins, and it’s a worthwhile goal to include a protein at every meal. Good protein sources are almonds, soybeans, cheese, milk, chicken, and energy bars. Sugars and fats aren’t just hanging out at the top of the food pyramid, they are wreaking havoc on your concentration and mood. So, avoid those. They taste good, but the cost on your effectiveness is just too high.
A: Altering. Avoid non-prescribed mood altering substances and behaviors. You got it—that means drugs. People who habitually and regularly use illegal substances have higher rates of depression, lower academic performance, lower relationship satisfaction, lower self-esteem, and fewer reasonable future goals. Mood-altering behaviors are usually dangerous, and unnecessarily so. Cutting yourself or otherwise harming yourself can be mood-altering. It can be mood-altering to drive 100mph down a country road. Such unsafe and impulsive behaviors do not reduce stress in the long-term. In fact, 9 times out of 10, they just end up making things worse for you.
S: Sleep. Sleep is like food for your brain. It is the time when today’s learning experiences consolidate and go into long-term storage (you may experience this as dreaming). That’s why people advise you to get a good night’s sleep before a test. Sleep is also when important neurochemicals and hormones are released to support your growth and brain functioning. Poor sleep leads to impaired concentration, zits, impulsivity, irritability, weight gain, and vulnerability to illness.
If you’re like many teens, sleep is the first thing you de-prioritize in your schedule. You may cut into sleep hours without a second thought. Like, staying up late to study, work, or (electronically) socialize. Some set early alarms to finish up a paper or get in a workout. If you take nothing else away from this article, take this: PROTECT YOUR SLEEP. Defend it. Honor it. You need it.
Teens need between 8-11 hours of sleep a night. If you can’t fit your obligations comfortably into the other 13-16 hours a day, then you’re doing too much. Barriers to sleep are more prevalent than you may know. Barrier #1 and #2: your cell phone and IPAD. Scientists have found that the LED screens in hand-held devices interfere with your brain functioning in ways that delay sleep onset. Barriers #2, #3, and #4: your TV, video games, and personal computer. While TV and video games do not have the LED component, they can be pretty tough to turn off when you’re tired at night. Take-home message is this: put your electronics to bed at least one hour before you’d like to be asleep.
E: Exercise. Just do it. Aim for a minimum of 3 workouts a week. Workouts should last at least 30 minutes, and they should get your heart really pumping. Working out with a friend is a fun way to stick to a regimen. With exercise, remember: the cart usually comes before the horse. Not many people “feel like” working out until they are well into their workout. If you wait around until you feel like exercising, it may never happen. But you’ll notice that, once you get started, the motivation to workout follows. If you’re having a lot of trouble with exercise, research shows that just taking a few minutes to visualize your workout can increase your motivation and readiness.
Stress is a normal part of life. But it can be really difficult to manage. If your struggles with stress are more intense, these are your warning signs:
• feeling sad/irritable more days than not, and for most of each day
• worrying about almost everything, like your mind can’t stop going
• needing more than one hour to fall asleep, or waking up a lot at night
• gaining/losing 10+ pounds in one month
• thoughts of death, suicide, or self-harm
• thoughts or plans to hurt others
• feeling hopeless, or like nothing matters
• changing your life goals drastically within the past month (e.g., “I don’t care if I graduate.”)
• headaches, stomachaches, or indigestion
• isolating yourself from friends
• feeling ineffective (pushed over) in relationships
• wondering, “what’s the point?” of taking care of yourself
If you have any of these signs, then the P.L.E.A.S.E . skill alone may not help much. You should talk to a mental health professional. Seek out your school support staff to see if therapy may be helpful for you.
Many parents ask me if perfectionism is problematic in kids. It can be. It’s all a matter of adaptiveness. Does perfectionism help or hinder your child? In our fast-paced, information-saturated environments, our children need to continually adapt. But, perfectionism can be the opposite–perfectionism can be rigid and unmoving.
Psychologists typically distinguish between two types of perfectionists: the maladaptive one, and the adaptive one. On paper, these two look alike. They often achieve at the same high level. They have similar high standards. But, one of them is miserable: the maladaptive perfectionist.
The maladaptive perfectionist believes that any less-than-perfect work is unacceptable. They can become preoccupied with details so much that the point of the activity is lost. In fact, perfectionism in this form often interferes with task completion. Maladaptive perfectionists can be excessively devoted to work at the expense of leisure and play. They tend to be inflexible about rules, and come across as rigid and stubborn. Transitions or changes in plans can upset them. Maladaptive perfectionists tend to avoid group work, being unwilling to accept or approve of others’ contributions. Maladaptive perfectionists tend do fine in low-stress situations, but when asked to perform or produce they can become ineffective. Even when achieving at high levels, they tend to be less satisfied with their performance. For example, your child may reason, “I shouldn’t have to work so hard for an A+.” Maladaptive perfectionists have high levels of self-criticism. They are more vulnerable to depression, anxiety, eating disorders, and suicide. But, if asked, these kinds of perfectionists often say that perfectionism is their secret to success.
Adaptive perfectionists also have very high self-standards. But their innate desire to excel does not hinge on a flawless performance. These kids recognize that, sometimes, “perfect” can interfere with success. They are able to sacrifice perfectionism when short on resources (i.e., time, money, parent’s help, etc). These children feel good about a job well done.
There is an overlap between perfectionism and giftedness (children with Superior or higher IQ). Perfectionists and gifted children both have: self-discipline, perserverance, and motivation. These “non-intellectual” factors play a signifcant role in IQ; in fact, they’re requisites. To do well on IQ tests and in school, children must be able to:
- Recognize, alter, and maintain changes in their behaviors and moods in ways that advance their cognitive performance (self-discipline).
- Mentally tinker with something until getting it right, rather than giving up and saying “I don’t know” (perserverance).
- Internally drive themselves to do well, feeling innate pleasure at success (motivation).
Perfectionism can actually interfere with IQ. Very smart children usually do very well on tasks that have no time limit. But when required to work quickly without making mistakes, perfectionistic children can buckle under the pressure. They may be paralyzed by performance anxiety. They may refuse to be rushed, losing time in executing items to perfection.
Perfectionism can also interfere with social development. Children who are overly perfectionistic can become easily frustrated with peers who “don’t get it.” They may hold others to their own high standards, and criticize those who they see as falling short.
Perfectionism is not the same as OCD (Obsessive Compulsive Disorder). Children with OCD show strange behaviors and senseless compulsions. They may obsess about contamination, and so wash themselves in a specific, self-prescribed manner. They may obsess about getting things “just right,” and so rearrange objects into symmetry, touch or do things a certain number of times, or feel compelled to tie and retie their shoes. Frequently, children with OCD obsess about numbers. They may talk about “safe” or “unsafe” numbers, and aim to have items or behaviors occur in “safe” numbers. OCD interferes with functioning at home, at school, and in the community. OCD symptoms require lots of time, sometimes up to hours each day.
Normal child development includes phases of obsessions and compulsions. For example, between the ages of 4-8 many children engage in specific rituals (such as having a specific bedtime process, or wanting parents to respond with specific words). Fears about contamination (“cooties”) can also be common. Hoarding (collecting objects) is normal by the age of 7. Between the ages of 7-11, highly rituatlized and rule-bound play is normal. And, into teenage years, it is common for children to develop obessions about activities or idols.
You can help curb your child’s maladaptive perfectionism in several ways:
(1) Help your child alter her self-talk. She may believe that if someone does a task better than her, she is a complete failure. She may believe that you will criticize her if she makes a mistake. She may believe that others’ respect hinges on her being perfect.
(2) Help your child become aware of his perfectionistic tendencies. Show him that taking time to make every detail perfect delays his progress. Show him that messing up can provide opportunities for new ideas.
(3) Help your child see the positives. Point out what she is good at, and what others are good at. Encourage her to praise others’ abilities. Point out that, even if she did not do something perfectly, she may have had a lot of fun while doing it. Explain that spending positive time with school peers can be even more important than producing a flawless group project.
(4) Lead by example. Reassure yourself that your child will indeed make it in this competitive world. Enjoy learning for its own sake. Don’t obsess over standardized test scores. “Mess up” and be OK with it.
(5) Avoid overemphasizing accomplishments. Act on values that lead to greater life satisfaction, such as: spending time as a family, volunteering in your community, having fun, and doing things you’re good at (e.g., gardening, drawing, etc.).
(6) Don’t protect your child from disappointment. If he wants to quit soccer because he is not the best, encourage him to stick it out. If her school project is sloppy, avoid stepping in and doing it for her. Your child is not fragile. He can handle being disappointed. Defeat is a natural consequence, and there is no better teacher. Managing defeat and disappointment are critical skills children need in transitioning to college and workplaces. They’ll be more resilient if you allow them to “fail” as children.
If your child’s perfectionism cannot be altered, consider consulting with a child psychologist.
Good self-esteem is the ultimate buffer in kids’ lives. It bolsters them during failure. It navigates them through social pressures. It weathers their emotional (and hormonal) storms. It keeps their negative self-statements in check. Good self-esteem encourages kids to try new things. It helps them understand other people, and treat them well. It makes life more enjoyable. Self-esteem is not something kids build on their own. In fact, building self-esteem can have more to do with others than it does with the self.
Parents, your role in your child’s self-esteem is critical. From your child’s birth onward, you get more and more jobs in helping her develop positive self-esteem.
Birth to 1 Year: Good self-esteem starts when babies learn to fulfill their basic needs (love, hunger, comfort) by manipulating parents and caregivers. (“When I cry, Dad hugs me.”) There are 3 jobs for parents.
- Love, adore, and cuddle your baby.
- Give her everything she demands. There is no such thing as spoiling a child who is 0-6 months old. It takes a newborn a few months to realize he’s actually a separate person from his primary caregiver. (Can you imagine that a-ha moment?) After age 6 months, parents usually notice their child’s manipulation strategies are developing remarkably. You feel like a sucker. Still, meet her needs. But also start to teach effective communication skills. Children between 6-12 months are usually still in the pre-verbal stage; they cannot say what they want. For example, suppose a toy is not working and your son screams and shoves it in your face to fix it. First, validate his frustration (i.e., “Oh, it’s not working? That’s a bummer!”) Second, have him practice handing it to you nicely (i.e., “When you hand it to me without screaming, I’ll help you buddy.”) Third, think out loud as you fix the toy (i.e., “See this thing here. It’s not turning right. If I do this, it will work, see? Here, you try it.”)
- Be a model for calm effort in working through problems…and checking the stupid batteries…
1 Year to 3 Years: Good self-esteem means feeling brave and secure enough to explore and try new things. There are 4 more jobs for parents:
- Avoid “helicopter parenting” by smothering children. Nothing is so sweet as a safe moment to oneself. Encourage her unaccompanied excursions into the next room. Introduce him to the arts (i.e., banging on kitchen pans for drums). Praise her efforts, and the products of them (i.e., hang up her drawings on the fridge). Kids develop bravery by understanding that caregivers will keep them safe, and will be there if anything gets scary.
- Don’t neglect your child. Make sure he is in supervised, child-proofed environments that will not punish exploration with injury. When accidents happen (…do coffee-table manufacturers have toddlers?), validate the injury (“Ouch!”) and explain how it can be avoided in the future.
- Tell your child multiple times a day what INTRINSIC qualities you admire in her: sustained effort, working through frustration, showing care for others, athletic ability, smart reasoning, bravery, sense of humor, etc. When your child misbehaves, make a point to discourage the behavior, not the child. (“In our house, we don’t hit. You are not the kind of person who hits. Please take a time out.”) Do not under any circumstances apply negative labels to your child. Labels like “lazy,” “dramatic,” “babyish,” “worry wart,” and other unpleasant character appraisals shame your child, and have no positive impacts. Remember: Attribute good behaviors to your child’s character and bad behaviors to your child’s choices. (Behavior charts are a good way to get kids to behave without harming their self-esteem).
- Model good self-esteem. Normalize mistakes. Don’t talk down about yourself. Don’t talk down about your spouse. Toddlers are using your skills to build their own. To children, parents are the most attractive, important, effective, and powerful people in the world. (Feeling better about yourself now?)
3-6 Years: Good self-esteem is being able to do stuff for oneself. There are 3 more jobs for parents:
- Encourage and expect your child to take more and more responsibility for his Activities of Daily Living (ADL). These include: showering/bathing, brushing hair/teeth, getting dressed, using the toilet independently, feeding oneself appropriately, using the telephone/computer, taking care of pets, cleaning up after oneself, using safe behaviors (buckling self into the car seat), organizing school materials, and so on.
- Expect more from your child. It’s OK if kids don’t get ADLs perfect. In fact, they won’t. But it is important that parents have reasonable expectations for children to try their best at each job. High demandingness is one very important part of good parenting. Mandate good effort in a matter-of-fact way. We all have to do things we don’t want to; that’s part of life.
- Praise your child. Give warm support and even over-the-top, exaggerated cheers for jobs well done. Be sure to emphasize how proud you are of your child’s efforts, even if the outcome is not great. It’s not your imagination: your child IS incredibly unique, gifted, wonderful, and a genius at being himself. Let him know that.
6-11 Years: Good self-esteem means comparing oneself realistically to others and, in doing so, seeing self-worth. There are 3 more jobs for parents:
- The focus for kids this age turns increasingly away from parents to other people (particularly peers). Kids compare themselves to others and see that there are often major differences. For most kids, differences will be both positive and negative. Your child realizes that he is not the best student in math. She sees that she is a great basketball player. He understands that others are more popular. She gets that other kids have family troubles. He sees that other people have more expensive clothes and gadgets. Parents should verbalize values for intrinsic skills and character, and not necessarily for achievements. Be realistic and positive in appraisals of your child. (“Yes, I suppose he is a better pitcher than you. He has spent a lot of time practicing and he’s sure talented. If you work hard, you may be as good as him. If not, no biggie. You’re great at understanding technology.”) Introduce your child to (books about) heroes of character and effort, not heroes whose only attributes are beauty, fame, or fortune (as they see on TV and other media).
- Love the child you have, not the child you wanted to have. It’s time to come to terms with possible disappointments, and with, perhaps, your own childhood “failures.” Focus on the things you admire in your child, not on the ways you see her as falling short of your ideals. Strike the balance between pushing your child to do better and recognizing that she may be doing her very best. Indulge his passions, if they’re safe and appropriate.
- Keep close ties with your child’s school. Teachers have valuable information about how your child relates to others. Good schools help teachers structure the classroom in ways that help all children feel accepted. Good teachers ensure that children do not feel inferior.
12-20 Years: Good self-esteem is knowing who you are, and who you are not. There are 3 more jobs for parents:
- Teenagers have critical questions to answer about themselves, like “Who am I?,” “How do I fit in?,” and “What am I going to do in life?” Questions of identity relate to everything from hair color to religious views. Parents should permit this exploration, and support it. When you push too hard for your child to conform to your views, trouble happens. He may become confused about what’s important to him. Of course, there are family and societal values to be enforced: safe and ethical behaviors. Allowing your child to experiment with substances is not the thing to do. Permitting your child to dress provocatively is not the thing to do. But you may consider letting your child dye his hair. She should be able to select (safe) friends. He may wonder aloud (appropriately) about his sexual, religious, or political orientations.
- Forming an identity can take a while. Be patient. This stage spans several years of awkward fashions, silly fads, and important work on the self. Continue to love and support your child through this sometimes difficult stage. Support especially the times when she sticks to her values, while peers do not. For example, praise your son when he elects not to drink alcohol at a teen party.
- Avoid being defensive. For kids this age, everything is grist for the mill. Your child may call your rules too strict. She may accuse you of invading her privacy on Facebook or Twitter. He will say things at home aren’t fair. She may say your religious or political views are wrong. While taking into consideration your child’s view (she may have a good point!), remember that her accusations have more to do with her questions about herself. Matter-of-factly state your views, don’t attack his, and show your child how to communicate differences with respect.
An important, final note: mental illness is the arch enemy of good self-esteem. It ruthlessly attacks self-esteem. This can and does happen even for kids who have great parents. Mental illness can interfere with the development of good self-esteem from toddlerhood and up. When a child has poor self-esteem, particularly within the context of a supportive home environment, it’s a red flag for mental illness. The usual culprits are depression, anxiety, and attention problems. Signs of low self-esteem include:
- Recurrent, unjustified shame and guilt
- Hopelessness about the future
- Feeling unlucky, punished, or “waiting for the other shoe to drop”
- Suicidal ideas or behavior
- Self-harm ideas or behavior
Children with good self-esteem have experiences–often provided to them by parents–that prepare them well for their future. They expect to succeed in what matters most to them.
The Centers for Disease Control reported recently that about 1 in 25 teenagers take antidepressant medications, writes the Huffington Post. Depressive episodes in adolescents can look different from adult depression. For one, teens tend to show more irritability than sadness. Another difference is that teens are not as adept as adults in articulating issues associated with depression. Teens who meet criteria for a diagnosis of depression also usually have at least 4 of the following symptoms: (1) loss of interest in activities that used to be pleasurable to them, (2) changes in appetite or weight–either increases or decreases, (3) sleep problems, including troubles falling or staying asleep, or sleeping too much, (4) seeming either physically slowed-down or physically agitated and restless, (5) feeling fatigued or out of energy often, (6) feelings of guilt or worthlessness, (7) problems concentrating or making decisions, (8) recurrent thoughts of death or suicide. Depression is more likely to affect females. It also runs in families. Children who have not yet reached puberty are more likely to have depression in conjunction with other disorders–such as ADHD, Anxiety, or Disruptive Behavior Disorders.
If you suspect a teenager you know may be depressed, you should take action. Schedule an evaluation with a child psychologist. There are evidence-based treatments for depression, most of which are based in cogntive-behavioral therapies. You should notice symptom improvement after 12-16 weeks of treatment. If improvement is slow or nil, consider making an appointment with a child psychiatrist to discuss medication that may be appropriate as an adjunct to therapy.
Mental health professionals have long urged parents to limit kids’ TV time. Excessive TV watching has been linked to ADHD symptoms, and other concerns. Now, the American Academy of Pediatrics has recommended even stricter measures on TV. As in, no TV for children two years old or younger. Young children who watch TV have higher chances of developing sleep problems and speech delays. Beyond the speed of the frames (which seem to train young brains to attend only to super-fast stimuli), the content of programs is impossible for most babies to understand. In fact, according to Rachel Rettner’s new article, studies have shown that 18-month-olds “have the same reaction to a TV program regardless of whether it’s going forward or backward.” Yes parents, this would even be true for “educational programs” like Sesame Street. Likewise, the Baby Einstein shows have not been shown to help IQ.
What’s more, toddlers who watch TV miss out on an ultra-serious, critical event: play! Good, old-fashioned play is the developmental task for small children. It helps them build interpersonal skills, problem-solving techniques, and enhances creativity. Even having TV on “in the background” appears to have negative effects on children. Parents who watch TV while young children are around don’t interact with children as often. Solid development in speech, social skills, and emotion regulation happens when children engage in real-life dialogue with people around them. Play-dates, sports, clubs, social activities, and especially one-to-one time with parents are the best ways for children to learn and grow, and to develop into smart, effective, and well-adjusted adults.
The Centers for Disease Control reports a rise in the number of children diagnosed with ADHD.
Their report indicates a 10% rise in pediatric ADHD in the Midwest in the past 10 years. The looming question—to which no one can provide a definitive answer—is this: Does the increase mean more kids with “real” ADHD, or just more kids with the ADHD label? The difference is critical.
ADHD is considered a “mental disorder,” and as such is defined by the American Psychiatric Association (APA). It is believed to affect, according to APA’s most recent diagnostic manual, 3%-7% of school-aged children. If prevalence rates are said to be significantly higher (and they are, according to this article by the CDC), it is fair to use the term “epidemic” to describe the rise in ADHD.
ADHD symptoms can be “caused” by numerous triggers: vision problems, hearing problems, spinal misalignments, poor sleep and/or diet, underdeveloped prefrontal lobes in the brain, and structural “abnormalities” in other brain parts. Environmental triggers such as television, video games, and busy schedules can add to a child’s propensity to develop ADHD symptoms.
Are symptoms the same thing as the diagnosis? No. A psychiatric diagnosis confers that that the caues of “problems” are known. It is not simply confirming that a variety of symptoms are present. When a mental health professional diagnoses ADHD, she confirms that she KNOWS, for example, that hearing problems are not the primary cause of a child’s inattention. An ADHD diagnosis confirms that food allergies are not the primary cause of hyperactivity. An ADHD diagnosis proposes that ADHD problems do not stem from an untreated sleep disorder. The problem with the current ways in which children get diagnosed is that many (competent and well-meaning) care providers simply do not have the time, information, or other resources to properly evaluate a child for ADHD. Is it any wonder that ADHD is so easily and so often misdiagnosed and, thus, mistreated?
To get an accurate ADHD diagnosis, Plum Tree evaluates a child with a series of interviews, observations, and tests to determine if ADHD is the appropriate diagnosis. An ADHD diagnosis should only be applied after the mental health provider has:
- Spent lots of time with your child (more than 15 minutes)
- Obtained a detailed and structured history of your child’s health, behavior, and functioning from you AND others, including school professionals, babysitters, etc.
- Administered a computer test (TOVA) to measure objectively your child’s inattention and impulsivity rates
- Ruled out other mental health conditions and the possibilities of other health conditions
A CNN article reviews the role of electronic media in children’s lives—the good, the bad, and the narcissistic. The research was conducted by Larry D. Rosen, Ph.D., professor of psychology at California State University, Dominguez Hills, and technology researcher. Below is a summary of the major trends observed by Dr. Rosen. Social Media Effects on Children.
– Social media is a great tool for engaging and captivating children
– Online networking can teach socialization
– Online users show more “virtual empathy”
– Social Media can help children establish a sense of self
– Students using social media during study breaks received lower grades
– Children who use social media tend to be more narcissistic
– Research suggests social media can increase anxiety and depression in children
Dr. Weller suggests that parents stay up-to-date on social media trends. Become familiar with what sites your child uses. (St. Charles school district has recently offered teen-led classes to parents for help with this). Like anything done in mindful moderation, social media can play a role in a well-balanced life.
What is a child and adolescent psychologist?
Clinical psychologists have doctoral-level training to provide therapy (including coaching) and consultation, and psychological testing. They are the only providers who can administer psychological tests to diagnose mental illness. Training at this level allows for expert knowledge in “psychopathology”–mental illness. Child and adolescent psychologists have advanced training and backgrounds in providing psychological services to young people.
Just as you take your child to a medical doctor who specializes in children (pediatrician), you should look to a child psychologist if your child needs help with emotions, thoughts, and behaviors. A child and adolescent psychologist is an expert in developmental psychology—so she knows what is normal and abnormal for children from birth to young adulthood. It also usually means that she is “good with” kids. In order to get better, your child should enjoy (even while working hard) spending time with the psychologist. The psychologist should see the many strengths in your child—since these are the building blocks for improvement. Feedback about parenting strategies is critical when working with young people, and this is part of a psychologists’ duty, too. A child and adolescent psychologist should have strong lines of communication with parents and caregivers.
Therapist, psychiatrist, psychologist…who does what?
• Clinical Psychologists provide psychological assessments and therapy to different types and ages of people. They usually advertise their specialty. They may also obtain advanced training in types of therapeutic interventions. They do not (in Illinois) provide medications. Clinical psychologists with a Psy.D. have more clinically-based training. This means their studies focused on how theories and therapies actually impact clients. Psychologists with a Ph.D. have more research-based training. Providers with doctoral-level training have typically spent between 5-7 years in graduate studies. No matter the degree, psychologists treating clients should be licensed. This means the state government has certified that the practitioner has met educational and knowledge requirements to provide mental health services.
• Therapists include a variety of folks, and most of them have at least a Bachelor’s Degree and some training in helping people. It is more common for therapists to have a Master’s Degree. Therapists are also called counselors, coaches, mentors, and advisors. They cannot conduct psychological testing or provide medications. They provide talk-based and activity-based therapy to a range of populations. They usually advertise a specific area of interest or specialty. Providers with master’s-level training have typically spent 2 years in graduate studies. However, they must attend regular trainings to keep their license active. Licensed therapists have been certified by the state to have met basic educational and knowledge requirements to provide mental health services.
• School psychologists usually obtain Master’s Degrees (though some have a doctorate), and have extensive training in schools and educational systems. They can conduct IQ testing, but particularly Illinois schools have done away with this. They provide counseling and advice to children and academic support teams as to how best to help children at school. They are part of the gatekeeping team that determines what (if any) school supports can be used to optimize a child’s learning. They cannot provide medications.
• Psychiatrists are medical doctors that have advanced training in mental illness. They are the only providers (in the mental health field) who can determine if/what medication may be helpful in addressing psychiatric issues. Psychiatrists are also able to provide in-depth mental health counseling, although they do so less often than psychologists and therapists.
• Child and Adolescent Psychiatrists have advanced training in working with young people. Although pediatricians can write prescriptions for psychiatric medication, they do not have the advanced training and licensure of a Child and Adolescent Psychiatrist. Since they are so specialized, it can be difficult to get a short-notice appointment with a Child and Adolescent Psychiatrist. However, the appointment should be well worth the wait.
Of all mental health providers, it’s good to know: no matter the training or title, there are excellent–and not so excellent–providers at every level. A mental health provider should be a good fit for your family. You should feel informed, motivated, and comfortable with them. The provider should be implementing evidence-based treatments, where goals and benchmarks are defined as early as possible in treatment. If, after 3 months of regular services, your child has not shown reasonable improvements, it may be time to find a new provider.