Tuesday, December 23, 2008

Let the Moments Happen this Holiday Season

Many of us are trying too hard to make the perfect life for our children. This includes working non-stop to make "the ultimate" holiday experience. Reading Jamie Lee's post, How to Have Fun Without Even Trying (http://blogs.parentcenter.babycenter.com/), reminded me that the best memories are not produced through "planned" outings or events. The best memories occur spontaneously when you least expect them. If we try too hard to make a situation or an event perfect, we may be losing out on the golden opportunities that occur at random. These random occurrences could produce the most memorable memories ever.

My advice to everyone reading my postings during this holiday period is to have a general plan to follow. However, be open to deviations from this plan. Do not be too goal directed. For example, suppose you plan to take a walk through the Great Forest of the Mighty Trees in order to experience the awe of these spectacular structures of nature. Now imagine that your kids get out of the car and spot a giant ant hill and want to study it. You were looking forward to the brisk walk. Your kids want to look at the ant hill. What do you do? Do you yell at them to start walking? Or, do you look at the ant hill until they are done? Answer: YOU LOOK AT THE ANT HILL UNTIL THEY ARE DONE! By studying this ant hill, you may learn more than you have ever learned before. Plus, taking time to study an ant hill may be the best experience throughout the holiday festivities. Be open and be aware. Take advantage of these special moments.

For more holiday advice, read my previous posts:
Sail Through the Holidays with a Smile and Try Buying a Family Gift to Share.

Sunday, December 21, 2008

ADHD Pills for Everyone?

A group of scientists have recently written a commentary in Nature encouraging the legal and mainstream use of "enhancement drugs" such as Adderall and Ritalin for people who want to increase their performance in certain areas. These drugs would be made available to all people, not just those with a diagnosis of ADHD. These researchers state that "society must respond to the growing demand for cognitive enhancement" and that "we should welcome new methods to improving our brain function." These researchers argue that these medications help improve performance not only for those individuals with ADHD, but for many others without this diagnosis as well. It is clear that on university campuses around the world that students are using Ritalin and Adderall to get better grades.

Ed Silverman in his Pharmalot blog has written an excellent commentary to this article, Should Everyone Use ADHD Pills As Brain Boosters?. I encourage you to read the Nature and Silverman article and let me know what you think. For me, this is a bit scary.

Thursday, December 18, 2008

Locked Seclusion for Our Misbehaving Children?

Ashley Fantz of CNN has recently written an article, Children forced into cell-like school seclusion rooms, about a 13-year-old male, Jonathan King, who committed suicide in a seclusion room at a school in Georgia. Jonathan had a history of being aggressive toward his peers and was frequently placed in "time-out," a concrete room latched on the outside. Jonathan was placed in time-out the day he died and hung himself with a cord a teacher gave him to hold up his pants. He apparently was not searched prior to being placed in this locked seclusion. On top of this, a substitute employee was in charge of watching the room on the day Jonathan died. This employee reported that he had not been trained in the use of seclusion and didn't know Jonathan had threatened suicide weeks earlier.

Should we use locked seclusion for our misbehaving children? Is it safe? Sometimes locked seclusion is necessary to address very severe, aggressive, behavioral outbursts. When a child becomes physically assaultive and dangerous, a limited use of locked seclusion may be necessary. It can be used safely when proper procedures are followed. However, locked seclusion should only be utilized by trained mental health and special education professionals. It should not be used by frustrated and untrained parents or teachers who have run out of other things to try.

This story is a tragic reminder that we are not addressing the severe challenges of many of today's youth with professional care and best practices. In Jonathan's case, this tragedy could have been prevented. He obviously had significant mental health and behavioral issues that could have been impacted positively by a professional team of providers, including a psychologist, psychiatrist, and trained special educator. Instead he was supervised by someone with no training at all. A more appropriate scenario would have included the following: Jonathan would have been searched for dangerous items prior to being placed in time-out. Trained staff would have constantly watched him since he had recently threatened suicide. Every 15 minutes, staff would have documented his mental status and other observations. A specific plan of how to use locked seclusion would have been formulated in advance by a multidisciplinary team. If these "best practices" procedures would have been followed, then Jonathan would most likely be alive today.

In all fairness to the school, there is an increasing number of children in the educational system who are quite aggressive and hard to manage. Since there are few affordable treatment programs, parents are forced to keep their child in a school placement where minimal treatment is delivered. Schools are forced to accept these children when it is not appropriate to do so. As a result, the children frequently receive inadequate care by untrained professionals. What these children need is a comprehensive treatment program that holistically addresses their emotional, behavioral, and academic needs. However, these types of programs are few and far between. If a family has money, then there are more options. However, even with money, it is still hard to find quality and effective care.

This story also provides a reminder that we as a society continue to view punishment as an effective way to raise our children. My career began in residential care with adolescents who had severe behavioral challenges. I have worked in inpatient child psychiatric settings and have been a treatment director of a long-term residential treatment facility. Throughout my experiences, I have witnessed staff who would rather place a child in locked time-out than work to promote positive behavior. I have seen parents who do not believe in the powerful approach of "catching children being good." In one of my first employment experiences at the former Capistrano by the Sea Hospital in Dana Point, CA, Larry Stednitz, Ph.D. of http://www.strugglingteens.com/, taught me that children with the most severe difficulties can be changed through the use of engagement in activities and positive interventions. At Capistrano by the Sea, we worked with the severest of the severe with minimal use of seclusion and restraints.

Locked seclusion is necessary at times, but in my experience, it is vastly overused. Punishment is certainly necessary at times, but it should be used sparingly in a mild form. It is much more effective to use the principles of Re-Education, formulated by Nicholas Hobbs in his book, The Troubled and Troubling Child. Among these principles is a belief that we have to help kids be confident by establishing quality adult-child relationships and helping them develop a sense of competence with some type of skill or activity. When parents, teachers, and mental health professionals use these positive interventions with kids, the need for locked seclusion dramatically decreases.

In order to help all the other Jonathans in our country, we need to push for more cost-effective day treatment and residential treatment facilities that are staffed by trained mental health and special education professionals. We need to bring professionalism to this field and not accept educational programs that are staffed by people who do not know what they are doing. We need to keep educating others that positive interventions work with children and that severe punishment, such as the use of locked seclusion, should only be utilized as a last resort. We need more monitoring and regulation of programs that do use these restrictive behavior management techniques. We also need to support parents in helping them find quality care. When we help our troubled youth experience success, we experience success as well.

Wednesday, December 3, 2008

Gluten-Free Diet: Helpful or Hype??

Karen Springen of Newsweek has recently written an article titled, A New Diet Villain, about the newly popular gluten-free diet . She reports that Americans are spending $2 billion a year on gluten-free products that advocates claim can help autism, ADHD, and other disorders. She addresses whether this new diet is helpful or more about hype. According to professionals she interviewed, no systematic scientific studies have been conducted verifying the efficacy of the diet. However, many parents have noted remarkable results.

Dr. Kenneth Bock, in his book, Healing the New Childhood Epidemics: Autism, ADHD, Asthma, and Allergies: The Groundbreaking Program for the 4-A Disorders, outlines a strategy that looks at each patient with one of these disorders like a puzzle waiting to be solved: finding and treating the root cause of illness rather than its symptoms, reducing the body's toxin load and helping the body heal itself through nutritional and medical therapy. A gluten-free diet is part of his healing strategy. This book has been very enlightening for the parents of the children I work with. Several have claimed substantial improvement in their child's affect and the ability to socialize.

If these approaches intrigue you, as they do me, my advice is to read through the literature and make your own decision regarding what to do. We would love more scientific data, and I am sure it will come. Until then, we have to take our best guess in our decision-making to help our children be as successful as possible in the future.

What do you think? I would love to hear your opinion on this matter.

Monday, December 1, 2008

Does Your Child Have Sensory Processing Disorder?

Does your child get overly active in big groups? Does your child have difficulty tolerating clothing of certain textures? Is your child lethargic and in need of lots of prompting to do anything? These are just a few symptoms of a possible Sensory Processing Disorder. A very informative article by Michelle Kemper Brownlow, Desperately-Seeking Stimulation, provides much valuable information to help parents explore this avenue of inquiry. In my practice, many children are said to have this disorder. The diagnostic process of Sensory Processing Disorder is not well defined and the corresponding research is limited. However, the general theory described by Carol Stock Kranowitz in The Out-of-Sync Child is quite intriguing. And, many children in my community have been greatly helped by an occupational therapist. If your child has symptoms described by Ms. Brownlow, then more specific evaluation may be indicated.