Major depressive disorder (MDD) is more prevalent in the pediatric population than previously believed. According to some estimates, between 2% and 8% of children and adolescents have mood disorders. Depression in childhood often predicts recurrent episodes of depression later in life. This population is also at heightened risk of psychiatric disorders, substance abuse, social maladjustment, homelessness, and criminality. Clearly, depression in young people is not a problem that can be safely ignored. Early therapeutic intervention is essential and usually consists of cognitive-behavioral therapy and medication. Currently, the only antidepressant medication approved for use in children and adolescents is Prozac (fluoxetine). However, the lasting effects of Prozac exposure during youth are still not completely known. Conventional wisdom suggests that the benefits of treatment likely outweigh long-term risks, particularly in cases of MDD.

The adolescent brain, just like the adolescent body, experiences profound and rapid development. Chemicals in the brain called neurotransmitters direct cellular and structural growth throughout the brain, and this process gives rise to the adult brain: a well-regulated, stable organ that manages consciousness and the central nervous system. During the period of rapid growth, any disruptions or chemical stimuli can lead to functional changes later in life. For this reason, antidepressant use in childhood has come under great scrutiny. Prozac alters the balance of neurotransmitters in the brain. Some have argued that Prozac exposure during adolescence may result in lasting, even permanent behavioral changes. Researchers conducted a controlled experiment with adolescent rats to address some of these issues.

Rats given Prozac during adolescence displayed significant behavioral changes when tested as adults. For example, they showed less response in a forced-swim test and more response to anxiety-producing situations, such as a new environment. The increased anxiety was reduced by a second exposure to Prozac. Most disturbingly, sexual behavior in adulthood was impaired by Prozac taken during adolescence. This finding was completely unexpected. However, the researchers cautioned that the relationship between brain development and behavior is enormously complicated, and the current study only highlights this complexity. How much of these results translate to humans is also an open question. Rats are typically used in these studies because they mimic human physiology and neurobiology. Still, the underlying mechanisms of behavior are not well understood.

The adolescent rat study, among others, adds powerful evidence to the argument that Prozac initiates profound changes in the brain. These changes manifest themselves as behavioral and mood alterations. Human research is necessary to determine the scope of these alterations. As it stands, prescription of this antidepressant for children with MDD is still warranted.

References

1. PubMed Health. [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Fluoxetine. Retrieved April 11, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000885/
2. Iniguez, S. D., Warren, B. L., Bolanos-Guzman, C. (2010). Short- and long-term functional consequences of fluoxetine exposure during adolescence in male rats. Biological Psychiatry, 67(11), 1057-1066.

For children, teens, and college students, summertime is associated with freedom from school and positive emotions. However, summer can also be a time where certain mental health issues need to be tended to even more than usual. Experts share information on what mental health problems can be present more often during summer and how to prevent certain issues.

Peter Zafirides, a psychiatrist in Ohio, said he has noticed a common mental health issue for children, teens, and students during the summer. Many evaluate whether they should still take their medication for attention deficit hyperactivity disorder (ADHD).

“Stimulants are often prescribed during the school year, but depending on the severity of the underlying ADHD, the summers may provide for some time off the medications,” Zafirides said. “But it may not always be smooth-going. The combination of unmedicated ADHD symptoms, along with the less structured days of summer can be very problematic for kids and their parents. Beyond the attention symptoms that worsen, kids can experience mood changes, including anxiety and irritability.”

School can provide a consistent schedule, which can be better for children with certain mental illnesses. “The potential unstructured nature of the summer can feed in to any underlying anxiety disorders and depression present in these kids,” he added.

For children who have ADHD, Zafirides has tips to make summer more bearable. “Children and parents may benefit from sitting down at the beginning of the summer and talking about shared goals and expectations,” Zafirides said. “Have a plan ahead of time to regularly check in with each other and, in an open, nondefensive forum, talk about any changes in behavior or concerns about mood.”

He also has other suggestions that can apply to children and teens with any type of mental illness or mental health issues. “Get outside and enjoy the summer. Try to limit the amount of time online, watching TV, or playing video games,” Zafirides said. “Be active, get plenty of sleep and exercise. If medications will continue over the summer, make sure kids are taking them regularly. Again, summer is less structured, so compliance may not be as consistent, resulting in a worsening of a mental health condition. Always speak to your medical professional before either discontinuing or reducing the dosages of medication.”

Communication is key for healthy relationships and lives. “I think the most important aspect between parents and children in the summer months is to establish clear and respectful lines of communication without either side getting defensive or feeling they are not being heard,” Zafirides said. “An occasional small discussion may be all that is needed to avoid big problems over the summer.”

John Duffy, a clinical psychologist and author of The Available Parent: Radical Optimism for Raising Teens and Tweens said in an email that depression can be more noticeable during the summer. “I have found that depression driven by loneliness often becomes more pronounced in the summer,” Duffy said. “This may be due in part to the fact that people are more obviously out, about, and social in the summertime. For many young people, summer is a far less-structured time of year than any other season.”

Anxiety issues can also come to the surface. “We often find that anxiety-based issues become apparent due in part to the lack of structure,” Duffy said. “Though most young people claim this is the time of year they most look forward to, many become listless and irritable because of a lack of structured activity.”

The solution to these issues is to provide somewhat consistent structure during the summer. “This might include participation in a sport, a play, a camp or other club, volunteer activity, or a job,” Duffy said. “Kids do better when they are part of something. They are happier, less restless, and more driven. Summer also presents a unique opportunity for young people to investigate strengths and interests, and opportunity that is less open to them during the very-structured school year.”

Adults can experience the same mental health issues as children during the summer, especially depression and anxiety. “Depressed adults are more aware, for example, of the degree to which others are socially connected during the summer, and this can serve to amplify the depression,” Duffy said. “Many adults also tell me that, though they want to be more active, limitations imposed by work and other obligations prevent them from doing so. This can contribute to feelings of depression and anxiety as well.”

The National Alliance on Mental Illness website suggests that some people can actually experience seasonal affective disorder (SAD) during the summer. SAD is characterized by depressive episodes that occur during certain times of the year (typically during the winter). In the case of seasonal affective disorder that is experienced during the summer, symptoms tend to be weight loss, minimal appetite, anxiety, irritability, and insomnia. Heat and humidity could worsen this “reverse SAD,” according to the website. Some adults with bipolar disorder are more likely to experience the mania part during spring and summer as well, he said.

William Oswald, the CEO and director of Summit Malibu, a behavioral and addiction treatment center in California, said in an email that all types of mental health issues can occur more often during the summer, such as agoraphobia, addictions and compulsions, as well as the more common depression and seasonal affective disorder.

“When people have a purpose, or curriculum in this case, their minds stay occupied, and boredom is not as prevalent of an issue,” Oswald said. “When they go from being extremely busy to having nothing to do, oftentimes this boredom results in mild, or in some cases severe, forms of depression. Once untreated, depression sets in, people (teens and college students especially) end up self-medicating with drugs or alcohol as a means to simply feel better. This is true of seasonal affective disorder as well—some may not want to be outside, and in turn isolate, resulting in isolative behaviors and a depressive state.”

Oswald has specific preventative tips for each age group during the summer:

Children: “Setting play dates with other kids or sending them to a day-care program where they do outside activities can keep their minds occupied and also help with socialization. This is key to preventing isolating behaviors later on in life.”

Teens: “Having a part-time summer job is the most important thing they can do to protect their mental health. They will learn the importance of a work ethic, earn money (which they can then spend on fun activities), and [prevent] boredom—the number one offender during summer breaks.”

College students: “Having an internship or continuing to work on their educational goals will keep them focused and driven, preventing depression and other detrimental behaviors associated with the disorder.”

Unfortunately, these suggestions will not always work, and in that case it’s best to seek a mental health professional to keep any mental health issues from worsening.

For adults, it can be unfortunate to be stuck inside working when the weather is gorgeous (at least in some places). This can be just another trigger for depression and other mental illnesses like substance-related disorders. “Adults need to utilize their vacation days properly so they have something to look forward to and get to experience summertime weather on days other than the weekend,” Oswald said. “Making time for outdoor activities on the weekend and starting an exercise program will keep one’s mood elevated.”

Have you seen the movie? There are a lot of parenting situations in it that we can relate to. The main one that I see is with Marlin and Nemo. Nemo has a short fin and his dad is very protective of him, which is natural. Nemo wants to show his dad what he can do in spite of his short fin, but this is a scary situation for Marlin (the dad), because he does not know how to protect Nemo.

Nemo is reacting in an age-appropriate way: He wants to show his dad what he can do; Dad won’t let him, and then Nemo does it anyway. Sound familiar? This pattern happens a lot and at different ages and stages with parents and kids. As the kids get older, we may become more comfortable with letting go, but it will still be hard.

The question is this: How do we allow our children to do more things on their own when our own fears get in the way?

At a young age, kids begin to pull away and search for independence, and as parents, we encourage that, support them, and cheer them on. When they stumble, we help pick them up and tell them to try again. When they succeed, we feel great! When they “fail,” we get discouraged and/or keep cheering them on. The latter is a healthier response: to keep cheering for and encouraging them and to allow kids to keep striving.

The challenge is when they are hurt or held back by a physical or mental challenge that as parents we want to protect them from. We may also want to protect them because of our own fears or beliefs that someone is going to hurt them even more. When a child is showing the desire to try again or to show you that he can do something, that is when it can be okay to allow it.

With Nemo, he wanted to show his father he could swim far (out to the boat) and come back. Yes, he was being oppositional and was not listening or following directions, but that is not really the point.

Marlin was afraid that Nemo would not be able to swim to the boat, and from my perspective, Marlin was afraid that he would have to go get Nemo, and Marlin was more afraid of that than anything else. So here is something to think about: we need to be aware of where our fears come from as parents. Do our fears arise from our own insecurities or doubts that we will not be able to swim to the boat? Or maybe the fear is that when our child does well, he will need us less.

Wherever Marlin’s fears were coming from, Nemo did what he believed he could do. Yes, he got caught, and his dad searched and found him; and then Nemo was able to show Dad that in spite of his short fin, he was still able to do great things. Maybe if Marlin had allowed Nemo to show him earlier, then the situation would not have had to go that far, but then the movie would not have been made.

It took Dori to point out to Marlin that maybe it was time for him to let go. Yes, they were in the whale, but Marlin got the message: Allow Nemo to show what he can do, even if Marlin has some fears.

But let’s look again at the question posed earlier: When is it okay to allow your child to have more freedom? How can parents manage their fears when a child is insisting on what he can do?

1. Identify your fears. Be aware of them. When we look at our fears, we can do something about them. Are the fears more about your child or that you may not be able to protect him from getting hurt? You are not always going to be able to protect your child; he may get hurt, but he probably will also be okay.
2. Focus on what your child is able to do. Look at where improvements have been made, and see how you can help encourage him. Look at how you can support him to try something new or a little more challenging.
3. Is your child asking to try something new? Is he wanting to try more? If he is, then believe in him, and try to understand that he believes he is able to try it. You can share with him your thoughts and concerns. He may disagree and still want to try, and if so, then trust him. Yes, he may not fully succeed, and that’s okay. He will learn more about himself and become more confident in himself. When he does succeed, it will feel wonderful and he will be very proud to show you.
4. If you have conveyed your thoughts/fears to your child and he’s still insistent that he can do whatever it is, then support him. Encourage him and be there for him.
5. If he “fails”, do NOT say, “I TOLD YOU SO” because that would be your fears talking. Encourage him to try again; failure means not trying at all.

Back to Marlin and Nemo: Marlin learned that Nemo was able to do a lot of things, even with a short fin. He succeeded, and Marlin also succeeded: He learned that letting go is not only scary at times but also very rewarding. Nemo told him that he loved him and was thankful, and the letting go helped their relationship become more fun. Marlin also became better at telling jokes!

One last thought: When Marlin allowed Nemo to show what he could do, I think Marlin found his own “Nemo,” which I guess opens the door for another article on this topic: Finding “Nemo” Part II.

Related articles:
Increasing Children’s Self-Esteem
Importance of Coping Skills, Part 2: Building Resilience
When Not to Say “No” to Your Child

Your social life, the quality of it, was wired into your gray matter by the age of 3, according to current thinking on child development. After a minute of contemplating that statement, the immense impact of early childhood caregivers becomes clear. This subject comes to mind after reading a recent news story about Artyom Saleviev.

Artyom was first in the news in 2010. He is the Russian boy who was adopted by a U.S. couple, the Hansens, 3 years ago. After being part of the Hansen family for 5 months, Artyom was put on a plane bound for Russia by his adoptive mother. Artyom carried a letter which stated the Hansen’s no longer wanted him because of his disruptive behavior related to psychological problems. The recent news article states that Artyom is now living in a foster home (in Russia) and his behavior there is not disruptive.

In the United States, the number of children in the foster care system is close to 500,000. One-quarter of them are infants when they enter the system; 15% are age 3 or younger, some only infants. The most common reasons for removing them from a parent or relative’s home are an absence of supervision (36%) and a failure to provide (31%). What affect does this have on a baby or toddler? Are they so young they will not remember neglect or abuse by early caregivers? If only that were true.

Caregiver Influence

To understand the effect early caregivers have on infants and toddlers, we can look at the implications of attachment theory. This theory, which has been substantiated by research, states that interactions with our initial caretakers determine our future capacity to build emotional bonds with others.

By the age of 3 years, children are either secure in their attachments to their caregivers or insecure. Children who are secure have the benefit of responsive caregivers that consistently meet their needs for food, safety, and affection. In adulthood, they can form lasting emotional connections with others.

There are three types of insecure attachment: avoidant, ambivalent, and disorganized.

When caregivers discourage expressions of a child’s distress or affection, an avoidant style of attachment develops. The child learns to discourage his or her own feelings, which damps down the child’s capacity to feel loved by others. Avoidant children typically withdraw from social interaction and grow into adults who are extremely uncomfortable with feelings and intimacy.

Ambivalent attachment occurs when early caregivers give comfort inconsistently. They sometimes respond to the child’s needs and sometimes do not. With this kind of care, children become unsure whether their needs will be met. As adults, they are slow to trust and at risk for mood and eating disorders.

When a child’s needs are not responded to, or the child is abused, a disorganized pattern of attachment can lead to delayed development, social withdrawal, and aggressive or disruptive behavior. Adults with disorganized attachment are susceptible to personality disorders and chronic mental health problems. Their relationships are often chaotic or short-lived.

Our attachment style sticks with us for life, although alternative behaviors and ways of thinking can be learned to improve relationships.

Not All Memory Is Conscious

When Artyom Saleviev arrived in the United States, was he secure, avoidant, ambivalent, or disorganized in relation to others? The Hansens painted a picture of a very disorganized child, although his current foster mother in Russia does not. Regardless, his experience with the Hansens, and the ill-conceived way he was sent back to Russia, are not stand-alone events. They rest on the foundation of interactions he had, or did not have, very early in life.

Even if a school-age child like Artyom is adopted or finds his way to a nurturing foster caregiver, a pattern of connection with others is already established. It begins before the child enters foster care, as a result of the child’s experience with his first caregivers, and the pattern continues after he leaves the system.

Around one-third of those 18 to 24 who age out of foster care are homeless within 18 months (in the U.S.). Up to one-half are unemployed within 4 years of leaving, and approximately 30% to 40% have a mental disorder and likely no health insurance. More than three-fourths will become parents.

Perspective

To keep these sobering numbers in perspective, we can consider that people with less than stellar starts in life can, and do, lead productive lives and find a share of happiness. Humans are highly adaptable and resourceful. It is also a fact that people from “good” homes enter adulthood with mild to severe attachment issues, usually the avoidant or ambivalent type.

Difficulty trusting and connecting with others is not just a single family issue. It is part of the human condition and drives the drama we call history.

The foster care system is imperfect, but it is a nested problem. Looked at as a whole, the problem begins with the child’s experience of insufficient early caregiving and is later aggravated by the lack of support for these children during the transition to adulthood. The system is situated in a disorganized world where, unfortunately, such institutions are necessary. The best we can do is to strive to keep making improvements based on what we continue to learn about the special needs of these children.

References:

1. Child Welfare Information Gateway. Available from: http://www.childwelfare.gov
2. U.S. Department of Health and Human Services, Administration for Children and Families. Abuse, Neglect, Adoption & Foster Care Research: National Survey of Child and Adolescent Well-Being (NSCAW), 1997-2010. Available from: https://acf.gov/opre/project/national-survey-child-and-adolescent-well-being-nscaw-1997-2014-and-2015-2024
3. Radia, K. Adopted Russian boy rejected by U.S. mother adjusts in foster care. Available from: http://gma.yahoo.com/blogs/abc-blogs/adopted-russian-boy-rejected-u-mother-adjusts-foster-110037054–abc-news-topstories.html

Related articles:
Patterns of Attachment in Adults
Understanding Difficult Behavior – For Foster and Adoptive Parents

One of the most difficult parts of raising a child with autism is the fear of losing them. For my son, the combination of intelligence, impulsivity, and an inability to comprehend danger results in my family living in a constant state of hypervigilance and fear. When we go out, there is always the possibility he will try to run away. When we’re home, there is the fear that he will get out of the house. Our family has addressed this issue with an ability to think “outside the box” and one step ahead of our 14-year-old son, Ben.

1. Under lock and key
The most obvious way to keep a child safe at home are locked doors. We learned the hard way that deadbolt locks with a switch that can be turned by hand was only effective until he was 6 years old. One day he unlocked it and wandered out of the house while I was only one room away. Luckily, I caught him in time before he was halfway down the street. We switched to locks with keys and installed them on every door leading to the outside, my laundry room, my daughter’s bedroom, and our master bedroom. They are all master keyed so that our house key opens them all. In addition, we don’t keep our keys hanging next to the door. It’s inconvenient, but that’s the point.

2. Keeping watch: tag, you’re it
Another safety trick we use at home is something I learned from a life guard. While attending a beach outing for kids with special needs, they handed out lanyards with laminated cards that said “I’m Watching” on one side and had emergency first aid information on the other. This was to ensure that when there is a group of adults hanging out watching their kids play in the water, the parent wearing the lanyard is responsible for watching the child. This made me think about our own situation at home, where too often, my husband thought I was watching Ben while I assumed he was. This situation leads not only to missing kids but also to marital strife. So, we put the keys to the house on a lanyard, and the designated Ben-watcher wears it at all times. This way, when one of us needs to use the bathroom, we literally hand off the lanyard to the other person.

3. Tracking devices, helicopters and bloodhounds, oh my!
One of the most frustrating things about staying one step ahead is that we often don’t think about something until it presents itself as an obvious problem. Even after we changed the locks and donned our key lanyard, Ben’s safety was still not guaranteed. Last year, our greatest fear became a reality when Ben climbed our 6-foot privacy fence with the speed and dexterity of a tomcat. The person watching him was only a few yards away and watched him do it but could not reach him fast enough. He disappeared into the woods for 3 hours and was found with the aid of search helicopters and bloodhounds just before the sun set; he was cold, wet, and shivering.
After that incident, we obtained a tracking bracelet from our local county sheriff’s department that Ben wears on his ankle at all times. In the event that he ever goes missing, we can contact the police, who will find him using the radio signal from the device, rather than alerting the local news and calling the search cavalry. And from what they tell me, as long as the device is checked regularly and in working order, it doesn’t take 3 hours to find someone with this device.

4. Out and about
Parents of children with autism spectrum disorder know how difficult it can often be to take our children out into the world. A simple trip to the grocery store can become disastrous in no time flat. When our kids get overstimulated or can’t communicate, tantrums ensue and we often have to make a quick exit, while not making eye contact with fellow shoppers and store employees. Ben’s Houdini-like skills have also extended outside the home; school, stores, and Grandma’s house have all been settings for a “Ben Escape.” One thing we do now when going out is use a wheelchair with a seatbelt. Because of Ben’s sensory issues and difficulty transitioning, the wheelchair provides a secure, safe place for him to sit as well as the emotional stability of his seat remaining the same while his environment changes. Portable door alarms have been helpful on the rare occasion that we stay at a hotel. We’ve even been known to stack some of the hotel furniture in front of the door, from floor to ceiling, providing a barricade that would make a lot of noise if he tried to get past it. We’ve done the math, and we’re statistically more likely to lose our son than to have to evacuate in a hotel fire.

5. Vaseline
Yes, you read that right; Vaseline. Good old petroleum jelly became my best friend after Ben’s 3-hour tour of the woods. I needed a way to keep fence-hopping to a minimum, and apparently barbed wire is frowned upon by our home owners association. So, several jars and a very icky fence top later, the problem was solved. If having an autistic child in the drug-store line doesn’t solicit enough curious glances from fellow shoppers, nine extra-large jars of Vaseline is sure to.

For more information about wandering and a free box of safety materials, contact the National Autism Association at http://nationalautismassociation.org/big-red-safety-box/

Related articles:
The Difference 1 Makes: Reflections on the CDC Autism Rates
Autism on the Rise: Are We Prepared?

Healthy conflict resolution is essential to maintaining positive and constructive adult relationships. Individuals usually learn how to handle conflict in childhood. Children watch the way adults work through disagreements and model those patterns of behavior as they develop into adults and begin to form relationships with others. The bonds that children have with their caregivers also influence the way in which they address conflicts. People who have secure attachments with their parents and caregivers are often able to work through challenges with other people in respectful, affectionate, and loving ways. They are capable of recognizing when they need to ask for forgiveness and are willing to compromise to achieve a resolution that is mutually satisfying to all involved. Individuals who have insecure attachments, however, are often unable to handle situations as amicably. Insecure attachment can be expressed through avoidant or anxious behaviors. People who are avoidant in nature tend to withdraw and shut down when faced with conflict. Anxious individuals may demand attention, even negative attention, and use aggressive and hostile tactics to engage someone in a conflict dispute.

For children who have grown up witnessing dysfunctional conflict resolution strategies, having a secure attachment with others could help them avoid making the same mistakes of their parents. Rather than continuing the negative behaviors they have seen displayed by their own parents, these secure, self-reliant, and confident people may choose to use healthier mechanisms to maintain harmony in their adult relationships. Joyce A. Baptist of the School of Family Studies and Human Services at Kansas State University wanted to better understand how attachment style affected emotional processing learned in families of origin. She enlisted 203 young adults who had been raised in families with various emotional functioning styles for a study that evaluated how the adult children managed conflict.

Baptist found that the participants who had witnessed extreme disengagement in childhood were more likely to use aggressive and antagonistic disagreement strategies in adulthood. The most anxiously attached individuals in this group were the most apt to engage in hostile behaviors as their anxiety escalated. Those with minimally avoidant styles worked through disagreements in a more civil way. Baptist believes these results suggest that secure attachments can help protect individuals from dysfunctional and destructive conflict resolution patterns. These findings could impact how professionals assist people who have communication and compromise problems in their adult relationships. She added, “Considering the interrelations between emotional processing in families of origin and insecurities in attachment will allow therapists to better identify and treat the root of the destructive conflict behavior.”

Reference:
Baptist, J. A., Thompson, D. E., Norton, A. M., Hardy, N. R., Link, C. D. (2012). The effects of the intergenerational transmission of family emotional processes on conflict styles: The moderating role of attachment. American Journal of Family Therapy 40.1, 56-73.

When parents use children as pawns in their divorce, the psychological consequences can be devastating. Parental alienation (PA) is the act of deliberately alienating a child from a targeted parent (TP) by an alienating parent (AP) and can cause a psychological condition referred to as parental alienation syndrome (PAS). Although this term is relatively new, the damage this type of behavior inflicts is not. When one parent denies a child access to the TP, the child struggles with feelings of hatred and fear towards the TP. These children often live in an environment riddled with malicious and derogatory remarks about the TP, and as they age, maintain guilt over harboring these feelings toward their parent.

Research on children of divorce has shown that this pattern of behavior can cause children to have social impairments that negatively impact their quality of life as adults. But until now, no study has looked specifically at PAS and its effect on key factors of development. To address this issue, Naomi Ben-Ami of Yeshiva University in New York evaluated 118 adult children of divorce and compared the children who experienced PAS to those who did not. She assessed several areas of social and psychological well-being, including depression, trust, self-hatred/esteem, anger, guilt, marital status, and achievement and identity problems.

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Ben-Ami found that the PA participants had substantially lower levels of achievement than the non-PA group, which was demonstrated by fewer college degrees, less overall employment, lower college enrollment, and more economic hardship. They also exhibited attachment issues, impaired relationships, and decreased self-esteem, possibly as a result of the lack of attention they received from their APs. The controlling behavior of an AP was also shown to increase feelings of anger and guilt in the PA participants. These emotions, coupled with diminished self-sufficiency, elevated the risk for depression in the children who were exposed to PAS. Ben-Ami believes these findings support previous research that shows the destructive and long-term consequences that a child must bear when he or she becomes entangled in a parent’s highly fueled emotions arising from a divorce or separation. This type of evidence, if made available to parents and involved psychological and legal experts, could help prevent this type of activity and maintain the integrity of relationships, present and future. Ben-Ami added, “Ideally, the trajectory can be interrupted successfully to allow children to maintain healthy relationships with both parents, to be loved by them and loving with them.”

Reference:
Ben-Ami, N., Baker, A. J. L. The long-term correlates of childhood exposure to parental alienation on adult self-sufficiency and well-being. American Journal of Family Therapy 40.2 (2012): 169-83.

People who have suffered childhood trauma are at increased risk for psychological problems resulting from extreme stress. Borderline personality disorder (BPD) is one such condition that has been linked to severe childhood trauma. When the trauma is inflicted by a caregiver, the child’s ability to cope is significantly impaired. The effects of unhealthy coping, attachment dysfunction, and emotional regulation can affect many areas of the child’s life as they continue into adulthood. Affect dysregulation is the inability to control one’s moods and emotions and has been linked to BPD and other mental illnesses. Underregulation of emotions is expressed by lack of control, extreme emotional overwhelm; while overregulation is the result of numbing and is exhibited by an inability to express emotions. To determine which of these factors is more indicative of BPD in adults who suffered trauma during childhood by their primary caregiver (TPC), Annemiek van Dijke of the Delta Psychiatric Hospital in the Netherlands conducted a study of 472 clients with a diagnosis of BPD.

The participants’ levels of affect regulation were documented and they were evaluated for various forms of TPC, including sexual abuse, physical abuse, and emotional trauma. Van Dijke found that 63% of the participants had experienced some form of TPC and that those with underregulation had more symptoms of BPD than the participants with overregulated affect. Although the study did not consider other factors that could influence BPD, such as family history, other traumas, and the mental health of the caregivers, the results clearly emphasize the importance of examining emotional regulation, and specifically underregulation, in clients with a history of TPC.

The findings also showed that the participants with TPC were at increased risk for posttraumatic stress (PTSD). But Van Dijke noted that no research has been conducted to determine exactly how specific forms of TPC affect the severity of PTSD symptoms or how they are indirectly affected through affect regulation as a result of TPC. In sum, Van Dijke believes that these results can benefit clients who have suffered TPC by educating clinicians on the importance of helping clients build more secure relationships and develop healthier emotional expressions.

Reference:
Van Dijke, A., Ford, J. D., van Son, M., Frank, L., & van der Hart, O. (2012). Association of childhood-trauma-by-primary caregiver and affect dysregulation with borderline personality disorder symptoms in adulthood. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. doi: 10.1037/a0027256

Children who are enrolled in public schools in low-income communities are at a disadvantage both academically and psychologically. These children experience elevated rates of mental health problems due to their environments, family structures, and financial insecurity. At school, their opportunities are restricted as a result of a less than adequate learning environment, minimal resources, and external factors such as increased drug use and violence. All of these factors contribute to diminished behavioral regulation, loss of motivation, and poor academic achievement. Although there are many programs designed to address these issues in urban public schools, few have had substantial success. Obstacles such as feasibility, accessibility, funding, and implementation have prevented them from achieving success. Additionally, the majority of programs are aimed at meeting the needs of the students as a whole, and do not consider the needs of the teachers and children with disabilities.

BRIDGE, Bridging Mental Health and Education in Urban Schools, is a coaching and consultation program that was designed by a team of researchers and created to address all of these issues in urban elementary schools. To test its viability, one of the creators, Elise Cappella of the Department of Applied Psychology at New York University, led a study using 36 classrooms from five different elementary schools in urban communities. After a brief intervention, Cappella and her colleagues saw results.

BRIDGE was directly responsible for increasing emotional support in the classrooms, which gave the children a feeling of security and improved behavioral regulation. The students felt more confident and saw their teacher as an ally, which directly impacted their motivation for success. Overall, the students exceeded the academic, social, and emotional levels of their peers as a result of the teachers’ participation in BRIDGE. Cappella noted that one significant difference between BRIDGE and other programs is the fact that BRIDGE is delivered to teachers by a variety of mental health professionals. This factor makes BRIDGE a program that can be portable, flexible, and easily administered. Teachers are coached in such a way that they become empowered with valuable resources that help bridge the gap often found between students and teachers in disadvantaged school systems. Cappella added, “It is encouraging that a consultation and coaching component of mental health practice based on actual interactions in the elementary classroom and effective strategies to improve these interactions promotes children’s functioning across domains in urban schools.”

Reference:
Cappella, E., Hamre, B. K., Kim, H. Y., Henry, D. B., Frazier, S. L., Atkins, M. S., & Schoenwald, S. K. (2012). Teacher consultation and coaching within mental health practice: classroom and child effects in urban elementary schools. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0027725

Adderall (dextroamphetamine and amphetamine) is one of the preferred treatment options for adults with attention-deficit hyperactivity disorder (ADHD). The medication works by increasing an individual’s ability to pay attention and control impulsive behaviors. In people without ADHD, abuse of Adderall generates a euphoric sensation, included elevated feelings of confidence and power. When taken as prescribed, Adderall carries a risk of several unpleasant side effects. These include difficulty sleeping, nervousness, restlessness, and headache. Chest pain, rapid heartbeat, and shortness of breath are all signs of a potentially serious condition, warranting immediate medical attention.

Although the risk is small, there have been several documented cases of young people experiencing sudden heart attacks after taking Adderall without a prescription. The dosages were not especially high in many of these cases. In one such example, a young male suffered an acute heart attack after ingesting 30 mg of Adderall and drinking an unspecified amount of alcohol. He had no history of heart abnormalities. Still more troubling, cardiac events are possible even in the absence of abuse. A 15-year-old boy in otherwise good health experienced a heart attack in response to his usual dose of Adderall. He fully recovered, and terminating the prescription removed any signs of heart irregularities. Doctors are not certain what causes these effects in people. Currently, there’s no test to determine who will or will not develop cardiac side effects when taking Adderall. The best practice right now is to monitor an individual’s symptoms closely and intervene at the first sign of trouble. In addition, a history of heart issues may argue for a treatment plan that does not include a powerful stimulant like Adderall.

The extended-release formulation of Adderall was removed from the Canadian market for several years out of concerns about heart attacks and rampant abuse of the medication. It was eventually reintroduced with stricter guidelines for attending physicians. As always, those who abuse prescription medications like Adderall face far greater risks of dangerous, even lethal, side effects. Heart rhythm problems and heart attacks are the most troubling potential consequences of Adderall abuse. Even those who take the medication according to a doctor’s prescription face the small but real threat of cardiac problems. As research into ADHD and stimulant medications continues, safer drugs and drugs less prone to abuse will most likely be introduced.

References:

1. Centers for Disease Control and Prevention. (n.d.) Facts about ADHD. Retrieved from http://www.cdc.gov/ncbddd/adhd/facts.html
2. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Dextroamphetamine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000310/
3. Jiao, X., Velez, S., Ringstad, J., Eyma, V., Miller, D., Bleiberg, M. (2009). Myocardial infarction associated with Adderall XR and alcohol use in a young man. Journal of the American Board of Family Medicine, 22(2), 197-201.
4. Sylvester, A.L., Agarwala, B. (2012). Acute myocardial infarction in a teenager due to Adderall XR. Pediatric Cardiology, 33(1), 155-157.

According to a new study led by A.C. Burnett of the Department of Psychology at the University of Melbourne in Australia, children born prematurely and with low birth weights (LBW) are three-and-a-half times more likely to develop mental health problems such as depression and anxiety than normal birth weight (NBW) children. Children born prematurely are already at increased risk for physical health problems, learning disabilities, and other cognitive challenges. Some research has provided evidence that children who are born prematurely are at a higher risk for behavioral problems and even attention-deficit hyperactivity disorder (ADHD). But until now, there has been little evidence suggesting that these children are also more vulnerable to mood disorders and mental health problems later in life.

In order to examine the relationship between LBW and mental health problems, Burnett analyzed previous studies and looked specifically at prematurity/LBW and how it influenced the development of anxiety and depression in adolescence and young adulthood. Burnett assessed data that was published between 1995 and 2010 and included individuals born prematurely with LBW, ranging in age from 10 to 25 years old. After review, Burnett discovered that children who were born prematurely and had LBW had a significantly higher risk than NBW peers, for the development of psychiatric problems later in life. In particular, the study revealed that the LBW participants were three times more likely to develop an anxiety or depressive disorder in adolescence or young adulthood than those who were born full-term.

The results of this study, the first of its kind, have significant clinical implications. Burnett believes that professionals treating the physical and cognitive impairments in LBW children should be aware of the negative psychological predisposition that these children possess, paying particular attention to mental health needs during adolescence and young adulthood. Burnett added, “The studies reviewed here indicate that, in addition to monitoring and management of medical and cognitive sequelae, the psychological well-being of formerly preterm individuals should be a key part of ongoing care in collaboration between clinicians, individuals and their families.”

Reference:
Burnett, A. C., Anderson, P. J., Cheong J., Doyle, L. W., Davey, C. G., Wood, S. J. Prevalence of Psychiatric Diagnoses in Preterm and Full-term Children, Adolescents and Young Adults: A Meta-analysis. Psychological Medicine 41.12 (2011): 2463-474. Print.

Families need to be together. After all, the family as a group exists to provide support, nurturance, food, shelter, resources, and a stable future to each member. While most families have their ups and downs, even stressed, impoverished, chaotic families want to live with one another. When is it in the family’s best interest for members to separate from one another? Can leaving the family home for a short while ever bring healing to the relationships in the long run?

Family separations occur in American culture in formal and informal ways. Formally, families can legally be ordered to separate by the courts because of domestic violence, child sexual, emotional, or physical abuse or neglect, chronic drug or alcohol abuse, and/or failure to educate and when there is a threat to the life, health, and well-being of one or more family members. Typically, less-intrusive assistance has been attempted at many levels before a court order occurs, including weeks or months of child-centered school counseling, family therapy, marriage counseling, social work support, addiction treatment, spiritual community support, or elder advocacy.

All of these actions occur at local, county, and state levels because we as a society believe that we have a stake in supporting and sustaining healthy families. State laws vary but generally have been written with family reunification as the end goal of this intervention process, wherever possible. Violent fathers, neglectful or addicted mothers, and abusive siblings can and often do change and grow into healthier, happier parents, spouses, siblings, and grandparents. We want families to get along well and have what they need to contribute to the world. No one benefits when families are so chaotic and dysfunctional that it takes dozens of people and thousands of hours and dollars to try to help.

[fat_widget_right]More informal separations occur every day, particularly among highly distressed married couples. Unable to live in the same home without physical or emotional pain, one member of the couple leaves the home temporarily and lives elsewhere. Unlike a formal, legal intervention of family separation, this kind of separation is less likely to change the marital interactions at all. What it usually does is create less fighting and conflict in the home, while increasing the stress of the separating spouse and any children in the family. The only person who may feel any relief is the remaining spouse, and this relief is generally temporary. The focus is shifted to the dozens of life details that, once shared, have to be renegotiated, from grocery shopping and bill paying to getting a child to baseball practice.

Unless a separated couple gets professional support and assistance immediately, the family begins to reshape around the absence of the separated parent. Children feel neglected and forgotten, no matter how diligent the separated parent is in spending time with the children. There is just no adequate substitute for living together, and the children’s behavior often suffers. The couples will simply shift their conflict away from one another in the short term and have no real plan of action for getting everyone back together. Because separation only tones down conflict and doesn’t solve it, I almost always suggest that separated couples who want to remain married work at getting back together as soon as possible, and always with professional family or marital therapy. If this is not the chosen path, statistics predict this couple will end up divorcing.

Separation is often a necessary choice when family behaviors become violent, abusive, or dangerous. But in nearly all cases, families should be helped to heal and reunify as soon as possible. Separation is not the best course of action unless it is the only course left for health, safety, or stability’s sake. Every one of us needs to feel like we belong and to be part of a group of people who know, appreciate, sacrifice for, and value us most of all. At our best, these are our families. It’s worth the effort to make them as healthy, whole, and loving as possible.

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