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Social Work Methods Help Diffuse Bullying Conflicts


Best Resources on Living with Autistic Partners


Best Resources on Relationship for Living with Autistic Partners

The Other Half of Asperger Syndrome is a guide to an Intimate Relationship with a Partner who has Asperger Syndrome. This resource give practical knowledge on everyday topics include living and coping with AS, anger and AS, getting the message across, sex and AS, parenting, staying together and most of all AS cannot be blamed for everything.

Asperger Syndrome and Long-Term Relationships is about a women married to a man with Asperger Syndrome, and this book provides the answers to many of the questions asked by increasing number of people in that situation. This book explains how behaviors that may have appeared odd - or even downright irritating - are the manifestation of AS, and shows how understanding can lead to greater tolerance or to change. This book provides a wealth of strategies for living successfully with the more uncompromising aspects of AS, pointing out that AS also brings enormous strengths to a relationship, and emphasizes the value of understanding. This resource describes many positive solutions that have worked for other couples.

Best Workbook for Autistic Partners

The ADHD Marriage Workbook permits couples to tackle their joint concerns in a planful, systematic manner. This workbook is full of helpful strategies that will enable intimate partners understand and negotiate the confusion

Considering EMDR?

What Every Client Should Know

What is EMDR?

Eye Movement Desensitization and Reprocessing, is a late-stage, trauma resolution method.

Developed in the late 1980's, EMDR currently has more scientific research as a treatment for

trauma than any other non-pharmaceutical intervention. Based on empirical evidence as well as

thousands of client and clinician testimonials, EMDR has proven an efficacious and rapid

method of reprocessing traumatic material. EMDR appears to assist in processing of traumatic information, resulting in enhanced integration - and a more adaptive perspective of the traumatic material. The utilization of

EMDR has been shown to obviate the need for some of the more difficult abreactive work (i.e.

reliving the trauma), often associated with the psychoanalytic treatment of a variety of

conditions, including generalized and specific anxieties, panic, PTSD symptoms (such as intrusive

thoughts, nightmares, and flashbacks), dissociative disorders, mood disorders and other

traumatic experiences. So, theoretically, EMDR is about integration- bilateral hemispheric

(right/left brain) integration; triune brain (brain stem, limbic system and cerebral cortex)

integration; and at least some type of mind/body integration, but practically, it’s about

convincing the mind and body that the traumatic event is, indeed over. EMDR helps to put the

past in the past, where it belongs, instead of staying stuck in it (feeling like it is happened all

over again in the present-with the same thoughts, emotions and body sensations- that

accompanied the event in the past).

How is EMDR Done?

EMDR is accomplished in four stages:

1. Establishment of Safety-safety within the therapeutic relationship and safety within

each individual EMDR session. During each EMDR session, your therapist will begin by

activating your own internal resources. (S)he will guide you in an imaginal, multisensory

imagery exercise designed to activate images, emotions and body sensations of safety,

protection, nurture and comfort. Once these images have been activated, the actual

trauma reprocessing will begin.

2. Activating the Traumatic Memory Network-The therapist will ask a series of questions

regarding the traumatic memory. The purpose of these questions (or script) is to

activate the entire traumatic memory network.

3. Adding Alternating Bilateral Stimulation-Once the entire traumatic memory is

activated, the therapist will add alternating bilateral stimulation via any or all of the

following:

a) begin the buzzing in your hands by turning on the Theratapper

b) play alternating auditory tones via headphones or ear buds

c) begin moving his/her hands back and forth, so you may visually track the

movement across the midline of your body)

4. Reestablishment of Safety-regardless of whether the traumatic material was

completely processed or not, the session will end at a pre-set time. Before you leave, you

will be stable, embodied, oriented and calm. Depending on you and your therapist’s

preferences, this may be accomplished in a variety of ways including, but not limited to

re-activating your own internal resources, breathing exercises, prolonged muscle

relaxation, etc.

Is EMDR Dangerous?

You should know that this modality (EMDR for single-incident trauma) is a pretty simple

protocol-easy for any literate person to master-, however, when administered by someone

lacking requisite knowledge of trauma’s sequelae, this simple protocol may prove challenging,

fear-inducing and-oftentimes re-traumatizing for clients.

So there’s no misinterpretation of the last sentence, the EMDR protocol-original or modifiedis

not dangerous, but any type of trauma work that deliberately activates a traumatic

memory network without insisting that both client and clinician are adequately prepared to

tolerate the effects of that activation is dangerous and irresponsible.

It follows then, that more valuable than a clinician with a training certificate in EMDR, clients

are better served by competent, clinicians who possess a thorough knowledge of trauma-its

effects and aftereffects, as well as knowledge of the current evidence-based, state-of-the art

trauma resolution methods, which should include, but be not limited to the EMDR.

What Should I Expect from My Therapist?

As a client, you should expect that your clinician will-and does- continuously and vigilantly

attend and re-attend to your safety and stabilization needs. To that end, please be aware that

you are entitled to, and should expect the following:

A solid therapeutic relationship, i.e. a good rapport and adequate trust in your therapist

An explicit crisis plan-co-written by you

Psychoeducation regarding trauma-its effects, aftereffects and current treatment

options-including the modalities utilized by your therapist.

Instruction in-and acquisition of- skills for self, affect and emotion regulation, arousal

reduction and distress tolerance prior to trauma work, i.e., before any reprocessing of

trauma, you should:

o Feel stable

o Have access to an external support system

o Have a decent sense of self and identity

o in a relatively healthy manner, be able to handle or manage the intensity of

your own emotions

o Be sure to ask your clinician specifically what all of this means and how (s)he

will prepare you for reprocessing traumatic material

Generalized Anxiety Disorder

"I always thought I was just a worrier. I'd feel keyed up and unable to relax. At times it would come and go, and at times it would be constant. It could go on for days. I'd worry about what I was going to fix for a dinner party, or what would be a great present for somebody. I just couldn't let something go.

"I'd have terrible sleeping problems. There were times I'd wake up wired in the middle of the night. I had trouble concentrating, even reading the newspaper or a novel. Sometimes I'd feel a little lightheaded. My heart would race or pound. And that would make me worry more. I was always imagining things were worse than they really were: when I got a stomachache, I'd think it was an ulcer.

"When my problems were at their worst, I'd miss work and feel just terrible about it. Then I worried that I'd lose my job. My life was miserable until I got treatment."

Generalized anxiety disorder (GAD) is much more than the normal anxiety people experience day to day. It's chronic and fills one's day with exaggerated worry and tension, even though there is little or nothing to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety.

People with GAD can't seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. Their worries are accompanied by physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flashes. People with GAD may feel lightheaded or out of breath. They also may feel nauseated or have to go to the bathroom frequently.

Individuals with GAD seem unable to relax, and they may startle more easily than other people. They tend to have difficulty concentrating, too. Often, they have trouble falling or staying asleep.

Unlike people with several other anxiety disorders, people with GAD don't characteristically avoid certain situations as a result of their disorder. When impairment associated with GAD is mild, people with the disorder may be able to function in social settings or on the job. If severe, however, GAD can be very debilitating, making it difficult to carry out even the most ordinary daily activities.

GAD affects about 4 million adult Americans and about twice as many women as men. The disorder comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age. It is diagnosed when someone spends at least 6 months worrying excessively about a number of everyday problems. There is evidence that genes play a modest role in GAD.

GAD is commonly treated with medications. GAD rarely occurs alone, however; it is usually accompanied by another anxiety disorder, depression, or substance abuse. These other conditions must be treated along with GAD.

No. 7 (Updated May 2008)
CHILDREN WHO WON’T GO TO SCHOOL (Separation Anxiety)
Going to school is usually an exciting and enjoyable event for young children. However,
for some, it can cause intense fear or panic. Parents should be concerned if their child
regularly complains about feeling sick or often asks to stay home from school with minor
physical complaints. Not wanting to go to school may occur at anytime, but is most
common in children five to seven and 11-14, times when children are dealing with the
new challenges of elementary and middle school. These children may suffer from a
paralyzing fear of leaving the safety of their parents and home. The child’s panic and
refusal to go to school is very difficult for parents to cope with, but these fears and
behavior can be treated successfully, with professional help.
Refusal to go to school often begins following a period at home in which the child has
become closer to the parent, such as a summer vacation, a holiday break, or a brief
illness. It also may follow a stressful occurrence, such as the death of a pet or relative, a
change in schools, or a move to a new neighborhood.
The child may complain of a headache, sore throat, or stomachache shortly before it is
time to leave for school. The illness subsides after the child is allowed to stay home, only
to reappear the next morning before school. In some cases the child may simply refuse to
leave the house. Since the panic comes from leaving home rather than being in school,
frequently the child is calm once in school.
Children with an unreasonable fear of school may:
• feel unsafe staying in a room by themselves
• display clinging behavior
• display excessive worry and fear about parents or about harm to themselves
• shadow the mother or father around the house
• have difficulty going to sleep
• have nightmares
• have exaggerated, unrealistic fears of animals, monster, burglars
• fear being alone in the dark, or
• have severe tantrums when forced to go to school
Such symptoms and behaviors are common among children with separation anxiety
disorder. The potential long-term effects (anxiety and panic disorder as an adult) are
serious for a child who has persistent separation anxiety and does not receive professional
Children Who Won’t Go to School, “Facts for Families,” No. 7 (5/08)
assistance. The child may also develop serious educational or social problems if their
fears and anxiety keep them away from school and friends for an extended period of time.
When fears persist the parents and child should consult with a qualified mental health
professional, who will work with them to develop a plan to immediately return the child
to school and other activities. Refusal to go to school in the older child or adolescent is
generally a more serious illness, and often requires more intensive treatment.
Excessive fears and panic about leaving home/parents and going to school can be
successfully treated.

Facts for Families© information sheets are developed, owned and distributed by the American Academy of Child and Adolescent
Psychiatry (AACAP) and are supported by a grant from the Klingenstein Third Generation Foundation. 

How to Cope With Loss

 Richard Tedeschi, Ph.D., is a licensed psychologist who specializes in bereavement and trauma and is a professor of psychology at the U of North Carolina at Charlotte, where he teaches psychotherapy.

Q:  What are some common emotions someone can expect to go through following a loss?A:  Well, depending on the kind of loss, all kinds of emotions can be involved. Sadness, of course, is the most predominant. Depending on the circumstances, perhaps, anger, guilt and, in some circumstances, relief. It's really a whole gamut of things. Emotions change over time, too; the emotions initially experienced may not be what people feel down the road.

Q:  Is there a time frame for the grieving process?A:  There used to be these old models of grief that said that people go through certain stages and it takes a certain amount of time ? those have been discredited. People now see grief much more as an individual process, so it's hard to put a time frame on it; it's hard to say that it goes through certain particular stages or phases for any individual. Some people manage to resolve the most intense emotions of grief relatively quickly, for others it takes a long period of time.

Q:  What are some examples of how the grieving process may differ from person to person?A:  If you have a parent who is 95 years old, and you've had a good solid relationship with that parent, and then that parent dies because of declining health, you're not going to be surprised by this occurrence. You are going to be able to look at their life as a good thing, and this life is not particularly tragic, but natural. Because of your good relationship and the anticipation of the death, you've done your personal business with them. There's nothing that's really left unsaid or undone, and it feels that the relationship is somehow complete. So the emotions after that may not be particularly disturbing ones or difficult to manage, although there will be emotions none the less. Let's take a different example. Let's take a parent with a young child who dies and someone is clearly to blame, something went wrong. It's an unexpected death, it's shocking and it seems incomprehensible that your child would die, especially so young, and if somebody is at fault you'll have all sorts of feelings about that. So these feelings will be more intense and difficult and strung out over a longer period of time because of the unexpected nature of this ? the fact that there has been some sort of wrongdoing involved, that this life has been cut artificially short. In other words, there is going to be a lot of unfinished business. It's going to be a lot different kind of grief than in the first situation I mentioned.

Q:  What are some general suggestions for coping with grief?  A: Don't be afraid of the feelings you're feeling.

  • Don't think you're crazy for feeling the things you're feeling.
  • Accept your feelings and don't let other people tell you how you should grieve.
  • Trust your own judgment about your feelings and what you need to do to help yourself.
  • Don't fall for the supposed grief formulas that some people talk about, that you go through the stage of anger, that you go through the stage of bargaining, that you go through the stage of resolution. It's all a mixed-up process ? expect to be confused by it to a great degree.
  • Talk to people. Find a good listener and someone who can hang in there with you for a long period of time.
  • Expect that some people will be uncomfortable being around you. And not everyone will be someone you can turn to.
  • Expect that in the immediate aftermath of the event, you'll get much more support than you will down the road, and maybe you'll feel like you still need support when people don't realize it anymore.

    Those are some of the expectations people should have, and one of the most important ways of dealing with those things is to trust yourself. Realize that this is a process that may take some time, and find a good listener.

    Q:  Do you have any suggestions for those who are helping a friend to cope with loss? A:  Listening is the most important thing. There are not going to be solutions to this problem of this loss. You can't bring the person back. You're not going to be able to find some magic words to make them feel better. So just being open to what this person needs to discuss will be useful. Respecting their particular way of grieving so that you don't become pushy and you don't disappear either. And following the lead of the person who is grieving. Paying attention to what they need in their own personal situation rather than feeling like you should know the answers or have a solution or have any kind of a formula for them. They'll let you know about their own needs if you're a good listener.

    Q:  You've been suggesting ways to cope with grief. Are there ways of coping that may be unhealthy? A:  Some of the things that would be unhealthy would be turning to alcohol or drugs to buffer the pain of this. There are a lot of similar avoidance maneuvers that people can engage in ? such as overeating or anything with an addictive nature to it that people can turn to just because they get some temporary relief from the pain of things. Some people may start to think things like, 'I wish I were dead and I would be reunited with my loved one in heaven.' This is not particularly unusual in grieving people, but if they are taking that very seriously, then I would become concerned. Those are the kinds of things that are unhealthy in grieving, though I'm very reluctant to label things in general as unhealthy because people in grief experience so many things that feel odd and unusual. For the vast majority of people that I've seen who are bereaved, all these odd and unusual things, things that look odd and unusual from the outside, things that may even feel odd and unusual to themselves, all these things end up being helpful for most people. People have all kinds of thoughts about the death after it has occurred that some of us might think are kind of strange. This [the death of a loved one] just brings out in most normal people all sorts of unusual considerations and thoughts and reactions, and I hesitate to think of any of them as pathological in any way.

    Q:  Many people will have to deal with an anticipated loss at some point in their life ? such as losing someone to a terminal illness. How do people cope with these expected losses? A:  When people are terminally ill, there are a number of things that will go on with them and the family around them. To some extent they will be hoping that maybe this won't happen. Depending on the circumstances and the changing circumstances, that hope may be dashed or strengthened by what is going on. In the best of circumstances, people are in some way preparing for this. They're open to it and they're open to discussing it, which is usually helpful. For the loved ones who are going to be left behind, even when the death occurs, even if they've done a lot of preparation, it still has a quality of some shock and additional sadness. You just can't get used to it all ahead of time. So even when you do this preparation and continue the process of living and are open to the discussion of what might happen, you deal with all the declines in the person's capabilities. And when the death occurs ? it's still a death and it's still hard.

    Q:  Will children grieve differently than adults? A:  Many, many years ago people thought that children didn't really grieve, but that's not true ? they grieve in different ways. In some ways, of course, children are confused ? depending on the age you're talking about ? about what has happened. They may not understand death. It's a difficult concept for them to grasp in some ways; they don't understand what happens after some people die, but neither do adults very much. Of course, if they had a close relationship with the person who has died, they will miss them. How they express that may be a little different than the way adults do. Some children express it more in their behavior, rather than expressing it directly in a description of what is going on inside of them. Children are good about expressing their grief in their play and art and different kinds of actions like this. They'll draw pictures very well, and that will help a whole lot and you'll be able to see it in what they draw ? they [the pictures] end up being expressions of how they're feeling about things, but they often don't have the words to do it.

    Q:  What can parents do to help children through the grieving process? A:  Again, let the person take that lead to some degree. Don't tell the child more than they want to hear. Let the child ask questions about the situation and answer them honestly and at a level they can understand. It's best to kind of open up topics and let the child ask additional questions. For example, if you are going to a funeral, tell them: "We're going to be going to the funeral, and these are some of the things you're going to see and some of the things that will happen. There may be some people who cry. There'll be some people who talk about Uncle Charlie, and what kind of person he was. We'll be singing some songs." Just describe some general things and then the child will ask questions as they need to. You can just answer them at their level and without a lot of unnecessary elaboration.

    Q:  What steps can someone take toward resuming a normal life after loss? A:  I think it's very important to recognize that it's a part of living that all of us are going to have to be involved with. It's very important to be able to talk about it and not to avoid people who are in grief. But again [for the person who's grieving], it's important [that those around them] take the lead, take the signal from the person in grief about what they need. And maybe there will be times that they won't want to talk about it, so you shouldn't push yourself on them. Being open means being ready when they're ready and not avoiding them or being nervous about being around them. There are a lot of books written about grief, so that's a good resource for people, and also to talk to other people who are in similar circumstances. That kind of support can be helpful so they can learn that what they're thinking and feeling is not so unusual, and they don't have to be worried on top of their grief ? worried about their own reactions and if they're OK. And of course, if they don't have a good listener, someone who is open and supportive to them, then they may need to find some professional or organization that can help them and act as those listeners and supports. Most communities have bereavement services of some sort, and they should not hesitate to seek them out.

    Q:  What are some common emotions someone can expect to go through following a loss? A:  Well, depending on the kind of loss, all kinds of emotions can be involved. Sadness, of course, is the most predominant. Depending on the circumstances, perhaps, anger, guilt and, in some circumstances, relief. It's really a whole gamut of things. Emotions change over time, too; the emotions initially experienced may not be what people feel down the road.

    Q:  Is there a time frame for the grieving process? A:  There used to be these old models of grief that said that people go through certain stages and it takes a certain amount of time ? those have been discredited. People now see grief much more as an individual process, so it's hard to put a time frame on it; it's hard to say that it goes through certain particular stages or phases for any individual. Some people manage to resolve the most intense emotions of grief relatively quickly, for others it takes a long period of time.

    Q:  What are some examples of how the grieving process may differ from person to person? A:  If you have a parent who is 95 years old, and you've had a good solid relationship with that parent, and then that parent dies because of declining health, you're not going to be surprised by this occurrence. You are going to be able to look at their life as a good thing, and this life is not particularly tragic, but natural. Because of your good relationship and the anticipation of the death, you've done your personal business with them. There's nothing that's really left unsaid or undone, and it feels that the relationship is somehow complete. So the emotions after that may not be particularly disturbing ones or difficult to manage, although there will be emotions none the less. Let's take a different example. Let's take a parent with a young child who dies and someone is clearly to blame, something went wrong. It's an unexpected death, it's shocking and it seems incomprehensible that your child would die, especially so young, and if somebody is at fault you'll have all sorts of feelings about that. So these feelings will be more intense and difficult and strung out over a longer period of time because of the unexpected nature of this ? the fact that there has been some sort of wrongdoing involved, that this life has been cut artificially short. In other words, there is going to be a lot of unfinished business. It's going to be a lot different kind of grief than in the first situation I mentioned.

    Q:  What are some general suggestions for coping with grief? A::  

  • Don't be afraid of the feelings you're feeling.
  • Don't think you're crazy for feeling the things you're feeling.
  • Accept your feelings and don't let other people tell you how you should grieve.
  • Trust your own judgment about your feelings and what you need to do to help yourself.
  • Don't fall for the supposed grief formulas that some people talk about, that you go through the stage of anger, that you go through the stage of bargaining, that you go through the stage of resolution. It's all a mixed-up process ? expect to be confused by it to a great degree.
  • Talk to people. Find a good listener and someone who can hang in there with you for a long period of time.
  • Expect that some people will be uncomfortable being around you. And not everyone will be someone you can turn to.
  • Expect that in the immediate aftermath of the event, you'll get much more support than you will down the road, and maybe you'll feel like you still need support when people don't realize it anymore.

    Those are some of the expectations people should have, and one of the most important ways of dealing with those things is to trust yourself. Realize that this is a process that may take some time, and find a good listener.

    Q:  Do you have any suggestions for those who are helping a friend to cope with loss?  A:  Listening is the most important thing. There are not going to be solutions to this problem of this loss. You can't bring the person back. You're not going to be able to find some magic words to make them feel better. So just being open to what this person needs to discuss will be useful. Respecting their particular way of grieving so that you don't become pushy and you don't disappear either. And following the lead of the person who is grieving. Paying attention to what they need in their own personal situation rather than feeling like you should know the answers or have a solution or have any kind of a formula for them. They'll let you know about their own needs if you're a good listener.

    Q:  You've been suggesting ways to cope with grief. Are there ways of coping that may be unhealthy?  A:  Some of the things that would be unhealthy would be turning to alcohol or drugs to buffer the pain of this. There are a lot of similar avoidance maneuvers that people can engage in ? such as overeating or anything with an addictive nature to it that people can turn to just because they get some temporary relief from the pain of things. Some people may start to think things like, 'I wish I were dead and I would be reunited with my loved one in heaven.' This is not particularly unusual in grieving people, but if they are taking that very seriously, then I would become concerned. Those are the kinds of things that are unhealthy in grieving, though I'm very reluctant to label things in general as unhealthy because people in grief experience so many things that feel odd and unusual. For the vast majority of people that I've seen who are bereaved, all these odd and unusual things, things that look odd and unusual from the outside, things that may even feel odd and unusual to themselves, all these things end up being helpful for most people. People have all kinds of thoughts about the death after it has occurred that some of us might think are kind of strange. This [the death of a loved one] just brings out in most normal people all sorts of unusual considerations and thoughts and reactions, and I hesitate to think of any of them as pathological in any way.

    Q:  Many people will have to deal with an anticipated loss at some point in their life ? such as losing someone to a terminal illness. How do people cope with these expected losses?  A:  When people are terminally ill, there are a number of things that will go on with them and the family around them. To some extent they will be hoping that maybe this won't happen. Depending on the circumstances and the changing circumstances, that hope may be dashed or strengthened by what is going on. In the best of circumstances, people are in some way preparing for this. They're open to it and they're open to discussing it, which is usually helpful. For the loved ones who are going to be left behind, even when the death occurs, even if they've done a lot of preparation, it still has a quality of some shock and additional sadness. You just can't get used to it all ahead of time. So even when you do this preparation and continue the process of living and are open to the discussion of what might happen, you deal with all the declines in the person's capabilities. And when the death occurs ? it's still a death and it's still hard.

    Q:  Will children grieve differently than adults?  A:  Many, many years ago people thought that children didn't really grieve, but that's not true ? they grieve in different ways. In some ways, of course, children are confused ? depending on the age you're talking about ? about what has happened. They may not understand death. It's a difficult concept for them to grasp in some ways; they don't understand what happens after some people die, but neither do adults very much. Of course, if they had a close relationship with the person who has died, they will miss them. How they express that may be a little different than the way adults do. Some children express it more in their behavior, rather than expressing it directly in a description of what is going on inside of them. Children are good about expressing their grief in their play and art and different kinds of actions like this. They'll draw pictures very well, and that will help a whole lot and you'll be able to see it in what they draw ? they [the pictures] end up being expressions of how they're feeling about things, but they often don't have the words to do it.

    Q:  What can parents do to help children through the grieving process?  A:  Again, let the person take that lead to some degree. Don't tell the child more than they want to hear. Let the child ask questions about the situation and answer them honestly and at a level they can understand. It's best to kind of open up topics and let the child ask additional questions. For example, if you are going to a funeral, tell them: "We're going to be going to the funeral, and these are some of the things you're going to see and some of the things that will happen. There may be some people who cry. There'll be some people who talk about Uncle Charlie, and what kind of person he was. We'll be singing some songs." Just describe some general things and then the child will ask questions as they need to. You can just answer them at their level and without a lot of unnecessary elaboration.

    Q:  What steps can someone take toward resuming a normal life after loss?  A:  I think it's very important to recognize that it's a part of living that all of us are going to have to be involved with. It's very important to be able to talk about it and not to avoid people who are in grief. But again [for the person who's grieving], it's important [that those around them] take the lead, take the signal from the person in grief about what they need. And maybe there will be times that they won't want to talk about it, so you shouldn't push yourself on them. Being open means being ready when they're ready and not avoiding them or being nervous about being around them. There are a lot of books written about grief, so that's a good resource for people, and also to talk to other people who are in similar circumstances. That kind of support can be helpful so they can learn that what they're thinking and feeling is not so unusual, and they don't have to be worried on top of their grief ? worried about their own reactions and if they're OK. And of course, if they don't have a good listener, someone who is open and supportive to them, then they may need to find some professional or organization that can help them and act as those listeners and supports. Most communities have bereavement services of some sort, and they should not hesitate to seek them out.

    Q:  What are some common emotions someone can expect to go through following a loss?  A:  Well, depending on the kind of loss, all kinds of emotions can be involved. Sadness, of course, is the most predominant. Depending on the circumstances, perhaps, anger, guilt and, in some circumstances, relief. It's really a whole gamut of things. Emotions change over time, too; the emotions initially experienced may not be what people feel down the road.

    Q:  Is there a time frame for the grieving process?  A:  There used to be these old models of grief that said that people go through certain stages and it takes a certain amount of time ? those have been discredited. People now see grief much more as an individual process, so it's hard to put a time frame on it; it's hard to say that it goes through certain particular stages or phases for any individual. Some people manage to resolve the most intense emotions of grief relatively quickly, for others it takes a long period of time.

    Q:  What are some examples of how the grieving process may differ from person to person?  A:  If you have a parent who is 95 years old, and you've had a good solid relationship with that parent, and then that parent dies because of declining health, you're not going to be surprised by this occurrence. You are going to be able to look at their life as a good thing, and this life is not particularly tragic, but natural. Because of your good relationship and the anticipation of the death, you've done your personal business with them. There's nothing that's really left unsaid or undone, and it feels that the relationship is somehow complete. So the emotions after that may not be particularly disturbing ones or difficult to manage, although there will be emotions none the less. Let's take a different example. Let's take a parent with a young child who dies and someone is clearly to blame, something went wrong. It's an unexpected death, it's shocking and it seems incomprehensible that your child would die, especially so young, and if somebody is at fault you'll have all sorts of feelings about that. So these feelings will be more intense and difficult and strung out over a longer period of time because of the unexpected nature of this ? the fact that there has been some sort of wrongdoing involved, that this life has been cut artificially short. In other words, there is going to be a lot of unfinished business. It's going to be a lot different kind of grief than in the first situation I mentioned.

    Q:  What are some general suggestions for coping with grief?  A:  

  • Don't be afraid of the feelings you're feeling.
  • Don't think you're crazy for feeling the things you're feeling.
  • Accept your feelings and don't let other people tell you how you should grieve.
  • Trust your own judgment about your feelings and what you need to do to help yourself.
  • Don't fall for the supposed grief formulas that some people talk about, that you go through the stage of anger, that you go through the stage of bargaining, that you go through the stage of resolution. It's all a mixed-up process ? expect to be confused by it to a great degree.
  • Talk to people. Find a good listener and someone who can hang in there with you for a long period of time.
  • Expect that some people will be uncomfortable being around you. And not everyone will be someone you can turn to.
  • Expect that in the immediate aftermath of the event, you'll get much more support than you will down the road, and maybe you'll feel like you still need support when people don't realize it anymore.

    Those are some of the expectations people should have, and one of the most important ways of dealing with those things is to trust yourself. Realize that this is a process that may take some time, and find a good listener.

    Q:  Do you have any suggestions for those who are helping a friend to cope with loss?  A:  Listening is the most important thing. There are not going to be solutions to this problem of this loss. You can't bring the person back. You're not going to be able to find some magic words to make them feel better. So just being open to what this person needs to discuss will be useful. Respecting their particular way of grieving so that you don't become pushy and you don't disappear either. And following the lead of the person who is grieving. Paying attention to what they need in their own personal situation rather than feeling like you should know the answers or have a solution or have any kind of a formula for them. They'll let you know about their own needs if you're a good listener.

    Q:  You've been suggesting ways to cope with grief. Are there ways of coping that may be unhealthy?  A:  Some of the things that would be unhealthy would be turning to alcohol or drugs to buffer the pain of this. There are a lot of similar avoidance maneuvers that people can engage in ? such as overeating or anything with an addictive nature to it that people can turn to just because they get some temporary relief from the pain of things. Some people may start to think things like, 'I wish I were dead and I would be reunited with my loved one in heaven.' This is not particularly unusual in grieving people, but if they are taking that very seriously, then I would become concerned. Those are the kinds of things that are unhealthy in grieving, though I'm very reluctant to label things in general as unhealthy because people in grief experience so many things that feel odd and unusual. For the vast majority of people that I've seen who are bereaved, all these odd and unusual things, things that look odd and unusual from the outside, things that may even feel odd and unusual to themselves, all these things end up being helpful for most people. People have all kinds of thoughts about the death after it has occurred that some of us might think are kind of strange. This [the death of a loved one] just brings out in most normal people all sorts of unusual considerations and thoughts and reactions, and I hesitate to think of any of them as pathological in any way.

    Q:  Many people will have to deal with an anticipated loss at some point in their life ? such as losing someone to a terminal illness. How do people cope with these expected losses?  A:  When people are terminally ill, there are a number of things that will go on with them and the family around them. To some extent they will be hoping that maybe this won't happen. Depending on the circumstances and the changing circumstances, that hope may be dashed or strengthened by what is going on. In the best of circumstances, people are in some way preparing for this. They're open to it and they're open to discussing it, which is usually helpful. For the loved ones who are going to be left behind, even when the death occurs, even if they've done a lot of preparation, it still has a quality of some shock and additional sadness. You just can't get used to it all ahead of time. So even when you do this preparation and continue the process of living and are open to the discussion of what might happen, you deal with all the declines in the person's capabilities. And when the death occurs ? it's still a death and it's still hard.

    Q:  Will children grieve differently than adults?  A:  Many, many years ago people thought that children didn't really grieve, but that's not true ? they grieve in different ways. In some ways, of course, children are confused ? depending on the age you're talking about ? about what has happened. They may not understand death. It's a difficult concept for them to grasp in some ways; they don't understand what happens after some people die, but neither do adults very much. Of course, if they had a close relationship with the person who has died, they will miss them. How they express that may be a little different than the way adults do. Some children express it more in their behavior, rather than expressing it directly in a description of what is going on inside of them. Children are good about expressing their grief in their play and art and different kinds of actions like this. They'll draw pictures very well, and that will help a whole lot and you'll be able to see it in what they draw ? they [the pictures] end up being expressions of how they're feeling about things, but they often don't have the words to do it.

    Q:  What can parents do to help children through the grieving process?  A:  Again, let the person take that lead to some degree. Don't tell the child more than they want to hear. Let the child ask questions about the situation and answer them honestly and at a level they can understand. It's best to kind of open up topics and let the child ask additional questions. For example, if you are going to a funeral, tell them: "We're going to be going to the funeral, and these are some of the things you're going to see and some of the things that will happen. There may be some people who cry. There'll be some people who talk about Uncle Charlie, and what kind of person he was. We'll be singing some songs." Just describe some general things and then the child will ask questions as they need to. You can just answer them at their level and without a lot of unnecessary elaboration.

    Q:  What steps can someone take toward resuming a normal life after loss?  A:  I think it's very important to recognize that it's a part of living that all of us are going to have to be involved with. It's very important to be able to talk about it and not to avoid people who are in grief. But again [for the person who's grieving], it's important [that those around them] take the lead, take the signal from the person in grief about what they need. And maybe there will be times that they won't want to talk about it, so you shouldn't push yourself on them. Being open means being ready when they're ready and not avoiding them or being nervous about being around them. There are a lot of books written about grief, so that's a good resource for people, and also to talk to other people who are in similar circumstances. That kind of support can be helpful so they can learn that what they're thinking and feeling is not so unusual, and they don't have to be worried on top of their grief ? worried about their own reactions and if they're OK. And of course, if they don't have a good listener, someone who is open and supportive to them, then they may need to find some professional or organization that can help them and act as those listeners and supports. Most communities have bereavement services of some sort, and they should not hesitate to seek them out.

  • Experiencing Teen Drama Overload? Blame Biology

    So it's no wonder that today's teens feel much more free to act out than their predecessors ever hoped. And they do. Just ask any parent of a teenager, who will likely complain about rudeness, ill manners, constant criticism and even being yelled at by their teenager.

    But over the past decade, researchers have found it's not just a case of raging hormones. Teens may actually not be able to help engaging in questionable behavior. And their reactions may be, in large part, due to dramatic changes in their rapidly developing brains.

    A Game Plan For Parents

    Fighting with your son over car privileges? Can't get your daughter to log off Facebook and finish her algebra homework? Laura Kastner, clinical psychologist at the University of Washington, talks us through two common scenarios that parents with adolescents face.

    Patti Neighmond: Tori Guettler says she knows she spoiled her 15-year-old son Alex when he was younger. Tori says she didn't expect that the dozens of Thomas the Tank Engine toys she bought Alex when he was little would lead to demands for $600 snowboards and $300 cell phones. What does she do now to undo what she knows she and her husband did?

    Laura Kastner: You have to say, "I know I've given you the idea that you get privileges around here, and I apologize for that. But things are going to change now. There are things you must do every week to earn the right to the car keys on Saturday night."

    You have to basically accept that he may not accept it. But you have a policy that's easy to enforce: If the chores are done, you hand over car keys. If the chores aren't done -- it's his choice.

    Neighmond: Ann Doss Hardy is the mother of 16-year-old Emma. Hardy says she is concerned about Emma getting homework done. When Emma says she's doing her homework, sometimes she's actually on Facebook. What does Ann do?

    Kastner: It's more likely than not that teenagers are going to go to this low-level lying just to get out of trouble. But we have to remember that low-level lying, like what you're describing, is very normal.

    Research has shown that whether it is children with low achievement or high achievement, academics are the biggest area of fighting in families. Most teenagers are going to flip back and forth to Facebook while doing their homework, unless parents enforce an electronic-free policy -- as in, no phones, no TV, no social networking. Teenagers have a tough time -- just like adults -- fighting some of their temptations.

    If the child is doing well academically, then leave it alone. It might take that child five hours to finish her homework rather than two. But she might say, "This is the way I want to do it because I can tolerate homework if I'm chatting with my friends online."

    If there's an academic problem, I really recommend making electronic-free homework time. The child will say, "I really need to go online for my homework." You say, "Fine, we'll have 90 minutes of electronic-free time." Then you know you have a chance at some high-quality concentration.

    Taryn Cregon And Zoe Take the relationship between Taryn Cregon, a single parent who lives in Mays Landing, N.J., and her 13-year-old daughter, Zoe. "I still have, on some days, a wonderful relationship with my daughter," Cregon says. "But it goes from this really back-and-forth, loving relationship to almost seeming like that person looks at you like you're enemy No. 1. All the time. You know, it's really tough."

    It's particularly poignant, Cregon says, since she and Zoe used to be so close, enjoying camping together and going to theaters and museums. Now, Zoe wants to be with her friends all the time, complains about family outings, and often starts arguments in the mornings before camp or school.

    "She's really a beautiful person," says Cregon. "I see her with small children at camp and her little cousins and stuff, and she's fabulous. And she's really sweet with her uncle, her aunt, my mom. It's just me!"

    In one incident, Cregon was getting ready for work and Zoe was getting ready for camp when, suddenly, Cregon heard hair-spraying in the living room. She'd recently bought a new couch and feared Zoe had spritzed it with hair chemicals. An argument ensued, and Cregon was left dumbfounded, wondering how her daughter could be so irresponsible and thoughtless ? and then argue when called on it.

    The dilemma is pretty typical, according to psychologist Laura Kastner, who along with Jennifer Wyatt wrote a recent book, Getting to Calm: Cool-headed Strategies for Parenting Tweens and Teens. For more than 30 years, Kastner has helped parents and children work toward greater calm in the home. In the hair-spray incident, both mother and daughter got tangled up in what Kastner describes as emotional flooding.

    "When we flood, we are having neurons fire in this emotional part of the brain," says Kastner.

    It's the fright-flight-freeze cycle. Heart rates increase, cognition gets distorted and people often think in simple black-and-white terms.

    "I'm good. You're bad," says Kastner. "And they're both doing that at the same time." Kastner describes it as the worst time in any intimate relationship.

    It's All In The Brain

    Over the past decade, researchers have found it's not just a case of raging hormones. Teens may actually not be able to help their reactions due to dramatic changes in their rapidly developing brains.

    James Chattra ? a pediatrician practicing in Redmond, Wash. ? says that at about age 12, the brain begins a massive shift in the prefrontal cortex, or the "thinking" part of the brain.

    "It's going through this amazing pruning and rewiring and shift. But because of that, sometimes the prefrontal cortex that allows us to take a break, stop and think, is not working as well," Chattra says.

    About half of the "thinking" neurons in certain regions of the brain, Chattra says, are literally "wiped out."

    So in light of this biological reality, what can parents do? Laura Kastner has some answers: For starters, parents have to understand the massive brain change that's occurring with their teenager ? even in situations more dire and dangerous than hair spray.

    Staying Cool

    Here's a typical scenario, Kastner says: Your child goes to a sleepover. The kids sneak out, go to someone's house, and spray shaving cream all over the house and cars. The police come, give them a tongue lashing and send them back to the host family, who promptly delivers them home to you in the middle of the night.  

    When Zoe was 10, she and her mother enjoyed going on outings together. Now that Zoe is 13, they fight a lot more than they used to.

    "Sometimes, parents say, 'What were you thinking?' " says Kastner. "And the joke's on us. They weren't thinking. They were running like wildebeests in the canyon. Just go, go, go. You know, they were flooded and excited and not really thinking through the consequences of their actions."

    In situations like this, Kastner says the first line of defense for parents is to stay calm. Tell the teen to just go to bed and that you will deal with consequences tomorrow. Ask them to write a note of self-reflection ? about their regrets, why they went off track, what they would do differently if given another chance, and what skills they might need to avoid the situation in the first place.

    Kastner suggests even writing a letter of apology to the host family, the family that got shaving-creamed, and maybe even the police officer who wasted his time responding to the incident. Based on the quality of this self-critique, Kastner says, parents can then determine discipline or consequences.

    "It will be small, medium or large, based on the quality" of the self-critique and how much the parents believe their children learned from the mistake, she says. Parents might even have the teenager suggest their own discipline. And there's an added benefit to the teens' writing. It engages the "thinking" part of the brain, and gets the teenager away from the emotional frenzy of the night.

    Emotional Regulation And Parents

    Steering clear of emotions is difficult, even for adults. But Kastner says it's something parents just have to learn how to do. There are some obvious tools: Step outside for a moment. Take a breath. Think mindfulness or Zen.

    Pediatrician James Chattra says Kastner's advice is right on target. "She incorporates this mountain of good research and says, practically, this is how you can apply this. This is how it translates when you're trying to think about your conversations with your kids," he says. "So the key to her is that she brings good science, good research to the old art of parenting."

    And forget having the last word, she says. "Let them have the last word," Kastner says about the kids.

    A lot of parents may feel they don't want their kids to think they can get away with something. Parents might be right, she says. But is that strategy effective?

    "A lot of extended arguments that happen with children are happening because we take the bait," Kastner says.

    Parents respond to attacks, get angry when called names and end up co-miserable with their kids who are already generally irritated that their parents are the boss anyway.

    "We need to let that riffraff go," she says, "and cease-and-desist because it's going nowhere."

    Kastner likens such a cease-and-desist reaction to the protocol exercised by police, firefighters and pilots: Don't think. Just follow protocol, which is ? first and foremost ? cool down. She says, "We don't want to drive under the influence of alcohol, and we don't want to talk to our loved ones under the influence of extreme emotion."

    "Courage in Action" - from the editors of "Chicken Soup for the Soul" series

    A couple of years ago, I witnessed courage that ran chills up and down my spine.

    At a high school assembly, I had spoken about picking on people and how each of us has the ability to stand up for people instead of putting them down. Afterwards, we had a time when anyone could come out of the bleachers and speak into the microphone. Students could say thank you to someone who had helped them, and some people came up and did just that. A girl thanked some friends who had helped her through family troubles. A boy spoke of some people who had supported him during and emotionally difficult time.

    Then a senior girl stood up. She stepped over to the mike, pointed to the sophomore section and challenged her whole school. "Let's stop picking on that boy. Sure, he's different from us, but we are in this thing together. On the inside, he's no different from us and he needs our acceptance, love and approval. He needs a friend. Why do we continually brutalize him and put him down? I'm challenging this entire school to lighten up and give him a chance!"

    All the time she shared, I had my back to the section where that boy sat and I had no idea who he was. But obviously, the school knew. I felt almost afraid to look at his section, thinking that boy must be red in the face, wanting to crawl under his seat and hide from the world. But as I glanced back, I saw a boy smiling from ear to ear. His whole body bounced up and down, and he raised one fist in the air.  His body language said, "Thank you. Thank you. Keep telling them. You saved my life today!".  _ by Bill Sanders

    ADHD Experts: 8 Ways to Focus at Work & Home - 8 simple ways for adults with ADD to reduce distractions on the job and with the family.

    1. Narrow your line of sight  - While at your desk, keep only what you're working on in front of you. Get everything else out of your line of sight.
    — Sandy Maynard, ADDitude's coach on call

    2. Give yourself a message - If you need to buckle down and work on a research paper for a few hours, write a note and post it within view:

    "This is not the time to clean my room. I can do that tomorrow." "This is only the first draft. It does not need perfect sentence structure and wording."
    — Patricia Quinn, M.D., Nancy Ratey, Ed.M., and Theresa Maitland, Ph.D., coauthors of Coaching College Students with ADHD

    3. Withhold criticism - Don't critique the job you're doing until you've completed it. That way, you can avoid getting waylaid by perfectionism or frustration at how much you have left to do.
    — Christine Adamec, author of Moms with ADD

    4. Make a list - If a swarm of concerns is keeping you from attending to the task at hand, take five minutes to write down what you have to do. Once these tasks are on paper and you no longer have to worry about remembering everything, you'll find it easier to focus.
    — Thomas Whiteman, Ph.D., and Michele Novotni, Ph.D., coauthors of Adult ADD

     5. Ask for a friendly reminder - Confide in a friend who sits near you in class or in business meetings. Ask him or her to tap you lightly on the shoulder if you appear to be zoning out.
    — Khris, teen contributor to A Bird's-Eye View of Life with ADD and ADHD

    6. Get regular exercise - It's the best way to promote long-term focus. Exercise sends more oxygen to the brain, and stimulates the release of nutrients, hormones, neurotransmitters, and other agents that optimize brain function.
    — Edward Hallowell, M.D., and John Ratey, M.D., coauthors of Delivered from Distraction

    7. Know your limits - When you simply can't listen any more and find yourself drifting, be frank. Tell the person you're talking to, "I'm sorry. Can we stop for a minute? My meds are gone and I can't pay attention."
    — Alex Zeigler, coauthor of A Bird's-Eye View of Life with ADD and ADHD

    8. Set a goal - If you have a goal that's aligned with who you are and what you're excited about, you'll move mountains to stay on task and get the job done.
    — Michael Sandler,
    Success at School columnist for ADDitude


    This article comes from the June/July 2005 issue of ADDitude.

     

    Famous People with ADD

     This page has been one of the most popular on One ADD Place. We get many questions asking how various names got on the list. Although, not all these famous people have been "officially diagnosed," they have exhibited many of the signs of ADD, AD/HD & LD. The point of this list is to inspire those of us who have similar challenges. We thank the Kitty Petty ADD/LD Institute for this valuable contribution to One ADD Place.

    Albert Einstein
    Galileo
    Mozart
    Wright Brothers
    Leonardo da Vinci
    Cher
    Bruce Jenner
    Tom Cruise
    Charles Schwab
    Henry Winkler
    Danny Glover
    Walt Disney
    John Lennon
    Greg Louganis
    Winston Churchill
    Henry Ford
    Stephen Hawkings
    Jules Verne
    Alexander Graham Bell
    Woodrow Wilson
    Hans Christian Anderson
    Nelson Rockefeller

    Thomas Edison
    Gen. George Patton
    Agatha Christie
    John F. Kennedy
    Whoopi Goldberg
    Rodin
    Thomas Thoreau
    David H. Murdock
    Dustin Hoffman
    Pete Rose
    Russell White
    Jason Kidd
    Russell Varian
    Robin Williams
    Louis Pasteur
    Werner von Braun
    Dwight D. Eisenhower
    Robert Kennedy
    Luci Baines Johnson Nugent
    George Bush's children
    Prince Charles

    Gen. Westmoreland
    Eddie Rickenbacker
    Gregory Boyington
    Harry Belafonte
    F. Scott Fitzgerald
    Mariel Hemingway
    Steve McQueen
    George C. Scott
    Tom Smothers
    Suzanne Somers
    Lindsay Wagner
    George Bernard Shaw
    Beethoven
    Carl Lewis
    Jackie Stewart
    "Magic" Johnson
    Weyerhauser family
    Wrigley
    John Corcoran
    Sylvester Stallone


    THE DEPRESSED CHILD (reprinted with permission from "Facts for Families" information developed by the American Academy of Child and Adolescent Psychiatry.)

    Not only adults become depressed. Children and teenagers also may have depression as well.
    The good news is that depression is a treatable illness.
    Depression is defined as an illness when the feelings of depression persist and interfere with a child or adolescent?s ability to function. About five percent of children and adolescents in the general population suffer from depression at any given point in time. Children under stress, who experience loss, or who have attentional, learning, conduct or anxiety disorders are at a higher risk for depression. Depression also tends to run in families. The behavior of depressed children and teenagers may differ from the behavior of depressed adults. Child and adolescent psychiatrists advise parents to be aware of signs of depression in their youngsters.
    If one or more of these signs of depression persist, parents should seek help:
    ? Frequent sadness, tearfulness, crying
    ? Decreased interest in activities; or inability to enjoy previously favorite activities
    ? Hopelessness
    ? Persistent boredom; low energy
    ? Social isolation, poor communication
    ? Low self esteem and guilt
    ? Extreme sensitivity to rejection or failure
    ? Increased irritability, anger, or hostility
    ? Difficulty with relationships
    ? Frequent complaints of physical illnesses such as headaches and stomachaches
    ? Frequent absences from school or poor performance in school
    ? Poor concentration
    ? A major change in eating and/or sleeping patterns
    ? Talk of or efforts to run away from home
    ? Thoughts or expressions of suicide or self destructive behavior
    A child who used to play often with friends may now spend most of the time alone and without interests. Things that were once fun now bring little joy to the depressed child. Children and adolescents who are depressed may say they want to be dead or may talk about suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed adolescents may abuse alcohol or other drugs as a way of trying to feel better.
    Children and adolescents who cause trouble at home or at school may also be suffering from depression. Because the youngster may not always seem sad, parents and teachers may not realize that troublesome behavior is a sign of depression. When asked directly, these children can sometimes state they are unhappy or sad. Early diagnosis and treatment are essential for depressed children. Depression is a real illness that requires professional help. Comprehensive treatment often includes both individual and family therapy. For example, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of individual therapy shown to be effective in treating depression. Treatment may also include the use of antidepressant medication. For help, parents should ask their physician to refer them to a qualified mental health professional, who can diagnose and treat depression in children and teenagers.

    Networker News BY ROB WATERS (Reprinted from Psychotherapy Networker)

     'Children in Crisis? Concerns about the growing popularity of the bipolar diagnosis '                                                     '

    Ten years ago, bipolar disorder was considered a disabling adult mental illness that was almost never described in children. Today child psychiatrists are diagnosing it in a growing number of children and adolescents, fueling a surge in the use of antipsychotic medications among the young. This has sparked a backlash from critics who see the rise of "juvenile bipolar disorder" as the latest fad sweeping the psychiatry field.

    While the exact number of children diagnosed with the disorder is unknown, there's little doubt that it's risen dramatically. The Child and Adolescent Bipolar Foundation, a parent-led advocacy group, estimates that at least 750,000 American children and adolescents suffer from the disorder, most of them undiagnosed and untreated.

    Data provided to the Networker by NDC Health Corp, an Atlanta-based firm that tracks trends in the use of prescribed medications, shows that the number of antipsychotic drugs prescribed to children and teenagers grew by 50 percent--from 250,000 to 375,000 prescriptions--between January 2002 and June 2005. While antipsychotics are prescribed to children for a variety of reasons, the most common, experts say, is to treat bipolar disorder.

    Bipolar disorder was first flagged as a pediatric illness in the mid-1990s, when researchers led by Joseph Biederman of Harvard and Barbara Geller of Washington University in St. Louis published papers describing "mania-like symptoms" in young patients, many of whom were also diagnosed with attention deficit/hyperactivity disorder (AD/HD). Biederman and Geller contended that clinicians were failing to diagnose bipolar disorder in children, partly because the symptoms resemble AD/HD and partly because the disorder looks so different in children than in adults.

    In the classic, adult version of the disease, people stay mired for weeks or months in a deep depression and then, almost overnight, fly into a manic phase, in which they're intensely creative, need little sleep, and exercise little control over their appetites for sex, alcohol, drugs, or gambling. With children, Biederman and Geller say, the shifts between depression and mania happen much more quickly--in days or even hours. The researchers term this "ultra-rapid cycling."

    Critics scoff at this loosening of the criteria and argue that kids are being pathologized for normal behavior. "They're making a diagnosis of bipolar because a child has mood switches," say Dominic Riccio, a New York City psychologist and family therapist. "If a child goes from happy to sad and has impulsive outbursts, it's characterized as bipolar. But children have mood swings. To characterize this as mental illness is a serious flaw in scientific thinking."

    Biederman and his colleagues at Harvard have redefined the disorder in another way, too. Bipolar kids, they say, are perpetually pissed off, slipping easily into explosive rages. These aren't just tantrums. Janet Wozniak, a Biederman associate and director of the pediatric bipolar clinic at Massachusetts General Hospital, describes such an episode as "an outburst with kicking, hitting, biting, and spitting that goes on for 30 or 60 minutes." Geller and her allies disagree with Biederman, however, contending that the use of irritability as the key sign of bipolar disorder in children stretches the criteria.

    The debate over bipolar disorder's validity as a childhood diagnosis might have remained an obscure academic issue were it not for psychiatrist Demitri Papolos and his wife Janice, a journalist. Their 1999 book, The Bipolar Child, described the disorder as a "neglected public health problem," and put juvenile bipolar disorder on the map.

    Spurred by the discussion of the Papoloses' book on morning talk shows, parents of children diagnosed with bipolar disorder created the Child and Adolescent Bipolar Foundation, with a large, active website and funding from pharmaceutical companies. Soon parents across the country began wondering whether their own children might have the disorder, and asking their doctors and therapists.

    One such clinician was psychiatrist Jennifer Harris, who, in 2002, was completing a fellowship at the adolescent unit of Cambridge Hospital in Massachusetts. "We saw a huge number of kids coming in with that diagnosis," says Harris. "A lot of them turned out not to have it when you did a thorough assessment."

    Harris's explanation for the increase of the bipolar diagnosis among children is that many clinicians find it easier to tell parents their child has a brain-based disorder than to suggest changes in their parenting. "The enormity of the problems many children face makes the simplicity of a biological explanation tremendously appealing," she says. "It allows us to feel we're doing something so that we can avoid feeling helpless with our most difficult patients."

    Harris recently began working with a 10-year-old boy who was diagnosed with bipolar by another clinician and put on Neurontin, a mood stabilizer, and Zoloft, an antidepressant. When she probed deeper, she learned that his mother had metastatic cancer. She also found out that that child had a learning disability that made it hard for him to read social cues and, she believes, led him to erupt angrily when he felt someone was slighting him. In treating this boy, Harris did the kind of work few psychiatrists do these days: she met with his family and his teachers, worked with his counselor, and got him in a social-skills group. He's now off medications, and his behavior and moods have greatly improved.

    Elizabeth Root, a social worker at a community mental health clinic in Cortland, a small town in upstate New York, has also seen a huge increase in children diagnosed with bipolar and taking medication cocktails. All of them, she says, have something in common: significant stress in their homes. "There are so many psychosocial pressures on parents and children today," she says, including divorce, family violence, and parents who work long hours with little time for shared meals or conversation. Food sensitivities and air pollution can also affect behavior, she feels. Also many children said to have bipolar disorder have previously been diagnosed with AD/HD, depression, or anxiety and put on stimulants, which are known to cause anxiety, or antidepressants, which can trigger edgy restlessness and manic behavior.

    Instead of prescribing medications for seemingly out-of-control youngsters, Root says she works hard to learn about the stresses and strengths in the lives of children and their families, and to get family members to come in for therapy sessions. Mostly, she tries to get parents to use the Nurtured Heart approach designed by Howard Glasser, a Tucson-based child and family therapist.

    Glasser developed his program for children with AD/HD, but says it works equally well for those said to have bipolar disorder. In fact, however, he rejects both labels; in his view, kids called AD/HD and those called bipolar are children with "more life force, more intensity, and more intense needs than they can handle. Some kids are born that way, and some kids acquire intensity living in homes that are stressful."

    Glasser's approach takes typical behavior-management strategies and turns them on their head. Instead of setting out a program of escalating consequences for negative behavior, he advocates elaborately rewarding good behavior and accomplishments, while applying consequences for negative behavior in a low-key, nonemotional way.

    Nurtured Heart therapy is one of several programs that offer parents techniques for supporting their children while managing their challenging behavior. Harvard's Ross Greene, author of The Explosive Child, has developed a system he calls Collaborative Problem Solving, which teaches children empathy and the ability to think through solutions before problems emerge.

    Even the staunchest advocates of medication think such approaches are useful adjuncts to drug therapy. The trouble is that, in today's health care environment, medications are often the first resort, and psychotherapeutic approaches, if tried at all, are the first to fall away.

    The message to all these children now being called bipolar is as distorted as is it reductionist. Instead of children's angry or disturbing behaviors being seen as essentially normal, if unproductive, responses to an increasingly fragmented and disconnected home and cultural life, the problem is located within the child. The explanation for their behavior becomes that their brains are biochemically imbalanced and need to be fixed. That's a message some parents and clinicians may find appealing, but it'll do little in the long run to address the serious family and social problems rampant today, which medications are powerless to treat. 

    No. 1 (10/92) (Updated May 2008)

    CHILDREN & DIVORCE

    One out of every two marriages today ends in divorce and many divorcing families

    include children. Parents who are getting a divorce are frequently worried about the effect

    the divorce will have on their children. During this difficult period, parents may be

    preoccupied with their own problems, but continue to be the most important people in

    their children's lives.

    While parents may be devastated or relieved by the divorce, children are invariably

    frightened and confused by the threat to their security. Some parents feel so hurt or

    overwhelmed by the divorce that they may turn to the child for comfort or direction.

    Divorce can be misinterpreted by children unless parents tell them what is happening,

    how they are involved and not involved, and what will happen to them.

    Children often believe they have caused the conflict between their parents. Many children

    assume the responsibility for bringing their parents back together, sometimes by

    sacrificing themselves. Vulnerability to both physical and mental illnesses can originate

    in the traumatic loss of one or both parents through divorce. With care and attention,

    however, a family's strengths can be mobilized during a divorce, and children can be

    helped to deal constructively with the resolution of parental conflict.

    Talking to children about a divorce is difficult. The following tips can help both the child

    and parents with the challenge and stress of these conversations:

    Do not keep it a secret or wait until the last minute.

    Tell your child together with your spouse.

    Keep things simple and straight forward.

    Tell them the divorce is not their fault.

    Admit that this will be sad and upsetting for everyone.

    Reassure your child that you both still love them and will always be their parents.

    Do not discuss each other’s faults or problems with the child.

    Parents should be alert to signs of distress in their child or children. Young children may

    react to divorce by becoming more aggressive and uncooperative or by withdrawing.

    Older children may feel deep sadness and loss. Their schoolwork may suffer and

    behavior problems are common. As teenagers and adults, children of divorce can have

    trouble with their own relationships and experience problems with self-esteem.

    Children will do best if they know that their mother and father will still be their parents

    and remain involved with them even though the marriage is ending and the parents won't

    Children of Divorce, “Facts for Families,” No. 1 (5/08)

    live together. Long custody disputes or pressure on a child to "choose" sides can be

    particularly harmful for the youngster and can add to the damage of the divorce. Research

    shows that children do best when parents can cooperate on behalf of the child.

    Parents' ongoing commitment to the child's well-being is vital. If a child shows signs of

    distress, the family doctor or pediatrician can refer the parents to a child and adolescent

    psychiatrist for evaluation and treatment. In addition, the child and adolescent

    psychiatrist can meet with the parents to help them learn how to make the strain of the

    divorce easier on the entire family. Psychotherapy for the children of a divorce, and the

    divorcing parents, can be helpful.