medication for mental health in kids

When is it Appropriate to Seek Medication Management for Mental Health Symptom Reduction in Children?

 

 

 

For many families, the conversation about medication management to reduce mental health symptoms in children is off the table before the realities of this intervention can be explored. Medication can be a beneficial intervention, in tandem with therapy, to translate the skill development from the clinical setting into positive behavioral changes in the natural environment.

When is medication recommended to manage mental health symptoms in children?

Medication might be recommended as a therapeutic approach early on in treatment depending on the severity of the presented concerns and the impact of these symptoms on the child’s overall quality of life. For instance, if the child struggling with impulsivity and reduced focus/attention is doing poorly in school, if he has challenges reading social cues in peer relationships, and is he is internalizing negative feelings of self as the result, medication may be recommended sooner rather than later to improve client’s overall level of functioning.

The goal of social work intervention is to address the socio-emotional concerns through teaching client awareness into the triggers that precipitate the maladaptive behaviors (i.e. distracting thoughts/stimuli that reduce focus, decisions that elicit anger that snowballs into a meltdown, etc.) and the skills to modify their behavior. In some cases, the client can demonstrate and prove comprehension of the skills presented but in practice, have a hard time implementing the learned coping strategies in real-life scenarios. If the child’s quality of life and overall functioning remain to be negatively impacted despite intellectualization of how to handle their emotions or redirect their behavior, medication might serve as the glue to carry these compensatory strategies into reality.

To decide if a medication consultation is right for you, use this checklist:

  • Does my child struggle with implementing the therapeutic skills they learn in treatment?
  • Despite involvement in therapy, is my child’s quality of life negatively impacted socially, academically, personally?
  • Has there been an increase in the frequency and duration of symptoms (i.e. more meltdowns per week, more redirections to re-regulate body to remain calm, etc.)?
  • Does my (the parent) and my family’s quality of life continue to be negatively impacted with frequent impulsive reactions, mood dysregulation, or hyperactive nature of the child?

Consult with your pediatrician and therapist if you have any questions about if medication would be a right fit for your child. And remember, just because you may decide to try medication does not mean that it is a magic bullet fix or that it has to be a life sentence. Ongoing therapeutic intervention in addition to medication can be the right course of treatment for some children.


mental illness in children

The Rise of Mental Illness in Children

 

 

The Journal of Pediatrics published a recent article that childhood developmental conditions including ADHD and Autism are increasing at a rate of 16% from 2001 to 2011 (Read a review of this article on the CNN blog, The Chart, here). Although this might sound astounding and like this should be an area of concern, the researchers have posited that this actually might be a positive.

In all likelihood, these rates were probably the same. What we have now is an increased awareness of a variety of developmental disabilities as well as increased acceptance of such conditions. Having increased acceptance is extremely positive in that now we are able to provide support and services to help these children that otherwise would not be available.

Here are some tips for parents for children who might have a neurodevelopmental condition like ADHD or Autism:

  1. Seek out a good, comprehensive evaluation in order to first help identify the specific condition that the child might present with.
  2. Identify your treatment team. Your team will consist of multiple individuals including teachers, therapists, administration, and special education teachers. Make sure the team is all on the same page and aware of the specifics that the child presents with.
  3. Seek out resources and information to help support you and your family. There are multiple, empirically supported organizations that provide parents and family members with not only support but also resources to help the child out.

Although the rates of a variety of neurodevelopmental conditions are on the rise, it is likely that these conditions have always been as prevalent as they are today. The social stigma associated with the conditions is no longer as strong, and these children are now able to receive specific services and interventions that would be beneficial for them.




set up a routine for homework success

Set-Up a Routine for Homework Happiness

 

 

 

Children with attentional problems or issues with executive functioning often have difficulties with homework completion. Several issues associated with executive functioning lead to concerns with the ability to complete daily work including the following:

  • Initiation on work
  • Organization concerns
  • Time management
  • Difficulty transitioning

When is the best time for my child to do homework?

Oftentimes children will want to have a break from school work when they come home. They want to play for a while before doing work. I would actually recommend that the child immediately start homework when he gets home. Research has indicated that children with attentional problems and poor executive functioning have difficulty transitioning between tasks. The child is still in the school mindset when he arrives home. Having the child take a break and then later transition back to homework likely will prove difficult. Instead, I would recommend that the child have a light snack and then immediately start the work.

How should I structure the homework space?

Organization, or lack thereof, is a hallmark feature of poor executive functioning. With that in mind, I would highly recommend that the homework environment in which the child is working be as organized and structured as possible. Have a specific desk or table where work is to be done. Keep the table as clean as possible with a minimal amount of distractions in the room. Oftentimes, having the child complete homework in his room proves to be a disaster. There are too many distractions that keep the child’s interest away from the homework assignment. It may prove best to select a quiet room away from family members with the fewest distractions possible.  Click here to watch a Pediatric TV Episode on setting up a homework station.

How do I work on time management with my child?

Parents often state that the child has no idea about time management or how long tasks should last. I often recommend that parents have the child provide an estimate of how long he perceives a task should last. Time the child and then provide the difference as to how long he thought the work would last and how long it actually lasted. Then the next day, have the child again provide an estimate as to how long the task will last. If the child is way off with the estimate, pull out the data from the night before and ask if he wants to revise his estimate. Keep this going until the child starts to develop an actual idea of how long tasks should last.

These are just a few tips to keep homework as structured as possible. Help the child start homework right away as it will help with initiation on tasks as well as ensuring a smooth transition between demands. Keep the room and desk as organized as possible to limit distractions and off-task behaviors. Provide some guidance with time management by helping identify how long tasks and assignments should last.

Read here for 8 more tips to ease homework time stress!







extra-curricular success for children with special needs

Ensure Extra-Curricular Success for Children with Special Needs

Often parents of children with special needs are worried and fearful about the ability of their child to succeed in extra-curricular activities such as sports, boy scouts, dance, art class, etc. Parents often fear the worst and are afraid of how the child will behave or act in such circumstances.  I would recommend that parents utilize several tips in order to help ensure success with each out-of-school activity, as these activities have many proven benefits for a child’s self-esteem.

Tips for Working with Coaches to Ensure Success for Children with Special Needs in Extra-Curricular Activities:

1. Be frank with the coach or director of the activity. Inform him or her about the child’s concerns. These are often individuals who volunteer to help children and more times than naught have the child’s best interest in mind.

2. Let the individual know what types of behaviors the child has exhibited in the past. What happened in school when parents were away, etc?

3. Create a list of accommodations that have proven to be beneficial for the child. Let the coach or instructor in on some of the modifications that have been helpful in the academic setting, as he may be able to apply the modification to the activity setting.

4. Be present, or within immediate reach, for the first few sessions.

5. Have the child go and see the building and room will the activity will occur. If possible, meet the instructor to form a relationship in advance.

Ultimately the main goal of after school activities is to increase socialization while teaching a skill, activity, or sport. The above tips should help provide some strategies to ensure the maximum success for children who have special needs in such situations.





 

prep your child's teacher to help your child with ADHD

How to Prep Your Child’s Teacher to Work with an ADHD Diagnosis

To start the school year out right for your child with and ADHD (or other) diagnosis, it is important to establish a close collaboration between you, your child’s teacher, any professionals of the treatment team, and your child!  Here is how you can prepare your child’s teacher to best understand your child’s needs to get off to a great start this academic year.

10 tips to prepare your child’s teacher to best help your child with an ADHD diagnosis:

1. Request to set up a meeting at the start of school year.

2. Get an idea of what your child’s teacher knows about ADHD and his general attitude towards ADHD. Some teachers may be more or less informed about ADHD, as research and diagnostic criteria has changed quite a bit over the years.
3. Inform the teacher of your child’s ADHD diagnosis (or other diagnosis), if he is on any medication or if you chose an alternative treatment method.

4. Find out what the culture of the classroom is like:

  • Structure: Is the daily schedule posted?  Does the teacher request frequent “brain breaks” during the day?
  • How does she describe her teaching style?
  • Rules & Expectations: Are there visual reminders posted around the room? What is the reward system? Incentives? Token System?  Nature of the homework assignments? Seating arrangements?
  • Can your child sit facing the front and close to the teacher?

5. Discuss the best way to contact one another (i.e. via phone or email).
6. Discuss if any notes home or behavioral report cards are necessary or how often?
7. Pass along any recommendations to your child’s teacher that she can implement that you have found helpful  for your child.

Examples:

  • “Jake does well when given one command at a time versus following multiple steps at once.”
  • “At home, we have found that having Jessica repeat back directions or rules, helps her to be more accountable.”
  •  “We use the token system at home and Sam seems to do well with it when we are consistent.”

8. Be supportive and open.

  • Assist the teacher in any way by being supportive and open to suggestions he or she may have.
  • Let the teacher know you want to work as team to make it a successful year for everyone.

9. Offer Praise and appreciation: A positive attitude with your child’s teacher creates a stronger relationship with all involved!

10. Request to set up a follow-up meeting to check-in : This could be half-way through the school year or sooner depending on the needs of your child.

Click here to read about self-regulating strategies to help children with ADHD.







ADHD in boys and girls

ADHD in Girls v. Boys

 

 

 

 

Although there are many features of ADHD that may overlap between genders, studies have shown there to be characteristics that differ among boys and girls. Neither of these characteristics are exclusive to the gender, but these are generally the characteristics seen in girls and boys with an ADHD diagnosis:

 ADHD Features in GIRLS:

  • Tend to show more symptoms of inattentiveness vs. hyperactivity
  • Are more likely to be diagnosed later in their academic career
  • Some adult women are not diagnosed until their child goes through the process and is diagnosed themselves!
  • Have a higher likelihood of being under-identified and under-treated
  • Display more symptoms of inattention, daydreaming, and memory problems
  • May be initially misdiagnosed
  • Tend to go under the radar during early school years
  • Tend to be slower learners and less motivated
  • Are at-risk for self-esteem issues, mood issues, and substance abuse
  • Adolescent-aged girls have lower self-efficacy and coping skills
  • Have a higher tendency to internalize problems
  • Are easily overwhelmed
  • Have difficulty with time management

 ADHD Features in BOYS:

  • Have a 2:1 ratio diagnosis of boys to girls
  • Are more likely to be detected and diagnosed early on in the school–age years
  • Show more symptoms of hyperactivity and behavioral problems
  • Have higher rates of impulsivity
  • Have Higher incidents of externalizing problems associated with ADHD symptoms (i.e. aggression, trouble getting along with peers)
  • Have trouble sitting still or disruptive in the classroom




Girl Day dreaming

Self-Regulation Strategies For Kids With ADHD

Symptoms related to ADHD can manifest differently from child to child. Redirecting hyperactive, impulsive, and/or inattentive behaviors can be achieved through following these strategies:

Engagement In Whole Body Listening

Educate your child that listening does not just include opening your ears to the sound of words, but that it in fact means that the entire body is calm, engaged, and focused. The child’s body should be directed toward the speaker or the task at hand, with feet still on the floor, hands still in their lap or on the desk, eyes looking at the task or person speaking, ears listening to the spoken content, and with their brain focused on the current material.

If your child is too hyperactive and is having trouble regaining whole body listening, encourage them to engage in muscle relaxation activities such as squeezing hands/fists/body into a ball tightly for 10 seconds and then releasing. They can do these reps about 5 times or until they are able to extinguish the extra energy causing them to become hyperactive.

On-topic vs. Off-topic Thinking

Help your child gain awareness about what their brain is processing. Chances are, if your child is thinking about Minecraft, a fun science experiment that he did in school, or what he will have for dinner that night, he is NOT listening to what you are saying. If your child appears inattentive, ask them what they are thinking about. If they reply in alignment with the message you have presented, they are using “on-topic” thinking which fosters enhanced focus/attention. If they reply that they were thinking about unrelated material, educate them that this is “off-topic” and they can shelve this idea until after their work is over or after the directive is completed.Girl Day dreaming

Stop-Sign Technique

Help your child reverse their acting and thinking processes. Impulsivity occurs at times when we are absently thinking and as a result, behave quickly. When we react before we think, we do not think about the potential ramifications of our actions and therefore can make poor choices. If you notice your child acting quickly and in the process of engaging in a non-preferred or unexpected behavior, shout out “stop” and/or hold your hand out to signal stop. Have your child cease whatever they were engaging in and have them evaluate the potential consequences if they continue doing what they are doing. Having the child assess the outcome of their action will help them reconfigure more compliant behaviors. You can help your child problem-solve in this process and model for them the appropriate steps for formulating the best choices through thinking before acting.

These strategies can be interactive and process-oriented between child and parent in the hope that the child can then internalize these strategies and autonomously utilize them. Don’t be afraid to help redirect your child, but also encourage them to utilize these skills independently.






Child misbehaving in school

Behavior In The Classroom

Many times children with behavioral concerns, attention issues, emotional concerns, or learning disorders will exhibit negative behaviors within the classroom setting.  Behaviors, by nature, are reasonable and driven by some factor.  The majority of the time, there is a purpose and a reason as to why a child engages in a negative behavior. What this indicates is that it is vital to figure out what the driving force of the behavior was as well as what the consequences of the behavior are.

If a parent or teacher has significant concerns about a child’s behavior, it is truly important to figure out what is going on.  Many times in these situations a Functional Behavioral Analysis (FBA) is required.  An FBAis when some behavioral specialist with the school will go and observe the child over several days and several times during the days.  The individual will first identify the percentage of time the child is off task in comparison to a few peers.  It is always important to have the percentage of off task behavior with several other children in the classroom.  This way there is anecdotal data indicating that child ‘X’ was off task xx% while the other children on average were off task only xx% which could indicate that the child in question actually is off task more than peers.

Child misbehaving in schoolOnce off-task time is established the focus is then on identifying the antecedents and consequences of the behaviors at hand.  There almost always is a driving force (the antecedent) which causes the behavior.  In addition, there usually is a reaction, either positive or negative (consequence), which results in increasing the likelihood of the behavior in the future.

Once the FBA has concluded and information has been disseminated to the team, the next step is to create an action plan to decrease negative behaviors while increasing positive, on-task behaviors.  This is when a functional intervention plan is created.  This plan utilizes the data created by the FBA to set up reinforcement of on-task behaviors, identify triggers and situations that might increase the negative behavior, and set up manageable goals.  A goal must be manageable and attainable.  For example, if a child is off task on average 80% of the day, a goal of being off task 10% of the day would be unrealistic.  What might be established is that with reinforcement and behavioral management, the goal for the first few weeks would be that the child is off task only 70% of the day, then slowly decrease it until the goal is consistent with the amount of time that the rest of the class is off task.

The take home message about behavior in school is that in order to change behavior we have to first identify what the behavior we want to change is, how often it occurs, and why it occurs (what triggers it and what does the child get out of it).








Child having trouble reading

Learning Disabilities or ADHD: Which Is It?

My child is disorganized, has trouble during homework time and following directions, and doesn’t seem to be reading like other kids his age…Is it ADHD or maybe a learning issue?

ADHD and learning disabilities often co-occur. In fact, about 1/3 of children with ADHD also have an additional learning disability. Sometimes parents might wonder if the ADHD is causing the learning disability or if the learning disability causing the inattention. The fact is that they are two discrete disorders with their own set of symptoms. It is true that some of the symptoms may be common to both disorders including:

-          Poor executive functioning
-          Lack of organizational skills
-          Inefficient use of strategies (mnemonic tricks, imagery, rhymes)
-          Behavior problems
-          Low self-esteem

Learning and attention problems are on a continuum ranging from mild to severe.  With the various overlapping symptoms and the fact that behaviors, that may be a result of a learning disorder, can look like ADHD, it can be difficult to distinguish between the two. Although they are both neurologically based, they are assessed and treated differently. A learning disorder (i.e. dyslexia, reading, writing, math) can affect the way that information is stored and relayed back causing a breakdown in information and learning.

Intervention for learning disorders may include the following:

-          Academic skills tutoring
-          Development of compensatory strategies
-          Self-advocacy skills
-          Implementation of an Individualized Education Plan (IEP) or other school accommodations

Although ADHD can interfere with a child’s ability for learning, it is often treated with the following:

-          Behavioral modifications
-          Family counseling and parent training
-          Modifications to the learning environment
-          Implementation of medication
-          Classroom accommodations
-          Executive functioning tutoring

Whether your child struggles with a learning disability, ADHD or both, parent support and education are important to help your child succeed. CHADD.org  is a great website that offers resources such as training and classes that help with parenting and discipline concerns.

Tips to Help Your Child with Word Retrieval

Parents may notice that their child may take longer to respond, may have difficulty picking the right word or may use filler words like “um” or “uh” more often than expected. All of these are signs of word finding difficulties, or trouble retrieving a desired word. These children are not having difficulties with vocabulary, they know the words, they simply can’t always access them in a desired moment. Difficulties with word finding or word retrieval is commonly associated with ADHD, reading disorders, and specific language disorders. If left untreated, word finding difficulties can impact a child’s success in school, notably in both oral and written communication.

So my child has word finding difficulties – now what?

A licensed speech-language pathologist can help! Direct therapy can target these difficulties and create strategies to help both at home and at school.  Parents can also work with their children at home by incorporating these tips into their everyday communications:

Wait: your child knows what he wants to say, he may just need a little more time. Allowing your child to work through these difficulties, retrieve the desired word, and participate in a conversation will help not only his self-esteem, but will also encourage strategy use.

Describe it: encourage your child to describe an object or experience if he is struggling. As adults, we all have all said, “It’s on the tip of my tongue” and have used this strategy. Support your child by having him describe the following:

  • Color (it can be brown)
  • Shape (it’s round)
  • Size (it fits in my hand)
  • Feel (soft or crunchy)
  • Parts (might have chocolate chips, raisins, or sprinkles)
  • Where we find it (at the grocery store)
  • Who uses it (we all do)
  • When do we use it (after dinner)
  • What do we do with it (eat it)

These strategies can be helpful for children who are not having word finding difficulties, too! Describing things will encourage language development and growth and will allow children to expand their repertoire!