Tuesday, May 19, 2015

Tips for Parents who have Children Diagnosed with ADHD

Any parent who has a child that has been diagnosed with ADHD can use help managing their lives! The following tips may offer assistance:

STRUCTURE - Children with ADHD need structure to function successfully.
  • Providing meals, bath, homework and bedtime as closely as possible at the same time every day can be helpful.
  • These kids also benefit by doing their homework in the same place every day.
  • Allowing them to do something physical after school instead of sitting down immediately to start their homework can help them to focus.
  • Having them break down their work into small manageable “bites” can often be the answer to decreasing their sense of being overwhelmed.
  • Giving them 25-30 minute increments for homework or tasks then a 5-10 minute break can also be very effective.
  • At home you need to check their homework and ensure they have put it into their book bag. Often they will have completed their homework but forget to turn it in. They will need your patience and your help to stay organized as this is often very challenging for them. Providing a check list for chores, routines and homework can also help your child improve their organization.

PREDICTABILITY- ADHD children need predictability or they tend to get anxious, antsy or act out.

TRANSITIONS - Transitions can be difficult. To decrease their anxiety, provide them with a simple, succinct explanation ahead of time and rehearse the transition with them when appropriate.

BRIEF EXPLANATIONS - Keep your words brief. When our explanations are too long, these kids will often tune out as it is difficult for them to continue concentrating. They often are uncomfortable admitting this at home and school. This leads to moving forward with insufficient information, thus leading to trouble.

HELP WITH SHORT-TERM MEMORY - Most people don’t understand that ADHD kids may have short-term memory problems – you may think that they are not listening but they really are! This is why they don’t recall the directions. What will increase their success is giving them no more than 2 step directions and showing them exactly what you want to do. They learn visually so it is helpful for them to have a picture of the activity. Check off lists can also be helpful with pictures for children who are younger.

RELAXATION - ADHD children frequently act impulsively. They need you to help them slow down, take some deep breaths and look at the consequences of their behavior before just plunging in.  Since they can be anxious it is helpful to teach them relaxation skills:
·         Deep breathing (slowly)
·         Give the whole family the opportunity to have a “calm half hour” when no one talks, no electronics, and everyone does something quietly. This teaches them it is okay to not always be on the go; and relaxation actually feels good!
·         Recognize when your child may be over-stimulated.  
·         Planning less activities in a row or introducing calming activities can go a long way to help your child self regulate.
·         Help your child find some activities that are self soothing is also important.

NOTICE WHAT THEY DO WELL - As with all children, it’s important to notice when they are doing things well and to provide an enthusiastic response.  Children with ADHD often develop a poor sense of self-esteem as adults are correcting them quite a bit. They often feel that they can do nothing right (“Lower your voice, can’t you settle down? Why do you always have to be moving? Why aren’t you paying attention to me? Why can’t you ever do your homework without a scene?”).

COGNITIVE BEHAVIORAL THERAPY - Sometimes therapy can help them to develop a greater belief in themselves as well as provide support to parents who are often feeling frustrated and overwhelmed. Cognitive Behavioral Therapy is a key component to your child’s success as it helps them learn that what they think determines how they feel. Learning how to challenge their thoughts can give them an invaluable tool for handling their emotions. Since impatience is often a product of having ADHD, many children can benefit by learning good anger management skills which help them in developing healthy relations and self-control.

HELP THEM TO LEARN HOW TO DO OTHER THINGS WELL - Creating a behavior program where two behaviors are targeted and the child earns a point for each time the target behavior is executed is essential. These points lead up to a reward which increases their incentive to change their behavior. Rewards can be material, extra time with you, choosing what they will have for dinner, staying up later, or having a friend over are a few suggestions. It is essential to ignore the behavior you do not want and reinforce the behavior you do want enthusiastically!

HELP THEM LEARN GOOD SOCIAL SKILLS - In addition, they can use some assistance with social skills. They tend to interrupt peers when they are talking – they are sometimes concerned that they will forget what they want to say! They may need your help in understanding how they represent themselves to others. Rehearsing effective communication, friendship skills, how to handle being bullied, manners and how to decrease their impulsivity, etc., is a way for your child to feel more confident. Help your child to be able to pick out their strengths and state them to themselves often. This helps them to develop positive self-talk.

MOVEMENT IS KEY - Children with ADHD sometimes learn kinesthetically which means they like motion. When their body is occupied it is easier for them to focus (for example, chewing gum, squeezing a squishy ball, using clay, swinging their foot back and forth, etc.).  They require a lot of physical exercise which helps them to ground their energy, decrease overstimulation and hyperactivity. Getting a mini trampoline works well when they need to get their energy out when the weather is inclement. If enrolling them in sports, they do best in a sport such as soccer, hockey, or lacrosse which has continuous movement. Playing baseball may be more difficult as it may be difficult for them to wait their turn.

ADVOCATE FOR THEM IN SCHOOL - Parents play a very crucial role as their child’s advocate in the school system. When your child is diagnosed with ADHD they are entitled to modifications at school which enhances their ability to learn. The law that provides them with the right to modifications is called “The American Disabilities Act” (ADA). Unless they have any learning disabilities they are not qualified as “Special Ed” but rather “Other Health Impaired” under what is called a “504 plan”. Schools will rarely tell you about this option unless you bring it up. Possible modifications:
  • Taking tests in a room other than the classroom so there will be fewer distractions
  • Getting more time to take a test since their attention may wander. This can also provide them some extra time to check their work as they often rush through to finish, increasing their chances to make careless mistakes.
  • They can check in with the school social worker/psychologist at the beginning and the end of the day to process any problems that may have come up.
  • They can be allowed to chew gum, use a squishy ball, have a wiggle seat, get up for a sensory break, leave the room for a stretch break or drink of water, bring papers to the office for a teacher, have a classroom job and have the teacher give them a subtle cue when they are off task.

After school activities that allow for expending energy and making friendships are pivotal to their success.

MEDICATION? - You may want to consider options to treat the child’s ADHD with medication. You will need to consult with a good Child Psychiatrist. After the diagnosis is made it is often permissible to obtain the medication from your primary care physician. However, a mental health professional is required to diagnose your child.

Children with ADHD have many gifts such as well developed intuition, sensitivity, creativity, intellectual prowess and unique ways of looking at the world. They can teach us a great deal from their perspective!


Andrea Schear, LCSW

Friday, May 15, 2015

Magnifying the Uncomfortable

The other day my husband, who has been having seasonal allergy problems this year, told me that he heard on the news that this year we are experiencing a “tsunami of pollen”.  In my interesting imagination, I thought of a disaster movie with an actual tsunami of pollen coming toward us all! What a calamity!!! Who would play the hero of the movie…the fighter of the pollen tsunami? Would it be Brad Pitt or some younger buff star?

Actually, I just laughed and told him that this was a classic cognitive distortion, or what we call here at NECBT, a Mental Mishap. The proper name for this is “Magnification”; making something much bigger than it is, or creating mountains out of molehills.  We do this so often with the words that we use. Think of how many times the weatherman said this past winter, “It is absolutely HORRIBLE out there!”.  Or, how many times a co-worker has said to you, “the traffic is TERRIBLE today!”.

How does this dramatic use of language help us? Do we use it to receive sympathy? Or do we use it because it seems true to us?  The first thing I want to explore is the definitions of horrible and terrible. Horrible and terrible have a similar definition: Very shocking and unpleasant. Is the weather or traffic very shocking?  The truth is that it may be unpleasant but it certainly is expected. The use of this language is just magnifying the uncomfortable.

The problem with magnifying what is uncomfortable is that the only thing it does is cause us to feel worse about the normal frustrations of every day life. It doesn’t make us feel better. When we use magnifying words, it clouds our thinking which in turn clouds how we feel. Changing the way we use our words can change the way we feel. Or, as we teach patients, the words we use shape our perception of reality and how we deal with our reality. If we come to work feeling really grumpy because the traffic was “horrible”, how is that going to impact the rest of our day? If instead we came to work acknowledging that some days the traffic is worse than others (a rational thought), we will get on with our work with a healthier outlook and in turn feel calm.

Try to be more aware of your own magnification. As for the pollen tsunami, let’s call it what it is….Spring!


Bonnie Lillis, LPC

Clinical Director, NECBT

Friday, May 1, 2015

What is OCD (Obsessive Compulsive Disorder) – How to Get it Under Control

Obsessive Compulsive Disorder (OCD) is one of the most debilitating forms of anxiety. It plays on one’s thoughts putting meaning to meaningless things.  OCD pushes one to believe that they are in control of their anxiety by engaging in behaviors that relieve one of those anxious feelings; however, in reality the person is not in control - the OCD is.

A common question people who struggle with OCD tend to ask is “when will these thoughts stop popping into my head or will my OCD completely go away?”  The truth is those thoughts will not stop popping into one’s brain and the OCD will not completely go away. The good news is you can learn to control OCD and learn to live a healthy, productive life by treating the OCD with Interpersonal Cognitive Behavioral Therapy
(I-CBT), Exposure Response Prevention (ERP), and some medication.

So what is Interpersonal Cognitive Behavior Therapy and how can it make OCD easier to live with?  I-CBT is a type of therapy where we learn to identify irrational thoughts and change the way we think. Therefore, we change those well learned irrational thoughts to rational thoughts and begin to feel calmer and act better. Once you learn I-CBT then you can begin to learn and implement Exposure Response prevention (ERP) into your life.

ERP is a component of I-CBT. The individual who is being treated for OCD will be exposed to that feared thought or stimulus which triggers the individual to engage in compulsions. The individual will be blocked from engaging in the compulsions, which will bring the person’s anxiety up and then slowly back down.  The repetition of doing this exercise will cause the brain to habituate. When the brain habituates, the need to engage in compulsions goes to sleep. Once the brain habituates it is important to continue to practice the exposures to prevent an OCD relapse.  You could think of this as a bear going into hibernation. This may seem like a lot of work. However, rationally speaking, it is much more productive then spending and wasting so much of the time that OCD takes out of your life.

Also, it is important to note that I-CBT combined with ERP is extremely effective with specific phobias and other related anxiety disorders.  If you or someone that you know could benefit from our treatment at NECBT, please do not hesitate to call us at 860-430-5515.

David Goldwerd, MHC. I-CBT Clinician

www.necbt.com

Thursday, April 2, 2015

I Can't Do That Until........

I was reminded of this phrase today. How many of you have said this?

I can’t ask her out until….

I can’t travel until….

I can’t go to… until…

I can’t put on a bathing suit until …..(yep, spring is here and we women are thinking of the dreaded bathing suits!)

I actually hear this frequently at NECBT. It is what we call a Mental Mishap (general irrationalization) – “Confusing Can’t with Don’t Want To”. Now, I am not saying that every instance of “I can’t” is irrational. An example of this is: I can’t run a mile in 3 minutes; at least not unless I start running now and gradually raise my speed. In truth, I probably would have a heart attack if I tried doing this without starting off slow!

So,…. personal story time. In my mid-40s my children were in middle school or maybe high school. All my adult life I worked as an Administrative Assistant. When I was working as an Office Manager for a group of Psychotherapists, I started to think about going back to school to become a counselor. When I was a teenager I only went to college for a year and over the years I took courses here and there. I had a great deal of education to complete to accomplish this goal. Here was my thought process:

I can’t do this – how are we going to help our boys with their college expenses?
I can’t even think of doing this until my boys are out of school.
I can’t do this – I would be bankrupting our measly retirement funds.
I can’t do this – I am too old!
I can’t do this – I’m afraid I’m not smart enough!

I can go on and on. What other people in my life were able to tell me was that all of these things were excuses. Some were reasonable concerns but none-the-less, excuses. So, I stopped allowing my thinking from preventing myself from doing what I felt led to do.

I finished my Bachelor degree in my 40s and my Master degree in my 50s. I have had the unbelievable experience of helping others since then. My spirit is fed on a daily basis and I have new purpose and meaning in my life. If I had allowed my “I can’ts” to prevent me, I would not be doing what I love today.

Think about some of these others who did not prevent mental illness from living their purpose – they said “I Can!” in spite of this.

Buzz Aldrin – Astronaut – Second man to walk on the moon – Depression
Adam Ant – Performer – Bipolar Disorder
Beethoven – Composer – Believed to have Bipolar Disorder
Drew Carey and Jim Carrey – Comedians – Depression
Winston Churchill – Prime Minister of England – Bipolar
Ernest Hemingway – Author - Depression
Billy Joel – Singer, Songwriter, Composer, Pianist – Depression
Winona Ryder – Panic Attacks
Howie Mandell – Comedian – Obsessive Compulsive Disorder
Abraham Lincoln – President of the United States – Depression

How about you? Are you saying “I Can’t” to something you desire? Are you preventing your dreams from coming true? I encourage you: Do not let life pass by through the use of the irrational I Can’ts! You Can!

Bonnie Lillis, LPC

Clinical Director, NECBT

Wednesday, March 25, 2015

Parent Bashing and Lessons Learned

As you can imagine, therapists who work in this field hear a great deal about the issues that parents have caused in their patient’s lives. If I can be completely honest with you, I have caught myself, at times, engaging in parent bashing myself (sorry Mom and Dad!).

Now, let me clarify something from the get-go – there are some really bad parents out there who have caused true trauma in their children’s lives. I do not condone abusive behavior. The parent bashing I am talking about in this article is the finger pointing that we use too much in order to blame our parents for the myriad of issues we have not dealt with in our lives.

As for me, becoming a parent has created a certain compassion for my own parents. I realize how hard it is to parent! There are so many difficult decisions to make, so many emotions to deal with and way too much second guessing and stressing. I realize how very human I am and acknowledge that I have made and continue to make mistakes while raising my children (sorry boys!).

Here’s the deal: my parents were not perfect and neither am I. I have a choice to continue to blame them for my issues or I can think about their parenting (as well as my own issues) in a different way. This is true Cognitive Behavioral Therapy – looking at my thoughts, testing them to see if they are facts, if they make me feel the way I want to feel and do they help me reach whatever my goal may be. By doing this, I have come up with some rational thoughts as well as values that my parents instilled in me.

1.      If you fall down, get back up again. Don’t give up! Failing something does not mean that you are a failure – it just means that you needed to learn something. Try to learn the lesson and move forward.

2.      Also, don’t be afraid to fail. It’s important to challenge yourself to go out of your comfort zone and maybe you will find your true dream. If you are afraid to fail, you will never reach your true potential.

3.      Once you start something, finish it even though you don’t want to. If you decide you want to try baseball, you need to finish the season. This breeds tenacity to push forward even when it is hard.

4.      Don’t expect constant pats on the back – a good work ethic is self rewarding as it means that you are working at your best and brightest.

5.      Stand up for what you believe in. Without strong values or beliefs, it is very hard to have as much meaning and purpose in your life.

6.      Family is extremely important. They know you and love you even when you are unlovable. They also laugh with you and share memories no one else can understand.

7.      Play outside more than inside. The great outdoors has more beauty and fascination than any TV show.

8.      Don’t expect someone to rescue you. Sometimes you have to find the inner strength and self-love to rescue yourself.

Thank you Mom and Dad! Yes, my parents taught me some wonderful things even in their brokenness. What are some of the things your broken parents taught you? How about trying to think in a different way about your parents today and come up with some of the good things they helped you learn. It may change your perspective!

Bonnie Lillis, LPC, CI-CBT

Thursday, March 19, 2015

The Erosion of Self-Esteem and Creation of Negative Body Images

What is your body image? How we think about how we look can either positively or negatively impact our self esteem or how we feel about ourselves. Our body image is formed out of every positive and negative experience we have had. Mine started at a young age when my mother complained that she had to buy me “chubbies” instead of wearing the hand-me-downs of my sisters. It has continued to take hits from classmates, friends and most of all from what I call the “tyranny of the media”. Think about all of the images you are bombarded with on a daily basis – the ones that show the perfect bodies, the beautiful faces, and even their seemingly perfect lives. This does not even include the sexualization of women based on their so-called perfection…..and that message can have us question whether we are attractive if we don’t look "perfect".

What I find so disturbing is that children and teens are so impressionable. Our children are literally attacked by images through social media, Youtube videos, magazines, movies, television shows and especially commercials. Here are some disturbing facts, taken from www.nationaleatingdisorders.org.

·         42% of 1st-3rd grade girls want to be thinner (Collins, 1991).
·         In elementary school fewer than 25% of girls diet regularly. Yet those who do know what dieting involves and can talk about calorie restriction and food choices for weight loss fairly effectively (Smolak, 2011; Wertheim et al., 2009).
·         81% of 10 year olds are afraid of being fat (Mellin et al., 1991).
·         46% of 9-11 year-olds are “sometimes” or “very often” on diets, and 82% of their families are “sometimes” or “very often” on diets (Gustafson-Larson & Terry, 1992).
·         Over one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives (Neumark-Sztainer, 2005).
·         35-57% of adolescent girls engage in crash dieting, fasting, self-induced vomiting, diet pills, or laxatives. Overweight girls are more likely than normal weight girls to engage in such extreme dieting (Boutelle, Neumark-Sztainer, Story, &Resnick, 2002; Neumark-Sztainer&Hannan, 2001; Wertheim et al., 2009).
·         Even among clearly non-overweight girls, over 1/3 report dieting (Wertheim et al., 2009).
·         Girls who diet frequently are 12 times as likely to binge as girls who don’t diet (Neumark-Sztainer, 2005).
·         Of American elementary school girls who read magazines, 69% say that the pictures influence their concept of the ideal body shape. 47% say the pictures make them want to lose weight (Martin, 2010).
·         The average American woman is 5’4” tall and weighs 165 pounds. The average Miss America winner is 5’7” and weighs 121 pounds (Martin, 2010).
·         The average BMI of Miss America winners has decreased from around 22 in the 1920s to 16.9 in the 2000s. The World Health Organization classifies a normal BMI as falling between 18.5 and 24.9 (Martin, 2010).
Do these statistics disturb you as much as much as they do me?

Bottom line (no pun intended), we are allowing the media to erode the vulnerable self-esteem of our children and teens. Here are some things to think about to help our children, and us – think of it as putting on strong armor so that these messages don’t sink in as negative attacks.

Myth: I want to look like a magazine model in real life. 

Fact: Even models don’t look like their pictures in real life.  There are many tricks to “doctoring” pictures.  Some techniques include airbrushing, computer alterations, special lighting to cast shadows in just the right places, even black and white photography, especially on “muscular” men, so that the definition of muscles is greater.  All types of media trick us into thinking that there are people who look far more “perfect” than any person really ever does.

Fashion models are actually thinner than 98% of women. Why would we allow this low percentage of people regulate how the rest of us feel?

So, how can we fight this? One way is to have a radical acceptance of our body and to develop an attitude of gratitude for what our body actually accomplishes. Here are some of those marvelous accomplishments we take for granted every day:

         Fights off infection
         Allows you to move
         Rewards you with the sight of a sunset
         Heals the bruises
         Expresses emotions
         Creates another human being
         Defends you and heals you from attack
         Gives you pain to inform you that something needs to be cared for
         Releases you from pain
         Allows you to hear the sound of laughter
         Refreshes you after a night’s sleep
         Allows you to touch, hear, smell, see, laugh, cry, scream, and live!

Finally, we are much more than what we look like. We are strong, loving, intelligent…you can name the adjectives for yourself. As for your body - respect it, love it and become comfortable living in and with it! You are so worth it!


Bonnie Lillis, LPC, CI-CBT

Monday, March 16, 2015

GOOD GRIEF!

I can imagine that any person who is in the process of grieving would get aggravated with the title of this blog. Please forgive me if I have offended you and allow me to explain.

You are absolutely correct when you think, “there is nothing good about this grief!”. Grieving is an exhausting holistic process; physically, emotionally and spiritually. There is nothing that “feels good” about grieving. In fact, many wonder if they will ever feel good again! Allow me to encourage you – there will come a time when you will feel better. However, in order for this to happen you need to do some good grief work. It is work! Here is what I mean:

  1. Lean into the pain. Ouch, do I have to? No one wants to feel the intense pain that accompanies grief. You do need to allow yourself time to feel this pain; to cry, wail, or be angry. Feeling these emotions and expressing them will help you to process your grief. Crying also helps release much of the tension in your body. It is an important part of grief. 
  1. Understand and accept that you are in the wilderness. Imagine that you have been dropped in a field and have no idea where you are, where to go, or what to do to survive. Dr. Alan Wolfelt calls this the wilderness of the soul. It is a dark and lonely place that only you can wander and explore in order to eventually reconstruct a new normality for your life. 
  1. Find someone who listens without telling you what to do. This can be a friend, someone in the clergy, a family member or a professional counselor (we have phenomenal counselors at NECBT!). After a few months find a bereavement support group as it can be very helpful to talk with a group of people who understand what you are experiencing. NECBT is starting one soon.
  1. Finally, take care of yourself. This means try to drink as much water as you can, try to eat healthy foods, try to get some exercise and find something to do that makes you feel good. This means taking breaks from your grieving. Again, grieving is hard work. You need to take brief vacations from it in order to start reconnecting with the world. 
This is good grief. If you push away the pain, bury your anger, self medicate or don’t acknowledge your experience, this process will take much longer. Also, it will eventually come out in another negative way.  Practice good grief; you will find your way out of the wilderness!


Bonnie Lillis, LPC, CI-CBT