Tips for Talking to Children about the Connecticut School Shooting

By David Fassler, M.D.

Parents and teachers are faced with the challenge of discussing the recent tragic school shooting in Newtown, Connecticut with young children. Although these may be difficult conversations, they are also important.

There are no "right" or "wrong" ways to talk with children about such traumatic events. However, here are some suggestions that may be helpful:

• Create an open and supportive environment where children know they can ask questions. At the same time, it's best not to force children to talk about things unless and until they're ready.
• Give children honest answers and information. Children will usually know, or eventually find out, if you're “making things up.” It may affect their ability to trust you or your reassurances in the future.
• Use words and concepts children can understand. Gear your explanations to the child's age, language, and developmental level.
• Be prepared to repeat information and explanations several times. Some information may be hard for them to accept or understand. Asking the same question over and over may also be a way for a child to ask for reassurance.
• Acknowledge and validate the child's thoughts, feelings, and reactions. Let them know that you think their questions and concerns are important and appropriate.
• Remember that children tend to personalize situations. For example, they may worry about their own safety or the safety of friends or siblings when going to school.
• Let children know that lots of people are helping the families affected by the recent shooting.
• Don't let children watch too much news coverage with frightening images. The repetition of such scenes can be disturbing and confusing.  

Children learn from watching their parents. They are very interested in how you respond to local and national events. They also learn from listening to your conversations with other adults.

Children who have experienced trauma or losses in the past are particularly vulnerable to prolonged or intense reactions to news or images of violent incidents. These children may need extra support and attention.

Children who are preoccupied with ongoing questions or concerns about safety should be evaluated by a trained and qualified mental health professional. Other signs that a child may need additional help include sleep disturbances, intrusive thoughts or worries, or recurring fears about death, leaving parents or going to school. If these behaviors persist, ask your child's pediatrician, family physician, or school counselor to help arrange an appropriate referral.

Although parents may follow the news with close scrutiny, most children just want to be children. They may not want to think about or discuss violent events. They'd rather play ball, climb trees, or ride bikes.

Senseless, violent crime is not easy for anyone to comprehend or accept. Understandably, some young children may feel frightened or confused. As parents, teachers and caring adults, we can best help by listening and responding in an honest, consistent, and supportive manner.

Fortunately, most children -- even those exposed to trauma -- are quite resilient. However, by creating an open environment where they feel free to ask questions, we can help them cope with stressful events and experiences, and reduce the risk of lasting emotional difficulties.

David Fassler, M.D., is a child and adolescent psychiatrist practicing in Burlington, Vermont. He is also a clinical professor in the Department of Psychiatry at the University of Vermont, College of Medicine.

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Grief and Loss Never Take a Holiday

By Joshua Reiher, Medical Student

Reviewed by Claudia Reardon, M.D.

The holiday season is in full swing. This time of year is meant to celebrate life, love, family, and friends. However, the holidays can also be difficult, especially if you or someone you know has lost a loved one. Maybe you are grieving the loss of a grandparent, parent, child, sibling, spouse, friend, or pet. Loss is a normal part of being human, and we will all face it at some point. Other causes of grief that you may not have considered:

• A loved one suffering from severe mental illness
• Divorce or breakup after a long term relationship
• Miscarriage during pregnancy

When a person experiences loss, he or she is said to be grieving. Grief is a natural emotional and physical response to any loss.

• People feel a wide range of emotions such as sadness, anger, disbelief, denial, guilt, loneliness, regret, anxiety, acceptance, and many others.
• Physically, people may undergo weight and/or appetite changes, decreased energy, lack of concentration, disturbances in sleep, loss of interest in sex, headaches, and so on.

Grief is a personal and individual experience—no two people grieve the same way. There is no one right or wrong way of grieving as long as it does not lead to behaviors that harm yourself or others. Bereavement is the period of time a person goes through grief following the loss of a loved one. Bereavement varies in duration and intensity, but it can last a year or longer in some cases.

Everyone is different, and reactions to loss are influenced by many factors such as:  

• Cultural beliefs and religious traditions
• Access to support and community resources
• Relationship with the person who left / passed away
• Personality and mental health history  

When to ask for help

While coping after a loss is painful and challenging, most people eventually find effective ways to heal and return to their daily life activities such as school or work. Some people, however, have more difficulty with recovering from a loss, and their emotional and physical symptoms do not improve. They may develop a psychiatric illness called depression. If you are concerned about yourself or someone you know, there are many treatments available including:  

• Talk therapy
• Community support groups with other people who have similar experiences
• Medications such as antidepressants

Additional resources to consider:

• Mental Health America: Coping with bereavement
• Substance Abuse and Mental Health Services Administration: How to deal with grief
• American Cancer Society: Coping with grief during the holidays

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Sleep Hygiene: 5 practical tips for more refreshing sleep

By Arshya Vahabzadeh, M.D. Follow @VahabzadehMD

Sleep is an essential part of our lives. Unfortunately, a growing number of Americans are not getting enough quality sleep. Some 70 million Americans have diagnosable chronic sleep problems. Key symptoms include reduced daytime alertness and disturbed sleep at night.

The effects of poor sleep can impact every aspect of our lives. Lack of sleep has been associated with problems at work, difficulties in relationships, medical and mental conditions, and an overall reduced quality of life. While some of these problems would benefit from a visit to your doctor, there are practical tips you can try for improved sleep. In this post on “sleep hygiene,” I discuss a useful set of practices for better sleep.

1. Resist coffee & other caffeinated drinks close to bedtime.

Caffeine is a stimulant and will keep you awake. Caffeine can be found in a range of products including coffee, tea, soft drinks, herbal supplements, and chocolate. Some people find it difficult to stop drinking coffee or soda. In that case, consider reduced or caffeine free versions. Also, drinking these products earlier in the day may reduce the effects of caffeine when it’s bedtime.

2. Don’t watch TV in bed.

Your body needs to associate your bed with sleep. Working, watching TV, or playing computer games in bed can disturb this association. This may lead to confusion for your body about what you want to do when you lie down in bed.

3. Keep your bedroom comfortable.

Make sure you have a suitable bed that’s comfortable; check the temperature of your bedroom; and remove any sources of bright lights or loud sounds. Bright lights close to bedtime can breakdown melatonin, a chemical which helps to regulate the sleep-wake cycle.

4. Exercise!

Being physically active or exercising can help to tire you out so you fall asleep more easily. But you should not do any strenuous exercise right before bedtime because this may be counterproductive. If you want to exercise close to bedtime, try something relaxing like yoga.

5. Establish a sleep routine & stick to it.

Go to bed and wake up at the same times every night and day. Avoid daytime naps or staying up late and sleeping in on weekends.

If you’ve tried these tips and still struggle with sleep, you should talk to your doctor. Depression and anxiety can cause disturbances in sleep. Your primary care physician or a psychiatrist can help find a solution.

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Safety Tips for Children with Autism Who Wander

By Arshya Vahabzadeh, M.D. Follow @VahabzadehMD

Resident Psychiatrist and Research Assistant, Emory & Marcus Autism Centers

With 1 in 88 children in the United States having autism, an increasing number of parents and caregivers face the challenges of caring for an autistic child. One of the most difficult areas is dealing with a child who repeatedly wanders away. This can be particularly dangerous for children with autism, as they may have little understanding of their own safety and have a limited ability to communicate to others for help.

Close to half of children with autism have attempted to wander away from a safe situation, and many parents report "near misses" that could have easily resulted in their child drowning or being injured by a vehicle. Sadly, injuries to children with autism are all too common.

In this post, I'll share several ways to help keep your child with autism safe when dealing with wandering behavior.

Understand what causes your child to wander away

This is much easier said than done! Look for subtle clues in their environment. Is the wandering / running aimed at going towards something your child is interested in, like a toy or place; or is your child escaping from situations like a room with many people, a loud TV, or something which is unfamiliar to them? Also look at the response of other people to the behavior -- if wandering / running away results in your child getting something he or she wants, like a candy bar, then this "rewarding" may cause the behavior to happen again.

Increase awareness and identification

Other family members and neighbors should know to get help if they see your unaccompanied child wandering. Some parents give their children medical ID bracelets or plastic wristbands with their child's information and condition. Parents may also use monitoring devices for their child like a personal GPS tracking device.

Keep the house safe

Many parents invest in extra locks and safety latches for the house. Some install window locks and have fencing around their yards. Especially important, because of the risk of drowning, pools and other water containing structures should be fenced or emptied if possible.

Talk to the school and local police

Make school staff aware of your child's risk for wandering or running away so they can keep a closer eye on your child. If possible, attend field trips or make a special plan with the school. Informing local police about your child's condition makes it easier for them to take action if they see him or her walking around unaccompanied. You should carry around a recent photo of your child and pay close attention to what your child is wearing on a daily basis in case you need to describe his or her clothing to a third party.

Sleep is important too

Parents often worry about what could happen to their child when they are asleep. This may be a bigger problem if their child is staying awake during the night. Decreasing the amount of caffeine your child drinks can help. Setting a sleep routine and avoiding daytime napping may also be useful. Sleeping disorders are common among children with autism. If your child's sleep continues to be a problem, talk to your family doctor or see a specialist.

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When recovery from depression seems hopeless, are there other options? A patient's perspective

By Andy Behrman, Guest Blogger

My experience with electroconvulsive therapy (ECT) began in 1995, when I opted for ECT as a last resort for treating my bipolar disorder. For so many people who were termed medication resistant and suffering with depression or bipolar disorder, ECT was the “last stop” when it came to treatment. But the variety of medications and other treatments now available to patients suffering from depression has expanded dramatically over the last 17 years.

I recently became extremely curious about a treatment for depression called TMS (transcranial magnetic stimulation). I was surprised to discover that even though TMS is a non-invasive outpatient procedure with few side effects, does not require anesthesia, and was approved by the FDA as far back as 2008, it is still very much “under the radar” and is a treatment which many patients are not very familiar.

According to Kira Stein, M.D., psychiatrist and medical director of Los Angeles-based West Coast TMS Institute, “In a recently published multicenter naturalistic study, 58% of patients significantly responded to TMS treatment, with 37% undergoing complete remission."

Today, TMS is primarily being used to treat those of us suffering with depression. The statistics for depression are alarming: 1 in 6 people experience it in their lifetime, which means that more than 50 million Americans are likely to struggle with clinical depression. Unfortunately, of this population, only 1 in 4 people get adequate treatment. One of the biggest concerns is the risk of suicide, as more than 36,000 people in the United States take their lives every year. Untreated depression, which causes disability at work and disrupted family and interpersonal relationships, can also lead to self-medication with drugs and alcohol. Depression has reached epidemic proportions and has become a silent killer.

When I speak to audiences about mental illness, I always encourage people who suffer from depression to seek advice from a mental health professional. Sometimes, getting people to overcome the stigma of suffering from depression is one of the hardest jobs I have to do. It is often the patient who resists seeking help, often because of the stigma, who really ends up at risk. But today, there are more treatment options than when I was ill. Technology is giving doctors more tools, and patients much more hope, for recovery.

Andy Behrman is the author of “Electroboy: A Memoir of Mania,” a personal story about his bipolar disorder, his experience electroconvulsive therapy (ECT), and his recovery from drug and alcohol addiction. Behrman advocates for mental health awareness and suicide prevention. He speaks to college audiences, health care professionals, and local and national mental health support groups working to stop stigma surrounding mental illness.

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Addiction: A Real Disease with Effective Treatments

By Amanda von Horn, Medical Student

Reviewed by Claudia L. Reardon, M.D.

For September's National Recovery Month, let's discuss recovery from alcohol / drug addiction. Odds are that you or someone you know has struggled with addiction, whether it be alcohol, street drugs, or prescription medications. Unfortunately, many believe that those who struggle with addiction are simply weak, lacking morals, or don’t have the desire or will-power to stop using. The fact is that addiction is a chronic brain disease with real physical and psychological symptoms. People may voluntarily use drugs or alcohol initially, but the drugs themselves can change the brain and make it extremely difficult to stop using, even if they have a strong desire to quit. 

This post answers some commonly asked questions about the disease of addiction. Hopefully you will share the information so others understand that with treatment and support, people do recover.

What actually is addiction?

Addiction is a long-term, often relapsing brain disease that results in repetitive and compulsive substance use despite harmful effects or consequences. 

 

Why is it so hard to stop using drugs/alcohol?

With long-term drug/alcohol use, there are significant changes in the “reward” pathways of the brain. These changes can result in needing more and more drugs just to feel normal. Stopping the drug often causes withdrawal, with symptoms such as intense nausea/vomiting, fevers and chills, horrible depression and/or anxiety, and in some cases even life-threatening seizures. 

Why does addiction affect some people more than others?

Addiction can be caused by many factors, and it is hard to predict individuals who are more vulnerable to the disease. A person’s biology and genetics can play a big role; for example, if a parent abuses drugs/alcohol, the child has a higher chance of having the same problem than does a child of parents who don’t use. 

I am struggling with addiction. What kind of treatment is available?

No one treatment is appropriate for everyone. Effective treatment often involves a combination of medication, counseling, behavioral therapy, and 12-step programs such as Alcoholics Anonymous and Narcotics Anonymous. In many cases, a person may need hospitalization to treat the physical symptoms of withdrawal in the early stages of recovery. 

The recovery plan must address not only the patient’s addiction but all aspects of his or her life in order for treatment to be effective long-term. Since relapse is often a part of the recovery process, it is important to identify “triggers” (people, places, or things that set off an alcohol or drug craving for someone in recovery) and how to cope with these triggers without the use of alcohol or drugs. 

If you or someone you know is struggling with addiction, please consult a physician for evaluation. Recovery is possible, and there is no better time to ask for help than now.

For more information on addiction, visit http://psychiatry.org/addiction. 

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Binge Drinking: What you should know before your next tailgate party

By Heidi Huang, Medical Student
Reviewed by Claudia L. Reardon, M.D.

Have you ever been in a situation where one alcoholic drink led to another and before you knew it, you had one too many drinks?

Whether it’s at college parties, summer cookouts, or tailgating at sports events, millions of Americans have experienced what it is like to binge drink and some do so regularly. Recent studies show that 1 in 6 Americans binge drink at least 4 times a month with an average of 8 drinks each time they binge drink.

Have you ever wondered if this is harmful and what to do to prevent drinking too much? Here are some commonly asked questions about binge drinking.

What is the definition of binge drinking?

Binge drinking is drinking 5 or more alcoholic drinks for men and 4 or more drinks for women in one sitting.

What are the consequences?

• There are over fifty different injuries and diseases associated with heavy alcohol use and binge drinking. Some of these include car accidents, violence, arrests, unintended pregnancies, sexually transmitted diseases, depression, and suicide.
• Heavy alcohol use causes 80,000 deaths in the U.S. each year, and binge drinking accounts for more than half of these deaths.
• Binge drinking increases your chances of developing a full-blown alcohol addiction.

Why do people binge drink?

• Some people may not be aware of the safe limits for drinking.
• People often feel social pressure from friends and peers to drink. For example, while tailgating at a football game or attending college social events, you may feel pressure to binge drink because everyone else is drinking a lot, and people are offering you too much to drink.
• Most binge drinkers are not alcoholics and are able to go many days without having a drink. Because of this, they may feel their alcohol use is not a problem and may not be aware of the serious consequences of binge drinking.
• BUT binge drinking may be part of an alcohol addiction problem.

 What are some strategies to avoid binge drinking?

1. Stay within safe limits: For men, this means no more than 4 drinks in one day and no more than 14 in a week. For women, this means no more than 3 drinks in one day and no more than 7 in a week.
2. Keep track of the number of drinks you have: Take mental note or write it down. One drink is the same as 12 ounces of beer or 5 ounces of table wine or 1.5 ounces of liquor.
3. Pace yourself: Try to have less than 1 drink per hour.
4. Alternate with non-alcoholic beverages such as water or soda.
5. Avoid drinking contests and drinking games.
6. Find someone who you can trust and who can offer some support to help limit the amount you drink.
7. Know that it is perfectly acceptable to politely refuse a drink when you have had enough.

When to get help from a health professional?

It can be difficult to tell when binge drinking will become or is already part of a more serious alcohol addiction such as alcohol abuse or alcohol dependence. If you are unsure about your alcohol use pattern or want to reduce your drinking, you should talk to your doctor or other health professional for more information and guidance to cut down. In the meantime, try some of these tips at your next get-together or sports event.

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Demystifying Schizophrenia

By Walker B. Shapiro, Medical Student
Reviewed by Claudia L. Reardon, M.D.

You have probably heard of schizophrenia - in newspapers, books, movies, and TV shows; you or somebody you know may be affected with this mental illness. Nonetheless, confusion about schizophrenia is common. This post provides some basic facts about schizophrenia, including common symptoms and available treatments. Schizophrenia is a chronic, treatable brain disease that affects an individual’s thought patterns, behavior, and perceptions of reality.

Some general facts about schizophrenia:
Affects more than 1% of the population with similar rates around the world
Affects men and women with similar frequency
Symptoms usually start between ages 16-30
Most people with schizophrenia are not dangerous or violent

The symptoms of schizophrenia vary greatly between individuals. They can also change and get better or worse over time. Some of the most common symptoms are listed below:

• Hallucinations – hearing voices is common
• Delusions – fixed belief in something untrue or impossible
• Paranoia – unhealthy or unfounded suspicion
• Disorganized thoughts – may go on tangents or not make sense when speaking
• Loss of interest or motivation – may not enjoy daily activities or social interaction

Schizophrenia is a serious chronic disease, but treatment is available to help people get back to thinking clearly and leading full lives. The most important treatment elements include:

• Medications (‘antipsychotics’) – help restore and maintain normal, healthy thought patterns
• Therapy and rehabilitation – help cope with stress and return to work, school, independent living, and social interaction

If you are concerned that somebody you know might be suffering from schizophrenia, encourage them to see a doctor for evaluation.

Find more facts on schizophrenia at www.psychiatry.org/schizophrenia.

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Tips for Talking to Children about Aurora Shooting

By David Fassler, M.D.

Parents and caretakers are faced with the challenge of discussing the recent tragic shooting in Aurora, Colorado with children. Although these may be difficult conversations, they are also important. There are no “right” or “wrong” ways to talk with children about such traumatic events. However, here are some suggestions that may be helpful:

• Create an open and supportive environment where children know they can ask questions. At the same time, it's best not to force children to talk about things unless and until they're ready. 

• Give children honest answers and information. Children will usually know, or eventually find out, if you're “making things up.” It may affect their ability to trust you or your reassurances in the future.

• Use words and concepts children can understand. Gear your explanations to the child's age, language, and developmental level.

• Be prepared to repeat information and explanations several times. Some information may be hard for them to accept or understand. Asking the same question over and over may also be a way for a child to ask for reassurance.

• Acknowledge and validate the child's thoughts, feelings, and reactions. Let them know that you think their questions and concerns are important and appropriate. 

• Remember that children tend to personalize situations. For example, they may worry about their own safety or the safety of friends when going to the movies or other public areas.

• Let children know that lots of people are helping the families affected by the recent shooting. 

• Children learn from watching their parents. They are very interested in how you respond to local and national events. They also learn from listening to your conversations with other adults.

• Don't let children watch too much television / news coverage with frightening images. The repetition of such scenes can be disturbing and confusing. 

• Children who have experienced trauma or losses in the past are particularly vulnerable to prolonged or intense reactions to news or images of violent incidents. These children may need extra support and attention.

• Children who are preoccupied with questions or concerns about safety should be evaluated by a trained and qualified mental health professional. Other signs that a child may need additional help include ongoing sleep disturbances; intrusive thoughts or worries; recurring fears about death, leaving parents, or going out to public areas. If these behaviors persist, ask your child's pediatrician, family physician, or school counselor to help arrange an appropriate referral.

• Although parents may follow the news with close scrutiny, most children just want to be children. They may not want to think about or discuss violent events.  They'd rather play ball, climb trees, or ride bikes.

A senseless, violent crime is not easy for anyone to comprehend or accept. Understandably, some young children may feel frightened or confused. As parents and caring adults, we can best help by listening and responding in an honest, consistent, and supportive manner.

Fortunately, most children -- even those exposed to trauma -- are quite resilient. However, by creating an open environment where they feel free to ask questions, we can help them cope with stressful events and experiences and reduce the risk of lasting emotional difficulties.

David Fassler, M.D., is a child and adolescent psychiatrist practicing in Burlington, Vermont.  He is also a clinical professor in the Department of Psychiatry at the University of Vermont College of Medicine.

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