Even Young Children can Experience PTSD

When you think of PTSD (posttraumatic stress disorder), soldiers returning from combat may come to mind.  But years of research suggest many others experience PTSD, too, even young children, though their symptoms may differ from those of older children, adolescents and adults.

PTSD in adults and children can occur after exposure to a traumatic event — living through one, witnessing one in person, or learning about a traumatic event that involved a family member. A traumatic event can include a violent experience in the home or community, a fire, a natural disaster, a car accident, or the sudden death of a family member. The younger a child is, the greater the impact. The loss of a parent or being removed from a parent, for example, feels like a threat to a child, according to child psychiatrist Judith Cohen, M.D., medical director of the Center for Traumatic Stress in Children & Adolescents at Allegheny General Hospital in Pittsburgh.

Many children experience trauma — an estimated 14 to 43 percent, according to the National Center for PTSD. Of those, as many as 15 percent of girls and 6 percent of boys develop PTSD. Children with PTSD may experience distressful thoughts, ­and memories of the trauma may occur without warning. They may also have trouble sleeping and nightmares (though they may not seem clearly tied to the event). Traumatized children may try to avoid people or objects that are reminders of the event and they may act more irritable, have angry outbursts, or be easily startled. They may regress, wet the bed or talk baby-talk, and they may experience physical symptoms, such as headaches and stomachaches. The symptoms can cause major distress and can impact how a child behaves or relates to family members.

To help a child heal from PTSD, treatment involves working with the child and parents and caregivers, creating a feeling of safety, helping the child to understand the condition, and encouraging the youngster to talk about his or her feelings (through art and play), to help develop relaxation and coping skills. Rehabilitation begins with building trust and it needs to be fun and engaging for young children, according to Dr. Cohen. Several different types of treatment are available for children with symptoms of PTSD and early intervention can be important in helping little ones cope with and heal from the effects of trauma.

For more information on understanding and helping children of all ages heal from traumatic events visit the National Child Traumatic Stress Network.

By Debbie Cohen, health writer, APA

15 Tips for Talking to Kids about Ebola

By David Fassler, M.D.

Child and adolescent psychiatrist 

Parents and teachers may find themselves faced with the challenge of discussing the evolving Ebola epidemic with children. Although these may be difficult conversations, they are also important. There are no “right” or “wrong” ways to talk with kids about Ebola, but here are some suggestions if you need help. 

1. Provide 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 Ebola unless and until they’re ready.

2. Answer questions honestly. Kids will usually know, or eventually find out, if you’re “making things up." It may affect their trust in you or your reassurances in the future.

3. Use words and ideas children can understand. Gear your explanations to the child’s age, language, and developmental level.

4. Help kids find accurate and up to date information. Print out Fact Sheets from the CDC, CNN, WHO and kidshealth.org.

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

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

7. Remember that kids often personalize situations. For example, they may worry about their own safety and the safety of family members. They may also worry about friends or relatives who travel or live far away.

8. Be comforting, but don’t make unrealistic promises. It’s fine to let children know that they are safe in their home or at school. But you can’t promise that there will be no cases of Ebola in your state or community.

9. Let kids know that there are lots of people helping the families affected by Ebola. This time is a good opportunity to show children that when something scary or bad happens, there are people to help.

10. Children learn from watching their parents and teachers. They will be very interested in how you react to news about Ebola. They also learn from listening to your conversations with other adults.

11. Don’t let kids watch too much television with frightening images. The repetition of such scenes can be disturbing and confusing.

12. Children who have experienced serious illness, loss, or other traumatic events in the past are particularly vulnerable to graphic news reports or images of death. These children may need extra support and attention.

13. Watch for physical symptoms including headaches and stomachaches. Often times, kids express anxiety through physical aches and pains. An increase in such symptoms without apparent medical cause may be a sign that a child is feeling anxious or overwhelmed.

14. Children who are consumed with questions or worry about Ebola should be evaluated by a trained and qualified mental health professional. Other signs that a child may need additional care include: ongoing sleep problems, frequent fears about illness or death, or reluctance to leave parents or go to school. If such behaviors continue, ask your child’s pediatrician, family physician, or school counselor to help you contact a mental health professional. 

15. Although parents and teachers may follow the news and the daily updates with interest and attention, most kids just want to be kids. They may not want to think about what’s happening across the country or elsewhere in the world. They’d rather play ball, climb trees, or ride bikes.

Public health emergencies are not easy for anyone to comprehend or accept. Understandably, many young children feel frightened and confused.  As parents, teachers, and caring adults, we can best help by listening and responding honestly and comfortingly. Fortunately, most children, even those who have experienced loss or illness, 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.

David Fassler, M.D., is a child and adolescent psychiatrist practicing in Burlington, Vermont. He is also a Clinical Professor of Psychiatry at the University of Vermont.

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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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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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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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How to "Bully-Proof" Kids

By Gariane Phillips Gunter, M.D. 

Do you think October's national anti-bullying campaign was successful in stopping bullies? The Washington Post recently blogged about our country having a hard time defining bullying among kids. So, what can we, as parents, do to protect our children and teens? Here are some tips for "bully-proofing" your kids:

Distinguish between events and feelings - It is important to teach your children the difference in their interpretations of life situations. This helps kids learn to understand and relate to the feelings of others. They will be able to determine if someone is treating them appropriately - or if they are, in fact, being bullied.

Develop a sense of self - Another great way to bully-proof your child is to help them develop a sense of self. Encourage them to learn about and understand who they "are" because children who struggle to identify self-awareness or constantly strive to be their "hero" are never going to be able to live up to those expectations. This can be detrimental for their self-esteem - making them a direct target for bullying. Kids with low self-esteem are less likely to stick up for who they are which makes them prime targets for those looking to pick on someone (bullies often bully due to their own low self-esteem).

Monitor their online lives - Parents or caregivers should have access to online accounts and cell phones to ensure their teens' safety over the Internet. Cyberbullying continues to be a nationwide epidemic.  

Positive activities - It is also important to encourage your kids to explore activities that make them feel good about themselves. Find something that they are really good at because it will help increase their overall self-esteem and feeling of self-worth. Encouraging courageous behavior is another great way to guide children. You can teach them to stand up for themselves and for their peers and other friends. When groups of kids or teens stand together to put an end to a bullying situation, the bully is more likely to back off and won't mess with your child again.

Following these tips when your kids are young is the best way to show them how to establish early on that they will not tolerate bullying. 

Sources: http://www.makebeatsnotbeatdowns.org/, http://www.olweus.org/
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The Significance of a Sleeping Brain

By Sara Coffey, D.O.

As a mother of a newborn, "sleep" is an increasingly interesting and important topic in our household.  Not only for my baby, but for my husband and myself - which brings me to the book Healthy Sleep Habits, Happy Child by Dr. Weissbluth.  Since I'm a psychiatry resident as well as a mom, I'm especially drawn to Dr. Weissbluth's discussion on studies showing sleep linked to temperament and attention in children.

Children need sleep in order to develop.  A sleeping brain is more than just a resting brain; it is a brain that's able to restore, process, and complete essential tasks that an active awake brain is unable to do.  Dr. Weissbluth explains that for young infants, daytime sleeping or naps can help to enhance the brain’s capacity to think.  When we become adults, our busy schedules cause us to forget the importance of these daytime respites and restorations.  Our hectic grown-up days may not always allow naptime, but naps are essential to raising healthy infants and kids.  

The significance of sleep doesn't only apply to young children.  Did you know that teenagers need more sleep than pre-teens?  So, to all parents who are noticing behavior problems, irritability, decreased concentration, or other changes in your children's moods, focus on their sleeping habits.  HealthyMinds.org blogger Dr. Gariane Gunter shares how many hours of sleep a child needs according to his or her age in this post.  I've included some of her tips below:

• Birth-6 Months: Children need 16-20 hours
• 6-12 Months: Children need 14-15 hours
• Ages 1-3: Children need 10-13 hours
• Ages 3-10: Children need 10-12 hours
• Ages 11-12: Children need 9-12 hours
• Teenagers need 10-12 hours of sleep per night

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Can My Child Have Bipolar Disorder? Pediatric Bipolar Disorder: Fact or Fiction

By Molly McVoy, M.D.   

Can children really have bipolar disorder?  Or, is it a parenting issue?  Is this mental illness overly-diagnosed?

Many of these questions have been raised in the media with increased frequency over the last several months.  What's most concerning is, that instead of focusing on diagnosis and treatment for children with serious mental illness, the debate has focused on who is to blame: is it parents, psychiatrists, drug companies, schools?  The bottom line is that children are suffering, and parents are struggling to keep their children safe, healthy, and happy.  More attention should be paid to actually helping these children, not to pointing fingers of blame.

Pediatric bipolar disorder is a rare but very real illness.  The most recent statistics indicate the mental illness affects approximately 1.5% of children.  Contrary to popular reports, the most recent studies also indicate the rates of pediatric bipolar disorder are not increasing over time, and the rates do not vary between US and non-US populations.¹

When pediatric bipolar disorder occurs, it can be very impairing.  Affected children have extreme mood swings – not for minutes at a time but for days.  Children can become suicidal, violent, and often feel quite out of control.  When properly diagnosed and treated, the lives of these children and their families can improve dramatically.  Treatment often involves a combination of mood stabilizing medication and intensive psychotherapy.  But when missed or misdiagnosed, these children may go on to suffer for a lifetime.

Stigma continues to be associated with a mental health diagnosis, and nowhere is that truer than in pediatric mental illness.  Perhaps, in the future, efforts will focus on how to help, not who to blame.

Links:

http://www.aacap.org/

http://www.bpkids.org/

References:

1. VanMeter, AR, Moreira, AL, Youngstrom, EA. Meta-analysis of epidemiologic studies of pediatric bipolar disorder. J Clin Psychiatry. 2011, May 31.

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Family Game Night Can Make You Smarter

By Scott Benson, M.D. 

My daughter brought two treats when she came home for college break.  A new game, Bananagrams, and a new book by Richard Restak, M.D. and puzzle master Scott Kim called The Playful Brain: the surprising science of how puzzles improve your mind. 

In this collaboration, Kim shares some of his favorite puzzle formats, and Dr. Restak explains the science behind the games.  Together they cover a wide variety of puzzles that have been shown to keep us alert, thinking, and youthful in mind and spirit.  fMRI data (which shows electrical activity in different parts of your brain) helps to tease out which areas of the brain are activated as people solve different types of puzzles.  

Scientists have not been able to prove a direct link between these forms of brain exercise and prevention of various forms of dementia.  But the puzzles, and games like Bananagrams, provide a focus for interpersonal interaction – playing with your family, talking with your neighbors – which does have a powerful effect on mood and our sense of well-being. 

Summer is the perfect time to bond with your kids in a board game challenge.  How do you get your family to put down their cell phones and turn off the TV to play a game?  Please share suggestions!

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Talking to Kids about the Earthquake in Japan

By Adair Parr, M.D.

Our hearts and condolences go out to the people of Japan and the families involved in the earthquake and subsequent tsunami in Japan last week. 

Everyone has seen the live images, captured on cell phones and video cameras, coming from Japan.  They are vivid, dramatic, compelling, and scary.  We have all watched the coverage on television and online as more and more photos and videos circulate showing the massive tsunami wave rolling over the sea wall, shaking houses and buildings, fires, explosions,  and the massive destruction afterwards.  The subsequent explosions of the nuclear reactor and news of a nuclear reactor meltdown near Sendei, Japan are also extremely disturbing. 

Our 24 hour news cycle enhances the impact of these images which can be traumatizing for viewers of all ages.  Media has a particularly powerful influence on children and adolescents, and the pictures it shows shapes a child’s perception of the world.  Young children watching images of disaster believe that the event is happening in real time, and they’re in danger.  At such times, helping children feel safe and protected in their own home and community is important.  Parents should keep in mind the following tips when viewing photos and videos during and after disasters:

• Be vigilant!  Not all sources of media provide warnings about upcoming traumatic images.
• Viewing traumatic images may be re-traumatizing.
• Limit children’s exposure to media coverage of the event.
• Co-view media coverage of the trauma and discuss content with children and adolescents.
• Encourage children to draw, write, play music, and exercise in ways to express their feelings about the traumatic events.
• Maintain structure and family routines. 

HealthyMinds.org has more information on how to talk to your children about disasters.

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How Much Sleep Do Kids Need?

By Gariane Gunter, M.D.

Children these days are busier than ever!  I often hear from parents that it is such a rush to fit everything in and still get the kids to bed on time.  I struggle with the same dilemma at my house.  As a mom, I understand how difficult early bedtimes can be, however, as a psychiatrist, I know why an adequate sleep schedule is so significant for our child's physical and emotional health.   

The American Academy of Pediatrics Guide to Your Child's Sleep provides some helpful guidelines regarding just how much sleep children need at different stages in their development. Keep in mind that these numbers reflect total sleep hours in a 24-hour period. So if your child still naps, you'll need to take that into account when you add up his typical sleep hours.

Birth-6 Months, children need 16-20 hours
6-12 Months, children need 14-15 hours
Ages 1-3, children need 10-13 hours
Ages 3-10, children need 10-12 hours
Ages 11-12, children need 9-12 hours
Teenagers need 10-12 hours of sleep per night

Kids need a lot of sleep, huh?!  Children and teens who are sleep deprived may show some difficult behaviors.  They may display frequent irritability, overreact emotionally, have difficulty concentrating, forget things easily, wake often during the night, and may even display hyperactive behaviors.

Teaching kids how to keep a nighttime routine that gets them to bed early will help your children be at their best.  Sweet Dreams!

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Talking To Kids About Disappointment In Sports

By Claudia Reardon, M.D.

Participating in sports is generally thought of as a physically and emotionally healthy activity for children and teenagers. However, it is inevitable that children who play sports will at some point deal with disappointment. Not every play or game will go their way. While dealing with this disappointment can be difficult for children, it's also a great opportunity for growth. The excitement of the Super Bowl and other winter sporting events provide a chance to talk with your children about disappointment.

Here are some tips to keep in mind if you parent or coach a child or teenager who is dealing with disappointment in sports:

1. Acknowledge your child’s feelings about what happened. For example, you can say, “I understand that you are feeling really upset that you didn’t win the race.” Of course, this does not mean that you should agree with catastrophic statements that they might make, such as that they are the worst player that ever played or that their life is ruined because of a bad game.

2. It’s okay if kids don’t want to talk about a disappointing game or event immediately. You might simply acknowledge their feelings and tell them that you’re there for them to talk whenever they want to.

3. Help your children shift focus to what they did RIGHT on the playing field. This is especially important if your child is a perfectionist, in which case he or she is likely to focus on the one mistake rather than seeing the “big picture” of everything he or she has done right.

4. It’s certainly okay if your children’s disappointment leads them to want to improve their sports skills. Help them figure out exactly what skill they would like to improve, and then brainstorm ways to improve in that area. They might even ask for suggestions from the coach. Help your children set realistic goals and then give them praise as they work toward those goals.

5. Ask your children if they think their favorite athletes ever make mistakes in their sport. If these athletes said that they were terrible players and wanted to quit after one bad play or bad game, would your children agree with that? Of course not!

6. Disappointment is a great opportunity to reinforce resilience and determination. Remind your child that he or she is “the kind of person who doesn’t give up easily.”

7. If a child is disappointed in his or her sporting performance, that is not an excuse for poor sportsmanship. It is not okay for them to express their disappointment as anger toward the winner.

8. Remind your children that failing to make a good play or to win a game does not mean that they’re a failure overall. There still are lots of great things about them, and everyone fails sometimes. Remind them of all the things they have done well recently.
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Raising Awareness About Stuttering and Speech Disorders

By Adair Parr, M.D.

The Oscar nominations were recently announced and one particular movie in the best picture category is a film which addresses a common problem: stuttering. The King’s Speech depicts the courageous efforts of King George VI of Britain, played by actor Colin Firth, to overcome a stutter which first began when he was a young boy. Although many films have featured characters who stutter, this is the first film to focus on the process of someone overcoming speech difficulties.

The King’s Speech highlights the speech therapy that the king went through to overcome his stutter. The movie aptly demonstrates his frustration with prior attempts at speech therapy. His work with Australian speech therapist Lionel Logue, portrayed by actor Geoffrey Rush in the film, allowed him to move beyond the previous failures that he had in speech therapy and to achieve success. The story is particularly inspiring as you watch this man deliver a powerful speech to the British people on the brink of World War II. Hopefully, the movie will result in less stigma about stuttering.

Here is a video of His Majesty King George delivering his actual speech on Sept. 3rd, 1939.

Stuttering is a type of speech disorder which affects the fluency of speech. Stuttering is a fairly common phenomenon. Approximately 1 percent of children stutter, and up to 5 percent may display transient stuttering. Stuttering begins during childhood, typically between ages 2 and 4 and may last throughout life. It may involve repetitions of words, prolongation of speech sounds and blocked sound.
What should you do if your child has a stutter or other speech disorder? It is recommended that you seek an evaluation from a certified speech-language pathologist. Your pediatrician, physician or school system may help you find local resources. More information on stuttering is available at the American Speech-Language Hearing Association website.

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When Divorce Happens

By Gariane Gunter, M.D. 

A recent study was published in Health Day that discusses the mental health of children of divorced parents. While I am not in the position to support or deny the findings, the topic of divorce when children are involved is often a difficult one. Every family is different, but the following are some general tips for divorcing parents that can be helpful.

1. Attempt to keep a positive attitude during the point of separation. This is often a very trying time for the family. Stick to a routine and embrace the activities your children have always enjoyed.

2. Don’t forget to nurture yourself. Going for a walk, having coffee with a friend, or reading a good book are ways to rest and regain energy. It’s normal to feel exhausted when separating; and possibly for many months to follow.

3. Encourage kids to openly discuss their feelings, positive or negative, about what's happening.

It's important for divorcing, as well as already divorced parents, to sit down with their kids and encourage them to say what they're thinking and feeling. But you'll need to keep this separate from your own feelings. Most often, children experience a sense of loss of family and may blame you, the other parent, or both of you for what is going on in their lives. You really need to be prepared to answer questions your kids might raise. They might feel guilty and imagine that they "caused" the problem. Kids and teenagers may feel angry or frightened, or worried about their future. Counselors can assist with this difficult conversation and provide a safe environment if safety is a concern.

4. Although very tempting, try not to speak negatively about your former spouse when your children are present. This issue, often called “parental alienation” can be a problem. Doing things such as putting your child in the middle, saying negative things about the other parent, and using your child as a messenger puts your child in a “no win” situation and creates lifelong relationship issues for all involved. The reasons include the following:

• The comments may confuse and frighten children.
• Many of your concerns about your former spouse are difficult for you to express. It is very important that you keep these concerns to yourself. Children just do not have the emotional maturity to withstand information/situations that adults find stressful.
• Your child’s identity and self concept is based on parental behavior. Even if it is next to impossible to say anything good about your former spouse, try to do so. If this is impossible then don’t say anything.
• Children love to eavesdrop. Telephone conversations are their favorite snooping ground. Make all effort to not discuss your divorce-related difficulties on the telephone when your children are around.

5. During the crisis point of separation try to remember that your children need you both parents more than ever. This is not a time to deny access unless a professional deems it necessary to do so for safety related reasons.

6. It is important to accept the fact that a separation involves feelings of loss for children. Try not to panic if the following behaviors occur during the first few months of separation:

• Sleep difficulties like disrupted sleep, an inability to sleep, exhaustion etc.

• Social isolation

• Anger, intolerance, grumpiness

• Avoidance of divorce related conversations

• Obsessing about the divorce

• Appetite changes

• Feelings of worthlessness

• Tears and feelings of overwhelming sadness

7. Although many children do not ask to see a counselor when their parents separate, they usually find counseling very helpful.

8. It is important to acknowledge that children are very loyal and protective of their parents. If children are placed in loyalty binds they can experience anxiety. Try to alleviate their anxiety if they decided to “pick a side.” This is a coping skill which teens in particular use. If your child engages in “picking a side” try not to feel rejected.

9. Think of yourself as a survivor not a victim. And be patient. Everyone takes different times to heal.
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The Truth About Domestic Violence

By Roberto Blanco, M.D.

In my work with patients across the world, I can´t help but notice how many come to psychiatric clinics as a result of domestic violence. Despite its prevalence in other countries, domestic violence is also quite common in the United States. In the United States alone, 22 percent of women are physically assaulted by an intimate partner during their lifetimes and over 5 million are victims every year. Domestic violence touches all elements of society regardless of age, race, or socioeconomic status.

As a child psychiatrist, I can´t help but think of the smallest victims of domestic violence as I often see them in my clinical work. These are the children who are either involved secondarily by witnessing the abuse or become victims directly themselves. The effects of domestic violence on this population are far ranging and long lasting. As these children develop, they may struggle to deal with conflict. They may also become aggressive or experience severe depression, nightmares and other symptoms of post-traumatic stress, as well as other anxieties or fears.

The effects of domestic violence on children are dependent on the nature and severity of the abuse and on the developmental level of the child. Young babies and infants cannot understand why violence occurs in the home and so violence in this population can cause deep-seated changes in personality, self-esteem, and ways of interacting with others that can last for a lifetime. Often older children have a better understanding of what is going on, but still often blame themselves for the abuse and can have excessive guilt or anger as a result.

Domestic violence does not need to be only physical to qualify as a form of abuse. Abuse can also take the form of emotional, financial, or sexual control or disregard. Initially, characteristics of an abusive relationship can often be endearing such as wanting to be with you all of the time. Over time, this can become intense jealousy for no reason, excessive control over relationships and behaviors, and aggression or violence. Options for milder forms of emotional abuse can include family and/or individual therapy. For severe cases, there may be a need to get out of the situation or to a safe house. For more information on domestic violence, please see the American Pyschiatric Association's brochure  Let´s Talk Facts About Domestic Violence.
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Bipolar in kids? Probably not.

By Scott Benson, M.D.

The 5-year-old little girl had been referred to a therapist by her school because of her severe disruptive behavior. The almost daily tantrums had everyone concerned. She was uncooperative with the assessment and arrangements made for further evaluation. The therapist wrote a diagnosis of bipolar disorder.

The patient was certainly reactive to any limits and her tantrums seemed like they would never end. But she slept well at night; she rarely had behavior problems with her grandparents who provided afterschool care.

After a few parent training sessions with the little girl and her parents her behavior control improved. But continued treatment was threatened when her dad tried to get her on his new health insurance. The diagnosis of bipolar got the application bumped by the computer and it took a lot of calls and several letters to get her on the policy so that her treatment could continue.

At times it seems we are a little too quick to throw a label on a child’s behavior, and bipolar disorder seems to be the most popular current label.

But new research at the October meeting of the American Academy of Child and Adolescent Psychiatry found that children with some symptoms of mania probably do not have bipolar disorder.

Boris Birmaher, M.D., a child and adolescent psychiatrist at the University of Pittsburgh presented his group’s research. More than 2,000 children presenting to 10 different academic centers were included in the Longitudinal Assessment of Manic Symptoms (LAMS) study. 621 were found to have elevated symptoms of mania, but the full evaluation did not find sufficient symptoms for a diagnosis of bipolar disorder. Most had attention deficit hyperactivity disorder (ADHD), others had another disruptive behavior disorder. Children who did have bipolar disorder have poor function and are likely to require treatment in hospitals.

"Kids with manic symptoms don't necessarily have bipolar disorder," he told Reuters Health. On the other hand, "Many children with bipolar disorder are not being correctly diagnosed."

The LAMS study which will follow these children for five years should provide direction for the assessment and treatment of children with severe behavior problems. In the mean time parents should insist on an adequate evaluation for children with severe behaviors.

The Parents' Medication Guide for Bipolar Disorder in Children & Adolescents is a great source of information for understanding the evaluation process and treatment options. Or visit HealthyMinds.org for more information on bipolar disorder or mental health issues in children.