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Medication

14 Jul

Recalculating Part II: Considering Medication

 

The suggestion to put your child on medication may bring an automatic “No way!” to your mind. After all, haven’t we all sat through TV ads about drugs that, judging by the actor’s beatific expression, seem to be miracle cures? And then haven’t we all felt the skepticism creep in as the announcer’s voice speeds up and reels off a series of unpleasant, and even life-threatening, side effects?

 

Most parents are very hesitant to put a child on medication, but there are some factors that might combine to make it a useful option. For instance, in some cases a child’s anxiety limits his ability to go to school, participate in sports or other activities, or participate in therapy that is designed to help him learn to tolerate anxious feelings. Sometimes, the child’s behavior can be seriously disruptive to family life, or even threaten the child’s health, such as when a fear of choking makes him reluctant to eat. I have been involved in cases, such as ones dealing with a child with school anxiety, in which there has been very good collaboration between the school, home and treatment professionals , and it is still not enough because the child is just too distressed and anxious to participate on her own behalf. In these cases, and in others, such as obsessive compulsive disorder, medication has often been quite helpful. Medication can help turn down the volume or intensity of the anxiety so that the hard work of learning coping skills becomes more obtainable.  So yes, medication can be helpful. And we need to stop and ask ourselves whether we have made a good faith effort to explore behavioral intervention, pausing to make sure that the treatment has been appropriate to the problem,  and then  can honestly say to ourselves “These reasonable efforts aren’t enough”.  Of course defining “enough” involves calculating a number of factors that are not always easy to define.  

 

Deciding to use medication is similar to the decision-making process for any intervention: It involves sorting out the “risk-benefit ratio.” In other words, are the potential benefits worth the potential risks? Additional, we need to ask of the possible interventions which ones are likely to be effective for the problem at hand. For your own thinking and also to get the best possible advice from any professional you may consult, it is important to clearly describe the problem and it’s history.   A behavior checksheet can assist in this process but it cannot replace your own observations. . A concisely summarized, one-page report from a parent can help a professional give more effective help — and of course, the parent must feel that the professional is trustworthy. A good professional has the attitude of Jerome Groopman in his book, How Doctors Think. In his conclusion, he states, “But after writing this book, I realized that I can have another vital partner who helps my thinking, a partner who may, with a few pertinent and focused questions, protect me from the cascade of cognitive pitfalls that cause misguided care” (p 268-269).  I would hope that you have a physician for your child with such a perspective. In the best of circumstances a decision to consider using medication involves a careful weighing of options and creation of collaborative relationship with the professionals involved.

More Fight than Flight

14 Jul

The Middle School Child

 

You are just trying to help and you get comments such as “you’re retarded”, “no, not all the time” or “I don’t’ want to talk about it”. Is there a new way in which you are feeling ineffectual as a parent? Perhaps you have a tween or middle school child. In order to help your middle schooler with an anxiety problem, we must first acknowledge that he or she is at a very particular stage of life that is characterized by the physical transformation of puberty and an increased awareness of himself and the world around him. And of course there is a great deal of variability in how children respond to these changes. But, accommodating these changes throws his emotional equilibrium out of balance for a while. Julie Ross has described this age in her book How to Hug a Porcupine: Negotiating the Prickly Points of the Tween Years, as follows:

 

The essence of our children remains, but they are drawn inward for a period in order to develop properly. Similar to the caterpillar who spins a chrysalis to

protect itself while it changes into a butterfly, our children ‘protect’ themselves with anger, sensitivity, tears, defiance and disorganization. These behaviors are the human chrysalis, the outer shell that protects the delicate, unformed butterfly while it is most vulnerable (P. 5).

This a time in the life of your child where the words “tolerance” “patience” and “forbearance” will be needed in your vocabulary but will be perhaps hibernating in your child’s. Your best efforts to help and engage in a discussion may be met with a very off-putting “Leave me alone!” or “Nothing will help” And this reflects not so much disrespect, but rather the fragile nature of her psyche at this phase of growing up.

 

 While something different is happening to their bodies which cannot be denied, there a counter pressure to not feel that they different in thoughts and feelings from their peers. As a rule, they don’t like anything that makes them feel singled out and imagining that they get anxious in ways that their peers don’t get the alarm bells ringing. This problem is made more acute because the definition of what is normal shrinks during this time period to what they imagine is typical for their peers. But the operative phrase here is “imagine,” since they often do not have any solid evidence of what their peers may be thinking or feeling. This is an age when having a fear or anxious preoccupation can be terrifyingly embarrassing because it potentially signifies that they are different.

 

This is also the age where the development of social phobia is frequently reported to begin. As a parent, you will naturally feel some urgency to help, but any help must begin with the understanding that your child is on the doorstep of adolescence, and that this is even more important than the anxiety. The latter will be easier to address if the common pitfalls of communicating with this age group are minimized —and as Julie Ross points out in her book, there are many ways to miscommunicate with tweens. So maintaining, and even reinventing, your relationship with your middle school child is the necessary first step before other issues can be addressed.

 

 

Sensory-Intergration

14 Jul

From  Your Anxious Child: Emails to Parents by Edward H. Plimpton, PhD

Sensory-Integration

Any parent who has more than one child knows,  every child is different from the moment they are born. Sometimes the difference is easy to understand such as when you have one boy and one girl, but that is only the tip of the iceberg.  Did your biceps get buffed when your child was an infant because the only way to calm her was to swing her in a bassinet? Did you find a new use for your washing machine as a way of calming your baby? (Placing the baby on top, not in the washing machine to be perfectly clear). Or did you find yourself driving around endless in your neighborhood so your child could fall asleep? Or perhaps you had one child who just melted into your body when you held him and another who seemed to arch away or squirm when held. What gives?

 These are examples of differences in temperament or variations in how the child experiences the sensory world.  There can be tremendous range in how we experience touch, so that some people hate to be tickled or others find it moderately enjoyable. Some people enjoy the sensation of being on a roller coaster and other experience as one step away from waterboarding.  These differences in how we experience the tactile stimulation of being held or the vestibular sensation of being on a roller coaster reflect variations in how we process or integrate sensory information.  Anxious children can often suffer from problems in sensory-integration, in which they cannot handle and process the incoming stimulation. A child who clings to you when you take her to a birthday party may be overwhelmed by the noise of the party because their ears are super sensitive.  It is not so much a problem being shy as it is of being overwhelmed by the sights, sounds and even the smells of the birthday party.

 What appears to be anxiety in trying something new might be more specifically describes as a problem in sensory-integration. It is all too much. And in such situations you might find child unable to articulate any  reason why they won’t join the birthday party other than she just doesn’t feel right. In contrast,  a child who is anxious in the more traditional sense of the term may be able to articulate some reason why they don’t want to join the party, such as   “I only know the birthday girl”. Admittedly, the distinction may not always be clear cut.  But there are a range of Sensory-Integration interventions, a subspecialty of occupational therapy, that may help your child modulate his sensory experience and consequently be less anxious and overwhelmed. This may involve providing your child with certain sensory experiences which can correct or compensate for her difficulty in processing the information that their senses provide them. If this sounds like your child, a consultation with a Sensory-Integration therapist may be helpful

My child won’t get out of the car!

14 Jul

Won’t get out the car!! What to do?

Suggestion from Edward H. Plimpton, PhD

 

Parents dealing with a child who is anxious may find themselves in a situation where their child seems physically frozen with fear.   It might be that they won’t get into the dentist chair, get out of the car to go to school or join the other children at a birthday party. When it happens more than once, a plan of action is needed. As with all problems, it is important to consider a range of factors that may be at play here. But there is also the practical problem of what to do and there some interventions that may be helpful regardless of the underlying reason.   For sake of discussion, let’s consider the child who won’t get out of the car.

  1. We should begin by recognizing that this can be very stressful for the parent. You may be trying to get to work on time, having already been late a number of times because of your child’s struggles, and you are feeling the pressure. In addition, we need to remember how contagious feelings are, which adds to your and your child’s distress. As you are driving to school you are left wondering how you are going to get your child out of the car and into school. So just as in airplanes, when the oxygen mask drops down from the ceiling-first attend to yourself and then you can help someone else. First, try to notice any physical tension in your body.  This is a simple request, but can be surprisingly helpful. Try to slow down and breathe in a calm, relaxed manner. You will more effective dealing with your child if you start from a position of being relatively calm. After all, it is a two-way street: Your child’s anxiety affects you, and your mood affects your child. You have to be calm in order for your child to be calm.
  2. If a child is curled up in the far corner of your van or is holding onto the car door for dear life, he or she is clearly overwhelmed by his or her feelings. It may feel like you have a stubborn or manipulative child, but that does not mean that is the child’s motive. It is more a reflection of how overwhelmed they feel rather than manipulation. It may be that just getting into the car was a major accomplishment.              Conceptually, we think of anxiety as reflecting our biological defensive system of fight or flight. But there is a more primitive defensive response that occurs when we can’t engage in fight or flight—we become immobilized or freeze. It is similar to the way in which animals play dead when caught by a predator. And your child in the car may be in a frozen state.  

If you can engage your child in some activity in the car, whether it is playing some version of license plate, listening to a song, or having a conversation,-any activity that helps him/her get out of his/her head and the anxious preoccupation is good. Likewise, if we can get the child to do some relaxation breathing, rather than hyperventilating, that would certainly help the cause.  But I understand that this may not be possible.

  1. Don’t pull your child out of the car. It will only make the situation worse and could result in tug of war in which someone gets hurt.
  2. Approach your child in a calm manner. Empathize with how overwhelmed he/she must feel. “I can see you shaking and huddled up, I  am guessing you are feeling  pretty scared”, or “I am guessing you are pretty scared, and if I felt that scared, I would hold onto back seat for dear life as well”   Trying to understand how your child feels isn’t the same as giving him permission to miss another day of school. But rather if you child feels understood, then she may become more flexible. It would not be unusual in such a situation for your child not to give any indication of whether you said something useful or it was just stupid. Don’t despair; it is hard to feel eloquent when you are talking to someone huddled in a ball.
  3. This really may be the best they can do in the moment. Try to get the child to look at you. Try to see if your child will tolerate any physical contact from you, whether-a hand on the shoulder-or a hug. We are trying to make the child feel safe and calm down her nervous system.  
  4. One yardstick to keep in mind is that many panic attacks resolve themselves in about 15 minutes, so stay calm and hang in there. You may just need to give the situation some time.
  5. You might say, “Being upset is hard work, let me know if you need something to drink or eat.”
  6. It is always helpful if there is a compelling reason for the child to get out of the car that can help override his current feelings. Sometimes schools can give children special assignments such as helping the gym teacher or feeding and caring for a school pet.
  7. Although no one wants to jump to put their child on medication, and it shouldn’t be the first intervention,  there is a place for medication in helping children get control of themselves so that they can participate more fully in solution of this problem.  Medication won’t solve any problems, but it may turn down the anxiety dial so that the child can be more available to solve this problem.