Before You Medicate: Considerations Before Starting Your Child on ADHD Medication Part 1

Over the last few years the health care community has been forced to take a hard look at the prescription medications that providers have been putting out into the community.  The rampant misuse of doctor prescribed opiates, stimulants, and ?benzos? has compelled clinicians to re-evaluate their methods for treating patients.   But as encouraging as this trend has been, it is still important for us as patients and consumers to take an active role in our treatment.  A balance must be struck between relying on the expertise of providersand being conscious of what we choose to consume.

I want to preface this by saying that the correct medication can do wonders for your mental health.  The difficulty stems from (1) thinking that ONLY medications can help and (2) not taking the time to figure out the true nature of the problem before deciding on treatment.

Rule out other causes

It may be tempting to want to get your child on an ADHD medication at the first sign of problems in the home or school.  The presence of inattention, difficulty concentrating, irritability, excessive activity or aggression can all be disruptive to your child?s academic success and relationships with family or friends.  But, like most endeavors, mental wellness must be built on a solid foundation that cannot be rushed.  And the best place to start, is with a proper diagnosis.

This is often easier said than done.  For example irritability, increased sensitivity, sleeplessness, temper tantrums, and difficulty concentrating can all be seen by your clinician as signs of ADHD.  However, these symptoms are also what you might expect to see with DEPRESSION, as it presents in children.   Taking the time to ensure a thorough diagnosis may save you years of chasing your tale with minimal benefit (not to mention money).

Who should I have diagnose?

First and foremost, a diagnosis of ADHD has to come from a health care professional.  Resist the urge to self-diagnose!  While no one would argue that you aren?t the expert on your child (you almost certainly are) there are clinicians out there who are experts in mental illness, which is what you need.  If your child?s school is lucky enough to have a school psychologist, try reaching out to them to discuss options.  In the community, the primary clinicians diagnosing ADHD are psychiatrist.  These are medical doctors, with expertise in treating mental illness, and they are the only providers (at least in Kansas and Missouri) that can prescribe medication.  A Licensed Psychologist may also be a good person to reach out to for an initial diagnosis.  Although they cannot prescribe, they can help you create an optimal treatment plan for your child.

With all respect to teachers out there, teachers should not be diagnosing.  A well-reasoned recommendation from your child?s teacher may be worth taking into consideration, as they do spend a significant amount of time with your child in a structured environment.  But teachers should never diagnose.  I would also strongly encourage against letting your primary care physician prescribe psychopharmaceuticals to your child.  While they may have had some training in the past on mental illness, that does not mean they?re still well versed in the subject (you likely wouldn?t let your pediatrician perform an operation on you right?).  It?s far if your PCP suspects your child may be suffering from a mental illness, to just ask them for a recommendation to a good psychiatrist or psychologist.

What goes into a GOOD diagnosis?

As I previously stated, there is no definitive test for ADHD.  I am fond of saying things like, ?there?s no thermometer for depression or blood test for inattention?.  But that does not mean we should be taking shots in the dark hoping to hit something; especially when it comes to prescribing medications to a developing brain.  There are some ways for you to know that your child is receiving a good, well thought out diagnosis.  A thorough evaluationshould include the following:

  • Extensive history ? Any thorough diagnostic intervention is going to include a detailed history going back to infancy or earlier.  You never know where important diagnostic information may pop up, so having as much information as possible is a plus.
  • Multiple settings ? An often overlooked aspect of ADHD is that it appears in multiple settings.? You would normally expect impairment to be fairly global, with signs of hyperactivity/inattention appearing in multiple areas of life.? If you only see symptoms in one area (at school, at home, out with friends, etc.) then it would be a good idea to explore other diagnoses.?*this can be accomplished through testing discussed below*
  • Areas of strength ? aside from the difficulties, children with ADHD almost always have tasks or topics for them that are considered strengths and aren?t impaired by symptoms of hyperactivity or inattention.? When interviewing parents of children with ADHD, you almost always hear, ?Little Johnny just can?t focus on anything, except when it comes to ______ .? With that he?s focused in.?? It?s important to focus on these areas (reading, video games, sports, etc.) and take them into consideration during diagnosing.
  • Psychological testing?? I know, I know, I said there?s no DEFINITIVE test for ADHD.? But there are assessments that can lend some measure of objectivity to the diagnosing process and help rule out other issues besides ADHD. These tests include the Conners 3?, BASC-3, or Brown ADD Scales??and should be administered and interpreted only by a qualified professional.? A good psychological assessment should include 1) a developmental history, (2) a parent rating scale, (3) a teacher rating scale, (4) a self-report, and (5) observation.?

Now, clinicians certainly don?t HAVE to go through all of these steps before giving an ADHD diagnosis.  In fact, there are plenty out there that will give your child a diagnosis and prescription after one, 50 minute interview.  But like any treatment, you want to be sure your provider is treating the correct thing.  Just like you would want testing done to confirm lung cancer, rather than asthma for example, before starting chemotherapy.  Before your provider prescribes your child stimulants, it?s worth taking the time to rule out other causes; like depression.

Take away

There are plenty of good and effective medications and treatments available to help manage ADHD symptoms in your child.  But, there are ZERO shortcuts.  Before you invest the time, energy, and money into your child?s treatment, it?s crucial that you insist your clinician take the time to ensure an accurate diagnosis.

Thank you for reading.  Feel free to reach out with any questions or topics of interest.  In Part 2 we will be discussing treatments available, what the latest research is saying, and self-care.

Adjusting Your Nighttime Routine: Tips for Better Sleep and Good Mental Health

For those people who struggle to get a good night?s sleep, have you considered that you might be your own worst enemy? There are some definite ?dos? and ?don?ts? to observe, which include important measures that have a direct effect on your ability to sleep and maintain good mental health. Consistent, restorative sleep is closely tied to mental health ? when you?re tired, your mood suffers, you?re impatient, and you have trouble concentrating. Consequently, your sense of well-being is compromised, and symptoms of depression and anxiety may occur as a result.

What?s more, sleep is especially important for people recovering from drug or alcohol abuse. Sleep has a powerful healing effect on the body and mind, bolstering the immune system and strengthening your metabolism. It also improves your mental outlook, an important factor in recovering from the ravages of addiction.

Consider the following points if a lack of sleep is affecting your mental condition and ability to function on a daily basis.

Observe a Sleep Schedule

Many of us get to bed only when our daily responsibilities have been completed and, as such, fail to get the necessary seven to nine hours of sleep every night. Your body functions best when you follow a regular schedule, and going to bed at the same time and waking up every morning at the same time is the best way to recalibrate your internal clock. Also, stick with your sleep schedule through the weekend and on holidays so as not to disrupt your sleep schedule. Eventually, your body will fall into line and let you know when it?s time for bed.

Winding Down

You can?t expect to climb into bed and fall asleep straight away if you?re experiencing sleep deprivation and insomnia. It?s important to spend an hour or two winding down, so prepare yourself to sleep by observing relaxing habits such as reading a book, taking a hot bath, or engaging in meditation. These activities can calm your thoughts and slow your heart rate, both of which are necessary for you to feel sleepy.

Sleep-Conducive Environment

Insomnia can be a serious problem, leading to both mental and physical complications. If it persists, it might be time to take a close look at your sleep environment. People often make the mistake of leaving a TV or computer screen on at night or keeping a smartphone on the nightstand. These are disruptions that can prevent sleep. What?s needed is a dark and quiet environment, so consider installing blackout shades and using a white noise app or machine to mask any disruptive external sound. Pay close attention to the comfort of your bed ? rough sheets and heavy blankets may drive up your body temperature, making it hard to get to sleep.

Don?t Force It

As a kid, do you remember being told by a parent just to lie in bed until you got tired? It?s a convenient piece of parental advice, but it doesn?t work when you?re an adult with a sleep problem. Whether you?re tossing and turning or just lying in bed thinking about next week?s big client presentation or an argument you had with your spouse, you?re only making the situation worse. Instead, get up and sit quietly in a darkened room, or do some light reading until your eyelids start to get heavy.

Limit Food and Drink at Night

Ingesting caffeine at night is a bad idea if you suffer from insomnia, as is eating a meal too close to bedtime. Your metabolism has to work to process the food, and you won?t feel like sleeping. Some people like to have a few drinks before bed, thinking it?ll help them wind down after a busy day. Unfortunately, alcohol undermines the healing, rejuvenating REM sleep you need to feel good and stay healthy.

Think through your sleep habits if you?re having difficulty at night. You might find that a simple adjustment will make a big difference. A consistent nighttime routine, a restful sleep space, and a little willpower in the evening can restore your mental well-being and leave you feeling refreshed and reinvigorated during the day.

Image courtesy of Pixabay

Dr. Weil?s 4-7-8 Relaxing Breath

We live in anxious, chaotic times. Watch 10 minutes of any news channel or spend time on any social media app and notice your blood pressure rise. We pride ourselves on our abilities to multi-task. You?ve seen them (or this may be us), during rush hour, driving, talking/texting, putting on make-up (or dry shaving), and eating breakfast, all the while trying to navigate successfully to our destinations. Mindfulness is a call for us to slow down and focus on one thing, one event, one activity at a time…purposeful breathing is at the foundation.

?Breathing?? you may ask, ?Don?t we know how to breathe?? Clearly, it is automatic in the sense that we don?t even have to think about it. The medulla oblongata is the part of the hindbrain that detects levels of CO2 and O2 in the bloodstream and automatically determines if any changes are needed, sending nerve impulses to the heart and diaphragm to either increase or decrease activity. However, the breathing I am talking about in this blog is deliberate and intentional, to produce physiological calmness, emotional well-being, and mental clarity.

Dr. Weil offers us his 4-7-8 breathing rhythm, the ?relaxing breath.? On his YouTube video, he explains that breathing in this manner over time can produce wonderfully ?pleasant states of consciousness? and is one of the best ways to control anxiety and emotional reactivity (especially if you have been triggered in some manner).

To begin, hold your tongue in the Yogi position (behind front teeth, where teeth meet the gumline) exhale for a count of 8, inhale (through your nose) for the count of 4, hold this breath for a count of 7, and exhale completely for a count of 8. Do 3 more breath cycles to complete the circuit and notice any changes. Keeping the ratio is important, of note, the exhale is twice as long as the inhale and holding the breath for 7 facilitates a drop in blood pressure. Practice this throughout the day (bare minimum is twice a day), especially when you notice yourself getting upset, irritated, or otherwise emotionally reactive. Choosing to breathe in this rhythm instead of emotionally reacting allows a gap between irritant and reaction; thus, thoughtfully responding and in control of your words and actions (not emotionally reacting).

The applications for using this skill are numerous: someone cuts you off in traffic (breathe); your child speaks to you in a perceived disrespectful tone (breathe); you are in the check-out line at the store and there is no movement and your ice cream is melting (breathe); you are next in the queue to be interviewed (breathe); you are sitting down to take a test (breathe); you are getting ready to take a free-throw to win your basketball game (breathe); you get the idea. For as many anxious moments we face throughout the days, months, and years of our lives, use this breathing rhythm to calm your body and your mind and be deliberate in your words and actions. Relationships can flourish when we take the time and make the effort to regain emotional control once triggered. Practice Dr. Weil?s breathing rhythm at every opportunity…you will benefit greatly.

*For Dr. Weil?s account, watch his YouTube video here.  

4 Ways to Help Encourage Your Children to Attend School

School refusal is becoming and evermore common concern for parents of children and teens.? School anxiety effects 25% of school aged children, with 2-5% refusing to attend school altogether.? With it?s short- and long-term consequences being particularly concerning, parents often feel unsure about how to address the problem.

For our purposes, school refusal should be considered separate from general truancy, due to the presence of emotional distress (specifically around attending school) and an absence of antisocial behaviors.? School refusal is a psychosocial problem, meaning it can be considered the result of both psychological and environmental issues.? This may manifest as complaints of physical symptoms shortly before it is time to leave for school or asking to the nurse, but once allowed to stay home, the symptoms quickly disappear.? Common physical symptoms include headaches, stomachaches, nausea, or diarrhea with behavioral symptoms manifesting in tantrums, inflexibility, separation anxiety, avoidance, or defiance.

The emotional distress that is frequently associated with school refusal often manifests as fear or anxiety, with about 50% considered to have anxiety disorders. However, while it is often characterized as anxiety driven avoidance of school and school-based activities, there seems to be no absolute-uniformity in the development of these behaviors. ?Depression has also been shown to be associated with poor school attendance. ?And although mood-related issues are often centered around school or school related activities, that is not always necessarily the case.? For example, the presence of depression often manifests in symptoms that may result in poor attendance yet not be directly related to school, such as general lethargy and/or loss of interest.

The question then becomes, what can be done to help combat school refusal problems?? Most of the research done on school refusal interventions has centered around Cognitive Behavioral Therapy (CBT), behavioral interventions, and psychopharmacological interventions. A 2016 study that examined the effects of combined intervention of CBT and fluoxetine (Prozac) showed significant improvement in school attendance and mood concerns; with the improvements showing stability at 6 and 12 months. Behavioral interventions often draw upon principles of operant conditioning, focusing on how school refusal has become reinforced; either positively or negatively.? Graded or In Vivo exposure both have a long history of use in anxiety management and can be implemented to help re-acclimate the child to being in school.? Parents can also help support consistent attendance by emphasizing the positive aspects of school, helping to develop a support system within the school, meet regularly with teachers/counselors, encourage distractions such as hobbies and interests, and talking with your child about their feelings/fears about school.

4 Ways to Help Encourage Your Children to Attend School

Although it can be scary and troubling when your son or daughter starts refusing to go to school, it?s important to remember there are things you can do to help.?students chairs

  1. Don?t panic!? It?s tempting to interpret refusal as disrespect, rather fear or distress.? Keep your cool.
  2. Intervene early, as it will improve outcomes.
  3. Utilize outside support; spouse, teachers, counselors, therapists, etc.? You don?t have to do it on your own.?(816) 448-1663
  4. Be supportive.

For more information about helping your child or teen manage their anxiety reach out to Armstrong Family Counseling, (816) 448-1663?or at ArmstrongFamilyCounseling.com.

Coping With Addiction: How To Get Back On Track After A Relapse

For the millions of Americans who are living with an addiction, learning how to cope with the stress and pressure of getting sober can be overwhelming. Relapses are common, and they can bring a weight of guilt with them, which can in turn lead to more substance abuse. It?s a very difficult cycle to break, but it?s important to figure out the best ways to get healthy in every way–mind, body, and soul–so that you can get back on track without sacrificing everything you?ve worked so hard for.

Fortunately, there are several things you can do to help things fall into place after a relapse. From opening up communication with your family members to practicing meditation and learning how to relax, taking care of yourself is the first priority. Whether that means ridding yourself of guilt and shame or simply learning how to cope with stress, finding out what works for you will help you break the cycle for good.

Keep reading for some great tips on how to feel better and get healthy after a relapse.

Ask for help

It can be very challenging and humbling to ask for help, especially if you?ve already done it once before, but suffering a relapse is nothing to be ashamed of. It happens to many individuals who have made a commitment to turn their lives around, and it?s not an indication of failure. The key is to recognize the issue and ask for help as soon as possible so that you may begin rebuilding. Find a counselor, therapist, or group session you can join, or talk to your sponsor or a close family member or friend.

Relax

Stress is a major contributing factor to many relapses, so it?s imperative to learn how to cope with those feelings and reduce them. This might mean learning how to say no, finding a way to reduce your task load at work, or working on family issues.

Think about the things that bring you the most stress and how you can effectively make your life easier. In the meantime, you can practice meditation and/or yoga to help break down those feelings. This has long been a benefit for those who are struggling with stress and anxiety. Make sure you have a quiet space to relax in that is free of distractions. You can find out more about creating a meditation space here.

Forgive yourself

The way you handle your relapse is extremely important. If you feel guilt or shame, it will be nearly impossible for you to move on and make healthy choices, so it?s important to learn how to handle those emotions and how to forgive yourself. This may require the help of a therapist, or you might talk to your friends and family about your struggle. Sometimes, simply being open and honest about what we?re going through is the best way to move on.

Adjust your strategy

It?s always possible to make changes to the way you approach your sobriety, and it?s important to do so if you feel it isn?t working. You might take a look at the people you spend the most time with. Are they supportive? Are there people in your life who abuse drugs or alcohol when you?re around? It can be difficult to make major changes, especially when it comes to your relationships, but it?s critical to make your own health a priority.

Coping with addiction relapse is never easy, and it often takes time to get to the place you want to be in. Try to be patient with yourself during this time, and think hard about the way any changes you make to your lifestyle will affect you down the road. With a good plan, you can get your life back on track.

Constance Ray started Recoverywell.org with the goal of creating a safe place for people to share how addiction has affected them, whether they are combating it themselves or watching someone they care about work to overcome it. The goal is to share stories of hope from survivors who know that the fight against addiction is one worth having, because no matter how it affects you, life can get better.

 

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