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.
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.
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.?
- Don?t panic!? It?s tempting to interpret refusal as disrespect, rather fear or distress.? Keep your cool.
- Intervene early, as it will improve outcomes.
- Utilize outside support; spouse, teachers, counselors, therapists, etc.? You don?t have to do it on your own.?(816) 448-1663
- Be supportive.
What do you do?
My real title is Option Bringer. Clients that seek counseling often feel that there are little to no options in what they are struggling with. My role is to show them that there are options. I accomplish this by connecting. Connection is the key! My approach emphasizes creating a safe nonjudgmental space that allows clients to process their thoughts, feelings, and experiences. I enjoy giving clients homework in the form of worksheets that they can utilize to gain insight, knowledge and perspective. These are ?tools? that can provide clients success if they utilize them. All of this can provide hope and a way forward even in the most difficult of circumstances.
How do your life experiences contribute to your counseling style?
Helen Keller once said, ?Character cannot be developed in ease and quiet. Only through experience of trial and suffering can the soul be strengthened, ambition inspired, and success achieved.? My life and all its mountain tops and valleys are a reflection of this quote. Listing my ?credentials? in life doesn?t seem enough. We all have our trials and moments of great stress and grief that shape our life. I have endured and been blessed by my own. From the pain of addiction to the loss of my sister to suicide, those things were not easy to overcome. But God?s grace showed me I can. His strength was what I needed to stand and find my way out of the darkness.
This road of growth and change also wasn?t without error. Mistakes, yes, there were a few. But I learned from them. Through it all, including my years in graduate school and this journey of counseling, I have had a couple of constants that have kept me going. First, is my relation with Jesus Christ. He has guided me through all the twists and turns of my life. He has never left my side or walked away, even when I detoured from Him. Whatever success I have in this field I owe to Him. I can?t do this without His direction and His wisdom. Then there is my wife LeeAnn. She has validated and affirmed me like no one else. She helped me believe that I can go from being pessimistic to optimistic. I am driven to be the best I can be due to her never-ending patient love for me. So game on! I am in this game, an active participant, and I look forward to helping you elevate your game.
What do you specialize?
I work predominantly with adults 18 and up. Within that age group, I work and support clients in the following areas:
Blended Family issues.
Foster Parent issues
Depression and Anxiety
Domestic Violence, both victim and perpetrator
How do you approach therapy?
Everything in the client/counselor relationship starts with rapport. This is a strength I believe I have. As I mentioned earlier, having connection with the client is a cornerstone to success. Being consistent and showing up as myself. Showing up as authentic and fully present is something I strive for in every session. I don?t try to be someone I?m not.
Clients benefit when they see that they can be authentic. They don?t have to pretend they have it all together. They can be themselves around me. As trust increases, clients often start to peal back the different layers of their life. That?s when the real work begins. Lastly, as a Christian, whatever skill sets I have I rely on Him for guidance. So prayer is something that if clients ask for it, I offer it to them. Prayer is vital to what success I have and prayer is an effective weapon against the difficulties that all of us go through.
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As we’ve recently celebrated Father?s Day, I was reminded that the purpose of Father?s Day is to acknowledge all fathers and celebrate their special day. However, if your family has been impacted by divorce, it may not seem like a celebration. If this sounds like your situation, it may feel extremely stressful for you, your ex, and your children. If you are a mother, please remember you are normally the first person your child bonds with. Therefore, you can assume a positive role of modeling how to respect their father, no matter how you may feel about him (unless he was abusive and safety is a concern.) I would ask the same type of respect from him on Mother?s Day.
By having an open dialogue with your ex, your communication models how you have set aside any negative feelings toward the father(s) of your children because you know that is best for your child or children. Depending on the ages of your child/children, volunteer to take them to a card store so they can choose a Father?s Day card. Or, if that isn?t in your budget, suggest that they make a card.
If your child/children express an interest in giving dad a gift, again, follow through with their idea. If finances are an issue, once again, encourage them to make something for dad. Even if you have negative feelings toward their father, by helping them with these tasks, you are modeling for them how to ?care? for another human being.
Allow your children to spend Father?s Day with their dad on his special day. Try to do this no matter what is outlined in your parenting plan (if you don?t have a parenting plan or need to revise it and don?t want to pay for an attorney or the cost of going to court, consider contacting a mediator to help you resolve any conflicts or to assist you in making changes to the plan.) Flexibility and mutual consideration as co-parents makes your children much healthier emotionally and mentally.
If geography or travel logistics are an issue in bringing together your children and their father, suggest using social media so they can ?see each other.? Depression, loneliness and isolation are common in divorced or estranged parent(s.) If you experience these things frequently, please contact a therapist and /or seek help. I can help you. Your children need you in their lives.
Fathers, you need to ask your ex-spouse and/or the mother of your children for what you need. Maybe you (father) would really like your child/children to spend Father?s Day and an additional day since school is out for the summer. If you and your ex can communicate and practice being flexible, you are less likely to feel resentful.
For both parents, even though you are divorced, remember to stay focused on the needs and well-being of your child/children. It is crucial to plan ahead for holidays or other ?special? days so your child/children see that even though you are divorced, both of you are co-parenting in healthy ways.
If you are struggling with co-parenting, or other issues, mediation may be something to consider. Mediation is a more peaceful, economical resolution to resolve conflict. Please contact me. I am a therapist and a?Kansas State Supreme Court Approved Mediator.? Let’s start rebuilding your relationships today!
Remember the song ?Danger Zone? from the movie Top Gun? I loved that movie, and the Kenny Loggins song is a must for any retro fan. In the movie, the song was the perfect soundtrack for those flying scenes, as the pilots pushed their aircraft to the limits and beyond?into the danger zone, where the engines could stall or worse. It was a perilous place to be.
Serious mountain climbers know about the ?death zone.? On Mount Everest and some of the other highest peaks in the world, once a climber reaches about 26,000 feet, the amount of oxygen is insufficient to sustain human life. Many climbers have died because they weren?t properly prepared or didn?t have enough oxygen with them.
Most of us will probably never climb into a fighter jet cockpit or attempt to summit the world?s tallest mountain, but there is another danger zone where we dads often find ourselves with our families: the comfort zone. I like being in the comfort zone. It?s free of stress and the craziness of life that is so often around me at home. Some might call this my ?happy place.? There are times that we need an oasis where we can drown out life around us and find peace and serenity. But if we want what?s best for our families, the comfort zone is a place we are never meant to stay for very long.
When I first got married, I married not only my wife but also her family, which included two boys in their mid to late teens. For a while I had a hard time building a relationship with them. I?d get home from work in the evening and they?d usually be in the living room, watching a television show I didn?t get or couldn?t care less about. It was much easier for me to get my dinner and retreat into the more comfortable sanctuary of my bedroom. I could read a book or watch TV and I didn?t have to engage with them unless it was on my terms.
At the time, I thought: What was the point? I couldn?t relate to them and they certainly couldn?t relate to me, at least on the surface. Clearly, I was missing the point. I was off in my comfort zone, and I wasn?t going to be intentional about being a dad to them.
My wife LeeAnn was so patient with me, and every now and then she would enter my serene hideaway and remind me that I didn?t marry just her, but also two boys she loved deeply. If I wanted to develop a better relationship with them, I had to leave the Comfort Zone. I had to engage them.
That word ?engage? has transformed who I am as a father. This didn?t happen overnight, and there were starts and stops as I kept fighting off selfishness and the desire to go back to the Comfort Zone. But then one day my father-in-law gave me advice on how to be intentional as a dad. He said that if I wanted to become closer to the children, I had to drop the labels?quit thinking of them as my stepsons and foster daughters but rather as my sons and daughters. I had to stop labeling myself as a step dad and foster dad, and just be dad. He said the labels that we use often create distance and give those of us that are not biological dads an excuse to keep that separation.
I had to stop labeling myself as a step dad and foster dad, and just be dad.
He was right. While an attorney might say that, from a legal perspective, step and foster kids are the correct wording, I have grown past that and see them as my children, for as long as God allows them in my life. Several months ago, we decided after 5 years of fostering, to take a break. It was good for our marriage, and last year, I discovered a whole new zone: The Grandparent Zone. Our youngest son and his wife gave birth to a beautiful baby boy. Now I get to learn to just be grand-dad!
Being an engaged dad means being hands-on and enthusiastically involved in your children?s lives. It?s getting to know them on their level and being consistent in letting them know you are there. It also means that as they get older you are coaching them and modeling how to live by your actions and how you live. An example of this is how they see you handle conflict or adversity and perhaps more important, how you treat your spouse or their mother. Believe me, your young ones are watching.
You can?t do these things by being in your comfort zone. That sends a whole other message that says ?Leave me alone,? or ?You?re not worth my time.?
That sounds cruel, doesn?t it? Yet our country is full of disengaged fathers. I see it in the neighborhood we live in, and as a foster dad, I see it in the families of the girls we work with. Many dads are physically absent, others are present but emotionally distant, and some have hurt their kids so much that they aren?t allowed to be around and in their life.
Engaged fathers and father figures really do make a difference. Since I have left my Comfort Zone as a dad, my relationships with both of my stepsons are vastly improved. Things are far from easy, but they can see that I?m more interested in them and many more activities and conversations have had positive results.
Do your relationships with your children need a transformation? Be an intentional, hands-on dad. You will make mistakes here and there, but you will also learn from them. Embrace your role as a father and make a difference in the lives of other kids. Close up shop on the Comfort Zone.
Even now, I have days when the comfort zone is awfully tempting. But I rely on my faith, my patient and loving wife, and other dads who encourage me.
Just Get Out of the Comfort Zone. Just Be DAD.
***Michael French is a father in Kansas City, a Christian Relationship expert at Armstrong Family Counseling, and was a top 5 finalist in the National Center for Fathering 2014 Kansas City?Father of the Year Contest. He is a Licensed Professional Counselor & has been blogging about his experiences at his website?Dads Unite. Mike has been married to LeeAnn for 10 years and has two grown stepsons and one adopted daughters.?