Let's Talk about Mental Health...

The month of May is Mental Health Awareness Month!

Image Credit: eachmindmatters.org

On May 13th, 2014, over approximately 1,500 people gathered on the steps of the California State Capitol to share ideas, tools, and resources for reducing stigma and raising mental health awareness. "Mental Health Matters Day" is part of an ongoing movement in California, fueled by Proposition 63, to reduce the stigma associated with mental illness and to increase awareness and access to mental health services in local communities across the state.

Image Credit: eachmindmatters.org

As a school counselor, I feel it is very important to talk about mental illness - an issue that affects 61.5 million adults in America each year.

What is Mental Illness? (National Alliance on Mental Illness - NAMI)

"A mental illness is a medical condition that disrupts a person's thinking, feeling, mood, ability to related to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life."

"Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD) and borderline personality disorder. The good news about mental illness is that recovery is possible."

"Mental illnesses can affect persons of any age, race, religion or income. Mental illnesses are not the result of personal weakness, lack of character or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan."

Image Credit: childmind.org

Mental Illness and Children

Many are less familiar with is how mental illness can affect children and adolescents. According to the National Alliance on Mental Illness (NAMI):

• One-half of all chronic mental illness begins by the age of 14, three-quarters by age 24. Despite effective treatment, there are long delays - sometimes decades - between the first appearance of symptoms and when people get help. 

• Approximately 20 percent of youth ages 13 to 18 experience severe mental disorders in a given year. For ages 8 to 15, the estimate is 13 percent. Almost one-half of youth ages 8 to 15 with a mental illness received no mental health services in the previous year. 

• Over 50 percent of students with a mental health condition age 14 and older who are served by special education drop out - the highest dropout rate of any disability group.

Image Credit: Huffington Post

When Should I Be Concerned?

Below are a few tools that parents can reference if they have concerns about a child's behavior or recent changes in mood. Keep in mind that tools are only to provide reference and that any ongoing concerns should be addressed by the student's pediatrician or a mental health professional. 

http://www.childmind.org/en/health/symptom-checker

It's important to remember that there are many children living with a parent that has mental illness. This may impact the student in a number of ways, including emotionally, behaviorally, and academically. Depending on the parent's access to resources and treatment, the student may not be in a 

stable environment or lacking the additional academic support at home. Additionally, cultural factors play a huge part in whether individuals with mental health seek treatment and services. These include language, cultural/community views of mental illnesses, and religion. 

Resources

NAMI: http://www.nami.org/template.cfm?section=Child_and_Adolescent_Action_Center

HERE you can find some excellent resources provided by NAMI for parents and caregivers of students which includes parenting resources, treatment and best practices, and much more. They even have resources for schools and child-serving professionals (HERE).

Interested in the other ways Proposition 63 is working to reduce the stigma of mental illness across California? Watch this Public Television documentary created by KVIE in Sacramento. "A New State of Mind" will air on KVIE on May 30th, 2014. You can also watch it at this link HERE or below. Another documentary, titled, "A Choice to Heal - Mental Health in California"will be aired on CBS stations on May 31, 2014 in the cities of Sacramento, Fresno, San Francisco, and Lost Angeles. This documentary will be hosted by Kevin Hines (http://www.kevinhinesstory.com), a survivor of his own suicide attempt 14 years ago and will also feature Mariel Hemingway, who addresses the history of mental illness in her own family. 

If you have additional questions about mental health or would like further information about how to bring awareness to the issue, you may contact me directly at chines@natomascharter.org.

All About ADHD

Image Credit: Mind Med 

ADHD, or Attention Deficit Hyperactivity Disorder, is a biological disorder that is one of the most researched topics in child and adolescent mental health. Although the definition of ADHD has changed many times in the last decade (reflecting changes in conceptualization of the disorder and the newest research) the needs of the individuals and families living with ADHD have not. 

ADHD is not a mythical disorder. ADHD is a neurobiological disorder recognized by the American Medical Association, American Psychiatric Association, and American Pediatric Association (among many others). ADHD is more than a disorder of attention, hyperactivity, or poor impulse control, although these characteristics are generally the most observed.

"ADHD is not just a temporary state that a child will outgrow, or a normal phase of childhood that will pass in time. It is not behaviors caused by parental failure to discipline the child, or willfulness caused by bad temperament  but a real disorder that can be confusing, heartbreaking and nerve-wracking to the child and family that surrounds them. Even though there are no outward signs that a handicap is present, ADHD, like other disabilities, can bring significant challenges to the child and their family." (Lougy, DeRuvo, & Rosenthal, 2009). 


 Image Credit: Not Just a Bean Bag

ADHD is currently understood as a developmental impairment of the brain's self-management system (executive functioning). There is no relationship between intelligence and ADHD. Rather, there seems to be an important relationship ADHD and the ability to regulate emotions, as well as motivation. 

"Impairments of ADHD are not due to a global excess or lack of a specific chemical within or around the brain. The primary problem is related to chemicals manufactured, released, and reloaded...Persons with ADHD tend not to release enough of these essential chemicals, or to release and reload them too quickly. ADHD medication helps to improve this process."
(Thomas Brown, Ph.D. - ADDitudemag)

ADHD disrupts a person's ability to manage his/her behavior or to act with certain consequences in mind - which explains why individuals with ADHD struggle most when they must complete tasks with no "immediate payoff" - for school-age children and adolescents, this can mean homework, reading, writing, or household responsibilities. If the task at hand does not offer immediate reinforcement or reward, chances are the individual with ADHD will struggle to complete the given task.

"Goal-directed, future-oriented behavior demands that a person be able to motivate himself/herself internally. This ability is described as willpower, self-discipline, ambition, persistence, determination, or drive. ADHD disrupts this mechanism, leaving those with the disorder 'low on fuel' in motivating behavior toward future rewards.

If a task provides motivation and offers immediate gratification - such as playing a video game - a person with ADHD will have no problem sticking with it. Give these kids a task for which there is no external reinforcement or payoff, however, and their persistence falls apart. They jump from one uncompleted activity to another and become bored and disengaged."

(Carol Brady, Ph.D., Robert M.A. Hirschfeld, M.D., Russell Barkley, Ph.D. - ADDitudemag)

"Clinical data indicate that executive function impairments are situationally-variable; each person with ADHD tends to have some specific activities or situations in which he/she has no difficulty in using executive functions that are significant impaired for him/her in most situations. Typically, these are activities in which the ADDer has a strong personal interest or about which he/she believes something unpleasant will follow quickly if he does not do the task right now."
(Thomas Brown, Ph. D. - ADDitudemag)

    Image Credit: The Crimson White

The American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-V) separates ADHD by the categories of Inattention, Hyperactivity, Impulsivity.

Click HERE for ADDitudemag.com's Checklist of 18 ADHD Symptoms.

In general, symptoms of ADHD manifest differently for every individual. How these symptoms present themselves as well as when they become a significant impairment (childhood vs. adolescence vs. adulthood) can vary greatly from person to person.

"Recent research has shown that many with ADHD function well during childhood and do not manifest any significant symptoms until adolescence or later, when greater challenges to executive function are encountered. Over the past decade research has shown that impairing symptoms of ADHD often persist well into adulthood. However, studies have also shown that some individuals with ADHD during childhood experience significant reductions in their impairments as they grow older."
(Thomas Brown, Ph. D. - ADDitudemag)

Research suggests that there are significant gender-related differences in the manifestation of ADHD. Girls are generally less impulsive and are more likely to exhibit the inattentive type of ADHD. Research also indicates that children diagnosed with Autism Spectrum Disorder or Oppositional Defiant Disorder (ODD) are often likely to have a co-occurring diagnosis of ADHD.

    Image Credit: Silicon Valley Brain Spect Imaging, Inc. 

Unfortunately, there are still many misconceptions and myths about individuals with ADHD. It can be difficult to understand ADHD, as symptoms can vary greatly between individuals and change situationally. Many struggle to understand why someone with ADHD can maintain focus or "hyperfocus" on things that interest them, like video games, but have a hard time sticking with other things, like school work. This can lead to assumptions that the child is being "willfully disobedient" or lacking discipline. Dr. Robert Hirschfeld, M.D., describes his son's experience with ADHD and the common misconceptions that accompany ADHD:

"Unfortunately, when it comes to brain disorders, such as ADHD, depression, or other neurobiological conditions, a harmful attitude creeps in : the belief that attention deficit disorder, and other disorders originating in the mind, reflect 'bad character' and that all it takes is more willpower to overcome them.

As a psychiatrist, and also as the father of an ADHD child, I know how destructive this view is. Many people with depression suffer for years because they've tried to makes themselves feel better, and they still can't function. Coworkers and spouses become frustrated and blame the sufferer when attempts to 'jolly' a person out of a depression don't work. Their lack of understanding adds guilt and shame to the long list of problems that depressed people cope with.

My son could not will himself to not have ADHD. Trying to get him to change his ADHD behavior didn't work. And had we stopped at that, his life would have been marked by frustration and failure. Without proper medical, psychological, and educational interventions, no amount of willpower could have helped. Fortunately, our continued interventions enabled our son to share his own destiny and experience many successes."

    Image Credit: nwfdailynews

The primary treatment for ADHD is a combination of medication and therapy. Experts in the field agree that medication should be considered for children with ADHD, whose symptoms are interfering with social, emotional, or academic functioning. Types of behavior therapy and alternative treatments can be helpful in managing ADHD symptoms, however, they do not take the place of medication. Experts also agree that children should be told about their diagnosis. Often, many parents will ask the doctor to tell the child about ADHD and to answer any questions he/she might have. Keeping the diagnosis a secret does a disservice to the child, and ultimately communicates that there is something wrong with having ADHD. There are now a variety of books and resources (see the Resources section later on) for children newly diagnosed with ADHD. These materials can help further explain ADHD, answer questions, and normalize any feelings or worries they might have.

"'If your child has been diagnosed with ADHD and is struggling, he probably needs medication, '" says Stephen Copps, M.D., an ADHD specialist in Macon, Georgia. 'Medication is the cornerstone of therapy. It's appropriate for most children with diagnosable ADHD. It is not a last resort.'

Of course, it's essential that your child's diagnosis of ADHD is a reliable one. ADHD-like symptoms can be caused by a range of disorders, including anxiety, depression, and obsessive-compulsive disorder. In some cases, a child's symptoms arise from the frustration associated with having to struggle with a learning disorder. 

Make sure the doctor uses the diagnostic criteria spelled out in the...Diagnostic and Statistical Manual of Mental Disorders, commonly referred to as the DSM-IV [note: the newest edition is the DSM-V]. The doctor should get input from your child's teacher as well as from you, his/her parents."
(ADDitudemag.com)

"Studies and Clinical trials have shown that ADHD medications give the following benefits to some children and adults: 

• improve the working memory, classroom behaviors, the motivation to execute tasks, and to persist in solving problems
• minimize boredom, distractibility when doing tasks, and emotional outbursts
• increase test performance, rates of graduation, and other achievements that can have lasting effects
• normalize structural abnormalities in specific brain regions"

(Thomas Brown, Ph. D. - ADDitudemag)

    Image Credit: ADDitudemag.com

What Can I do?

As a parent or teacher of a student with ADHD, it can be difficult to know how to best support the student and provide them with the tools they need to be successful. Certain behaviors associated with ADHD can be frustrating for parents and teachers trying to help, as well as the student, who may often face disappointment, shame, or negative self-esteem as a result of behaviors they cannot control.

Expert Advice:

"To help a child with ADHD complete work when there is little immediate reward or interest in the task, adults can establish artificial rewards to sustain motivation. Earning tokens, chips, or other external rewards will help them persist. Without such rewards, they cannot themselves must the intrinsic willpower to stick with a task. So, if your child with attention deficit disorder needs to read an entire chapter of a textbook, offer a reward for each segment of the work. Eventually, he will be able to sustain attention for longer periods, as tenacity becomes a habitual response to work."

(Russell Barkley, Ph.D. - ADDitudemag)

"Providing ADHD kids with structure--and supporting a habit of following that structure--helps them develop self-management skills that offset the impulse to veer off track. People with ADHD who never learn these skills are in for a bumpy ride. Dismissing typical ADHD behaviors as 'boys being boys' denies kids the help they need to become independent, responsible teens and adults."

(Carol Brady, Ph.D. - ADDitudemag)

ADDitudemag.com is a comprehensive resource for any parent, teacher, or professional working with a child that has ADHD. ADDitude Magazine has clear, user-friendly information and advice from experts in the field of ADHD and mental health practitioners. Parents can find parenting strategies, education and learning resources, first-person stories from individuals dealing with ADHD, online communities for parents to share tips and resources, and much more. Their free webinars offered are very informative and provide the newest information about treating ADHD from experts around the country: http://www.additudemag.com/webinars/

My Favorite ADDitude Articles for Parents and Teachers:

Classroom and School Accomodations for Children with ADHD

http://www.additudemag.com/adhd/article/print/5901.html

ADHD at School: Giving Instructions and Helping Children Follow Directions

http://www.additudemag.com/adhd/article/print/1033.html

ADHD Parenting Tips from an ADHD Coach

http://www.additudemag.com/adhd/article/print/8948.html

12 Parenting Strategies that Work for ADHD Kids

http://www.additudemag.com/adhd/article/print/985.html

ADHD Secrets My Teacher (And Parent) Should Know

http://www.additudemag.com/adhd/article/print/10599.html

Image Credit: FTSI Connecting

Additional Resources

ADHD Webpage

Richard Lougy, MFT

http://www.thesekidsaredrivingmecrazy.com/

Free resources and professional services, for parents, teachers, and other caretakers of children with ADHD.

Books for Parents 

A New Understanding of ADHD in Children and Adults: Executive Function Impairments

Thomas E. Brown

The Gift of ADHD

Lara Honos-Webb

1-2-3 Magic

Thomas W. Phelan

Smart but Stuck: Emotions in Teens and Adults with ADHD

Thomas E. Brown, Ph.D.

Books for Children

The Survival Guide for Kids with ADD or ADHD

John F. Taylor

It's Hard To Be A Verb

Julia Cook 

Super Emotions! A Book for Children with ADD/ADHD
Lionel Lowry

Learning to Slow Down and Pay Attention: A Book for Kids about ADHD
Kathleen G. Nadeau

Being Present

Counselors talk a lot about “being present.” I can’t tell you how many times I’ve encouraged teens and parents to unplug their cell phones, turn off their computers, and carve out some time to be present with one another. Sometimes I suggest taking a walk together after dinner, spending a weekend afternoon outdoors, or just eating a meal together (without the presence of any electronic devices). Not only is this time important for communication and stress relief, but it allows us to be “present” in our daily lives. In this modern world we live in, we are often more future-oriented than present-oriented - always planning for some infinite event in the near or distant future. For example: soccer tournaments, SAT preparation classes, family vacations, birthday parties, a trip to the grocery store, car repairs, that upcoming insurance payment, taxes…

Personally, my to-do list is about 12-15 items long, and each week, as I check one or two things off, I add at least four or five more items. (Sigh). Every day after leaving work, my cell phone continues to “ding” with notifications, new emails, and reminders, which all distract me from the precious few hours I have at home to be present with my children (who I haven’t seen all day!)

Even the weekends seem hectic, and often I feel compelled to try and power through my endless to-do list - dragging the kids along with me from store to store, just trying to get a few extra things done.

This past Saturday was just this kind of day. I was attending a baby shower in a city an hour away with my 1 year-old daughter. After leaving the house, I realized I was almost out of gas, and that I had forgotten to bring baby wipes (not to mention I only had one spare diaper with me). Instead of turning around and going all the way back home, I stopped at the grocery store to pick up a few items. 

I rushed through the aisles, eyes darting, as I looked for the aisle with baby products. I could feel the imaginary clock ticking as I pushed the cart with my daughter, thinking about how late I was probably going to be, and how I still needed to fill up the car with gas.

I approached the self-checkout with my items, tapped quickly and loudly on the screen, swiped my card, bagged the items, and made a beeline for the door. Suddenly, an older woman, about my grandmother’s age, appeared in my line of vision. I looked ahead, thinking she was just passing by, but she got closer, and reached out to touch my shoulder.

“Stop! Oh please stop! You have to let me see that baby!” she exclaimed.

“Oh!” I said, startled, and smiled. “Of course!”

(I was slightly frustrated by the fact that this would throw me even more off schedule, but I certainly did not want to offend such a kind woman.)

She stood quietly for a moment, admiring my daughter, who sat staring back at her from the carseat.

“She’s beautiful,” she whispered.

All this time, as I rushed through the aisles and the self-checkout, I realized I had not once stopped to smile or even look at my daughter. I was so focused on getting to the baby shower, sticking to my schedule, and finding the closest gas station, that I had completely forgotten one of the most important people in my life was sitting right in front of me.

I could feel my shoulders relax and the tension in my face melt away, as I stared at my daughter and thought to myself: Yes, I am so lucky.

“Thank you,” I replied.

To my surprise, she grabbed my cheeks with her hands (just as a grandmother would) and told me to enjoy my little ones, because, “They grow so fast!”

You’re absolutely right. Too fast! My son is going to kindergarten next year. How is that possible? My baby is no longer a baby - she’s a toddler! My oldest will be ten this year.

I thanked her again, and slowly headed for the door.

Walking towards the car, I noticed that I no longer could hear the imaginary clock ticking loudly, and I was no longer rushed to find the next gas station. As I sang a little song to my daughter and smiled at her on my way to the car, I noticed that I felt lighter and happier.

As we drove to find a gas station, I realized the Universe had just reached out, touched me on the shoulder, and given me a very important message:

SLOW DOWN and be present.

For more inspiration and guidance, I would recommend checking out Rachel Macy Safford’s blog: http://www.handsfreemama.com/. This blog has some wonderful posts related to parenting, letting go, and being present. She also has a brand new book, titled: “Hands Free Mama: A Guide to Putting Down the Phone, Burning the To-Do List, and Letting Go of Perfection to Grasp What Really Matters!”

Dream Big

“If I cannot do great things, I can do small things in a great way.” - Dr. Martin Luther King, Jr.

Each January, we celebrate the life of Dr. Martin Luther King in our schools and communities, and remember his inspiring words, which echoed from the steps of the Lincoln Memorial and through a crowd of 250,000 during the March on Washington.

Dr. King dreamed of brotherhood, justice, equality, and dreamed that one day, we would all be free. He sought peace and dedicated his whole life to pursuing it.

Teaching our children about PEACE is a great way to honor the memory of Dr. King. However, children must be taught about the hard work and determination needed to achieve peace.

Dr. King did not accomplish his work quickly, or easily. He struggled, he was rejected by others, and he was faced with opposition time and time again.

It is easy to associate peace with quiet or calm, when in fact, it is just the opposite. In order to create peace, you have to be bold and courageous!

Dr. King was more than a bystander. He knew that remaining silent in the face of injustice was just as harmful as the outright support of inequality or discrimination.

To honor Dr. King, we can teach our children to stand up and speak up in the face of unfair treatment. We can support our children by teaching them skills to advocate for themselves, but also for others, especially those who may not be able to advocate for themselves.

We can teach our children to hope and dream. Dream BIG. Our children may have small hands and small feet, but their potential is immense. Anything they can do, can be done in a great way. That’s all that matters.

Finally, we can ask our children about their dreams: “What are your dreams for peace?” I imagine they are bright and colorful and filled with themes of love and equality.

One of my favorite young dreamers is Kid President. If you haven't seen one of his many YouTube videos already, he is definitely worth watching! This 9-year-old has created a phenomenon of encouragement and inspiration. He gives young people a voice and ideas to change the world! Since becoming Kid President, he has had the opportunity to meet singers, actors, and even President Barack Obama. Kid President shares his Dream:




Below is a short biography about 9-year-old Robby. He has already overcome some significant challenges in his life:



You can watch more of his videos, follow the blog, and read more about Kid President at:

http://www.kidpresident.com/

I also came across a story about a group of fifth grade students from Massachusetts who turned an after-school enrichment club into a larger-than-life demonstration of peace. In 2004, these students set a goal: to make the biggest book in the world about peace. The students sent thousands of letters to people around the world, asking for their responses to the following questions:

-What is world peace?

-Will there ever be world peace?

-Where would you like to see the world in 20 years?

The students received more than 3,000 responses from teachers, veterans, politicians, and even famous visionaries such as Nelson Mandela, the Dalai Lama, and former President Jimmy Carter. Their story is inspiring. You can read more about these peace-seeking students and how their work has influenced their plans for the future:

http://www.pagesforpeace.org/home.html

In addition, you can watch videos about their work and the teacher who led this project:

Dr. King’s work is never finished. And the work of future generations is just beginning.

Dream BIG.