How I Manage My Bipolar Disorder

by

Krystal Reddick

 

I went six years between my first (2007) and second (2013) hospitalizations. I pride myself on that. I was hospitalized for a third time in 2014. Through my three hospitalizations and three IOPs (Intensive Outpatient Therapy) I’ve met people on their 10th or 15th hospitalization. Some people are chronically unemployed or on disability. Their illness dictates the course for their life.

It doesn’t necessarily have to be this way.

To make sure I stay stable and highly functioning, I do a number of things:

1. For the past seven years, I’ve seen my therapist every three weeks and my psychiatrist every three months.
2. I’m a compliant patient; I take my medicine faithfully and go to all follow-up appointments.
3. I make time for leisure (reading, hanging out with friends, going out to eat, getting massages, shopping, watching TV, etc.).
4. For the past year I’ve been getting acupuncture regularly. I’m trying to balance out my reliance on Western medicine with more holistic practices.
5. I’m protective of my sleep. Not getting enough sleep can trigger depression or mania.
6. I exercise two to four days per week. There are numerous health benefits gained from exercise.
7. I try to eat healthy. I can definitely do a better job at this. I saw a nutritionist this summer and have made the dietary changes she suggested.
8. I try to minimize my stress triggers. Keeping up with all of the paperwork for my job usually takes a toll on me. So I try to manage my procrastination. I don’t always succeed at this. But I’m trying.

A stable life is highly doable. You have to take stock of your life and shape one you’d be proud and happy to live. It is a lot of work. But what in life isn’t?

 

Click here for original article: http://www.huffingtonpost.com/krystal-reddick/how-i-manage-my-bipolar-d_b_5559720.html?utm_hp_ref=healthy-living

Anxiety and Depression Together

By Hara Estroff Marano

The disorders are two sides of the same coin. Over the past couple of years, clinicians and researchers alike have been moving toward a new conclusion: Depression and anxiety are not two disorders that coexist. They are two faces of one disorder.

Are you anxious or are you depressed? In the world of mental health care, where exact diagnosis dictates treatment, anxiety and depression are regarded as two distinct disorders. But in the world of real people, many suffer from both conditions. In fact, most mood disorders present as a combination of anxiety and depression. Surveys show that 60-70% of those with depression also have anxiety. And half of those with chronic anxiety also have clinically significant symptoms of depression.

The coexistence of anxiety and depression-called comorbidity in the psych biz-carries some serious repercussions. It makes the course of disorder more chronic, it impairs functioning at work and in relationships more, and it substantially raises suicide risk.

Over the past couple of years, clinicians and researchers alike have been moving towards a new conclusion: Depression and anxiety are not two disorders that coexist. They are two faces of one disorder.

“They’re probably two sides of the same coin,” says David Barlow, Ph.D., director of the Center for Anxiety and Related Disorders at Boston University. “The genetics seem to be the same. The neurobiology seems to overlap. The psychological and biological nature of the vulnerability are the same. It just seems that some people with the vulnerability react with anxiety to life stressors. And some people, in addition, go beyond that to become depressed.”

They close down. “Depression seems to be a shutdown,” explains Barlow. “Anxiety is a kind of looking to the future, seeing dangerous things that might happen in the next hour, day or weeks. Depression is all that with the addition of ‘I really don’t think I’m going to be able to cope with this, maybe I’ll just give up.’ It’s shutdown marked by mental, cognitive or behavioral slowing.”

At the core of the double disorder is some shared mechanism gone awry. Research points to overreactivity of the stress response system, which sends into overdrive emotional centers of the brain, including the “fear center” in the amygdala. Negative stimuli make a disproportionate impact and hijack response systems.

Mental health professionals often have difficulty distinguishing anxiety from depression, and to some degree they’re off the hook. The treatments that work best for depression also combat anxiety. Cognitive-behavioral therapy (CBT) gets at response patterns central to both conditions. And the drugs most commonly used against depression, the SSRIs, or selective serotonin reuptake inhibitors, have also been proved effective against an array of anxiety disorders, from social phobia to panic and post-traumatic stress disorder (PTSD). Which drug a patient should get is based more on what he or she can tolerate rather than on symptoms.

And therein lies a problem. According to physicians Edward Shorter of Canada and Peter Tyrer of England, the prevailing view of anxiety and depression as two distinct disorders, with multiple flavors of anxiety, is a “wrong classification” that has led the pharmaceutical industry down a “blind alley.” It’s bad enough that the separation of anxiety and depression lacks clinical relevance. But it’s also “one reason for the big slowdown in drug discovery in psychiatric drugs,” the two contend in a recent article published in the British Medical Journal. It’s difficult to create effective drugs for marketing-driven disease “niches.”

Who is at risk for combined anxiety and depression? There’s definitely a family component. “Looking at [what disorders populate] the family history of a person who presents with either primary anxiety or depression provides a clue to whether he or she will end up with both,” says Joseph Himle, Ph.D., associate director of the anxiety disorders unit at University of Michigan.

The nature of the anxiety disorder also has an influence. Obsessive-compulsive disorder, panic disorder and social phobia are particularly associated with depression. Specific phobias are less so.

Age plays a role, too. A person who develops an anxiety disorder for the first time after age 40 is likely also to have depression, observes Himle. “Someone who develops panic attacks for the first time at age 50 often has a history of depression or is experiencing depression at the same time.”

Usually, anxiety precedes depression, typically by several years. Currently, the average age of onset of any anxiety disorder is late childhood/early adolescence. Psychologist Michael Yapko, Ph.D., contends that presents a huge opportunity for the prevention of depression, as the average age of first onset is now mid-20s. “A young person is not likely to outgrow anxiety unless treated and taught cognitive skills,” he says. “But aggressive treatment of the anxiety when it appears can prevent the subsequent development of depression.”

“The shared cornerstone of anxiety and depression is the perceptual process of overestimating the risk in a situation and underestimating personal resources for coping.” Those vulnerable see lots of risk in everyday things-applying for a job, asking for a favor, asking for a date.

Further, anxiety and depression share an avoidant coping style. Sufferers avoid what they fear instead of developing the skills to handle the kinds of situations that make them uncomfortable. Often enough a lack of social skills is at the root.

In fact, says Jerilyn Ross, LICSW, president of the Anxiety Disorders Association of America, the link between social phobia and depression is “dramatic. It often affects young people who can’t go out, can’t date, don’t have friends. They’re very isolated, all alone, and feel cut off.”

Sometimes anxiety is dispositional, and sometimes it’s transmitted to children by parental overconcern. “The largest group of depression/anxiety sufferers is Baby Boomers,” says Yapko. “The fastest growing group is their children. They can’t teach kids what they don’t know. Plus their desire to raise perfect children puts tremendous pressures on the kids. They’re creating a bumper crop of anxious/depressed children.”

Treatment seldom hinges on which disorder came first. “In many cases,” says Ross, “the depression exists because the anxiety is so draining. Once you treat the anxiety, the depression lifts.”

In practice, treatment is targeted at depression and anxiety simultaneously. “There’s increasing interest in treating both disorders at the same time,” reports Himle. “Cognitive behavioral therapy is particularly attractive because it has applications to both.”

Studies show that it is effective against both. But sometimes the depression is so incapacitating that it has to be tackled first. Depression, for example, typically interferes with exposure therapy for anxiety, in which people confront in a graduated way situations they avoid because they give rise to overwhelming fear.

“Exposure therapy requires substantial effort,” explains Himle. “That’s effort that depressed people often do not have available to them.” Antidepressants can make a difference. Most SSRIs are approved for use in anxiety disorders and are the first line of drug therapy. But which drug works best for whom can not be predicted in advance. It takes some trial and error.

Ross finds CBT 80-90% successful in getting people functioning well, “provided it’s done correctly.” Not all psychotherapy is CBT, which has a very specific set of procedures, nor is every mental health professional trained in CBT. “Patients have to make sure that is what they are really getting.”

Medication and CBT are equally effective in reducing anxiety/depression. But CBT is better at preventing relapse, and it creates greater patient satisfaction. “It’s more empowering,” says Yapko. “Patients like feeling responsible for their own success.” Further, new data suggests that the active coping CBT encourages creates new brain circuits that circumvent the dysfunctional response pathways.

Treatment averages 12 to 15 weeks, and patients can expect to see significant improvement by six weeks. “CBT doesn’t involve years and years of talk therapy,” says Ross. “There’s homework, practice and development of lifestyle changes. Once patients learn how to identify the trigger thoughts or feelings, or events or people, they need to keep doing that. CBT gives people the tools they need.”

Original post:

https://www.psychologytoday.com/articles/200310/anxiety-and-depression-together

How is Obsessive-compulsive disorder (OCD) diagnosed?

Original article: http://www.mind.org.uk/information-support/types-of-mental-health-problems/obsessive-compulsive-disorder-ocd/treatments/#.Vd9SZn0jnm4

 

If you are concerned that you have OCD, and you want to seek professional help, the first step would normally be to visit your GP.

Your GP can provide an assessment and diagnosis, and help you access appropriate treatment.

If you visit a doctor to talk about OCD, they are likely to ask you direct questions about possible symptoms. For example:

• Do you wash or clean a lot?
• Do you check things a lot?
• Is there any thought that keeps bothering you that you’d like to get rid of but can’t?
• Do your daily activities take a long time to finish?
• Are you concerned about putting things in a special order or do you find mess very upsetting?
• Do these issues trouble you?
• How are they affecting your everyday life?

A doctor will then consider your answers against a list of medical criteria in order to make a diagnosis. If you receive a diagnosis of OCD, it should also say how severe your OCD is; for example, if you have mild, moderate or severe OCD.

It can be extremely difficult to discuss your experiences with a doctor, particularly if you experience distressing thoughts about issues such as religion, sex or violence. However, it is important to try and talk as honestly as you can, so your GP can suggest the right type of help for you.

If you find it difficult talking about your OCD, you may find it useful to prepare beforehand. You could think about how you would answer the questions above and write down the answers to take with you. Then if you start to feel embarrassed or overwhelmed when you are with your GP, you can refer to your notes – or even hand them to the doctor.

What treatments are available?

Before you have any treatment, your doctor should discuss all your
treatment options with you, and your views and wishes should be taken
into account.

NICE’s ‘stepped’ model

If you access help on the NHS, your treatment should be in line with
NICE (National Institute for Health and Care Excellence) guidelines.
NICE recommends ‘stepped’ treatment for OCD. This means that you
should receive different types of treatment depending on how severe
your symptoms are and how you responded to any previous treatment.

The diagram below is adapted from NICE’s guidelines.

However, the treatments recommended in the NICE guidelines are not appropriate for everyone. There are a number of options available to treat OCD and different things work for different people. You may find that a combination of approaches is most helpful for you, and different approaches may help you at different times.

Cognitive behavioural therapy (CBT)

CBT techniques helped me to see the intrusive thoughts for what they are, and put  them in their place. Cognitive behavioural therapy (CBT) is a talking treatment which aims to identify connections between your thoughts, feelings and behaviour. It aims to help you develop practical skills to manage any negative patterns of thinking or behaviour that may be causing you difficulties. It can be done one-to-one, or in a group. There is considerable evidence to suggest that this therapy is especially effective in dealing with OCD.

The behavioural element (also known as Exposure Response Prevention – ERP) is strongly recommended for treating OCD. ERP works by helping you to confront your obsessions and resist the urge to carry out compulsions. The aim is to help  you feel less anxious about obsessive thoughts over time, and make you less likely to engage in compulsive behaviour. For example, if you fear that you will harm someone and avoid sharp objects as a result, you might build up to a therapy session where you hold a knife while sitting in a room with other people. This technique needs to be carefully managed to avoid causing distress and anxiety, so it is important that you understand the treatment fully and feel comfortable with your therapist.

“It’s hugely frustrating and exhausting trying to break out of patterns that you know aren’t helpful or healthy. It can feel hopeless. But by challenging the behaviours, thoughts or compulsion you can eventually achieve fresh change that seemed impossible.”

You are entitled to receive free CBT on the NHS, and your GP should be able to  refer you to a local practitioner. However, waiting times for talking treatments on the NHS can be long. If you feel that you don’t want to wait or that you would like more support than is being offered, you may choose to see a therapist privately. The British Association for Behavioural and Cognitive Psychotherapies maintains a register of accredited CBT therapists.

Medication

Some people find drug treatment helpful for OCD, either alone or combined with talking treatments, such as cognitive behaviour therapy (CBT).

“I’ve been on meds for the last three years and my OCD is so much more controllable. Before taking any medication, it is important to read the patient information leaflet (that comes with the medicine) and discuss possible benefits and side effects with your doctor.”

Antidepressants

The drugs prescribed most commonly are SSRI antidepressants, such as fluoxetine (Prozac), fluvoxamine (Faverin), paroxetine (Seroxat), citalopram (Cipramil) and sertraline (Lustral). These drugs are all recommended by NICE for the treatment of OCD. These drugs may have side effects, including nausea, headache, sleep disturbance, gastric upsets and increased anxiety. They may also cause sexual problems. The tricyclic antidepressant clomipramine (Anafranil) is also licensed for the treatment of obsessional states in adults. This should  normally only be prescribed if an SSRI antidepressant has already been tried and not been effective. The side effects of clomipramine can include a dry mouth, blurred vision, constipation, drowsiness and dizziness.

Tranquillisers

If you are experiencing very severe anxiety as a result of OCD, you may be offered tranquillising drugs, such as diazepam (Valium). This type of medication should only be used for short periods of treatment because of the risk of addiction. The side effects of tranquillisers can include drowsiness, confusion, unsteadiness and nausea.

Beta-blockers

Beta-blockers are occasionally given to people to treat the immediate symptoms of severe anxiety. They don’t treat the anxiety itself, but act on the heart and blood pressure to reduce physical symptoms, such as palpitations. The beta-blocker  most commonly used for anxiety is propranolol (Inderal). The main side effects include a slow heartbeat, diarrhoea and nausea, cold fingers, tiredness and sleep problems.

Neurosurgery for mental disorder

Neurosurgery (previously known as psychosurgery) is surgery on the brain. It is not recommended for treating OCD, but is very occasionally offered in severe cases, when other treatments have been unsuccessful. Neurosurgery is strictly regulated under the Mental Health Act, and can’t be given without consent.

Community mental health and social care

If your OCD is severe or complex, your GP may refer you to a community mental health team (CMHT). A CMHT is usually made up of range of professionals, such as psychiatrists, psychologists, social workers and occupational therapists. The team can offer medication, basic counselling or other mental health treatments like cognitive behaviour therapy (CBT). They should also be able to help with you with wider issues you have as a result of your OCD, such as difficulties around housing, benefits or everyday living. Even if you are not referred to a CMHT, or if you feel you are not receiving the support you need, you may be entitled to have a social care assessment to see if you are eligible for social care support.

Specialist OCD services

If you require more intensive support, it is recommended that you are referred to a specialist OCD service in your area. However, in reality, access to specialist  services across the country is patchy and you may need to travel outside your  local area.

If you feel you are not getting access to the treatment you require, you may find it useful to have an advocate. This is someone who can support you and speak up for you, so you can get the help you need. You can find an advocate by contacting your local Patient Advice and Liaison Service (PALS) via NHS Choices. Some local Minds also run advocacy services.

How is Obsessive-compulsive disorder (OCD) diagnosed?

Original article: http://www.mind.org.uk/information-support/types-of-mental-health-problems/obsessive-compulsive-disorder-ocd/treatments/#.Vd9SZn0jnm4

 

If you are concerned that you have OCD, and you want to seek professional help, the first step would normally be to visit your GP.

Your GP can provide an assessment and diagnosis, and help you access appropriate treatment.

If you visit a doctor to talk about OCD, they are likely to ask you direct questions about possible symptoms. For example:

• Do you wash or clean a lot?
• Do you check things a lot?
• Is there any thought that keeps bothering you that you’d like to get rid of but can’t?
• Do your daily activities take a long time to finish?
• Are you concerned about putting things in a special order or do you find mess very upsetting?
• Do these issues trouble you?
• How are they affecting your everyday life?

A doctor will then consider your answers against a list of medical criteria in order to make a diagnosis. If you receive a diagnosis of OCD, it should also say how severe your OCD is; for example, if you have mild, moderate or severe OCD.

It can be extremely difficult to discuss your experiences with a doctor, particularly if you experience distressing thoughts about issues such as religion, sex or violence. However, it is important to try and talk as honestly as you can, so your GP can suggest the right type of help for you.

If you find it difficult talking about your OCD, you may find it useful to prepare beforehand. You could think about how you would answer the questions above and write down the answers to take with you. Then if you start to feel embarrassed or overwhelmed when you are with your GP, you can refer to your notes – or even hand them to the doctor.

What treatments are available?

Before you have any treatment, your doctor should discuss all your
treatment options with you, and your views and wishes should be taken
into account.

NICE’s ‘stepped’ model

If you access help on the NHS, your treatment should be in line with
NICE (National Institute for Health and Care Excellence) guidelines.
NICE recommends ‘stepped’ treatment for OCD. This means that you
should receive different types of treatment depending on how severe
your symptoms are and how you responded to any previous treatment.

The diagram below is adapted from NICE’s guidelines.

However, the treatments recommended in the NICE guidelines are not appropriate for everyone. There are a number of options available to treat OCD and different things work for different people. You may find that a combination of approaches is most helpful for you, and different approaches may help you at different times.

Cognitive behavioural therapy (CBT)

CBT techniques helped me to see the intrusive thoughts for what they are, and put  them in their place. Cognitive behavioural therapy (CBT) is a talking treatment which aims to identify connections between your thoughts, feelings and behaviour. It aims to help you develop practical skills to manage any negative patterns of thinking or behaviour that may be causing you difficulties. It can be done one-to-one, or in a group. There is considerable evidence to suggest that this therapy is especially effective in dealing with OCD.

The behavioural element (also known as Exposure Response Prevention – ERP) is strongly recommended for treating OCD. ERP works by helping you to confront your obsessions and resist the urge to carry out compulsions. The aim is to help  you feel less anxious about obsessive thoughts over time, and make you less likely to engage in compulsive behaviour. For example, if you fear that you will harm someone and avoid sharp objects as a result, you might build up to a therapy session where you hold a knife while sitting in a room with other people. This technique needs to be carefully managed to avoid causing distress and anxiety, so it is important that you understand the treatment fully and feel comfortable with your therapist.

“It’s hugely frustrating and exhausting trying to break out of patterns that you know aren’t helpful or healthy. It can feel hopeless. But by challenging the behaviours, thoughts or compulsion you can eventually achieve fresh change that seemed impossible.”

You are entitled to receive free CBT on the NHS, and your GP should be able to  refer you to a local practitioner. However, waiting times for talking treatments on the NHS can be long. If you feel that you don’t want to wait or that you would like more support than is being offered, you may choose to see a therapist privately. The British Association for Behavioural and Cognitive Psychotherapies maintains a register of accredited CBT therapists.

Medication

Some people find drug treatment helpful for OCD, either alone or combined with talking treatments, such as cognitive behaviour therapy (CBT).

“I’ve been on meds for the last three years and my OCD is so much more controllable. Before taking any medication, it is important to read the patient information leaflet (that comes with the medicine) and discuss possible benefits and side effects with your doctor.”

Antidepressants

The drugs prescribed most commonly are SSRI antidepressants, such as fluoxetine (Prozac), fluvoxamine (Faverin), paroxetine (Seroxat), citalopram (Cipramil) and sertraline (Lustral). These drugs are all recommended by NICE for the treatment of OCD. These drugs may have side effects, including nausea, headache, sleep disturbance, gastric upsets and increased anxiety. They may also cause sexual problems. The tricyclic antidepressant clomipramine (Anafranil) is also licensed for the treatment of obsessional states in adults. This should  normally only be prescribed if an SSRI antidepressant has already been tried and not been effective. The side effects of clomipramine can include a dry mouth, blurred vision, constipation, drowsiness and dizziness.

Tranquillisers

If you are experiencing very severe anxiety as a result of OCD, you may be offered tranquillising drugs, such as diazepam (Valium). This type of medication should only be used for short periods of treatment because of the risk of addiction. The side effects of tranquillisers can include drowsiness, confusion, unsteadiness and nausea.

Beta-blockers

Beta-blockers are occasionally given to people to treat the immediate symptoms of severe anxiety. They don’t treat the anxiety itself, but act on the heart and blood pressure to reduce physical symptoms, such as palpitations. The beta-blocker  most commonly used for anxiety is propranolol (Inderal). The main side effects include a slow heartbeat, diarrhoea and nausea, cold fingers, tiredness and sleep problems.

Neurosurgery for mental disorder

Neurosurgery (previously known as psychosurgery) is surgery on the brain. It is not recommended for treating OCD, but is very occasionally offered in severe cases, when other treatments have been unsuccessful. Neurosurgery is strictly regulated under the Mental Health Act, and can’t be given without consent.

Community mental health and social care

If your OCD is severe or complex, your GP may refer you to a community mental health team (CMHT). A CMHT is usually made up of range of professionals, such as psychiatrists, psychologists, social workers and occupational therapists. The team can offer medication, basic counselling or other mental health treatments like cognitive behaviour therapy (CBT). They should also be able to help with you with wider issues you have as a result of your OCD, such as difficulties around housing, benefits or everyday living. Even if you are not referred to a CMHT, or if you feel you are not receiving the support you need, you may be entitled to have a social care assessment to see if you are eligible for social care support.

Specialist OCD services

If you require more intensive support, it is recommended that you are referred to a specialist OCD service in your area. However, in reality, access to specialist  services across the country is patchy and you may need to travel outside your  local area.

If you feel you are not getting access to the treatment you require, you may find it useful to have an advocate. This is someone who can support you and speak up for you, so you can get the help you need. You can find an advocate by contacting your local Patient Advice and Liaison Service (PALS) via NHS Choices. Some local Minds also run advocacy services.

ADHD Isn’t a Disorder of Attention

By Margarita Tartakovsky, M.S.

 

Many people think of ADHD as a disorder of attention or lack thereof. This is the traditional view of ADHD. But ADHD is much more complex. It involves issues with executive functioning, a set of cognitive skills, which has far-reaching effects.

In his comprehensive and excellent book Mindful Parenting for ADHD: A Guide to Cultivating Calm, Reducing Stress & Helping Children Thrive, developmental behavioral pediatrician Mark Bertin, MD, likens ADHD to an iceberg.

Above the water, people see poor focus, impulsivity and other noticeable symptoms. However, below the surface are a slew of issues caused by impaired executive function (which Bertin calls “an inefficient, off-task brain manager”).

Understanding the role of executive function in ADHD is critical for parents, so they can find the right tools to address their child’s ADHD. Plus, what may look like deliberate misbehaving may be an issue with ADHD, a symptom that requires a different solution.

And if you’re an adult with ADHD, learning about the underlying issues can help you better understand yourself and find strategies that actually work — versus trying harder, which doesn’t.

It helps to think of executive function as involving six skills. In Mindful Parenting for ADHD, Dr. Bertin models this idea after an outline from ADHD expert Thomas E. Brown. The categories are:

Attention Management

ADHD isn’t an inability to pay attention. ADHD makes it harder to manage your attention. According to Bertin, “It leads to trouble focusing when demands rise, being overly focused when intensely engaged, and difficulty shifting attention.”

For instance, in noisy settings, kids with ADHD can lose the details of a conversation, feel overwhelmed and shut down (or act out). It’s also common for kids with ADHD to be so engrossed in an activity that they won’t register anything you say to them during that time.

Action Management

This is the “ability to monitor your own physical activity and behavior,” Bertin writes. Delays in this type of executive function can lead to fidgeting, hyperactivity and impulsiveness.

It also can take longer to learn from mistakes, which requires being aware of the details and consequences of your actions. And it can cause motor delays, poor coordination and problems with handwriting.

Task Management

This includes organizing, planning, prioritizing and managing time. As kids get older, it’s task management (and not attention) that tends to become the most problematic.

Also, “Unlike some ADHD-related difficulties, task management doesn’t respond robustly to medication,” Bertin writes. This means that it’s important to teach your kids strategies for getting organized.

Information Management

People with ADHD can have poor working memory. “Working memory is the capacity to manage the voluminous information we encounter in the world and integrate it with what we know,” Bertin writes. We need to be able to temporarily hold information for everything from conversations to reading to writing.

This explains why your child may not follow through when you give them a series of requests. They simply lose the details. What can help is to write a list for your child, or give them a shorter list of verbal instructions.

Emotion Management

Kids with ADHD tend to be more emotionally reactive. They get upset and frustrated faster than others. But that’s because they may not have the ability to control their emotions and instead react right away.

Effort Management

Individuals with ADHD have difficulty sustaining effort. It isn’t that they don’t value work or aren’t motivated, but they may run out of steam. Some kids with ADHD also may not work as quickly or efficiently.

Trying to push them can backfire. “For many kids with ADHD, external pressure may decrease productivity …Stress decreases cognitive efficiency, making it harder to solve problems and make choices,” Bertin writes. This can include tasks such as leaving the house and taking tests.

Other Issues

Bertin features a list of other signs in Mindful Parenting for ADHD because many ADHD symptoms involve several parts of executive function. For instance, kids with ADHD tend to struggle with maintaining routines, and parents might need to help them manage these routines longer than other kids.

Kids with ADHD also have inconsistent performance. This leads to a common myth: If you just try harder, you’ll do better. However, as Bertin notes, “Their inconsistency is their ADHD. If they could succeed more often, they would.”

Managing time is another issue. For instance, individuals with ADHD may not initially see all the steps that are required for a project, thereby taking a whole lot more time. They may underestimate how long a task will take (“I’ll watch the movie tonight and write my paper before the bus tomorrow”). They may not track their time accurately or prioritize effectively (playing until it’s too late to do homework).

In addition, people with ADHD often have a hard time finishing what they start. Kids may rarely put things away, leaving cabinets open and leaving their toys and clothes all over the house.

ADHD is complex and disruptions in executive functioning affect all areas of a person’s life. But this doesn’t mean that you or your child is doomed. Rather, by learning more about how ADHD really works, you can find specific strategies to address each challenge.

And thankfully there are many tools to pick from. You can start by typing in “strategies for ADHD” in the search bar on Psych Central and checking out Bertin’s valuable book.

 

Original article: http://psychcentral.com/blog/archives/2015/12/12/adhd-isnt-a-disorder-of-attention/

The stimulated mind of a child: The impact of environmental factors on behaviour.

A number of students are referred to me exhibiting signs related to behavioural and emotional challenges. More times than not, I will see clients who are moderate to severe in their behaviours. So we’re talking about students who are involved in disruptive behaviours or illicit activities, atypical behaviours, and consistent violators of school policies. To be more specific, these are children who were referred to the multidisciplinary team, for the following issues at school and at home:

• verbally abusive
• fighting with fist and weapons
• uncontrollable sudden outbursts of anger
• vandalism
• constant stealing
• excessive lying
• drugs and alcohol abuse etc.

Generally, I will begin with a Functional Behavioural Assessment (FBA) on the student.  This will include a number of observations, interviews with teachers, parents and the student, along with checking reports from other stakeholders.  The objective is to get as much information as possible.

Over the years I have come to notice that behavioural or emotional challenges do not always exist in isolation (in this case only in one particular setting), but, sometimes their expressions do.

Some years ago, after graduate school, as I was starting off as a psychologist working with children with emotional and behavioural disorders, at the time I did not realise there was so much more I had to learn.  I remember taking the approach that clients will be consistent in their behaviours, regardless of the environment they were placed in. But human beings are not like programmed robots.  For instance, if we install software on our laptops, then regardless of where we are in the world, it should work the same.  So, if I take my laptop to Europe, Africa, United States or the Caribbean, when the icon for Microsoft Office Word is clicked, the program will open.  People should be the same, right?  No!  This approach will be so wrong.

Behaviour is affected biochemically, but environmental factors (or lack of specific ones) around us, also influences our reactions or expressions.

It is therefore very important, that to reduce or to completely eradicate an unwanted behaviour, we look at things which maybe contributing as fuel to the behaviour.  When this is identified, we should manipulate it to modify the behaviour.

Now, the understanding that children are affected by their environment has vital importance on the way they learn as well. For this reason, as an educational psychologist working with teachers and students, I encourage teachers to create an environment with things that acts as positive stimuli. These positive stimuli may include:

• posters,
• a library,
• multimedia,
• adequate space for group work and other social interactions,
• proper lighting and temperature,
• and a reasonably outfitted soundproofed room etc.

What are some additional features you believe can be used to act as positive stimuli to our children learning?

8 keys to avoiding teacher burnout (part one)

 Angela Watson’s Truth for Teachers.

1)  Love your students (even when they’re not so loveable!)

Enjoying and growing with your students is one of the most important ways to combat burnout. Unfortunately when you’re stressed, it can feel almost impossible to see the kids as the beautiful people that they are. It’s really helped me to build times into our daily schedule which force me to step back and remember what’s important.

For example, in our class meetings, I set a timer for one minute and the entire class greeted one another by name, usually with a handshake of some sort.  That’s all the time to takes for every student to smile up at me, shake my hand, and say, “Good morning, Mrs. Watson!”  This act alone sets the tone for the day and reminds me that I’m dealing with kids who have feelings, too.

I also had my students give a ‘fist bump or handshake’ when they left the classroom each afternoon. This personal acknowledgement gave me another chance to connect with each child and really calmed me down at the end of the day when I was feeling stressed.  Sometimes I also had ‘tickets out the door’—the kids wrote one thing they learned that day and handed me their paper (the ‘ticket’) at dismissal.  Having a written record that YES, this day was worth getting out of bed for because I did actually get through to the kids, was enough to help me keep going sometimes when feeling discouraged.

You can have lunch or snack with your kids as a reward every now and then—an unstructured time to just sit and talk about what’s going on in their lives really endears them to you (and vice versa).

Look for little ways like this to accomplish the goal of seeing students as individual people with unique needs, feelings, and experiences. Sometimes the school system trains us to think of kids as machines that can be pushed to the limit every minute of the day and perform at 100% of their ability regardless of outside factors, and we have to intentionally do things to remind ourselves that this is not the case.

When kids feel cared for and respected, they will work harder for you and follow your rules, making the day less stressful and more productive for everyone. It’s worth taking the time and energy to connect with your kids, because the payoffs are ten fold!

2)  Focus on your big picture vision

It’s easy to get caught up in the little things that are so frustrating about being a teacher: repeating directions over and over, dealing with the same behavior problem from the same kid every single day, completing meaningless paperwork, grading a million papers…and if you focus on the small things that drive you crazy, you WILL get burned out.

There is a reason you became a teacher—was it to make a difference in a child’s life?  To express your creativity?  To immerse yourself in a subject you love and inspire students to do the same?

Reconnect with that part of you.

Write out your personal mission statement and post it somewhere in the room where you (and maybe only you) will see it throughout the day.

Create goals that you know you can meet and celebrate your success when you reach them.

Don’t major in the minors or allow yourself to become discouraged by distractions. The extent of your work and your impact goes far beyond what you see from day to day. Seeds are being planted, and lives are being changed, whether you see the results immediately or not.

3) Create a strong support system

I am blessed to have had at least one person in each school I’ve worked in that I considered a true friend—not just a colleague or associate, but a person that I could call at 2 a.m. with a flat tire and know that she would pick me up. When I was single, I hung out with someone from my job almost every single day, whether it was for something fun like shopping at the mall or hanging out on the beach, or something practical, like running errands together or keeping an eye on her kids while she cooked dinner for us (a good trade, I might add.) Knowing that I had someone I can go to with any problem, personal or professional, was the main thing that got me through the day sometimes—that thought of, whew, in an hour I can go next door and just vent!

If you wish you had friends like that in your school, give it time.  Because teachers spend so much time isolated in their own classrooms, there aren’t many opportunities to get to know one another, and it can take awhile to get close to your colleagues. Be open to opportunities, and don’t write anyone off–I’ve often bonded with people that I would have never imagined myself growing close to! Even finding just one wise person you trust and can share ideas with might be all you need.

When time goes by and you feel like you still aren’t making connections with anyone in your current teaching position, you could also consider moving to another grade level or even school where there are teachers that have similar personalities (and ideally, life situations) as you.  Having a strong support system is just that critical, and it’s sometimes worth the move!

When a student needs a break and you have a trusted colleague, you can send the child to him or her to work for awhile, no questions asked.  When you miss a meeting, you have someone to take notes for you. When you’re rearranging your classroom or revamping your behavior plan, you have someone to bounce ideas off. If you have even a single co-worker that you can count on for that, it’s going to make a big difference in your energy level and enthusiasm at work.

Even if you don’t have true friends at work—or if you prefer to keep your personal and professional lives separate—it is important to have people you trust and can go to when you’re stressed at school.  Your spouse, friends, and family do NOT understand what it is like to be a teacher unless they have been educators themselves—what we go through on a daily basis in completely beyond the realm of imagination for the general public.  You need to talk to another teacher who understands the pressure you’re under, so seek people out in teacher Facebook groups, message board forums, Twitter chats, and so on. Join one of my book clubs or The 40 Hour Teacher Workweek Club. There are fantastic teachers out there who want to offer support and friendship!

4)  Focus on flexibility and express your creativity

For me, one of the best aspects of being a teacher is the ability to be creative and let my classroom and daily routines reflect my personality and interests. Before you complain that YOU don’t have that kind of flexibility, let me assure you, I taught in Florida where third graders were automatically retained if they didn’t pass the state standardized test, so I was under a tremendous amount of pressure.  We had to have our schedules posted and were supposed to adhere to them at all times. Our lesson plans had to be planned as a grade level team and followed precisely.

And even with these types of restraints, I still maintained a sense of freedom in my classroom.  Sure, I needed to teach a specific standard on this day between 11:15 a.m. and 11:45 a.m., but I could teach it any way I wanted—with apps, individual dry erase boards, games, manipulatives, group activities, music, and so on.

I’d start the lesson I had planned, gauge the kids’ interest, and then adjust accordingly. I don’t know of any teachers, other than those who have scripted lessons, who are not allowed that sort of freedom, in reality if not on paper.  Don’t lose sight of how awesome it is to choose many of the activities you do each day!

You probably have more control over your classroom than you realize. If your head hurts, you can have the kids can do more independent work; if you’re feeling energetic, you can teach using a game; if you want to sit down for awhile, you can call the kids to the carpet and teach while relaxing in a rocking chair.  We have a tremendous amount of flexibility that we CANNOT overlook.

Think about how many people sit behind a desk nine hours a day, every day, doing the work other people assign to them. Hardly anyone gets to change tasks to suit their moods and still be productive—we do, because teaching is as much an art as it is a science, and there are a limitless number of ways to teach effectively.

Yes, there are many limits and restraints on teachers that threaten to suck all the joy out of our profession. But when you focus on what you DO have control over and all the ways that you CAN be flexible and express your creativity, you return to that original passion you had for teaching.

You took this job because you wanted to do awesome things with kids every day. So do that! Stay focused on your vision rather than the restraints that create burnout.

Go into your classroom and focus on what’s meaningful. Use the flexibility and opportunities to be creative that you’re given. Surround yourself with awesome teachers and a strong support network so you don’t feel isolated. Return to your big picture vision as a teacher, and enjoy your students. You can do this, and remember–it’s not going to be easy, it’s going to be worth it! Next Sunday, I’ll share four more keys to avoiding burnout right here in this post. 

 

Original: http://thecornerstoneforteachers.com/blog

ADHD Isn’t a Disorder of Attention

By Margarita Tartakovsky, M.S.

 

Many people think of ADHD as a disorder of attention or lack thereof. This is the traditional view of ADHD. But ADHD is much more complex. It involves issues with executive functioning, a set of cognitive skills, which has far-reaching effects.

In his comprehensive and excellent book Mindful Parenting for ADHD: A Guide to Cultivating Calm, Reducing Stress & Helping Children Thrive, developmental behavioral pediatrician Mark Bertin, MD, likens ADHD to an iceberg.

Above the water, people see poor focus, impulsivity and other noticeable symptoms. However, below the surface are a slew of issues caused by impaired executive function (which Bertin calls “an inefficient, off-task brain manager”).

Understanding the role of executive function in ADHD is critical for parents, so they can find the right tools to address their child’s ADHD. Plus, what may look like deliberate misbehaving may be an issue with ADHD, a symptom that requires a different solution.

And if you’re an adult with ADHD, learning about the underlying issues can help you better understand yourself and find strategies that actually work — versus trying harder, which doesn’t.

It helps to think of executive function as involving six skills. In Mindful Parenting for ADHD, Dr. Bertin models this idea after an outline from ADHD expert Thomas E. Brown. The categories are:

Attention Management

ADHD isn’t an inability to pay attention. ADHD makes it harder to manage your attention. According to Bertin, “It leads to trouble focusing when demands rise, being overly focused when intensely engaged, and difficulty shifting attention.”

For instance, in noisy settings, kids with ADHD can lose the details of a conversation, feel overwhelmed and shut down (or act out). It’s also common for kids with ADHD to be so engrossed in an activity that they won’t register anything you say to them during that time.

Action Management

This is the “ability to monitor your own physical activity and behavior,” Bertin writes. Delays in this type of executive function can lead to fidgeting, hyperactivity and impulsiveness.

It also can take longer to learn from mistakes, which requires being aware of the details and consequences of your actions. And it can cause motor delays, poor coordination and problems with handwriting.

Task Management

This includes organizing, planning, prioritizing and managing time. As kids get older, it’s task management (and not attention) that tends to become the most problematic.

Also, “Unlike some ADHD-related difficulties, task management doesn’t respond robustly to medication,” Bertin writes. This means that it’s important to teach your kids strategies for getting organized.

Information Management

People with ADHD can have poor working memory. “Working memory is the capacity to manage the voluminous information we encounter in the world and integrate it with what we know,” Bertin writes. We need to be able to temporarily hold information for everything from conversations to reading to writing.

This explains why your child may not follow through when you give them a series of requests. They simply lose the details. What can help is to write a list for your child, or give them a shorter list of verbal instructions.

Emotion Management

Kids with ADHD tend to be more emotionally reactive. They get upset and frustrated faster than others. But that’s because they may not have the ability to control their emotions and instead react right away.

Effort Management

Individuals with ADHD have difficulty sustaining effort. It isn’t that they don’t value work or aren’t motivated, but they may run out of steam. Some kids with ADHD also may not work as quickly or efficiently.

Trying to push them can backfire. “For many kids with ADHD, external pressure may decrease productivity …Stress decreases cognitive efficiency, making it harder to solve problems and make choices,” Bertin writes. This can include tasks such as leaving the house and taking tests.

Other Issues

Bertin features a list of other signs in Mindful Parenting for ADHD because many ADHD symptoms involve several parts of executive function. For instance, kids with ADHD tend to struggle with maintaining routines, and parents might need to help them manage these routines longer than other kids.

Kids with ADHD also have inconsistent performance. This leads to a common myth: If you just try harder, you’ll do better. However, as Bertin notes, “Their inconsistency is their ADHD. If they could succeed more often, they would.”

Managing time is another issue. For instance, individuals with ADHD may not initially see all the steps that are required for a project, thereby taking a whole lot more time. They may underestimate how long a task will take (“I’ll watch the movie tonight and write my paper before the bus tomorrow”). They may not track their time accurately or prioritize effectively (playing until it’s too late to do homework).

In addition, people with ADHD often have a hard time finishing what they start. Kids may rarely put things away, leaving cabinets open and leaving their toys and clothes all over the house.

ADHD is complex and disruptions in executive functioning affect all areas of a person’s life. But this doesn’t mean that you or your child is doomed. Rather, by learning more about how ADHD really works, you can find specific strategies to address each challenge.

And thankfully there are many tools to pick from. You can start by typing in “strategies for ADHD” in the search bar on Psych Central and checking out Bertin’s valuable book.

 

Original article: http://psychcentral.com/blog/archives/2015/12/12/adhd-isnt-a-disorder-of-attention/

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