How to "Bully-Proof" Kids

By Gariane Phillips Gunter, M.D. 



Do you think October's national anti-bullying campaign was successful in stopping bullies? The Washington Post recently blogged about our country having a hard time defining bullying among kids. So, what can we, as parents, do to protect our children and teens? Here are some tips for "bully-proofing" your kids:

Distinguish between events and feelings - It is important to teach your children the difference in their interpretations of life situations. This helps kids learn to understand and relate to the feelings of others. They will be able to determine if someone is treating them appropriately - or if they are, in fact, being bullied.

Develop a sense of self - Another great way to bully-proof your child is to help them develop a sense of self. Encourage them to learn about and understand who they "are" because children who struggle to identify self-awareness or constantly strive to be their "hero" are never going to be able to live up to those expectations. This can be detrimental for their self-esteem - making them a direct target for bullying. Kids with low self-esteem are less likely to stick up for who they are which makes them prime targets for those looking to pick on someone (bullies often bully due to their own low self-esteem).

Monitor their online lives - Parents or caregivers should have access to online accounts and cell phones to ensure their teens' safety over the Internet. Cyberbullying continues to be a nationwide epidemic.  



Positive activities - It is also important to encourage your kids to explore activities that make them feel good about themselves. Find something that they are really good at because it will help increase their overall self-esteem and feeling of self-worth. Encouraging courageous behavior is another great way to guide children. You can teach them to stand up for themselves and for their peers and other friends. When groups of kids or teens stand together to put an end to a bullying situation, the bully is more likely to back off and won't mess with your child again.



Following these tips when your kids are young is the best way to show them how to establish early on that they will not tolerate bullying. 



Sources: http://www.makebeatsnotbeatdowns.org/, http://www.olweus.org/

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The Significance of a Sleeping Brain

By Sara Coffey, D.O.

As a mother of a newborn, "sleep" is an increasingly interesting and important topic in our household.  Not only for my baby, but for my husband and myself - which brings me to the book Healthy Sleep Habits, Happy Child by Dr. Weissbluth.  Since I'm a psychiatry resident as well as a mom, I'm especially drawn to Dr. Weissbluth's discussion on studies showing sleep linked to temperament and attention in children.

Children need sleep in order to develop.  A sleeping brain is more than just a resting brain; it is a brain that's able to restore, process, and complete essential tasks that an active awake brain is unable to do.  Dr. Weissbluth explains that for young infants, daytime sleeping or naps can help to enhance the brain’s capacity to think.  When we become adults, our busy schedules cause us to forget the importance of these daytime respites and restorations.  Our hectic grown-up days may not always allow naptime, but naps are essential to raising healthy infants and kids.  

The significance of sleep doesn't only apply to young children.  Did you know that teenagers need more sleep than pre-teens?  So, to all parents who are noticing behavior problems, irritability, decreased concentration, or other changes in your children's moods, focus on their sleeping habits.  HealthyMinds.org blogger Dr. Gariane Gunter shares how many hours of sleep a child needs according to his or her age in this post.  I've included some of her tips below:

• Birth-6 Months: Children need 16-20 hours


• 6-12 Months: Children need 14-15 hours


• Ages 1-3: Children need 10-13 hours


• Ages 3-10: Children need 10-12 hours


• Ages 11-12: Children need 9-12 hours


• Teenagers need 10-12 hours of sleep per night

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Can My Child Have Bipolar Disorder? Pediatric Bipolar Disorder: Fact or Fiction

By Molly McVoy, M.D.   



Can children really have bipolar disorder?  Or, is it a parenting issue?  Is this mental illness overly-diagnosed?

Many of these questions have been raised in the media with increased frequency over the last several months.  What's most concerning is, that instead of focusing on diagnosis and treatment for children with serious mental illness, the debate has focused on who is to blame: is it parents, psychiatrists, drug companies, schools?  The bottom line is that children are suffering, and parents are struggling to keep their children safe, healthy, and happy.  More attention should be paid to actually helping these children, not to pointing fingers of blame.

Pediatric bipolar disorder is a rare but very real illness.  The most recent statistics indicate the mental illness affects approximately 1.5% of children.  Contrary to popular reports, the most recent studies also indicate the rates of pediatric bipolar disorder are not increasing over time, and the rates do not vary between US and non-US populations.¹

When pediatric bipolar disorder occurs, it can be very impairing.  Affected children have extreme mood swings – not for minutes at a time but for days.  Children can become suicidal, violent, and often feel quite out of control.  When properly diagnosed and treated, the lives of these children and their families can improve dramatically.  Treatment often involves a combination of mood stabilizing medication and intensive psychotherapy.  But when missed or misdiagnosed, these children may go on to suffer for a lifetime.



Stigma continues to be associated with a mental health diagnosis, and nowhere is that truer than in pediatric mental illness.  Perhaps, in the future, efforts will focus on how to help, not who to blame.

Links:

http://www.aacap.org/

http://www.bpkids.org/

References:

1. VanMeter, AR, Moreira, AL, Youngstrom, EA. Meta-analysis of epidemiologic studies of pediatric bipolar disorder. J Clin Psychiatry. 2011, May 31.

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Family Game Night Can Make You Smarter

By Scott Benson, M.D. 

My daughter brought two treats when she came home for college break.  A new game, Bananagrams, and a new book by Richard Restak, M.D. and puzzle master Scott Kim called The Playful Brain: the surprising science of how puzzles improve your mind. 

In this collaboration, Kim shares some of his favorite puzzle formats, and Dr. Restak explains the science behind the games.  Together they cover a wide variety of puzzles that have been shown to keep us alert, thinking, and youthful in mind and spirit.  fMRI data (which shows electrical activity in different parts of your brain) helps to tease out which areas of the brain are activated as people solve different types of puzzles.  

Scientists have not been able to prove a direct link between these forms of brain exercise and prevention of various forms of dementia.  But the puzzles, and games like Bananagrams, provide a focus for interpersonal interaction – playing with your family, talking with your neighbors – which does have a powerful effect on mood and our sense of well-being. 

Summer is the perfect time to bond with your kids in a board game challenge.  How do you get your family to put down their cell phones and turn off the TV to play a game?  Please share suggestions!

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Talking to Kids about the Earthquake in Japan

By Adair Parr, M.D.

Our hearts and condolences go out to the people of Japan and the families involved in the earthquake and subsequent tsunami in Japan last week. 

Everyone has seen the live images, captured on cell phones and video cameras, coming from Japan.  They are vivid, dramatic, compelling, and scary.  We have all watched the coverage on television and online as more and more photos and videos circulate showing the massive tsunami wave rolling over the sea wall, shaking houses and buildings, fires, explosions,  and the massive destruction afterwards.  The subsequent explosions of the nuclear reactor and news of a nuclear reactor meltdown near Sendei, Japan are also extremely disturbing. 

Our 24 hour news cycle enhances the impact of these images which can be traumatizing for viewers of all ages.  Media has a particularly powerful influence on children and adolescents, and the pictures it shows shapes a child’s perception of the world.  Young children watching images of disaster believe that the event is happening in real time, and they’re in danger.  At such times, helping children feel safe and protected in their own home and community is important.  Parents should keep in mind the following tips when viewing photos and videos during and after disasters:

• Be vigilant!  Not all sources of media provide warnings about upcoming traumatic images.


• Viewing traumatic images may be re-traumatizing.


• Limit children’s exposure to media coverage of the event.


• Co-view media coverage of the trauma and discuss content with children and adolescents.


• Encourage children to draw, write, play music, and exercise in ways to express their feelings about the traumatic events.


• Maintain structure and family routines. 

HealthyMinds.org has more information on how to talk to your children about disasters.

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How Much Sleep Do Kids Need?

By Gariane Gunter, M.D.

Children these days are busier than ever!  I often hear from parents that it is such a rush to fit everything in and still get the kids to bed on time.  I struggle with the same dilemma at my house.  As a mom, I understand how difficult early bedtimes can be, however, as a psychiatrist, I know why an adequate sleep schedule is so significant for our child's physical and emotional health.   

The American Academy of Pediatrics Guide to Your Child's Sleep provides some helpful guidelines regarding just how much sleep children need at different stages in their development. Keep in mind that these numbers reflect total sleep hours in a 24-hour period. So if your child still naps, you'll need to take that into account when you add up his typical sleep hours.

Birth-6 Months, children need 16-20 hours

6-12 Months, children need 14-15 hours

Ages 1-3, children need 10-13 hours

Ages 3-10, children need 10-12 hours

Ages 11-12, children need 9-12 hours

Teenagers need 10-12 hours of sleep per night

Kids need a lot of sleep, huh?!  Children and teens who are sleep deprived may show some difficult behaviors.  They may display frequent irritability, overreact emotionally, have difficulty concentrating, forget things easily, wake often during the night, and may even display hyperactive behaviors.

Teaching kids how to keep a nighttime routine that gets them to bed early will help your children be at their best.  Sweet Dreams!

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Talking To Kids About Disappointment In Sports

By Claudia Reardon, M.D.



Participating in sports is generally thought of as a physically and emotionally healthy activity for children and teenagers. However, it is inevitable that children who play sports will at some point deal with disappointment. Not every play or game will go their way. While dealing with this disappointment can be difficult for children, it's also a great opportunity for growth. The excitement of the Super Bowl and other winter sporting events provide a chance to talk with your children about disappointment.

Here are some tips to keep in mind if you parent or coach a child or teenager who is dealing with disappointment in sports:



1. Acknowledge your child’s feelings about what happened. For example, you can say, “I understand that you are feeling really upset that you didn’t win the race.” Of course, this does not mean that you should agree with catastrophic statements that they might make, such as that they are the worst player that ever played or that their life is ruined because of a bad game.



2. It’s okay if kids don’t want to talk about a disappointing game or event immediately. You might simply acknowledge their feelings and tell them that you’re there for them to talk whenever they want to.



3. Help your children shift focus to what they did RIGHT on the playing field. This is especially important if your child is a perfectionist, in which case he or she is likely to focus on the one mistake rather than seeing the “big picture” of everything he or she has done right.



4. It’s certainly okay if your children’s disappointment leads them to want to improve their sports skills. Help them figure out exactly what skill they would like to improve, and then brainstorm ways to improve in that area. They might even ask for suggestions from the coach. Help your children set realistic goals and then give them praise as they work toward those goals.



5. Ask your children if they think their favorite athletes ever make mistakes in their sport. If these athletes said that they were terrible players and wanted to quit after one bad play or bad game, would your children agree with that? Of course not!



6. Disappointment is a great opportunity to reinforce resilience and determination. Remind your child that he or she is “the kind of person who doesn’t give up easily.”



7. If a child is disappointed in his or her sporting performance, that is not an excuse for poor sportsmanship. It is not okay for them to express their disappointment as anger toward the winner.



8. Remind your children that failing to make a good play or to win a game does not mean that they’re a failure overall. There still are lots of great things about them, and everyone fails sometimes. Remind them of all the things they have done well recently.

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Raising Awareness About Stuttering and Speech Disorders

By Adair Parr, M.D.



The Oscar nominations were recently announced and one particular movie in the best picture category is a film which addresses a common problem: stuttering. The King’s Speech depicts the courageous efforts of King George VI of Britain, played by actor Colin Firth, to overcome a stutter which first began when he was a young boy. Although many films have featured characters who stutter, this is the first film to focus on the process of someone overcoming speech difficulties.



The King’s Speech highlights the speech therapy that the king went through to overcome his stutter. The movie aptly demonstrates his frustration with prior attempts at speech therapy. His work with Australian speech therapist Lionel Logue, portrayed by actor Geoffrey Rush in the film, allowed him to move beyond the previous failures that he had in speech therapy and to achieve success. The story is particularly inspiring as you watch this man deliver a powerful speech to the British people on the brink of World War II. Hopefully, the movie will result in less stigma about stuttering.



Here is a video of His Majesty King George delivering his actual speech on Sept. 3rd, 1939.

Stuttering is a type of speech disorder which affects the fluency of speech. Stuttering is a fairly common phenomenon. Approximately 1 percent of children stutter, and up to 5 percent may display transient stuttering. Stuttering begins during childhood, typically between ages 2 and 4 and may last throughout life. It may involve repetitions of words, prolongation of speech sounds and blocked sound.

What should you do if your child has a stutter or other speech disorder? It is recommended that you seek an evaluation from a certified speech-language pathologist. Your pediatrician, physician or school system may help you find local resources. More information on stuttering is available at the American Speech-Language Hearing Association website.

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When Divorce Happens

By Gariane Gunter, M.D. 



A recent study was published in Health Day that discusses the mental health of children of divorced parents. While I am not in the position to support or deny the findings, the topic of divorce when children are involved is often a difficult one. Every family is different, but the following are some general tips for divorcing parents that can be helpful.



1. Attempt to keep a positive attitude during the point of separation. This is often a very trying time for the family. Stick to a routine and embrace the activities your children have always enjoyed.

2. Don’t forget to nurture yourself. Going for a walk, having coffee with a friend, or reading a good book are ways to rest and regain energy. It’s normal to feel exhausted when separating; and possibly for many months to follow.

3. Encourage kids to openly discuss their feelings, positive or negative, about what's happening.

It's important for divorcing, as well as already divorced parents, to sit down with their kids and encourage them to say what they're thinking and feeling. But you'll need to keep this separate from your own feelings. Most often, children experience a sense of loss of family and may blame you, the other parent, or both of you for what is going on in their lives. You really need to be prepared to answer questions your kids might raise. They might feel guilty and imagine that they "caused" the problem. Kids and teenagers may feel angry or frightened, or worried about their future. Counselors can assist with this difficult conversation and provide a safe environment if safety is a concern.

4. Although very tempting, try not to speak negatively about your former spouse when your children are present. This issue, often called “parental alienation” can be a problem. Doing things such as putting your child in the middle, saying negative things about the other parent, and using your child as a messenger puts your child in a “no win” situation and creates lifelong relationship issues for all involved. The reasons include the following:



• The comments may confuse and frighten children.

• Many of your concerns about your former spouse are difficult for you to express. It is very important that you keep these concerns to yourself. Children just do not have the emotional maturity to withstand information/situations that adults find stressful.

• Your child’s identity and self concept is based on parental behavior. Even if it is next to impossible to say anything good about your former spouse, try to do so. If this is impossible then don’t say anything.

• Children love to eavesdrop. Telephone conversations are their favorite snooping ground. Make all effort to not discuss your divorce-related difficulties on the telephone when your children are around.

5. During the crisis point of separation try to remember that your children need you both parents more than ever. This is not a time to deny access unless a professional deems it necessary to do so for safety related reasons.

6. It is important to accept the fact that a separation involves feelings of loss for children. Try not to panic if the following behaviors occur during the first few months of separation:

• Sleep difficulties like disrupted sleep, an inability to sleep, exhaustion etc.

• Social isolation

• Anger, intolerance, grumpiness

• Avoidance of divorce related conversations

• Obsessing about the divorce

• Appetite changes

• Feelings of worthlessness

• Tears and feelings of overwhelming sadness

7. Although many children do not ask to see a counselor when their parents separate, they usually find counseling very helpful.

8. It is important to acknowledge that children are very loyal and protective of their parents. If children are placed in loyalty binds they can experience anxiety. Try to alleviate their anxiety if they decided to “pick a side.” This is a coping skill which teens in particular use. If your child engages in “picking a side” try not to feel rejected.



9. Think of yourself as a survivor not a victim. And be patient. Everyone takes different times to heal.

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The Truth About Domestic Violence

By Roberto Blanco, M.D.



In my work with patients across the world, I can´t help but notice how many come to psychiatric clinics as a result of domestic violence. Despite its prevalence in other countries, domestic violence is also quite common in the United States. In the United States alone, 22 percent of women are physically assaulted by an intimate partner during their lifetimes and over 5 million are victims every year. Domestic violence touches all elements of society regardless of age, race, or socioeconomic status.

As a child psychiatrist, I can´t help but think of the smallest victims of domestic violence as I often see them in my clinical work. These are the children who are either involved secondarily by witnessing the abuse or become victims directly themselves. The effects of domestic violence on this population are far ranging and long lasting. As these children develop, they may struggle to deal with conflict. They may also become aggressive or experience severe depression, nightmares and other symptoms of post-traumatic stress, as well as other anxieties or fears.



The effects of domestic violence on children are dependent on the nature and severity of the abuse and on the developmental level of the child. Young babies and infants cannot understand why violence occurs in the home and so violence in this population can cause deep-seated changes in personality, self-esteem, and ways of interacting with others that can last for a lifetime. Often older children have a better understanding of what is going on, but still often blame themselves for the abuse and can have excessive guilt or anger as a result.



Domestic violence does not need to be only physical to qualify as a form of abuse. Abuse can also take the form of emotional, financial, or sexual control or disregard. Initially, characteristics of an abusive relationship can often be endearing such as wanting to be with you all of the time. Over time, this can become intense jealousy for no reason, excessive control over relationships and behaviors, and aggression or violence. Options for milder forms of emotional abuse can include family and/or individual therapy. For severe cases, there may be a need to get out of the situation or to a safe house. For more information on domestic violence, please see the American Pyschiatric Association's brochure  Let´s Talk Facts About Domestic Violence.

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Bipolar in kids? Probably not.

By Scott Benson, M.D.



The 5-year-old little girl had been referred to a therapist by her school because of her severe disruptive behavior. The almost daily tantrums had everyone concerned. She was uncooperative with the assessment and arrangements made for further evaluation. The therapist wrote a diagnosis of bipolar disorder.

The patient was certainly reactive to any limits and her tantrums seemed like they would never end. But she slept well at night; she rarely had behavior problems with her grandparents who provided afterschool care.

After a few parent training sessions with the little girl and her parents her behavior control improved. But continued treatment was threatened when her dad tried to get her on his new health insurance. The diagnosis of bipolar got the application bumped by the computer and it took a lot of calls and several letters to get her on the policy so that her treatment could continue.

At times it seems we are a little too quick to throw a label on a child’s behavior, and bipolar disorder seems to be the most popular current label.

But new research at the October meeting of the American Academy of Child and Adolescent Psychiatry found that children with some symptoms of mania probably do not have bipolar disorder.

Boris Birmaher, M.D., a child and adolescent psychiatrist at the University of Pittsburgh presented his group’s research. More than 2,000 children presenting to 10 different academic centers were included in the Longitudinal Assessment of Manic Symptoms (LAMS) study. 621 were found to have elevated symptoms of mania, but the full evaluation did not find sufficient symptoms for a diagnosis of bipolar disorder. Most had attention deficit hyperactivity disorder (ADHD), others had another disruptive behavior disorder. Children who did have bipolar disorder have poor function and are likely to require treatment in hospitals.

"Kids with manic symptoms don't necessarily have bipolar disorder," he told Reuters Health. On the other hand, "Many children with bipolar disorder are not being correctly diagnosed."

The LAMS study which will follow these children for five years should provide direction for the assessment and treatment of children with severe behavior problems. In the mean time parents should insist on an adequate evaluation for children with severe behaviors.

The Parents' Medication Guide for Bipolar Disorder in Children & Adolescents is a great source of information for understanding the evaluation process and treatment options. Or visit HealthyMinds.org for more information on bipolar disorder or mental health issues in children.

Parenting in the Internet Age

By Molly McVoy, M.D.

Facebook, blogging, Twitter, email, texting. How is a parent supposed to keep up with all of the technology available to children and teens in today’s world? Many parents and children struggle with safety on the Internet. Although there are no easy answers, some simple steps can help keep you and your child safe.

First, and most important: all of the things that make a good parent in everyday life also make a good parent on the Internet. Spend time with your child in their daily life and spend time with them learning about what they do online. Educate yourself on your child’s school and social life. In the same way, educate yourself about the websites they visit and who they are talking to online.

In addition, keep their access to technology limited and in public settings. Put the computer in the kitchen or the living room – in other words, in a place where secrecy is difficult and monitoring is easy. Online time should only come after homework and other activities are done for the day. Also, talk about what they are doing online, but do not invade their privacy by reading emails unless absolutely necessary. If you suspect dangerous things are happening by or to your child online, then invading their privacy may be necessary. Otherwise, encourage open communication and respect their privacy.

For more information:

http://www.webwisekids.org/

http://www.kids.gov/6_8/6_8_computers_internet.shtml

http://www.attorneygeneral.gov/uploadedFiles/Consumers/cybersafety.pdf

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Coping with Stress in America

By Adair Parr, M.D.

A survey by the American Psychological Association highlighted the negative impact that stress can have on families and children. This is an extremely important topic that affects many family caregivers, who are under a great deal of stress taking care of loved ones. More and more Americans are affected by stress. The survey indicates that many Americans feel that they are experiencing unhealthy amounts of stress. The economy is one of the main reasons. Fewer are satisfied with the ways that their employer helps employees balance work and non-work demands and many are concerned about job stability.

In addition, stress impacts the entire family. Children recognize when their parents are stressed and that could make them feel sad and worried. Nevertheless, parents frequently underestimate the impact that their own stress has on their children.



Stress affects both our mental and physical health. Some people manage stress by smoking, drinking or over-eating. That can lead to bigger problems. The study shows that Americans understand the importance of healthy behaviors like getting enough sleep, exercising and eating healthy. However, lack of time and motivation gets in the way of following through on these goals. Willpower was identified as a barrier to many healthy behaviors, even when they are recommended by a health care provider.

Managing your stress is extremely important. Stress does affect the family members you care for. There are healthy ways to manage your stress. Some suggestions are: exercising or playing sports; listening to music; spending time with friends and family; going to religious services; journaling; and practicing yoga / meditation. 





If you find that you are overwhelmed or suffering physical symptoms from stress like headache, poor appetite and insomnia, or if you are feeling depressed or suffering from chronic irritability and crying spells, you may need to see a mental health provider. The Healthy Minds website has brochures about dozens of mental health issues including early warning signs of mental illness.

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ADHD: Can My Kid Just Outgrow It?

By R. Scott Benson, MD





Won't he just outgrow it? This is the wish of every parent – that a little time, a little more love, or discipline, or happy thoughts will solve what might be a serious problem. And I hear this question often from parents of pre-schoolers who are having behavior problems in pre-K programs or daycare settings.

But we can’t wait. And now there is even more research to support the importance of a careful evaluation and treatment when indicated. This month’s Archives of General Psychiatry reports the results of a long term study of children who were diagnosed with ADHD between the ages of 4 and 6 years old. There was a control group of children without ADHD. As adolescents the children with the early diagnosis of ADHD had higher rates of depression and suicidal thoughts. Fortunately, there were no suicides in this study. Benjamin Lahey, Ph.D., the study director is a professor of health studies and psychiatry at the University of Chicago. He said the study “reinforces our belief that parents of young children with ADHD should pay close attention to their child’s behavior and its consequences and seek treatment to prevent possible long-term problems.”



So the better question is “What treatment is recommended for pre-schoolers?” And we have good science to help answer that question. Carefully managed studies have shown that pre-school children and their families should have at least 12 weeks of behavior management training as a first level of care. And this is not just any behavior management. At a conference in Florida, Dr. Regina Bussing recommended that families should consider a number of behavior training programs – the Positive Parenting Program, The Incredible Years, and Parent Child Interaction Therapy. These are intense programs that are very different from a few words of advice from a well-meaning pediatrician or the do-it-yourself manuals that are so prevalent in the bookstores.



Let us know of other successful behavior training programs in your community, and we will post those links here.

A Parent’s Guide To Social Networking

By Adair Parr, M.D.

If you are like most parents, your teenager knows more about social networking than you do. According to a Pew Internet Project study, nearly three-quarters of teens online use social networking sites. What’s more, many teenagers now access social networking through cell phones, further increasing their online presence. The phenomenal rise of Facebook is documented in the movie, The Social Network, which was number one at the box office this past weekend.



Are your teenagers on Facebook? Are you wondering where to draw the line? Many parents feel overwhelmed by understanding media and technology and feel that they will never catch up to their kids. While you may not text as fast as they do, making an effort to learn about social networking is important. Teens are designed to experiment with risky behavior and social networking is one area in which they may try such behaviors. By educating yourself on the topic, you will be better prepared as a parent to help your child to use media and social networking responsibly.



What can you do to help ensure your teen’s responsible use of social networking?

1. Talk to your kids about the media in their life. Ask your teen how social networking changes lives.


2. Keep the lines of communication open with your teen. Know who they are communicating with online.


3. Remind your teenager to limit the amount of personal information online.


4. Remember that everything your teenager posts is public information. Once it is posted, it is online forever.


5. Educate your teenager about cyberbullying and what to do if he or she is a victim of cyberbullying.


6. Model responsible media use behavior for your teenager.

The Healthy Minds website has additional information about mental health for college-age students and children. Check out these resources to help parents navigate the murky waters of social media:

• Common Sense Media


• Be Net Savvy


• Net Lingo


• Facebook Safety


• Frontline, KidsOnline 

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Mental Illness in School: No Child Left Behind?

By Molly McVoy, M.D.

How much do I tell my child’s teacher about her depression? About his bipolar disorder? About her ADHD? Will he fall behind if the teacher doesn’t know? Will she be judged if I tell the school? When do I get testing, an IEP, special Ed? What do those mean?

Parents of children with psychiatric illness struggle with these questions and many others. Often, there are no easy answers. A child’s success at school may be one of the best predictors of future success. Giving a child and his/her family the best tools to succeed in school is one of my top priorities as a child psychiatrist.

When deciding how much to tell your child’s school about his/her psychiatric illness, consider your child’s ability to function at school rather than his/her specific type of illness. You are not required to tell the school anything; that is up to you as a parent. If telling your child’s teacher about his/her psychiatric illness will give him/her a better chance to do well, then consider telling the teacher. If your child’s illness is affecting his/her day to day functioning and behavior at school, then consider telling the teacher. Teachers are your partners in helping your child succeed. If the illness is relatively well controlled and is not affecting his/her daily behavior at school, the school may not need to know. For more information, visit the American Academy of Child and Adolescent Psychiatry.

When it comes to accessing special education services, most schools and teachers want to do everything they can to help your child. I usually recommend families listen to the principal and teachers.They are the experts in education. However, if you are dissatisfied with the educational services you are receiving, my next recommendation is know your rights, know your state’s laws. Every state must provide a free education that meets the needs of each child – no matter what those needs are. What varies widely, however, is how each state manages that requirement. The U.S. Department of Education website has basic information on your rights as a parent and offers links to each state.html. Know your state law, know your rights. Come armed with that information and work with your doctor and school for your child to succeed!

Could My Child Be Depressed?

By Gariane Phillips Gunter, M.D

Most of us know someone who has suffered from depression at some point in their lives. However, did you know that depression is not just something that affects adults? Depression is a serious illness that can affect anyone, at any age, including children and adolescents. When a youth is depressed nearly every part of the young person's life is impacted as well as the lives of their family. If left untreated, pediatric depression can lead to problems in school and with friends, to accidents, to substance abuse, and, in its most extreme cases, to suicide. It can disrupt relationships among family members and friends, harm school performance and limit other educational opportunities. It can lead to other health problems through its effects on eating, sleeping, and physical activity. Because it has so many consequences, it is important that depression is recognized and treated successfully. When it is, most children can get back on track with their lives.

Children suffering from depression may not have the same symptoms as adults with the same diagnosis. While adults may appear down or tearful to those around them, children may appear more irritable or complain about physical symptoms such as stomach aches or headaches. Below are differences in symptoms that may be seen in adults versus children.

Youth living with depression need a thorough evaluation and comprehensive treatment from an appropriately trained professional. Each treatment must be tailored to the individual child or adolescent. Cognitive-behavioral therapy (CBT), a form of talk therapy, has been demonstrated to significantly contribute to recovery. In addition some antidepressant medications, when monitored, can be an effective part of the treatment for pediatric depression. If you think that someone you know may be suffering from depression, please encourage them to see their doctor.

The American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association released a revised and expanded version of The Use of Medication in Treating Childhood and Adolescent Depression: Information for Patients and Families, part of the ParentsMedGuide series of publications to help parents understand depression and treatment options.

Reading, Writing and Anxiety? Helping Children Make the Transition Back To School

By Adair Parr, M.D., J.D.



The arrival of September signals back to school for most children. It is an exciting time of year, as it means meeting new teachers and classmates, starting fall sports and getting back into the swing of the classroom. Most children have some degree of anxiety about starting school, especially when they are just starting school, entering middle or high school or are changing schools.



Despite such worries, many children adjust to a new school year fairly easily. Other children have some initial anxiety, which they overcome in the first days or weeks of school. These feelings are particularly common among elementary school children but may be experienced by middle school or high school students as well.



School-aged children and even teenagers may express feelings of anxiety through frequent headaches or stomachaches, rather than overt worries about school. For tips on how to help transition your child to the new school year, see “The ABCs of Starting School” on Healthy Minds.



When should you seek help if you suspect that school is making your child anxious?




For some children, feelings of anxiety associated with back to school interfere with functioning either at home or at school or socially. If your child continues to have difficulty with school more than a month after school has started, it is important to seek help.




*Talk to your child’s teacher or counselor to see what they have noticed.



*If your child has significant physical symptoms, like recurrent headaches or stomachaches, schedule a visit to the pediatrician.



*Talk to your child and ask whether anything is happening at school that frightens them or worries them.



*Ask your child about bullying, which may be contributing to your child’s anxiety.



After exploring these concerns, some children will need further help and may require a visit to a mental health professional for an evaluation. A school counselor or pediatrician can help with a referral if this is the case. A child’s main job is to learn; untreated anxiety can interfere with social and academic development.



Anxiety is commonly treated with cognitive behavior therapy but some children require medication. By being attentive to the many changes associated with starting school, you can help your child with this important transition.

Does the sandman still come to your house?

By R. Scott Benson, M.D.

Keeping children up at night?

Some worrisome stories were on the evening news last week; but the part of the news broadcast that caught my attention were six ads for medication to promote a peaceful night of sleep.



These ads are having their desired effect as I have more and more families expressing concern about their children’s sleep. They read the stories about shifting school start times to improve teens’ school performance, but the first question they ask me is usually about the latest new medications.

Research is clear: there are many things that should be done before we reflexively open the medicine cabinet.

1. Consider the impact of 24-hour access to electronic communication tools. Does your child keep a cell phone in their room overnight? To talk to whom? 


2. Remove televisions and computers from children’s bedrooms. There is strong evidence that easy access to these devices interferes with sleep.


3. Watch out for shifts in sleep schedules on the weekend. Most of us thought we could stay up late on weekend nights, make up for the sleep by staying in bed until noon on Saturday, and sleep in again on Sunday. But it only takes these two days to reset your biologic clock. No wonder that Monday finds a body at school but the mind is home in bed.


4. Plan evening routines so your child finishes activities (including homework) more than an hour before planned bedtime. It takes a while to settle after an hour of frustrating work on spelling words.

The first step in evaluating any concern about sleep is keeping a careful sleep diary. There are samples available at SleepEducation.com, the website of the American Academy of Sleep Medicine. The University of Michigan has a wealth of material on their website devoted to children’s sleep problems.



Sleep tight.

School's in Session - Lesson 1: ADHD

By Gariane Phillips Gunter, M.D.





School started just a month or so ago, but some parents may have already received calls about their child’s “behavior." An article published in USA Today reported on a study conducted at Michigan State University which stated that kids who are the youngest in their grades are 60% more likely to be diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) than the oldest children.





My goal for this blog posting is not to validate nor dispute this data but to offer facts about the diagnosis of ADHD. First and foremost, the diagnosis of ADHD should only be made by a trained professional after a thorough assessment of the child and collateral information.





The main features of ADHD include hyperactivity, impulsiveness, and an inability to sustain attention or concentration. These symptoms occur at levels that cause significant distress, impairment, and are far more severe than typically found in children of similar ages and developmental levels. More common in boys than in girls, ADHD often develops before age seven, but is usually diagnosed between ages eight and ten.





Children with ADHD:





• Have difficulty finishing any activity that requires focus  

• Don't seem to listen

• Are excessively active, running, or climbing at inappropriate times, squirming in or jumping out of their seats

• Are very easily distracted

• Talk incessantly, often blurting out responses before questions are finished

• Have serious difficulty waiting their turn in games or groups

• May have specific learning disabilities





Treatment can include the use of medications, psychotherapy, and special educational programs to help a child keep up academically. Psychotherapy enables children to cope with their disorder and the reaction of others to it. An essential component of psychotherapy involves the work of the child psychiatrist with both the child and the parents to develop techniques for behavior management. 





If your child is diagnosed with ADHD there are effective treatments and medications available to help him or her have a successful year at school. Please contact your child's doctor for further guidance.