August 2009

OD: The New ADHD?

(Part II)
Yesterday I introduced you to the newest disorder on the block: Obnoxious Disorder (or OD, for short). Today, I want to educate you regarding the possible causes of this debilitating neurological disorder.

Before I do that, I want to also describe two additional types of OD that did not make it into the DSM-V but garnered serious consideration by the task force. The first concerned younger children: Whining/Tattling Type. Its symptoms are self-explanatory. There was also some consideration for “Like” Type, which is a problem where children tend to say “like” in a manner unbefitting the word. It’s like really annoying, but apparently is not like serious enough to be considered like a mental disorder. Personally, I like think they missed the boat on this one. It like makes someone sound like a mental defective.
The DSM-V estimates that the prevalence of Obnoxious Disorder ranges from 12-15% boys in the United States and 6-8% of girls. It does not explain the possible reasons for this significant difference (although billions in research grants are sought from the National Institute of Mental Health to investigate this crucial question). While no known biological cause is known, some possibilities have been postulated. Some medical researchers believe that persons with OD may have too much stupamine, a close cousin of the neurotransmitter dopamine. A competing hypothesis includes prenatal exposure to Barbara Streisand. Some researchers have also postulated that the following social factors may contribute to Obnoxious Disorder:
• Uncles. Apparently, very heavy influence by uncles may result in learned obnoxious behaviors. (This may be particularly true for Bodily Noises Type)
• GameCube, Xbox 360, PlayStation2, PS2, ad nauseum. Any adult who knows a child who is obsessed with the newest and coolest toys knows how this tends to create severely obnoxious behavior.
• T.V. This is, of course, debatable, but the following shows could certainly be considered “obnoxifacient”: “Family Guy”, “South Park”, “Caillou”, and “The Wiggles”. For those of you who have seen the latter show, you know what I mean.
Hopefully, when you encounter an obnoxious child, you can now feel secure in knowing that someone can diagnose and treat such a culturally draining problem. Schools, parents, and mental health professionals must work as a team to fight this dreaded epidemic.

In the future, I will discuss how Obnoxious Disorder is diagnosed and treated. Until then, I suggest that parents keep all uncles away from children and that they practice saying, “No, you can’t have that toy” and “Let’s just watch ‘Mr. Rogers’ Neighborhood’”. No one was ever obnoxious in Mr. Rogers’ neighborhood.

OD: The New ADHD (Part I)

Teachers, parents, social workers, and all who deal with children on a regular basis: listen up. There’s a new disorder on the block, and whether you like it or not, it’s going to change the way you deal with children. The American Psychiatric Association has just completed work on the latest edition of its standard diagnostic manual, labeled the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (or DSM-V for short). Every new edition brings a host of new official disorders; the new 5th Edition is no exception, including a whopping 14 newly labeled emotional illnesses.

The newest disorder that will most likely affect children will be Obnoxious Disorder (or “OD”). It will be included in the section called Disorders Usually First Diagnosed in Childhood—the same section that includes Attention-Deficit/Hyperactivity Disorder—although adults may also be diagnosed. As with ADHD, there are three official types of the disorder, but they all share some common symptoms. The official DSM-V criteria for Obnoxious Disorder include:
1. A pervasive pattern of behavior that others find obnoxious, highly irritating, or otherwise intolerable.
2. Despite behavioral cues (such as punishment or social ostracizing), the child is unable to reduce his/her obnoxious behavior.
3. The behavior causes significant distress in relationships with peers or adults, or in the child’s academic performance.
4. The obnoxious behavior is not a result of a general medical condition or of substance abuse.
The first of the three specific types of Obnoxious Disorder is Bodily Noises Type (Type I), characterized by “loud and incessant noises produced from natural or forced bodily functions, most often used for attention or disrupting serious situations (such as class, worship services)”. The second type is New Toy Craze Type (Type II). As the name suggests, this includes “behavior—often extremely loud and incessant—used by the child either to convince a parent to buy a popular new toy or to show off his/her possession of the new toy”. This type is differentiated from the more benign Barbie Obsession Disorder. Finally, Type III is Precocious/Bragging Type, which is marked by “an obsessive need to exhibit intellectual, athletic, or other strengths; these exhibitions are repetitive and are usually not welcome by peers or adults”.

Tomorrow, I will describe the prevalence and causes of OD, then discuss treatments and preventative measures.

Train the Brain Not to Drain

Earlier this week, I described the three keys to help nighttime wetters stay dry:

Drink lots of water during the daytime, stopping after dinner.
Void twice before bedtime.
Train the bladder by adding it to the list of organs that the brain controls at night.

I’m going to explain these a bit more now.

First, imagine your bladder is a balloon. If it is empty or has only a bit of air in it, it does not “feel” much pressure. If it is full or near-full, it stretches and “feel” full. Similarly, the more you stretch your bladder during the daytime, the more your bladder will connect that stretching with a need to void (urinate). If your bladder is used to being stretched to a greater degree, then it will not perceive the need to void when it is stretched to a lesser degree. This is what drinking during the daytime provides your bladder. Have your child drink a large glass or bottle of water first thing in the morning, frequent sips throughout the day, and right when he/she gets home from school.

Second, some children do not take the time or concentration needed to properly void their bladder before bedtime. Sometimes patience is key. It is best to try voiding about a half hour before bed, then once just before bed; sometimes letting out that little bit right before bed makes a big difference.

Third, your child can train his/her bladder. It can be trained to do one of two things.

The bladder alerts the brain that it is somewhat full. The brain responds by increasing alertness, becoming semi-conscious, at least enough to get up to void.
The bladder alerts the brain that it is somewhat full. The brain responds by telling the bladder, “Don’t worry, you can hold it until the morning. You know how to do that.”

The child literally speaks to the bladder (I know this sounds nuts, but believe me, it works), telling it that he/she is the boss: “Bladder, listen up! You obey the brain during the daytime. All the other organs obey the brain at night; it’s time for you to follow suit. You need to wake me up if you feel full. Sound the alarm and I will wake up and empty you. Or, I will just tell you to be quiet and stay full until the morning. I know you can do it.”

Over time, the child’s conscious messages will become unconscious and embedded in the bladder’s connection to the brain. It will start to “obey” the brain.

If your child does ALL three of these, he/she can become dry at night, every night. I have seen it many times in my practice.

Hurray for School!

A recent poll taken by a prestigious polling company (OK, it was me) revealed a massive difference between parents and their children when it comes to feelings about the beginning of the schoolyear. 92% of parents were overjoyed, relieved, or generally excited for their children to return to school; 83% of children were, shall we say, less than exuberant.

Why such a disparity? Shouldn’t children be excited to go back to school for all of the new experiences and relationships they will encounter? Aren’t kids thrilled to meet new friends, discover where their locker is, what their teacher will be like, whom they might sit next to, where their desk is, what new rules are in play, and what new students are enrolled? If your child bemoans the onset of the schoolyear simply because he or she would simply love to continue the freedom and joy that summer holds, then you’ve got yourself a normal child with normal desires.
But what of the student who absolutely dreads going back to school? The student who suddenly isn’t sleeping, isn’t eating, is highly irritable, or reports significant bad dreams or fears is likely anxious about returning to school. In this case, listen to your child. Begin a dialogue about school and what might possibly provoke the anxiety about returning.
Here are the usual suspects:
1. Fear of incompetence in academics, due to undiscovered learning disability or weakness
2. Social fears: fear of not fitting in, not growing like peers, being sensitive about braces or clothes
3. Fear of bullies
4. Fear of change–like going to a new school, not knowing the social norms or the layout of the school
See if you can get to the bottom of the anxieties; allow your child to talk about them freely and try to help separate reality from fiction, rational fear from irrational fear.

From Wet to Dry

by: Dr. Dathan Paterno

Does your child struggle with nighttime wetness? If so, he or she is not alone. A surprising percentage of children continue to wet the bed into their early teens.

The good news is that nighttime wetness will likely resolve itself on its own, sooner or later, without drugs, bells, whistles, or therapy. The better news is that parents can equip their children to take control of the problem and greatly speed up the process of becoming dry at night, every night.

Here’s a sneak preview on how to get your child dry at night. There are three keys (I’ll explain all three in greater detail in my next post):

1. Have your child drink more water during the daytime, through dinner.

It may seem counterintuitive to have your child drink more water; many parents have been taught to restrict water intake, thinking that this will make the child less likely to need to urinate during the nighttime. The reality is that this makes the problem worse!

Drinking more water during the daytime stretches out the bladder (not dangerously; we’re not talking about a balloon that’s about to pop), making the amount of urine that accumulates during the nighttime seem less than it would otherwise. This avoids the cue to the brain to release urine.

2. After dinner, make sure your child voids (empties the bladder) at least twice before bedtime. Get it all out!

3. Have your child practice mind-body control exercise that helps the child gain control of his/her bladder.

Your child can understand that the brain controls many organs and functions during the nighttime, including heart, lungs, digestion, and dreams (yes, dreams!), so he or she can control the bladder during the nighttime. All it takes is time and devoted attention to making the right connection.

Again, I’ll explain this more in detail next time. But take heart: your child can become dry every night, sooner rather than later!

Perfecting the Perilous Parenting Pendulum

I was watching an episode of the AMC show “Mad Men” earlier this week and found a perfect example of the type of parent whose discipline is weak because of his own childhood experience of discipline. The show’s main character, Donald Draper, works hard and provides well for his family, but he doesn’t interact much with his children when he is home. In one episode, his stay-at-home wife begins to resent his unwillingness to discipline their son, who clearly needs some “tweaking.”

But Don Draper simply will not express anger toward his son. While I sometimes sense an initial swell of anger boiling under the surface, he is quite adept at subduing and suppressing it. He seems to always retain the loving, supportive, and gracious father persona that he desperately wishes to be. The problem isn’t that he is all of those things; the problem is that he is only those things. When his son desperately needs a firm, angry (but in control) father, he only witnesses a caring, concerned father.

Late in the episode, Don finally does lose his temper when his son ignores his mother’s commands at the dinner table. He hurls his son’s toy across the room, shattering it into pieces. He then walks out of the room and while looking at his wife says, “There, are you happy now?” Mrs. Draper follows him upstairs and tries to convince the husband that her son needs a spanking. She even says, “You wouldn’t be the man you are without your dad spanking you.” He then admits to her, “He used to beat the #$&* out of me. The only thing that did was make me fantasize for years about murdering him.”

Here we see what I call the “parenting pendulum. In order to avoid becoming a monster like his father, he pushes to the other extreme by becoming too permissive. His initial impulse is honorable, but he neglects one of his son’s important needs in the process.

A high percentage of the permissive parents I work with admit that they had extremely domineering, authoritarian parents. They commit to never being like their fathers and so err on the side of caution. Our work focuses on teaching the parents how neither extreme serves their children well and how an assertive, authoritative parenting style bolsters the family hierarchy, which is critical for healthy child development.

Think about your own pendulums. Where did your parents go wrong and how are you compensating for it by pushing your parenting to the opposite end of the spectrum? Consider the possibility that you can come to the middle and not have to worry about copying your parents’ mistakes. You can be in charge, firm, and in control without being an abusive, unloving control freak.

Making Your Home a Learning Environment for Your Children\

by Jessica Fox, M.A., L.P.C.

You have probably heard the phrase “children are like sponges.” In other words, children soak up knowledge and details at a fast and intense pace. I experienced this first hand as an early education teacher before I became a counselor.

Many parents struggle with the ages between 2 years and 5 years where they want to push their child ahead of the game when it comes to reading. There are many ways to get your children interested in reading and comprehension without forcing them to read a book that is not age-appropriate or pushing them too hard to write words or full sentences.

With all of the new technology out there to help youngsters learn to read and write, let us not forget about some simple activities that can encourage your children without making them feel stupid if they are not where you think they should be with regard to reading and writing.

Yes, there is a ton of competition out there and the earlier your child is exposed to literacy the better. But you might notice that the harder you push your child to read before age 5, the more they may resist. Here is a list of other ways to expose your children to word comprehension without pushing too hard and inadvertently turning them off to reading:

*Many of these activities are based on the “whole language” approach.
  1. Label toys and furniture in your child’s room or playroom (you can also label it in two different languages to help your child become bilingual)
  2. Point to each word when you read to your child; read slowly and with punctuation
  3. When your child reads to you, do not be afraid to correct his/her mistakes (practice makes permanent, NOT perfect)
  4. Make a grocery list and let your toddler or young child help
  5. Play a rhyming game with your child
  6. Point out and say traffic signs when driving in the car
  7. Answer your child’s questions, even when they are repetitive and become annoying or seem inane! Patience, patience, patience!
  8. Follow your child’s lead—read a page from a book, and when your child sounds like he/she wants to try, let your child have a go and take over again when he/she has had enough.
  9. Let your child finish the sentence of a book he/she knows from memory. Or, if he/she knows the book from memory, make your child point to each word as he/she recites it.