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Bipolar Kids?

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Kids who are diagnosed as being bipolar are often given medications that have only been approved for adults.

I felt encouraged when I started reading, “Mommy, Am I Really Bipolar?” in the June 27 issue of Newsweek. In the beginning of the article, Dr. Stuart Kaplan, a child psychiatrist with close to five decades of experience, makes the case there is no scientific basis for a bipolar diagnosis for kids.

He claims the bipolar childhood diagnosis only took hold for two main reasons.  First, the authors of a book called The Bipolar Child were featured on 20/20 and Oprah. Following those broadcasts, pharmaceutical companies immediately seized on the current buzz. They began to offer lucrative opportunities for doctors to give industry-sponsored talks to other doctors, with the hopes that more kids would be diagnosed as bipolar and be prescribed their already adult-approved drugs.

In 2006, I was mistakenly invited to attend one of those talks. I say it was an error because I thought I was being invited to a dinner to share ideas on innovative ways to help kids who struggled with attention issues.

I did not know that I was going to be the only non-doctor in the room.  I did not know that the expensive dinner would be complete with centerpieces and take-home goodies that had the sponsoring drug company’s name on everything. I did not know the guest speaker was going to be a psychiatrist who was paid by the drug company. And yes, this psychiatrist spent more than an hour convincing the rest of the doctors in the room to consider a childhood bipolar diagnosis and to use these new drug options with their patients.

So five years later, no surprise that I find myself feeling rather enthused when reading Dr. Kaplan’s article. Here, he’s telling the world that hundreds of thousands of children in the United States are taking adult drugs for a diagnosis he believes does not exist in childhood.  He even goes on to mock how “not waking easily” in the morning has now become considered a sign of being bipolar (this behavior is on the accepted checklist).

The more I read, the more I’m loving it.  Someone in the medical community is challenging what often seems like an indiscriminate prescribing of powerful drugs to young children. Someone with clout is getting others to think about exploring whether this (and other) behaviors could actually be related to something else less ominous.

For example, I’ve met lots of kids with underdeveloped vestibular systems who have trouble waking up in the morning.  How do we know there was a vestibular connection? Well, once these kids’ vestibular systems improved (by doing specific movements, not by taking drugs), they awakened easily.

So I’m smiling as I continue to read, believing that Dr. Kaplan is setting the stage for what’s going to be a good thought-provoking article for mainstream America. But then I read a little more—and, boy, was I ever wrong.

True, he does not believe these kids are bipolar . . . but (are you ready?) he claims these are really kids who have severe ADD and OCD. Worst of all, his point is misdiagnosing these kids means they’re now missing out on being treated with drugs for those diagnoses.

Ah, not to be discouraged. Dr. Kaplan ends his article with hope that the tide may be turning.  The American Psychiatric Association is presently deciding on new criteria that could dramatically reduce the bipolar “fad diagnosis.”  They are recommending a new diagnosis called temper disregulation disorder, citing that this would be a more accurate way to describe extreme irritability in children.

Too cynical to think that drug companies are already starting to ponder what could be prescribed for this diagnosis?

Well, I’m not giving up that, someday, the article I thought I was going to read will be printed in mainstream media.  But guess for now, that time has yet to come.

 

Making Mealtime Pleasant

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With a bit of insight and effort, we can ensure that family meals are a positive experience.

I’m lucky. I have the fondest memories of family dinners, both when growing up and when we were raising our girls. But now it’s estimated that just 28% of families eat together seven nights a week.

Sure, today’s families are busy. But I wonder if family meals have declined because they’re often perceived as stressful. Yet, it doesn’t have to be that way.

Here are some ways to ensure mealtime is a positive experience for all family members.

1. Minimize behavior that we already know annoys us. For example, if our child rocks in his chair, we can buy him a vestibular cushion which then satisfies his need to rock without distracting others. We can also create ways for everyone to rock during mealtime (e.g. all family members rock three times whenever something is passed to someone).

If our child likes to stand while eating, we can deliberately leave something on the kitchen counter and then ask our needing-to-stand child to get it for us. This gives our child a chance to get up, only now he’s doing so in a way that helps the rest of the family.

If our child takes forever to finish his food, we give him less food while eating with the family (he can have more after mealtime if he’s still hungry). We can also set a time when mealtime is over—regardless whether everyone has finished the food on the plate.  In such case, the plates are cleared and any food left on the child’s plate is then served to him at the beginning of the next meal, ensuring food isn’t wasted.

If our child has a hard time sitting in general, we can excuse him early, acknowledging that we’ve enjoyed her company and understand it’s hard for her to sit for long periods of time. Who says every family member—regardless of age or differing brain organization profiles—has to sit the same amount of time for a meal?

2. Engage in only positive interactions. During the meal, family members tell stories about their day, share jokes or riddles, give opinions on current events, and answer open-ended creative thinking questions. Speeches on how to be better organized with homework, the importance of doing chores without complaining, and other concerns are tabled for another time.

3. Decide whether good manners trump everything during mealtime. When kids have retained primitive reflexes and underdeveloped lower centers, they often eat as though they were a toddler. For example, they prefer using their hands over utensils.  They’re messy. They chew with her mouth open. They can’t keep a napkin on their lap.  Sure, we can harp on showing good manners at every meal (even though prior reprimands have not yielded a change), but that means we also forego everything else positive that comes with sharing a family meal. So, we need to decide: Is it worth it?

4.  Understand how underdeveloped lower centers of the brain can interfere with how food feels and tastes. When the midbrain is underdeveloped, some kids have an aversion to how certain foods feel—even more so than how the food actually tastes—in their mouth. This child may seem like a “fussy eater,” but it’s different than the child who just doesn’t feel like trying a new food or insists on having whatever he wants to eat.  Does that mean that we turn our kitchen into a restaurant and cook completely different meals for everyone? No. But we find ways to modify within what’s been prepared. For example, if our child does not like tomatoes, we can serve him spaghetti noodles with butter instead of sauce.

5. Include our kids in the preparation of meals. Why not have our kids shop and help prepare the food? How about starting a garden?  How about giving them a chance to plan the menu or even create an original dish?  All of the above help kids become more generally invested in mealtime.

6. Ban all electronics from the table. That, of course, also includes having the TV on in the background.

So, perhaps, we no longer strive for a perfect Emily Post etiquette kind of meal.  Instead, maybe, we look at mealtime as a wonderful opportunity to connect with and honor all family members.

 

 

Honoring Our Kids

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Honor begins at home.

Lynne Kenney is my guest blogger this week. After she found the Brain Highways website and blog, we discovered that we both encourage parents to honor their kids. Here are her thoughts on the subject.

We all wish to grow healthy, happy relationships with our children. We interact, play and talk with our children to enjoy one another and feel connected. In those moments when we are in conflict with our kids at home, we wonder, “What can I do to enhance my relationships with my children?”

One way to improve our relationships is to show that we honor one another. In its simplest terms, honor is the degree of value, worth and importance you place on a relationship. It is granting another person a position of value in your life. You likely model honor in your own home naturally. You are caring, loving and trustworthy. If you are ready to delve deeper, here are some steps to spring you forward in the depth and experience of teaching honor in your own home.

1. You are your children’s finest role model. If you respect your children in your words and behaviors, they learn to do the same with others.

2. Honor is about allegiance. When you teach your children to honor their relationships, they become friends who stand up for one another, support one another and are true to each other.

3. Honoring honesty, hard work and patience builds children who value hard work and completing tasks to their rightful end.

Reflect for a moment: Do you honor your relationships? Is it important to you that people honor and give value to what you say and feel? How do you show your children that you honor them?

Here are some questions to ponder. You might even wish to write them in a journal and note what you do, when and why. This process will bring honor front of mind, help you monitor your tone and change your behavior as needed.

  • Do I share their exuberance when they show me their schoolwork?
  • Do I make their lunches based on what’s quick, or do I buy food that will keep them healthy, and that they in turn like?
  • Do I take phone calls in my car when I am with my children?
  • Do we make an effort to sit down to family breakfast and dinner?
  • Do I attend my children’s sporting events and pay attention to them, or do I take calls on my cell phone while my children are doing their best on the playing field?
  • Do I involve my children in the tasks of everyday life, such as cleaning, cooking and caring for our home? Or do I tell them, “I’ll do it” because that is easier than working through the process with them or dealing with pending messes?
  • Do I take the time to genuinely learn about my child’s interests?
  • Do I schedule my work hours when the children are at school or do I work at home all hours of the night when they are home and need me?
  • Do I focus on what my children do right rather than what my children do wrong?

No one is perfect, but when we strive to be mindful about how we honor our family, it builds trust, respect and love.

In relationships where we honor one another, listen to our children’s unique voices and really hear what they need, we improve how we communicate, how we express our love and how we get along across a lifetime. If you are ready to take steps today try this:

1. Be consistent with your children.

2. Be attuned to their individual needs.

3. Respond to your children by getting off the couch, computer or phone and going to them. Proximity matters when you are communicating with your children.

4. Take your child’s concerns seriously. This means acknowledging their feelings. Do not mock or tease your children. Sarcasm is painful and it cuts deeply.

5. Match your child’s exuberance and excitement by sharing whole-heartedly in their joy.

6. Give your children your undivided attention in the moments they need you.

If we wish to raise ethical children in this complicated world, we need to begin with the lessons we teach at home. Being present, modeling respect and showing the meaning of honor is a solid start at any age.

 

Dr. Lynne Kenney is a mom, pediatric psychologist, international expert on the Parenting Team and the author of The Family Coach Method.

Ending Kids’ Out of Control Behavior

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We don’t waste time blaming others for allowing out-of-control behavior. We now just take responsibility to end it.

I tell kids that out-of-control behaviors are never-evers. Why? Well, it’s a behavior that never, ever—anywhere on this planet—do people embrace. For example, no one is seeking a friend or spouse or employer who hits, screams, bites, spits, or throws things when upset.

Yet, every time a child is allowed to do a never-ever (and if the child does these, then there is some “permission” in the air), the brain registers such behavior as okay, even helpful, if it results in a reaction from others that is perceived as favorable (e.g. the child receives attention, ruins everyone else’s sense of harmony, no longer has to do whatever, etc.).

But here’s what becomes even more concerning: Parents of kids who do never-evers become desensitized to their kids’ out-of-bounds behavior—and that, itself, makes eliminating it more difficult.

For example, the parents may no longer view it as shocking that an eleven-year-old boy hits his mother or spits or slams doors when something doesn’t go his way—even though others are viewing that same behavior with disbelief.

So how do such parents become desensitized? Well, the brain often kicks in a self-defense mechanism (i.e. becomes desensitized) to a repeated negative experience that does not improve. For example, I recall how my friend was initially sickened by the level of poverty she encountered during her first three weeks in India. But by her last week there, she no longer saw the suffering as when she first arrived. In just a short period of time, she had become desensitized to all the anguish.

How Parents May Be Encouraging Never-Evers (and Not Know It)

Not only do parents become desensitized to extreme, out-of-bounds behavior, but other factors also keep them alive.

1. Parents rationalize the behavior.

At the Brain Highways Center, here are some of the common reasons parents have expressed to explain/justify their child’s never-evers:

• She’s nonverbal, so this is how she communicates.

• He gets tired.

• She gets overstimulated.

• He doesn’t understand what is being asked.

• She does (fill in the blank) because she’s been diagnosed with (fill in the blank).

• He doesn’t really know what he’s doing in that state of mind.

• He’s too underdeveloped to internalize any cause-and-effect response to his behavior.

Yet, a never-ever is just that. There are no excuses. Period.

Plus, none of the above reasons even hold up. For example, the nonverbal child still communicates without words when she’s happy, so why would being nonverbal suddenly be an issue when she’s not getting her way?

And kids, regardless of their diagnosis, are not aliens who slip into some bizarre state of mind that triggers never-ever tantrum behavior.

Tired? Overstimulated? Very possible, but why would that justify never-ever behavior?

Too underdeveloped to understand cause-and-effect? Actually, the child proves that he does understand cause–and-effect. After all, he’s learned to pull out the never-ever behavior whenever he doesn’t like something because such behavior often gets him what he wants (see number 2).
One fact is for certain: As long as parents rationalize never-ever behaviors in any way, they will continue.

2. The child’s brain registers others’ response to the never-ever as beneficial.

Suppose we put a screaming child in her room for a “time-out.” Yet, this response may give the child exactly what he wants (i.e. gets out of doing whatever). If that child then decides when to return (to whatever), he’s still controlling the situation. If he gets to merely apologize and waltz back into the family as though no never-ever happened, he’s additionally given a distorted sense of power since he’s the one who is always deciding when and if he’s going to interact nicely with others.

Moreover, if the child can repeat outrageous behavior—but then all is forgiven after he apologizes verbally and is acting pleasant again–why would the child ever stop doing never-evers? In the adult world, out-of-bounds behavior followed by a sweet apology is framed as an abusive relationship. Yet, we don’t often recognize a similar kind of relationship between a child and parent. Granted, it’s pretty chilling to think that our child is abusing us—and we’re allowing it. But that doesn’t make it not so.

Sometimes parents respond to the outrageous behavior by immediately comforting the child, with the idea of trying to calm her down. But how does that kind of response register in a child’s brain? Let’s see: The child screams. Kicks. Throws something–and that results in getting the parent’s undivided attention, complete with full-on comfort. Any surprise that this brain also views never-evers as beneficial?

In some homes, family members (including the parents) have become intimidated by the never-ever behavior. Consequently, they’ll now try to avoid being the recipient of such actions. Yet, the child who does the never-ever behavior knows this. So, once again, her brain believes such behavior is actually in her best interest. For example, she has learned she may get out of doing something or will be required to do less of something simply because others fear her reaction if asked to comply.

3. One or more people in the home need chaos in order to avoid dealing with some other issue.

Yes, never-ever behaviors are a great distraction. After all, when would we have time to think about something in our own life or relationships (that we’d rather not) if we’re so busy dealing with an out-of-control child? In fact, if there is an invitation for pandemonium in the air, another child in the house often steps into the role as soon as the out-of-control child’s behavior starts to improve.

Stopping Never-Evers Today

Any chance never-ever behaviors go away on their own? No. In fact, never-evers always escalate in intensity with time. For example, the child who darts out the door (to run away) at age four grabs the car keys to escape at fourteen. The child who throws toys and books at five throws furniture at fifteen. And so it goes.

So then, how do we stop never-evers if we’ve allowed them in our lives?

1. We look at the behavior as others view it (i.e. appalling, atrocious, etc.) We acknowledge that we have become desensitized to behavior that has and always will be an unacceptable way to respond.

2. We accept that we have played a role in teaching our kids to act this way. But that also means we can teach them something that creates a more useful brain map as soon as we respond differently. So, that’s encouraging!

3. We realize that we have already taught (on some level) our kids about never-evers. For example, while we may have allowed door slamming, kicking, and screaming, our kids know that they can never ever take a knife and slash furniture when they’re upset. So the same “presence” we used to establish that boundary can also transfer to the never-evers we have inadvertently allowed.

4. We pause and ask ourselves questions before deciding how to respond. What kind of brain map will result from my reaction? Will that be useful in my child’s life—or will it actually reinforce behavior that will alienate others and prevent my child from learning a constructive way to respond?

5. We spell out what never-ever behaviors our child does and explain why we would not want the brain to believe such responses are okay. For example, the child who hits and screams while riding in a car first learns that such behavior is unsafe. Simply, we cannot have distracted drivers. It’s not only unsafe for those in the car, but also for others on the road.

If needed, we get creative and use visuals to help our kids really understand why the never-ever has to stop. Here’s an impressive, graphic video a mom made to help her child understand why he cannot hit his face or bang his head when he’s upset.

6. We share, up front, what will happen if the never-ever appears. For example (continuing with the child who hits and screams while riding in the car), if we can’t trust the child to act in a way that ensures everyone’s safety, then we cannot trust her to ride in the car. And yes, guess that means that the child does not go to (fill in the blank) if he has to get there by car. Only after some time (perhaps three or four days—it can’t be a quick turn-around), do we reconsider whether we can trust the child in a car again and give him a chance to prove that.

For some kids, we may actually do a burial service of never-ever behaviors. In such case, we dig a hole in the backyard and bury a list of the child’s specific never-evers. Sometimes, this visual/event helps our kids get that we are absolutely done with those behaviors.

7. We respond to never-evers differently than to general kid-infractions. Forgetting to make the bed or leaving a mess can’t get the same response as punching the wall or ripping a shirt or kicking. We also can’t use the same generic consequence—time out, take away a toy or privilege—for never-ever behavior if we’re going to get the message across that such behavior is way out-of-bounds.

A mere apology is additionally deemed no longer enough to move forward. Instead, we must create an opportunity for our child to experience how such behavior interferes with his life—right now—even though the rest of us are going to (merrily) continue with ours, regardless. The latter is important. We are no longer held hostage by our child’s never-evers.

8. We hold the child accountable for his actions. For example, if he destroys something, he completes a job (e.g. scrubs grout) to earn money to pay for whatever he ruined. If he throws a chair, he now sits on the floor (sitting in a chair is not an automatic “right”).

9. As we do all of the above, our demeanor remains one of indifference. We may now sing a song or flip through a magazine while the child’s having a tantrum. We are no longer angry since that still gives our child a feeling of power (i.e. he likes that he can upset us). We are no longer consoling since that gives our child a confusing message (i.e. his brain registers never-evers as a way to get comforted). In contrast, our indifference negates whatever distorted power the never-ever may have previously generated. After all, never-ever behavior is intended to provoke, throw everyone off-balance. But now it does nothing.

In short, once we understand about never-evers, we no longer participate in ways that enable such behavior. We now realize that doing so actually hurts our child. And that can’t be what any parent wants to do.

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