~ Manners and Conduct In School and Out, by The Deans of Girls in Chicago High Schools, 1921
via University of Oregon
Is it really that bad of advice? :)
Surprising Rate of Women Have Depression After Childbirth -
CHICAGO —- A surprisingly high number of women have postpartum depressive symptoms, according to a new, large-scale study by a Northwestern Medicine® researcher.
This is the largest scale depression screening of postpartum women and the first time a full psychiatric assessment has been done in a study of postpartum women who screened positive for depression.
The study, which included a depression screening of 10,000 women who had recently delivered infants at single obstetrical hospital, revealed a large percentage of women who suffered recurrent episodes of major depression.
The study underscored the importance of prenatal as well as postpartum screening. Mothers’ and infants’ health and lives hang in the balance. The lives of several women who were suicidal when staff members called them for the screening were saved likely as a result of the study’s screening and immediate intervention.
“In the U.S., the vast majority of postpartum women with depression are not identified or treated even though they are at higher risk for psychiatric disorders,” said Northwestern Medicine lead study author Katherine L. Wisner, M.D. “It’s a huge public health problem. A woman’s mental health has a profound effect on fetal development as well as her child’s physical and emotional development.”
Wisner is director of Northwestern’s Asher Center for the Study and Treatment of Depressive Disorders and the Norman and Helen Asher Professor of Psychiatry and Behavioral Sciences and professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. She’s also a physician at Northwestern Memorial Hospital.
“A lot of women do not understand what is happening to them,” Wisner said. “They think they’re just stressed or they believe it is how having a baby is supposed to feel.”
The paper was be published in JAMA Psychiatry March 13. Wisner conducted the research when she was at the University of Pittsburgh.
In the study, 14 percent of the women screened positive for depression. Of that group, 826 received full psychiatric assessments during at-home visits. Some of the key findings from those assessments:
- In women who screened positive for depression, 19.3 percent thought of harming themselves.
“Most of these women would not have been screened and therefore would not have been identified as seriously at risk,” Wisner said. “We believe screening will save lives.”
Suicide accounts for about 20 percent of postpartum deaths and is the second most common cause of mortality in postpartum women.
- Many women who screened positive for major depression postpartum had already experienced at least one episode of depression previously and, in addition, had an anxiety disorder. The study found 30 percent of women had depression onset prior to pregnancy, 40 percent postpartum and 30 percent during pregnancy. More than two-thirds of these women also had an anxiety disorder.
“Clinicians need to know that the most common clinical presentation in the post-birth period is more complex than a single episode of depression,” Wisner said. “The depression is recurrent and superimposed on an anxiety disorder.“
- Of the women who screened positive for major depression, 22 percent had bipolar disorder, the majority of whom had not been diagnosed by their physicians. There is often a delay in correctly diagnosing bipolar disorder, which depends on identifying not only the depressed phase but the manic or hypomanic phase as well. But postpartum is the highest risk period for new episodes of mania in a woman’s life.
“That’s a very high rate of bipolar disorder that has never been reported in a population screened for postpartum depression before,” said Wisner. “It is significant because antidepressant drug treatment alone can worsen the course of bipolar disorder.”
In addition, women who have been pregnant in the past year are less likely to seek treatment for depression than women who have not been pregnant, previous research has shown.
Maximizing a woman’s overall mental and physical health in pregnancy and after childbirth is critically important.
“Depression during pregnancy increases the risk to a woman and her fetus,” Wisner said. “Depression is a physiological dysregulation disorder of the entire body.”
Maternal prenatal stress and depression is linked to preterm birth and low infant birth weight, which increases the risk of cardiovascular disease. Depression also affects a woman’s appetite, nutrition and prenatal care and is associated with increased alcohol and drug use. Women with untreated depression have a higher body mass index preconception, which carries additional risks.
When a new mother is depressed, her emotional state can interfere with child development and increases the rate of insecure attachment and poor cognitive performance of her child, Wisner said.
Screening prenatal and postpartum are essential (Illinois requires mandatory screening for perinatal mental health disorders), but the health care field must develop cost effective and accessible treatment, Wisner emphasized.
“If we identify patients we must have treatment to offer them,” Wisner said.
The study was funded by grant RO1 MH 071825 from the National Institute of Mental Health of the National Institutes of Health.
Avaz today is an app designed to assist to children communicate non-verbally by addressing their difficulty in processing information such as letters, words and sentences. The app reworks the information into easy-to-understand pictures, rerouting through visual pathways rather than verbal ones. Avaz is prescribed through therapist evaluation for purchase by the child’s parents or through the school’s therapy program. Gradually introduced, the software becomes a part of the child’s life as it helps them to communicate in both academic and social environments. Taking a holistic view of the language development process, Avaz teaches the child underlying patterns of language while seamlessly integrating with existing methods of speech therapy. Moreover, the app is very easy to customize, allowing users to add a new phrase in just 15 seconds. And it’s available on the App Store for $99.
Learning Disability Apps and Important Innovations Under Way
I love this.
Most Children With ADHD Face Mental Health Problems as Adults -
As a result of a groundbreaking new study, researchers conclude that ADHD should no longer be viewed as a disorder primarily affecting the behavior and learning of children, but as a major health condition with lifelong implications and need for effective treatment.
Ron remarks: It’s about time!!!
The Six Best Ways to Manage Anxiety - From Psychology Today
(1) Reevaluating the probability of the threatening event actually happening
Anxiety makes us feel threat is imminent yet most of the time what we worry about never happens. By recording our worries and how many came true, we can notice how much we overestimate the prospect of negative events.
Even if a bad event happened, we may still be able to handle it by using our coping skills and problem-solving abilities or by enlisting others to help. Although not pleasant, we could still survive encountering a spider, having a panic attack, or losing money. It’s important to realize that very few things are the end of the world.
(3) Using deep breathing and relaxation to calm down
By deliberately relaxing our muscles we begin to calm down so we can think clearly. If you practice this without a threat present at first, it can start to become automic and will be easier to use in the moment when you face a threat. Deep breathing engages the parasympathetic nervous system to put the brakes on sympathetic arousal.
(4) Becoming mindful of our own physical and mental reactions
The skill of mindfulness involves calmly observing our own reactions, including fear, without panic or feeling compelled to act. It is something that can be taught in therapy and improves with practice.
(5) Accepting the Fear and Committing to Living a Life Based on Core Values
Acceptance and Commitment Therapy (ACT) is an approach that encourages people to accept the inevitability of negative thoughts and feelings and not try to repress or control them. By directing attention away from the fear and back onto life tasks and valued goals, we can live a full life despite the fear.
Exposure is the most powerful technique for anxiety and it involves facing what we fear and staying in the situation long enough for the fear to habituate or go down, as it naturally does. Fear makes us avoid or run away, so our minds and bodies never learn that much of what we fear is not truly dangerous.
What is Positive Parenting?
Wouldn’t it be nice if children came with an instruction manual? The ways in which we are expected to parent our children today is often different from the way we were parented. Social attitudes have dramatically changed parenting expectations about work and family life, about discipline, about communication, about sibling rivalry, about homework and more. Without sufficient guidelines to help modern-day parents, they are left feeling helpless and frustrated.
To cope with these changes, parents need to adopt more positive parenting techniques. A positive parent provides children with structure and security, with love and limits,and with self-control and self-respect. Raised in this atmosphere, children will develop healthy attitudes about relationships, and they will be more responsible and have a healthier sense of self.
Because many parents were raised with punishment, they have a misunderstanding about how to get cooperation and teach respect without yelling, spanking or using time out. Positive parents understand the difference between discipline and punishment. Discipline engages children’s thinking brains and helps children make important choices about what is right and wrong. Punishment uses aggression, isolation and shame to coerce right behavior. Discipline models self-control and respect. Punishment creates fear.
‘Positive discipline’ parents encourage children to find their own solutions to problems while acting as a coach or emotional tutor. These parents act as a model of what they want their own children to be. They avoid “do it because I told you so” or “do what I say, not what I do,” because they know that children who hear this will behave when parents are around but do what they want when they’re alone or with peers.
Positive Parenting Tips
One of the simplest ways to be a positive parent is to offer children choices: “Do you want milk or juice with breakfast?” Two choices are enough! If your child says she wants soda, repeat the choices again. After going a couple of rounds without a choice, step in and make the decision for her. Don’t back down at this point; stand your ground and offer firm limits. Your child will be more ready to make a choice about drinks tomorrow. You can offer a lot of choices to your child throughout the day, so that making decisions becomes natural. After a while, your child will feel empowered about her ability to choose, so that the need for a power struggle decreases. This will help you as a parent to feel more competent about your skills as well.
Another positive parenting tip is to show lots of empathy for a problem your child brings up, such as a teacher who gave him a low test score. Quizzing your child about why he got such a low grade or pointing out that he didn’t study like he had been told to can turn into a fight rather than the chance to problem solve together. Instead, you can say, “You’re very upset about this score. You felt you should have gotten a better one.” Follow this empathetic response up with a positive brainstorming comment such as, “What could you do next time to get a better score?” At first children who hear these responses will defend themselves, but over time they will offer some ideas about the need to study more, prepare better, or perhaps get a tutor. Engaging in problem-solving conversations can help a child learn how to do better in school and life.
Making these positive parenting changes is not easy. Parents will fall back into old, negative patterns. That is just one more opportunity to model change. Be honest about the mistakes. Talk about how you will correct them next time, and let your child witness your transformation.
from Winter 2013 Adoptalk
Used with permission by Mary Boo.
By Katja Rowell, M.D. © 2013 Dr. Katja Rowell is a family doctor turned childhood feeding specialist. Her mission is to bring peace and joy to the family table. She consults with parents, is a blogger, mom, family cook, and sought-after speaker. Her book Love Me, Feed Me: The Adoptive Parent’s Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More distills the support she provides clients. (Published in 2012 and available on Amazon.com.)
The information in this article is educational. It is not meant to replace careful evaluation and treatment by medical, nutritional, or mental health professionals.
Whether a child is 15 days or 15 years old, feeding and nurturing through shared meals is a critical way to deepen attachment. Dr. Bruce Perry, of the Child Trauma Academy, refers to ideal bonding opportunities as repetitive, relationship-building, patternbased, and involving the senses— which describes the family meal experience perfectly. But the family table is not always an easy place for adopted and foster children. Indeed, one mom said that her fantasies of pleasant family meals were met “with a slap in the face” when her two children, adopted from Russia, struggled with food anxieties and sensory issues. Unfortunately, conflict around food and eating habits are more common for foster and adopted children due to their past experiences. When conflict defines interactions around food, those bonding opportunities are lost, and trust and attachment can suffer as well.
“We had a 15-year-old boy in foster care with a history of runaway episodes,” Amy recalls. “He was gone for about 30 hours. When he came back, I decided there was no point being upset, so just told him we’d been scared, made sure he was safe and healthy, and quickly threw a box of mac-n-cheese on the stove to get him some comfort food. That floored him, because it turns out that he’d been denied food in his home after his running. I think it ended up bonding him to us much more than anything else could have.”
Parents want to raise children who are healthy and happy. Many try to instill healthy eating habits by enforcing nutrition rules or portion control. But when raising children who have experienced food insecurity, healing the anxiety around food is key to helping children grow up to be competent eaters who can self-regulate and learn to eat a variety of foods.
Food Insecurity Leads to Survival Behaviors
When children are not fed reliably, do not get enough food, or have to compete for enough, they become anxious. When food-insecure children do have access to food, they often don’t understand or trust that it is coming again in adequate amounts. Food insecurity and unsupportive feeding deeply color the initial relationship a child has with food. It can take weeks, months, and even years of reliable feeding for that trust to build and for children to believe they will be fed.
Some children who have been food insecure demonstrate hoarding behaviors. These survival strategies may manifest themselves in the following:
Healing Food Anxieties
Deciding whether to stash or not to stash. Many resources on hoarding advise allowing the child to have snacks in his backpack or carry food in a pocket, or even have containers of food in the bedroom. Anneliese, mother of two boys, one adopted, one biological, recalls that the main feeding advice she got from her social worker was to let her son carry around baggies of carrots all day: “I just didn’t think that was going to help.” Other experts advise parents to avoid the stash and serve regular meals and snacks. The reality is, it is not an either-or or one-size-fits-all answer.
Parents may decide to offer a stash, or not, and see how things go. The stash may help at first, and the child simply loses interest with time. Consider 18- month-old Marcus, who did not want to let go of his biscuit. He certainly can be allowed to hang on to the biscuit for a while, and maybe even have one in his pocket. Follow his lead. If he throws a tantrum when it’s taken away, allow him to carry it. But the parent also has to be absolutely reliable about regularly providing food. Parents may need to offer food more frequently at first, perhaps every hour or so.
Three-year-old Arielle, adopted at 11 months, was on calorie restriction and was experiencing intense food anxiety and preoccupation. Mom let her carry food in an attempt to address her anxiety, but Arielle gobbled it up and begged for more. In this scenario, Arielle’s actions were not the hoarding behaviors seen when a child first arrives from a place of food insecurity, but were actually symptoms of a feeding relationship disruption due to her food restriction (more below). Letting her have her own stash of food to carry around didn’t work in this situation.
To facilitate bonding and food security, food should come from the parents whenever possible. When a child is allowed to get food whenever he wants, he may still feel responsible for getting his own food. It is a missed opportunity to nurture and deepen the attachment with the child. Feeding a child directly shows him that he will be taken care of and builds trust. Meeting his needs, over and over again, is the basis for attachment.
Reassuring the child with words and actions. One foster mom had a little boy she couldn’t keep out of the fridge. He would occasionally eat to the point of making himself sick. Mom didn’t want to lock the fridge to restrict his food access. Instead, she assigned him a refrigerator drawer. She stocked it with familiar food and told him that the drawer would always be full, and while he could not take food at random, this drawer was his. He checked the drawer often, with Mom’s reassurance that it was his food, and he could help choose from it for meals and snack times. Mom made certain it was never empty, and gradually he forgot about it, mostly because Mom reassured him with regularly scheduled meals and snacks.
Another preschool boy, adopted from Eastern Europe, loved cereal. He would frantically gobble as much as he could and cry when limited. His parents finally realized that when he saw an empty box, he thought there would be no more cereal, ever. They were able to reassure him, and for a while overstocked the pantry with his favorite cereals. At breakfast, he was allowed to eat as much as he wanted, but simple reassurances and a trip to look at the pantry helped him realize he would get enough. Soon he was eating about the same as his brother and was no longer anxious at meals.
Being reliable about feeding. While parents can allow a stash if it works for their child, the best way to lessen hoarding behaviors is to lessen anxiety around food.
“Sam had some hoarding issues, but it didn’t last long. We let it run its course. We chose not to have food available to the boys all day and night. I didn’t think it would reassure them. I fed them regularly and sat and ate with them. They pretty quickly learned to trust they would get fed.” — Mia, mother of two boys adopted at age five and seven
Deborah Gray, in Attaching and Adoption, wrote about “high nurture, high structure” parenting. This dovetails nicely with feeding in the Trust Model, pioneered by therapist and nutritionist Ellyn Satter. Parents provide regular meals and snacks with balanced and tasty foods, and the child decides how much to eat from what is provided.
Keeping initial hoarding from becoming entrenched food obsession.Even if a child is labeled as obese or overweight, she can still feel food insecure, and attempts to limit her intake will make her more anxious and prone to overeat. Many children who experienced food insecurity have initial behaviors that scare parents, especially if the child is bigger than average. A foster child may be obese and not regulating food intake due to food insecurity or other factors.
Research tells us that restrictive feeding tends to lead to higher weight and increased eating in the absence of hunger. I believe food restriction and efforts to control weight lead to more entrenched food obsession, with food-seeking behaviors worsening, not improving.
It is critical to address a child’s initial food anxiety with nurturing, reliable feeding, and allow the child to “overeat” while she learns to trust her cues of hunger and fullness. I believe these children’s food regulation skills are simply buried, and they can learn to tune in to hunger and fullness cues.What it boils down to is this: with reliable, pleasant, and satisfying meals and snacks, even the food insecure child will learn over time that he doesn’t have to worry about when or how much he will get to eat. Parents get to worry or think about the food, so the child doesn’t have to.
Tips to Reduce Food Anxiety
It Happened to Me: I Have a Severely Disabled Child -
We thought once we got the all-clear on the amniocentesis tests, we were assured of healthy babies.
Jill remembers the very first time Ben got called to the principal’s office. The kindergarteners were standing in line waiting for the bus home when Ben pushed a classmate to the ground. Then he encouraged a few of the other kids to start kicking. The boy wasn’t down for long before a teacher, who had witnessed the whole thing, came over to intervene. Ben, the teacher later told Jill, seemed to think it was funny. Jill was horrified.
Ben and his collaborators were sentenced to five hours each of community service around the school during recess: cleaning dry erase boards, packing up balls in the gym. At home, Jill talked to Ben about what it means to act appropriately at school and to be kind to others, and continued to talk to him in the months following. He was a smart boy; he understood, she thought. After all, at home, he was generally well behaved.
And yet, three years later, Ben remains the undisputed class troublemaker. Teachers almost seem to assume that he’ll act out. Often, Jill suspects, this is precisely the reason he does. He knows what’s expected of him.
During the elementary school years, boys tend to misbehave more than girls, though girls catch up later during adolescence, in other ways. We used to say that boys were more “active,” as if to excuse, or at least explain, misbehavior. But the truth is that the line between “active” and “disruptive” is thin, kids aren’t particularly skilled at walking it, and disruptive is a problem. Parents of kids like Ben know that once a boy has been labeled a troublemaker at school, it can be very difficult for him to shake the label. Often, that’s because he becomes the label; he, like Ben, lives up to the expectations other have laid out for him.
It’s not easy for parents to admit their son is the one causing trouble, and can be even harder to reconcile when the child is well behaved at home. It’s a natural impulse to defend kids, especially when you didn’t actually see what happened, and want to help them argue their way out of trouble — whether that’s after-school detention or a speeding ticket. It’s also natural for parents to want to intervene when their troublemaker finds himself an outcast among friends, as many often do. “Many of the boys stopped wanting to play with Ben at recess because it often meant they’d get into trouble, too,” remembers Jill. “It was heartbreaking, but in a way I couldn’t really blame them. It wasn’t untrue.”
If your child is the troublemaker, it’s important to help set him straight sooner rather than later — ideally before he gets labeled and before he finds himself losing friends. A few ideas to keep in mind:
Practice tough love (on yourself, too). Be honest with yourself about your son’s behavior. Your job is to be his champion, but not his defender when he’s behaved inappropriately. If he’s the class clown, even if he’s not “hurting anyone,” you need to acknowledge that, and respect the consequences. Learning to develop the skills needed to be part of a group is a critical part of growing up, and something your son needs to learn. Maybe even the hard way.
Cooperate. The best results come when parents can work with, and not against, teachers. When you argue with the school, his coach, or the staff at the daycare, you’re letting your son off the hook. You can support him without letting him avoid the consequences of his actions. The more you help him skirt the issue, the less likely he is to change. And if you do disagree with the way a teacher is handling your child, never discuss it in front of him. That will only further undermine her authority in his eyes. Take your concern directly to the teacher, way out of earshot of your son.
Be specific. When your son acts out at home or in school, don’t just tell him what he did wrong. Have him tell you — and then talk together about why that behavior was unacceptable. Teach him strategies to act better. One way to do this is to present specific scenarios. Set up micro-scenes and have him act out responses: What to do when he’s bored in class, angry with a friend, feeling the urge to tell a joke during quiet time. Then remind him of all his positive qualities and point out when he does something right, like helping a friend or making his bed without being asked. Being labeled a troublemaker can be difficult on a child’s self-esteem, so remember to give it a gentle boost now and again. If he thinks he only does wrong, he’ll continue to do wrong.
Let things go… If your son is losing friends because of his behavior, don’t try to intervene, no matter how difficult it is to watch. Children have the right to decide if they’re not comfortable playing with other children. Respect their decision and know that it will be a learning tool for your son, then talk to him about why his friends may be turning away. Learning how to get along with others is an important part of becoming independent, and while you can help him understand what it means to be a good friend, you can’t force other children to overlook your son’s problematic behavior. In fact, the less you help, the quicker he’ll figure it out himself.
… But don’t give up. If the pattern continues or gets worse, you may want to consider enlisting the help of your pediatrician or a counselor. Some kids have trouble adjusting to change, at school or at home. But if his behavior has been consistent over months or even years, something may be bothering him that he’s unable to articulate.