Are Co-Parenting Classes Helpful for Divorced Parents?

Bass, T. (n.d.). When mom and dad work together, everyone benefits: Effective co-parenting. The Alliance for Early Childhood. Retrieved May 2019 from http://www.theallianceforec.org/library.php?c=6&news=106       

Ceder, J. (2019). Should I take a parenting class? verywell family. Retrieved May 2019 from https://www.verywellfamily.com/what-are-parenting-classes-4144875    

Co-Parenting and divorce class. (n.d.). Family Builders. Retrieved May 2019 from https://familybuildersok.org/co-parenting-divorce/     

Online co-parenting/divorce class. (n.d.). Online Parenting Programs. Retrieved May 2019 from https://www.onlineparentingprograms.com/online-classes/co-parenting-divorce-class.html

Welcome to co-parenting & divorce education. (n.d.). Open Path: Online Wellness Education. Retrieved May 2019 from https://mentalhealth.openpathcollective.org/co-parenting/

Is a Parenting Marriage Healthy for Your Children?

Fleck, A. (n.d.). Development of children in a loveless marriage. Livestrong. Retrieved May 2019 from https://www.livestrong.com/article/1006420-development-children-loveless-marriage/

Larson, V. (2015). Forget conscious uncoupling: The way forward for families is platonic parenting. The Guardian. Retrieved May 2019 from https://www.theguardian.com/lifeandstyle/2015/apr/15/forget-conscious-uncoupling-families-platonic-parenting

Mueller, P. (2017). Platonic Parenting: Could it Work for You? The Good Men Project. Retrieved May 2019 from https://goodmenproject.com/families/platonic-parenting-could-it-work-for-you-bbab/

Try parenting marriage—an alternative to divorce. (n.d.). Marriage.com. Retrieved May 2019 fromhttps://www.marriage.com/advice/family/try-parenting-marriage/

What is Co-Parenting?

Calleia, D. (2014). 11 successful co-parenting commandments. Today’s Parent. Retrieved May 2019 from https://www.todaysparent.com/family/parenting/11-successful-co-parenting-commandments/

Gaspard, T. (2018). What’s the difference between co-parenting and parallel parenting? Divorce Magazine. Retrieved May 2018 from https://www.divorcemag.com/blog/difference-between-co-parenting-and-parallel-parenting/

Serani, D. (2012). The do’s and don’ts of co-parenting well. Psychology Today. Retrieved May 2019 from https://www.psychologytoday.com/us/blog/two-takes-depression/201203/the-dos-and-donts-co-parenting-well

What is co-parenting? (n.d.). CoParents.com. Retrieved May 2019 from https://www.coparents.com/coparenting/what-is-co-parenting.php

What is co-parenting? (n.d.). OurFamilyWizard. Retrieved May 2019 from https://www.ourfamilywizard.com/blog/what-co-parenting

Do We Need Co-Parenting Counseling, Therapy, or Mediation?

Co-Parenting counseling. (n.d.). FamilyCounselorServices.com. Retrieved May 2019 from https://familycounselorservices.com/co-parenting_counseling.html

Co-Parenting counseling. (n.d.). Relationship Therapy Center. Retrieved May 2019 from https://www.therelationshiptherapycenter.com/co-parenting

Co-Parenting mediation. (n.d.). Parenting Matters. Retrieved May 2019 from https://aparentingmatter.com/co-parenting-mediation/

Parenting plan mediation…A “custody plan”. (n.d.). Coach Mediate Consult. Retrieved May 2019 from https://coachmediateconsult.com/mediate/

Tuckman, S. (2014). 5 good reasons to try co-parenting therapy. GoodTherapy. Retrieved May 2019 from https://www.goodtherapy.org/blog/5-good-reasons-to-try-co-parenting-therapy-0917144

Tips for Co-Parenting with a Toxic Ex

Bates-Duford, T. (2016). Tips for healthy co-parenting with a toxic ex. Divorce Magazine. Retrieved May 2018 from https://www.divorcemag.com/blog/tips-for-healthy-co-parenting-with-a-toxic-ex/

Finn, K. (2018). What you MUST do if you’re co-parenting with a toxic ex. The Good Men Project. Retrieved May 2019 from https://goodmenproject.com/divorce/what-you-must-do-if-youre-co-parenting-with-a-toxic-ex-wcz/

Gaspard, T. (2018). What’s the difference between co-parenting and parallel parenting? Divorce Magazine. Retrieved May 2019 from https://www.divorcemag.com/blog/difference-between-co-parenting-and-parallel-parenting/

Giorgetti, D. (2018). 15 things to remember when co-parenting with a toxic ex-spouse. The Mighty. Retrieved May 2019 from https://themighty.com/2018/06/ex-spouse-co-parenting-toxic-alienation-turn-child-against-me/

Penland, J. (n.d.) You can’t co-parent with a toxic ex, but you can do this instead. Scary Mommy. Retrieved May 2019 from https://www.scarymommy.com/cant-co-parenting-with-a-toxic-ex/

What Is a Parenting Plan and How Do I Make One?

A parenting plan the works for you and your children. (n.d.). DivorceHelpforParents.com. Retrieved May 2019 from http://www.divorcehelpforparents.com/parenting-plan.html

Abigail, F. (2019). What is a parenting plan and why do I need one? Avvo. Retrieved May 2019 from https://www.avvo.com/legal-guides/ugc/what-is-a-parenting-plan-and-why-do-i-need-one--1

Cook, C.S. (2018). What is a parenting plan? Avvo. Retrieved May 2019 from https://www.avvo.com/legal-guides/ugc/what-is-a-parenting-plan--1

Kruk, E. (2015). Developing co-parenting plans. Psychology Today. Retrieved May 2019 from https://www.psychologytoday.com/us/blog/co-parenting-after-divorce/201510/developing-co-parenting-plans

Parenting plan examples—a plan that fits your needs. (n.d.). Our Family Wizard. Retrieved May 2019 from https://www.ourfamilywizard.com/blog/parenting-plan-examples-a-plan-that-fits-your-needs

Sample parenting plans: Ideas to implement: (n.d.). DivorceHelpForParents.com. Retrieved May 2019 from http://www.divorcehelpforparents.com/sample-parenting-plans.html

What does a parenting plan include? (2018). Goldberg Jones. Retrieved May 2019 from https://www.goldbergjones-wa.com/child-custody/parenting-plan-includes/

How do you avoid caregiver stress or caregiver burnout? Parents of high-demand children need to rest and get away.

Many people worry about burning out from the constant drain of caring for a child 24/7, and this can be an even more crucial issue for the parents of a child with bipolar disorder, ADHD or other serious mental health condition.

Parents frequently hear questions such as "How can you stand to be with your kid 24/7?". The answer can be found in one word... Respite. Without planning adequate opportunities for the parent/educator/caregiver to be free from demands, rested and rejuvenated, parenting is likely to rapidly deteriorate into a painful power struggle benefiting no one.

Sometimes the other parent can provide "time off" for the parent, but for single parents or parents who have a spouse who travels, additional plans must be made. Grandparents might provide respite by taking the child(ren) for a few hours or overnight. A local high school or college student can be hired for a relatively low wage and provide respite. Schools who have psych programs or special education programs often have students who would jump at the chance to work with a child with a psychological condition. When more stable, many children with a mental illness benefit from classes such as art classes or volunteer work, and that time can provide a brief respite as well. It is imperative not to neglect this most urgent of issues if you are to remain effective parents and happy people.

Put the Glass Down

A lecturer was speaking to his students on stress management. He raised a glass of water and asked the audience, "How heavy do you think this glass of water is?" The students' answers ranged from 20g to 500gm.

"It does not matter on the absolute weight. It depends on how long you hold it. If I hold it for a minute, it is OK. If I hold it for an hour, I will have an ache in my right arm. If I hold it for a day, you will have to call an ambulance. It is the exact same weight, but the longer I hold it, the heavier it becomes."

"If we carry our burdens all the time, sooner or later, we will not be able to carry on, the burden becoming increasingly heavier. What you have to do is to put the glass down, rest for a while before holding it up again" We have to put down the burden periodically, so that we can be refreshed and are able to carry on.

So before you return home from work tonight, put the burden of work down. Don't carry it back home. You can pick it up tomorrow. Whatever burdens you are having now on your shoulders, let it down for a moment if you can. Pick it up again later when you have rested...

~Author Unknown

 

What is self-injury? Why do adolescents engage in self-injurious behaviors and what can parents do about it?

Self-injury is the act of deliberately destroying body tissue, at times to change a way of feeling. Self-injury is seen differently by groups and cultures within society. This appears to have become more popular lately, especially in adolescents. The causes and severity of self-injury can vary. Some forms may include:

• carving
• scratching
• branding
• marking picking, and pulling skin and hair
• burning/abrasions
• cutting
• biting
• headbanging
• bruising
• hitting
• tattooing
• excessive body piercing

Some adolescents may self-mutilate to take risks, rebel, reject their parents' values, state their individuality or merely be accepted. Others, however, may injure themselves out of desperation or anger to seek attention, to show their hopelessness and worthlessness, or because they have suicidal thoughts. These children may suffer from serious psychiatric problems such as depression, psychosis, posttraumatic stress disorder (PTSD) and bipolar disorder. Additionally, some adolescents who engage in self-injury may develop borderline personality disorder as adults. Some young children may resort to self-injurious acts from time to time but often grow out of it. Children with mental retardation and/or autism may also show these behaviors which may persist into adulthood. Children who have been abused or abandoned may self-mutilate.

Why do adolescents self-injure?

Adolescents who have difficulty talking about their feelings may show their emotional tension, physical discomfort, pain and low self-esteem with self-injurious behaviors. Although they may feel like the "steam" in the "pressure cooker" has been released following the act of hurting themselves, teenagers may instead feel hurt, anger, fear, and hate. The effects of peer pressure and contagion can also influence adolescents to injure themselves. Even though fads come and go, most of the wounds on the adolescents' skin will be permanent. Occasionally, teenagers may hide their scars, burns, and bruises due to feeling embarrassed, rejected or criticized about their deformities.

What can parents and teenagers do about self-injury?

Parents are encouraged to talk with their children about respecting and valuing their bodies. Parents should also serve as role models for their teenagers by not engaging in acts of self-harm. Some helpful ways for adolescents to avoid hurting themselves include learning to:

• accept reality and find ways to make the present moment more tolerable.
• identify feelings and talk them out rather than acting on them.
• distract themselves from feelings of self-harm (for example, counting to ten, waiting 15 minutes, saying "NO!" or "STOP!," practicing breathing exercises, journaling, drawing, thinking about positive images, using ice and rubber bands, etc.)
• stop, think, and evaluate the pros and cons of self-injury.
• soothe themselves in a positive, non-injurious, way.
• practice positive stress management.
• develop better social skills.

Evaluation by a mental health professional may assist in identifying and treating the underlying causes of self-injury. Feelings of wanting to die or kill themselves are reasons for adolescents to seek professional care emergently. A child and adolescent psychiatrist can also diagnose and treat serious psychiatric disorders that may accompany self-injurious behavior.

Sources:

• American Academy of Child and Adolescent Psychiatry, Facts for Families, No. 73; Updated December 1999.

 

Detailed overview of the types of eating disorders, signs and symptoms of anorexia, bulimia and binge eating disorder and how to get your child started in eating disorders treatment.

The three common types of eating disorders are anorexia nervosa and bulimia nervosa. They can occur separately or together in the same person. Eating disorders most often affect young women. Less than 10% of people with eating disorders are boys and men. A person who has an eating disorder is not necessarily skinny. Some people with eating disorders are even overweight.

• Most importantly, you should know that eating disorders require medical attention!

What is anorexia nervosa?

To be diagnosed with anorexia, a person must:

• Be 15% below their ideal weight
• Have an intense fear of being fat, even though they are underweight
• Have a distorted image of their body and denial of the problem of their being underweight
• Have amenorrhea (missing at least 3 periods in a row)
• May also binge and purge

It usually affects teens and mostly girls. An estimated 1% of white females have anorexia nervosa. It is more common among people in higher-income groups and in groups that value thinness (like athletes, ballet dancers, and models). It usually starts at age 13-14 or at age17-18.

What is bulimia?

To diagnose bulimia nervosa, a person must:

• Binge eat (eat larger amounts of food in a given period of time than most people would normally eat in similar situation)
• Feel a lack of control during binge eating
• Purge the excess food by making themselves vomit, fasting (not eating for 24 hours), exercising excessively (for more than an hour), or abusing diet pills, laxatives, enemas, or diuretics (water pills)
• Binge and purge regularly over a period of time
• Have a self-image based mostly on their body shape and weight instead of other qualities

People with bulimia may be anywhere from underweight, to normal weight, to overweight. It is estimated that as much as 3% of college-aged women have bulimia.

What is binge eating disorder?

Binge eating disorder is diagnosed when a person:

• Continues to binge eat over time (eating larger amounts of food in a given period of time than most people would normally eat in similar situation)
• Feels a lack of control during binge eating
• Eats fast during binges
• Overeats until uncomfortable
• Eats a lot when not hungry
• Eats alone out of embarrassment
• Feels disgusted with themselves, depressed or very guilty after overeating
• Is worried about their binge eating

Binge eating disorder does not include the purging consistent with anorexia and bulimia. About 40% of obese people may have this problem.

The exact causes of eating disorders are not known for sure. Many different factors working together probably cause a person to develop an eating disorder. Dieting can lead to eating disorders, with the greatest risk to severe dieters. Around two-thirds of new cases of eating disorder are in girls and women who have dieted moderately [1].

Is an eating disorder dangerous to my child's health?

Many dangerous medical and psychological problems can result from eating disorders. Eating disorders can be deadly. They require medical attention!

Is it dangerous to use medications to lose weight?

The products a person might use to lose weight can be very dangerous. The regular use of diuretics (water pills), laxatives, and weight loss pills can cause a variety of life-threatening problems, even if they don't cause very much weight loss. Using syrup of ipecac to cause vomiting can also lead to life-threatening complications.

How can I tell what's a sensible diet?

Generally speaking, most kids and teens should not be on a restrictive diet. In fact, restricting eating to control weight is not only ineffective, but dieting actually promotes weight gain in tweens and teens [2].

How can I tell whether my child is underweight?

If you are concerned about your child's weight, you should take them to see their doctor. There are some different measurements a doctor may take to tell whether your child is underweight.

• Weight and height can be compared and plotted on a growth chart.
• The best measurement to take is body mass index (BMI). It is fairly complicated to calculate and understand. You can calculate your child's BMI on a web BMI calculator, and check your child's BMI against the right chart for their age and sex to find out their percentile. A body mass index (BMI) below the 5th percentile for the child's age and sex is considered underweight.

How can I tell if my child might have an eating disorder?

Look for these behaviors, signs and symptoms:

• Eating tiny portions or refusing to eat
• Intense fear of being fat
• Distorted body image
• Strenuous exercising (for more than an hour)
• Hoarding and hiding food
• Eating in secret
• Disappearing after eating—often to the bathroom
• Large changes in weight, both up and down
• Social withdrawal
• Depression
• Irritability
• Hiding weight loss by wearing bulky clothes
• Little concern over extreme weight loss
• Stomach cramps
• Menstrual irregularities—missing periods
• Dizziness
• Feeling cold all the time
• Sleep problems
• Cuts and calluses across the top of finger joints (from sticking finger down throat to cause vomiting)
• Dry skin
• Puffy face Fine hair on body
• Thinning of hair on head, dry and brittle hair
• Cavities, or discoloration of teeth, from vomiting
• Muscle weakness
• Yellow skin
• Cold, mottled hands and feet or swelling of feet

If your child has some of these signs, you should bring them to the doctor right away. There are some diseases that can appear to be an eating disorder that would need to be ruled out. If the eating disorder is not treated, it can become life-threatening. Take a quiz to see if someone you care about may have disordered eating.

How can I help my child?

• In a calm and caring way, tell your child what you saw or heard. Use "I" statements and let him or her know you are concerned. For example, "I'm worried about you because you haven't eaten lunch this week."
• Listen carefully to what your child says. Teens with eating disorders might feel ashamed or afraid. They may think that life doesn't matter. Feeling out of control is also common.
• What if they get mad or deny it? It is very common for kids with problems to say that there is nothing wrong. Tell them you want to help. You may need to approach them several times.
• Get more tips on how to help your child or family member if you suspect they have an eating disorder.

How are eating disorders treated? How can I get my child started in treatment?

The first goal in treating severe anorexia is to put some weight back on. Then, the goals will focus on learning about nutrition and normal eating patterns, improving self-esteem, relating to others, interacting with family, and treating medical and other psychological problems.

• To get started, call the National Eating Disorders Association's Toll-Free Information and Referral Helpline at 1-800-931-2237.

What can we do to help prevent eating disorders?

You may feel you want to protect your child from the hurt of being teased about their weight. Unfortunately, focusing on your child's body may do more harm than good. Your child may begin to value themselves solely on what they look like and feel they have to look a certain way to gain approval and acceptance.

Try not to put much emphasis on what your child looks like. Instead, emphasize your child's inner qualities. Pay attention to the messages you send your child about appearance and weight. Do you constantly diet, and talk about "good foods" and "bad foods?" Do you make negative comments on your own body in front of your child? It may also help to discourage your daughter from reading lots of women's fashion magazines and from being exposed to other media that portray underweight women as being glamorous. Discuss media images of "ideal bodies" with your children. Teach your kids to be media literate, which will help protect them from harmful messages about food, eating, and body size from TV, music videos, magazines, and ads.

• Parents are key players in prevention—strategies for parents
• Build your child's self-image.

My child seems to have a very distorted view of how they look. What's going on?

Your child may have Body Dysmorphic Disorder (BDD). This means being wrapped up in their appearance way more than normal, and obsessing about real or imagined defects in how they look. It is a kind of distorted thinking. It affects males and females about equally. Find out more about BDD, including list of clues to BDD's presence, and books and articles about the disorder. If you suspect your child has BDD or body image problems, you should seek professional help. The Butler Hospital BDD and Body Image Program recommends getting an evaluation from a psychiatrist or licensed psychologist with expertise in treating BDD. If you can't find anyone with this expertise, then find someone with expertise in treating obsessive-compulsive disorder (OCD), as OCD seems to be related to BDD.

What book should I read to help my child develop healthy eating habits?

How to Get Your Kid to Eat...But Not Too Much, by Ellyn Satter. This is a book all parents should read, whether their children have eating problems or not. It applies to kids from birth through the teen years. The advice in this book can help you help your child to develop a healthy relationship with food.

What are some other resources?

• The National Eating Disorders Association is the largest not-for-profit organization in the United States working to prevent eating disorders, eliminate body dissatisfaction, and provide treatment referrals to those suffering from anorexia, bulimia and binge eating disorder and those concerned with body image, eating and weight issues. Their Web site offers information about eating disorders and body image; referrals to treatment centers, doctors, therapists, and support groups; opportunities to get involved in prevention efforts; prevention programs for all ages; and educational materials. Call 1-206 382-3587 for more information. Call the Toll-Free Information and Referral HelpLine at 1-800-931-2237.
• The National Eating Disorder Information Centre (NEDIC) is a Canadian organization that provides information and resources on eating disorders and weight preoccupation. Phone 416-340-4156.
• The National Association of Anorexia Nervosa and Associated Disorders (ANAD) has an international network of support groups, offers referrals to health care professionals, publishes a newsletter, and will mail information packets customized to individual needs upon request. They work to educate the public, promote research projects, and fight insurance discrimination and dangerous advertising. Their national hotline (847-831-3438) can give you a listing of support groups and referrals in your area.
• Anorexia Nervosa and Related Eating Disorders (ANRED)has merged into NEDA, but maintains its own Web site, which provides lots of information about anorexia nervosa, bulimia nervosa, binge eating disorder, compulsive exercising, and other less well-known food and weight disorders. Their web information includes details about recovery and prevention.
• The Academy of Eating Disorders is an organization for professionals from all fields who deal with eating disorders. Phone 703-556-9222.
• The Nutrition Information Service is part of the University of Alabama-Birmingham, and provides up-to-date, accurate, and useful nutrition, health, and food information to the community and health care professionals. Call their toll-free nutrition hotline with your questions: 1-800-231-DIET (3438). Hours are 8:00 am to 4:00 pm Monday through Friday.
• The Council on Size and Weight Discrimination, Inc. provides information on eating disorders, "sizism," the non-dieting movement, and size discrimination. Phone: (914) 679-1209.
• The National Association to Advance Fat Acceptance provides support and attempts to eliminate discrimination against fat people. Provides information to health professionals on how to treat very large patients (e.g., weighing). Phone: (916) 558-6880.

Sources:

[1] Patton GC, Selzer R, Coffey C, Carlin JB, Wolfe R. Onset of eating disorders: population-based cohort over 3 years. BMJ.1999; 318 :765 -768

[2] Field AE, Austin SB, Taylor CB, Malspeis S, Rosner B, Rockett HR, Gillman MW, and Colditz GA. Relation Between Dieting and Weight Change Among Preadolescents and Adolescents. Pediatrics, Oct 2003; 112: 900-906.

Ed. Note: Article provided by University of Michigan Health System

Schizophrenia and Parenting: How to Handle Psychotic Events

Garey, J. (n.d.). Watching for signs of psychosis in teens. Child Mind Institute. Retrieved June 2019 from https://childmind.org/article/watching-for-signs-of-psychosis-in-teens/

Parenting a schizophrenic child: How to raise a child with schizophrenia. (n.d.). Retrieved June 2013 from https://www.webpsychology.com/news/2015/05/14/parenting-schizophrenic-child-how-raise-child-schizophrenia-217196

Pies, R. (1999). How families can cope with schizophrenia. WebMD. Retrieved June 2019 from https://www.webmd.com/schizophrenia/features/families-cope-schizophrenia#2

Roy, P. (n.d.). What you need to know about helping children and youth with psychosis: Information for parents and caregivers. (2010). Children’s Hospital of Eastern Ontario (CHEO). Retrieved June 2019 from http://www.cheo.on.ca/uploads/Psychosis/Psychosis%20ENG.pdf  

Schizophrenia (n.d.). Children’s Hospital Of Wisconsin. Retrieved June 2019 from https://www.chw.org/medical-care/psychiatry-and-behavioral-medicine/conditions/schizophrenia    

Welby, M. (2018). Psychotic episode and the support of others: How to help someone with psychosis. Dr. Melissa Welby. Retrieved June 2019 from https://drmelissawelby.com/psychotic-episode-support-help-someone-with-psychosis/

 

Many parents with a mental illness, facing child custody disputes, deal with difficult challenges.

Some state laws cite mental illness as a condition that can lead to loss of custody or parental rights. Thus, parents with mental illness often avoid seeking mental health services for fear of losing custody of their children. Custody loss rates for parents with mental illness range as high as 70-80 percent, and a higher proportion of parents with serious mental illnesses lose custody of their children than parents without mental illness. Studies that have investigated this issue report that:

• Only one-third of children with a parent who has a serious mental illness are being raised by that parent.
• In New York, 16 percent of the families involved in the foster care system and 21 percent of those receiving family preservation services include a parent with a mental illness.
• Grandparents and other relatives are the most frequent caretakers if a parent is psychiatrically hospitalized, however other possible placements include voluntary or involuntary placement in foster care.[1]

The major reason states take away custody from parents with mental illness is the severity of the illness, and the absence of other competent adults in the home.[2] Although mental disability alone is insufficient to establish parental unfitness, some symptoms of mental illness, such as disorientation and adverse side effects from psychiatric medications, may demonstrate parental unfitness. A research study found that nearly 25 percent of caseworkers had filed reports of suspected child abuse or neglect concerning their clients.[3]

The loss of custody can be traumatic for a parent and can exacerbate their illness, making it more difficult for them to regain custody. If mental illness prevents a parent from protecting their child from harmful situations, the likelihood of losing custody is drastically increased.

Legal Issues

All people have the right to bear and raise children without government interference. However, this is not a guaranteed right. Governments may intervene in family life in order to protect children from abuse or neglect, imminent danger or perceived imminent danger. When parents are not able, either alone or with support, to provide the necessary care and protection for their child, the state may remove the child from the home and provide substitute care.

Adoption and Safe Families Act

The Federal Adoption and Safe Families Act, Public Law 105-89 (ASFA) was signed into law on November 19, 1997. This legislation is the first substantive change in federal child welfare law since the Adoption Assistance and Child Welfare Act of 1980, Public Law 96-272.4 It is intended to achieve a balance of safety, well-being, and permanency for children in foster care. It requires that state child welfare agencies make "reasonable efforts" to prevent the unnecessary placement of children in foster care and to provide services necessary to reunify children in foster care with their families. ASFA establishes expedited timelines for determining whether children who enter foster care can be moved into permanent homes promptly—their own familial home, a relative's home, adoptive home, or other planned permanent living arrangement.

While ASFA is designed to protect children, it also includes provisions pertaining to parental rights. For example, under ASFA, parents have the right to receive supports and services to help them retain custody and keep their families intact. The child welfare system must provide these services according to an individualized plan that has been developed and agreed upon by all parties to ensure parents with mental illnesses are not discriminated against due to their illness. A plan with parental input also helps ensure that, when appropriate, efforts are made by state welfare agencies to promote family permanency, including establishing whether children in foster care can be moved into a permanent living situation.

Helping Families Stay Intact

Parental mental illness alone can cause strain on a family; parental mental illness combined with parental custody fears can cause even greater strain. Such strain, as well as the lack of specialized services for families in the child welfare system and the overall stigma associated with mental illness, makes it difficult for families to get the help they need. With the right services and supports though, many families can stay together and thrive. The following efforts by advocates can help families living with mental illness maintain custody and stay intact:

• Help parents become educated about their rights and obtain legal assistance and information
• Advocate for parents as services plans are developed and assist adult consumers to develop their own self-care plans and advance directives to strengthen their parenting skills and manage their own illness
• Enable parent-child visitation during psychiatric hospitalization to maintain the bond between parent and child
• Train child protective services workers to better understand parental mental illness
• Educate the legal system about advances in the treatment of serious mental illness
• Advocate for increased specialized services for parents with serious mental illnesses available through the court system

References:

1. Network practical tools for changing the environment. Making the Invisible Visible: Parents with Psychiatric Disabilities. National Technical Assistance Center for State Mental Health Planning. Special Issue Parents with Psychiatric Disabilities. Spring, 2000.
2. Roberta Sands. "The Parenting Experience of Low-Income Single Women with Serious Mental Disorders. Families in Society." The Journal of Contemporary Human Services. 76 (2), 86-89. 1995.
3. Joanne Nicholson, Elaine Sweeny, and Jeffrey Geller. Mothers With Mental Illness: II. Family Relationships and the Context of Parenting. May 1998. Vol. 49. No. 5.
4. Ibid.

This fact sheet is made possible through an unrestricted educational grant from The E.H.A. Foundation.

Source: Mental Health America

Identifying Parkinson’s disease signs can be frightening – especially if you’re otherwise healthy. Parkinson’s disease affects over 60,000 Americans per year, mostly males over the age of 65. However, Parkinson’s disease can affect anyone at any time, including those under 40. If you are diagnosed with Parkinson's, a positive attitude can help determine your quality of life. Let's look at how to dispel fear and inspire hope after Parkinson’s disease signs become a diagnosis.

Parkinson’s Disease: Early Symptoms

Parkinson’s disease early warning signs include:

• Changes in handwriting – especially if letters are small and cramped
• Loss of smell
• Tremors and shaking
• Difficulty sleeping due to sudden and extreme movements that wake you up
• Slowed movement
• Muscle tension
• Voice changes
• Difficulty forming facial expressions
• Depression and anxiety
• Spells of dizziness or fainting

If you spot any of these initial symptoms of Parkinson’s disease– don’t panic. Breathe, and remember you’re not alone. Don’t attempt to diagnose yourself at home. Your doctor will assess your symptoms and make an informed diagnosis. From there, you have plenty of options to help control and treat Parkinson's disease, such as medication and occupational therapy.

What to Do If You’re Scared by Parkinson’s Disease Signs

It’s normal to feel scared if you spot the early warning signs of Parkinson’s disease. After all, Parkinson’s is a life-altering condition for which there is no cure. However, it’s important to act if you notice these changes listed above, partly so your doctor can rule out other causes. If you do have Parkinson’s disease, getting diagnosed early will help assure the best treatment possible.

If you are diagnosed with Parkinson’s, one of the first things you should do is to write down any questions you have. It's common to forget your concerns when you’re at the doctor’s office, so take some time to think about what you need to know, perhaps when relaxing at home or out walking by yourself. You may also want to discuss your worries and fears with a partner or close friend.

You should also beware of the Internet when researching Parkinson’s disease signs and symptoms. While the web can be a great source of information, you should always seek information from reputable sites – such as HealthyPlace, major health websites or the Michael J Fox Foundation. At this stage, it’s important to separate fact from fiction so that you know what to expect in the future.

How Not to Be Afraid of Parkinson’s Disease

If you have Parkinson's disease, you're bound to be afraid at times, particularly as your symptoms progress. However, the secret to living well with Parkinson's disease is not letting the fear override your determination to live a fulfilling life. As with many negative emotions, the best antidote to fear is connection – so don't try to go through this alone.

Parkinson's disease signs and symptoms can be incredibly isolating, so making connections is vital if you want to live a good life with the condition. Reach out to your friends and family, and don't be afraid to ask for help. Join online services such as Parkinson’s Social Network or find a Parkinson’s disease support group in your local area. If you're struggling with the emotional impact of Parkinson's disease, it would be wise to speak to a therapist who specializes in long-term illness. Alternatively, you can talk to a nurse or therapist at the National Parkinson’s Foundation Helpline by calling 1-800-4PD-INFO (473-4636).

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Is There Such a Thing as a Bad Child?

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What Are Child Behavior Problems?

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What Behavior Modification Techniques Might Help My Child?

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My Child Has Behavior Issues—What Can I Do?

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Can a Child with Behavior Problems Learn to be ‘Good’?

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My Child is Developing Behavior Problems at School: Help!

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What are Emotional and Behavioral Disorders?

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What Causes Emotional and Behavioral Disorders?

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Parkinson’s disease symptoms can occur at any time, though the condition is usually found in adults over the age of 65. Although it can be scary to notice signs of Parkinson's in yourself or a loved one, it’s important to act on early signs of the disease so you can take the appropriate steps toward treatment of Parkinson's disease. Getting older comes with many health challenges. However, knowing how to recognize the symptoms of Parkinson's disease is vital in taking charge of your wellbeing.

Early Parkinson’s Disease Symptoms  

In the case of Parkinson’s disease, first symptoms can be different for everyone. Some people usually live for years without realizing they have the condition, while others notice a change in motor symptoms straight away.

Early signs of Parkinson's disease include:

Slow movement: If you notice that you or a loved one is moving more slowly than usual, rest assured that this could be a normal sign of aging. However, if you're finding it difficult to even get out of a chair, it's worth seeing a doctor – particularly if you have other Parkinson's disease symptoms. Limb stiffness can also occur in the early stages of the condition.

Tremors: Tremors are usually the first symptom people with Parkinson's disease notice. Shaking usually begins in hands, fingers or limbs, typically on one side. This is often first noticed by a change in handwriting known as micrographia. Uncontrollable movement can also occur during sleep ("Parkinson’s Disease Effects on the Body? Tremor, Motor Symptoms").

Speech changes: People with Parkinson’s disease report changes to their speech as one of the first notable signs. If you notice speech or voice changes in yourself or a loved one, it’s important to speak to your doctor to check for other symptoms of Parkinson’s disease.

Rigid facial expressions: Because of the way it affects gross motor skills, Parkinson's disease can also change your facial expressions, making it difficult for you to control the muscles in your face. People may comment that you have a "blank stare" or look serious.

Many Parkinson's disease symptoms are mild in the early stages ("Relationship Between Parkinson’s Disease and Loss of Smell"). As a result, the condition often goes unnoticed. If you spot any of the above changes to your normal movement or activity, it's important to see your doctor – not only to diagnose Parkinson's disease and treat your condition but also to rule out any other causes.

Parkinson’s Disease and Dementia: What’s the Link?

Many people worry when they notice the onset of Parkinson’s symptoms. One of their main concerns is a condition called Parkinson’s disease dementia, which is marked by a decline in thinking, reasoning and problem-solving. Around 50-80 percent of people with Parkinson's will go on to experience Parkinson's disease dementia.  

Symptoms of Parkinson’s disease dementia include:

• Confusion
• Delusions
• Depression
• Hallucinations
• Forgetfulness
• Sleep disturbances
• Loss of interest in activities
• Mood swings
• Inability to concentrate
• Increased depression and anxiety

What to Do If You Notice Parkinson’s Disease Symptoms

If you experience Parkinson’s disease motor symptoms or symptoms of Parkinson’s disease dementia, you should seek advice from your doctor. It's also a good idea to keep a record of your symptoms; that way, your medical team will get a full view of your condition. If you're caring for a loved one with Parkinson's or Parkinson's disease dementia, it would be helpful to keep a journal for them.

Parkinson's is a progressive disease, so the symptoms will not go away. However, with the right combination of medication and physical therapy, you can limit the effect Parkinson’s has on your life. If you're struggling with your Parkinson's disease symptoms, you can contact the National Parkinson's Foundation Helpline on 1-800-4PD-INFO (473-4636) for support and advice.

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Parkinsonian symptoms can get worse at certain times, and many people have good days and bad days with Parkinson's disease. While symptoms can fluctuate naturally, patients can also experience periods where their medication doesn't work as effectively as usual, typically when they've been taking it for a long time. Some people with Parkinson's disease find that their symptoms are worse due to the decreased effects of levodopa medication (known as OFF periods) that occur over time. Let’s look at why this happens and explore ways to treat daytime Parkinsonian symptoms.

Why Are Parkinsonian Symptoms Worse in the Morning?

Most patients with advanced Parkinson’s disease experience fluctuating symptoms, known as ON and OFF episodes, when they take medications such as carbidopa/levodopa. When you first take a dose, you may experience an ON episode where you are energetic and able to move around freely. OFF episodes can occur when you're waiting for your next dose of medication, resulting in a marked decline in physical ability and a returning of symptoms.

Some people find that Parkinsonian symptoms are worse in the morning. The medical term for the daytime worsening of Parkinsonian symptoms is “morning akinesia," affecting around 60% of Parkinson’s patients. OFF episodes occur when levodopa medications become less effective over time, resulting in motor fluctuations. These periods usually start first thing in the morning after a treatment-free night.

Why Do “OFF” Episodes Happen During the Day?

There are various reasons why you might experience OFF episodes in the morning or during the day. A period is termed an OFF episode when levodopa plasma concentration decreases, causing the medication to wear off temporarily and symptoms to return. According to a 2011 study, daytime OFF episodes reflect the “natural dopaminergic decline with insufficient nighttime storage of the dopaminergic system during sleep.”

In other words, your body naturally struggles to produce dopamine at night, which leads to inadequate stores of dopamine during the day. As we know, it is primarily the loss of dopamine cells in the brain that causes PD motor symptoms, and this is what levodopa/carbidopa intends to treat. Unfortunately, the medication stops being as effective over time (usually three to five years), causing patients to experience more OFF than ON episodes. Daytime worsening of Parkinsonian symptoms can also be caused by nighttime stress or sleep disturbances in Parkinson's patients.

Tips for Dealing with Morning Akinesia

Depending on the severity of your Parkinsonian symptoms, morning akinesia can make it difficult to dress, bathe, use the toilet and prepare breakfast for yourself. Here are some tips to help you deal with morning akinesia and the worsening of PD symptoms:

• Talk to your doctor about shortening the time between doses. You should never make changes to your medication schedule without advice from a professional, but your doctor may suggest reducing your interval between doses by 30 to 60 minutes, especially if you have advanced Parkinson’s.
• Ask to change your levodopa medication. Some people with Parkinson’s disease respond well to different forms of levodopa medication, such as controlled-release L-dopa. Your doctor may also recommend adding a medication such as dopamine agonists or MAO-B inhibitors, to reduce your OFF episodes.
• Make things as easy as possible. You have an advantage if you know when your OFF episodes occur, so take this as an opportunity to make things easier on yourself. Lay out clothes to wear the night before (ideally comfortable items with no fiddly buttons or laces) and prepare your breakfast items for the next morning. It may be helpful to avoid cooking hot meals during your OFF periods if you experience tremors or frozen gait as this can lead to accidents.
• Take your medication as soon as you wake up. Store your medicine next to your bed so you can take it last thing at night and first thing in the morning. If you take multiple pills, make sure you discuss the best way to space your doses with your doctor.
• Ask for help. Depending on the stage of your Parkinsonian symptoms, you may need help looking after yourself when your OFF periods occur. If you live with a partner or family member, be sure to ask for additional support during these episodes, and don't be afraid to ask for what you need. If you live alone and are struggling with day-to-day life, talk to your doctor about your care options.

Most patients who experience morning akinesia are in the advanced stages of Parkinson's disease, meaning their Parkinson's symptoms are more pronounced. At this point, your doctor may suggest a different combination of medicines or see if you are eligible for surgery. If you know your Parkinsonian symptoms are worse in the morning, it's important to seek the help you need to take care of yourself and stay safe.

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