Talking to your kids about drugs, alcohol and other addictions is very important and can't start too early. Learn what to say here.

Our children are exposed to all manner of threats to their wellbeing, personal safety, and development. From drug abuse, smoking, gangs and school violence to online pornography, sexual experimentation - and the list is endless. Their peers, the media and other outside influences challenge their resolve relentlessly.

Do You Know the Warning Signs of Drug and Alcohol Abuse?

Talk to your kids about drugs, tobacco, and alcohol

It is difficult for many kids to "just say no" to drugs, alcohol, and tobacco. Everyone wants to fit in, and today drugs and alcohol are more readily available to kids than ever before. Telling children and teens to just say no to drugs simply is not enough. They must be encouraged to reject drugs because it is the right thing to do, not just because you told them to say no. After years of research, it has been proven that young people can be positively influenced by knowing the risks and dangers of drug use long before they might start experimenting. Children who don't have the facts about drugs, alcohol, and tobacco are at a far greater risk of trying them.

Talking about awkward issues like drugs and alcohol is difficult for parents and children, but retreating from such discussions can leave children unprepared to deal with their peers - and that can be perilous. Help yourself and help your kids by:

1. Get the facts. A great start is that you are reading this!
2. Ask your child's school what is being taught about drugs, alcohol, and tobacco so that you can reinforce these lessons at home. Drug, alcohol and tobacco education is a part of a national curriculum in science classes.
3. Share your views with your kids and explain why you believe what you do. Make it clear that drugs, alcohol, and tobacco are simply not acceptable and will not be tolerated.
4. Talk to other parents, especially the parents of the children your kids play with as this can create a cohesive approach

If young people are given guidance and information from people they trust (you, teachers, etc.), they will be less likely to make the wrong decisions about using these substances. Don't be afraid to role-play with your children. Help them develop skills to resist the peer pressures they will most certainly encounter later.

Parents, take some time to browse around. Learn the warning signs and investigate professional sources for support and treatment.

What Are Gateway Drugs?

A gateway drug is a drug that opens the door to the use of other, harder drugs. Gateway drugs are typically inexpensive and readily available. While there is no guarantee that a youngster will make the leap from gateway drugs to far more toxic and dangerous drugs such as methamphetamines, cocaine, or heroin, research suggests that in the majority of the cases they will not.

Still, who wants to roll the dice with their youngster's health and future happiness? Most addicts began their downward spiral with the gateway drugs; very few youngsters or adults jump right into hard drugs. Keeping children free and clear of the gateway substances for as long as possible is your mission.

(excerpt from "The Official Parents Guide" by Glenn Levant, President and Founding Director, D.A.R.E.)

A parenting plan is a legal document that establishes the custody agreement between a child’s divorcing parents. Parenting plans are created for the child rather than for the parents. The purpose of such a plan is to help this new family life run smoothly so children thrive after the divorce. The agreement allows kids to have two parents who are active and involved in their lives. The spirit of a parenting plan is to allow children to have positive relationships with both parents, guilt-free and without interference from either parent.

Parenting plans are crafted when parents are separated before a divorce is final. This is an incredibly stressful period for each parent and their children; therefore, there are different ways you can make one.

When a divorce is friendly and you and your ex are cooperating, the two of you can work together to write a co-parenting agreement. However, in many cases, parents are too emotional to plan for custody arrangements without help. If that’s the case for you, you can work with a mediator, an attorney, or a co-parenting counselor to craft an agreement ("Do We Need Co-Parenting Counseling, Therapy or Mediation?").

Parenting plans seek to ensure the best interest of the children. Here’s what that looks like.

What You Need to Include in Your Parenting Plan

Certain elements are recommended for parenting agreements. According to Dr. Edward Kruk (2015), president of the International Council on Shared Parenting, five important elements must be included in a parenting plan:

• A general opening statement establishing cooperation in shared parenting
• Specific details about time-sharing and residential arrangements
• Sharing of all parenting responsibilities (education, medical needs, etc.)
• Particulars such as where the kids will be on holidays and special days (like no-school days)
• The length of time the agreement is good for and when it will be revised

These items are essential for any parenting agreement. There are other items, too, that are recommended:

• Financial responsibilities of each parent
• Who will make medical decisions
• What schools the kids will attend
• What activities they can do and how you and your ex will handle the logistics
• How transportation between homes will take place
• Parental drug and alcohol restrictions
• When and if a parent can have a date over when the kids are there
• Smaller details (will the kids transport clothing and supplies back and forth, or will each parent have what they need?)

When creating your co-parenting agreement, consider your children’s ages. What is best for a toddler will be different from a teenager, for example. What will work to accommodate their unique needs? Do your kids have special needs? Factor that into your plan, too.

With these elements in mind, let’s look at what parenting plans are like.

Parenting Plan Examples

A parenting plan is an official, legal document. It begins with details like parents’ names and birthdates, the names and birthdates of the children, and other legal information. Usually, you’ll then see a written explanation of the custody arrangement, including the amount of time your children will be with each of their parents, the daily arrangements, and the holiday schedule.

Some agreements are simple and straightforward. These are easy to reference and follow, but they can be too open to interpretation. Other agreements are detailed and all-inclusive. These leave little to chance but can be cumbersome to read and implement.

Many plans include a calendar complete with details regarding when kids are with which parent and transportation notes. Known activities and school vacations are also included. This type of plan can be handy because details are determined when the plan is made rather than negotiated later.  

Other parenting plan examples exist. There are plans for different:

• Types of custody
• Developmental stages
• Geographic locations
• Natures of divorce (contentious versus cooperative)

Tips to Help You Create the Best Parenting Plan for Your Children

The healthiest parenting plans share certain features. Consider these tips to help all of you transition positively into your new arrangement:

• Make your plan detailed; it’s less stressful in the long run.
• Be flexible so you can adjust when needed.
• List what you want to avoid (like belittling the other parent in front of the kids).
• Specify what must be honored (upholding time agreements, for example)
• Follow the plan for at least six months and then revisit it to make needed changes.

Your parenting plan is a road map to guide you down the best path for your children. The pathway to success is a parenting agreement that is sufficiently detailed and kid-centered. Your plan is the answer to the central question: How will two separate parents care for the children they share and love?

See Also:

• Tips for Co-Parenting with a Toxic Ex

article references

Do you know the warning signs of drug and alcohol abuse? As a parent, you should!

Not my kid!

It can happen to you. We must understand that in modern society, every child is in danger of getting involved with drugs, nicotine or alcohol.

The mood swings and unpredictable behavior that most teens experience makes it difficult for parents to tell if a child is using drugs. The anti-drug education our kids get in school barely counters the "street education" they pick up from peers and our culture.

What are the signs that your child is experimenting with drugs or alcohol, or is at risk of doing so?

• change of friends (be extra wary if new friendships develop with older teenagers or young adults
• if a best friend uses drugs
• careless about her personal appearance
• a decline in participation at home
• diminished interest in hobbies, sports, or favorite activities
• irritability, overreacts to mild criticism or avoids family contact
• eating and sleeping patterns have changed
• lack of appreciation for values that used to be important
• extreme emotional mood swings
• secretive phone calls
• lying
• changes in school performance, tardiness, truancy, and/or disciplinary problems, frequently breaks curfews
• missing money, personal belongings, prescription drugs or alcohol
• trouble with the law, shoplifting, truancy, DUI, disorderly conduct
• using street or drug language
• eyes are red or glassy, or nose is runny, but no allergies
• a family history of drug use or alcoholism
• cigarette smoking can be an early sign that other substance use may be in the picture
• you discover pipes (or bongs), rolling papers, medicine bottles, butane lighters, homemade pipes or other suspected drug paraphernalia

See Also:

• Drug Addiction Signs and Symptoms
• Alcoholism Symptoms: Warning Signs of Alcoholism

Source:

• NIMH

Descriptions of psychiatric medications for treating child and adolescent psychiatric disorders; including benefits and side-effects.

The information below includes most of the medications used to treat child and adolescent psychiatric disorders. You will find the problems each medication might treat and some of the common side effects. This guide is intended to be informative and useful, but it is not comprehensive. Children should take these medications only under the careful supervision of their physicians.

Listed are only those adverse effects that occur more commonly and those that are rare but potentially serious. Always alert your physician about any other medications, over the counter pill and 'alternative treatments' that you may be taking.

Classes* of Psychiatric Medications:

Stimulants Non-Stimulant (Selective Norepinephrine Reuptake Inhibitor) Antihypertensive SSRIs or SRIs (specific serotonin reuptake inhibitors) Tricyclic Antidepressants Other Antidepressants Other Antidepressants 2 MAOIs (monoamine oxidase inhibitors)

Antipsychotics (sometimes called Neuroleptics) Second generation (atypical) antipsychotics Anxiolytic (benxodiazepine) Anxiolytic Hypnotics (sleep) Mood Stabilizers Anti-Convulsants (anti-seizure)

*The class of a medication is often a useful way of grouping similar medications. However, there is no particular format or rule for this and therefore the class name is somewhat arbitrary. The name can signify it most common use (many of these medications can treat more than one disorder), its mechanism of action or rarely some side-effect.

The brand name of a medication is the name a company will use to sell its unique formulation of a medication. When a drug is first developed it will have two names. The first is the name which describes its chemical structure but is never used outside the laboratory. The second is what will be its generic name. This name will be used until the medication is approved by the FDA and ready to be sold to the public. Once the medication is ready for sale it will be given a brand name. After the patent expires other companies will be allowed to make the medication and it will generally be sold under the generic name. (The following example will illustrate the various names for a single medication. See if you can guess what the medication is from its chemical name: N-Methyl--[4-(trifluoromethyl)phenoxy]benzenepropanamine, Not sure? Its generic name is fluoxetine. Still not sure? The brand name is Prozac.

Class: Stimulants

Benefits: Treats the core symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) including, impulsivity, hyperactivity and inattention. There is very little documented difference in the effectiveness between the amphetamine and methylphenidate medicines. However, some children respond to one group better than another. Side Effects: Loss of appetite, difficulty falling asleep, irritability and /or moodiness. Some children may develop tics while on the medicine while those with a tic disorder may find that the tics worsen. Both growth and weight should be monitored, since weight loss can occur, and there is some evidence that stimulants may cause a slowdown in growth. Very rarely they may cause hallucinations or exacerbate manic symptoms These medications can increase blood pressure and pulse slightly. Please tell your doctor if there are any relatives with a history of heart disease at an early age.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Ritalin Focalin Methylin Methylin Chewable Methylin Liquid	methylphenidate	These are short acting—generally lasting about 3-4 hours.
Concerta Focalin XR Metadate CD Ritalin LA Daytrana Patch	methylphenidate	These are long acting—generally lasting about 8-12 hours. Each one is formulated somewhat differently but there is generally no way to determine which will last the longest for any individual. Daytrana is the newest and uses a patch to deliver methylphenidate through the skin. The patch may cause some skin irritation.
Dexedrine Dextrostat Adderall	amphetamine	These are short acting—generally lasting about 3-6 hours. Each one is formulated somewhat differently but there is generally no way to determine which will last the longest for any individual. Adderall is a mixture of different forms of amphetamine (amphetamine salts).
Adderall XR	amphetamine salts	Lasts 8-10 hours
Dexedrine Spansules	amphetamine	Lasts 8-10 hours

 

---

CLASS: Non-Stimulant (Selective Norepinephrine Reuptake Inhibitor)

Benefits: Treats the core symptoms of ADHD. May not have as robust an effect on symptoms as the stimulants but may help individuals who have anxiety along with their ADHD. Side Effects: Decreased appetite, nausea, insomnia or tiredness, dry mouth.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Strattera	atomoxetine	Has the potential to last 24 hours. Can often be given just once a day although some patients require a second dose in the late afternoon. Unlike most medications this one is dosed based upon the patient's weight.

CLASS: Antihypertensive

Benefits: Historically used for the control of high blood pressure. Often used as a first medical treatment for the tics of Tourette Disorder. Can be useful in treating the hyperactive and impulsive symptoms of ADHD. Can sometimes help with children who have aggressive behaviors. Generally not useful for the inattentive symptoms. Side Effects: Dry mouth, sedation, dizziness. Rarely can trigger depressive symptoms.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Tenex	guanfacine	The TTS is a patch that is changed every 3-4 days. It may cause local irritation.
Catapres, Catapres TTS patch	clonidine

CLASS: SSRIs or SRIs (specific serotonin reuptake inhibitors)

Benefits: Historically used for the control of high blood pressure. Often used as a first medical treatment for the tics of Tourette Disorder. Can be useful in treating the hyperactive and impulsive symptoms of ADHD. Can sometimes help with children who have aggressive behaviors. Generally not useful for the inattentive symptoms. Side Effects: Dry mouth, sedation, dizziness. Rarely can trigger depressive symptoms.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Tenex	guanfacine	The TTS is a patch that is changed every 3-4 days. It may cause local irritation.
Catapres, Catapres TTS patch	clonidine

CLASS: Tricyclic Antidepressants

Benefits: This group has been used to treat depression, ADHD, enuresis and chronic pain. Unlike the other tricyclics, Anafranil is used to treat OCD. Side Effects: Sedation, weight gain, nausea, dry mouth, constipation. May cause changes in heart rhythm.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Tofranil	imipramine	This group of medications is now rarely used for the treatment of depression or ADHD. The SRI's have generally replaced them for the treatment of depression and Strattera has replaced them for the treatment of ADHD. As a group they have effects mainly on the neurotransmitter norepinephrine and less so on serotonin.
Norpramin	desipramine
Elavil	amitryptyline
Pamelor	nortriptyline
Sinequan	doxepin
Anafranil	clomipramine	This was the first medication approved in the U.S. for the treatment of OCD. Sometimes used to augment the SRIs.

CLASS: Other Antidepressants

Benefits: For depression. Used for the treatment of smoking cessation (under the name Zyban) Has been used to treat symptoms of ADHD. Generally not useful for anxiety disorders. Side Effects: dry mouth, decreased appetite. At high dose may increase susceptibility to a seizure.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Wellbutrin Wellbutrin SR Wellbutrin XL	bupropion	Bupropion looks chemically similar to the amphetamines.

CLASS: Other Antidepressants

Benefits: Treats depression. May be helpful in anxiety. Some studies suggest that they can be helpful for depression where physical complaints (e.g. headaches, general pain) are a dominant feature. Side Effects: Generally similar to the SSRI group. Remeron and Cymbalta tend to be sedating.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Effexor	venlafaxine	Has occasionally been used to treat ADHD especially in adults.
Effexor XR	venlafaxine	Long acting version of Effexor.
Remeron	mirtazapine
Cymbalta	duloxetine	This medication has both elements of both the SRI and the tricyclic antidepressants.

CLASS: MAOIs (monoamine oxidase inhibitors)

Benefits: Used to treat treatment-resistant depression and anxiety. Side Effects: Dizziness, sedation gastrointestinal symptoms, low blood pressure, changes in appetite and weight.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Nardil	phenelzine	These medications are rarely used in children and adolescents. Tyramine, an amino acid in some foods can interact with these medications to trigger severe high blood pressure. People taking them must follow a restricted diet (Emsam at lower doses does not require the diet).
Parnate	tranylcypromine
Emsam patch	selegiline

CLASS: Antipsychotics (sometimes called Neuroleptics)

Benefits: Treats psychosis, schizophrenia, bipolar disorder and aggression. Orap and Haldol are used to treat Tourette Disorder. Has been used to treat behavioral symptoms of Autism. Side Effects: Dizziness, sedation, dry mouth, constipation, blurred vision, increased appetite, restlessness, muscle stiffness. Prolonged use may result in a movement disorder called tardive dyskinesia.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Haldol	haloperidol	With the introduction of newer antipsychotics these medications are used much less frequently. This is only a partial list of the medications in this class.
Orap	pimozide
Prolixin	fluphenazine
Mellaril	thioridazine
Thorazine	chlorpromazine
Stelazine	trifluoperazine
Moban	molindone
Loxitane	loxapine

CLASS: Second generation (atypical) antipsychotics

Benefits: Treats psychotic conditions such as schizophrenia, can be useful in helping stabilize mood in bipolar disorder and in impulsive/aggressive behavior. Side Effects: Weight gain, sedation, dizziness, insulin resistance, muscle stiffness.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Risperdal	risperidone	Has been studied in the treatment of aggression and irritability in Autism.
Zyprexa	olanzapine
Seroquel	quetiapine
Geodon	ziprasidone
Abilify	aripiprazole
Clozaril	clozapine	May be the most effective medication in treatment resistant psychotic conditions. Must get weekly blood tests to monitor for a rare side effect that can depress the formation of blood cells.

 

CLASS: Anxiolytic (benxodiazepine)

Benefits: Reduces panic anxiety symptoms. Generally used for short term treatment. Side Effects: Sedation, dizziness.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Xanax Xanax XR	alprazolam	Can cause paradoxical hyperexcitability especially in young children. Is occasionally used for the treatment of mania. Often works immediately.
Klonopin	clonazepam
Ativan	lorazepam

CLASS: Anxiolytics

Benefits: Used for the treatment of general anxiety symptoms—not helpful for separation anxiety or social phobia. Side Effects: Dizziness, nausea, sedation.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Buspar	buspirone	Often takes several weeks to work.

CLASS: Hypnotics (sleep)

Benefits: Enhances sleep onset and quality of sleep. Side Effects: Dizziness, can cause paradoxical hyperexcitability especially in young children.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Ambien Ambien CR	zolpidem	These medications are generally not used as a first line treatment of insomnia. Understanding and dealing with the underlying issues that are disrupting sleep is always the first step.
Lunesta	eszopiclone
Sonata	zaleplon
Rozerem	ramelteon

CLASS: Mood Stabilizers

Benefits: Treats the symptoms of bipolar disorder. Side Effects: Excessive thirst, frequent urination gastrointestinal symptoms, acne, weight gain.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Lithium Lithobid Eskalith	lithium	Requires frequent monitoring of lithium blood level, thyroid and kidney functioning. Excessive doses are dangerous. The most established and well studied medication for bipolar disorder.

 

CLASS: Anti-Convulsants (anti-seizure)

Benefits: This group of medications has been used in the treatment of bipolar disorder and aggressive behavior. Side Effects: Sedation, tremor, gastrointestinal distress, weight gain.
MEDICATION NAME		NOTES
Brand Name	Generic Name
Depakote	divalproex valproate	Well studied in the treatment of bipolar disorder. Has been used as a treatment of migraines. Requires occasional lab tests. May cause polycystic ovary disease.
Tegretol Carbatrol	carbamazepine	Well studied in the treatment of bipolar disorder. Requires occasional lab tests.
Trileptal	oxcarbazepine	A newer version of carbamazepine.
Lamictal	lamotrigine	Appears to be very helpful in treating the depressive phase of bipolar disorder but is not clearly helpful in the manic phase. Very rarely, can trigger a life-threatening rash.
The utility of the following medications in bipolar disorder is still under investigation.
Topamax	topiramate	Does not cause weight gain.
Neurontin	gabapentin	There is some evidence that it can be helpful in treating anxiety disorders.

*The class of a medication is often a useful way of grouping similar medications. However, there is no particular format or rule for this and therefore the class name is somewhat arbitrary. The name can signify it most common use (many of these medications can treat more than one disorder), its mechanism of action or rarely some side-effect.

**The brand name of a medication is the name a company will use to sell its unique formulation of a medication. When a drug is first developed it will have two names. The first is the name which describes its chemical structure but is never used outside the laboratory. The second is what will be its generic name. This name will be used until the medication is approved by the FDA and ready to be sold to the public. Once the medication is ready for sale it will be given a brand name. After the patent expires other companies will be allowed to make the medication and it will generally be sold under the generic name. (The following example will illustrate the various names for a single medication. See if you can guess what the medication is from its chemical name: N-Methyl--[4-(trifluoromethyl)phenoxy]benzenepropanamine, Not sure? Its generic name is fluoxetine. Still not sure? The brand name is Prozac.

About the author: Dr. Hirsch has more than twenty-five years of experience in treating children and adolescents with psychiatric disorders. He is Medical Director of the NYU Child Study Center and Associate Professor of Child and Adolescent Psychiatry at the NYU School of Medicine. In addition, Dr. Hirsch is Medical Director of the Division of Child and Adolescent Psychiatry at Bellevue Hospital Center.

Excellent insights into parenting a child with ADHD. Here's how to help your ADHD child and reduce your stress.

Children with ADHD have a hard time paying attention. They act without thinking first. They also tend to be more active than children without ADHD. Children with ADHD often don't finish things, don't seem to listen to adults, and don't follow rules very well. They often seem very mad and sad. They wish people wouldn't be so mad at them. They wish people would know how they feel inside.

There are ways you as a parent can help. Picture a team. To win, everyone must work together. It is the same with helping a child with ADHD. You can be like a coach. And patient, caring, understanding coaches often get the best results. But the best coaches are also firm and fair, and they expect those they are helping to stick to the rules. When you can mix caring, concern, firmness, and fairness, ADHD children can learn to do better. And they feel better about themselves. This reduces the stress on you as a parent!

Focus on your child's experience

Children with ADHD just don't do things like other children. They seem to waste time and may act younger than other children their age. You may think they should know better. It's easy to be angry and upset with them. When you start to feel angry, it helps to try to look at the world through the eyes of your child. It can be a tough world to live in!

Children with ADHD have a hard time paying attention, even when they try and try. They hate to fail but can't seem to help themselves. They are not causing problems on purpose. But they start to think that others expect them to fail. This makes them very sad and sometimes mad. But children with ADHD are often curious, creative and smart. They just don't know how to focus all that energy in a way that works and pleases others. Sometimes it helps for parents just to say, "I know it's very hard for you. But we will work on it together." Instead of feeling "bad," this lets the child feel like the parent will work with him or her to solve a problem

Get to know your child

Of course, you know your child. This section is about taking a second look, and looking for certain things.

All children with ADHD have things they do well. And they have areas that are special problems. Many parents have found that paying close attention to both "strong" and "weak" areas is very helpful. Knowing what things your child does well will help you build on those skills. And praise for doing well in those areas of strength can build up the child's sense of being "good."

Successful parenting of children with ADHD requires a close bond, patience, and an ability to laugh with your child. We suggest you try to look for good things that your child does, not just the problems. You will find many positive things about your child-those things that interest, excite, and keep their attention. Talking about these things with your child will make him or her very happy.

At the same time, knowing your child's problem spots will let you watch for them. When you see a problem spot, you can pay special attention and help them learn other ways to act. You can focus your "coaching" efforts in the areas in which your child needs the most help. You will also begin to notice how they react to failure and how hard they are trying. Once you see how hard it is for them and how hard they are trying, it may be easier for you to work together.

If you and your child work together and share common interests, then you are working as a team. This will help your child accept learning to pay attention to the rules and chores you have for him or her. Having fun with your child, by sharing activities that are of interest to both of you, will give you strength and patience as you tackle difficult learning tasks together.

Communicate with your child

Let your child know that you are there to help him or her through the problems that he or she may have. Let them know that you love them and like who they are. Let them know that you understand how hard it is for them to pay attention or to be still. Letting your child know that he or she is loved and that you like to spend time with him or her will make the tasks you solve together feel more like helping. Remember that it is easy for children to think you want them to change because you don't like them. They don't know that it is how they act that needs work. They start thinking it is who they are that is a problem.

Talking to a child with ADHD can take much patience. Often they don't seem to listen. But they do listen and they do want to please you. It's just so hard for them! It takes much time and loving patience. You play a key role in explaining things to your child. Sometimes it helps to put rules or reasons in their own words. And it's important to get right down "on their level." Many parents find that it is very helpful to make eye contact when explaining things. This helps make sure that the child hears and understands what he or she is told.

Changing Behavior

One of the biggest problems for children with ADHD is forgetting to think before they act. It's also hard to get them to carry out tasks that need to get done, such as homework. You can play a big role in helping them learn to do better. Again, it helps to think of yourself as a "coach." Below are several tools that you can use to help "coach" your child in learning some new things.

Help the child with ADHD to get organized

Children with ADHD have a hard time focusing. Their minds "wander" easily. Help them become more organized! There are a number of things you can try.

Tell your child clearly what you want them to do. When you tell your child to do something, we suggest you write out a short list. Make sure your child understands, in his or her own words, what you want. Be firm and clear about what you want your child to do. "Here is a list of things for you to do. Please finish your math homework, feed the dog, and take out the kitchen trash. These must all be done by 5 o'clock. Do you have any questions about what you are to do?"

Help them learn to STOP! and think things through. They need to learn that Actions and Results go together. You can coach them to train themselves to think, "If I do this, what will happen?" They can learn to do this with lots of practice and reminders. You might give rewards for times they remember. You will need patience when they forget. But, in time, it can happen.

You can provide help for your child in lots of other ways. A child with ADHD has so much trouble focusing. There seem to be so many other things to think about and look at! There are several ways you can help them:

• Break down large projects into small steps.
• Try to keep a routine in your home that your child can count on.
• Change is hard for kids with ADHD! Whenever possible, prepare for changes (moving, vacations, new school) ahead of time. Then your child will not get as overloaded with new things, places, and people.

Some children will actually do well in new situations for a while but soon they can become overwhelmed by the changes and new problems to solve.

Children with ADHD also often lose things. This can be very upsetting for you and for them. Make a plan to help your child remember where he or she puts things. You could set up a special place in your home where your child can put things that are needed every day (keys, wallet, book bag or backpack). Help them learn to put the items in the same place every time. This also gives you a way to keep track of these items.

Rewards

Try to give your child lots of praise and support. Children with ADHD often do many things well. But sometimes the good actions get lost. Sometimes these children think all they hear about is what they've done wrong. Make sure you take time to notice the good actions and reward these by calling attention to them ("Catch them being good!").

Plan ahead for rewards. Talk with your child about what he or she can expect. If possible, involve the child in planning what will happen if he or she does well.

Rewards work best when they are:

• predictable or expected;
• consistent - the same each time;
• clear; and
• fair.

You can try asking your child to tell you what he or she thinks you want him or her to do. The more they think about results, the more they will begin to be in charge of their own actions.

If your child can't finish a task, or does it poorly, at least let them know that their effort is still good. This will help your child know that the effort he or she has made matters to you. Children with ADHD become upset quickly. You need to help your child know that while things don't always work out, the effort put into a task is still rewarding. Getting these good messages from parents and adults means a lot to them.

The classic way of rewarding children is to let them earn something they want when they do what's expected of them. Earning points can be a good way of doing this. You can make a chart with the things you want them to do on one side, and leave a space for your child to mark off the tasks as they are finished. The next column should contain the number of points he or she will receive for doing the task correctly. The points can be used for something your child likes. This could be small amounts of money, a toy, or some fun activity.

Discipline

Children with ADHD often have trouble following rules. Using only rewards may not be enough. Use of firm but fair discipline will usually be needed. Of course, the purpose of discipline is to shape and guide your child's actions and behavior.

It is very important that your child knows exactly what he or she needs to change or stop doing. They need to know what you expect them to do. They also need to know exactly what will happen if they fail to do as expected. If you plan results ahead of time it is less likely you will react too harshly out of anger, as this is not usually very helpful.

In deciding on a plan to discipline your child, try to be fair. Make sure the punishment fits the situation. Discipline that is too harsh will not be helpful. It can make your child feel like giving up if discipline is too strong. Be careful not to expect more than your child is able to do. Wherever possible, make sure your child knows exactly what will happen if he or she does or fails to do certain things. Then follow through!

"Time-outs" are one way to discipline your child. Time-outs are specific periods of time that your child must spend alone in a certain place in the home. This could be their room or any other place where they are alone. The goal of a time-out is to teach your child to be able to pay attention to his or her own actions and feelings. The quiet and being by themselves of time-outs can help your child calm down if he or she is too active.

Decide ahead of time which actions will result in time-outs. Give a time-out every time your child does these actions. Time-outs should be used only for big behavior problems (such as hitting a brother or sister). If possible, don't pay attention to temper tantrums during the time-out. These are ways the child tries to get you to back down and give up. If you keep at it, he or she will learn that you mean what you say!

We have not talked about spanking because most experts on children believe this is not a good way of getting children to change their actions or to learn new ones. And spanking risks hurting the child or making him or her angry and upset. Many experts also believe that a child who is spanked is also more likely to use hitting with other children as a way of trying to work out conflicts. There are many other forms of discipline. What is important is that they help the child understand the expected results of his or her actions. Be firm. Be sure to help your child to make the connection: "Because you did such-and-such, here is what is going to happen."

There is a lot you can do to help a child with ADHD. We hope that you find the above ideas helpful. Remember that each child is different. You may need to try several different things before you find things that really work. In our next help sheet, we will talk about some things you can do to help yourself to feel less upset and frustrated.

Your doctor or therapist may have suggestions for books that you can read about ADHD. You may also find it helpful to contact the national office of Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) at 1-800-233-4050. You may also want to contact the National Attention Deficit Disorders Association (ADDA) at 1-847-432-ADDA.

Sources:

• NIMH - ADHD publication
• CHADD website
• ADDA website

Knowing how to discipline a child is one of the top issues that parents struggle with. Children are still learning social norms and acceptable behavior. As they grow, they begin to internalize rules and limits, a process that involves testing them. Remembering that they’re learning, processing, and testing your rules will help you avoid reacting without thinking and punishing them. Even though it’s hard to know with certainty how to discipline your child, you can learn to do it positively and well.

How to Discipline a Child: Know the Meaning of “Discipline”

The word discipline doesn’t mean punish. To discipline means to teach. The act of disciplining your child is about guiding them and teaching them tools for positive behavior. Through your teaching over the course of their development from infancy to adulthood, good behavior will prevail over misbehavior.

There is a common misconception of what it means to discipline a child. Rather than punishing that child as a short-term solution of a misdeed, at the heart of child discipline are long-term goals. How do you want your child to be, to function, as an independent adult? Your answer will guide you when you discipline your child.

True discipline isn’t problem-focused. It’s focused instead on shaping your child to develop positive character traits. Approach discipline as long-term goals to concentrate on teaching your kids how to behave and function in society. To discipline a child means to guide them every day as they build respect and responsibility and self-regulation skills.

When you think of disciplining your child, let these questions guide you:

• Will my actions guide my children?
• Does what I’m doing teach them to be respectful to others?
• What messages are they taking from my discipline?

Discipline and Your Parenting Style

There are different approaches to parenting, all with different discipline styles. How to discipline a child effectively involves adopting the most helpful parenting style. Three major parenting styles are authoritative, authoritarian, and permissive parenting. Of these, authoritative is considered by parenting and child development experts to be the healthiest.

Regarding discipline, authoritative parents have a healthy approach. These parents:

• Create firm expectations, boundaries, and limits
• Make them clear to their kids
• Consistently follow through with consequences when their kids misbehave
• Know that discipline is about love and affection, and they use them to show their kids that they’re valued even when they make mistakes.

The other two styles are examples of how not to discipline a child.

• Authoritarian parents have clear, rigid rules
• Enforce them with punishments
• Show little affection for their kids.
• Permissive parents set few rules, and the ones they make are undefined and enforced inconsistently  
• They lavish love and affection onto their kids.

There are healthy ways to discipline your child. The following strategies and tips will guide you so you can guide your kids.

How to Discipline a Child: Effective Discipline Strategies and Tips

The following ideas will help you know how to discipline your child in a way that fits you, your child, and your long-term goals for them.

Reward the good. Pay attention to your kids, and catch them being good. Tell them when you notice them doing something positive. Occasionally reward your kids for good behaviors in order to reinforce the cooperation and character traits you are teaching them. Observing and pointing out positive behaviors is more effective than waiting for them to do something wrong and then punishing them for it.

Structure and consistency. Your child needs structure and routine in order to thrive. To behave well, they need clear and specific guidelines. To follow rules and stay within boundaries, kids need to know what they are. Be open in your communication and ensure that your child understands what you expect and what they consequences will be if they break the rules.

Discipline for the big picture. When you remember that discipline means guiding your kids so they grow into well-functioning adults, you will be more confident in knowing how to discipline your child. Use these principles to help you:

• Look for underlying reasons for their behavior. Are they tired, hungry, or emotional from a rough day at school? Talking to them about these is more helpful than punishing them for misbehaving.
• Be respectful of your child, even when you are delivering a consequence.
• Always be willing to create fresh starts. When you’ve given a consequence and your child has had some space and time to cool down, offer a fresh start. The consequence still holds, but your child learns how to move on after problems.

Discipline isn’t an easy part of child-raising, but it’s important in order to facilitate healthy development and character-building. The more you know about how to discipline your child, the easier it will become.

See Also:

• How to Discipline a Child Without Hitting or Yelling
• Disrespectful Child: What Kind of Discipline Should You Use?
• Ways to Discipline Ungrateful, Spoiled Children
• Is There Such Thing as a Bad Child?

article references

Journalist Pete Earley talks about his struggles to get help for his son, who became bipolar while away at college. Earley says, unless a mentally ill person becomes a threat to himself or others, it's often difficult to secure any kind of treatment. Earley, who is the author of the book Crazy, speaks with Linda Wertheimer about the state of mental health treatment.

Source: NPR

Lauren Mathews, 15, at the Hamilton County Special School in Norwood. She has been hospitalized repeatedly for mental illness, including violent moods and voices in her head. Her family can't afford long-term psychiatric help. | MORE PHOTOS |

Christy Mathews struggled for years to pay for treatment for her mentally ill daughter, a 15-year-old who burns and cuts herself and last year threatened to stab her mom with a steak knife.

Desperate and afraid, Mathews tried to get Hamilton County officials to pay for Lauren to live in a psychiatric facility. A social worker finally told her she could get help - if Mathews gave up custody of her daughter to the county.

"I shouldn't be forced to give my daughter up to get her the help she needs, but that's how the system works," she says. "What you have to go through is unreal."

Mathews refused to turn over Lauren, but thousands of parents in Ohio and elsewhere have been forced to give in.

In the past three years, Ohio parents who've run out of insurance or money have given up custody of as many as 1,800 children so the government will pay to treat their mental illness, a Cincinnati Enquirer investigation has found.

Even then, kids don't always get the help they need. Ohio counties place more than 7,000 children a year in centers where some are abused, molested, improperly drugged and left in wretched conditions, an examination of inspection records, court documents, and interviews reveals.

At least 38 of Ohio's 88 counties acknowledge taking children from parents, who give up their rights to say where their kids are sent for treatment, how long they stay or even what kind of medicine they are given.

County officials say that obtaining custody is the only way they can tap federal money to cover treatment costs that run as high as $1,000 a day. But not even Michael Hogan, director of Ohio's Department of Mental Health, defends the practice. "We must stop trading custody for care. It's terrible," he says. "A civilized society should not do this."

Trading custody for care is a "travesty," adds Gayle Channing Tenenbaum, a lobbyist for the Ohio Public Children Services Association.

"As a state," she says, "we've totally given up on these kids."

A 'terrible problem'

More than 86,000 children in Ohio are mentally ill, and many parents find that insurance money for treatment runs out long before their kids get better. Unlike coverage for physical diseases and ailments, policies typically limit benefits for mental illness to 20 to 30 days a year.

That's usually far too little. So parents frequently spend years bouncing from one agency to another - only to be told by each that no money or treatment options are available. 

KEY FINDINGS

The Enquirer found that Ohio's system for treating children with mental illness is entrenched in bureaucracy and plagued by abuse. Our investigation found:

- Insurance plans that pay for other illnesses severely limit what they pay to treat mental illness.

- To get public help, thousands of parents who can't afford treatment give custody of their kids to the government.

- Some children sent to treatment centers are abused, molested, overdrugged or left to live in wretched conditions.

- Shortages of psychiatrists, staff and treatment centers mean long waits for care - or none at all.

- No one's in charge. Two state agencies and hundreds of county agencies confound even the people running them.

"When it comes to mental health, the system is lacking, lacking, lacking," says John Saros, director of Franklin County Children Services. "And when the system isn't working, very decent parents go to extreme measures for their child. It's very, very frustrating because I see us doing bad things to kids in the name of trying to help them."

Parents find themselves staggered not only by the costs but by a complex bureaucracy that puts as many as five different agencies in a single county in charge of different aspects of one child's care.

Ohio's 88 counties operate 55 public children's services agencies, 33 public children's services boards, 43 mental health, and drug addiction boards and another seven mental health boards. The Ohio Department of Job and Family Services and the state Department of Mental Health, the two state agencies that are supposed to watch over all the county agencies, don't even share information on children.

Barbara Riley, assistant director in Job and Family Services, first said federal law prohibited the agencies from talking to each other about children in the system. After checking with her legal staff, she said they could share data - but don't.

"I have learned that I have more latitude than I thought," she says. "The conversation now has to start about what we know, who knows it and where information is housed."

While officials try to sort it all out, parents who navigate the different agencies might get lucky and find treatment for their children. But thousands never do, or they live in poor counties where there is no treatment to be had.

"There are long waiting lists, a lack of well-trained people, and a lot of times people don't get referred for help unless they are suicidal," says Tenenbaum, the children's lobbyist.

As a last resort, some parents turn to county child welfare agencies that can tap into federal funds originally set aside to help care for abused or neglected children. But such agencies say they can't get the federal money unless children are in government custody - so parents desperate for help sign away their kids.

"It's really sad. Families do everything from giving up custody to selling their houses to pay for care," says Dr. Mike Sorter, director of the division of child psychiatry for Cincinnati Children's Hospital Medical Center. "What other illness is there that forces you to give up custody of your child in order to get them help?"

Staggering costs

Ohio's system is so disorganized that no one can say exactly how many parents have been forced to give up their mentally ill children, although the Enquirer found the practice occurs in at least 38 counties including Hamilton, Butler, Warren, and Clermont.

Counties that don't trade custody for care include those that pool resources from different agencies and rural counties with fewer children.

The state Mental Health Department estimates that 300 families give up custody of children each year, but advocates who work in the field maintain that 600 is a more accurate number. Giving up custody is no formality, either. Parents often have to go to court to get their kids back.

Yet a federal study found that families in 13 states, including Kentucky, gave up custody of 12,700 kids in 2001.

Roger Shooter, director of the Knox County Job and Family Services agency, says counties are in a no-win situation. They don't want to take custody from parents, but officials say they can't afford the costs of treating a mentally ill child without federal help. "We've got kids who are purely mentally ill that are costing $350 a day," Shooter says.

Such rates are commonplace, records and interviews show. Last year a treatment center charged one county mental health board $151,000 - $414 a day - for treatment alone for one child. Centers charge child welfare agencies additional money - as much as $340 a day per child - for room and board.

Add the cost of medication, and costs can grow to more than $1,000 a day for children who are mentally ill, especially if they also are drug addicted, sex offenders, fire setters, violent or schizophrenic.

Hamilton County sent more than 200 kids to treatment centers over the past eight months and paid $8.2 million for their room and board costs. Some children stayed a few days. Others stayed for months.

Some question how long Ohio taxpayers can continue to pay such astronomical bills - even with money from the federal government. "There is no way parents can afford the treatment centers, but there is a serious concern as to whether or not the child welfare system can afford them, either," says Saros, the Franklin County director.

Some children are sent out of state when beds aren't available locally. County officials say that social workers have traveled as far away as Missouri or Texas to check on children. In December, counties had 398 kids in out-of-state homes, including treatment centers, group homes, and foster homes. 

"Finding beds is a huge issue. If a kid comes in at 5 p.m. on a Friday afternoon you can't leave him in the waiting room all weekend. You have to find a place for him and move him through," Saros explains.

"These aren't easy kids to help. Some have learned a lot of horrible behaviors, and everybody is trying to figure out what to do with them."

What to do?

Mathews, the Delhi Township mom, knows how hard it is to find help for her 15-year-old-daughter, Lauren, who has posttraumatic stress disorder, lithium-induced diabetes and bipolar disorder, which causes severe mood swings.

The teenager has taken 16 medications in the past four years, from anti-psychotic drugs to mood stabilizers. She also has been hospitalized eight times for her mental illness. Her mom, dad, and teenage brother have been through extensive group therapy trying to find a way to help.

Nothing's worked.

"She has no friends, no one to talk to and nothing to do. She is deeply depressed," says Mathews, who starts to cry when she describes Lauren's illness. "I have a 17-month-old baby at home and with my husband losing his job, the new baby and taking care of Lauren, I'm just exhausted."

Later, in a bare conference room in the psychiatric unit at Cincinnati Children's Hospital, Lauren shows little emotion when her mom talks about the problems. She slumps in a chair in her oversized jacket, her short brown hair pulled into tiny pigtails.

"I'm bored," she says finally.

She pulls back a jacket sleeve to reveal a line of scars running up her arm and smiles a little. She got them after repeatedly cutting and burning herself with knives and cigarettes. "Her anxiety has been so horrible that she has cut and picked at her entire body," her mom explains.

Lauren just shrugs. "People talk too much," she says. "It annoys me."

Mathews, 36, desperately wants Lauren sent to a long-term facility for treatment, but not if it means relinquishing custody. "My child has a mom and dad. She has a family. Why would I put her in foster care?" Mathews says. "I don't want her to think we're giving her away."

She would pay for care herself but her husband is laid off from his truck-driving job. "We are a middle-class family. "We don't have $8,000 to $10,000 a month for care. What are we supposed to do?"

Last month, Mathews had one hope left. She was trying to persuade the county to pick up the tab for her daughter through a local mental health program called Hamilton Choices. But Lauren had waited more than six months for an assessment, and the family didn't hear from a Choices official until mid-February - the day after the Enquirer called the agency to inquire about her case.

The agency met with Lauren that same week and told her the county hadn't contacted the agency about Lauren until three weeks earlier. "If the paper hadn't gotten into this, I never would have heard from them," Mathews says. "That's what it takes to get someone to pay attention to you in this system."

On March 12, Lauren was hospitalized again after she started hearing voices in her head and acting out at school. So Choices agreed last week to pay to send the teen to a treatment facility in College Hill.

Mathews is thrilled her daughter is finally getting treatment but hopes it's not too late. She recalls that Lauren got so violent last fall that she threatened to kill herself with a steak knife and the police had to handcuff the teen just to take her to the hospital. Next time, Mathews worries, Lauren could actually hurt someone or end up going to jail.

"She's going to be 18 in three years and she will be out of the system. If someone doesn't help her, she'll either be in prison or pregnant, and either way they'll have to support her then," she says.

"Why not help her now?"

Lauren Mathews is bipolar and suffers from hyperglycemia, diabetes, and coronary disease as a result of medication, bad eating habits and smoking. Last week, after years of trying, her family finally got help for her. These pictures tell part of her story.

The foot of the basement steps is Lauren's favorite "chillin'" spot. For her medical problems, Lauren has taken 16 medications in the past four years and has been hospitalized eight times.

Lauren Mathews is bi-polar and suffers from other complications, including hypoglycemia and coronary disease as a result of her medication, eating habits and smoking. Here, she is framed by a hospital bed rail. She was hospitalized for four days to treat diabetes.

Dietician Ivy Sheehan directs Lauren toward nutritional foods.

Lauren waits impatiently for her discharge from the Children's Hospital Medical Center. She had her belongings packed hours in advance.

Accompanied by her mother, Lauren leaves Children's Hospital.

Lauren and her mom, Christy, talk about eating as Lauren spoons up a bowl of beef stew.

Lauren eats a bowl of beef stew as her grandmother, Shirley, plays with Lauren's sister Morgan in the background.

Illuminated only by the glow from her lighter, Lauren lights up in her "chillin' spot."

Lauren attends the Hamilton County Special School. Her attendance has been inconsistent due to health reason, and she has failed to earn any high school credit in the past two semesters.

Lauren attends Hamilton County Special School, but her illnesses have made attendance inconsistent. Last week, she moved into a psychiatric facility in College Hill, where she will get more in-depth attention.

Lauren reads and interacts with Norwood Head Start students.

Photos by Michael E. Keating

Source: The Enquirer

Using praise and positive reinforcement can truly improve your child's behavior. Here's how to do that.

Positive reinforcement is the most powerful and useful method of changing or developing behaviors. Unfortunately, good behavior is usually ignored in most homes, at school, and at work. Reinforcement is very familiar to everyone, but it is not used as often as it should be. In fact, if you master the use of positive reinforcement with your child, you will notice really dramatic improvements in behavior. The difficulty is in knowing how to use reinforcement and then in actually using it.

The following suggestions on how to help the child with behavior problems is taken from Parent Management Training by Alan F. Kazdin, Director and Chair of the Child Study Center at the Yale University School of Medicine and Director of the Yale Parenting Center and Child Conduct clinic.

How to make your praise most effective

• Deliver praise when you are near your child. When you are close to your child, you can be sure that the behavior you are praising is taking place. Also, when you are close, your child is more likely to pay attention to what you are saying.
• Use a sincere, enthusiastic tone of voice. You don't need to be loud, but make sure that you sound thrilled about what your child is doing.
• Use nonverbal reinforcement. Show your child you are pleased by smiling, winking, or touching. Hug your child, high five him, or pat him on the back.
• Be specific. When praising your child, say exactly what behavior you approve of." Wow, thank you so much for picking up your shoes and putting them in the closet." You want to be specific.

Just as positive opposites make a positive behavior more likely, so do prompts. A prompt is a cue or direction we give to get someone to do a behavior, for example:

1. Be specific. Tell your child specifically what you want.
DON'T SAY "Pick up your toys."	SAY "Please pick up your toys and put them in the toy box."
"Be good." or "Don't fool around."	"When you're on the school bus, remember to keep your hands to yourself and stay in your seat."

2. Be calm. Keep a positive or neutral tone in your voice when you give a prompt.
DON'T SAY "Put your dish in the sink!"	SAY "Please put your dish in the sink when you are done,"
3. Be close. Go up to your child when you talk and make eye contact.
DON'T SAY "Suzy, go tell your brother to hurry up with his shoes.'	SAY "Johnny, please put your shoes on in the next minute or so, so I can help you with your coat."

Effective Discipline Guidelines

Effective discipline really begins with rewarding and praising positive behaviors. When you are faced with problem behavior, mild punishment techniques can be effective, but only when they are paired with positive reinforcement for the positive opposite of the problem behavior.

1. Remain calm.

2. If you need to take a privilege away, take it away for a short period of time, such as TV or phone privileges for an afternoon or an evening. How immediate and consistent punishment is usually is more important than how big the loss is or how upset your child becomes.

3. Praise and reinforce your child's positive behaviors (positive opposites):

• Temper tantrums versus handling problems calmly
• Teasing others versus playing cooperatively with others
• Talking back versus using your words calmly and respectfully
• Physical aggression versus keeping one's hands and feet to oneself when angry

Whenever you want to change behavior, focus on the positive opposite. The positive opposite is the key to increasing positive behavior, and every problem behavior has a positive opposite. It is the behavior you want your child to be doing instead of the negative behavior. Your child is more likely to do the positive behavior if given the positive opposite than if punished.

Prompt for a behavior no more than twice. Three prompts for the same behavior is nagging.

Source: Rotella, C. (2005). When your child whines, screams, hits, kicks, and bites-relax: This man can help you find your inner parent. Yale Alumni Magazine, 69(1); 40-49.

Sources:

• Excerpts from Parent Management Training by Alan E. Kazdin
• Rotella, C. (2005). When your child whines, screams, hits, kicks, and bites-relax: This man can help you find your inner parent. Yale Alumni Magazine, 69(1); 40-49.

Detailed information parents need to effectively help their child with OCD.

• Does my child have OCD?
• What is OCD?
• What causes OCD?
• Can OCD be treated?
• How common is OCD?
• How to get help for my child
• What happens in treatment sessions?
• The parent's role
• Further support and information on OCD
• Recommended reading about OCD in children

Does my child have OCD?

Nearly everyone has occasionally experienced brief runs of repetitive thoughts, urges, or impulses, (like having to check the door is locked several times, or have doubts that they have washed their hands thoroughly enough after handling something dirty). Usually, these can be dispelled easily and so cause little discomfort. For some children, however, these kinds of worries really take a hold, and they find that they get stuck in cycles of doing something over and over again, like washing their hands again and again, counting up to a certain number, or checking something several times to be sure they've done it right. When these kinds of behaviours become a persistent problem and interfere with the child's life, it is know as obsessive-compulsive disorder (or OCD for short). Sometimes it can be hard for parents to tell if some of the things their child does are normal or if there might be a problem. A guide may be how much time your child is engaging in performing their rituals. If it's more than one hour this might indicate a problem. Another guide may be how upset your child gets when he/she carries out the rituals or you try to stop them. If distress is extreme and prolonged this might indicate a problem.

Below are some frequently asked questions about OCD.

What is OCD?

Obsessive-Compulsive Disorder (OCD) is a form of anxiety disorder, which can vary in severity from very mild to severe and can take many different and novel forms. Some children are bothered by upsetting thoughts that they can't get rid of no matter how hard they try; other kids may find they feel compelled to wash or to check things, even though logically they know there is no need. When children are troubled by their obsessional problems they can experience very high levels of anxiety and distress, and they can find the problem takes up a lot of their time and attention. It can seem that the problem is taking over their life, and that there is little time for anything other than worrying, washing, checking or other obsessional behaviours. It can interfere with a child's ability to enjoy life, with their personal relationships and with almost every aspect of their life.

What causes OCD?

Researchers do not completely know why people get OCD, but it's believed there are some reasons that increase the chances of some people getting OCD. For example, children and teenagers who develop OCD often feel very 'responsible' for causing or stopping harm happening to themselves or other people like their mom or dad. This feeling of being 'very responsible' can increase the chances of OCD. Other things that increase the chances of OCD include awful things that go on for a long time (like being bullied) or awful things that happen all of a sudden (such as someone dying). Feeling depressed for a long time can also increase the chances.

Other possible reasons include the idea that the brain works differently in people with OCD and the idea that the chances of getting OCD increase if other family members have it too. But the good news is that no matter what causes OCD, it can be treated with a treatment called cognitive behavior therapy (CBT).

Can OCD be treated?

From the research that has been carried out so far, we know that it is important to treat OCD as early as possible. It's known from previous research that CBT can help people who suffer from OCD. When people do CBT they learn how thoughts, feelings and what they do are connected. They also learn how to deal with upsetting thoughts and feelings. CBT works well for people with many different problems, such as panic attacks, fears like that of spiders or injections, and depression. CBT also works for adults with OCD, and many good experiences working with CBT and OCD in young people have been reported. Recent pilot work by Professor Paul Salkovskis and Dr. Tim Williams on CBT for young people with OCD has been very promising, with the results showing a significant positive effect of CBT treatment.

While many kids can do well with behavioral therapy alone, others will need a combination of behavioral therapy and medication. Therapy can help your child and family learn strategies to manage the ebb and flow of OCD symptoms, while medication, such as selective serotonin reuptake inhibitors (SSRIs), often can reduce the impulse to engage in the ritualistic behavior.

How common is OCD?

Research studies have estimated that between 1.9% and 3% of children suffer from OCD. If you think of a typical secondary school with 1,000 pupils, between 19 - 30 of them may have OCD. Follow up studies have shown that OCD should be treated as early as possible to prevent problems in later life.

How to get help

If you think your child has OCD and you want to get help then the first thing to do is to contact your family doctor. Your doctor can then arrange a referral to child and adolescent mental health professionals in your area who know how to treat OCD.

What happens in treatment sessions?

Once your child has been assessed and it has been decided that this treatment might be helpful, a number of appointments will be arranged. Each appointment can last up to one-and-a-half hours. Your child's therapist may also want to make a home visit at some point during treatment. As well as coming to these appointments, your child will carry out experiments and practice what he / she has learned between sessions. Depending on the therapist, your child may also need to listen to an audio-tape of each session. There will be no 'surprises' during treatment and your child and their therapist will work together. Your child may also need to be brave at times to try out new ways of doing things.

The parent's role

It's important to understand that OCD is never the child's fault. Once a child is in treatment, it's important for parents to participate, to learn more about OCD, and to modify expectations and be supportive. Keep in mind that kids with OCD get better at different rates so try to avoid any day-to-day comparisons of your child's behaviors, and recognize and praise any small improvements. Keep in mind that it's the OCD that is causing the problem, not the child. The more that personal criticism can be avoided, the better.

It's can be helpful to your child to keep family routines as normal as possible, and for all family members to learn strategies to help the child with OCD.

Children and adolescents often feel shame and embarrassment about their OCD. Many fear it means they're crazy. Good communication between parents and children can increase understanding of the problem and help the parents appropriately support their child.

You have to be your child's advocate in school. You must make sure that the child' s teacher and the school administrators understand the disorder.

Use support groups. Sharing common problems with other parents is an excellent way to help you feel that you are not alone and is great support. You also might gain so practical insights about what you can do to deal with the daily problems that come up.

Further support and information on OCD

There are many organizations providing support and information to those with OCD or other anxiety disorders, and to their friends and families. Listed below are a few of the organizations that you may wish to contact:

• OC Foundation
• Anxiety Disorders Association of America

Recommended reading about OCD in children

Freeing Your Child From Obsessive-Compulsive Disorder by Tamar E. Chansky, PHD. Three Rivers Press, New York.

Sources:

• OC Foundation
• Anthony Kane, MD (parent of ADHD child, ADD ADHD Advances website)