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When Kids Self Medicate

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Why Do Sally & Johnny Use Drugs?

By Alan I. Leshner, Ph.D., Director, National Institute of Drug Abuse, National Institutes of Health

(NAPS) - Now that their children have returned to school, right at the top of virtually every parent's concerns is the fear that their children might become innvolved with drugs.

And they're right to be concerned. Whether in cities, suburbia or rural communities, whether in wealthy or poor neighborhoods, drugs are now readily available to all young people.

And even the seemingly nerdiest kids can speak with apparent fluency & familiarity about marijuana, cocaine, heroin & such strange-sounding things as blunts, ecstasy, roofies, Special K & crystal meth.

Drugs are an equal opportunity destroyer. 50% of young people have used an illegal drug by the time they leave high school. What's a parent to do?

How can you predict if your children are going to use drugs? What can you do to prevent it?

How can you help them once they've started using?

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continued from above....

The first step is to understand why Sally or Johnny might be using drugs. Researchers have identified over 50 factors that might put someone at risk for drug use.

These risk factors can be found at the individual, the family, peer groups & broader community levels.

They include things like:

  • having too much free time
  • weak family structures
  • peer group
  • the glorification of drug use by some in the popular media

But those risk factors really only talk about overall probabilities of whether young people with certain characteristics might be more or less prone to using drugs. Knowing about these risk factors can help keep a parent alert, but no set of risk factors determines that a particular child will use drugs & many kids who have many of those risk ractors don't even try drugs.

So parents really have to deal with the individual child's situation & state of mind.

Two Paths to Drug Use

Research on the pathways to drug use & addiction suggests the immediate decision to use drugs is driven, basically, by one of two types of reasons.

One group of young people seems to use drugs simply to feel good. They're seeking novelty or excitement, to have a good time. I include in this group those who say they use drugs just because all their friends are doing it; they just want to join in common fun or to be "cool."

These kids are the ones most likely to be responsive to prevention programming that educates about the harmful effects of drugs on their bodies & are most influenced by the powerful protective factor of having strong & loving parents interested & involved in all aspects of their lives. These kids also seem to have the best chances of being successfully taught to seek alternative ways of having fun & to resist the temptation to seek novelty in drugs & other harmful ways.

But there's also a second, very different group of young people who are using drugs for quite different, actually more intractable reasons. These are kids who in some way or another are suffering & use drugs to try to make themselves feel better, or even normal.

This group often includes people stuck in very difficult life situations - poverty or abusive families, i.e. It also includes kids suffering from a variety of untreated mental disorders, like clinical depression, manic depressive illness, panic disorders, schizophrenia.

Estimates are that as many as 10 million children & adolescents may suffer from emotional & psychiatric problems of such magnitude that their ability to function is compromised & the majority of those kids are at extremely high risk of becoming addicted to drugs.

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These young people aren't using drugs just to feel good. These children are actually trying to medicate themselves with drugs. They use drugs becase they think they'll make them feel better or normal, in the same way that other people might be given anti-depressants or anti-anxiety medications.

The problem, of course, is that using illicit drugs isn't an effective treatment. In addition to other, perhaps more obvious problems - like that their use interferes with normal functioning - this kind of drug use actually will ultimately make them feel worse, not better.

Medical research has shown clearly that this kind of drug use only exacerbates underlying psychological problems.

Treatment Different For "Self Medicators"

Both the preventive & the treatment approaches for these "self-medicating" young people need to be quite different from the approaches one would use with novelty seekers or social users.

i.e., it can't be very meaningful to warn people who feel terrible today that using drugs may alter their brains a month from now. Their problem is getting thru today.

And encouragement to seek alternative sources of fun or to seek nicer friends doesn't seem very meaningful for them either. Again, they are trying to get thru today's issues.

Even the otherwise powerful protective factor of loving, supportive family involvement in the life of the child isn't very effective in these areas. Those young peopie who are trying to self-medicate must have help with their underlying problems. They need professional treatment.

Whatever the reasons, how do you know if your children are using drugs & what do you do if they are?

Telltale signs include:

  • recent mood & energy level changes
  • changes in eating habits
  • specific signs like redness around the eyes
  • changes in social & educational performance

Listen carefully to what your children are telling you about their lives & how they feel. And watch how they behave It may seem natural for an adolescent to be a bit surly, but most adolescents are not actually sullen, withdrawn, apathetic & lethargic. You should talk to your child about any of these symptoms. You do need to know.

What Can Parents Do?

What, if the answer is "yes," your child is using drugs? What do you do? In a small percentage of cases, parents can work with their own kids to get them to stop using drugs.

This might be easiest when the young person is just using drugs occasionally to have a good time. And, of course, the earlier you start talking to your children about drugs, the better the chances are they won't become involved with them. If a child reaches the age of 20 without using alcohol, tobacco or marijuana, the probability is almost zero he or she will ever develop a serious drug problem.

But if you suspect your child is really trying to self-medicate, or if you suspect your child is using regularly or even is addicted, you need to get help right away from the professionals. These aren't, problems the typical parents can handle alone. And help is available.

There are many professional social workers, nurses, drug counselors, psychologists & psychiatrists well trained to deal with both mental disorders & drug use use problems.

Your child's school, your family doctor, or community health center can help get you a referral. Don't assume Sally or Johnny's drug use is just a passing phase or something every kid must go thru. It isn't. It may well be the beginning of a lifetime of problems that could be prevented with early intervention.

For further information the reader can contact the National Clearinghouse For Alcohol and Drug Information (NCADI) at 1-8OO-729-668O or the NIDA Web Site at http://www.nida.nih.gov

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Fear of Drugs Tops ADHD Parents' List

By Alaine Benard 2002

Hallowell & Ratey, MD’s, estimate that as many as 15 million Americans have AD/HD. In “A Double-Edged Sword”, Maureen Martin Dale says that up to 50% of that group will use drugs & alcohol to self-medicate their AD/HD symptoms.

As the rates climb, so do the number of parents who are scared their child’s future will include drug use & addiction.

The studies reveal conflicting results about which group of children is more likely to fall into drug use - the one’s on medication or the ones using alternative treatments or no medications. One can build an equally good case for either argument. Many say Ritalin-like drugs are simply a gateway drug to marijuana, cocaine & other addictive narcotics. Others claim that non-treated AD/HD leads to higher incidents of drug addiction.

Recent lawsuits & legislation changes have added to the anxiety parents experience when faced with the already difficult decision-making process. Making informed choices about their child’s treatment are certainly made complicated by the vast amount of conflicting information from doctors & experts.

Finding the best option is made an even more daunting task when personal fears & misinformation are added to the equation.

One fact remains clear; people with AD/HD are more likely to self-medicate than other people. Besides drug & alcohol, some use food or compulsive behaviors to self-medicate their brains, bodies & feelings.

They're trying to gain calm & focus or are seeking escape from the painful symptoms & emotions associated with AD/HD. What seems to work at first often turns into a life-long addiction to that substance.

Drug abuse, eating disorders, alcoholism, or a life of crime & violence are the sad end result for many who practice self-medication.

Parents can do several things to insure their fear of drug use isn't realized. Take a long, hard look at your family histories.

Is your child predisposed to alcohol or chemical dependency?

Has one or both parents ever had an addiction problem?

Does the child have risk-taking tendencies?

Are they easily pressured or influenced?

Is there a co-morbid condition present that makes self-medication more probable?

Do peers or family members who use alcohol or drugs expose the child to them?

Each “Yes answer lowers the child’s chance of staying drug-free.

So, what weapons can parents wield to keep their children safe from the horrors of addiction?

Fortunately, we as parents possess the most important arsenal - our own influence. Parents who understand the importance of their role will accomplish much more than those willing to abdicate responsibility for educating & guarding their children, to others.

Schools, religious training, scouting & coaches have only a small percentage of power to keep children safe from drugs. We can't fool ourselves into thinking this is enough in the war we must wage.

We're in charge of the education of our children. To do this properly, we must consider our position as primary role model. We must first make the commitment to be drug-free ourselves. This includes telling partners, spouses, family members & friends that drug use use is unacceptable in our homes & in the presence of children.

We can't say one thing & do another, then expect our children not to follow in our footsteps.

Ellen Morehouse, Executive Director of Student Assistance Services, an alcohol & drug abuse agency, offers great advice on how parents who once used drugs should respond when asked about their past.

She says, “Before you answer that question, ask your child what she thinks & why she wants to know. Then let her know that you feel it's best not to answer the question. Explain that any answer you might offer could lead her to the wrong conclusion & provide the following examples:

”If I tell you that I did use drugs you might think it's okay for you to use them."

Morehouse suggests,

Go on to explain why it's not okay for her to use drugs:

"If I tell you I didn't use drugs, then you may think: I was a 'nerd' who can't understand why kids may want to use drugs, or if I had used them, I wouldn't be so against it.”

Parents might withhold certain information from their children if it isn't appropriate for children to have the information, or if the information could leave the wrong impression,” Morehouse also advised.

Participate in the school D.A.R.E. program with your child by going to the graduation ceremony & following it up with a special celebration. This will show how important staying drug-free is to your family.

Be aware of how media exposure affects children. Despite the appearance of drug use being ‘cool,’ it isn't. Explain this to your child & talk often about media influence & advertising gimmicks. Talk to them about whom they idolize.

Find out who their heroes are. This may give you a clue as to whom they want to imitate. Don't just ask once. Make this topic a familiar one in your household & ask for friends', relatives' & your child's friends' input also.

Take every opportunity to praise their choices of idols that aren't portrayed as alcoholics or addicts.

Know the warning signs & take action if drug use is suspected. A free downloadable book is available at: http://www.ed.gov/offices/OESE/SDFS/parents_guide/

The book offers valuable help with chapters on talking effectively, age-appropriate teaching methods, treatment options, available support groups & vast collection of free resources.

Parental willingness to be proactive & involved in their children’s lives decreases the odds against their self-medicating. Teaching them good coping methods to deal with their AD/HD symptoms, boosting their self-esteem & spending much time in one-on-one conversation show them that you're involved.

Children who feel loved & cared for by their parents, no matter their medical history, are less likely to turn to the deceiving arms of drugs for comfort. These simple & repetitive steps parents can easily take, show their children the number one drug proofing method - constant & abiding love.

Some experts are beginning research on the curative powers of a healthy prayer & spiritual life. All of these things add to a parents' anti-drug armory & will help diminish our fear while also teaching our children the joy of soaring high without drugs.

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Self-Medication

Here's To Your Health!

By Johanna C. Scully in Features
Issue date: 2/10/05
 
Carina Scott, a junior drama major, saw first-hand the dangers of over-the-counter painkillers (OTCs). As a freshman in high school her sister had a terrible allergic reaction to Motrin. She developed a rash all over her body, was unable to walk & missed days of school.
 
Her parents had given her the Motrin in accordance to the family doctor's recommendations for specific aches & pains. Scott doesn't recall her or her family ever talking to their primary care physician about adverse reactions that can occur when taking OTCs, but now they're very cautious when it comes to these easily available drugs.

"I worry about side effects of taking OTC's. I never take them when I'm taking prescriptions or when I drink alcohol. And I make sure to read the labels & understand the dosage," said Scott, who takes Advil or Motrin every once in a while for headaches & muscle aches despite what happened with her sister.

Tasha Fonseca, a sophomore drama & English major, strongly believes that the American society is overmedicated. There are too many OTCs available at the discretion of uneducated or maybe nave Americans.

"It's really alarming how overprescribed people are. I think doctors are telling people to take 2 pills when they would be fine with one," Fonseca said.

She also added that this college & other college campuses have a big problem with OTC overuse. Some do it to get high while others took OTC's for weeks for an injury & then became dependent. Doctors don't warn patients enough that it's possible to become addicted to OTC's & when people stop taking them abruptly, severe withdrawal symptoms can occur.

According to the National Consumers League (NCL), over 175 million Americans take OTC medication for pain relief, 44% of them exceed the recommended dose & millions ignore critical label information.
 
People so desperately want the pain to go away so they can go on rushing about their daily lives that they take more medicine than they should & they don't talk to their doctors about possible risks.
 
Statistics show that 16,500 people die & 103,000 are hospitalized each year from OTC complications. This is a very real problem & one that consumers must be educated on.
OTC painkiller ingredients, such as Ibuprofen & Naproxen, which are contained in products such as Advil, Motrin, Tylenol & Aleve, are called non-steroidal anti-inflammatory drugs (NSAIDs). They bring relief to millions for arthritis, headaches & other common pains, but people make the mistake of believing that just because they're easy to buy & are approved by the FDA, they're completely safe to use.

Maureen B. Houck, director of the Univ. Health & Wellness Center said, "People need to be smart consumers. We need to teach our students to be smart consumers as well. Not only do we need to be wary about OTC's; we need to be cautious with any supplement or herb. People think that just because it says organic or homeopathic it's safe. You can have an adverse reaction to anything."

Houck, who does take Tylenol or Ibuprofen occasionally & has been in Healthcare for over 30 years, said that there's always a risk for reaction.
"People think that Tylenol is innocuous, but in reality it can have severe side effects," Houck said.
The Health & Wellness Center doesn't recommend the same OTC to everyone. Everything is individualized depending on the patient's underlying conditions, but in flu season, they say Tylenol is the best OTC for aches & fever.
 
Houck & the doctors of the Health & Wellness Center strongly recommend stress reduction techniques such as listening to music, practicing yoga or Tai'chi or anything that works for you.
 
Exercise really is the best medicine because it releases natural painkillers.

Some people have probably heard about the investigations & lawsuits involving Aleve & Motrin. Aleve, manufactured by Bayer Healthcare, is used to reduce pain, inflammation & stiffness caused by many conditions, such as osteoarthritis, rheumatoid arthritis, gout, injury, abdominal cramps associated with menstruation & tendonitis.

On Dec. 20, 2004, the FDA announced that the National Institute of Health was immediately halting a study involving Naproxen, which is the primary ingredient of Aleve. The study was to see if Naproxen could be used to treat Alzheimer's.
 
Instead researchers found that the participants taking the drug had a 50% higher risk of having strokes & heart attacks than the participants taking the placebo had.
 
This discovery came in the wake of Vioxx being taken off the market for the same reasons.

This year, cases of allergic reactions to OTC's have significantly gone up. In Saratoga, California 9-year-old Kaitlyn Langstaff died after taking Children's Motrin, 7-year-old Sabrina Brierton Johnson of Los Angeles went blind 2 months after taking the same drug & 3 year-old Heather Rose Kiss of New Jersey died a week after taking a few doses of Children's Advil.
 
All three had developed a rare & extremely painful disease from the OTCs called Stevens-Johnson Syndrome. But both the FDA & Children's Advil spokespeople have said that the disease is so rare because only 6 in 1 million people get it, that it isn't necessary to put it on the label.

The Stevens-Johnson Syndrome Foundation has said that they've seen a rise in the disease involving children & Ibuprofen in the past year & that most doctors & parents don't know about it.

Vee Ounarath, a senior computer science major, discovered he was allergic to Ibuprofen when he took Tylenol to recover from a hangover & broke out in a rash covering his whole body & his face swelled up so bad he couldn't see.

Dr. John Amdur, a Human Nutrition professor at the Univ. who also has his own Chiropractic business, Amdur Chiropractic, said that not knowing the risks of OTC use is a dangerous problem especially on college campuses where kids self medicate & mix OTC's with alcohol.
 
He said that doctors today recommend OTC's like they're candy, but they can cause stroke, kidney & liver damage & failure & stomach bleeding & ulcers. He always tells his patients not to use OTC's since they just thin the blood & block the pain so they may not know that they're creating holes in their stomachs.
 
What he does tell his patients who are in chronic pain to use is Arnica, a homeopathic remedy that stimulates the release of natural painkillers in the body. Also he can't stress ice & heat therapy enough.

"I have had plenty of patients who've had reactions to OTCs such as their throat closing, hives & kidney problems. And all of these symptoms occurred per doctor's advice," Amdur said. "Years ago we needed a prescription for these medicines, like Advil, that we can buy so easily today.
 
I say it's not worth the risk, so if you can avoid them, do."

Mark Williams, a Columbia Univ. graduate & Pharmacist at Eckerd's Pharmacy in East Meadow, said that all pharmacists are required to discuss with their patients the risks of mixing OTCs with prescriptions, but many don't.
 
Mixing drugs can be a very dangerous thing. For instance a patient could be taking a drug for alcoholism & also be taking an OTC containing alcohol. Some OTCs can negate the effects of prescribed medicines & some can further irritate the condition you're taking the prescription for.
 
i.e., a person on high blood pressure medication who takes an over-the-counter decongestant that warns of increasing blood pressure could have a heart attack.

"I think adults are more health conscious today & especially with the Internet, the information is out there," Williams said. "But young people haven't changed - they think they're invincible & they need to be more educated on this topic."

Williams, who has been a pharmacist for 29 years, also added that some people could have a piece of chocolate cake or a bite of lobster & have a reaction or die, Motrin or Advil companies can't be completely at fault. He does think that it is admirable that Tylenol has stepped up to the plate with its new commercials in which the CEO of the Tylenol company states that if consumers aren't going to follow the directions on the back of the package, then the company would rather consumers didn't buy Tylenol at all.

Taking too many OTC's, which are supposed to relieve pain, can do the reverse in the case of headaches. If you have recurring headaches & have been taking OTC's such as Advil continuously, stop.
 
Try another technique to banish the pain, such as deep breathing, or aromatherapy or listening to calming music. Again, the best pain reliever for headaches, menstrual pain or minor aches & pains is exercise. So the next time you're in pain, instead of popping a pill & risking your health, try taking a walk, make sure you read all labels & talk to your doctor.

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Mental Health Matters: Children & Stress

By Janice A. Youngwith

School, soccer practice, piano lessons, Little League registration, scout meetings, religious education classes, field trips, homework projects, carpools, drive through fast-food dinners....some family calendars are beginning to look pretty complicated.

Whatever happened to downtime?

For today's super-scheduled kids, life can be pretty frantic. According to the National Mental Health Association (NMHA), children in overscheduled families are more prone to stress, depression and lower self-esteem. With experts extolling the benefits of strong family relationships for good development and mental health, it's no wonder some families are beginning to question the balance between scheduled activities and need for family time.

"It's easier for parents to identify a child's physical needs like nutritious, balanced meals, shelter, clothing, rest, immunizations, physical activity and healthy lifestyles," says Kris Umfress, Ph.D. clinical child psychologist at Advocate Lutheran General Hospital. Park Ridge. "However, a child's mental and emotional needs may not be as obvious."

According to Dr. Umfress, even young school-age children are not immune to the stress of today's suburban lifestyles. She points to a recent 2004 Kids Health survey of nine- to 13-year-olds naming top stressors as grades, looks and appearance, being liked, weight issues, futures, friends, and being a disappointment.

"Some of these children, especially girls, may be internalizers," Dr. Umfress notes. "Physical signs of stress for them may include upset tummies and headaches. On the other hand, parents may note acting out or inappropriate behavior. These kids, especially boys, externalize their stress response."

Changes in eating, sleep or performance also may be signals moms and dads may note when stress becomes problematic.

As children mature, stressors may change by high school as teens shift focus and worry about cars, finances, college, jobs and their future.

What's A Parent To Do?
Because stress often is anxiety-based among younger children, parents with young families tend to worry about emotional health and well-being but don't know how to get started.

For these tiny tots, parent-guided problem-solving, modeling behaviors and parental assistance in managing schedules is vital. As children age, they should become more adept at problem-solving and better equipped to manage stressors.

Anxiety disorders are the most common type of mental health disorder in children, affecting as up to 10 percent of young people.

"All children experience some anxiety; this is normal and expected," Dr. Umfress explains. "Anxiety becomes a problem when it interrupts a child's normal activities, like attending school, making friends or sleeping. Persistent and intense anxiety that disrupts daily routine is a mental health issue that requires intervention."

Limiting schedules, monitoring down time and recognizing changes in eating and sleep patterns is especially key for this age group, according to Christina Miksis, Ph.D., clinical psychologist providing outpatient counseling for children ages five to 18 at Alexian Center for Mental Health, Arlington Heights.

"As children grow, it's also vital to encourage quiet time, reading and relaxation," she reports. "In today's TV and computer age, it's especially important for parents to understand that that the sounds and visuals accompanying TV and computer screen time isn't relaxing and doesn't count as down time."

Both Dr. Miksis and Dr. Umfress encourage building resilience in kids, teaching them how to manage problems and challenges and showing them that change can be positive.

"Seeing problems are solvable, even at a young age, is important," Dr. Miksis notes. "Anxiety is internal stress and fears we put on ourselves. Teach your children to look to others for support and learn that talking out problems with family and friends diminishes stress and helps build strong relationships."

While some children work best under stress and are born procrastinators when it comes to homework deadlines, Dr. Miksis cautions that the stress of overbooked schedules and family/school demands can become too much.

"As children grow, stressors do change," she notes. "Teens report friends, school, jobs, breakups, peer pressure, family and peer conflicts, illness, classmates, activities, moves and life changes, academic performance, college and career choices all are stressful."

The eighth and nine grade years may be especially challenging and vulnerable years as puberty begins and young teens began to expand social circles. The first year of college is also an especially fragile time as teens become more independent and face for the first time a variety of adult day-to-day challenges.

Dr. Miksis cautions that teens and 'tweens often are especially worried about limiting activities as they try to manage advanced placement classes, basketball schedules and other outside interests.

"Saying no can be very difficult," she cautions. "Most don't want to miss out on something friends enjoy or don't want to disappoint mom and dad."

NMHA experts agree with Drs. Miksis and Umfress. They say the basics for a child's good mental health includes:

  • Unconditional love. Let children know your love doesn't depend on their accomplishments.
  • Nurture a child's confidence and self-esteem. Praise and encourage, set realistic goals and be honest about your mistakes. Avoid sarcasm.
  • Encourage children to play. Playtime is important and helps children learn to creative, develop problem-solving skills and self-control, and learn to get along with others.
  • Enroll kids in an after-school activity. This is a great way for kids to stay productive, learn something new and gain self-esteem.
  • Give appropriate guidance and discipline when necessary. Be firm but kind and realistic in expectations. The goal is not to control the child, but to help them learn self-control.
  • Communicate. Make time each day to listen to your children and talk with them about what is happening in their lives. Share emotions and feelings.
  • Get help. If you are concerned about your child's mental health, consult with teachers, a guidance counselor or another adult who may have information about his/her behavior. If you think there is a problem, seek professional help. Early identification and treatment can help children with mental health problems reach their full potential.

When Stress Becomes To Much
"When it comes to teen and childhood stress and mental health issues, family support and ongoing family involvement are the key to successful evaluation, treatment and recovery," says Tahseen Mohammed, M.D., a child and adolescent psychiatrist currently serving as medical director of Northwest Community Hospital's inpatient youth services.

Anxiety, depression, school refusal or truancy, problems on the job, alcohol and substance abuse are definite red flag warning signs parents need to heed, according to Dr. Mohammed.

Parents of children with anxiety disorders often report they feel as if they are "walking on egg shells." Family counseling sessions where behavioral contracts are discussed and education for parents about the nature of the illness can help parents navigate the turbulent times and ultimately aid in the process of returning the child to school and daily life.

According to the American Academy of Child & Adolescent Psychiatry, other warning signs for younger children which parents should heed include a marked falling school performance, poor grades despite trying very hard, severe worry or anxiety as shown by refusal to go to school, go to sleep or take part in activities normal for the child's age, hyperactivity or fidgeting, constant movement beyond regular play, persistent nightmares, persistent disobedience or aggression (lasting more than six months) and frequent, unexplained temper tantrums.

Warning signs for pre-adolescents and teens include a marked change in school performance, inability to cope with problems and daily activities, marked changes in sleeping and/or eating habits, frequent physical complaints, sexual acting out, depression shown by sustained or prolonged negative mood and attitude often accompanied by poor appetite, difficulty sleeping and thoughts or death, alcohol and drug abuse, persistent nightmares, threats of self-harm or harm to others, self-injury or destructive behavior, threats to run away, strange thoughts and beliefs, and aggressive or non-aggressive consistent violation of the rights of others, truancy, theft and vandalism.

"A detailed psychiatric assessment may uncover underlying depression, mood or anxiety disorders which may only be helped by a combination of medication and therapy," Dr. Mohammed explains. "It's often very challenging to unmask underlying issues when teens have begun to self-medicate or use substances to help feel better. Observation and a detailed medical, family and social history are needed. The level of service a teen may need (outpatient, individual or family therapy, medication management, day treatment or inpatient treatment) depends on the severity of the condition, support system, resources and other medical and psychological conditions."

At times outpatient services simply aren't enough to keep the child or teen safe or keep them from hurting others. In those instances, Dr. Mohammed says, hospitalization may be the best option.

"There is definitely a great need for mental health services for children and teens," he notes. "Schools are perhaps our greatest referral source and we're constantly reaching out to support them with resources."


To learn more about children and stress, contact the Mental Health Association in Illinois at 312-368-9070, or the National Mental Health Association at 800-969-NMHA (6642). Online, visit the www.mhai.org or www.nmha.org.

Common Anxiety Disorders in Children

Generalized Anxiety Disorder
Children with generalized anxiety disorder (GAD) have recurring fears and worries that they find difficult to control.İ They worry about almost everything - school, sports, being on time, even natural disasters.İ They may be restless, irritable, tense, or easily tired, and they may have trouble concentrating or sleeping.İ Children with GAD are usually eager to please others and may be "perfectionists," dissatisfied with their own less-than-perfect performance.

Separation Anxiety Disorder
Children with separation anxiety disorder have intense anxiety about being away from home or caregivers that affects their ability to function socially and in school.İ These children have a great need to stay at home or be close to their parents.İ Children with this disorder may worry excessively about their parents when they
are apart from them.İ When they are together, the child may cling to parents, refuse to go to school, or be afraid to sleep alone.İ Repeated nightmares about separation and physical symptoms such as stomachaches and headaches are also common in children with separation anxiety disorder.

Social Phobia
Social phobia usually emerges in the mid-teens and typically does not affect young children.İ Young people with this disorder have a constant fear of social or performance situations such as speaking in class or eating in public.İ This fear is often accompanied by physical symptoms such as sweating, blushing, heart palpitations, shortness of breath, or muscle tenseness.İ Young people with this disorder typically respond to these feelings by avoiding the feared situation.İ For example, they may stay home from school or avoid parties.İ Young people with social phobia are often overly sensitive to criticism, have trouble being assertive, and suffer from low self-esteem.İ Social phobia can be limited to specific situations, so the adolescent may fear dating and recreational events but be confident in academic and work situations.

Obsessive-Compulsive Disorder
Obsessive compulsive disorder (OCD) typically begins in early childhood or adolescence.İ Children with OCD have frequent and uncontrollable thoughts (called "obsessions") and may perform routines or rituals (called "compulsions") in an attempt to eliminate the thoughts.İ Those with the disorder often repeat behaviors to avoid some imagined consequence.İ For example, a compulsion common to people with OCD is excessive hand washing due to a fear of germs.İ Other common compulsions include counting, repeating words silently, and rechecking completed tasks.İ In the case of OCD, these obsessions and compulsions take up so much time that they interfere with daily living and cause a young person a great deal of anxiety.

Post-Traumatic Stress Disorder
Children who experience a physical or emotional trauma such as witnessing a shooting or disaster, surviving physical or sexual abuse, or being in a car accident may develop post-traumatic stress disorder (PTSD).İ Children are more easily traumatized than adults.İ An event that may not be traumatic to an adult - such as a bumpy plane ride - might be traumatic to a child.İ A child may "re-experience" the trauma through nightmares, constant thoughts about what happened, or reenacting the event while playing.İ A child with PTSD will experience symptoms of general anxiety, including irritability or trouble sleeping and eating.İ Children may exhibit other symptoms such as being easily startled.

What Can Parents and Caregivers Do?
By identifying, diagnosing and treating anxiety disorders early, parents and others can help children reach their full potential.İ Anxiety disorders are treatable.İ Effective treatment for anxiety disorders may include some form of psychotherapy, behavioral therapy, or medications.İ Children who exhibit persistent symptoms of an anxiety disorder should be referred to and evaluated by a mental health professional who specializes in treating children.İ The diagnostic evaluation may include psychological testing and consultation with other specialists.İ A comprehensive treatment plan should be developed with the family, and, whenever possible, the child should be involved in making treatment decisions.

Children's mental health matters! To learn more, talk to a doctor or mental health professional, contact your local Mental Health Association or access the resources listed on the Directory of Mental Health Services page.

Source: National Mental Health Association

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Substance Use in Children & Adolescents with Mental Health Needs

A Survey by Parent/Professional Advocacy League

Written by Lisa Lambert, Assistant Director

PAL Survey:

Substance Use in Children & Adolescents with Mental Health Needs

For many years, a number of families of children and adolescents with mental health needs have reported that their children also use alcohol and other substances.

Many families have been concerned that these co-occurring disorders complicate their access to services and treatments. Often they must navigate separate systems to find treatment which can complicate and delay access to care.

In August 2004, Parent/Professional Advocacy League (PAL) conducted a very brief survey of the approximately 35 Family Support Specialists (FSS) in the PAL network in Massachusetts. There has been a 74 percent rate of response. The Family Support Specialists work with hundreds of families in communities throughout the Commonwealth. These families receive support through support groups, visits, phone calls and by being accompanied to various school and planning meetings.

Through these interactions, many families share their concerns around their children. Some of those concerns include substance use.

STIGMA

Conducting this survey has generated many conversations about stigma and other barriers to treatment. Many families have become more comfortable revealing that their adolescent has depression or attention deficit disorder and will discuss that in a group setting more freely than revealing that their teen uses illegal substances.

However, many Family Support Specialists report that when the mental health diagnosis is more severe (e.g., bipolar disorder), families find it less stigmatizing to talk about their son’s use of alcohol or their daughter’s misuse of prescription medications than to divulge that their teen is prescribed an antipsychotic medication.

The degree of stigma is directly related to the serious of the diagnosis. Stigma also plays a role in choosing treatments. While some communities are accepting of a teen receiving outpatient therapy, in others the parent would rather admit that their child goes to an Alcoholics Anonymous meeting.

Further, a few families feel that substance use programs offer better linkages to jobs and vocational opportunities that mental health treatment programs, making them preferable.

Family Support Specialists also noted that many families are fearful of disclosing illegal substance use because of their concerns about legal ramifications. Many noted that their estimates of the number of teens who use substances are probably low since it is often many months before a parent feels “safe” revealing their son or daughter’s alcohol or substance use. If families were able to reveal their child or adolescent’s substance use without fear of penalty, the numbers in our survey might be higher.

SURVEY RESULTS

The Family Support Specialists were asked six basic questions in order to get some rough data on the frequency of substance use among children whose families are part of the PAL network. There was a wide range of responses, which often reflected the wide range of ages of the children reported on. Among FSS who primarily support families of teens, the responses reflected higher substance use. For FSS who support families of children of many ages, the responses were lower.

The results below include a range of responses. However, all the children and adolescents who were reported on have mental health needs.

When asked how many of the families they interact with report that their child or adolescent uses alcohol or other substances, responses ranged from 10 percent to 90 percent. Overall, approximately 43 percent of parents that FSS work with reported that their child or teen uses substances.

When asked how often these youth are using alcohol or other substances:

18 percent reported that they are using substances once a month or less

33 percent reported that they are using twice a month or more and

49 percent reported that these youth were using substances daily or several times a week.

Of the youth reported on, nearly half are using substances on a regular basis

Additional comments revealed that very few youth were using alcohol or other substances simply on a recreational basis. When asked whether the parents they work with believe their child or adolescent is using substances to self medicate, a large number, 74%, replied yes.

Childhood Depression
Nancy Schimelpfening
 

The Myth of a Happy Childhood

Do you ever find yourself wishing you could recapture the carefree days of childhood?

Kids have absolutely nothing to worry about, do they?

No bills to pay, bosses to answer to, or obligations to keep. They have none of the everyday stresses that we adults have. But, is childhood really a time of bliss?

The truth is, childhood is far from being without stress.

Children can be faced with many difficulties that they are ill-equipped to handle emotionally:

just to name a few. Children by nature feel powerless against these situations & the effects can remain with them well into adulthood.

But, what if your child doesn't fall into any of these categories? Does this guarantee a child free from depression? The answer is no.

A very important factor in childhood depression is that it may be a biologically based illness. Children with an inherited tendency for depression will be highly susceptible to the strains caused by the need for peer acceptance.

Because it is caused by an imbalance in brain chemistry, it may appear to you that there is nothing so severely wrong in your child's life that would merit being depressed. Just as with adult depression, a child's perception of the world may be distorted. He may feel that he is unlovable, "stupid", or "bad" even though these things simply aren't true.

Further complicating matters is the fact that young children don't have labels for these feelings & can't vocalize what it is that's happening to them.

They may not even realize that they aren't normal feelings. To a child, it may seem that this is "just the way life is".

What can you as a parent, teacher, or other concerned adult do to help? The most important step is recognition of the problem. On the next page, we'll discuss how to identify a depressed child.

Childhood Depression
 

Recognition

In order to recognize when a child is depressed, it's important to become aware of the symptoms & the signs to look for.

Because children aren't as articulate as adults in expressing their emotions, it's unlikely that they'll come to us & say "I'm depressed" as an adult might do.

In fact, they may not even realize themselves that something is out of the ordinary.

Children live in a world controlled by adults & can easily feel powerless over what's happening to them. This puts the responsibility upon us as adults to look for signs of trouble & help children cope.

The warning signs of depression fall basically into 4 different categories:

  • emotional signs
  • cognitive signs (those involving thinking)
  • physical complaints
  • behavioral changes

Not every child who is depressed experiences every symptom.

Depending upon the degree of depression, they may experience a few symptoms or many. Also, severity of each symptom may vary.

Emotional Signs

Typical moods or emotions experienced by children suffering from depression include:

    Sadness - The child may feel despondent & hopeless. They may cry easily. Some children will hide their tears by becoming withdrawn.

    Loss of pleasure or interest - A child who has always enjoyed playing sports, i.e., may suddenly decide to not try out for the team this year. They may complain of feeling "bored" or reject an offer to participate in an activity, which they've always enjoyed in the past.

    Anxiety - The child may become anxious, tense & panicky. The source of their anxiety may well give you a clue to what's causing their depression.

    Turmoil - The child may feel worried & irritable. They may brood or lash out in anger as a result of the distress they're feeling.

Cognitive Signs

A depressive mood can bring on negative, self-defeating thoughts. These skewed thought processes may help perpetuate the problem because they make the child resistant to words of encouragement or advice. Once the depression lifts, the child will be much more receptive to help. The signs to look for are:

    Difficulty organizing thoughts - People with depression often have problems concentrating or remembering. In children, this may be evidenced by problems in school or an inability to complete tasks.

    Negative view - People with depression may become pessimistic, perceiving themselves, their life, and their world in a very negative light.

    Worthlessness & guilt - Depressed children may obsess over their perceived faults & failures, feel tremendous guilt & declare themselves worthless.

    Helplessness & hopelessness - Depressed children often believe that there is nothing they can do to relieve their feelings of depression. In particular, a child with dysthymia may perceive that this is "just the way it is" because this is their only experience.

    Feelings of isolation - A child who has been picked on frequently may become very sensitive to slights from his peers.

    Suicidal Thoughts - Thoughts of death are not limited to adults. Children may also wish that they were dead and express these thoughts.

Physical Signs

Depression isn't just an illness of the mind. It causes changes in us physically as well.

    Changes in appetite or weight - Many people with depression find that their appetite either decreases or increases. Children who usually have a healthy appetite may suddenly lose interest in eating. Children may also respond in the opposite way, but eating too much to self-medicate their feelings.

    Sleep disturbances - Children with depression may have difficulty falling asleep & staying asleep once they do. They may wake too early or oversleep. They may have trouble staying awake during the day at school.

    Sluggishness -Children with depression often talk, react, and walk slower. They may be less active and playful than usual.

    Agitation - Depressed children may show signs of agitation by fidgeting or not being able to sit still.

Behavioral Signs

These signs will be the most obvious & easy for your detect.

    Avoidance & withdrawal - Children with depression may avoid everyday or enjoyable activities & responsibilities. They may withdraw from friends & family. The bedroom can become a favorite place to escape & find solitude.

    Clinging & demanding - The depressed child may become more dependent on some relationships & behave with an exaggerated sense of insecurity.

    Activities in excess - A depressed child may appear to be out of control in regard to certain activities. He or she may spend long hours playing a video game or overeat.

    Restlessness - The restlessness brought on by depression may lead to such behaviors as fidgeting, acting up in class, or reckless behavior

    Self-Harm - Depressed individuals may cause themselves physical pain or take excessive risks. Self-injury is one example of such behavior.

If you suspect that a child is depressed, the next step is seeking professional help in obtaining a diagnosis & treatment. This will be addressed on the following page.

Seeking Help for Your Child

If you suspect that a child is depressed, the next step is seeking professional help in obtaining a diagnosis and treatment. In researching this part of the series, I came upon a resource from the American Academy of Child and Adolescent Psychiatry (AACAP) called "Facts for Families". "Facts for Families" is a series of brochures which discusses various issues relating to childhood mental illness. I am including links to those which are relevant to this topic, but highly recommend taking a look at the full list of topics because they cover a wide variety of useful information.

Fact No. 24 - Know When to Seek Help - Parents are often the first to pick up on signs that a child needs help. Learn the signals that indicate a psychiatric evaluation may be needed.

Fact No. 25 - Knowing Where to Find Help - Think your child needs help, but you're not sure where to find it? Helpful advice about locating a child and adolescent psychiatrist.

Fact No. 52 - Comprehensive Psychiatric Evaluation - Evaluation by a child and adolescent psychiatrist is appropriate for any child or adolescent with emotional or behavioral problems. This brochure explains what to expect during an evaluation.

Questions and Answers About Child and Adolescent Psychiatry - This FAQ from AACAP helps answer many of the questions parents may have.

Fact No. 26 - Understanding you Mental Health Insurance - The costs of treatment and how to pay for it are a very real concern for parents. This brochure explains what questions to ask about your healthcare plan.

After reading these publications, you should have a good idea on what you need to do to find help. If you've made it this far in reading this article, you may have already made an appointment to see someone or at least made the decision to seek professional help. I'm sure, however, that there are still many questions and fears going through your mind. In the next part of this series, I will attempt to address the emotions you are going through and ease your mind about the process of seeking psychiatric help for your child. I will also give you some resources to help you talk with your child about upcoming events and ease their fears.

Easing the Fear of Seeing a Doctor

"Going to the doctor" is frightening under any circumstances, but the idea of seeing a doctor for "crazy people" brings about it's own special fears, both for parent and child. Your child may or may not express these fears, but don't take their silence to mean that all is well. Positive and honest communication about their illness and what to expect during treatment are essential. The role you play in getting them prepared for their first doctors visit is crucial in setting the tone for treatment. Your child looks up to you and will take cues about how to react to the experience from you.

Talking to Your Child About Depression

Talk to your child about how he's feeling. As you talk with him, be non-judgmental. Reassure him that while he may be thinking many bad things about himself, you love him and value him.

If you have depression, let him know that you have the same illness. Explain to him on his level what it is that causes him to feel so sad. Depending upon your child's educational level, you can both allow him to read on his own or read yourself and then explain to him the mechanics of depression. KidsHealth.Org is an excellent educational site for both parent and child. Articles such as "The Brain is the Boss" , "What Medicines Are and How They Work" , and "Why Am I So Sad?" will help children to see that there are reasons for they way they feel, and there are ways to get better.

Shame and Stigma

Even in adults, feelings of shame accompany the thought of being treated for a mental illness. There are feelings that we must be crazy or other people will think we are crazy. Children can be especially cruel; in particular if your child has already exhibited behaviors such as withdrawal or acting out, which have caused him to stand out from his peers. No one wants to be odd or different. Address these feelings with your child. Reassure him that he is not crazy. He has a chemical deficiency in his brain that makes him feel sad, or anxious, or have trouble concentrating in school and that this deficiency can be fixed. Let him know that he is not bad. He hasn't done anything wrong that he is being punished for. Also, let him know that no one has to know that he has seen a doctor; but, if anyone should find out, it's nothing to be ashamed of. Many, many people have depression, including famous people.

The Visit Itself

Common fears among children visiting doctors are pain and the unknown. Children have very active imaginations. They may have also seen psychiatry portrayed in a negative way in movies. Giving them a rundown of what to expect will help allay these fears and prevent them from imagining the worst. If you haven't done so already, read the following brochures from AACAP. Once you have an understanding of what to expect you can relay this information to your child in terms they can understand.

Getting Your Child Involved

Two ways of getting your child involved are making lists of symptoms and letting your child make a list of questions for the doctor. This process is helpful because not only are you getting together information that will be useful for the doctor, but also because your are teaching your child to recognize his own illness and how to take an active part in his own healthcare. This will give him a feeling of mastering his illness and will help him in controlling it should it turn out to be a chronic condition.

Choosing the Right Doctor

A doctor who is clinical or detached in manner or cannot establish good rapport with children will make your child even more apprehensive. If possible, obtain a recommendation of a good doctor from your family doctor, a school counselor, or friend. Choose a psychiatrist who specializes in treating children if possible. If you find that the psychiatrist you have chosen makes your child feel ill-at-ease or does not seem to understand your child's needs, don't be afraid to change doctors.

Once you make it through the initial evaluation and diagnosis, you will probably have many questions about treatments. In the next part of this series, we will discuss the safety of drug treatments for children and answer some of the frequently asked questions about psychotherapy.

Treatment Options for Kids

Medications

Rather than repeat information about the various drug treatments available for depression which you can easily find just about anywhere on the Web, including elsewhere on my Web site, I've decided to focus on an aspect of antidepressants that are of special concern when it comes to kids. How safe are they? Are we damaging our children's developing bodies and brains when we give them drugs which may effect them in ways not yet discovered?

I wish I could give you a definitive answer on this topic, but I can't. What I can do is give you some resources to read over and help you make the most informed decision that you can. In addition to reading the following, talk with your doctor about your fears. He or she is an expert in this field and will have access to the latest scientific information.

What it all boils down to, however, is making a decision that's best for your child. Along with your doctor, you must weigh the risks against the benefits.

    FDA: Suicidality in Children Using Antidepressants

    Do Babies Really Need Prozac?

    New Antidepressants for Kids

    Medication Can Help Depressed Kids

    Questions to Ask about Psychiatric Medications for Children and Adolescents

    Kindergartners in the Prozac Nation

    Prohibitionist Oregonian Newspaper Takes a Look at Prozac Use by Kids

    Alarm Stops Bedwetting Better Than Drugs

    Tricyclics in Children

    Medicating Kids: A Pacifier for Childhood Depression

    You may have noticed as I have that there are a lots of people out there saying its "bad, bad, bad", but not giving sound reasons for this opinion. In making a choice that will affect your child's mental health and well-being sound scientific evidence rather than fear of the unknown is essential. For this reason, I am also including a link to Medscape Psychiatry. Membership is free and you can search for journal articles and news reports relevant to medical topics. Although I've linked to the psychiatry page for your convenience, you're not limited to this area of medicine. I also recommend going to your favorite search engine and searching for keywords such as "children" and "antidepressants". You'll come up with even more information and opinions.

    Frequently Asked Questions About Psychotherapy

    Q. What is the difference between psychotherapy and pharmacotherapy?

    A. Psychotherapy is often referred to as simply "therapy" or "talk therapy". It is usually practiced by psychologists. Pharmacotherapy is another name for drug therapy and involves the use of antidepressant medications. Only psychiatrists can prescribe medications.

    Q. What is the difference between a psychologist and a psychiatrist?

    A. The simplest way to describe the difference between them is that a psychologist primarily aids the depressed patient by counseling and psychotherapy. A psychiatrist may also perform psychotherapy; but, in addition, can prescribe medications and perform ECT (electroconvulsive therapy). A psychiatrist is a medical doctor. A psychologist may hold a doctoral degree (Ph.D.) and be called "doctor"; but, is not a medical doctor (M.D.).

    Q. What is the best type of psychotherapy?

    A. There are many theoretical approaches to psychotherapy, but probably the most effective in the treatment of childhood depression and depression in general is Cognitive-Behavioral Therapy. This type of therapy focuses upon the role of thinking and belief systems as the root of depression. People with depression have certain characteristic thought patterns, called cognitive distortions, which give them a skewed perception of the world around them. During therapy, the psychologist works with the patient to help them recognize their dysfunctional thoughts, emotions, and behaviors and to change them to a more realistic perspective. Interpersonal therapy, which focuses on interpersonal relationships and coping with conflict, and family therapy may also be useful in certain cases.

    Q. Are both medication and psychotherapy necessary to treat my child's depression?

    A. Depending upon the severity of your child's depression and its causes, therapyalone, medication alone, or therapy combined with medications may be advised by your doctor. Generally speaking a combination of both will get the best results. An antidepressant helps to correct the chemical imbalance within the brain responsible for the symptoms of depression. After this imbalance is corrected, a person will begin to feel better; but, the negative thought patterns which lead to depression may still remain. Therapy will help the person to alter these thought patterns and better cope with stressors in their life that contribute to their depression.

    Q. I still have questions. Where can I learn more?

    A. There is an excellent FAQ by Dr. Donald J. Franklin, Ph.D. which answers many more of the commonly asked questions about psychologists and psychology. Brochure #53 from the American Academy of Child and Adolescent Psychiatry's Facts for Families gives a very good overview of what to expect from therapy as well.

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this is simply an informational website concerning emotions & feelings. it does not advise anyone to perform methods -treatments - practice described within, endorse methods described anywhere within or advise any visitor with medical or psychological treatment that should be considered only thru a medical doctor, medical professional, or mental health professional.  in no way are we a medical professional or mental health professional.