welcome to children 101

mental health issues facing children

about children 101
mental health issues facing children
Mental Health: in the womb & the first year of life....
Mental Health: Two, Three & Four for more!
Mental Health: The Elementary School Child
Mental Health: The Chaos Begins - Almost Teens...
Emotions & Feelings
Just Love 'Em - What Children Need
Children & Fear
children & anger
Children & Control
Power Struggles
learning to communicate...it's a 2 way street!
Setting Limits & Boundaries
self esteem
Dealing with a bully
Character & Values
Social Skills
Children & Friendships
Children Need Extended Family Relationships
Lifestyle Factors
Children & Responsibilities
About School & Education
Sex Education
Spirituality & Children
Gifted Children
Children with Special Needs
Children with Special Problems
children with special gifts
Children & Stress
Child Abuse & Neglect
Dysfunctional Family Life
Children & Divorce
Parenting Tips
An Adoption in the Family
Single Parenting
Same Sex Parenting
Step Families
Foster Families
No Kids? Be A Mentor!
When Kids Self Medicate
When A Parent Dies
When A Sibling Dies
Children & Trauma
coping mechanisms for kids
teaching life skills

welcome to the emotional feelings network of sites

A not for profit network of self-help websites.

Welcome! I hope I can help you find what you're looking for! Anytime you see an underlined word in a different color you're being offered an opportunity to learn more than what you came here for. It's important to understand the true meanings of your emotions and feelings as well as many other topics that are within this network. This entire network is set up to help those who want to help themselves find a sense of peace in their lives - discover who resides within and recover from whatever life has dealt you. Clicking on the underlined link words will open a new window so whatever page you began on will remain waiting for you to get back to it!


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starting out at the beginning....

Starting out in the beginning of life, your child's mental health is being formed day by day, actually experience by experience. It's really amazing how quickly babies learn. What's more amazing is what they learn before they take their first breath of fresh air!
This page encompasses some facts concerning how our children establish the quality of mental health they may live with their entire lives and about the development of the human brain in these early years.

Feel free to email me anytime concerning this website with questions, comments or just to say hello!
Click here to send me mail now!

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By Paul C. Holinger, M.D., M.P.H., author of What Babies Say Before They Can Talk
visit my new personal blog!
and you can help support me in my writing ventures by visiting my health and happiness column for the Dayton, Ohio area by clicking here! Even though you don't live in the Dayton area you can get some great health and happiness ideas by reading my column and then looking for something similar in your area!
I do appreciate you so much!

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More Effort Needed To Prevent Mental, Emotional, And Behavioral Disorders In Young People

Main Category: Mental Health
Also Included In: Depression;  Psychology / Psychiatry;  Pediatrics / Children's Health
Article Date: 16 Feb 2009 - 1:00 PST

The federal government should make preventing mental, emotional, and behavioral disorders and promoting mental health in young people a national priority, says a new report from the National Research Council and Institute of Medicine.

These disorders - which include:

  • depression
  • anxiety
  • conduct disorder
  • and substance abuse

- are about as common as fractured limbs in children and adolescents.

Collectively, they take a tremendous toll on the well-being of young people and their families, costing the U.S. an estimated $247 billion annually, the report says.

Research has shown that a number of programs are effective at preventing these problems and promoting mental health, the report says. Such programs could be implemented more broadly, but currently there is no clear federal presence to lead these efforts.

The White House should create an entity that can coordinate agency initiatives in this area, set public goals for prevention, and provide needed research and funding to achieve them, said the committee that wrote the report.

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"There is a substantial gap between what is known about preventing mental, emotional, and behavioral disorders and what is actually being done," said Kenneth E. Warner, committee chair and dean of the University of Michigan School of Public Health.
"It is no longer accurate to argue that these disorders can never be prevented. Many can. The nation is well-positioned to equip young people with the skills and habits needed to live healthy, happy, and productive lives in caring relationships. But we need to develop the systems to deliver effective prevention programs to a far wider group of children and adolescents."

Most mental, emotional, and behavioral disorders have their roots in childhood and adolescence, the report notes. Among adults who have experienced these disorders, more than half report the onset as occurring in childhood or early adolescence.
In any given year, an estimated 14% to 20% of young people have one of these disorders.

First symptoms typically occur 2 to 4 years before the onset of a full-blown disorder - creating a window of opportunity when preventive programs might make a difference, the report says. And some programs have shown effectiveness at preventing specific disorders in at-risk groups.
For example, the Clarke Cognitive-Behavioral Prevention Intervention, which focuses on helping adolescents at risk for depression learn to cope with stress, has prevented episodes of major depression in several controlled experiments.

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Other programs have demonstrated broader preventive effects in general populations of young people, the report says. Programs that can be offered in family or educational settings show particular promise in promoting mental health and addressing major risk factors.

One example of an effective school-based program is the Good Behavior Game, which divides elementary school classes into teams and reinforces desirable behaviors with rewards such as extra free time and other privileges. Studies have shown that the program significantly reduces aggressive and disruptive behavior during first grade. The one-year intervention also has benefits over the long term, lowering the students' risk of alcohol and drug abuse, as well as rates of suicidal thoughts and attempts.
And it significantly reduces the likelihood that highly aggressive boys will be diagnosed with antisocial personality disorder as adults. Research has shown that programs that focus on enhancing social and emotional skills can also improve students' academic performance, the report notes.

Still other programs improve children's mental health and behavior by enhancing parenting skills, the report says. The Positive Parenting Program, for example, uses a range of approaches, from a television series on how to handle common child-rearing problems to in-person skills training for parents struggling to handle children's aggressiveness or lack of cooperation. These methods have been shown to lower kids' disruptive behaviors, a positive change that persisted one year later.

The report recommends that the White House create an entity to lead a broad implementation of evidence-based prevention approaches and to direct research on interventions. The new leadership body should set public goals for preventing specific disorders and promoting mental health and provide the funding to achieve them.
The departments of Education, Justice, and Health and Human Services should align their resources and programs with this strategy. These agencies should also fund state, county, and community efforts to implement and improve evidence-based programs. At the same time, the report cautions, federal and state agencies should not support programs that lack empirical evidence, even if they have community endorsement.

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The committee also urged continued research to build understanding of what interventions work for whom and when, and how best to implement them. The National Institutes of Health should develop a comprehensive 10-year plan to research ways to promote mental health and prevent mental, emotional, and behavioral disorders in young people.
In addition, agencies and foundations should establish equality in research funding between ways to prevent mental and behavioral disorders and ways to treat these problems, the report says; currently, the balance is weighted toward research on treatment.

The report also discusses screening programs that attempt to identify children with risk factors for mental, emotional, or behavioral disorders. Screening can be helpful for targeting interventions, but it should be used only if it meets certain criteria, including that the disorders to be prevented are a serious threat to mental health and that there is an effective intervention to address the risks or early symptoms.
Parents should be given detailed information about the purpose and methods of screening, and the wishes of those who don't want their children included should be respected. Without community acceptance and sufficient capacity to respond to the needs identified, screening is of limited value, the committee noted. It added that approaches to connecting screening with specific interventions need to be tested.

The report was sponsored by the Substance Abuse and Mental Health Services Administration, the National Institute on Drug Abuse, the National Institute of Mental Health, and the National Institute on Alcohol Abuse and Alcoholism. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.
They are private, nonprofit institutions that provide science, technology, and health policy advice under a congressional charter. The Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering. A committee roster follows.

Copies of Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities are available from the National Academies Press on the Internet at http://www.nap.edu.

Article adapted by Medical News Today from original press release.

[ This news release and report are available at
http://national-academies.org ]


Board on Children, Youth, and Families
Board on Health Care Services

Committee on Prevention of Mental Disorders and Substance Abuse Among Children,
Youth, and Young Adults: Research Advances and Promising Interventions

Kenneth E. Warner, Ph.D. (chair)
Avedis Donabedian Distinguished University Professor of Public Health and Dean
School of Public Health
University of Michigan
Ann Arbor

Thomas F. Boat, M.D. (vice chair)
Executive Associate Dean
College of Medicine
University of Cincinnati

William R. Beardslee, M.D.
Gardner Monks Professor of Child Psychiatry
Harvard Medical School; and
Academic Chairman
Department of Psychiatry
Children's Hospital Boston

Carl C. Bell, M.D.
President and CEO
Community Mental Health Council and Foundation Inc.; and
Professor of Psychiatry and Public Health
University of Illinois

Anthony Biglan, M.D.
Senior Scientist, and
Center on Early Adolescence
Oregon Research Institute

C. Hendricks Brown, Ph.D.
Distinguished University Health Professor of Public Health, and
Prevention Science and Methodology Group
Department of Epidemology and Biostatistics
College of Public Health

Elizabeth Jane Costello, Ph.D.
Professor of Medical Psychology
Department of Psychiatry and Behavioral Sciences
Duke University Medical Center
Durham, N.C.

Teresa D. LaFromboise, M.D.
Associate Professor of Counseling Psychology
School of Education, and
Native American Studies
Stanford University
Stanford, Calif.

Ricardo F. Muñoz, Ph.D.
Chief Psychologist
San Francisco General Hospital; and
Professor of Psychology
University of California
San Francisco

Peter J. Pecora, Ph.D.
Senior Director
Research Services
Casey Family Programs, and
School of Social Work
University of Washington

Bradley S. Peterson, M.D.
Deputy Director of Pediatric Neuropsychiatry Research, and
Director of MRI Research
Columbia University
New York City

Linda A. Randolph, M.D.,M.P.H.
President and CEO
Developing Families Center Inc.
Washington, D.C.

Irwin Sandler, M.D.
Regents' Professor of Psychology, and
Principal Investigator
Prevention Research Center
Arizona State University

Mary Ellen O'Connell, MMHS
Study Director

Source: Sara Frueh
National Academy of Sciences

source site: click here

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is your child depressed?

from the report of the sugeon general....
Children & Mental Health

Spanning roughly 20 years, childhood and adolescence are marked by dramatic changes in physical, cognitive and social-emotional skills and capacities.

Mental health in childhood and adolescence is defined by the achievement of expected developmental cognitive, social and emotional milestones and by secure attachments, satisfying social relationships and effective coping skills.

Mentally healthy children and adolescents enjoy a positive quality of life; function well at home, in school and in their communities and are free of disabling symptoms of psychopathology (Hoagwood et al., 1996).

If interested, Read Chapter Two of the Report of the Surgeon General concerning mental health by clicking here. (more important information concerning mental health)

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interrupting the present article with this excerpt from: Child and Adolescent Mental Health SAMHSA

Mental Health Is Important

Mental health is how people think, feel and act as they face life's situations.

It affects:

  • how people handle stress
  • relate to one another
  • make decisions

Mental health influences the ways individuals look at themselves, their lives and others in their lives. Like physical health, mental health is important at every stage of life.

All aspects of our lives are affected by our mental health.

Caring for and protecting our children is an obligation and is critical to their daily lives and their independence.

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The basic principles for understanding health and illness discussed in the previous chapter apply to children and adolescents, but it's important to underscore the often heard admonition that “children are not little adults.”

Even more than is true for adults, children must be seen in the context of their social environments, that is, family, peer group and their larger physical and cultural surroundings.

Childhood mental health is expressed in this context, as children proceed through development.

Development, characterized by periods of transition and reorganization, is the focus of much research on children and adolescents. Studies focus on normal and abnormal development, trying to understand and predict the forces that will keep children and adolescents mentally healthy and maintain them on course to become mentally healthy adults.

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These studies ask what places some at risk for mental illness and what protects some but not others, despite exposure to the same risk factors.

In addition to studies of normal development and of risk factors, much additional research focuses on mental illness in childhood and adolescence and what can be done to prevent or treat it. The science is challenging because of the ongoing process of development.

The normally developing child hardly stays the same long enough to make stable measurements. Adult criteria for illness can be difficult to apply to children and adolescents, when the signs and symptoms of mental disorders are often also the characteristics of normal development.

i.e., a temper tantrum could be an expected behavior in a young child but not in an adult. At some point, however, it becomes clearer that certain symptoms and behaviors cause great distress and may lead to dysfunction of children, their family and others in their social environment.

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interrupting the present article with this excerpt from: Child and Adolescent Mental Health SAMHSA

Children and Adolescents Can Have Serious Mental Health Problems: Like adults, children and adolescents can have mental health disorders that interfere with the way they think, feel and act. When untreated, mental health disorders can lead to:

Untreated mental health disorders can be very costly to families, communities and the health care system.

Mental Health Disorders Are More Common in Young People than Many Realize
Studies show that at least 1 in 5 children and adolescents have a mental health disorder.

At least 1 in 10, or about 6 million people, have a serious emotional disturbance

The Causes Are Complicated
Mental health disorders in children and adolescents are caused mostly by biology and environment.

Examples of biological causes are:

  • genetics

  • chemical imbalances in the body

  • damage to the central nervous system, such as a head injury

Many environmental factors also put young people at risk for developing mental health disorders. Examples include:

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At these points, it's helpful to consider serious deviations from expected cognitive, social and emotional development as “mental disorders.”  Specific treatments and services are available for children and adolescents with such mental disorders, but one can't forget that these disorders emerge in the context of an ongoing developmental process and shifting relationships within the family and community.

These developmental factors must be carefully addressed, if one is to maximize the healthy development of children with mental disorders, promote remediation of associated impairments and enhance their adult outcomes.

The developmental perspective helps us understand how estimated prevalence rates for mental disorders in children and adolescents vary as a function of the degree of impairment that the child experiences in association with specific symptom patterns.

i.e., the MECA Study (Methodology for Epidemiology of Mental Disorders in Children & Adolescents) estimated that almost 21% of U.S. children ages 9 to 17 had a diagnosable mental or addictive disorder associated with at least minimum impairment (see Table 3-1).

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Table 3-1. Children & adolescents age 9 - 17 w/mental or addictive disorders, combined MECA sample, 6-month (current) prevalence*

Anxiety Disorders 13.0
Mood Disorders 6.2
Disruptive Disorders 10.3
Substance Use Disorders 2.0
Any Disorder 20.9

* Disorders include diagnosis-specific impairment and CGAS < or = 70 (mild global impairment) Source: Shaffer et al., 1996a

When diagnostic criteria required the presence of significant functional impairment, estimates dropped to 11%. This estimate translates into a total of 4 million youth who suffer from a major mental illness that results in significant impairments at home, at school & with peers.

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Finally, when extreme functional impairment is the criterion, the estimates dropped to 5%.

Given the process of development, it isn't surprising that these disorders in some youth are known to wax and wane, such that some afflicted children improve as development unfolds, perhaps as a result of healthy influences impinging on them.

Similarly, other youth, formerly only “at risk,” may develop full-blown forms of disorder, as severe and devastating in their impact on the youth and his or her family as are the analogous conditions that affect adults. Characterizing such disorders as relatively unchangeable underestimates the potential beneficial influences that can redirect a child whose development has gone awry.

Likewise, characterizing children with mental disorders as “only” the victims of negative environmental influences that might be fixed if societal factors were just changed runs the risk of underestimating the severity of these conditions and the need for focused, intensive clinical interventions for suffering children and adolescents.

Thus, the science of mental health in childhood and adolescence is a complex mix of the study of development and the study of discrete conditions or disorders. Both perspectives are useful. Each alone has its limitations, but together they constitute a more fully informed approach that spans mental health and illness and allows one to design developmentally informed strategies for prevention and treatment.

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Normal Development

Development is the lifelong process of growth, maturation and change that unfolds at the fastest pace during childhood and adolescence. An appreciation of normal development is crucial to understand mental health in children and adolescents and the risks they face in maintaining mental health.

Distortions in the process of development may lead to mental disorders. This section deals with the normal development of understanding (cognitive development) in young children and the development of social relationships and temperament.

Theories of Development

Historically, the changes that take place in a child’s psyche between birth and adulthood were largely ignored. Child development first became a subject of serious inquiry at the beginning of this century but was mostly viewed from the perspective of mental disorders and from the cultural mainstream of Europe and white America.

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Some of the“grand theories” of child development, such as that propounded by Sigmund Freud, grew out of this focus and they unquestionably drew attention to the importance of child development in laying the foundation for adult mental health.

Even those theories that resulted from the observation of healthy children, such as Piaget’s theory of cognitive development, paid little attention to the relationship between the development of the“inner self” and the environment into which the individual was placed. In contrast, the interaction of an individual with the environment was central to the school of thought known as behaviorism.

Theories of normal development, introduced in Chapter 2, are presented briefly below, because they form the basis of many current approaches to understanding and treating mental illness and mental health problems in children and adults. These theories haven't achieved the broader objective of explaining how children grow into healthy adults.

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More study and perhaps new theories will be needed to improve our ability to guide healthy child-rearing with scientific evidence.

Development Viewed as a Series of Stages

Freud and the psychoanalyst Erik Erikson proposed a series of stages of development reflecting the attainment of biological objectives.

The stages are expressed in terms of functioning as an individual and with others, within the family and the broader social environment (particularly in Erikson’s theories) (see Chapter 2).

Although criticized as unscientific and relevant primarily to the era and culture in which they were conceived, these theories introduced the importance of thinking developmentally, that is, of considering the ever-changing physical and psychological capacities and tasks faced by people as they age.

They emphasized the concept of “maturation” and moving through the stages of life, adapting to changing physical capacities and new psychological and social challenges.

And they described mental health problems associated with failure to achieve milestones and objectives in their developmental schemes.

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These theories have guided generations of psychodynamic therapists and child development experts. They're important to understand as the underpinnings of many therapeutic approaches, such as interpersonal therapy, some of which have been evaluated and found to be efficacious for some conditions.

By and large, however, these theories have rarely been tested empirically.

Intellectual Development

The Swiss psychologist Jean Piaget also developed a stage-constructed theory of children’s intellectual development. Piaget’s theory, based on several decades’ observations of children (Inhelder & Piaget, 1958), was about how children gradually acquire the ability to understand the world around them thru active engagement with it.

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He was the first to recognize that infants take an active role in getting to know their world and that children have a different understanding of the world than do adults. The principal limitations of Piaget’s theories are that they're descriptive rather than explanatory.

Furthermore, he neglected variability in development and temperament and didn't consider the crucial interplay between a child’s intellectual development and his or her social experiences (Bidell & Fischer, 1992).

Behavioral Development
Other approaches to understanding development are less focused on the stages of development. Behavioral psychology focused on observation and measurement, explaining development in terms of responses to stimuli, such as rewards.

Not only did the theories of the early pioneers (e.g., Pavlov, Watson & Skinner) generate a number of valuable treatments, but their focus on precise description set the stage for current programs of research based on direct observation.

Social learning theory (Bandura, 1977) emphasized role models and their impact on children and adolescents as they develop. Several important clinical tools came out of behaviorism (e.g., reinforcement and behavior modification) and social learning theory (cognitive-behavioral therapy). Both treatment approaches are used effectively with children and adolescents.

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Social and Language Development

Parent-Child Relationships

It's common knowledge that infants and for the most part, their principal caretakers typically develop a close bond during the first year of life and that in the 2nd year of life children become distressed when they're forcibly separated from their mothers.

However, the clinical importance of these bonds wasn't fully appreciated until John Bowlby introduced the concept of attachment in a report on the effects of maternal deprivation (Bowlby, 1951). Bowlby (1969) postulated that the pattern of an infant’s early attachment to parents would form the basis for all later social relationships.

On the basis of his experience with disturbed children, he hypothesized that, when the mother was unavailable or only partially available during the first months of the child’s life, the attachment process would be interrupted, leaving enduring emotional scars and predisposing a child to behavioral problems.

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A mother’s bond with her child often starts when she feels fetal movements during pregnancy. Immediately after birth, most, but by no means all, mothers experience a surge of affection that is followed by a feeling that the baby belongs to them.

This experience may not occur at all or be delayed under conditions of addiction or postnatal depression (Robson & Kumar, 1980; Kumar, 1997). Yet, like all enduring relationships, it seems that the relationship between mother and child develops gradually and strengthens over time.

Some infants who experience severe neglect in early life may develop mentally and emotionally without lasting consequences, i.e., they're adopted and their adoptive parents provide sensitive, stable and enriching care or if depressed or substance-abusing mothers recover fully (Koluchova, 1972; Dennis, 1973; Downey & Coyne, 1990).

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Unfortunately, however, early neglect is all too often the precursor of later neglect. When the child remains subject to deprivation, inadequate or insensitive care, lack of affection, low levels of stimulation and poor education over long periods of time, later adjustment is likely to be severely compromised (Dennis, 1973; Curtiss, 1977).

In general, it appears that the particular caregiver with whom infants interact (i.e., biological mother or another) is less important for the development of good social relationships than the fact that infants interact over a period of time with someone who is familiar and sensitive (Lamb, 1975; Bowlby, 1988).

One of the problems in the later development of children who experience early institutionalization or significant neglect is that there may have been no opportunities for the caretakers and the infants to establish strong and mutual attachments in a reciprocating relationship.

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interrupting the present article with this excerpt from: Child and Adolescent Mental Health SAMHSA

Signs of Mental Health Disorders Can Signal a Need for Help Children and adolescents with mental health issues need to get help as soon as possible. A variety of signs may point to mental health disorders or serious emotional disturbances in children or adolescents.

Pay attention if a child or adolescent you know has any of these warning signs:

A child or adolescent is troubled by feeling:

A child or adolescent experiences big changes, such as:

  • Showing declining performance in school.

  • Losing interest in things once enjoyed.

  • Experiencing unexplained changes in sleeping or eating patterns.

  • Avoiding friends or family and wanting to be alone all the time.

  • Daydreaming too much and not completing tasks.

  • Feeling life is too hard to handle.

  • Hearing voices that can't be explained.

  • Experiencing suicidal thoughts.

A child or adolescent experiences:

  • Poor concentration and is unable to think straight or make up his or her mind.

  • An inability to sit still or focus attention.

  • Worry about being harmed, hurting others, or doing something "bad".

  • A need to wash, clean things, or perform certain routines hundreds of times a day, in order to avoid an unsubstantiated danger.

  • Racing thoughts that are almost too fast to follow.

  • Persistent nightmares.

A child or adolescent behaves in ways that cause problems, such as:

  • Using alcohol or other drugs.

  • Eating large amounts of food and then purging, or abusing laxatives, to avoid weight gain.

  • Dieting and/or exercising obsessively.

  • Violating the rights of others or constantly breaking the law without regard for other people.

  • Setting fires.

  • Doing things that can be life threatening.

  • Killing animals.

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Origins of Language

Recent research has established that successful use of language and communication is a cornerstone of childhood mental health.

Not only are strong language capabilities critical to the development of such skills as listening and speaking, but they also are fundamental to the acquisition of proficient reading and writing abilities. In turn, children with a variety of speech and language impediments are at increasing risk as their language abilities fall behind those of their peers.

Caretaker and baby start to communicate with each other vocally as well as visually during the first months of life. Many, but not all, developmental psychologists believe that this early pattern of mother-infant reciprocity and interchange is the basis on which subsequent language and communication develop.

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Various theorists have attempted to explain the relations between language and cognitive development (Vygotsky, 1962; Chomsky, 1965, 1975, 1986; Bruner, 1971; Luria, 1971), but no single theory has achieved preeminence.

While a number of theories address language development from different perspectives, all theories suggest that language development depends on both biological and socio-environmental factors. It's clear that language competence is a critical aspect of children’s mental health.

Relationships With Other Children

To be healthy, children must form relationships not only with their parents, but also with siblings and with peers. Peer relationships change over time.

In the toddler period, children’s social skills are very limited; they spend most of their time playing side by side rather than with each other in a give and take fashion.

As children grow, their abilities to form close relationships become highly dependent on their social skills. These include an ability to interpret and understand other children’s nonverbal cues, such as body language and pitch of voice.

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Children whose social skills develop optimally respond to what other children say, use eye contact, often mention the other child’s name and may use touch to get attention. If they want to do something that other children oppose, they can articulate the reasons why their plan is a good one.

They can suppress their own wishes and desires to reach a compromise with other children and may be willing to change, at least in the presence of another child, a stated belief or wish. When they're with a group of children they don't know, they're quiet but observant until they have a feeling for the structure and dynamics of the group (Coie & Kuperschmidt, 1983; Dodge, 1983; Putallaz, 1983; Dodge & Feldman, 1990; Kagan et al., 1998).

In contrast, children who lack such skills tend to be rejected by other children. Commonly, they are withdrawn, don't listen well and offer few if any reasons for their wishes; they rarely praise others and find it difficult to join in cooperative activities (Dodge, 1983). They often exhibit features of oppositional defiant or conduct disorder, such as regular fighting, dominating and pushing others around, or being spiteful (Dodge et al., 1990).

Social skills improve with opportunities to mix with others (Bridgeman, 1981). In recent years, knowledge of the importance of children’s acquisition of social skills has led to the development and integration of social skills training components into a number of successful therapeutic interventions.

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During the past 2 decades, as psychologists began to view the child less as a passive recipient of environmental input but rather as an active player in the process, the importance of temperament has become better appreciated (Plomin, 1986).

Temperament is defined as the repertoire of traits with which each child is born; this repertoire determines how people react to the world around them. Such variations in characteristics were first described systematically by Anna Freud from her observations of children orphaned by the ravages of World War II.

She noticed that some children were affectionate, some wanted to be close but were too shy to approach adults and some were difficult because they were easily angered and frustrated (A. Freud, 1965).

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The first major longitudinal observations on temperament were begun in the 1950's by Thomas & Chess (1977). They distinguished 10 aspects of temperament, but there appear to be many different ways to describe temperamental differences (Goldsmith et al., 1987).

Although there's some continuity in temperamental qualities throughout the life span (Chess & Thomas, 1984; Mitchell, 1993), temperament is often modified during development, particularly by the interaction with the caregiver.

i.e., a timid child can become bolder with the help of parental encouragement (Kagan, 1984, 1989). Some traits of temperament, such as attention span, goal orientation, lack of distractibility and curiosity, can affect cognitive functioning because the more pronounced these traits are, the better a child will learn (Campos et al., 1983).

Of note, it isn't always clear whether extremes of temperament should be considered within the spectrum of mental disorder (i.e., shyness or anxiety) or whether certain forms of temperament might predispose a child to the development of certain mental disorders.

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Developmental Psychopathology

Current Developmental Theory Applied to Child Mental Health and Illness

A number of central concepts and guiding assumptions underpin our current understanding of children’s mental health and illness. These have been variously defined by different investigators (Sroufe & Rutter, 1984; Cicchetti & Cohen, 1995; Jensen, 1998), but by and large these tenets are based on the premise that psychopathology in childhood arises from the complex, multi-layered interactions of specific characteristics of the child (including biological, psychological and genetic factors), his or her environment (including parent, sibling and family relations, peer and neighborhood factors, school and community factors and the larger social-cultural context) and the specific manner in which these factors interact with and shape each other over the course of development.

Thus, an understanding of a child’s particular history and past experiences (including biologic events affecting brain development) is essential to unravel the why’s and wherefore’s of a child’s particular behaviors, both normal and abnormal.

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While this principle assumes developmental continuities, to the extent that early experiences are “brought forward” into the current behavior, it's also important to consider developmental discontinuities, where qualitative shifts in the child’s biological, psychological and social capacities may occur.

These may not be easily discerned or predicted ahead of time and may reflect the emergence of new capacities (or incapacities) as the child’s psychological self, brain and social environment undergo significant reorganization.

A second precept underlying an adequate understanding of children’s mental health and illness concerns the innate tendencies of the child to adapt to his or her environment.

This principle of adaptation incorporates and acknowledges children’s “self-righting” and “self-organizing” tendencies; namely, that a child within a given context naturally adapts (as much as possible) to a particular ecological niche, or when necessary, modifies that niche to get needs met.

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When environments themselves are highly disordered or pathological, children’s adaptations to such settings may also be pathologic, especially when compared with children’s behaviors within more healthy settings.

This principle underscores the likelihood that some (but not all) “pathologic” behavioral syndromes might be best characterized as adaptive responses when the child or adolescent encounters difficult or adverse circumstances.

Notably, this ability to adapt behaviorally is reflected at multiple levels, including the level of brain and nervous system structures (sometimes called neuroplasticity).

A third consideration that guides both research-based and clinical approaches to understanding child mental health and illness concerns the importance of age and timing factors. i.e., a behavior that may be quite normal at one age (e.g., young children’s distress when separated from their primary caretaking figure) can be an important symptom or indicator of mental illness at another age.

Similarly, stressors or risk factors may have no, little, or profound impact, depending on the age at which they occur and whether they occur alone or with other accumulated risk factors.

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A 4th premise underpinning an adequate understanding of children’s mental health and illness concerns the importance of the child’s context. Perhaps the most important context for developing children is their caretaking environment.

Research with both humans and animals has demonstrated that gross disruptions in this critical parameter have immediate and long-term effects, not just on the young organism’s later social-emotional development but also on physical health, long-term morbidity and mortality, later parenting practices and even behavioral outcomes of its offspring.

Moreover, context may play a role in the definition of what actually constitutes psychopathology or health. The same behavior in one setting or culture might be acceptable and even “normative,” whereas it may be seen as pathological in another.

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Yet another principle central to understanding child mental health  and illness is that normal and abnormal developmental processes are often separated only by differences of degree. Thus, supposed differences between normal and abnormal behavior may be better understood by taking into account the differences in the amount or degree of the particular behavior, or the degree of exposure to a particular risk factor. Frequently, no sharp distinctions can be made.

The virtue of these developmental considerations when applied to children is that:

  • (a) they enable a broader, more informed search for factors related to the onset of, maintenance of and recovery from abnormal forms of child behavior
  • (b) they help move beyond static diagnostic terms that tend to reduce the behaviors of a complex, developing, adapting and feeling child to an oversimplified diagnostic term
  • (c) they offer a new perspective on potential targets for intervention, whether child-focused or directed toward environmental or contextual factors
  • (d) they highlight the possibility of important timing considerations: windows of opportunity during a child’s development when preventive or treatment interventions may be especially effective.

In the sections that follow, these considerations will help the reader understand the important differences from chapters focusing principally on adults, as well as the unique opportunities for intervention that occur because of these differences.

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Overview of Risk Factors and Prevention

Current approaches to understanding the etiology of mental disorders in childhood are driven by empirical advances in neuroscience and behavioral research rather than by theories.

Epidemiological research on the factors that make children vulnerable to mental illness is important for several reasons: delineating the range of risk factors for particular mental disorders helps to understand their etiology; the populations most at risk can be identified; understanding the relative strength of different risk factors allows for the design of appropriate prevention programs for children in different contexts and resources can be better allocated to intervene so as to maximize their effectiveness.

Risk Factors

There is now good evidence that both biological factors and adverse psychosocial experiences during childhood influence, but not necessarily “cause,” the mental disorders of childhood. Adverse experiences may occur at home, at school or in the community.

A stressor or risk factor may have no, little, or a profound impact, depending on individual differences among children and the age at which the child is exposed to it, as well as whether it occurs alone or in association with other risk factors. Although children are influenced by their psychosocial environment, most are inherently resilient and can deal with some degree of adversity.

However, some children, possibly those with an inherent biological vulnerability (e.g., genes that convey susceptibility to an illness), are more likely to be harmed by an adverse environment and there are some environmental adversities, especially those that are long-standing or repeated, that seem likely to induce a mental disorder in all but the hardiest of children.

A recent analysis of risk factors by Kraemer and colleagues (1997) has provided a useful framework for differentiating among categories of risk and may help point this work in a more productive direction.

Risk factors for developing a mental disorder or experiencing problems in social-emotional development include:

  • prenatal damage from exposure to alcohol, illegal drugs and tobacco
  • low birth weight
  • difficult temperament or an inherited predisposition to a mental disorder
  • external risk factors such as poverty, deprivation, abuse and neglect
  • unsatisfactory relationships
  • parental mental health disorder
  • exposure to traumatic events

Biological Influences on Mental Disorders

It seems likely that the roots of most mental disorders lie in some combination of genetic and environmental factors, the latter may be biological or psychosocial (Rutter et al., 1999). However, increasing consensus has emerged that biologic factors exert especially pronounced influences on several disorders in particular, including:

  • pervasive developmental disorder (Piven & O’Leary, 1997)
  • autism (Piven & O’Leary, 1997)
  • early-onset schizophrenia (McClellan & Werry, in press)

It's also likely that biological factors play a large part in the etiology of social phobia (Pine, 1997), obsessive-compulsive disorder (Leonard et al., 1997) and other disorders such as Tourette’s disorder (Leckman et al., 1997).

Two important points about biological factors should be borne in mind. The first is that biological influences aren't necessarily synonymous with those of genetics or inheritance. Biological abnormalities of the central nervous system that influence behavior, thinking, or feeling can be caused by:

  • injury
  • infection
  • poor nutrition
  • exposure to toxins, such as lead in the environment

These abnormalities aren't inherited. Mental disorders that are most likely to have genetic components include:

Second, it's erroneous to assume that biological and environmental factors are independent of each other, when in fact they interact.

i.e., traumatic experiences may induce biological changes that persist. Conversely, children with a biologically based behavior may modify their environment.

i.e., low-birth-weight infants who have sustained brain damage and thereby become excessively irritable, may change the behavior of caretakers in a way that adversely affects the caretaker’s ability to provide good care.

Thus, it is now well documented that a number of biologic risk factors exert important effects on brain structure and function and increase the likelihood of subsequently developing mental disorders.

These well-established factors include intrauterine exposure to alcohol or cigarette smoke (Nichols & Chen, 1981), perinatal trauma (Whitaker et al., 1997), environmental exposure to lead (Needleman et al., 1990), malnutrition of pregnancy, traumatic brain injury, nonspecific forms of mental retardation and specific chromosomal syndromes.

Psychosocial Risk Factors
A landmark study on risks from the environment (Rutter & Quinton, 1977) showed that several factors can endanger a child’s mental health. Dysfunctional aspects of family life such as:

  • severe parental discord
  • a parent’s psychopathology or criminality
  • overcrowding or large family size can predispose to conduct disorders and antisocial personality disorders, especially if the child doesn't have a loving relationship w/at least one of the parents (Rutter, 1979)
  • economic hardship can indirectly increase a child’s risk of developing a behavioral disorder because it may cause behavioral problems in the parents or increase the risk of child abuse (Dutton, 1986; Link et al., 1986; Wilson, 1987; Schorr, 1988)
  • exposure to acts of violence also is identified as a possible cause of stress-related mental health problems (Jenkins & Bell, 1997)
  • studies point to poor caregiving practices as being a risk factor for children of depressed parents (Zahn-Waxler et al., 1990)

The quality of the relationship between infants or children and their primary caregiver, as manifested by the security of attachment, has long been felt to be of paramount importance to mental health across the life span.

In this regard, the relationship between maternal problems and those factors in children that predispose them to form insecure attachments, particularly young infants’ and toddlers’ security of attachment and temperament style and their impact on the development of mood and conduct disorders, is of great interest to researchers.

Many investigators have taken the view that the nature and the outcome of the attachment process are related to later depression, especially when the child is raised in an abusive environment (Toth & Cicchetti, 1996) and to later conduct disorder (Sampson & Laub, 1993).

The relationship of attachment to mental disorders has been the subject of several important review articles (Rutter, 1995; van IJzendoorn et al., 1995).

There's controversy as to whether the key determinant of “insecure” responses to strange situations stems from maternal behavior or from an inborn predisposition to respond to an unfamiliar stranger with avoidant behaviors, such as is found in socially phobic children (Belsky & Rovine, 1987; Kagan et al., 1988; Thompson et al., 1988; Kagan, 1994, 1995).

Kagan demonstrated that infants who were more prone to being active, agitated and tearful at 4 months of age were less spontaneous and sociable and more likely to show anxiety symptoms at age 4 (Snidman et al., 1995; Kagan et al., 1998).

These findings are of considerable significance, because long-term study of such highly reactive, behaviorally inhibited infants and toddlers has shown that they are excessively shy and avoidant in early childhood and that this behavior persists and predisposes to later anxiety (Biederman et al., 1993).

There is also some controversy as to whether “difficult” temperament in an infant is an early manifestation of a behavior problem, particularly in children who go on to demonstrate such problems as conduct disorder (Olds et al., 1999).

One analysis of the attachment literature suggests that abnormal or insecure forms of attachment are largely the product of maternal problems, such as depression and substance abuse, rather than of individual differences in the child (van IJzendoorn et al., 1992).

The relationship between a child’s temperament and parenting style is complex (Thomas et al., 1968); it may be either protective if it's good or a risk factor if it's poor. Thus, a difficult child’s chances of developing mental health problems are much reduced if he or she grows up in a family in which there are clear rules and consistent enforcement (Maziade et al., 1985), while a child exposed to inconsistent discipline is at greater risk for later behavior problems (Werner & Smith, 1992).

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Family and Genetic Risk Factors

As noted above in the relationships between temperament and attachment, in some instances the relative contributions of biologic influences and environmental influences are difficult to tease apart, a problem that particularly affects studies investigating the impact of family and genetic influences on risk for childhood mental disorder.

i.e., research has shown that between 20 & 50% of depressed children and adolescents have a family history of depression (Puig-Antich et al., 1989; Todd et al., 1993; Williamson et al., 1995; Kovacs, 1997b). The exact reasons for this increased risk haven't been fully clarified, but experts tend to agree that both factors interact to result in this increased risk (Weissman et al., 1997).

Family research has found that children of depressed parents are more than 3 times as likely as children of nondepressed parents to experience a depressive disorder (see Birmaher et al., 1996a and 1996b for review).

Parental depression also increases the risk of anxiety disorders, conduct disorder and alcohol dependence (Downey & Coyne, 1990; Weissman et al., 1997; Wickramaratne & Weissman, 1998). The risk is greater if both parents have had a depressive illness, if the parents were depressed when they were young, or if a parent had several episodes of depression (Merikangas et al., 1988; Downey & Coyne, 1990; McCracken, 1992a, 1992b; Mufson et al., 1992; Warner et al., 1995; Wickramaratne & Weissman, 1998).

Effects of Parental depression
Depressed parents may be withdrawn and lack energy and consequently pay little attention to, or provide inadequate supervision of, their children.

Alternatively, such parents may be excessively irritable and overcritical, thereby upsetting children, demoralizing them and distancing them (Cohn et al., 1986; Field et al., 1990).

At a more subtle level, parents’ distress,  being pessimistic, tearful, or threatening suicide, is sometimes seen or heard by the child, thereby inducing anxiety. Depressed parents may not model effective coping strategies for stress; instead of “moving on,” some provide an example of“giving up” (Garber & Hilsman, 1992).

Depression is also often associated with marital discord, which may have its own adverse effect on children and adolescents. Conversely, the behavior of the depressed child or teenager may contribute to family stress as much as being a product of it.

The poor academic performance, withdrawal from normal peer activities and lack of energy or motivation of a depressed teenager may lead to intrusive or reprimanding reactions from parents that may further reduce the youngster’s self-esteem and optimism.

The consequences of maternal depression vary with the state of development of the child and some of the effects are quite subtle (Cicchetti & Toth, 1998).

i.e., in infancy, a withdrawn or unresponsive depressed mother may increase an infant’s distress and an intrusive or hostile depressed mother may lead the infant to avoid looking at and communicating with her (Cohn et al., 1986). Other studies have shown that if infants’ smiles are met with a somber or gloomy face, they respond by showing a similarly somber expression and then by averting their eyes (Murray et al., 1993).

During the toddler stage of development, research shows that the playful interactions of a toddler with a depressed mother are often briefer and more likely to be interrupted (by either the mother or the child) than those with a nondepressed parent (Jameson et al., 1997).

Research has shown that some depressed mothers are less able to provide structure or to modify the behavior of excited toddlers, increasing the risk of out-of-control behavior, the development of a later conduct disorder, or later aggressive dealings with peers (Zahn-Waxler et al., 1990; Hay et al., 1992).

A depressed mother's inability to control a young child’s behavior may result in the child failing to learn appropriate skills for settling disputes without reliance on aggression.

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Stressful Life Events

The relationship between stressful life events and risk for child mental disorders is well established (e.g., Garmezy, 1983; Hammen, 1988; Jensen et al., 1991; Garber & Hilsman, 1992), although this relationship in children and adolescents is complicated, perhaps reflecting the impact of individual differences and developmental changes.

i.e., there's a relationship between stressful life events, such as parental death or divorce and the onset of major depression in young children, especially if they occur in early childhood and lead to a permanent and negative change in the child’s circumstances.

Yet findings are mixed as to whether the same relationship is true for depression in mid-childhood or in adolescence (Birmaher et al., 1996a & 1996b; Garrison et al., 1997).

Childhood Maltreatment

Child abuse is a very widespread problem; it's estimated that over 3 million children are maltreated every year in the US (National Committee to Prevent Child Abuse, 1995).

Physical abuse is associated with insecure attachment (Main & Solomon, 1990), psychiatric disorders such as post-traumatic stress disorder, conduct disorder, ADHD (Famularo et al., 1992), depression (Kaufman, 1991) and impaired social functioning with peers (Salzinger et al., 1993).

Psychological maltreatment is believed to occur more frequently than physical maltreatment (Cicchetti & Carlson, 1989); it is associated with depression, conduct disorder and delinquency (Kazdin et al., 1985) and can impair social and cognitive functioning in children (Smetana & Kelly, 1989).

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Peer and Sibling Influences

The influence of maladaptive peers can be very damaging to a child and greatly increases the likelihood of adverse outcomes such as delinquency, particularly if the child comes from a family beset by many stressors (Friday & Hage, 1976; Loeber & Farrington, 1998).

One way to reduce antisocial behavior in adolescents is to encourage such youths to interact with better adapted youths under the supervision of a mental health worker (Feldman et al., 1983). Sibling rivalry is a common component of family life and especially in the presence of other risk factors, may contribute to family stresses (Patterson & Dishion, 1988).

Although almost universal, in the presence of other risk factors it may be the origin of aggressive behavior that eventually extends beyond the family (Patterson & Dishion, 1988). In stressed or large families, parents have many demands placed on their time and find it difficult to oversee, or place limits on, their young children’s behavior.

When parental attention is in short supply, young siblings squabbling with each other attract available attention. In such situations, parents rarely comment on good or neutral behavior but do pay attention, even if in a highly critical and negative way, when their children start to fight; as a result, the act of fighting may be inadvertently rewarded.

Thus, any attention, whether it be praise or physical punishment, increases the likelihood that the behavior is repeated.

Correlations and Interactions Among Risk Factors

Recent evidence suggests that social/environmental risk factors may combine with physical risk factors of the child, such as:

  • neurological damage caused by birth complications or low birthweight

  • fearlessness 

  • stimulation-seeking behavior

  • learning impairments

  • autonomic underarousal

  • insensitivity to physical pain 

  • punishment (Raine et al., 1996, 1997, 1998)

However, testing models of the impact of risk factor interactions for the development of mental disorders is difficult, because some of the risk factors are difficult to measure.

Thus, the trend these days is to move away from the consideration of individual risk factors toward identifying measurable risk factors and their combinations and incorporating all of them into a single model that can be tested (Patterson, 1996).

The next section describes a series of preventive interventions directed against the environmental risk factors described above.

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Childhood is an important time to prevent mental disorders and to promote healthy development, because many adult mental disorders have related antecedent problems in childhood.

Thus, it's logical to try to intervene early in children’s lives before problems are established and become more refractory. The field of prevention has now developed to the point that reduction of risk, prevention of onset and early intervention are realistic possibilities.

Scientific methodologies in prevention are increasingly sophisticated and the results from high-quality research trials are as credible as those in other areas of biomedical and psychosocial science.

There's a growing recognition that prevention does work; i.e., improving parenting skills through training can substantially reduce antisocial behavior in children (Patterson et al., 1993).

The wider human services and law enforcement communities, not just the mental health community, have made prevention a priority. Policymakers and service providers in health, education, social services and juvenile justice have become invested in intervening early in children’s lives:

they've come to appreciate that mental health is inexorably linked with general health, child care and success in the classroom and inversely related to involvement in the juvenile justice system.

It's also perceived that investment in prevention may be cost-effective. Although much research still needs to be done, communities and managed health care organizations eager to develop, maintain and measure empirically supported preventive interventions are encouraged to use a risk and evidence-based framework developed by the National Mental Health Association (Mrazek, 1998).

Some forms of primary prevention are so familiar that they are no longer thought of as mental health prevention activities, when, in fact, they are. For example, vaccination against measles prevents its neurobehavioral complications; safe sex practices and maternal screening prevent newborn infections such as syphilis and HIV, which also have neurobehavioral manifestations.

Efforts to control alcohol use during pregnancy help prevent fetal alcohol syndrome (Stratton et al., 1996). All these conditions may produce mental disorders in children.

This section describes several exemplary interventions that focus on enhancing mental health and primary prevention of behavior problems and mental health disorders.

Prevention of a disorder or its recurrence or exacerbation is discussed together with that disorder in other sections of this chapter. Prevention strategies usually target high-risk infants, young children, adolescents and/or their caregivers, addressing the risk factors described above.

Project Head Start

Project Head Start, though generally conceived of as an early childhood intervention program, is probably this country’s best known prevention program.

In 1965, when it was designed and first implemented in 2,500 communities, Head Start’s target population was economically disadvantaged preschool children.

Its goal was to improve the social competence of these children through an 8-week comprehensive intervention that included a center-based component and a home visit by community aides, focusing on social, health and education services (Karoly et al., 1998).

A number of psychologists, most notably Jerome Bruner (1971), argued that children can be trained to think in a more logical way and that the development of logic isn't entirely predetermined.

Bruner’s views were very influential in launching early intervention programs such as Head Start. There is now ample evidence that, by providing an appropriately stimulating environment, significant advances in knowledge and reasoning ability can be achieved.

The program has served over 15 million children and has cost $31 billion since its inception (General Accounting Office, 1997). It has changed in many ways in the intervening years and there now is considerable program variation across localities (Zigler & Styfco, 1993).

Early evaluations of Head Start showed promising results in terms of higher IQ scores, but over the years many of the findings have met with criticism and skepticism. The reason is that there has been no national randomized controlled trial to evaluate the program as originally designed (Karoly et al., 1998).

Repeated evaluations of Head Start programs that did not employ such a rigorous design (Berrento-Clement et al., 1984; Seitz et al., 1985; Lee et al., 1990; Yoshikawa, 1995) have shown that, although focused early education can improve test scores, the advantage is short-lived.

The test scores of children of comparable ability who don't receive early childhood education quickly catch up with those who have been in Head Start programs (Lee et al., 1990). Yet there appear to be more enduring academic outcomes.

A review of 36 studies of Head Start and other early childhood programs found them to lower enrollment in special education and to enhance rates of high school graduation and promotion to the next grade level (Barnett, 1995).

Head Start and other forms of early education offer arguably even more important benefits, which don't become apparent until children are older.

The advantages are mainly social, rather than cognitive, and include better peer relations, less truancy and less antisocial behavior (Berrento-Clement et al., 1984; Provence, 1985; Seitz et al., 1985; Webster-Stratton, 1998; Weikart, 1998).

Although important from a societal perspective, it isn't known whether these very significant benefits are due to direct effects on the child or to the parent education programs that often accompany Head Start programs (Zigler & Styfco, 1993).

Carolina Abecedarian Project

The Carolina Abecedarian Project is an example of an early educational intervention for high-risk children that has been tested more rigorously than Head Start in well-designed, randomized and controlled trials.

It addresses the issue of the timing of the intervention, that is, when an intervention should begin and how long it should continue. Unlike Head Start, children were enrolled in this program at birth and remained in it for several years.

In the Carolina Abecedarian Project, children who had been identified at birth as being at high risk for school failure on the basis of social and economic variables were enrolled in a child-centered prevention-oriented intervention program delivered in a day care setting from infancy to age 5 (Campbell & Ramey, 1994 1).

The preschool intervention operated 8 hours a day for 50 weeks a year and included an infant curriculum to enhance development and parent activities.

At elementary school age, a 2nd intervention was provided: the children, who were then in kindergarten, received 15 home visits a year for 3 years from a teacher who prepared a home program to supplement the school’s basic curriculum. There were significant positive effects from the 2-phase intervention on intellectual development and academic achievement and these effects were maintained through age 12, which was 4 years after the intervention ended.

Infant Health and Development Program
The Infant Health and Development Program
(IHDP) also began at birth and continued for several years and was also designed for low-birth-weight and premature infants (
McCarton et al., 1997

The intervention was provided until the children reached 3 years of age. It included pediatric care, home visits, parent group meetings and center-based schooling 5 days a week from 12 months of age to 3 years.

At the end of the intervention, the group receiving it had significantly higher mean IQ scores than did the control group. Of note, although children’s behavior problems weren't targeted by the intervention, mothers of children in the intervention group reported significantly fewer behavior problems than those in the control group.

Elmira Prenatal / Early Infancy Project

The Elmira Prenatal/Early Infancy Project is an excellent example of a preventive intervention that targeted an at-risk population to prevent the onset of a series of health, social and mental health problems in children and in their mothers (Olds et al., 1998 & previous years3 ).

This study warrants special attention because of its positive and enduring findings, randomized, controlled design, cost-benefit analysis and unusually long-term follow up of 15 years. The study began by focusing on pregnant women bearing their first child in a small, semi-rural county in upstate New York.

The children of these women were considered high risk because of their mother’s young maternal age, single-parent status, or low socioeconomic level. There were 4 study groups to which random assignment was made.

The 1st group received developmental screening at ages 1 and 2.

The 2nd group received screening and free transportation to health care.

The 3rd group received screening, transportation and nurse home visits once every 2 weeks during pregnancy.

The 4th group received all of the above plus continued home visits by a nurse on a diminishing schedule until the infants were 24 months of age.

The intervention focused on parent education, enhancement of the women’s informal support systems and linkage with community services.

Women in both groups receiving home visits from nurses had many positive behavioral outcomes compared with groups that received screening only or screening plus transportation.

Among the women at highest risk for caregiver dysfunction, those who were visited by a nurse had fewer instances of verified child abuse and neglect during the first 2 years of their children’s lives.

They were observed in their homes to restrict and punish their children less frequently and they provided more appropriate play materials. There were no differences between groups in the rates of new cases of child abuse and neglect or in the children’s intellectual functioning in the period when the children were 25 to 48 months of age.

However, nurse-visited children had fewer behavioral and parental coping problems (as noted in the physician record). Nurse-visited mothers were observed to be more involved with their children than were mothers in the comparison groups.

A cost-benefit analysis estimated program costs (direct costs of nurse visitation, costs of services to which nurses linked families & costs of transportation) and benefits (cost outcomes presumed to be affected by the program thru improved maternal & child functioning, such as less use of Aid to Families With Dependent Children, Medicaid, food stamps, child protective services & greater tax revenues generated by women’s working).

Taking a time point of 2 years after the program ended, the net cost of the program for the sample as a whole was $1,582 per family, but for low-income families, the cost of the program was recovered with a dividend of $180 per family.

Fifteen years after the birth of the index child (13 years after termination of the intervention), women who were visited by nurses during pregnancy and infancy had significantly fewer subsequent pregnancies, less use of welfare, fewer verified reports of abuse and neglect, fewer behavioral impairments due to use of alcohol and other drugs and fewer arrests.

Their children, now adolescents, reported fewer instances of running away, fewer arrests, fewer convictions and violations of probation, fewer lifetime sex partners, fewer cigarettes smoked per day and fewer days having consumed alcohol in the last 6 months. The parents of these adolescents reported that their children had fewer behavioral problems related to use of alcohol & other drugs.

Primary Mental Health Project

The Primary Mental Health Project (PMHP) is a 42-year-old program for early detection and prevention of young children’s school adjustment problems.

PMHP currently operates in approximately 2,000 schools in 700 school districts nationally and internationally. 7 states in the United States are implementing the program systematically, based on authorizing legislation and state appropriations..

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PMHP has 4 key elements:

(1) a focus on primary grade children

(2) systematic use of brief objective screening measures for early identification of children in need

(3) use of carefully selected, trained, closely supervised nonprofessionals (called child associates) to establish a caring and trusting relationship with children

(4) a changing role for the school professionals that features selection, training and supervision of child associates, early systematic screening and functioning as program coordinator, liaison and consultant to parents, teachers and other school personnel.

The PMHP model has been applied flexibly to diverse ethnic and sociodemographic groups in settings where help is most needed. Over 30 program evaluation studies, including several at the state level, underscore the program’s efficacy (Cowen et al., 1996).

Significant improvements were detected in children’s grades, achievement test scores and adjustment ratings by teachers and child associates. PMHP represents a successful mental health intervention that doesn't require highly trained and skilled mental health professionals.

Other Prevention Programs and Strategies

These and other prevention trials demonstrate that positive adaptation and social-emotional well-being in children and youth can be enhanced and that risk factors for behavioral and emotional disorders can be reduced, by intervening in home, school, day care and other settings. Programs have focused not only on mental health but also on other problem behaviors. (Botvin et al., 1995; St. Lawrence et al., 1995;Kellam & Anthony, 1998).

Other prevention trials are showing similar benefits. i.e., a large-scale, four-site school and home-based prevention trial, known as FastTrack, has shown clear benefits in reducing behavior problems among high-risk children, as well as in reducing needs for and use of special education, which has substantial cost-effectiveness implications (Conduct Problems Prevention Research Group, 1999a, 1999b).

Another trial is now under way to test the efficacy of a preventive intervention provided to adolescents whose parents are currently being treated for depression within a health maintenance organization (Clark et al., 1998).

Treatment of mood disorders also has potential effectiveness for the primary prevention of suicide, as explained in the later section on Depression and Suicide in Children and Adolescents

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starting out at the beginning....

note: concerning the surgeon general's report on your left, it's very informative for those who aren't familar with mental health perceptions & past history, as well as the changing face of mental health & illness in our world today.
unfortunately, it's an old piece. perhaps with the new appointment in health & human services we'll see a new & updated report in the near future. being familiar with the information is important though, as a basis or foundation, for future knowledge concerning the same. it's really helpful.
below you will find some additionall & very pertinent information as to why the overall picture concerning raising children will become increasingly important to you as a parent in recognizing personal issues that you may be or have been facing throughout your adult life & simply weren't aware of their basis.
thanks for visiting!

starting out at the beginning....


Anxiety Disorders & Depression in Children
what is attention deficit hyperactivity disorder?

Attention Deficit Hyperactivity Disorder (ADHD)Attention Deficit Hyperactivity Disorder, ADHD, is one of the most common mental disorders that develop in children. Children w/ADHD have impaired functioning in multiple settings, including home, school & in relationships w/peers. If untreated, the disorder can have long-term adverse effects into adolescence & adulthood.

starting out at the beginning....

Attention Deficit Disorder (ADD) & Learning "Disabilities" - By DeAnne Joy

Experts estimate that between 4-10% of our youth are now diagnosed as having Attention Deficit Disorder.

It can be frustrating and discouraging to deal with symptoms of ADD.

Here’s the great news: there's nothing "wrong" with your child or with you as the parent; there's nothing that needs to be “fixed.”

You and your child have ALL of the resources within you to experience success in school, at home and in the world. If your child is not succeeding in school or at home, it simply means that she doesn't have effective tools for doing so.

Once we teach her world-class skills for succeeding at home and in school, she'll no doubt be successful.

A diagnosis can be helpful in giving us a framework for understanding what the reason is behind the challenging behaviors or the poor school performance. You can understand the behavior better when you understand where it's coming from.

When you understand that it’s not a matter of whether or not your child is trying hard enough, rather that it's simply a matter of her not having the tools to be successful in learning, then you can respond differently to it.

ADD, Dyslexia and other learning “differences” are a way of describing how a person’s brain is wired or the way in which they process information. It doesn’t mean that they don't process or learn information; it simply means that they do it better using certain strategies or processes than with others, as we all do.

In order to help you understand your child's experience of the world, you need to understand exactly what goes on in the mind of a young person with ADD.

Here’s a way in which you can begin to understand the experience of a child with ADD.

I want you to imagine that you’re driving in a rainstorm without the windshield wipers on. Pretty frustrating, isn't it? Imagine the effort it would require to keep your mind focused on the road ahead just in order to keep yourself and others feeling safe and protected.

Yet, that's precisely what goes on in the mind of a young person with ADD. The screen simply becomes blurred without the ability to use the wipers to get rid of unnecessary cloudiness.

She's trying as hard as she can to process all of the information coming into her experience. Of course, what often happens is that the conscious mind becomes overwhelmed and she may simply shut down, stop paying attention and give up or it might be played out physically in the body which might be seen as anxious, aggressive or hyperactive behavior.

The first step in helping your child to learn effectively is to help her determine what her particular strategy is for learning and then to teach her very precise, effective strategies for learning information most effectively.

A visual learning strategy is the most effective strategy for learning academic tasks like spelling words, math facts and vocabulary words; learning visually makes learning fun, interesting and much less time-consuming.

In order to teach a young person a visual learning strategy, she must first believe that she CAN learn by making pictures in her mind. Often, young people who are diagnosed as having ADD or some other "learning difference" feel that they can't control their own mind, but rather that their mind controls them.

In order to begin to teach effective learning strategies, we need to begin with helping the child to see that indeed she CAN control her own mind and the pictures that she makes in her mind.

The first step is to assist the child in slowing down the pictures in her own mind and slowing her body down so that she can learn and implement simple, effective learning strategies and begin to experience more success at school as well as at home.

In addition, we want to provide her with the kind of environment that will best support her and her particular needs; for most kids and especially for kids with ADD, the environment that's most supportive of their needs is one that's unconditional, structured and consistent while providing them enough freedom to learn to negotiate the world on their own.

starting out at the beginning....

My Take on the Mental Health Issues Facing Children Today
by Kathleen Howe
I'm not only a mom, I'm the mom of kids who have experienced mental health issues. I've been on a lifelong path of dysfunction, mental illness, abuse and other very negative factors. It wasn't until about six years ago that I discovered how mental illness entered into my life and that it entered into my life in my childhood.
You see, you can get all the information that is in the left hand column from research professionals, medical professionals and mental health professionals, but unless they've been parents experiencing a mental illness themselves or with their children - I have an advantage of knowledge AND experience on my side.
First of all there's millions of people that aren't AWARE of the presence of mental illness in our world today. They have no idea. There are even very educated medical professionals who don't have a Blue's Clues Clue concerning mental illnesses. When I began this journey almost six years ago there was a very high percentage - over 50% of professional, educated people including medical doctors who believed that mental illness was a state of mind. Get over that myth. Mental illness is very real and if you don't believe me - then read the professionally written gobble-dee-gook in the left hand column. Check the sources as well!

In my own personal growth recovery journey I decided that I had to go back into my own history to see exactly what happened to me that determined I would live forty plus years living in abusive relationships. I used to blame my own inadequacy believing I was stupid for putting up to it. Much of it I just couldn't explain. But after researching long and very hard I learned some important information. Let me give you a time line and what I learned about mental health and mental development.

I began from before birth!
What was happening during the years my mother and father were raised? What was happening in the world? What were the social standards and expectations?
Yes, these factors affected my individual growth as a child. Amazing isn't it? What my grandmother believed had a direct effect on how I was raised as a child. My grandmother raised my mother and my mother believed what she was taught for the most part, so she continued on raising me believing the same things she was taught. See how it goes?
My mother was the oldest daughter in a family with a mother and father who were married and living together with a stay at home mom; as well as the three sisters she had. A family of four girls - what does this mean? Well, dig into your past and your parents' past as far as you can. Ask questions. I had heard through eavesdropping that my mother had actually been a twin. What would that have changed if my mother had been a twin? And that twin died sometime, what happened? Most important factor - that twin was supposedly a boy. The only boy in the family to carry on the family name - dies. That's important to realize.
So, if that rumor was true - how did it affect my mother? How would you feel if your twin had died at birth? How would you feel if no one ever talked about it like it was wrong or something horrible to be ashamed of? Wouldn't you think that this factor would affect my mother's thinking processes and belief systems?
This is how it all works. So my father is the oldest of three siblings, but his father had a family prior to my father's family. There had been a previous marriage and his wife had died from a medical problem. That wife had given birth to two boys. Why weren't they all closer with each other? We had a very close family, but I don't think I ever met the step brothers. Good reason for one of them, come to find out - one died from a physical ailment.
My father was raised in a family that prohibited alcohol in the house, and yet he was a drinker - often too much. I knew both sets of my grandparents because they lived in the same town. They were very different. My parents were high school sweethearts. But what happened that would cause my parents to be the narcissists they were? These are the things that you want to look into in your investigation.

Checking for important factors will allow you to develop your natural curiosity. Most of us have forgotten how to use it! I discovered that my father wasn't at my birth, but my grandfather instead of my grandmother was with my mother through her labor. The reason was that my father had enlisted into the Army. He was gone for some very long lengths of time during my first few years of life. I never realized this, but having an absent parent early in your childhood when you are developing who you really are - can make a difference! Read about absent parents and you'll find out!
Many parents don't realize until it's too late that having two parents can have a bearing on mental health.

Absent Parents and Left Behind Kids
By Judy H. Wright 

“Why did my daddy leave? Was it because I was a bad girl or he didn’t love us anymore?”

Explaining the absent parent is never easy, but it is necessary. For children, their primary fear is of abandonment and loss of parental love. There may be a number of reasons that the family is no longer intact, if it ever was, but the child is looking for reassurance that it is not their fault and that they will be cared for.

Children’s lives revolve around their family: The family unit is all they have ever known and to hear that a parent or caregiver is no longer going to be there is very traumatic and almost unbelievable. They will jump to a number of conclusions, most of them wrong and blaming themselves, in an effort to find answers and just cope. In an effort to make sense of the situation, they may become clingy to the caregiver and think “If he left, maybe you will too.”

Feelings of Abandonment and isolation:

No matter what other reactions children may demonstrate to the adults in their lives, almost all have a deep and pervasive sorrow and sadness about them. One of the best things you can do for your children is to allow them to express their grief. Prolonged crying and preoccupation with the lost relationship are normal responses.

Parents and family frequently try to hide their own despair and disappointment from the children, but by talking with them about feelings and emotions, you can give them permission to open up and share.

Single parenting:

1 out of every 4 American children lives in a single-parent home. While most single-parent homes are the result of divorce, many parents and grandparents are raising children alone for other reasons as well. Some may be alone due to the death of a spouse, military assignments, single parent adoption, incarceration, drug or alcohol abuse and a myriad of other reasons for a parent to be absent in the life of a child.

Put the children’s needs first:

As an adult it is your responsibility to care for the children, both physically and emotionally. Recognize that a long period of grief and mourning are natural.

A preschooler may regress in such things as toilet training or begin to have nightmares or new fears. School age children may be showing signs of anger, guilt and sadness.

You may see a drop in school grades and activities. Teenagers may assume they will be forced into an adult role or not have money enough for his needs. No matter what the age, some children feel responsible for the absent parent and harbor dreams about making it all right again.

If you can not work out problems by open communication and cooperation, do not hesitate to get professional help. Their self-esteem and future happiness may depend on it.

Family: Absent Parents And Left Behind Kids
©2006 Judy H. Wright, Parent Educator

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Perhaps the most important word in the article above is - "recognize." Reason being: it's up to parents to know their children well enough that they can "recognize" that there is something bothering their child. Do you believe that your parents knew enough about you that they would "recognize" when something was bothering you enough to affect your behavior? Would they deal with the problem by talking to you about it? Did you parent ever try to get you to talk about whatever it was that was bothering you?
If you're a baby boomer reading this - it's most likely that your parents didn't recognize that anything was bothering you. It was too difficult for mothers to perform their expected duties and recognize if something was bothering their child. Besides, my parents' generation believed whole heartedly that children were to be seen - not heard. They believed that it didn't matter how we felt. We were the minority or the subservients.
After researching the social norms in my parents' upbringing I found it amazing what women were expected to do.

women's role in the 50's?
pearls & oven mitts?
...it must be a 50's housewife!


Ain't Nobody's Business If You Do

"Your family, my family - which is composed of an immediate family of a wife & 3 children, a larger family w/ grandparents & aunts & uncles."
Vice President Dan Quayle
THOSE OF US WHO grew up in the 1950's got an image of the American family that wasn't, shall we say,
We were told, Father Knows Best, Leave It to Beaver & Ozzie & Harriet weren't just the way things were supposed to be, but the way things were.

Things were not that way.

It's probably good that life wasn't like the television shows in the '50s - we wouldn't have many women now. Take a look at the ratio of boys to girls on the most popular family shows.

  • Ozzie & Harriet had 2 boys, 0 girls.

  • Leave It to Beaver had 2 boys, 0 girls.

  • Rifleman had 1 boy, 1 rifle, 0 girls.

  • Lassie had 1 boy, one dog (supposedly a girl, but played by a boy) & 0 girls.

  • My Three Sons had - well, that one's obvious.

  • Bonanza had 3 grown-up boys.

  • Although Lucille Ball & Desi Arnaz in real life had 1 boy & 1 girl, on I Love Lucy they had 1 boy.

  • The only shows w/daughters were The Donna Reed Show (1 boy, 1 girl) & that lighthouse to womanhood despite its title....

  • Father Knows Best (1 boy, 2 girls).

Grown to maturity, that's a late -1960's dating population of 15 men to 3 women.

"Whatever trouble he's in, his family has the right to share it w/him. It's our duty to help him if we can & it's his duty to let us & he doesn't have the privilege to change that."

Jarrod Barkley
The Big Valley

  • Almost all the households were mama-papa-kiddies: the nuclear family.

(The exceptions were My Three Sons & Bonanza: Steve Douglas [Fred MacMurray] & Ben Cartwright were widowers.)

  • There were no prior marriages
  • No children from prior relationships
  • No threat or even thought of divorce
  • The closest thing we saw to physical abuse was Ralph Kramden's, "One of these days, Alice, one of these days . . to the moon!"
  • There were no infidelities
  • No drinking problems
  • No drugs

(not even prescription tranquilizers)

  • no racism

(How could there be? With the exception of Hop Sing & Ricky Ricardo, there was only 1 race; even the Hispanic gardener on Father Knows Best was named Frank Smith)

  • There was no dropping out of school
  • No political discussion

(much less political differences)

  • No unemployment

(except for Ozzie's early retirement)

  • No severe economic problem

(except for a crop failure on Lassie, when they had to sell all the livestock, including Lassie; but just before being carted off, Lassie pawed the ground & struck oil & everything was okay again. Except for Lassie, who looked as though the Exxon Valdez had dumped its forward holding tanks on her)

  • The father was the breadwinner
  • The mother was the bread maker

(the only mother who came close to working was Lucy, becoming the spokeswoman for Vitavita-Vegimen or that afternoon at the candy factory)

  • There was no fear of the bomb

(which is what we kids were terrified about in the '50's)

  • No severe disobedience

(although white lies, mischief & misunderstandings were needed for laughs)

  • Life was wholesome, wholesome, wholesome.[*FN]

As much as the religious right likes to point to 1950's sitcom wholesomeness as the Ideal American Family, these shows, in fact, had a remarkable lack of religion.

What religion were these people? They certainly weren't Jewish. And, other than possibly Ricky Ricardo, none of them was Catholic.

They were probably safely mainline Presbyterians.

But that was the name of the game: play it safe. In playing it safe, there was less mention of God & religion on these shows than actually took place in American families in the '50's.

That life doesn't exist anymore. But then, it never did.

When I was a boy, my family took great care w/our snapshots. We really planned them. We posed in front of expensive cars, homes that weren't ours. We borrowed dogs. Almost every family picture taken of us when I was young had a different borrowed dog in it.

The Good Wife's Guide
Housekeeping Monthly - May 13, 1955

  • Have dinner ready. Plan ahead, even the night before, to have a delicious meal ready, on time for his return. This is a way of letting him know that you've been thinking about him & are concerned about his needs. Most men are hungry when they come home & the prospect of a good meal (especially his favorite dish) is a part of the warm welcome needed.

  • Prepare yourself. Take 15 minutes to rest so you'll be refreshed when he arrives. Touch up your make-up, put a ribbon in your hair & be fresh-looking. He has just been with a lot of work-weary people.

  • Be a little gay & a little more interesting for him. His boring day may need a lift & one of your duties is to provide it.

  • Clear away the clutter. Make a last trip thru the main part of the house just before your husband arrives.

  • Gather up schoolbooks, toys, paper, etc. & then run a dust cloth over the tables.
  • Over the cooler months of the year you should prepare & light a fire for him to unwind by. Your husband will feel he has reached a haven of rest & order & it'll give you a lift too. After all, catering for his comfort will provide you with immense personal satisfaction.
  • Prepare the children. Take a few minutes to wash the children's hands & faces (If they're small), comb their hair & if necessary, change their clothes. They're little treasures & he would like to see them playing the part. Minimize all noise. At the time of his arrival, elminate all noise of the washer, dryer or vacumn. Try to encourage the children to be quiet.
  • Be happy to see him.
  • Greet him with a warm smile & show sincerity in your desire to please him.
  • Listen to him. You may have a dozen important things to tell him, but the moment of his arrival isn't the time. Let him talk first - remember, his topics of conversation are more important than yours.
  • Make the evening his. Never complain if he comes home late or goes out to dinner or other places of entertainment without you, instead try to understand his world of strain & pressure & his very real need to be at home & relax.

  • Don't greet him with complaints & problems.

  • Don't complain if he's late home for dinner or even if he stays out all night. Count this as minor compared to what he might have gone thru that day.

  • Make him comfortable. Have him lean back in a comfortable chair or have him lie down in the bedroom. Have a cool or warm drink ready for him.

  • Arrange his pillows & offer to take off his shoes. Speak in a low, soothing & pleasant voice.

  • Don't ask him questions about his actions or question his judgment of integrity. Remember, he's the master of the house & as such will always exercise his will with fairness & truthfulness. You have no right to question him.

  • A good wife always knows her place.

Do you understand now why your mother is neurotic? That's a tongue in cheek joke, but it's most likely true.
Did you have a family history of anxiety disorders or depression? Were you depressed early on - perhaps with postpartum depression or depression in the early years of toddler time? Children that grow up with a parent how is depressed have a much higher risk of becoming depressed themselves!


Lloyd J. Thomas, Ph.D. has 30+ years experience as a Life Coach and Licensed Psychologist.  He is available for coaching in any area presented in “Practical Life Coaching” (formerly “Practical Psychology”).  Initial coaching sessions are free.  Contact him:  DrLloyd@CreatingLeaders.com or LJTDAT@aol.com.
By Lloyd J. Thomas, Ph.D.

Over the past few months, millions of Americans have lost their jobs; the economy has spiraled downward; and the amount of anxiety in our lives has spiraled upward.  Health care professionals know that approximately 85 % of the reasons we seek medical treatment are “stress-related.”  I suspect that the incidence of stress-related illness is also dramatically increasing. 

I have spent the last 35 years of my professional career helping people to maximize the wellness of their lives.  During that time, I have identified several principles which, if understood and followed, lead to health, wealth and happiness beyond our usual imaginings, even when we are going through extremely stressful times.  Here are seven of those principles.

1.  If you don’t learn the lesson now, it will return over and over again.  So many of us are into quick and easy solutions to life’s perceived problems.  We take a “Band-Aid” approach.  When something bad happens, rather than feeling helpless and victimized, take extreme steps to discover and resolve the source of the difficulty. 

Become aware that by the time you realize the event as a “lesson,” you have probably experienced it at least 3-4 times before.  Learn from repeated (and undesired) experiences and replace them with new (and desired) ones based upon resolution of the source of the undesired experience.

Example: if you are currently unemployed, spend 8 hours a typical workday seeking employment:

  • networking
  • sending out resumes
  • seeking retraining
  • advertising yourself as available (and skilled)
  • checking websites and newspapers for “want ads” etc.

2.  We attract who and what we are ready for.  We don’t like to believe this one, but it’s true.  The sooner we take full responsibility for the quality of who we are, the quicker we will attract what the universe needs to give us. 

Someone once said,

“God’s delay is not God’s denial.” 

The solution is to grow, and to grow out of what you are attracting now, and into what you want to have.  A willingness and desire to change, sometimes drastically, is often the signal for the Universe to provide you everything you desire. 

Success at anything begins with change in yourself.  Ask yourself,

“What character traits do I need to develop or strengthen so I will contribute to the change in my life I really want?” 

When you express that character trait(s) in your daily life, you more likely attract the outcomes you desire.

3.  We are all interrelated and connected, yet distinct as individuals.  Energy, like the air, is always flowing between people, objects and the universe.  Energy is exchanged between the smallest of molecules as well as the largest of stars. 

Energy is either beneficial for you or it’s not.  You need to protect yourself from people or situations which deliver energy that is harmful to you. While we are all influenced by the energy of others, we can still do what we feel is best for us. 

We needn’t live through others.  Money is another form of energy.  Never commit yourself to spending it when you don’t already have it.

4.  Having it all is merely the beginning.  Most people spend their lives striving to “get it all.”  Don’t spend your lifetime getting it all.  Live your life as though you already have it all. 

At some point, your wants will diminish and if you’re still alive, you begin to realize you have it all.  When you have all you truly require, life becomes easy and choices become clear.  When you start from the position of having it all, your present and future becomes abundant and joyful.

5.  A personal foundation, based on positive values, makes all of life available and a whole lot easier.  You cannot effectively express yourself unless you have strengthened yourself.  Distinguish between being strong and having personal power. 

Many people have power, but are personally weak.  Life becomes a whole lot easier as you become fully responsible for its quality and nature.  When you value the highest and best in life, you become strong and effective at living.

6.  Healthy personal priorities are:

  • integrity first
  • needs second
  • wants third

Being true to yourself is critical.  Having integrity really means that what you think, say and do, are consistent and congruent with your highest values. 

It is your responsibility to see to it that your needs are met.  Meeting your needs is no one else’s job.  Only when your true needs are satisfied, can you trust your wants to be the best for you.  Only through helping others get what they want can you receive the best of what you want. 

Cheating others always ends up with cheating yourself.  Bernie Madoff and others know this principle all too well.

7.  The truth shall set you free, but it may make you miserable at first.  Our lives simply haven’t been set up to have the Truth come first. 

Most of our human problems arise when we are either unaware of the truth or deny it.  Telling the truth is a skill that is learned through practice.  If we model ourselves after liars, we come to believe lying is what is needed to make it in life. 

Most of us find changing our untruthful habits difficult and fear-producing.  However, when we always express the truth, we simplify our lives, reduce our anxiety and allow room for love to flourish.

Apply these principles to your own way of living, and you may just create the lifestyle you desire …even it stressful times.

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til' next time! kathleen
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.