Archive for April, 2010
Last week I received a consultative phone call from an upset mother. The daycare that her 5 year old son attends gave her an ultimatum, either obtain counseling for your son, put him on medication or he will no longer be welcome at the center. WOW, quite a statement for a daycare center to make! So you can see why she was so upset. When obtaining more detail from her. She stated that her son had begun to have more frequent “meltdowns” during the day. She described her son as being a “high energy” child that often acts impulsively and seems to always find trouble. She went on to explain that the center had some staffing changes along with program changes. She also stated that her son became a big brother 7 months prior. She continued to state that his little brother was born 10 weeks early and was in the NICU for almost 8 weeks. She was in the hospital for almost 2 full weeks before delivery due to preeclampsia. This had been a traumatic time for their family. The mother was so worried and felt helpless. Was it the major life change with having a new baby in the house? Could it be the program and staff changes that are creating this behavior? Most importantly what can be done to help her son? I went onto explain that counseling can help her son and also to talk with her pediatrician to determine whether or not to medicate her son.
In obtaining more information, I was suspecting that her son could be diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). What information was I using to suspect this disorder? Let me break down some of the basic information for you.
ADHD is the current term for a specific developmental disorder seen in both children and adults that is comprised of deficits in behavioral inhibition, sustained attention and resistance to distractions, and the regulation of one’s activity level to the demands of a situation (hyperactivity or restlessness).
There are three subtypes to this disorder. I will list the criteria listed from the Diagnostic and Statistical Manual (DSM-IV), The Bible for those working in the mental health field, for each subtype. They are:
Inattentive Type – six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level.
- often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
- often has difficulty sustaining attention in tasks or play activities.
- often does not seem to listen when spoken to directly.
- often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the work-place (not due to oppositional behavior or failure to understand instructions).
- often has difficulty organizing tasks and activities.
- often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
- often loses things necessary for tasks or activities (e.g.,toys, school assignments, pencils, books, or tools).
- is often easily distracted by extraneous stimuli.
- is often forgetful in daily activities.
Hyperactive type – six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
- often fidgets with hands or feet or squirms in seat.
- often leaves seat in classroom or in other situation in which remaining seated is expected.
- often runs about or climbs excessively in situation in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness).
- often has difficulty playing or engaging in leisure activities quietly.
- is often “on the go” or often acts as if “driven by a motor”.
- often talks excessively
- often blurts out answers before questions have been completed.
- often has difficulty awaiting turn.
- often interrupts or intrudes on others (e.g., butts into conversations or games).
Combined Type- Criteria from both categories have been met for the past 6 months.
Some of the additional criteria for ADHD include the following:
- Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
- Some impairment from the symptoms is present in two or more settings (e.g., at school, work, or at home).
- There must be clear evidence of clinically significant impairment in social, academic or occupational functioning.
ADHD is a performance deficit, not doing what you know. The child or the adult has problems maintaining a consistent level of performance. A diagnosis should not and cannot be made without some detailed history. These histories should include: A Detailed Family History, A Detailed School History, Interviews/Observations with the child, Other Psychological Testing as Indicated.
Based on the information that mom was giving me, her child did meet many of the diagnosis criteria. There is help available in dealing with ADHD, either as an adult or a child. One interesting note is that the research today is suggesting that ADHD has a genetic feature which indicates it is highly inherited, it is neurological suggesting that children are “born with it”, it is internal vs. eternal, and it is NOT deliberate on the part of the child.
Treatment for ADHD consist of Medical support (medication), Psychological support through a Professional Counselor (for the Child and the Parents), and Educational support through the school system.
Lory Naugle, MS, NCC, DCC, is a Professional Counselor in Private Practice. She offers counseling in her office and online. She specializes in Anxiety Disorders and ADHD for both children and adults.
When living with anxiety it is important to be aware of specific triggers. Once you begin to identify your triggers you can begin to lower the intensity of the anxiety and with practice take your anxiety to a non- existance level!
This morning I had to put into practice what I preach. I had a dental appointment! Going to the dentist for me is a major trigger. I am middle aged…not yet 50 but going to the dentist when I was a young girl was never a pleasant experience. In fact it was so bad that I used to pass out in the waiting room. Of course I had no idea back then that it was actually situational anxiety, neither did my parents.
Anxiety is always fear based. I was afraid of the dentist and the associated pain. My dentist always had his novicane injection laying on the table in front of the chair. As I remember it, it was HUGE! The needle was so long and the whole device was just so intimidating. No numbing before hand back then. The benefits of floride were just becoming discovered, so having cavities was a regular occurance. When I was in 5th grade I broke off a front tooth by falling off my poco stick. The process of getting my first cap was a terrifing experience. The cap did not match any of my other teeth due to the fact that it was a temporary one until all my permanent teeth came in. So another very negative experience with the dentist.
Dentistry has progressed a long way since then. In fact I can honestly say that most of the dental work today now verges on being painless! The needles are sharper and smaller and they numb the spot beforehand where the injection is to be! The drills are more high speed along with many other advancements.
I realize that my anxiety trigger was situational, going to the dentist. The root of any anxiety is fear! How did I decrease my anxiety level, easy by practicing the following:
* I stopped my “what ifs” thoughts by focusing on the present moment and not allowing my mind to make up all sorts of terrible garbage. I literally visualize a stop sign in my head and tell myself to stop thinking those thoughts, that I am safe and will be fine.
* I continued to practice deep breathing and make myself aware to stay in the present (NOW) time. Often times when we are experiencing anxiety our breathing becomes very shallow and our muscles begin to tense.
* I remind myself that the fear I am feeling is from past negative experiences and to let that go. Today is different and I will be just fine. When you face your fear it does something very powerful-it takes away its power over you thus reducing your anxiety.
I survived just fine. No pain and no more anxiety. Anxiety doesn’t have to control your life, you can attack it and take away it’s power.
Lory Naugle, MS, NCC, DCC is in private practice in Shippensburg, PA. She offers counseling in her office and through distance means such as Skype, secure email, chat and by telephone. See the online counseling page on her web site for more information or contact her to schedule an appointment.
It happened again this week, someone from our community had died unexpectedly. Some have had health issues such as diabetes or high blood pressure, sometimes it is found out later that they had a heart defect, whatever the reason it is still a shock to family and friends. Unexpected deaths can also be the result of traffic accidents or other types of “freak” accidents. No matter how the person died it bring the subject of death and dying to the forefront. We all die someday. Most of us don’t want to think about dying but honestly living and dying go hand in hand.
There are many songs written about living and dying such as Tim McGraw’s, ”Live like you are Dying” or Daughtry’s “Home”. The message in both of these songs is to live life to the fullest each day because we don’t know what tomorrow will bring.
For those of us that live with anxiety and worry, I’m not trying to make you more anxious just the opposite by not focusing on the future but on the gifts of today. As I am writing this entry the sun is out, the spring flowers and trees are blooming and the birds are singing. Spring is finally here and no matter what other worries or problems I am dealing with they don’t matter at this moment, I am taking in all the scenery. Here are some of the ways that I try to live each day to the fullest:
#1 Be Happy and Laugh at Life – Each day is a gift, begin each day by being grateful for the people and relationships you have in your life. Smile and see that your glass is half full and not half empty. When you begin to focus on the positives in your life it will radiate all around you. People are drawn to positive people. Have you ever been around someone who was so negative all the time, it sucks the energy right out of you, but on the other hand being around someone who is positive, despite the problems they are dealing with, makes you feel good. Laughter should be an everyday part of life. One of my constant sources of laughter is just laughing at myself. Whoever said that if you learn to laugh at yourself, you’ll always have something to laugh about, was absolutely correct. There is always a reason to laugh it is something that you purposefully choose to do. Begin today to choose to be happy, smile and laugh.
#2. Forgive Others and Yourself- Revenge and hatred always keep people from living life to its fullest. They are like poison that spill over into every aspect of a person’s life.People who are unforgiving create their own captivity, a type of horible prison they made for themselves. All the good emotions, joy, peace, hope, and dreams are buried under the unwillingness to forgive. Forgiveness is an incredible thing, not only being forgiven by others for our wrongs, but to forgive others who have wronged us. Forgiveness is a choice and then an action. Forgiveness is true freedom. God sent his only son to die for our sin debt on a cross. If we are forgiven for our sins through Jesus Christ surely you can make the choice to forgive others.
#3 Tell Others What They Mean to You Each Day – This is something that I have begun to practice in my own life. Relationships are what life is all about. Your family and friends are your most precious possessions. Nothing in this life can match their existence. No matter where you are or in what position, small gestures of love, acceptance, and respect can give real meaning to your life. Life is a journey, make sure you express yourself to those who are sharing this journey with you each day, for we don’t know what tomorrow will bring.
#4 Be Flexible-This is easier for some than others. We never know how the day is going to unfold. Some people are so set in their ways and schedules that when something unexpected arises and believe me it will, it “throws” them into a tizzy for the rest of the day. Unexpected things come up. Some are good and some are bad, that’s just life. Some of my most memorable times with friends and my husband have happened on the “spur of the moment”. Yes, I could have been doing laundry, yard work, or housework but guess what those things got done anyway.
We don’t know what tomorrow will bring, we don’t get a ”do over” or second chance at life. Carpe diem – Seize the Day- make the most out of everyday and start living life to its fullest.
Until Next Time,
Lory Naugle, MS, NCC, DCC