The Truth About Domestic Violence

By Roberto Blanco, M.D.



In my work with patients across the world, I can´t help but notice how many come to psychiatric clinics as a result of domestic violence. Despite its prevalence in other countries, domestic violence is also quite common in the United States. In the United States alone, 22 percent of women are physically assaulted by an intimate partner during their lifetimes and over 5 million are victims every year. Domestic violence touches all elements of society regardless of age, race, or socioeconomic status.

As a child psychiatrist, I can´t help but think of the smallest victims of domestic violence as I often see them in my clinical work. These are the children who are either involved secondarily by witnessing the abuse or become victims directly themselves. The effects of domestic violence on this population are far ranging and long lasting. As these children develop, they may struggle to deal with conflict. They may also become aggressive or experience severe depression, nightmares and other symptoms of post-traumatic stress, as well as other anxieties or fears.



The effects of domestic violence on children are dependent on the nature and severity of the abuse and on the developmental level of the child. Young babies and infants cannot understand why violence occurs in the home and so violence in this population can cause deep-seated changes in personality, self-esteem, and ways of interacting with others that can last for a lifetime. Often older children have a better understanding of what is going on, but still often blame themselves for the abuse and can have excessive guilt or anger as a result.



Domestic violence does not need to be only physical to qualify as a form of abuse. Abuse can also take the form of emotional, financial, or sexual control or disregard. Initially, characteristics of an abusive relationship can often be endearing such as wanting to be with you all of the time. Over time, this can become intense jealousy for no reason, excessive control over relationships and behaviors, and aggression or violence. Options for milder forms of emotional abuse can include family and/or individual therapy. For severe cases, there may be a need to get out of the situation or to a safe house. For more information on domestic violence, please see the American Pyschiatric Association's brochure  Let´s Talk Facts About Domestic Violence.

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Posted in: abuse,children,depression,domestic violence,family,parenting,PTSD,Roberto Blanco MD,women

Bipolar in kids? Probably not.

By Scott Benson, M.D.



The 5-year-old little girl had been referred to a therapist by her school because of her severe disruptive behavior. The almost daily tantrums had everyone concerned. She was uncooperative with the assessment and arrangements made for further evaluation. The therapist wrote a diagnosis of bipolar disorder.

The patient was certainly reactive to any limits and her tantrums seemed like they would never end. But she slept well at night; she rarely had behavior problems with her grandparents who provided afterschool care.

After a few parent training sessions with the little girl and her parents her behavior control improved. But continued treatment was threatened when her dad tried to get her on his new health insurance. The diagnosis of bipolar got the application bumped by the computer and it took a lot of calls and several letters to get her on the policy so that her treatment could continue.

At times it seems we are a little too quick to throw a label on a child’s behavior, and bipolar disorder seems to be the most popular current label.

But new research at the October meeting of the American Academy of Child and Adolescent Psychiatry found that children with some symptoms of mania probably do not have bipolar disorder.

Boris Birmaher, M.D., a child and adolescent psychiatrist at the University of Pittsburgh presented his group’s research. More than 2,000 children presenting to 10 different academic centers were included in the Longitudinal Assessment of Manic Symptoms (LAMS) study. 621 were found to have elevated symptoms of mania, but the full evaluation did not find sufficient symptoms for a diagnosis of bipolar disorder. Most had attention deficit hyperactivity disorder (ADHD), others had another disruptive behavior disorder. Children who did have bipolar disorder have poor function and are likely to require treatment in hospitals.

"Kids with manic symptoms don't necessarily have bipolar disorder," he told Reuters Health. On the other hand, "Many children with bipolar disorder are not being correctly diagnosed."

The LAMS study which will follow these children for five years should provide direction for the assessment and treatment of children with severe behavior problems. In the mean time parents should insist on an adequate evaluation for children with severe behaviors.

The Parents' Medication Guide for Bipolar Disorder in Children & Adolescents is a great source of information for understanding the evaluation process and treatment options. Or visit HealthyMinds.org for more information on bipolar disorder or mental health issues in children.

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Posted in: bipolar disorder,children,family,mental illness,parenting,R Scott Benson MD

Coping with Stress in America

By Adair Parr, M.D.

A survey by the American Psychological Association highlighted the negative impact that stress can have on families and children. This is an extremely important topic that affects many family caregivers, who are under a great deal of stress taking care of loved ones. More and more Americans are affected by stress. The survey indicates that many Americans feel that they are experiencing unhealthy amounts of stress. The economy is one of the main reasons. Fewer are satisfied with the ways that their employer helps employees balance work and non-work demands and many are concerned about job stability.

In addition, stress impacts the entire family. Children recognize when their parents are stressed and that could make them feel sad and worried. Nevertheless, parents frequently underestimate the impact that their own stress has on their children.



Stress affects both our mental and physical health. Some people manage stress by smoking, drinking or over-eating. That can lead to bigger problems. The study shows that Americans understand the importance of healthy behaviors like getting enough sleep, exercising and eating healthy. However, lack of time and motivation gets in the way of following through on these goals. Willpower was identified as a barrier to many healthy behaviors, even when they are recommended by a health care provider.

Managing your stress is extremely important. Stress does affect the family members you care for. There are healthy ways to manage your stress. Some suggestions are: exercising or playing sports; listening to music; spending time with friends and family; going to religious services; journaling; and practicing yoga / meditation. 





If you find that you are overwhelmed or suffering physical symptoms from stress like headache, poor appetite and insomnia, or if you are feeling depressed or suffering from chronic irritability and crying spells, you may need to see a mental health provider. The Healthy Minds website has brochures about dozens of mental health issues including early warning signs of mental illness.

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Posted in: Adair Parr MD,anxiety,caregivers,children,coping,family,mental health,stress

National Caregivers Month: Alzheimer's Disease

By Felicia Wong, MD



Alzheimer’s Disease is a progressive, irreversible brain disease. The cause is poorly understood, and there is no known cure. Symptoms of Alzheimer’s include memory loss, confusion, impaired judgment, personality changes, disorientation and loss of language skills. It is the most common form of irreversible dementia.

Watching someone you love slowly lose their memory, thinking and reasoning skills can be heartbreaking. Caring for a person with Alzheimer’s Disease is a difficult task and can become overwhelming at times. As Alzheimer’s patients gradually lose their memory and their skills , each day brings new challenges to the caregiver. This is why I wanted to recognize caregivers for Alzheimer's patients in November, which is National Family Caregivers Month and Alzheimer's Disease Awareness Month.



Over time, communication diminishes, rewards decrease, and without strong support from family, friends and the community, caregivers of Alzheimer's patients face challenges to their very own well-being. Maintaining emotional and physical fitness while providing care for a loved one with Alzheimer’s Disease is crucial. Preparing and protecting yourself, understanding your loved one’s experience, and accepting help from others can reduce the stress associated with care-giving, and maximize the joys of being there for a loved one.



Here is a link to tips to help caregivers of loved ones with Alzheimer’s cope.



Additional support for Alzheimer’s and Dementia Caregivers, including warning signs of caregiver burnout, and tips on how to plan your own self care can be found on Helpguide.



Find additional information on Alzheimer's and other issues affecting mental health in seniors on the American Psychiatric Association's Healthy Minds website.

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Posted in: Alzheimer's Disease,caregivers,family,Felicia Wong MD,stress

National Family Caregivers Month: Self-Care for Caregivers

By Felicia Wong, MD

I love helping others. That is why I became a doctor, and why I love my job as a psychiatrist. But when I was a pre-medical student in college, my mom shared the following words of wisdom with me:  “In order to take care of others, you need to take care of yourself first.”

It took me a moment to understand the importance of the point she was making. I had taken a break from my community service projects due to a sports injury, and was eager to return to them. However, at that time, I was not fully recovered and was often in pain, and would tire easily. My mom encouraged me to take some more time off in order to focus on my own recovery and healing. Initially, I felt guilty taking the time out for myself. But in the end, I realized mom was right. Once I became strong and well again, I had so much more to offer to others.

Caregivers tend to be selfless, and expect a lot of themselves without recognizing their own need for self-care. Studies have found that caregivers have higher levels of depression and stress than non-caregivers. Sometimes caregivers are so committed to helping others that they forget to take care of themselves. They fail to recognize that if they drive themselves to exhaustion or sickness, they may not be able to help at all.

Warning signs of caregiver burnout from the non-profit Helpguide.org include:

• You have much less energy than you used to


• It seems like you catch every cold or flu that’s going around


• You’re constantly exhausted, even after sleeping or taking a break


• You neglect your own needs, either because you’re too busy or you don’t care anymore


• Your life revolves around caregiving, but it gives you little satisfaction


• You have trouble relaxing, even when help is available


• You’re increasingly impatient and irritable with the person you’re caring for


• You feel overwhelmed, helpless, and hopeless

Key strategies to prevent burnout include getting the help you need, seeking emotional support, and taking time out to care for yourself.

• Learn and use stress-reduction techniques.


• Attend to your own healthcare needs.


• Get proper rest and nutrition.


• Exercise regularly.


• Take time off without feeling guilty.


• Participate in pleasant, nurturing activities.


• Seek and accept the support of others.


• Seek supportive counseling when you need it, or talk to a trusted counselor or friend.


• Identify and acknowledge your feelings.


• Change the negative ways you view situations.


• Set goals.

For additional strategies for self-care for caregivers, visit the Family Caregiver Alliance, and watch for my next post on caring for someone with Alzheimer's. 

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Posted in: caregivers,depression,family,Felicia Wong MD,mental health,stress

Working with Schools When your Child has Problems

By Gariane Gunter, M.D.

Well, we have made it through the first months of a new school year! However, for some students the start of a new year has been difficult. I have received many calls and heard numerous concerns from parents who are wondering how they can work with their child’s school to ensure a success. Below is a list of the Top Ten Tips for Working with Schools that was shared with me by a Lead School Psychologist in my area. I hope you have a great year!

Top Ten Tips for Working with Schools

1. Let the school know up front if you have concerns


2. It helps to be visible in the school but do not intrude on the learning


3. Every school is a little different in its approach






4. There are lots of different ways of working with student problems in schools. Not just one of them is right. 


5. If you want to talk to a classroom teacher, ask to make an appointment with them. When teachers are with students, their first responsibility is to teach and supervise them.


6. School folks got into education for the joy of working with students.


7. School Psychologists and Special Teachers are there to study individual students. Help them by giving your specific observations. Your observations matter.


8. Lots of teachers and other school folks use e-mail, but remember that teachers check e-mail when they have planning or breaks.


9. If you have made a request and you haven’t received a response, don’t wait too long before asking about it. Sometimes requests do get lost.


10. Schools can be fun places to be; it is where all children gather to learn. Enjoy your time there too!

Reference: Shirley A. Vickery, PhD

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Posted in: family,Gariane Phillips Gunter MD,parenting,school,teachers,women

Mental Illness in School: No Child Left Behind?

By Molly McVoy, M.D.

How much do I tell my child’s teacher about her depression? About his bipolar disorder? About her ADHD? Will he fall behind if the teacher doesn’t know? Will she be judged if I tell the school? When do I get testing, an IEP, special Ed? What do those mean?

Parents of children with psychiatric illness struggle with these questions and many others. Often, there are no easy answers. A child’s success at school may be one of the best predictors of future success. Giving a child and his/her family the best tools to succeed in school is one of my top priorities as a child psychiatrist.

When deciding how much to tell your child’s school about his/her psychiatric illness, consider your child’s ability to function at school rather than his/her specific type of illness. You are not required to tell the school anything; that is up to you as a parent. If telling your child’s teacher about his/her psychiatric illness will give him/her a better chance to do well, then consider telling the teacher. If your child’s illness is affecting his/her day to day functioning and behavior at school, then consider telling the teacher. Teachers are your partners in helping your child succeed. If the illness is relatively well controlled and is not affecting his/her daily behavior at school, the school may not need to know. For more information, visit the American Academy of Child and Adolescent Psychiatry.

When it comes to accessing special education services, most schools and teachers want to do everything they can to help your child. I usually recommend families listen to the principal and teachers.They are the experts in education. However, if you are dissatisfied with the educational services you are receiving, my next recommendation is know your rights, know your state’s laws. Every state must provide a free education that meets the needs of each child – no matter what those needs are. What varies widely, however, is how each state manages that requirement. The U.S. Department of Education website has basic information on your rights as a parent and offers links to each state.html. Know your state law, know your rights. Come armed with that information and work with your doctor and school for your child to succeed!

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Posted in: ADHD,children,family,Molly McVoy MD,stigma

Reading, Writing and Anxiety? Helping Children Make the Transition Back To School

By Adair Parr, M.D., J.D.



The arrival of September signals back to school for most children. It is an exciting time of year, as it means meeting new teachers and classmates, starting fall sports and getting back into the swing of the classroom. Most children have some degree of anxiety about starting school, especially when they are just starting school, entering middle or high school or are changing schools.



Despite such worries, many children adjust to a new school year fairly easily. Other children have some initial anxiety, which they overcome in the first days or weeks of school. These feelings are particularly common among elementary school children but may be experienced by middle school or high school students as well.



School-aged children and even teenagers may express feelings of anxiety through frequent headaches or stomachaches, rather than overt worries about school. For tips on how to help transition your child to the new school year, see “The ABCs of Starting School” on Healthy Minds.



When should you seek help if you suspect that school is making your child anxious?




For some children, feelings of anxiety associated with back to school interfere with functioning either at home or at school or socially. If your child continues to have difficulty with school more than a month after school has started, it is important to seek help.




*Talk to your child’s teacher or counselor to see what they have noticed.



*If your child has significant physical symptoms, like recurrent headaches or stomachaches, schedule a visit to the pediatrician.



*Talk to your child and ask whether anything is happening at school that frightens them or worries them.



*Ask your child about bullying, which may be contributing to your child’s anxiety.



After exploring these concerns, some children will need further help and may require a visit to a mental health professional for an evaluation. A school counselor or pediatrician can help with a referral if this is the case. A child’s main job is to learn; untreated anxiety can interfere with social and academic development.



Anxiety is commonly treated with cognitive behavior therapy but some children require medication. By being attentive to the many changes associated with starting school, you can help your child with this important transition.

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Posted in: Adair Parr MD,children,coping,family,teens

Does the sandman still come to your house?

By R. Scott Benson, M.D.

Keeping children up at night?

Some worrisome stories were on the evening news last week; but the part of the news broadcast that caught my attention were six ads for medication to promote a peaceful night of sleep.



These ads are having their desired effect as I have more and more families expressing concern about their children’s sleep. They read the stories about shifting school start times to improve teens’ school performance, but the first question they ask me is usually about the latest new medications.

Research is clear: there are many things that should be done before we reflexively open the medicine cabinet.

1. Consider the impact of 24-hour access to electronic communication tools. Does your child keep a cell phone in their room overnight? To talk to whom? 


2. Remove televisions and computers from children’s bedrooms. There is strong evidence that easy access to these devices interferes with sleep.


3. Watch out for shifts in sleep schedules on the weekend. Most of us thought we could stay up late on weekend nights, make up for the sleep by staying in bed until noon on Saturday, and sleep in again on Sunday. But it only takes these two days to reset your biologic clock. No wonder that Monday finds a body at school but the mind is home in bed.


4. Plan evening routines so your child finishes activities (including homework) more than an hour before planned bedtime. It takes a while to settle after an hour of frustrating work on spelling words.

The first step in evaluating any concern about sleep is keeping a careful sleep diary. There are samples available at SleepEducation.com, the website of the American Academy of Sleep Medicine. The University of Michigan has a wealth of material on their website devoted to children’s sleep problems.



Sleep tight.

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Posted in: cell phones,children,family,parenting,R Scott Benson MD,Sleep

Getting Help: How to Start the Conversation and Find Professional Services

By Felicia Wong, M.D.

Many people don’t seek mental health care when they need it. This is particularly true for members of ethnic minorities, for whom physical illness is often considered more culturally acceptable than mental illness. Research has shown, for example, that Asian Americans are three times less likely than members of other ethnic groups to seek mental health services. This has more to do with lack of appropriate services, and barriers to services—including stigma, language and cultural differences—rather than the lack of need for services.

The important thing to remember is that with proper treatment, most symptoms of mental illness can be controlled. If the possibility of mental illness is a concern for you or someone you care about, please recognize there is no shame in seeking treatment and/or help.

Over the years, many people have asked me how to get help for themselves, a family member or a friend who is suffering. Navigating the mental health system is not easy, and the stigma and shame associated with mental illness make it even more difficult. Where someone may find it easy to ask a friend to recommend a family doctor or a dentist, people sometimes hesitate to ask about psychiatrists or therapists due to fears of being judged, or perhaps appearing "emotionally weak".

There are many places to go for help. A good place to start is by asking your family doctor or primary care doctor. In a crisis, emergency rooms can provide temporary relief for you or a loved one, and emergency room personnel may be able to guide you to further help.

Other potential resources include:

• mental health specialists such as psychiatrists, psychologists, social workers or mental health counselors;


• community mental health centers;


• hospital psychiatry departments, outpatient clinics and/or inpatient units;


• family services, social agencies, or clergy;


• peer support groups;


• private clinics and facilities;


• employee assistance program; or


• the phone book or web - search "mental health," "health," "social services," "hotlines," or "physicians" for phone numbers and addresses.

For more information on how to find and choose a psychiatrist and what to expect in treatment, read about Choosing a Psychiatrist on Healthyminds.org,

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Posted in: Asian American,family,Felicia Wong MD,getting help,mental illness,minority mental health,psychiatrist,stigma,treatment

But not my kid!

By R. Scott Benson, M.D.



A recent study by the Jed Foundation and the American Psychiatric Foundation showed that most parents of college age children understand that there is a high rate of depression, suicide, and substance abuse problems in college.



“But not my kid!” Nearly two-thirds thought these problems would not affect their children.



Surveys of college students show that most experience important mental health issues in themselves or a friend. And other studies have shown that emotional problems are a leading impediment to college success.



Now that the excitement of senior trips and graduation has settled families are putting the finishing touches on a transition plan as their teenager moves to the excitement of higher education. Most families have discussed the obvious needs – a place to live, what courses to take, how to pay for all of it. But families should take time to discuss the possibility of problems and how to get help.



Since this new territory is fraught with emotional pitfalls the American Psychiatric Foundation has teamed with the Jed Foundation to develop a website of information that will provide a framework for this important discussion. Transition Year has material to help parents and teens learn the warning signs of problems. And systematically collect contact information preparing for the situation where help is needed. The site has collected links to reliable sources of information about psychiatric conditions that are often seen in college age youth.



The site would be useful to families who are still considering their child’s college options. An entire section on “Choosing a school” provides guidance on important issues to explore in order to find a best fit.



Of course in some communities the choice is simple. Go, Gators!

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Posted in: college,family,parenting,R Scott Benson MD,suicide prevention,teens

The Kids Are Out of School, Now What?

By Gariane Phillips Gunter, M.D.



Summer is here, whoohoo! People of all ages, across the nation are having fun in the sun. However, the U.S. Consumer Product Safety Commission (CPSC) warns that summer also is the time of year consumers are most likely to be injured.



What can you do to keep you and your family safe?




• One of the easiest and most effective ways to stay safe this summer is to wear a helmet and other safety gear when biking, skating and skateboarding, and when riding scooters, all-terrain vehicles, and horses.




• If you are sending the kids to camp, be sure to check out the camp to ensure that your children will be supervised adequately for safety.




• Protect to prevent a swimming pool tragedy. This includes placing barriers completely around your pool to prevent access, using door and pool alarms, closely supervising your child and being prepared in case of an emergency.




• When cooking outdoors with a gas grill, check the air tubes that lead into the burner for any blockage from insects, spiders, or food grease. Check grill hoses for cracking, brittleness, holes, and leaks. Make sure there are no sharp bends in the hose or tubing. If you ever detect a leak, immediately turn off the gas at the tank and don't attempt to light the grill until the leak is fixed. Newer grills and propane tanks have improved safety devices to prevent gas leaks.




• Make sure your home playground is safe. Use safe surfaces that cushion falls. Concrete, asphalt or packed dirt surfaces are too hard.




• Use softer-than standard baseballs, safety-release bases and batting helmets with face guards to reduce baseball-related injuries to children.




• If you are a soccer mom or dad, beware that movable soccer goals can fall over and kill children. Make sure the goal is anchored securely at all times and never allow anyone to climb on the net or goal framework or hang from the cross bar. Remove nets when the goals are not in use.




• To prevent serious injuries while using a trampoline, allow only one person on at a time, and do not allow somersaults. Use a shock-absorbing pad that completely covers the springs and place the trampoline away from structures and other play areas.




• Don't allow a game of hide-n-seek to become deadly. CPSC has received reports of numerous suffocation deaths involving children who crawled inside old cedar chests, latch-type freezers and refrigerators, iceboxes in campers, clothes dryers and picnic coolers. Childproof old appliances, warn children not to play inside them.




• If summer plans include camping and you want heat inside your tent or camper, use one of the new portable heaters that are equipped with an oxygen depletion sensor (ODS). If oxygen levels start to fall inside your tent or camper, the ODS automatically shuts down the heater before it can produce deadly levels of carbon monoxide (CO). Do not attempt to use alternative sources of heat or power to warm a tent or camper. Traditional camping heaters, charcoal grills, camping lanterns, and gas generators also can cause CO poisoning.




• Install window guards to prevent children from falling out of open windows. Guards should be installed in children's bedrooms, parents' bedrooms, and other rooms where young children spend time. Or, install window stops that permit windows to open no more than 4 inches. Whenever possible, open windows from the top - not the bottom. Also, keep furniture away from windows to discourage children from climbing near windows.




• Summer also means yard work. When mowing, keep small children out of the yard, and turn the mower off if children enter the area. Never carry children on a riding mower.




• Although summer schedules can be chaotic, don’t forget to follow up with your mental health provider for appointments as directed!




Have a safe and happy summer!!

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Posted in: children,family,head injury,Molly McVoy MD,parenting

Dads Get Postpartum Depression Too

By Gariane Phillips Gunter, M.D.



Over the past several years, with great help from Brooke Shields and others sharing their stories, postpartum depression in new moms has become well known. However, recent evidence suggests that new dads may be suffering too. A recent study in the May 19th issue of the Journal of the American Medical Association reports that “14% of American men develop depression, either during their partner’s pregnancies or in the first year after delivery”.



Unfortunately, dad’s depression may be overlooked as the symptoms may not present as sadness but as irritability, anger or isolation from their loved ones. Without identification and treatment of dad’s depression, negative outcomes for the new baby and family can occur.



New babies need secure, healthy attachments for their physical and emotional development and these attachments are strained when either parent is suffering from their own depression. If you are a new mom or dad and feel you may be suffering from depression, please talk to your doctor and ask for help.

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Posted in: depression,family,Gariane Phillips Gunter MD,men,postpartum depression

Talking about Mental Health

By R. Scott Benson, M.D.

In May a few years ago I was asked to give a talk to the seniors who exercised at the mall in the early morning hours. The timing was right for a mental health talk, since May is Mental Health Month.



The focus of my talk was new understanding of the brain and changing thoughts on the cause and treatment of mental illness. The audience was attentive but asked few questions. But after the talk an elderly man approached to clarify some comments I had made about schizophrenia. He called his wife over and they shared the painful story of their adult son’s deterioration as he developed unmistakable signs of this tragic disease.



This couple had been told by the treatment team that their parenting had caused their son’s condition and they needed to leave him alone so that he could recover. And they had carried a burden of guilt for years, viewing themselves as somehow toxic. I was able to answer a few of their questions and then I was encouraged them to join other families involved with our local chapters of Mental Health America and the National Alliance on Mental Illness.



The positive impact of these brave families sharing their stories was reinforced in a new survey from the American Psychiatric Association. And the results of this survey are a cause for celebration telling us how far we have come. More than a third said that stigma has declined, and openness about personal experiences by friends, family and public figures was influential.



The internet has become a valued source of information and was cited by 75% of those surveyed as at least moderately influential in reducing stigma associated with mental illness.



In addition to HealthyMinds, what are the reliable sources of information that have been useful to you? Where have you heard patient and family stories that have reduced stigma in your community?

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Posted in: family,mental health,NAMI,parenting,R Scott Benson MD,schizophrenia,stigma

When the treatment didn’t work.

By R. Scott Benson, M.D.



Once I realized how depressed his mother was I understood why the treatment for her son’s behavior problems had not worked. And there was nothing new about this scenario.



A study of the treatments for ADHD found that for most children the treatments were very effective – improvements in academic performance, peer and family relationship, and self-image. But in the group of children who did not get better, when the treatment didn’t work, there were high rates of depression in mothers.



The impact of depression on parents and parenting was the focus of a study from the National Research Council and the Institute of Medicine. Their report, Depression in Parents, Parenting, and Children, is available on-line. 7.5 million parents are affected with depression each year but fewer than a third receive any treatment. In addition to the stigma of seeking treatment there are practical barriers to care that need to be addressed. The children who are affected are treated in separate health care settings by professionals who are not prepared to look at the whole family. Many families face financial barriers to care since many health plans are not designed for the coordinated care these families need.



The family in my practice was struggling with their second grader and his behavior problems at school. The parents done all of the right things. They had been working with his teachers since kindergarten. They had tried a variety of behavior plans at home. There was no improvement, and his grades were falling in spite of good ability. Their pediatrician confirmed his attention problems and reluctantly they agreed to a trial of medicine.



There was not much improvement even with a higher dose. And there were unpleasant side effects with a second medicine. So she recommended a psychiatric evaluation.



The behaviors were typical of ADHD. But his mother gave a clue to the problem as she teared up, talking about the stress she was under with his problems and guilty feelings about not having enough time for her husband and other children. At a separate interview she described typical symptoms of depression. She had been in treatment during college but stopped treatment when she was first pregnant. I was able to make a referral to a colleague and as her mood improved her interaction with her children improved. And the smiley faces began appearing in the daily planner.

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Posted in: ADHD,family,parenting,treatment

New Routines for the New Year

by R. Scott Benson, M.D.



A reader asked what to do before you get to the doctor asking about medication for a child’s school behavior problems. I thought it appropriate to answer that question and take advantage of the tradition of setting New Year’s resolutions.



In general, the answer is increased structure, not punishment. Set routines that head off trouble before it starts. Families can improve structure with a behavior plan. You will get the best success if you focus on one problem area to address and promote a positive behavior that would prevent the problem. And it will take 2, 3, even 4 weeks to see consistent change.



Let me give an example. I asked a second grader “What time do you get up in the morning?” He gave his mother a puzzled look, hoping she would answer the question. But I pressed a little, “Tell me about getting up in the morning.” Now we get the interesting part. “Well, my mother wakes me up, but I can stay in bed. She calls me a couple of times before she sends my dad in. Then I get up.”



Many families do this kind of complicated dance every school morning. Of course, it adds to the parents’ frustration when the same sleepy-head child bounds out of bed early Saturday if cartoon time is scheduled.



One family faced with this fight every morning decided to send Dad first. And they kept score with punch tickets which could be traded for a treat (a special late movie on Friday, a lunch out with Dad on Saturday). And they practiced their lines, “Good morning, this will be a great day.” Or something similar.



Has you family found a different solution to this problem? What are the other conflicts that repeat every day in your house?

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Posted in: children,family,parenting

Thanksgiving – the true spirit of this holiday season.

By Roberto Blanco, M.D.



I love Thanksgiving. It is my favorite holiday of the year. Each year my family gets together to catch up, share quality time and make plans for the future. Leading up to the holiday season this year, however, I had been feeling less than excited about the holidays. Having become accustomed to my daily routine, I found myself searching for a way to escape that monotonous, empty feeling.



So, this year, in celebration of Thanksgiving, I began a list of gratitude: 100 things for which I am thankful. This is not a list of wants or obligations that we create for ourselves - a Christmas wish list, a list of New Year’s Resolutions, or a ‘Bucket List’ (a list of things to do or see before you die). It is a celebration of that with which you have already been blessed. On my list included things like having my health, living in a country with tremendous opportunity, and being able to spend time with family.



Nobody’s family, financial, or personal situations are perfect. For evidence of this, just look at the personal lives of celebrities. And so it’s not surprising that many people can get down during the holiday season because it often reminds us of what we don’t have or didn’t accomplish. This often leads to feelings of emptiness or longing that set the stage for self-destructive situations.



Many individuals take what they have been blessed with for granted and don’t truly appreciate what they have until it’s gone. If you have ever lost something dear to you, you understand this adage all too well. This year, let’s try not to make the same mistake. This year, let’s focus on what we have rather than what we don’t.

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Posted in: family,financial,holidays

Holiday Anxiety

By Jeffrey Borenstein, M.D.



As we begin the holiday season, people have hopes and perhaps expectations of an ideal holiday. Time with family and friends, time off from work or school, plans to travel – but the preparation and anticipation is often stressful. While some people may experience feelings of sadness this time of year, often people experience anxiety.





Family gatherings – both large and small may bring up memories and emotions which have been on the back burner but which now result in a higher level of emotions. The holiday season is also a busy time, juggling usual work/school/household activities with holiday preparations. With time off from work and school our usual routines are interrupted, which is an additional stressor. All this can result in feelings of anxiety. What should you do?



Most importantly – step back and realize what emotions you are feeling. If you are experiencing heightened anxiety, there are steps you can take. Take a look at the Healthy Minds information about anxiety. I am also providing a link to an article in the New York Times in which I was interviewed entitled, “Easing Anxiety in All It’s Forms.”



Excessive drinking during the holidays is also a problem for many people. Some use alcohol to help with their stress and anxiety and those with alcohol problems are particularly vulnerable. Instead of helping, drinking can do the opposite and make you feel worse. HealthyMinds.org has some tips on safe alcohol consumption.



To help you cope during the holidays, make sure you get adequate sleep, make sure you exercise (and walking counts) and share your feelings with friends or family. If you begin to feel overwhelmed and have difficulty functioning, you should seek professional assistance. Most importantly – realize that you are not alone. Many people experience holiday anxiety. Accept support from family, friends and if need be professionals.

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Posted in: anxiety,family,holidays,stress

What do the holidays mean to you? It’s how you frame the question.

R. Scott Benson, M.D.



Thanksgiving seems to be the one time a year we can get a national focus on family and sharing with others. And before we finish that pumpkin pie everyone seems to start working on the next holiday which comes in different names in different cultures, but typically involves gifts. In the Santa tradition the focus is on what will he bring me.



But then we realize that is not the real meaning of the holidays.





A tool from cognitive therapy might help at this point, reframing. Reframing involves recognizing distorted thinking and focusing on other thoughts that reflect the reality that we want.



Let’s try an example. Typically we ask children “what do you want?” and later we ask “what did you get?” And these are the questions that define the meaning of the holiday season for them.



I don’t think that is the meaning we intended. So we can try a different approach. And it takes a lot of practice. In working with children or in my community I try to start the conversation with “What have you been thinking about doing for your mother during the holidays?” Or “What do you think your brother would like this year?”



And after the presents have been opened I ask, “Who really liked the present you gave?” And always in this era of instance messaging and Tweeting it never hurts to ask “Have you started on your thank you notes yet?”



Well? Have you?

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Posted in: family,holidays,therapy

Does “The Most Wonderful Time of the Year” leave you with the blues? Thoughts on how to make this holiday season less stressful and more enjoyable.

By Gina Newsome Duncan, M.D. 

The holiday season can, indeed, be a wonderful and exciting time of year, but for some, it can also be stressful and overwhelming. Many of us tend to overextend ourselves during the holidays, both with our time and our finances. This can take a huge toll, leaving some of us physically exhausted and financially spent come January.

With the current economy, some people may feel pressured to make up for the cutbacks they’ve had to make in recent months by spending above their means. Others may be more realistic about what they can afford, but worry that they won’t be able to have a good holiday on a budget. We tend to think of the holiday season as a time for family, however, bringing everyone together can also be stressful if there are unresolved tensions within the family.

If you’re worried about being able to afford gifts this holiday season, talk with your loved ones about the real meaning of the holidays for your family. Do things that are consistent with your religious and cultural traditions.

The season may be bittersweet for some adults. If reminded of losses such as the loss of a loved one, find a way to incorporate old traditions and honor your loved ones during this season.

Here are some tips to help you cope with the holiday blues:

Don’t focus on having the “perfect” holiday. Focus instead on having an enjoyable holiday, and that includes time for relaxation.

Examine and then lower expectations—both those that you have of yourself and those that others have of you. Do you expect that you have to create the perfect holiday and give the perfect gift? Do you expect others to give you the perfect gift? Do you expect your children or relatives to be on their best behavior at all times? If so, you will likely be disappointed. Things are rarely (if ever!) perfect. Having this mindset will make it more likely that you will run yourself ragged and end the season feeling exhausted and inadequate.

Avoid overspending, as this will only cause increased post-holiday stress when you get your bank statement. Where possible, consider giving homemade gifts. Baked goods make delicious presents and are a lot less expensive than individual store-bought gifts. They also allow you to give something of yourself in a tangible way.



Do something nice for yourself. Take a break from your shopping and make time for a bubble bath or a nice walk.



Don’t be afraid to say no. Setting limits can be difficult. But overextending yourself can leave you feeling underappreciated and resentful. It’s hard to have the “holiday spirit” when you feel that way!



If worried about not having enough, try giving to the less fortunate. This can often produce a change in our perspective.



Shop online if the mall is too stressful.



For some, the holiday season itself is always enjoyable, but the months that follow can be difficult. The winter season in some areas of the country may not end until late March or early April. Some find that their moods go down predictably during this time of year. Read Dr. Felicia K. Wong’s recent post on Seasonal Affective Disorder for tips on coping with this common form of depression.

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Posted in: anxiety,family,financial,SAD