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Why have Marriage and Family Therapists?

I was asked today by one of my Marriage and Family Therapy (MFT) graduate students the following questions today that touched on the topic of why have the field of MFT when there is overlap with social work (MSWs), psychologists, mental health counselors, etc.: 
"I was wanting to ask you as a Phd person in the field, is there a lot of MFT people doing research?

"The other question I wanted to ask is why is so many of these mental health fields crossing into other areas? As an example: MSW people are doing substance abuse, counselors are doing MFT therapy, MFT people say that most of their practice involves seeing individuals... I am new to this field and am tring to understand why so many labels seem to cross into the same areas of mental health. Can you help me understand?"
 
I've included my response below:

Those are great questions. In terms of research numbers, we are a smaller field, so there is less research out there that is strictly MFT. There are only a few handfuls of doctoral programs in our field, and not every Masters student does original research for her/his thesis, and even fewer go out and get theirs published. There is also, as you have mentioned, a lot of cross-fertilization. It was pointed out to me a few years ago that the largest section in the American Psychological Association (APA) is the family psychology section. There are a lot of psychologists that work with families, and they see their work as on par with (or better than) ours; they usually don't see the need for separate training for MFT work. Needless to say, when you are looking for "MFT" research, it is always good to look beyond just that acronym and see what is out there under "couple counselng," "relationship therapy," "family counseling," etc., because there are people from other fields who also contribute to our work.

There is a definite need for this field, and the training that we receive fills a niche that others do not. I think that the defining differences are systemic thinking and a focus on relationships. I wouldn't say that the majority of my work is with individuals; I see about 20% couples, 50% children with parents (which I call family therapy), and about 30% individuals. There are a lot of cases where someone starts out seeking individual therapy, because they just assume that would be the modality of our work together, and I get them on board with the idea that family and significant others are an important part of their framework for change. For example, if a person is coming in for depression and she is married, I invite her to include her husband. Many other counselors/therapists wouldn't. But I tell her that a person's support network is very important to getting better, and that therapy often goes faster and is often more effective when it utilizes the client's closest relationships.

Our way of conceptualizing problems and solutions is relationally-focused, something that I can't say about the other therapists that I work with at the community mental health agency where I do therapy. I find that clients find the approach very refershing and positive. That touches on another difference with MFTs that isn't universally true, but tends to be true: we tend to be more collaborate, non-pathologizing, and a bit avante-garde in our approach to mental health. For example, we tend to go for alternative approaches rather than the standard approach, to question the status quo, and to want to bring new perspectives to the table. I think we add a lot of spice and flavor wherever we work, and I think the mental health industry serves people better with our option added to the mix on the mental health menu.
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My thoughts on Nov 4th.

I wish I could have pulled off an Iowa win for McCain, but I used up all my magical powers on Prop 8 in CA :(

I'm still in mourning--today was the first day since the 5th that I've been able to stand plugging into the political news.

Isn't it amazing that when conservatives lose elections they accept the results (note the calls for unity behind Obama that were made in McCain's concession speech), while when liberals lose elections they stage protests and file lawsuits? I guess I should be surprised that Californians would rather have unelected judges decide the meaning of marriage than have it settled by popular vote. That ballot initiative was won fair and square--in fact it was the record Latino and African-American turnout for Obama that helped pass Prop 8, since those supporters broke in disproportionate numbers in favor of the measure. Contributions by Mormon supporters of the Prop 8 measure have been demonized as bigotry, while openly discriminatory remarks about the LDS (Mormon) Church and its members' right to political speech have taken on an increasingly hostile tone.

Can you imagine the mayhem we'd be experiencing if Republicans were filing lawsuits right now to disqualify illegal votes and pushing for an investigation of the illegal fundraising in Obama's campaign? Can you imagine the uproar if extra votes were being found that were disproportionately Republican in the Minnesota senate race? Can you imagine the accusations of fascism if opponents of Prop 8 who contributed to the No campaign were being singled out publically and "shamed" for their contributions?

McCain and Bush have show their class in the way they have responded to the Obama victory. I hope history remembers.

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We're Moving!

   
Shauri and I are packing boxes tonight. We have had our house on the market for 6+ months, and decided to try renting it instead, and instantly got several bites. We had no idea the rental market was on the rise, but that would make sense with foreclosures higher. Anyway, we are moving tomorrow to Burlington, IA, where we'll be in a smaller home (1 fewer bedrooms, smaller bathroom, no basement, but ther is a storm cellar full of spiders!) and only 2 miles from my work (rather than 40mi). We're pretty excited.
 
At the same time, I'm also moving my office. My work has given me one about twice the size of my current one, and we'll be moving some of our furniture and a bookcase into it this weekend also. First I have to repaint it--someone with bad taste dabbed bright blue paint all over the walls in an absurd pattern.
 
As I was cleaning out the room, I came across the folder of my work public relations lady. Although it had a few clients' service plans in the beginning, the rest of the folder were campaigning materials for getting out the vote for Hillary on Iowa Caucus night. Suddenly a lot of things began to make sense. Remember my blog posts on National Children's Mental Health Awareness Week? Well those were an expanded version of a newsletter article that this same PR lady asked me to write. When I submitted it, she wrote back a stern warning that "This does not fit with the company mission" and that we needed to avoid "controversial topics." Since when was looking out for the mental health of children controversial? But now her response makes more sense--my criticism of DHS/CPS and child care must have hit a political nerve for her.
 
In this organization for political speech from the left to go forward unchecked, yet when it comes from the right, it is "controversial." People yuck it up about voting for Obama, how backward conservatives are, etc. in staff meetings as if they assumed we were all unanimous in our beliefs. In our lobby, Planned Parenthood materials are displayed prominently on the wall and on the magazine table, and a lady just told me a couple of hours ago that she was going to have Planned Parenthood at a women's support group (there were only 2 attending, so hopefully there wasn't much damage done). If I were to put out materials from Birthright, I wonder how long that would last? Or I wonder if the Boy Scouts of America would be welcome at a kids' support group?
 
It's been frustrating this election season to see the blatant bias; I think it is getting to me. That reminds me. Two days ago, I saw one of Orson Scott Cards columns titled, "Will the Last Honest Reported Turn the Lights On?" linked on the Drudge Report. I read it, and the next day noticed that Rush Limbaugh had picked up on it and had read it in its entirety on the air, and had also put the link on his website. Meridian Magazine, where the column appeared, was a bit overloaded that day. :) I tried to go back there and read it again, and it was very sloooow. So if you want to read it, head over to http://www.ornery.org/essays/warwatch/2008-10-05-1.html where you can read his other essays also. He's a Democrat btw, but an honest one.
 
When I was at Meridian Magazine two days ago, I saw a banner ad for beautifullymodest.com . Shauri and I had a fun time looking at the site last night, and were impressed by the opportunity they provide high school-aged girls to help design dresses and basically receive a fashion design internship. If I were a young lady who was into fashion, I would be all over that! Too bad there's nothing similar for guys, but really who is going to have an especially for guys modest clothing store?
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Painfully Inadequate

A couple weeks ago a good friend of mine suggested that I comment on the oil executives' testimony before the Senate. The best tidbit from that exchange, by far, was Senator Maxine Waters' admission that as a liberal, her ultimate goal would be to socialize/nationalize the oil industry--a complete government takeover. You can go here for more on that:

I've been working on a lot of other stuff lately--my personal and family life has been a mess. So, sorry to drop the ball on that. But I would like to point everyone to a great piece by Thomas Sowell on how painfully inadequate our two candidates are.
The point he makes about nuclear war is what got my attention. I take it very personally as one who has lived through nuclear war.
 
Haha, got your attention. No, I really haven't, but I have believed several dozen times that I was going through a nuclear war, and awakened to discover it was not real. I don't have a count of how many times I have seen mushroom clouds. I can tell you that the last time I had one of these dreams, I was trying to get to a safe place. I was in the Salt Lake Valley, where I grew up. My family was in a shelter, and I had gone to get some extra supplies, like water or something. There was a countdown--some enemy had threatened to nuke our cities, and had given us until a certain hour to comply with their demands. Our government was going to call their bluff. We all hoped that it wasn't real, that the enemy had been exaggerating or just lying when they said that they had the capability of nuking X number of our cities. Well, the hour arrived, and I was taking a gamble that the nukes really wouldn't go off. I was crossing a park, and way off in the distance, to the north, where downtown Salt Lake is, there was a big flash, and I turned to see the mushroom cloud rising. The nearest shelter was a maintenance shed in the park. Fortunately it wasn't locked. I opened the door and saw a big bucket. I grabbed it and filled it with the spigot attached to the shed--just so I could have some water, because I didn't know how long I'd be in there, and then got inside, and shut the door. I just hoped my family would be alright. 
 
I share this not because I think it was prophetic, but because that's what I picture the reality might be like if Iran gets a hold of nuclear weapons. Because like Thomas Sowell said, if Iran gets them, then we might as well say that the terrorists have them. And then the prediction made in one of last year's best films, "Children of Men"--that terrorists nuked New York when trying to blackmail the US--will be too real of a possibility. I have no doubt they want to do that, and that they would if they could.
 
There have been many times in the past 7 years when terrorists wanted to do something horrific, and were planning to, but somehow they were thwarted and were stopped. We haven't had another 9/11 (or worse), but it isn't because the terrorists aren't interested. We are working against them. And God seems to have helped a lot. I'm grateful for that. Like the British airlines plot that would have happened, if just a few other things had gone in their favor, but didn't. I see that as divine intervention. And I pray that he continues to intervene. I also pray that we won't be stupid this fall and elect someone who will hand our heads over to our enemies. 
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Children and Attachment: What Can We Do to Help?

Don’t Mess With Texas

May is Mental Health Month, and it started with National Children’s Mental Health Awareness Week, which was the first full week in May. Last week in this blog, I discussed two common mental health diagnoses among children (ADHD and ODD) to illustrate how some mental health problems can be caused mostly or partially by genetic factors.

There are also psychiatric problems that are almost purely caused by things that happen to you—what could be called situational or environmental mental health problems. For example, there are a lot of kids who would be pretty normal if they hadn’t had a forced separation from their parents at an early age, or if they hadn’t been abused, or if they hadn’t gone through some other major trauma.

I will focus this week’s blog on attachment-related mental health problems to illustrate mental health problems that are almost entirely environmentally caused. I say “almost,” because there is variation depending on temperament, intelligence, and other biologically-related factors. For example, two children could both be abandoned on the street, and one might have the resilience to be able to bounce back from this trauma. But most children would be deeply affected by it.

We look at the situation that is unfolding in Texas with the polygamist sect and we know that those 400-plus children are experiencing trauma—they are being yanked out of a familiar, loving, stable environment, and being put in foster homes away from their families, into a cultural environment that they have been raised to avoid, into an environment that would seem scary and dangerous to them.

Many of the boys, for example, are being put in a boys’ ranch type of setting, where they will be living side-by-side with kids who have stolen, run away from home, assaulted others, used drugs, etc. They will be exposed to swearing, TV, music, immodest clothing, and other influences that they believe to be harmful. Who could possibly argue that this would be a setting that would not cause these boys psychological harm? Especially when they have been taught that they needed to keep themselves separate from the outside world? They have been raised to avoid “the sins of this generation,” in the words of one father from the group. Now they are being dumped right into the middle of them.

The infants and children in the group were taken away from their mothers in the middle of the night. We can never go back and undo that damage. They were kept from their mothers when many of them were likely still nursing, possibly causing some of them to be weaned against their parents’ will. Days went by with those babies crying for their mothers, when the mothers could not reach them. The children have not been allowed to be alone with their mothers or fathers, to prevent “witness tampering.”

The children will be placed into a system that is not prepared for this heavy influx of children. Children will be separated from their siblings because the foster system isn’t designed to accommodate large families. Many will be placed far from home as the system stretches to find enough foster facilities. They will have emotional scars from this ordeal; they will be changed forever.

While some children in the group may be protected from underage marriage by the forced separation from parents, every child has been punished because the state didn’t have the patience to respectfully and peacefully ask for the information it needed in order to determine which children were in danger. Certainly the babies were not in imminent danger of underage marriage! The youngest among the children will likely be the ones most affected by the ordeal.

This unbelievable situation reminds us of the insane justification that a major in the U.S. military used in the Vietnam War for the destruction of the Ben Tre village: "It became necessary to destroy the village in order to save it." The atrocity that is happening in Texas should create an outcry across this nation among all people who are concerned about families and children’s emotional health.

Does Attachment Matter?

In my work as a mental health professional, the majority of cases that I see have at least some genetic piece to their cause—such as ADHD, most cases of depression and anxiety, and so forth. Probably the most common mental health problems that I see that are entirely avoidable are attachment problems. What is attachment? Attachment is precisely the kind of issue that the ordeal in Texas is all about.

Attachment is a bond that people form in their closest relationships. When the first bond—usually between a baby and Mom (but this could be any primary caretaker)—is allowed to be strong and steady, the child develops an internal sense of security about herself and the world—she trusts that people will be there for her when she needs help, and that the world is a fairly safe place. While this bond is forming, the infant is appropriately dependent. A parent who accepts this dependence as normal and natural (instead of rejecting it) helps the child to form a secure bond. If the bond is allowed to form properly, the securely attached child will develop into a child who can be appropriately independent as later ages: a child who feels safer exploring and engaging the world, who is more socially outgoing, and who develops into a happier and better-adjusted child.

When that initial bond is not strong—when it is disrupted in some way, the child often develops an insecure picture of herself and her place in the world—she becomes anxious about whether caretakers will be there for her, or avoids relationships because she has learned that people can’t be trusted. She may develop into a child who is clingy, who manipulates or feels she has to be in control, who uses tantrums to get her way, or who is shy and doesn’t do well with change. In these cases, we don’t say that the child “isn’t attached” or “failed to attach.” Rather, we say the child is insecurely attached, and once the problem is identified, we help the child to develop greater attachment security by helping the child heal and develop a stronger bond with her caregiver(s).

Reactive Attachment Disorder (RAD) is the extreme form of attachment problems and is relatively uncommon, but lesser varieties are more common—some studies estimate that about 30 percent of children are insecurely attached to some degree. Sometimes it is barely noticeable or only shows up in a few situations; other times it may seem like “everyone in the grocery store” can tell what the problem is! Among children with other mental health problems, we often see some evidence of attachment difficulties, especially where there has been trauma, abuse, or family disruption. Severe attachment problems can be mistaken for ADHD, ODD, bipolar, and some other disorders when a professional has not been trained to discern the difference.

“Too Attached”?

When I look at attitudes in our society about attachment, I feel deeply concerned that the rate of these problems will only continue to increase in our society. For example, the apparent ignorance of child protective services (CPS) in Texas about the effects of their actions on attachment. There seems to be a widespread assumption in society, and I hear this even among professionals, that separation from a parent at an early age is harmless, and can even be beneficial—that it can help a child grow.

I know one woman whose ex-husband wants to have their toddler daughter half the time, but during most of that time the little girl would not even be in his care. Instead, the daughter would either be in daycare or with the father’s girlfriend. When the mother voiced concern about this arrangement, a Department of Human Services (DHS) worker told the concerned mother that “daycare will be good for her,” and that the daughter needed to learn “how the world works.” How could anyone with a basic understanding of child development and attachment possibly believe that attachment disruptions with unfamiliar caretakers would be beneficial to a child?

This mother was also told that regular separation would be for the best, because her toddler daughter is “too dependent” on her—the daughter cries when separated from her mother, and there are (supposedly) too many hugs and kisses that the mother and daughter exchange when they are reunited! The ex-husband sees these as evidence that the daughter is “spoiled,” and has vowed that he’s going to “break her.” Again, these comments show a gross misunderstanding of child development and attachment. At such an early age, it is normal for a child to be distressed by separations from the caregiver and to seek a caregiver for comfort. Certainly a child can be “broken” of these natural separation responses, but is that the only thing that will be broken?

The toddler who is nonchalant or uncaring about separations is often praised as a “good child” because he’s so easy to drop off at daycare. But is this really a good thing when our children are easy to leave?

Sometimes these children are vulnerable to developing dismissive attitudes about attachment as an adult. For example, they can grow up with intimacy issues and have difficulty expressing emotions. Think about a child who is left to cry himself to sleep, or who is forced to endure prolonged separations from his parent before he is emotionally ready for it. When a child learns early in life that his dependence on a caregiver is a source of pain, and his feelings and needs will go unacknowledged and unheeded, he shuts off access to a vulnerable part of himself. He learns not to trust others with those feelings. He learns not to express his emotional needs.

What kind of a husband and father would such a boy grow up to become? An adult who is dismissing of his own attachment needs will be more likely to be dismissing of his children’s attachment needs also…and the cycle continues for another generation.

So if it’s not ideal for a child to be calm and uncaring when dropped off, what is the normal response? A securely attached toddler would be upset by the separation, but would eventually calm down—being consolable or soothable is also a sign of secure attachment. And if the caregiver comes back when the child is still upset, we could expect to see the child to feel reassured and consoled when reunited with her caregiver. Having this stable bond with her caretaker is essential for the child’s long-term mental health.

Unfortunately, in so many situations, nurturing this bond is not put as the first priority.

I have heard parents say that they avoid “giving in” to providing a nurturing response to their child because they don’t want their child to become “too attached.” They want to be able to lay the child down for a nap or drop the child off at daycare and not be bothered by any fussing. Ironically, it is the child whose attachment needs are adequately met in infancy that is the least needy later in life—the early investment pays huge dividends later on!

It Starts with Birth

So what are a child’s needs? Let’s look at early infancy. There are food, shelter, warmth, sleep, cleanliness; these are physical needs that we all (hopefully) recognize. So if you meet all of these, and nothing else, will the child thrive? Absolutely not.

In the decade after the collapse of the Soviet Union, for example, we heard horror stories of infants in Eastern Europe that were left in cribs for hours in orphanages, unattended because there were not enough staff to pick them up and give them emotional nurturing. The result was thousands of children with severe attachment problems. They would not respond to a smile. They avoided touch and were stiff when held. They bit and scratched themselves. They seemed to shut out the world. When they grew older, they seemed to have no social conscience.

In the U.S. we usually don’t see children that have gone through this degree of attachment trauma. Instead, we are more likely to see children who were treated like a burden or afterthought, who were yelled at, who were not picked up enough when they cried, who were allowed to cry themselves to sleep as infants. We see children who received little or poor amounts of touch and eye contact from their caregiver during feedings, who were placed in playpens, cribs, car seats, or strollers for long hours when awake instead of being held, played with, sang to and talked to.

We see children who are attached to a binky or blanket and are inconsolable when it is missing, who are babysat by TV programs or movies, and children who maybe only see their parent(s) for a few hours each day. We see children whose paid caretaker has been changed multiple times in the first three years of life, who have had multiple attachment disruptions. In short, we seem to be raising an entire generation of children where attachment problems will be commonplace.

The Ties that Bind

We live a society that is increasingly dismissive of children’s attachment needs, that assumes everything will be okay when children are put last. So many of us today were raised in less than stable environments, and we may think that this is normal, and then underestimate our children’s needs for our attention and nurturing. Among the nations of the world, parents in the U.S. spend less time on average with their children than any other nation, including the old Soviet Union. We spend long hours at work, and when we come home, our children may seem like strangers.

Is it any wonder that our children are reaping a windfall of rising mental health problems? Our choices about the time we spend with our children—and the quality of our interactions with them—have direct consequences on their emotions and behavior. Today we see an increase in aggression and defiance, in distractibility and impulsivity, in anxiety and depression, in addictive behavior and anti-social behavior. Is this avoidable? Some of it isn’t—some of it is genetic. Some of it is genetic but wouldn’t be triggered if our kids didn’t have such stressful, problematic lives, bad diets, environmental toxins, inadequate discipline, poor sleep patterns, and attachment disruptions. These and other factors may trigger inherited genetic weaknesses for mental health problems. Unfortunately, some of our kids’ problems can be caused by things that are entirely avoidable.

The New Normal?

A recently released studyby the National Institutes of Health (NIH, published in the March/April 2007 issue of Child Development) found that the more time children spent in daycare before kindergarten, the more likely they were to show aggression and defiance at age 10. These behaviors included demanding attention; arguing; bragging and boasting; cruelty, bullying or meanness to others; destroying things belonging to others; disobedience at school; getting into fights; lying or cheating; and screaming.

The researchers pointed out that those behaviors they saw were within the normal range and were not considered clinically disordered. Jay Belsky, one of the authors of the study, stated that children who have been in daycare probably aren’t abnormal enough that he could pick them out of a classroom just by observing them. Indeed, once children get into public schools, their behaviors tend to rub off onto peers, making it more difficult to tell the difference.

The study also found a benefit of daycare: slightly increased reading and vocabulary skills. Does this make up for the negative effects? Few of the parents I see in therapy would seem to want to have a child who is more aggressive and defiant, and who also knows how to use her mouth better. Especially if the words coming out of it are too mature for her age and not ones her parents want her learning.

With the widespread use of daycare in today’s society, are we willing to accept these behavior trends as the “new normal”? Do we need to find better ways of shielding children from these effects and getting help to the ones who have already been affected? Daycare is only one factor affecting children’s mental health; there are many other factors—for example the amounts of sleep children receive each night and parents’ effective use of authority, and how parents and teachers respond to a diagnosis. Giving children the best possible chance at a life relatively free of mental health symptoms is a complex undertaking.

As we celebrate Mental Health Month in May, let us use this opportunity to take a look at the kind of outcomes our society is creating for children. We need an increased awareness of the causes of children’s mental health problems, and which of them are avoidable. We need a greater awareness of the treatment options available. We need an increased commitment to giving our kids the nurturing, the environment, the tools, and the support to reaching their fullest possible potential.

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Children's Mental Health: ADHD and ODD

The #1 Child Mental Health Disorder

As part of National Children’s Mental Health Awareness Week (May 4-10, 2008), we need to get out the word about the risk factors and causes of mental illness. Yesterday I wrote about sleep problems, which tend to occur at a very high rate among children with mental health problems. A resource that I often refer to for these is Solving Your Child’s Sleep Problems, by Richard Ferber. It has recently been revised, and there are other more up-to-date books also available.

 

When children have mental health problems, it is important to understand that some are not the fault of outside factors, such as sleep difficulties (though these can always make things worse!). There are disorders that are genetic—you simply have them because you were born with the genes for them. Even among these, genes alone don’t determine how you will fare with mental illness.

 

A boy with Attention-Deficit/Hyperactivity Disorder (ADHD), for example, which is the most commonly diagnosed children’s mental health problem, may fare very differently depending on how his parents and teachers respond to him. If he has highly involved parents and teachers who educate themselves about ADHD, help him learn skills to manage his ADHD, get him into treatment that includes more than just medication, and work with him on managing his symptoms, he will fare far better than a child whose parents and teachers don’t want to be bothered with it and just want a pill to make it go away.

 

Why do I say “he” when talking about ADHD? Girls also have ADHD, yet the disorder tends to be noticed in boys more often than it’s noticed in girls. Even though boys and girls may have similar raw rates of the genetic causes of ADHD (we don’t know enough to say if they do or don’t), the response they get from their environment is often very different.

 

For ODD, Genes Alone Aren’t Enough

There are also some psychiatric problems that a child can have a genetic tendency toward, but may not be triggered unless the child has a great deal of stress or some other life event that causes it to show up. For example, some kids have a family history of bipolar, depression, anxiety, schizophrenia, or some other problem. They may have inherited a genetic tendency for getting a mental health disorder. But it may not show up as long as the kids have stable, low-stress lifestyles.

 

For example, most kids with Oppositional Defiant Disorder (ODD, which includes rebellion and problems with authority), have a strong-willed personality. But this factor alone doesn’t cause ODD—you need to also have the right mix of environmental factors to develop it—genetics alone isn’t enough to set it off. Triggers can include an absent or emotionally distant parent, parents who tend toward power struggles themselves, inconsistent parenting, problems with peers, and substance abuse.

 

Because ODD is a relational and not a purely individual problem, I usually recommend family therapy that includes teaching the parent(s) new skills and behaviors. This doesn’t mean that parents are blamed for the problem; of course the child needs to change. The adults in the child’s life are also an important part of that change. Even when parents aren’t part of the problem, they are in the best position to be a part of the solution.

 

Comorbidity—How Can ADHD Increase the Risk of ODD?

In my clinical work as a therapist of children, I have seen each of these disorders, ADHD and ODD, occur separately. But I am surprised at how often they occur together. This may say something about the strain on parents that comes with having a more difficult child—ADHD can be hard for some parents to understand. I have a book on my shelf called It’s Nobody’s Fault: New Hope and Help for Difficult Children and Their Parents, by Harold Koplewicz. This is just one of many books available to help parents of a child with a this disruptive behavior disorder. I see parents who insist that their child is just lazy, that he needs to have more discipline, that if he would just try he would be able to do everything that other children do. Undoubtedly these expectations, when they are unreasonable, put strain on the parent-child relationship, and set him up for developing ODD.

 

Sometimes these perceptions of laziness or lack of effort can be true—to an extent. But a child with ADHD does have a real problem, and it is a problem that is not of his choosing. Parents and children may need professional help to see what he is more capable of, and what expectations are unreasonable.

 

I have met children whose parents had high expectations, and they were thus able to help their child manage his ADHD, so well that as they grew to adulthood, they were able to function without medication. I have also seen children wilt under the criticism and unrelenting demands of an unsympathetic parent. It is important to have a balance.

 

Rebalancing Parenting

Parents can find a wealth of resources for help with rebellious children. One that I have been very impressed with is Parenting Your Out-of-Control Teenager: 7 Steps to Reestablish Authority and Reclaim Love, by Scott Sells. He has another book for therapists, called Treating the Tough Adolescent. What I appreciate most about his approach, besides the fact that he helps parents get in charge, is that he does this through both the soft and the hard side of parenting. So many parents that I see with a rebellious child want to really crack down on the rules and get control back through the hard side—discipline and consequences. But when this is main or only focus (as is so easy when dealing with ODD, which tends to create angry, exasperated parents), the parent-child relationship tends to suffer. Dr. Sells teaches that the soft side of parenting—building a bond with the child—is necessary if you want the hard side to succeed. He recommends, for example, regular parent-child outings that build the relationship, and the kicker is that these need to be unconditional—they cannot be “lost” through misbehavior. The child needs to know that your love and care for him doesn’t depend on him being “good.” I have used this concept of working on the soft and hard side of parenting together with many other disorders, and found it to be very successful. In fact, I would say that I’ve found the soft side needs to come first, and be given even more attention than the hard side. I’ll give two illustrations why.

 

John Gottman, author of some powerful books on improving marriage (such as the bestseller, The Seven Principles for Making Marriage Work), has done some of the best research available on couple relationships. By carefully studying the interactions of couples and then tracking whether those marriages ended in divorce, he found that in order for a marriage to be stable, there has to be at least five positive interactions for every one negative one. Positives could be a compliment, a smile, working together, and so forth. Negative could be criticism, rolling your eyes, getting defensive, etc. When the ratio of positive to negatives became less than 5 to 1, he found that marriages tended to become unstable, and eventually lead to divorce.

 

So what does this have to do with parenting? Parents and children can’t divorce, can they? Actually, many of the same dynamics that lead to marriages failing are the same that lead to rebellious and oppositional parent-child relationships. The biggest difference is that the relationship can’t end with a divorce. But the parties can and often do wish they could be rid of each other, and sometimes it does end with either the child running away, the parent sending the child to live with another relative, or the child being placed in a program for troubled kids.

 

It is important also to know a further finding in Gottman’s research on marital stability. Simply having a marriage last is fine, but what about having a happy marriage? He found that couples who had a 10 to 1 ratio of positive to negative interactions tend to have happy, satisfied relationships. Surely there is a lesson here for parenting as well. This conclusion is supported by the research-based parenting education program called “Incredible Years.” It teaches parents that when discipline is the main focus, the parent-child relationship is out of balance: like a pyramid balanced upside down on its tip. To illustrate the proper balance of relationship-nurturing to discipline, they have created a helpful concept called the “Parenting Pyramid.” Here is a link: http://www.incredibleyears.com/resources/parent-program-pyramid.pdf What it illustrates is that the actions on the bottom of the pyramid form the foundation of a parent-child relationship: things like empathy, attention and involvement, play, problem-solving, listening, and normal talking together. These help to increase the child’s problem-solving skills, cooperation, self-esteem, and attachment (bonding with the parent). This is what grows and sustains the relationship!

 

At the top of the pyramid are behaviors that you need to use sparingly or rarely, and the less often you use them, the more effective they will be! These are consequences, such as time out and loss of privileges. Use these to decrease aggression. Many parents use these far more often, for example to increase normal compliance and obedience. The pyramid suggests more appropriate measures for increasing these: setting clear limits, setting household rules, and using consistent follow-through. When these are done in the proper balance, you won’t have so much aggression and need for consequences. For more information on the Incredible Years program, you can find their website at www.incredibleyears.com .

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National Children's Mental Health Awareness Week

May is Mental Health Month. The National Federation of Families for Children’s Mental Health has declared May 4-10, 2008 as National Children’s Mental Health Awareness Week. Throughout the nation, agencies, schools, and community service providers are using this week to get out the word on children’s mental health issues: their causes, options for treatment, prevention information, and opportunities for support.

 

One Therapist’s Perspective

I work as a mental health professional at a community mental health center in a small city in the Midwest. I and other professionals like me help individuals, couples, and families; we help children, adolescents, and adults. In our work we see children every day for a wide range variety of mental health problems. The majority tend to have either behavioral or emotional problems. Many of the kids we see have difficulty with aggression or defiance, there are a lot of mood disorders, and sleep problems are also common.

 

Getting adequate sleep is a surprisingly common difficulty among children with mental health issues. It is hard to say which is the cause and which is the effect, but getting adequate sleep can be a hugely beneficial change for a lot of these kids. A child in elementary school typically needs 10 to 11 ½ hours of sleep per night, and kids in high school need 8 ½ to 9 ½ hours. The kids who come to my office often have much less—I sometimes see children who average as little as 5 to 6 hours per night. Of course this would worsen any problems a child may have with irritability, inattention, and moodiness. Sleep is the brain’s way of repairing and refreshing itself. Sleep deprivation isn’t just an annoyance or inconvenience; it is also a mental health risk. Those who do not get adequate sleep risk developing additional mental health problems.

 

The work that I and other mental health professionals accomplish includes educating both kids and parents about prevention (such as sleep), focusing attention on strengths and skills they already have that will help, teaching new attitudes and skills for managing and overcoming problems, and bringing together people involved with the problem to work out solutions. Although many of the mental health problems we see are not preventable, the effects of them can be managed and diminished.

 

Many changes can help a child with a mental health issue to improve and fare better—for example, by changing sleep patterns to get a full night’s sleep. Many children with mental health issues can lead happy and productive lives with treatment, support, and hard work from themselves and their caregivers.

 

This week I will publish a series of blogs on the topic of children’s mental health, focusing especially on prevention. The next will focus on the most commonly diagnosed childhood mental health disorder: ADHD. I will also address one that I sometimes see occurring with it, the childhood diagnosis with an odd-sounding name: Oppositional-Defiant Disorder.

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A Wakeup Call

The soap opera on the Democrats' side of the aisle is getting interesting. I've become convinced that I would rather have McCain for 4 years than pick up the pieces from a Democratic presidency with Romney in 2012--even if that means America won't be interested in a Romney candidacy in 2012. It seems like having a different Republican after three Rupublican administrations would be quite a stretch, and a McCain presidency might actually ruin Romney's chances of being elected before 2016. Or before 2020 if McCain has two terms, but now I'm really getting too far ahead.
 
On a completely different note (or not), I was sent an email by a friend about how our country got into the current mess its in. I cleaned it up a bit and added two paragraphs on things I'm knowledgable about--child attachment and childhood disorders, like ADHD and ODD. I was talking with my wife this week about a friend she has whose child has ODD (Oppositional Defiant Disorder). While ADHD (Attention Deficit/Hyperactivity Disorder) often has a biological component (meaning the child may have been born with the genetic predisposition for it), ODD is almost always a socially-caused problem. Which means that solutions usually don't just involve the kid, they are best when they involve family therapy. That can be hard for a parent to hear, because they just want the monster child fixed. But often, it's partially the parent's/parents' attitudes toward the child (including seeing the kid as a monster) that have led to where things currently are in the family. The only time family therapy with the child wouldn't be recommended is when the family is so horriblizing and demonizing of the child that having them in the same room with the kid (to scapegoat, blame, and demonize the child further) would only make things worse. And even then, you still need family therapy, just with the family apart from the child for awhile until there has been some progress.
 
Okay, off that soap box. Without further ado, here is the "wakeup call" viral email, with my modifications, that I got today:
 

Dear God:
   
Why didn't you save the school children at?
 
Northern Illinois University
De Kalb, Illinois
 
Virginia Tech

Amish Country, PA
   
Columbine High School
   
Moses Lake , Washington 2/2/96
   
Bethel , Alaska 2/19/97
   
Pearl , Mississippi 10/1/97
   
West Paducah , Kentucky 12/1/97
   
Stam P, Arkansas 12/15/97
   
Jonesboro , Arkansas 3/24/98
   
Edinboro , Pennsylvania 4/24/98
   
Fayetteville , Tennessee 5/19/98
   
Springfield , Oregon 5/21/98
   
Richmond , Virginia 6/15/98
   
Littleton , Colorado 4/20/99
   
Taber , Alberta , Canada 5/28/99
   
Conyers , Georgia 5/20/99 

Deming , New Mexico 11/19/99
   
Fort Gibson , Oklahoma 12/6/99
   
Santee , California 3/ 5/01 and
   
El Cajon , California 3/22/01
   
Sincerely,
   
Concerned Student
   
-----------------------------------------------------
   
Reply:
   
Dear Concerned Student:
   
I am not allowed in schools.
   
Sincerely,
   
God
   
----------------------------------------------------------
   
How did this get started?...
   
-----------------
   
Let's see,
   
I think it started when Madeline Murray O'Hare complained
   
She didn't want any prayer in our schools.
   
And we said, OK...
   
------------------
   
Then,
   
Someone said you better not read the Bible in school,
   
The Bible that says
   
"Thou shalt! Not kill,
   
Thou shalt not steal,
   
And love your neighbors as yourself,"
   
And we said, OK...
   
-----------------
 
Our doctors said
 
It's okay
 
If we don't breastfeed our children
 
And there's no harm
 
In setting them
 
In front of a TV for hours
 
And putting them
 
In the care of strangers
 
 
And we found this counsel pleasing
 
Because it allowed us to pass off
 
Our children to someone else's care
 
So we can do what we want
 
And so we can have a larger house
 
Where we neither eat nor pray together
 
Where our families feel like
 
Strangers
 
And our children grow up
 
Without a sense
 
Of belonging
 
------------------ 
   
Dr. Benjamin Spock said
   
We shouldn't spank our children
   
when they misbehaved
   
because their little personalities
   
would be warped and we might damage their self-esteem.

 
And we said,
   
An expert should know what he's talking about.
   
So we won't spank them anymore...
   
------------------
   
Then someone said
   
Teachers and principals better not
   
Discipline our children when they misbehave.
   
And the school administrators said
   
No faculty member in this school
   
Better touch a student when they misbehave
   
Because we don't want any bad publicity,
   
And we surely don't want to be sued.
   
And we accepted their
Reasoning...  

------------------
     
And the entertainment industry said,
   
let's make TV shows and movies that promote
   
Profanity, violence and illicit sex...
   
And let's record music that encourages
   
Rape, drugs, murder, suicide, and satanic themes...
   
And we said,
   
it's just entertainment
   
And it has no adverse effect
   
And nobody takes it seriously anyway,
   
So go right ahead.
 
------------------ 
 
And when our children had no self-restraint
 
We took them to psychologists
 
Who diagnosed them with mental disorders
 
And prescribed drugs
 
So they would calm down
 
And be more
 
Manageable
 
But never learn
 
Self-control
   
------------------
   
Now we're asking ourselves
   
Why our children have no conscience,
   
Why they don't know right from wrong, 
   
And why it doesn't bother them to
   
Kill strangers, classmates or even themselves.
   
------------------
   
Undoubtedly,
   
If we thought about it long and hard enough,
   
We could figure it out.
   
I'm sure it has a great deal to do with...
   
"WE REAP WHAT WE SOW,"
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Building a Zion Society

I wish I could say more about the death of William F. Buckley, Jr. Back in high school when I was devouring Barry Goldwater's The Conscience of a Conservative and scouring the newspaper editorials in the Salt Lake Tribune each week for Pat Buchanan's cutting and rousing columns, Buckley was on my short list of people I liked to read. I stopped reading him when I went off to college, but I can say he helped me learn what it means to be a conservative.
 
So, hats off for Buckley.
 
On a totally different note, I have been looking at the housing market and noting that our town, Mt. Pleasant, is still a seller's market, while everywhere around here (except Nauvoo, Illinois) is still a buyer's market. Since it now appears pretty certain that I'll be working in Burlington, Iowa for awhile, I've been considering whether to move there to save $6k each year on driving expenses. Houses are much cheaper there, and there are SO many for sale right now. I could get a house half as expensive, with about the same quality. I'd just have to put up with living in a more dangerous city. But I could also get 20 acres of partially wooded farmland and build a $50k house on it, within 15 minutes of Burlington, for about the same price as my current house. Oh, the possibilities! I could finally fulfill my dream of getting to live on a semi-self-sustaining minifarm--all less than an hour of the Nauvoo Temple. In fact, I'd be closer than we are now. But when I get excited about those thoughts, a little voice inside reminds me of a parable my institute director read to me as a freshman at Pacific University in 1992: "Consecration, a Law We can Live With."
 
Which lead to me picking A Storyteller in Zion off our bookshelf this morning as I ate my breakfast, because whenever I think of making a big purchase, the parable I just mentioned, which also appears in that book, always seems to percolate into my consciousness. I've found the parable has been reprinted, with the author's permission, at nauvoo.com. So for any of you out there interested in building a Zion society, go on over and check it out.
 
It's good. It always seems to help me recheck my priorities when it comes to big purchases.
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What will Romney do for the middle-class

I have a friend from high school, that I think the world of, who recently asked me what Mitt Romney would do for the middle class. I'll answer it shortly. First, though, I need to point out that Mitt Romney isn't a Democrat, so he isn't trying to compete in the games of "let's see who can promise the most." If you play that game against Democrats, you'll always loose. Not only will you never be able (in good conscience) to promise more than they (because they are far more comfortable with saying what they will do with other people's money). But you will also lose eventually in your pocketbook too. That money has to come from somewhere.

While there are populists in the Republican party (nod to Mike Huckabee), the heart of conservativism is not to tell the people whatever they want to hear, nor to play to the little guy (the "have-nots") and engage in class warfare rhetoric. For example, when John McCain says that her served for patriotism, not for profit, he is taking a jab at Mitt Romney's success in private business--and at the rest of the business class that supports our economy. While it is a cheap way to get support from those don't see themselves as "have's," it shows a fundamental lack of understanding about what runs this economy. Specifically, for-profit market forces. And it is also deeply dishonest, since John McCain benefited from his father-in-law's for-profit business sense when he married his second [trophy] wife.

The heart of conservativism is to stand by principles (not go with where the wind is blowing or what the people demand) and lead through sound policy, including sound monetary policy. That means not spending more than you have (something George W. Bush did not do well), but instead building the economy when you want to improve the lot of the average citizen. This is called supply-side economics, and its something Ronald Reagan did well (hence the term Reaganomics), and recently Republicans have done not so well.

That said (so there isn't misunderstanding of what the goals are--not to give us as much as possible, but to actually make the economy and nation run better), here is what I see Mitt Romney offering the middle class:

1. He will fight to defeat radical Islamic jihadists.
Mitt Romney understands the enemy that we are against, and he understands why this conflict is so critical to win. He understands that these enemies do not want us to just come home and leave them alone, and that they don't want to make peace with us. He understands that surrendering in Iraq, or anywhere else, would only embolden them, just as did the defeat of the Soviet Union in Aftghanistan, and the retreat of American forces in Somalia. He understands that if we leave the Middle East, our enemies will seek us here. He understands that they will not even stop when they have destroyed our way of life--their goal is nothing short of a worldwide Islamic Caliphate. He understands that this is even a more serious threat than Nazism was in the last century. He will bring together nations who share our goals to help counter these enemies, and he will seek to avoid war where possible. He isn't a war hawk like John McCain, and he won't throw us needlessly or precipitously into armed conflict.

How does this help the middle class? We don't get our country taken away from us. If we fail in this conflict, little else matters.

2. He will fight to preserve our families, the sanctity of life, and the moral principles that make America great.
Mitt Romney is firmly pro-life, he came down on the side of life in every decision that faced him as governor of Massachusetts, and he will seek to win hearts and minds for the sanctity of life. He opposes judicial activism, and has vowed to nominate judges who will strictly interpret the Constitution. This will mean an overturning of Roe v. Wade, which will send the question of abortion back to the states. Currently we don't have enough votes to pass a Sanctity of Life amendment to the Constitution. He recognizes that--even if we did have enough votes, it would be years for the process of getting the measure through the state legislatures before it could be ratified. But he supports such an amendment, and will work to get America to support such an measure.

In Massachusetts he lead the fight to preserve traditional marriage. He supports a Defense of Marriage amendment, and would work to get it passed. He opposes the proliferation of pornography, violence, and filth on the internet and in public places, where it is easily accessed by children. He has lived a life of decency and integrity, and will bring sound moral principles to his governance.

How does this help the middle class? It gives us a decent country to live in, and preserves the foundations of civilized society. If we don't have that foundation, the state of the economy matters little.

3. He will grow the economy.
Mitt Romney understands the economy. After his clean, decent character, this is probably his strongest suit. Mitt Romney is a turnaround artist--he understands what makes organizations fail, what makes jobs come and go, what policies help to build confidence and growth. When he came to Massachusetts they faced a $3billion budget shortfall. He turned it around without raising taxes. He eliminated waste and redundancy, and tightened economic policy. He did a complete audit of the state's financials, the same as he has done when he has taken on a turnaround job with a business. And he vows to do the same thing in Washington.

Mitt has made economic proposals that would directly benefit the middle class. A couple include making the Bush tax cuts permanent, eliminating the death tax, and eliminating investment and savings taxes for people with incomes under $200,000. If you're a middle-class American, you probably understand that investment is one of the main differences between the us and the upper class. If we want to move up, it is usually going to have to be by saving more money than we make, and by putting that money to work through investments. Mitt Romney wants to encourage that, and in his America, the middle-class would be able to grow their retirement savings faster and grow their portfolios faster.

Looking at his economics stimulus package proposal also reveals how well he understands the economy. The proposals are more than the "rebate" checks proposed by the Congress--they are more detailed, and better targeted to the areas of the economy that would promote growth. Here's a link: Romney Economic Stimulus Package

How does all this help the middle class? Rather than just giving us handouts (which would add to the deficit without promoting as much growth), Mitt's plans for the economy would help it to grow larger, making it more secure for the future and giving more for everyone.

This is just a sampling of what makes Mitt the better candidate. I haven't talked about his success in bringing private health insurance to all citizens of Massachusetts, what he would do to improve our energy policies to bring down those costs, what he would do to strengthen the dollar so that oil and other imports are less expensive, etc. There is a lot to love about Mitt, and the more you learn about him, the more you like him. Unlike other candidates (I'm thinking especially of Rudy Guilliani) who got less support the more the electorate got to know him, Mitt's support tends to soar the more time he spends in a state, and the more people read up on who he is and what he has to offer.

This is a man who made hundreds of millions in the private sector. He could have made over a billion when he sold his interests in Bain Capital, but instead accepted a smaller pricetag (estimated to be 1/4 of its value) so that he would leave behind a company that was strong and would be able to continue to grow. He is a builder, not a taker. He understands profit, but he isn't in this (or anything else) for the money. He could be making his first billion right now instead of running for office, but he loves this country and wants to help it be the greatest nation on earth. He brings smarts and talent to the office of President unheard-of in recent elections, and we would be fools not to take full advantage of the opportunity to elect the best candidate for our highest office.

I encourage you to learn more about him, and make an informed choice. Besides the mittromney.com website, I would also recommend mymanmitt.com , evangelicalsformitt.com , and nyformitt.blogspot.com .

On this Super Tuesday, man the best Republican win.

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Cleaning the Nauvoo Temple

I have to admit, after seeing the obvious media stacking against Romney's wins in Michigan and Nevada (discounting both to say that they don't really mean much) and the obvious media stacking in favor of McCain and Huckabee gearing up for South Carolina and Florida, I just didn't have much of a desire to blog for the last two weeks.

Florida was a bit of a cliff-hanger, and I really thought the win might come through--until the panhandle returns started coming in. But that night I wasn't listening to my radio like I wanted to be doing. Instead, I was helping to clean the LDS Nauvoo Temple. And I'm glad I did, because it was a unique and meaningful experience, that put a lot into perspective for me. As I walked through the halls with my vaccuum backpack (I was assigned to do the hardwood floors and the stairs), I kept feeling as I walked into room after room, the enormous weight and importance of what goes on inside those rooms. I think I felt it most in the offices, like the Temple President's office and the Recorder's office, and the Celestial Room, where I found five (5!) bits of lint on the strip of hardwood ringing the room. There was nobody there to say, this way, move along. I just got to linger, and feel the weight of that sacred building.

Recently a couple from our branch was sealed in the large sealing room on the 5th floor,and I noticed the spiral stairscase going up into the bell tower. So when I got assigned to do stairs, I joked to the supervisor, "Does this mean I get to do the bell tower?" He didn't say anything. But as I worked my way up from the baptistry, my thoughts often went back to that spiral staircase. When I was almost done, I finished on that floor, and I still had 15 more minutes to go on my shift.

The supervisor had told us to snoop around (yes, those are their exact words) and look for things to clean, saying that anywhere we weren't supposed to go would be locked. I was thrilled to get to go into the Bride's room and the Children's Waiting Room. Along with the Celestial room, those were my favorite rooms in the Jordan River Temple when I went through its open house as a young boy. I have to say, they had an antique looking doll in the kid's waiting room that looked very breakable. And mega blocks. It's a very neat room. So yes, I did snoop around, and I think I took a look into every room that wasn't locked--except the one at the top of that spiral staircase.

I noted that it not only had stairs (my jurisdiction), but that the stairs were hardwood (also my jurisdiction!). I thought about going up them and looking for lint, but something said no. As I headed for the northwest corner stairs to go down, I thought again about going up the belltower stairs, but again the feeling came to me, No. So I went down, checking the hole way for bits of lint I had missed, and finding a few.

When I got down to the basement again, I was met by the nice lady who had given us our assignments, Sister Alberts. "Tom (the supervisor) was looking for you," she said. "He's going to show you the bell tower."
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Monty Python and the Republican Primaries

“One!”

“Two!”

“Five!”

“—Three, Sir.”

“Three!”

 

In the classic comedy of Monty Python’s Holy Grail, King Arthur entertains us with his consistent inability to count, and with his trusty squire Patsy needing to remind him, repeatedly, not to skip over three and four.

 

It’s a lot like the current primary races. Here, the “we’ll-make-the-news-not-report-it” media can’t seem to count up to the Florida primaries without skipping some of the contests. Did any of us hear about the Wyoming primaries that took place last Saturday, right before the New Hampshire primaries? Of course not. And when talking about which contests are coming up, we hear about Michigan and South Carolina, then on to Florida. But isn’t there another western state nestled in there? That’s right—it’s Nevada, which actually comes before S.C.

 

When the jostling for first position by the states was still going on, it was explained to us that most of the candidates would ignore Wyoming because it had jumped position an