Posts Tagged ‘ treatment ’

Moms, Stress, and Depression

Thursday, August 15th, 2013

Moms who have young kids have lots of sources of stress – including unavoidable rites of passage of parenthood (sleep deprivation), everyday hassles (just can’t fit in that shower), and new responsibilities on top of old ones (how exactly do you take care of everything you need to do when you have to take care of a 6-month-old?). There are countless other streams of stress – including big “macro” society conditions like the economic recession – that impinge on everyday life  and influence parenting. Now, you may be thinking – and this is a reaction I frequently encounter – that if stress is inevitable, why bother discussing it? 

Well, there are four reasons.

First, stress takes its toll on moms. One of the strongest predictors of depression is high levels of stress. Given that women in general are at high risk for depression – some studies suggest nearly 1 in 3 women will experience clinical depression – the additional stresses of being a mom can have serious consequences. And keep in mind that one of the reasons that depression can become such a problem is that is a recurrent condition – it tends to come back after it subsides.

Second, children of depressed parents are at very high risk for early-onset depression as well as other behavioral problems. The process can start as early as infancy, accelerate in toddlerhood, and result in increased depressive symptoms in childhood, culminating with onset of clinical depression in the teen years. Chronic stress has other negative effects on childhood development that can lead to increased risk for health problems later in life. And there is some evidence that severe stress during pregnancy can have adverse effects on fetal development and contribute to things like low birth weight.

While stress and depression are insidious and impairing, there is, without question, hope. The third reason to reflect on all this is that depression is treatable. There is no one treatment, so it’s important to give yourself enough time to find the right mix of psychotherapy and/or pharmacology (antidepressants). The reality is that you can get a handle on depression and also lessen the risk of future depressive episodes with effective treatment.

Which leads to a fourth reason to talk about stress and depression – when moms get treated successfully, their kids improve as well. There have been large-scale studies showing that these positive effects can be long lasting, and include reductions in both child symptoms and actual diagnoses of depression and other disorders in the offspring. Other more fine-grained studies have shown how child symptoms of depression “mirror” parental levels – and when parental symptoms lessen with treatment, so do their kids’ symptoms. Note that no intervention needs to be done directly with the kids to gain a benefit – the effect comes simply from successfully treating the parent.

So, moms who are under lots of stress and feel like they are depressed should become aware of the symptoms of depression - and seek out well-qualified treatment. Doing this not only helps moms, but directly improves the lives of their kids.

Depressed Woman via

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5 Reasons Why Kids Don’t Get Mental Health Services

Monday, February 4th, 2013

Whether it’s autism, ADHD, anxiety, depression, or other mental health concerns, we know that rates keep rising. We also know that not nearly enough kids get the help they need. 

I’ve identified 5 barriers that make it tough for parents to get help for their kids:

Awareness: It’s important for parents to know the signs and signals of different disorders. All kids run around, may not always stay still, may not always pay attention. What’s the difference between that and warning signs of ADHD? How can you tell if a toddler is just somewhat unusual socially, versus showing early signs of autism? Early identification is critical because it is the first step of the process. Leaning on websites such as those offered by the Centers for Disease Control and Prevention and the National Institutes of Health can help. But these can be tough to sort through as well. Here are two examples of blog posts I’ve written to help promote awareness:

Recognizing ADHD Symptoms in Your Child

The 7 Early Signs of Autism Spectrum Disorder That Every Parent Should Know

Acceptance: Once a potential problem has been identified, it can be very tough for a parent to accept it. It’s natural to want it to just go away. But getting past that thinking is critical because you are the catalyst for helping your child take on the problem area.

Referral: Accepting that help is available is important – but finding that help can be challenging. You’ll need to network with your pediatrician and other professionals to get routed in the right direction. Word of mouth via other parents is always helpful because they’ve navigated the system.

Cost: You will need to be prepared to work with your insurance and your provider to get help for your kid. By “work” I mean investing time and energy and being persistent and asking everyone to be creative. It may also mean smiling a lot and being pleasant – and kicking up a storm when necessary. It’s your kid, they should get help.

Compliance: Once all these barriers have been taken on, you will find a long road ahead. It’s tough on you, it’s tough on your kids. It’s time and effort and possibly a fair amount of travel. It will take time away from other things. But it’s your kid, and the more effort you put in, the better. The one thing that sinks the process, more than anything else, is when parents and kids stop showing up.

Mental Health via


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Recognizing ADHD Symptoms In Your Child

Wednesday, August 15th, 2012

It can be very difficult to recognize the symptoms of ADHD in your child. You can certainly reference reputable and helpful sites (here’s one example from the National Institutes of Health) that list the common symptoms. But when you go through the list – fidgeting, can’t sit still, interrupting, being easily distracted, having trouble following directions, not able to wait for a turn – you might conclude that all young kids do these things. And to a degree, you would be right. 

To give parents a better sense of how clinicians approach ADHD, I spoke with Dr. Steven Kurtz, who is the Senior Director of the ADHD and Disruptive Behavior Disorders Center at the Child Mind Institute. Here are some key take-home messages that I derived from my conversation with him.

Dr. Kurtz agreed that many kids can show the behaviors associated with ADHD. However, kids with ADHD demonstrate these behaviors with much more frequency and intensity than other kids – in fact they show about 3 times the intensity and frequency. So there is a matter of degree here. Kids with ADHD also have a consistent pattern of demonstrating this higher frequency and intensity – these behaviors can be regularly observed in the home as well as in school. To give a better sense of what the behavior of kids with ADHD might look like, Dr. Kurtz gave me the following examples at different ages.

Imagine a 4-year-old being on a platform to the monkey bars at a playground, seeing another child walk by on the ground with a big ice cream cone, and literally walking off the platform without looking to take the ice cream (and getting a trip to the ER in the process).

Imagine circle time at school with the teacher reminding all the children to stay on their bottoms (“criss cross applesauce”) and having to address the one 5-year-old who scurries into the middle of the circle to grab the materials – which happens day after day, well after others have learned the “simple” skill of waiting.

Imagine being the 2nd grader whose teacher – even in April – has to tell you where the “Do Now” work goes, when others learned that in September, and feeling like you are hearing it for the first time.

Unless you have observed lots of children, it may be difficult for you to determine if the frequency and intensity of your child’s behavior may be a signal to be evaluated for ADHD. That is why it is helpful to consider the impressions of teachers, who see lots of kids on a daily basis. Keep in mind that only licensed clinicians are able to make a formal diagnosis of ADHD – so if a teacher (or teachers) make the suggestion to you, you should consider it seriously and talk to your pediatrician and school about potential recommendations for a professional evaluation.

The primary reason to seek out an evaluation is that kids with ADHD show evidence of impairment – these behaviors have negative consequences for them and interfere with their functioning. (Just re-read the examples above to prove the point). Kids with ADHD struggle with day-to-day things – especially in school – and can also experience problems with peers (as things like not being able to take turns can affect social interaction). A comprehensive evaluation will help provide a full picture of a child – their behavior at home as well as in school. Since kids with ADHD can show a variety of the symptoms (there is no one typical profile) and don’t always show signs of ADHD, the focus will be on assessing those symptoms that indicate increased frequency, intensity, and impairment. It’s also critical to keep in mind that kids with ADHD are not just “misbehaving” or suffer from a lack of good parenting. Rather, the idea is that they have difficulties coordinating their attention and directing their behavior (and the root of this is assumed to be biological in origin). Dr. Kurtz refers to this as “attention modulation disorder” – they often pay attention to the wrong things. The goal is to set up a treatment program that can help parents (and teachers) aid kids with ADHD to direct their attention to the right things. And while medication is helpful for some kids, a key element is to utilize behavioral therapy that will provide many practical ways to help shape a kid’s attention and behavior.

Kids with ADHD who do not receive interventions often go on to experience many difficulties down the road in school. The typical window for reliably seeing the first signs of ADHD is now believed to be between 4 and 7 years of age. Dr. Kurtz suggests that the average parent will wait 2 years after ADHD is suspected before seeking an evaluation, which he believes is akin to digging a deeper and deeper trench for a child. All that said, keep in mind that 3-7% of kids will be diagnosed with ADHD – that’s a lot of kids, but really the vast majority of kids do not have ADHD according to clinical diagnostic guidelines. If you suspect your child might have ADHD, the idea of the evaluation is to decide on a plan. In some cases, that might only involve tracking behavior closely over time – in others, some type of immediate treatment plan may be suggested.

There is no doubt that recognizing ADHD symptoms is not easy. Keeping in mind some of these tips may at least give you a framework for viewing your child’s behavior and development over time, and for interpreting the feedback of others. Being vigilant about these observations and having a good dialogue with your pediatrician and school may help you understand if you may need to seek out an evaluation.

ADHD graphic via

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Is ADHD On The Rise? Part Three: What Parents Should Keep In Mind

Wednesday, August 31st, 2011

This is the last of three “Q and A” sessions I’m conducting (with myself) to sort through the complex issues raised by the recent suggestion that ADHD is on the rise, and now thought to affect nearly 1 in 10 kids.

If ADHD is more common than ever, does that mean that all kids with ADHD are getting diagnosed?

Not necessarily. Many kids are not properly assessed and diagnosed by appropriate clinicians. Remember, for a child to be diagnosed, that child will either have to be referred for assessment (e.g., by a school) or the parent(s) will have to seek out a professional opinion. There are undoubtedly many children who have symptoms of ADHD, but do not get a full diagnostic screening. So if a parent thinks their child is showing signs of ADHD, or if they are told by a teacher that they should consider that possibility, the most important thing to do is work with either their pediatrician or school to get a referral to a qualified team of professionals who can perform a comprehensive screening.

Why is is “comprehensive screening” necessary? What does that mean?

Just because a child is showing evidence of ADHD, there could be a number of things going on clinically. There could be, for example, an underlying learning disorder, or other medical conditions. Ideally a team of professionals will conduct a complete assessment to rule out other possibilities.

But what if the screening concludes that a child has ADHD? What happens next?

There are lots of things to consider clinically. ADHD comes in a variety of forms — some kids can have, for example, just problems in paying attention without showing hyperactivity. It’s also important to determine the level of severity (it can range from mild to severe) and how much it interferes with behavior at home and in school. The diagnosis itself isn’t the most important thing — the key issue is to figure out the nature of the problem behaviors so a plan can be made to change them.

That means medication, right?

Not necessarily. Although medication helps a number of children, there are also behavioral methods that are effective and should be considered as well. It can depend on the type and severity of symptoms, which is why assessment is so important.

Last question. Aren’t all kids inattentive and hyperactive? Why label kids?

The clinical issue is when kids are much more inattentive and/or hyperactive than most other kids their age and gender — and especially if they are showing problems with school work or functioning at home. The diagnostic procedure is a way of determining if children are showing impairment and could profit from intervention, so that a plan can be made to make their life easier and help them do as well as they can in school.

Read the Previous Posts in the Series “Is ADHD On the Rise?”:

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