Morning Question # 9 Is Substance abuse or mental illness first?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Hands with pills

Addiction.
Photo courtesy of Pixabay

Does Substance abuse or mental illness occur first?

Both can be first, depends on the person. People who have early symptoms of mental illness are at high risk of developing substance abuse disorders. People who begin abusing substances early in life are more likely to develop mental illness. It may be hard for many people to remember a time before they had one or the other so it is hard to tell sometimes. I like to start by asking how old someone was when they first began to use drugs and alcohol and then ask what life was like before the drugs or alcohol. Some people can’t remember a time before one or both.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

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Caustic Bath Salts Kill

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

New drugs

Bath salts.
Photo courtesy of Pixabay.com

Calling these things bath salts is fiction if I ever heard a fanciful tale.

There are also called plant foods. No one I know of is putting this stuff in water and plants that get this stuff aren’t long for this world. What these so-called “bath salts” do is put people in the hospital emergency room. Sometimes they are fatal.

By calling them bath salts or plant food and putting a notice on the label that says “not intended for human consumption” the manufacturers and sellers of these products are getting around the Controlled Substances Act. These products are often found in head shops and boutiques along with glass pipes and “body detox” products. That the sellers know what people will do with these products is clear.

There are no specific ingredients for these products and manufacturers keep changing their formula to keep ahead of the laws. In the process, one key ingredient is becoming the dominant one. Most of the bath salts contain Methcathinone in one form or another.

Don’t confuse Methcathinone with Methamphetamine or Methadone. Pseudoephedrine is a precursor for both Methcathinone and Methamphetamine but the similarities don’t go much farther than that.

Dr. Smith of the Cookeville (Tennessee) Regional Medical Center wrote a two-part series on bath salts recently which appeared in the drugfree.org newsletter. He reports that the effects of Methcathinone are like those of Ecstasy (MDMA) in the early stages but as time goes on the effects become more like Methamphetamine. While Methcathinone was a rare event in the past Dr. Smith reports that he regularly sees people in the emergency room as a result of bath salts.

Methcathinone is a synthetic version of Khat which I mentioned in my recent post 7 New drugs Parents should be aware of.

The effects Dr. Smith reported seeing in the ER from bath salt users included sweating, high body temperature, high blood pressure, low thirst, paranoia, hallucinations, seizures, violence and self-injurious behavior, including suicidal thoughts and actions.

Deaths have been reported as a result of smoking bath salts, but how common this is, remains unknown. Most toxicology screens are not intended to pick up these rapidly changing synthetic chemicals and they are probably being under-reported.

A further concern is that people who buy their drugs in head shops are consuming an ever-increasing number of synthetic chemicals. The belief here, especially among teens is that since they are being sold legally they are safe or relatively safe. Most young people have no sense of the amount of risk they are taking by using these products.

Adding to their popularity is the belief, not always correctly, that these products will not show on a drug test and therefore are not going to cause any problems.

The American Academy of Pediatrics (AAP) has issued a report to physicians on spotting the side effects from smoking synthetic drugs. These drugs, particularly “synthetic marijuana” or synthetic cannabinoids resulted in over 4,500 calls to poison control centers in the United States in a one year period.

Among the reported symptoms of high levels of synthetic cannabinoids are agitation, excess sweating and inability to speak.

The sale and use of synthetic recreational drugs, both bath salts, and synthetic marijuana, is an evolving problem which is currently poorly recognized or treated.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Why ignoring them doesn’t work- or does it?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Bad behavior.
Photo courtesy of pixabay

8 rules for extinguishing bad behavior – Part 4 in our changing others series.

Parenting coaches tell parents to ignore bad behavior. They call this process “extinguishing.” They warn that paying too much attention to the child who is misbehaving only rewards them and increases the targeted behavior. Professional’s tell parents to use extinguishing a lot. Many parents say it doesn’t work. Why?

Parents hate it when their child throws a tantrum. They try lots of things to make the kid stop. Fresh from the therapist, they decide to take the professionals advice. The kid starts to scream. They ignore him. Eventually, he has to stop right? Four hours later the parents give up on the extinguishing method as their child is still screaming.

Rule 1: Bad behaviors are likely to get worse before they get better.

Most parents give up before the bad behavior ends. Kids can be a whole lot more stubborn than most parents. Isn’t it the reasonable person in a relationship that ends up giving in to the unreasonable one?

Rule 2: Kids will pick a place for their bad behaviors were you don’t want to make a scene.

If you chose to try to extinguish a bad behavior, in the early stages avoid places where you won’t be able to stick to your guns. Taking the kid with you to the store is sure to result in a tantrum in the early stages. It is easier to extinguish bad behavior at home than at the in-laws.

Rule 3: While extinguishing a bad behavior, make sure to reward any behavior change.

Just make sure not to fall into the bribe trap by offering positive rewards for stopping the bad behavior. We all have urges to do something positive to distract the misbehaving person, but if the distraction comes to close to the bad behavior it looks like the bad behavior got the reward. Wait till the child stops the tantrum for twenty seconds or so and then reward them for stopping.

Rule 4: Be sure you are not extinguishing a desired behavior.

A child crying can be annoying at times but they should cry when in pain. Make sure you check that there is no legitimate reason for the “bad” behavior before you decide to try ignoring it and play your “extinguishing” game.

Rule 5: If you want to stop something you need to always stop it.

Of and on actions are called intermittent reinforcement. But out food once for a wild animal and it will come back for a while until it is convinced that there will be no food. But if you feed it off and on it will keep coming back almost forever. People are like that also. If you want to extinguish a bad behavior, don’t give in, not even once. If you are not consistent the person you are trying to change won’t know which answer to expect and they will keep trying forever.

Rule 6: This is not a one-person job.

If one person in the home tries to extinguish a behavior but the rest of the family gives in it will not work. Make sure all the people who might reinforce the bad behavior are on board with the effort to extinguish the bad behavior.

Rule 7: There will be ups and downs.

Bad behavior that has been extinguished may return after a time. Why shouldn’t a child, or adult for that matter, try something again that had worked in the past. The person who has lost the advantage of their previously useful bad behavior is also likely to get frustrated. Sometimes they even get aggressive or violent. A tantruming child who is ignored long enough, may up the ante and come over and hit you. Consider how you will respond if the aggression increases.

Rule 8: Good behavior extinguishes also.

Good behavior that is not reinforced will start to fade quickly. While trying to get someone to cut down on or stop bad behaviors, you need to keep praising good actions or the good things stop also.

Our series on changing other people’s behavior focused here mostly on children is about to change direction. We talked about getting more good behavior and we have talked about how to reduce or stop an undesirable or bad behavior. But what do you do when the behavior you want from someone is a whole new action? How do you get them to start doing something they have never done before?

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Rewards gone wild

Need to change

Time for you to make a change?
Photo courtesy of Pixabay.com

Changing others part 3.

By David Joel Miller.

Sometimes positive reinforcement goes wild. Instead of increasing desirable positive behaviors, positive reinforcement incorrectly applied can create more negative behaviors. Let’s look at some examples.

It is Super Bowl Sunday. Dad wants to watch the game. The kids who are bored to death start getting loud and thrashing around. Dad decides to get this to stop and gives the kids some money and sends them to the store. They don’t interrupt the big game. But then over time, something begins to happen. Dad notices that now every time he wants to watch a game on T. V., the kids get loud and rambunctious. He brings them to the therapist because they are “disrespectful.” What has gone wrong?

It is way too easy to positively reinforce bad behavior. Once you reward bad behavior it begins to expand. Often we do this without noticing that this is what we have done.

Another example. The child, in the store, begins to wine. Mom is getting tired and so she decides she has had enough. She leaves the store and goes home. The problem of whiny kid solved, for now. But over the years mom notices she has a very whiny kid. She can no longer go anywhere the child does not want to go or the whining begins. Another example of how a quick response to a misbehaving child can result in positively reinforcing a bad behavior.

A more adult example. Dad can’t find his keys. He is late for work. He begins to swear and yell. Mom goes running and helps dad find the keys. Problem solved for today. But over time if mom runs every time dad is frustrated and yells, dad will yell and swear more. Mom is unknowingly training dad to yell and swear. Sometimes these case end up in counseling. More of them should. After a while, we start to believe that it is others that are making us mad and of course when mad we should vent our frustration. Anger management classes which include cognitive behavioral methods may be needed to break the cycle of anger, yelling and swear words.

But it can get worse. Even if you do not reinforce bad behavior in your child other people may. I worked with one client who had older sisters. They lived in a poor part of town where there were lots of gangs. They used to dress their little brother up like a gang banger. At three it looked “cute” when he reached thirteen and became a real gang banger they were surprised. They shouldn’t have been. They had positively reinforced his looking like and acting like a gang member so much it was natural for him to become one.

This is one reason it worries me when people dress little girls in sexy or “trampy” outfits. Then when she gets to be a teen they try to clamp down on her clothes and behavior. She has been so thoroughly positively reinforced for acting in a sexualized manner why would she change? Besides she is not home now for you to change her behavior. She is out on an overnight date with that “cute” gang banger.

But other people, sometimes with good intentions, also undo our efforts to help children. A child who is shy and feels lonely often begins to avoid others and hide in the corner. So all the staff starts going over to talk to the child. Soon the child is getting lots of attention, which is what the child wanted. So does the child come out of their shell and start being less shy? Not on your life. All that attention for the “shy behaviors” was so completely positively reinforced that the shyness increases.  The right approach would have been for all staff to have watched the child and when they looked over to smile. Positively reinforce any outgoing behavior no matter how small and it might increase. But one staff member can unintentionally undo the work of all the others. So in the home how often do family members, knowingly or unintentionally undo the change efforts of the rest of the family?

It is very important that all the adults in a child’s life be on the same page when it comes to behavior modification. It is also important to be consistent.

Here is hoping that this series is helping you in your efforts to change both yourself and those around you. More to come.

For more on the process of change see the blog post series “Stages of Change

There is also a series of posts on helping others change, under the heading of “Changing Others.” and “Creating the Change you need.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Treatment for teen’s risky behavior

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Teens

Teenagers.
Photo courtesy of Pixabay.com

An amazing discovery in the treatment of risky teen behavior was reported over the last several weeks. It went largely unnoticed by most mainstream media.

Furthermore, one single treatment has been shown to have high efficacy in treating teen risky behavior. It is extremely inexpensive and can be obtained and applied without a prescription. The treatment, while often resisted by teens with high-risk behaviors, has been shown to not only be effective under a wide range of conditions but to treat a large number of undesirable teen behaviors at a very minimal expense.

In a startling report, two researchers for the Center for Disease Control in Atlanta Georgia found after studying data for over 12,00 U. S. high school students that a single deficiency coexisted with a huge increase in teens risky behavior. While the government report was reluctant to say that this deficiency was the cause of risky teen behavior, they speculate that this one key ingredient might reduce overall risk-taking in teens significantly.

Unfortunate this key ingredient cannot be prescribed directly because it is not USDA approved for over the counter sales and is, in fact, available without a prescription. This one single item, not yet patented by a drug company, is available to almost all U. S.citizens for free.

High School students who were deficient in this one key item, and almost 70 percent of our teens were deficient, were almost two times more likely to be smokers. A continued deficiency if this ingredient, reported being necessary for happiness, resulted in a 50% increase in marijuana and alcohol use.

Long-term deficiencies in this factor were correlated with a huge increase in teen sexual activity. That was surprising since we most often have studied added factors that might cause an increase in sexual activity. Not many people would believe that a deficiency in a single ingredient necessary for life might increase the sexual activity of teens.

But wait – there is more, this deficiency doubled the risk for a suicide attempt. It was also related to getting into physical fights and being sad and hopeless. Kids who had this deficiency were also likely to be overweight, get less exercise and generally have a less healthy lifestyle.

So what was this deficiency? And how can we supplement teen’s lives to overcome this insufficiency?

The deficiency was a lack of sleep! Sleep deprivation was significant in kids with all these problems. And the one simple cure was more sleep!

Now teens will resist sleeping more, especially sleeping during the night. It appears that most teens are truly nocturnal creatures. More than one adolescent who was brought in to the psychiatric facility has confided to me that they rarely get much sleep at night. An increasing number of kids have T. V.’s and computers in their bedrooms. Many are online texting friends or playing games until close to morning. They have to set alarm clocks to wake up and even then they often can’t quite get it together in the morning.

Eventually, a teen who stays up most of the night finds they can’t function in the daytime. They are at risk to fall asleep at school, cut class or just plain be grouchy and get into fights and other negative behavior.

So it just might be that one thing a parent might do to improve their teen’s life is to make sure that child is getting enough sleep, even if that means restricting electronic avoidance of sleep.

Be careful if you teen has been avoiding sleep on a regular basis. If you suddenly try to take away their electronic addiction your teen may go into electronic withdrawal. During withdrawal from electronic sleep avoidance teens have been known to become grouchy, throw things break things, swear or even threaten to harm themselves or others. In extreme cases, you may need professional help to get the teen back on a night-time sleep schedule. But if your teen is having difficulties in life you just might want to examine their sleep habits and see if more sleep might improve their mood and behavior.

More sleep might improve your mood and emotions also. What do you think?

Till next time. David Joel Miller, LMFT, LPCC

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

6 Rules for surviving your teen

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Teens

Teenagers.
Photo courtesy of Pixabay.com

When the teen years rival armed combat how do you survive your teen unharmed?

Sometime between eleven and thirteen that cute cuddly kid turns into an unrecognizable scratching clawing creature. Once in a while, the parent gets away unharmed but not often.  Parents say they don’t know what happened to their child. They don’t recognize this kid. So what happened?

How do you survive the teen years and is there a life after teens? Here are some ideas; maybe we could call then rules for those years.

1. Don’t try to hold the lid on the boiling pot.

You have spent a decade on more raising a generally civilized child, as the teen years approach and the emotions boil parents often make the mistake of clamping down. Suddenly the cute little daughter who everyone likes – well – the everyone’s who like her, are no one you would want around. The result is trying to keep her in. “No dating till you’re thirty,” the parent says. Then the battle ensues. Parents try bolting the windows in her room shut, but like a magician, she somehow gets out. Parents put kids on monitoring. Call me every hour. The kids retaliate with more excuses than a congressman.

Controlling a teen, especially an older one by force is likely to wear you out and have no effect. Sometimes parents efforts to make the kid behave turn into violence. Sometimes the parent resorts to hitting the child, always a bad idea. You may discover you no longer have it in you to go ten rounds with a younger and stronger opponent. I have seen parents seriously hurt by their kids. The other, more serious problem with using force on a child is it teaches them to use force and there is no end to how far this will go. So rather than trying to keep the steam in the kettle by holding the lid down, try directing the steam where you want it to go.

As the teen approves adulthood parents may need to learn to discuss and even negotiate things with their offspring. I am not saying let the kids take over the house, but you do need to teach them how to handle more adult responsibilities. By sixteen or seventeen you should have taught your child the difference between right and wrong. If you haven’t it is probably too late and someone with more control than you will need to take on the job, someone like the police or parole. You need to keep up hope that the child will survive, unharmed, the episode of moral amnesia that so many of them experience.

2. Do not try to overprotect them!

You spent ten or more year protecting your child, every “good enough parent” does. Suddenly the experts tell you to stop trying to protect them. I know they will be sixty and you will still feel protective towards them but the teen years are the time for loosening the restrictions, not tightening them. You had to let them ride their bike without your hand on the seat, now you need to let them try some more adult things.

Every night in crisis centers around America we see kids whose parents have always been supportive or permissive, who suddenly engage in a life or death struggle for control with their teen. Kids who had no curfew now chaff as the parents set limits.  Parents worry about drugs, alcohol, driving and mostly sex. They try to keep their kids safe by keeping them away from the risks – that won’t work.

One day they will turn eighteen and then they will be allowed to make all their own decisions. Some kids start before that. There is no magic cloak of maturity you can give them on that occasion.  You need to begin now teaching them how to be responsible adults and one way they learn that is to try things and see what works and what doesn’t. Increasing rules and restrictions may feel like it is protecting your child but it may also be delaying the growth of maturity.

3. Notice when your child does something right.

Many kids report the only time their parents notice them is when they are correcting them. Constantly finding fault with teens is not likely to make them perfect. It often results in kids who are highly anxious, afraid to do anything because they are sure they will never be able to do it right, or you get kids who give up trying. If the only way to get your attention is to mess up, they will mess up on a daily basis. They are after all giving you what you are requesting. You will get more of whatever you attend to.

Now I am not suggestion hollow praise here. Kids can see right through praise that was given to increase self-esteem but which they see as just something everyone is able to do. What I am suggesting is that you need to pay close enough attention to your child to know when they do something noteworthy and then let them know that you noticed and approved of that.

4. Be their parents, not their friend.

Kids should be kids and parents should be parents. Sharing your drugs with your child does not make for a good relationship. It makes for a child who does not know how to observe boundaries. And even worse are the parents who flop back and forth. Once day you want to be the kids best friend, maybe even keep a secret from the rest of the family, the next they come down on the kid with all their force because the kid is not doing what they want.

5. Know the difference between rewards and punishments and bribes and abuse.

Lots of people in our society don’t seem to know this one. From the way we see celebrities and politicians acting you would think they are the same thing. They are not.

Rewards and punishment should be directly related to the person’s actions. For adults, this is easy to explain. If I show up for work on time and do my job I get a check. If I am late, I get docked some pay. If I keep coming in late I may lose my job. Parents get this confused and send the child to their room for getting bad grades. Bad grades should get more study time. Going to your room should be a punishment for not behaving around others. See there is some connection between the two.

Do I need to say that some of the punishments I see require me to report the parent to child protective services? Don’t ever let the punishment get out of proportion to the action. When it does it can turn into abuse. This is especially true of physical punishment and name calling. Calling your child stupid will not improve their grades; it will make many of them stop trying.

6 Pick your battles

Parents, especially of late teens begin to get desperate. Time is running out to teach your child how to behave, especially if you have a strong feeling they should behave exactly the way you want them to. So every day becomes a battleground. The chances that your child will turn out perfectly are not especially good. They all have their flaws. So do their parents.  Unless you really like to fight, day and night, I suggest you reserve your line in the sand efforts for the really big things. Which is more troublesome, your teen’s messy room or their drug habit?

Like all advice, these rules are easier to say than to do. My hope is that this is helpful to someone out there. If you have comments or suggestions please comment on this blog.

So there you have them, 6 rules for surviving your teen.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

ADHD Cure- – Treat Parents

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Sad child

ADHD?
Photo courtesy of Pixabay.com

Could we cure ADHD or depression in children, especially preschool children, by treating the parents?

Just read a report that concluded that the epidemic of ADHD in preschool children can be very effectively treated by training the parents in Parent Behavioral Therapy (PBT). This raised a lot of questions. Why the increase in ADHD? Why in Preschool children? And most importantly how could treating the parents – cure the children?

The Press Release about the report by the McMasters Center can be found here. 

The McMasters center report suggested a different way of viewing ADHD and the older ADD. As I understand their concept they are convinced there is one larger umbrella disorder – Disruptive Behavior Disorder meaning the kid is doing things or not doing things that cause the adults problems.  This more general description, which is a recognized diagnosis in the DSM-4-TR they then subdivide and refine into ADHD in all its varieties, Optional Defiant Disorder and finally the most severe form Conduct Disorder.

This makes sense to me since most of the referrals for ADHD screening begin with things like – he won’t stay in his seat, is not doing his work etc. These are complaints teachers and parents have, not things a child, especially a preschool child would complain about. Hence the child’s behavior disrupts an adult’s life and the diagnosis. They report that this disorder began with the label of “minimal brain damage” but when no one could find the specific brain damage we dropped that label.

Further, the study says that ADHD should be thought of as a spectrum disorder. So it might vary from no problem, through milder forms to “for sure you got it” forms. This like so many other mental illnesses is not a case of you got it or you don’t but rather how much of this disorder do you have. Also, there is no medical test for ADHD. We use screening tests and other ways of diagnosing this but the truth is who gets the diagnosis depends on who does the diagnosing.

So why an increase in ADHD cases in preschool children?

Calling them preschool children does not mean that they do not attend school. ADHD and related problems first began to be recognized about 1902 when most children on earth began to attend mandatory universal education.  Now a large number of children are attending preschool – hence lots of preschool age children are attending school. The report on effective ADHD treatments included all children under six in the preschool group. They especially noted that at this age it is difficult to separate the effects of a condition like ADHD from normal maturation.

I think young children – by definition are immature, so we don’t diagnose “too young” as a condition unless they don’t act like we want them to then they have some kind of disruptive behavior disorder. Some countries in Europe have children wait until they are at least six to start school on the premise that before six they are too immature to benefit from school. In America, we go the other way and start them out at age two or three on the premise that the younger we start pushing them the sooner they will grow up.

So who gets diagnosed with ADHD?

Most new diagnoses of ADHD occur when children begin to attend some form of formal education and are asked to sit still and concentrate on things the adults want them to learn instead of the things kids want to learn. The majority of diagnoses are made between the ages of five and ten years of age. Diagnoses of ADHD after the six grade drop sharply and those first diagnosed after age eighteen are even rarer.

The majority of those diagnosed are boys. In fact, boys in the primary grades are four times more likely to get the diagnoses than anyone else. In my own experience, the time’s children are more likely to get referred for assessment for ADHD are when they first start school, preschool, kindergarten or first grade. The next big surge in referrals is between the third and fourth grade when there is a shift from learning to read to reading to learn, and the poor readers get really bored.

The number of adult cases is half of those in children, so either a lot of people outgrow this condition with or without treatment or it is not so much of a problem once you are out of required school.  Or maybe a lot of kids get the diagnosis because they are bugging someone in the position to make a diagnosis.

The poor, especially those on Medicaid are much more likely to be diagnosed, but the rich (higher Socio-economic status) are much more likely to receive medication. The poor are more likely to stop taking meds after one prescription. For much the same reasons the poor are much more likely to drop out of parenting education programs.

When meds work for someone it is wonderful, unfortunately, the only way to see if a med will work for you or your child is to try it and there are side effects to worry about. Note that any meds may have side effects but some are worse than others.

In very young children – under the age of six, treatment with a stimulant ADHD med is likely to reduce the ADHD symptoms, but it increases the depression and other mood symptoms. Or maybe the sadness was always there but it becomes more noticeable when the child is able to sit still. The meds also suppress growth, something that a forty-year-old who is overweight might hope for – but not something we want to see in a child under six. And there is another problem.

In one well-documented study children who took a placebo – a non-active pill – did almost as well on managing their ADHD as children who took the real med. When the meds were stopped, 97.5 % of the kids on ADHD meds did not have a relapse, pretty impressive. But of the kids on a placebo who were treated with nothing resembling a drug other than the pill form it was given in, well a full 88% of these non-medicated kids did not relapse either. The conclusion here could be that the thing that helped the kids was the extra attention involved in treatment, not the medication.

Now, why not just send all these kids for therapy? Well as much as that helps some kids, and remember I am a therapist, there is a limitation on therapy. We see the kid for one hour a week. What happens the other 167 hours? So when parents take a class in Parent Behavioral Therapy or work with the therapist on how to help their child, they are able to maintain the treatment all week not just in the therapy hour.

Now if your child is on meds, please do not suddenly take them off, talk to your child’s doctor or psychiatrist first. But for very young children consider approaches other than medication.

The moral of this story? The more we adults work on our skills the more we can help kids with ADHD, with or without medication. So if your child has ADHD or depression or any other emotional problem, consider participating in therapy and learning new skills that might help your child.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.