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Lynne
www.lynnekenney.com
Monday, April 6, 2009
Wednesday, March 25, 2009
What is PANDAS?
PANDAS, is an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.
The term is used to describe a subset of children who have Obsessive Compulsive Disorder (OCD) and/or tic disorders such as Tourette's Syndrome, and in whom symptoms worsen following strep. infections such as "Strep throat" and Scarlet Fever.
The children usually have dramatic, "overnight" onset of symptoms, including motor or vocal tics, obsessions, and/or compulsions. In addition to these symptoms, children may also become moody, irritable or show concerns about separating from parents or loved ones. This abrupt onset is generally preceeded by a Strep. throat infection.
What is the mechanism behind this phenomenon? At present, it is unknown but researchers at the NIMH are pursuing a theory that the mechanism is similar to that of Rheumatic Fever, an autoimmune disorder triggered by strep. throat infections. In every bacterial infection, the body produces antibodies against the invading bacteria, and the antibodies help eliminate the bacteria from the body. However in Rheumatic Fever, the antibodies mistakenly recognize and "attack" the heart valves, joints, and/or certain parts of the brain. This phenomenon is called "molecular mimicry", which means that proteins on the cell wall of the strep. bacteria are similar in some way to the proteins of the heart valve, joints, or brain. Because the antibodies set off an immune reaction which damages those tissues, the child with Rheumatic Fever can get heart disease (especially mitral valve regurgitation), arthritis, and/or abnormal movements known as Sydenham’s Chorea or St. Vitus Dance.
In PANDAS, it is believed that something very similar to Sydenham’s Chorea occurs. One part of the brain that is affected in PANDAS is the Basal Ganglia, which is believed to be responsible for movement and behavior. Thus, the antibodies interact with the brain to cause tics and/or OCD, instead of Sydenham Chorea.
Frequently Asked Questions
Q. Is there a test for PANDAS?
A. No. The diagnosis of PANDAS is a clinical diagnosis, which means that there are no lab tests that can diagnose PANDAS. Instead clinicians use 5 diagnostic criteria for the diagnosis of PANDAS (see below). At the present time the clinical features of the illness are the only means of determining whether or not a child might have PANDAS.
Q. What are the diagnostic criteria for PANDAS?
A. They are:
1. Presence of Obsessive-compulsive disorder and/or a tic disorder
2. Pediatric onset of symptoms (age 3 years to puberty)
3. Episodic course of symptom severity
4. Association with group A Beta-hemolytic streptococcal infection (a positive throat culture for strep. or history of Scarlet Fever.)
5. Association with neurological abnormalities (motoric hyperactivity, or adventitious movements, such as choreiform movements)
Q. What is an episodic course of symptoms?
A. Children with PANDAS seem to have dramatic ups and downs in their OCD and/or tic severity. Tics or OCD which are almost always present at a relatively consistent level do not represent an episodic course. Many kids with OCD or tics have good days and bad days, or even good weeks and bad weeks. However, patients with PANDAS have a very sudden onset or worsening of their symptoms, followed by a slow, gradual improvement. If they get another strep. infection, their symptoms suddenly worsen again. The increased symptom severity usually persists for at least several weeks, but may last for several months or longer. The tics or OCD then seem to gradually fade away, and the children often enjoy a few weeks or several months without problems. When they have another strep. throat infection the tics or OCD return just as suddenly and dramatically as they did previously.
Q. Are there any other symptoms associated with PANDAS episodes?
A. Yes. Children with PANDAS often experience one or more of the following symptoms in conjunction with their OCD and/or tics:
1. ADHD symptoms (hyperactivity, inattention, fidgety)
2. Separation anxiety (Child is "clingy" and has difficulty separating from his/her caregivers. For example, the child may not want to be in a different room in the house from his/her parents.)
3. Mood changes (irritability, sadness, emotional lability)
4. Sleep disturbance
5. Night- time bed wetting and/or day- time urinary frequency
6. Fine/gross motor changes (e.g. changes in handwriting)
7. Joint pains
Q. My child has had strep. throat before, and he has tics and/or OCD. Does that mean he has PANDAS?
A. No. Many children have OCD and/or tics, and almost all school aged children get strep. throat at some point in their lives. In fact, the average grade-school student will have 2 – 3 strep. throat infections each year. PANDAS is considered when there is a very close relationship between the abrupt onset or worsening or OCD and/or tics, and a preceding strep. infection. If strep. is found in conjunction with two or three episodes of OCD/tics, then it may be that the child has PANDAS.
Q. Could an adult have PANDAS?
A. No. By definition, PANDAS is a pediatric disorder. It is possible that adolescents and adults may have immune mediated OCD, but this is not known. The research studies at the NIMH are restricted to children.
Q. My child has PANDAS. Should he have his tonsils removed?
A. The NIH does not recommend tonsillectomies for children with PANDAS, as there is no evidence that they are helpful. If a tonsillectomy is recommended because of frequent episodes of tonsillitis, it would be useful to discuss the pros and cons of the procedure with your child’s doctor, because of the role that the tonsils play in fighting strep. infections.
Q. What exactly is an anti-streptococcal antibody titer?
A. The anti-streptococcal antibody titer determines whether there is immunologic evidence of a previous strep. infection. Two different strep. tests are commercially available: the antistrepolysin O (ASO) titer, which rises 3-6 weeks after a strep. infection, and the antistreptococcal DNAase B (AntiDNAse-B) titer, which rises 6-8 weeks after a strep. infection.
Q. What does an elevated anti-streptococcal antibody titer mean? Is this bad for my child?
A. An elevated anti-strep. titer (such as ASO or AntiDNAse-B) means the child has had a strep. infection sometime within the past few months, and his body created antibodies to fight the strep. bacteria. Some children create lots of antibodies and have very high titers (up to 2,000), while others have more modest elevations. The height of the titer elevation doesn’t matter. Further, elevated titers are not a bad thing. They are measuring a normal, healthy response – the production of antibodies to fight off an infection. The antibodies stay in the body for some time after the infection is gone, but the amount of time that the antibodies persist varies greatly between different individuals. Some children have "positive" antibody titers for many months after a single infection.
Q. When is a strep. titer considered to be abnormal, or "elevated"?
A. The lab at NIH considers strep. titers between 0-400 to be normal. Other labs set the upper limit at 150 or 200. Since each lab measures titers in different ways, it is important to know the range used by the laboratory where the test was done – just ask where they draw the line between negative or positive titers.
It is important to note that some grade-school aged children have chronically "elevated" titers. These may actually be in the normal range for that child, as there is a lot of individual variability in titer values. Because of this variability, doctors will often draw a titer when the child is sick, or shortly thereafter, and then draw another titer several weeks later to see if the titer is "rising" – if so, this is strong evidence that the illness was due to strep. (Of course, a less expensive way to make this determination is to take a throat culture at the time that the child is ill.)
Q. Should an elevated strep. titer be treated with antibiotics?
A. No. Elevated titers indicate that a patient has had a past strep. exposure but the titers can not tell you precisely when the strep. infection occurred. Children may have "positive" titers for many months after one infection. Since these elevated titers are merely a marker of a prior infection and not proof of an ongoing infection it is not appropriate to give antibiotics for elevated titers. Antibiotics are recommended only when a child has a positive rapid strep. test or positive strep. throat culture.
Q. What are the treatment options for children with PANDAS?
A. The treatments for children with PANDAS are the same as if they had other types of OCD or tic disorders. Children with OCD, regardless of whether or not their illness is strep. triggered, benefit from cognitive behavioral therapy and/or anti-obsessional medications. A recent study showed that the combination of an SSRI medication (such as fluoxetine) and cognitive behavioral therapy was the best treatment for OCD, and that medication alone or cognitive behavioral therapy alone were better than no treatment, or use of a placebo (sugar pill). It often takes time for these treatments to work, so the sooner therapy is started, the better it is for the child.
Children with strep. triggered tics should be helped by the same tic medications that doctors use to treat other tic disorders. Your child’s primary physician can help you decide which type of specialist your child may need to see to receive these treatments.
Q. Can penicillin be used to treat PANDAS or prevent future PANDAS symptom exacerbations?
A. Penicillin and other antibiotics kill streptococcus and other types of bacteria. The antibiotics treat the sore throat or pharyngitis caused by the strep. by getting rid of the bacteria. However, in PANDAS, it appears that antibodies produced by the body in response to the strep. infection are the cause of the problem, not the bacteria themselves. Therefore one could not expect antibiotics such as penicillin to treat the symptoms of PANDAS. Researchers at the NIMH have been investigating the use of antibiotics as a form of prophylaxis or prevention of future problems. At this time, however, there isn’t enough evidence to recommend the long-term use of antibiotics.
Q. What about treating PANDAS with plasma exchange or immunoglobulin (IVIG)?
A. The results of a controlled trial of plasma exchange (also known as plasmapheresis) and immunoglobulin (IVIG) for the treatment of children in the PANDAS subgroup was published in "The Lancet", Vol. 354, October 2, 1999. All of the children participating in the study had clear evidence of a strep infection as the trigger of their OCD and tics, and all were severely ill at the time of treatment. The study showed that plasma exchange and IVIG were both effective for the treatment of severe, strep. triggered OCD and tics, and that there were persistent benefits of the interventions. However, there were a number of side-effects associated with the treatments, including nausea, vomiting, headaches and dizziness. In addition, there is a risk of infection with any invasive procedure, such as these. Thus, the treatments should be reserved for severely ill patients, and administered by a qualified team of health care professionals. The NIH is not currently conducting any trials with immunomodulatory therapies, and so is not able to offer either or the treatments.
Of note, a separate study was conducted to evaluate the effectiveness of plasma exchange in the treatment of chronic OCD (Nicolson et al: An Open Trial of Plasma Exchange in Childhood Onset Obsessive-compulsive Disorder Without Poststreptococcal Exacerbations. "J Am Acad Child Adolesc Psychiatry 2000," 39[10]: 1313-1315. None of those children benefited, suggesting that plasma exchange or IVIG is not helpful for children who do not have strep. triggered OCD or tics. Source NIH.
The term is used to describe a subset of children who have Obsessive Compulsive Disorder (OCD) and/or tic disorders such as Tourette's Syndrome, and in whom symptoms worsen following strep. infections such as "Strep throat" and Scarlet Fever.
The children usually have dramatic, "overnight" onset of symptoms, including motor or vocal tics, obsessions, and/or compulsions. In addition to these symptoms, children may also become moody, irritable or show concerns about separating from parents or loved ones. This abrupt onset is generally preceeded by a Strep. throat infection.
What is the mechanism behind this phenomenon? At present, it is unknown but researchers at the NIMH are pursuing a theory that the mechanism is similar to that of Rheumatic Fever, an autoimmune disorder triggered by strep. throat infections. In every bacterial infection, the body produces antibodies against the invading bacteria, and the antibodies help eliminate the bacteria from the body. However in Rheumatic Fever, the antibodies mistakenly recognize and "attack" the heart valves, joints, and/or certain parts of the brain. This phenomenon is called "molecular mimicry", which means that proteins on the cell wall of the strep. bacteria are similar in some way to the proteins of the heart valve, joints, or brain. Because the antibodies set off an immune reaction which damages those tissues, the child with Rheumatic Fever can get heart disease (especially mitral valve regurgitation), arthritis, and/or abnormal movements known as Sydenham’s Chorea or St. Vitus Dance.
In PANDAS, it is believed that something very similar to Sydenham’s Chorea occurs. One part of the brain that is affected in PANDAS is the Basal Ganglia, which is believed to be responsible for movement and behavior. Thus, the antibodies interact with the brain to cause tics and/or OCD, instead of Sydenham Chorea.
Frequently Asked Questions
Q. Is there a test for PANDAS?
A. No. The diagnosis of PANDAS is a clinical diagnosis, which means that there are no lab tests that can diagnose PANDAS. Instead clinicians use 5 diagnostic criteria for the diagnosis of PANDAS (see below). At the present time the clinical features of the illness are the only means of determining whether or not a child might have PANDAS.
Q. What are the diagnostic criteria for PANDAS?
A. They are:
1. Presence of Obsessive-compulsive disorder and/or a tic disorder
2. Pediatric onset of symptoms (age 3 years to puberty)
3. Episodic course of symptom severity
4. Association with group A Beta-hemolytic streptococcal infection (a positive throat culture for strep. or history of Scarlet Fever.)
5. Association with neurological abnormalities (motoric hyperactivity, or adventitious movements, such as choreiform movements)
Q. What is an episodic course of symptoms?
A. Children with PANDAS seem to have dramatic ups and downs in their OCD and/or tic severity. Tics or OCD which are almost always present at a relatively consistent level do not represent an episodic course. Many kids with OCD or tics have good days and bad days, or even good weeks and bad weeks. However, patients with PANDAS have a very sudden onset or worsening of their symptoms, followed by a slow, gradual improvement. If they get another strep. infection, their symptoms suddenly worsen again. The increased symptom severity usually persists for at least several weeks, but may last for several months or longer. The tics or OCD then seem to gradually fade away, and the children often enjoy a few weeks or several months without problems. When they have another strep. throat infection the tics or OCD return just as suddenly and dramatically as they did previously.
Q. Are there any other symptoms associated with PANDAS episodes?
A. Yes. Children with PANDAS often experience one or more of the following symptoms in conjunction with their OCD and/or tics:
1. ADHD symptoms (hyperactivity, inattention, fidgety)
2. Separation anxiety (Child is "clingy" and has difficulty separating from his/her caregivers. For example, the child may not want to be in a different room in the house from his/her parents.)
3. Mood changes (irritability, sadness, emotional lability)
4. Sleep disturbance
5. Night- time bed wetting and/or day- time urinary frequency
6. Fine/gross motor changes (e.g. changes in handwriting)
7. Joint pains
Q. My child has had strep. throat before, and he has tics and/or OCD. Does that mean he has PANDAS?
A. No. Many children have OCD and/or tics, and almost all school aged children get strep. throat at some point in their lives. In fact, the average grade-school student will have 2 – 3 strep. throat infections each year. PANDAS is considered when there is a very close relationship between the abrupt onset or worsening or OCD and/or tics, and a preceding strep. infection. If strep. is found in conjunction with two or three episodes of OCD/tics, then it may be that the child has PANDAS.
Q. Could an adult have PANDAS?
A. No. By definition, PANDAS is a pediatric disorder. It is possible that adolescents and adults may have immune mediated OCD, but this is not known. The research studies at the NIMH are restricted to children.
Q. My child has PANDAS. Should he have his tonsils removed?
A. The NIH does not recommend tonsillectomies for children with PANDAS, as there is no evidence that they are helpful. If a tonsillectomy is recommended because of frequent episodes of tonsillitis, it would be useful to discuss the pros and cons of the procedure with your child’s doctor, because of the role that the tonsils play in fighting strep. infections.
Q. What exactly is an anti-streptococcal antibody titer?
A. The anti-streptococcal antibody titer determines whether there is immunologic evidence of a previous strep. infection. Two different strep. tests are commercially available: the antistrepolysin O (ASO) titer, which rises 3-6 weeks after a strep. infection, and the antistreptococcal DNAase B (AntiDNAse-B) titer, which rises 6-8 weeks after a strep. infection.
Q. What does an elevated anti-streptococcal antibody titer mean? Is this bad for my child?
A. An elevated anti-strep. titer (such as ASO or AntiDNAse-B) means the child has had a strep. infection sometime within the past few months, and his body created antibodies to fight the strep. bacteria. Some children create lots of antibodies and have very high titers (up to 2,000), while others have more modest elevations. The height of the titer elevation doesn’t matter. Further, elevated titers are not a bad thing. They are measuring a normal, healthy response – the production of antibodies to fight off an infection. The antibodies stay in the body for some time after the infection is gone, but the amount of time that the antibodies persist varies greatly between different individuals. Some children have "positive" antibody titers for many months after a single infection.
Q. When is a strep. titer considered to be abnormal, or "elevated"?
A. The lab at NIH considers strep. titers between 0-400 to be normal. Other labs set the upper limit at 150 or 200. Since each lab measures titers in different ways, it is important to know the range used by the laboratory where the test was done – just ask where they draw the line between negative or positive titers.
It is important to note that some grade-school aged children have chronically "elevated" titers. These may actually be in the normal range for that child, as there is a lot of individual variability in titer values. Because of this variability, doctors will often draw a titer when the child is sick, or shortly thereafter, and then draw another titer several weeks later to see if the titer is "rising" – if so, this is strong evidence that the illness was due to strep. (Of course, a less expensive way to make this determination is to take a throat culture at the time that the child is ill.)
Q. Should an elevated strep. titer be treated with antibiotics?
A. No. Elevated titers indicate that a patient has had a past strep. exposure but the titers can not tell you precisely when the strep. infection occurred. Children may have "positive" titers for many months after one infection. Since these elevated titers are merely a marker of a prior infection and not proof of an ongoing infection it is not appropriate to give antibiotics for elevated titers. Antibiotics are recommended only when a child has a positive rapid strep. test or positive strep. throat culture.
Q. What are the treatment options for children with PANDAS?
A. The treatments for children with PANDAS are the same as if they had other types of OCD or tic disorders. Children with OCD, regardless of whether or not their illness is strep. triggered, benefit from cognitive behavioral therapy and/or anti-obsessional medications. A recent study showed that the combination of an SSRI medication (such as fluoxetine) and cognitive behavioral therapy was the best treatment for OCD, and that medication alone or cognitive behavioral therapy alone were better than no treatment, or use of a placebo (sugar pill). It often takes time for these treatments to work, so the sooner therapy is started, the better it is for the child.
Children with strep. triggered tics should be helped by the same tic medications that doctors use to treat other tic disorders. Your child’s primary physician can help you decide which type of specialist your child may need to see to receive these treatments.
Q. Can penicillin be used to treat PANDAS or prevent future PANDAS symptom exacerbations?
A. Penicillin and other antibiotics kill streptococcus and other types of bacteria. The antibiotics treat the sore throat or pharyngitis caused by the strep. by getting rid of the bacteria. However, in PANDAS, it appears that antibodies produced by the body in response to the strep. infection are the cause of the problem, not the bacteria themselves. Therefore one could not expect antibiotics such as penicillin to treat the symptoms of PANDAS. Researchers at the NIMH have been investigating the use of antibiotics as a form of prophylaxis or prevention of future problems. At this time, however, there isn’t enough evidence to recommend the long-term use of antibiotics.
Q. What about treating PANDAS with plasma exchange or immunoglobulin (IVIG)?
A. The results of a controlled trial of plasma exchange (also known as plasmapheresis) and immunoglobulin (IVIG) for the treatment of children in the PANDAS subgroup was published in "The Lancet", Vol. 354, October 2, 1999. All of the children participating in the study had clear evidence of a strep infection as the trigger of their OCD and tics, and all were severely ill at the time of treatment. The study showed that plasma exchange and IVIG were both effective for the treatment of severe, strep. triggered OCD and tics, and that there were persistent benefits of the interventions. However, there were a number of side-effects associated with the treatments, including nausea, vomiting, headaches and dizziness. In addition, there is a risk of infection with any invasive procedure, such as these. Thus, the treatments should be reserved for severely ill patients, and administered by a qualified team of health care professionals. The NIH is not currently conducting any trials with immunomodulatory therapies, and so is not able to offer either or the treatments.
Of note, a separate study was conducted to evaluate the effectiveness of plasma exchange in the treatment of chronic OCD (Nicolson et al: An Open Trial of Plasma Exchange in Childhood Onset Obsessive-compulsive Disorder Without Poststreptococcal Exacerbations. "J Am Acad Child Adolesc Psychiatry 2000," 39[10]: 1313-1315. None of those children benefited, suggesting that plasma exchange or IVIG is not helpful for children who do not have strep. triggered OCD or tics. Source NIH.
What is Tourette syndrome
Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in 1885 first described the condition in an 86-year-old French noblewoman.
The early symptoms of TS are almost always noticed first in childhood, with the average onset between the ages of 7 and 10 years. TS occurs in people from all ethnic groups; males are affected about three to four times more often than females. It is estimated that 200,000 Americans have the most severe form of TS, and as many as one in 100 exhibit milder and less complex symptoms such as chronic motor or vocal tics or transient tics of childhood. Although TS can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood.
What are the symptoms?
Tics are classified as either simple or complex. Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. Some of the more common simple tics include eye blinking and other vision irregularities, facial grimacing, shoulder shrugging, and head or shoulder jerking. Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting sounds. Complex tics are distinct, coordinated patterns of movements involving several muscle groups. Complex motor tics might include facial grimacing combined with a head twist and a shoulder shrug. Other complex motor tics may actually appear purposeful, including sniffing or touching objects, hopping, jumping, bending, or twisting. Simple vocal tics may include throat-clearing, sniffing/snorting, grunting, or barking. More complex vocal tics include words or phrases. Perhaps the most dramatic and disabling tics include motor movements that result in self-harm such as punching oneself in the face or vocal tics including coprolalia (uttering swear words) or echolalia (repeating the words or phrases of others). Some tics are preceded by an urge or sensation in the affected muscle group, commonly called a premonitory urge. Some with TS will describe a need to complete a tic in a certain way or a certain number of times in order to relieve the urge or decrease the sensation.
Tics are often worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can trigger or worsen tics, for example tight collars may trigger neck tics, or hearing another person sniff or throat-clear may trigger similar sounds. Tics do not go away during sleep but are often significantly diminished.
What is the course of TS?
Tics come and go over time, varying in type, frequency, location, and severity. The first symptoms usually occur in the head and neck area and may progress to include muscles of the trunk and extremities. Motor tics generally precede the development of vocal tics and simple tics often precede complex tics. Most patients experience peak tic severity before the mid-teen years with improvement for the majority of patients in the late teen years and early adulthood. Approximately 10 percent of those affected have a progressive or disabling course that lasts into adulthood.
Can people with TS control their tics?
Although the symptoms of TS are involuntary, some people can sometimes suppress, camouflage, or otherwise manage their tics in an effort to minimize their impact on functioning. However, people with TS often report a substantial buildup in tension when suppressing their tics to the point where they feel that the tic must be expressed. Tics in response to an environmental trigger can appear to be voluntary or purposeful but are not.
What causes TS?
Although the cause of TS is unknown, current research points to abnormalities in certain brain regions (including the basal ganglia, frontal lobes, and cortex), the circuits that interconnect these regions, and the neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication among nerve cells. Given the often complex presentation of TS, the cause of the disorder is likely to be equally complex.
What disorders are associated with TS?
Many with TS experience additional neurobehavioral problems including inattention; hyperactivity and impulsivity (attention deficit hyperactivity disorder—ADHD) and related problems with reading, writing, and arithmetic; and obsessive-compulsive symptoms such as intrusive thoughts/worries and repetitive behaviors. For example, worries about dirt and germs may be associated with repetitive hand-washing, and concerns about bad things happening may be associated with ritualistic behaviors such as counting, repeating, or ordering and arranging. People with TS have also reported problems with depression or anxiety disorders, as well as other difficulties with living, that may or may not be directly related to TS. Given the range of potential complications, people with TS are best served by receiving medical care that provides a comprehensive treatment plan.
How is TS diagnosed?
TS is a diagnosis that doctors make after verifying that the patient has had both motor and vocal tics for at least 1 year. The existence of other neurological or psychiatric conditions[1] can also help doctors arrive at a diagnosis. Common tics are not often misdiagnosed by knowledgeable clinicians. But atypical symptoms or atypical presentation (for example, onset of symptoms in adulthood) may require specific specialty expertise for diagnosis. There are no blood or laboratory tests needed for diagnosis, but neuroimaging studies, such as magnetic resonance imaging (MRI), computerized tomography (CT), and electroencephalogram (EEG) scans, or certain blood tests may be used to rule out other conditions that might be confused with TS.
It is not uncommon for patients to obtain a formal diagnosis of TS only after symptoms have been present for some time. The reasons for this are many. For families and physicians unfamiliar with TS, mild and even moderate tic symptoms may be considered inconsequential, part of a developmental phase, or the result of another condition. For example, parents may think that eye blinking is related to vision problems or that sniffing is related to seasonal allergies. Many patients are self-diagnosed after they, their parents, other relatives, or friends read or hear about TS from others.
[1] These include childhood-onset involuntary movement disorders such as dystonia, or psychiatric disorders characterized by repetitive behaviors/movements (for example, stereotypic behaviors in autism and compulsive behaviors in obsessive-compulsive disorder — OCD).
How is TS treated?
Because tic symptoms do not often cause impairment, the majority of people with TS require no medication for tic suppression. However, effective medications are available for those whose symptoms interfere with functioning. Neuroleptics are the most consistently useful medications for tic suppression; a number are available but some are more effective than others (for example, haloperidol and pimozide). Unfortunately, there is no one medication that is helpful to all people with TS, nor does any medication completely eliminate symptoms. In addition, all medications have side effects. Most neuroleptic side effects can be managed by initiating treatment slowly and reducing the dose when side effects occur. The most common side effects of neuroleptics include sedation, weight gain, and cognitive dulling. Neurological side effects such as tremor, dystonic reactions (twisting movements or postures), parkinsonian-like symptoms, and other dyskinetic (involuntary) movements are less common and are readily managed with dose reduction. Discontinuing neuroleptics after long-term use must be done slowly to avoid rebound increases in tics and withdrawal dyskinesias. One form of withdrawal dyskinesia called tardive dykinesia is a movement disorder distinct from TS that may result from the chronic use of neuroleptics. The risk of this side effect can be reduced by using lower doses of neuroleptics for shorter periods of time.
Other medications may also be useful for reducing tic severity, but most have not been as extensively studied or shown to be as consistently useful as neuroleptics. Additional medications with demonstrated efficacy include alpha-adrenergic agonists such as clonidine and guanfacine. These medications are used primarily for hypertension but are also used in the treatment of tics. The most common side effect from these medications that precludes their use is sedation.
Effective medications are also available to treat some of the associated neurobehavioral disorders that can occur in patients with TS. Recent research shows that stimulant medications such as methylphenidate and dextroamphetamine can lessen ADHD symptoms in people with TS without causing tics to become more severe. However, the product labeling for stimulants currently contraindicates the use of these drugs in children with tics/TS and those with a family history of tics. Scientists hope that future studies will include a thorough discussion of the risks and benefits of stimulants in those with TS or a family history of TS and will clarify this issue. For obsessive-compulsive symptoms that significantly disrupt daily functioning, the serotonin reuptake inhibitors (clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline) have been proven effective in some patients.
Psychotherapy may also be helpful. Although psychological problems do not cause TS, such problems may result from TS. Psychotherapy can help the person with TS better cope with the disorder and deal with the secondary social and emotional problems that sometimes occur. More recently, specific behavioral treatments that include awareness training and competing response training, such as voluntarily moving in response to a premonitory urge, have shown effectiveness in small controlled trials. Larger and more definitive NIH-funded studies are underway.
Is TS inherited?
Evidence from twin and family studies suggests that TS is an inherited disorder. Although early family studies suggested an autosomal dominant mode of inheritance (an autosomal dominant disorder is one in which only one copy of the defective gene, inherited from one parent, is necessary to produce the disorder), more recent studies suggest that the pattern of inheritance is much more complex. Although there may be a few genes with substantial effects, it is also possible that many genes with smaller effects and environmental factors may play a role in the development of TS. Genetic studies also suggest that some forms of ADHD and OCD are genetically related to TS, but there is less evidence for a genetic relationship between TS and other neurobehavioral problems that commonly co-occur with TS. It is important for families to understand that genetic predisposition may not necessarily result in full-blown TS; instead, it may express itself as a milder tic disorder or as obsessive-compulsive behaviors. It is also possible that the gene-carrying offspring will not develop any TS symptoms.
The sex of the person also plays an important role in TS gene expression. At-risk males are more likely to have tics and at-risk females are more likely to have obsessive-compulsive symptoms.
People with TS may have genetic risks for other neurobehavioral disorders such as depression or substance abuse. Genetic counseling of individuals with TS should include a full review of all potentially hereditary conditions in the family.
What is the prognosis?
Although there is no cure for TS, the condition in many individuals improves in the late teens and early 20s. As a result, some may actually become symptom-free or no longer need medication for tic suppression. Although the disorder is generally lifelong and chronic, it is not a degenerative condition. Individuals with TS have a normal life expectancy. TS does not impair intelligence. Although tic symptoms tend to decrease with age, it is possible that neurobehavioral disorders such as depression, panic attacks, mood swings, and antisocial behaviors can persist and cause impairment in adult life.
What is the best educational setting for children with TS?
Although students with TS often function well in the regular classroom, ADHD, learning disabilities, obsessive-compulsive symptoms, and frequent tics can greatly interfere with academic performance or social adjustment. After a comprehensive assessment, students should be placed in an educational setting that meets their individual needs. Students may require tutoring, smaller or special classes, and in some cases special schools.
All students with TS need a tolerant and compassionate setting that both encourages them to work to their full potential and is flexible enough to accommodate their special needs. This setting may include a private study area, exams outside the regular classroom, or even oral exams when the child's symptoms interfere with his or her ability to write. Untimed testing reduces stress for students with TS.
What research is being done?
Within the Federal government, the leading supporter of research on TS and other neurological disorders is the National Institute of Neurological Disorders and Stroke (NINDS). The NINDS, a part of the National Institutes of Health (NIH), is responsible for supporting and conducting research on the brain and central nervous system.
NINDS sponsors research on TS both in its laboratories at the NIH and through grants to major medical institutions across the country. The National Institute of Mental Health, the National Center for Research Resources, the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders also support research of relevance to TS. And another component of the Department of Health and Human Services, the Centers for Disease Control and Prevention, funds professional education programs as well as TS research.
Knowledge about TS comes from studies across a number of medical and scientific disciplines, including genetics, neuroimaging, neuropathology, clinical trials (medication and non-medication), epidemiology, neurophysiology, neuroimmunology, and descriptive/diagnostic clinical science.
Genetic studies. Currently, NIH-funded investigators are conducting a variety of large-scale genetic studies. Rapid advances in the technology of gene finding will allow for genome-wide screening approaches in TS, and finding a gene or genes for TS would be a major step toward understanding genetic risk factors. In addition, understanding the genetics of TS genes will strengthen clinical diagnosis, improve genetic counseling, lead to the clarification of pathophysiology, and provide clues for more effective therapies.
Neuroimaging studies. Within the past 5 years, advances in imaging technology and an increase in trained investigators have led to an increasing use of novel and powerful techniques to identify brain regions, circuitry, and neurochemical factors important in TS and related conditions.
Neuropathology. Within the past 5 years, there has been an increase in the number and quality of donated postmortem brains from TS patients available for research purposes. This increase, coupled with advances in neuropathological techniques, has led to initial findings with implications for neuroimaging studies and animal models of TS.
Clinical trials. A number of clinical trials in TS have recently been completed or are currently underway. These include studies of stimulant treatment of ADHD in TS and behavioral treatments for reducing tic severity in children and adults. Smaller trials of novel approaches to treatment such as dopamine agonist and GABAergic medications also show promise.
Epidemiology and clinical science. Careful epidemiological studies now estimate the prevalence of TS to be substantially higher than previously thought with a wider range of clinical severity. Furthermore, clinical studies are providing new findings regarding TS and co-existing conditions. These include subtyping studies of TS and OCD, an examination of the link between ADHD and learning problems in children with TS, a new appreciation of sensory tics, and the role of co-existing disorders in rage attacks. One of the most important and controversial areas of TS science involves the relationship between TS and autoimmune brain injury associated with group A beta-hemolytic streptococcal infections or other infectious processes. There are a number of epidemiological and clinical investigations currently underway in this intriguing area.
"Tourette Syndrome Fact Sheet", NINDS. Publication date April 2005.
NIH Publication No. 05-2163
Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient's medical history.
All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.
Last updated January 25, 2006
The early symptoms of TS are almost always noticed first in childhood, with the average onset between the ages of 7 and 10 years. TS occurs in people from all ethnic groups; males are affected about three to four times more often than females. It is estimated that 200,000 Americans have the most severe form of TS, and as many as one in 100 exhibit milder and less complex symptoms such as chronic motor or vocal tics or transient tics of childhood. Although TS can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood.
What are the symptoms?
Tics are classified as either simple or complex. Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. Some of the more common simple tics include eye blinking and other vision irregularities, facial grimacing, shoulder shrugging, and head or shoulder jerking. Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting sounds. Complex tics are distinct, coordinated patterns of movements involving several muscle groups. Complex motor tics might include facial grimacing combined with a head twist and a shoulder shrug. Other complex motor tics may actually appear purposeful, including sniffing or touching objects, hopping, jumping, bending, or twisting. Simple vocal tics may include throat-clearing, sniffing/snorting, grunting, or barking. More complex vocal tics include words or phrases. Perhaps the most dramatic and disabling tics include motor movements that result in self-harm such as punching oneself in the face or vocal tics including coprolalia (uttering swear words) or echolalia (repeating the words or phrases of others). Some tics are preceded by an urge or sensation in the affected muscle group, commonly called a premonitory urge. Some with TS will describe a need to complete a tic in a certain way or a certain number of times in order to relieve the urge or decrease the sensation.
Tics are often worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can trigger or worsen tics, for example tight collars may trigger neck tics, or hearing another person sniff or throat-clear may trigger similar sounds. Tics do not go away during sleep but are often significantly diminished.
What is the course of TS?
Tics come and go over time, varying in type, frequency, location, and severity. The first symptoms usually occur in the head and neck area and may progress to include muscles of the trunk and extremities. Motor tics generally precede the development of vocal tics and simple tics often precede complex tics. Most patients experience peak tic severity before the mid-teen years with improvement for the majority of patients in the late teen years and early adulthood. Approximately 10 percent of those affected have a progressive or disabling course that lasts into adulthood.
Can people with TS control their tics?
Although the symptoms of TS are involuntary, some people can sometimes suppress, camouflage, or otherwise manage their tics in an effort to minimize their impact on functioning. However, people with TS often report a substantial buildup in tension when suppressing their tics to the point where they feel that the tic must be expressed. Tics in response to an environmental trigger can appear to be voluntary or purposeful but are not.
What causes TS?
Although the cause of TS is unknown, current research points to abnormalities in certain brain regions (including the basal ganglia, frontal lobes, and cortex), the circuits that interconnect these regions, and the neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication among nerve cells. Given the often complex presentation of TS, the cause of the disorder is likely to be equally complex.
What disorders are associated with TS?
Many with TS experience additional neurobehavioral problems including inattention; hyperactivity and impulsivity (attention deficit hyperactivity disorder—ADHD) and related problems with reading, writing, and arithmetic; and obsessive-compulsive symptoms such as intrusive thoughts/worries and repetitive behaviors. For example, worries about dirt and germs may be associated with repetitive hand-washing, and concerns about bad things happening may be associated with ritualistic behaviors such as counting, repeating, or ordering and arranging. People with TS have also reported problems with depression or anxiety disorders, as well as other difficulties with living, that may or may not be directly related to TS. Given the range of potential complications, people with TS are best served by receiving medical care that provides a comprehensive treatment plan.
How is TS diagnosed?
TS is a diagnosis that doctors make after verifying that the patient has had both motor and vocal tics for at least 1 year. The existence of other neurological or psychiatric conditions[1] can also help doctors arrive at a diagnosis. Common tics are not often misdiagnosed by knowledgeable clinicians. But atypical symptoms or atypical presentation (for example, onset of symptoms in adulthood) may require specific specialty expertise for diagnosis. There are no blood or laboratory tests needed for diagnosis, but neuroimaging studies, such as magnetic resonance imaging (MRI), computerized tomography (CT), and electroencephalogram (EEG) scans, or certain blood tests may be used to rule out other conditions that might be confused with TS.
It is not uncommon for patients to obtain a formal diagnosis of TS only after symptoms have been present for some time. The reasons for this are many. For families and physicians unfamiliar with TS, mild and even moderate tic symptoms may be considered inconsequential, part of a developmental phase, or the result of another condition. For example, parents may think that eye blinking is related to vision problems or that sniffing is related to seasonal allergies. Many patients are self-diagnosed after they, their parents, other relatives, or friends read or hear about TS from others.
[1] These include childhood-onset involuntary movement disorders such as dystonia, or psychiatric disorders characterized by repetitive behaviors/movements (for example, stereotypic behaviors in autism and compulsive behaviors in obsessive-compulsive disorder — OCD).
How is TS treated?
Because tic symptoms do not often cause impairment, the majority of people with TS require no medication for tic suppression. However, effective medications are available for those whose symptoms interfere with functioning. Neuroleptics are the most consistently useful medications for tic suppression; a number are available but some are more effective than others (for example, haloperidol and pimozide). Unfortunately, there is no one medication that is helpful to all people with TS, nor does any medication completely eliminate symptoms. In addition, all medications have side effects. Most neuroleptic side effects can be managed by initiating treatment slowly and reducing the dose when side effects occur. The most common side effects of neuroleptics include sedation, weight gain, and cognitive dulling. Neurological side effects such as tremor, dystonic reactions (twisting movements or postures), parkinsonian-like symptoms, and other dyskinetic (involuntary) movements are less common and are readily managed with dose reduction. Discontinuing neuroleptics after long-term use must be done slowly to avoid rebound increases in tics and withdrawal dyskinesias. One form of withdrawal dyskinesia called tardive dykinesia is a movement disorder distinct from TS that may result from the chronic use of neuroleptics. The risk of this side effect can be reduced by using lower doses of neuroleptics for shorter periods of time.
Other medications may also be useful for reducing tic severity, but most have not been as extensively studied or shown to be as consistently useful as neuroleptics. Additional medications with demonstrated efficacy include alpha-adrenergic agonists such as clonidine and guanfacine. These medications are used primarily for hypertension but are also used in the treatment of tics. The most common side effect from these medications that precludes their use is sedation.
Effective medications are also available to treat some of the associated neurobehavioral disorders that can occur in patients with TS. Recent research shows that stimulant medications such as methylphenidate and dextroamphetamine can lessen ADHD symptoms in people with TS without causing tics to become more severe. However, the product labeling for stimulants currently contraindicates the use of these drugs in children with tics/TS and those with a family history of tics. Scientists hope that future studies will include a thorough discussion of the risks and benefits of stimulants in those with TS or a family history of TS and will clarify this issue. For obsessive-compulsive symptoms that significantly disrupt daily functioning, the serotonin reuptake inhibitors (clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline) have been proven effective in some patients.
Psychotherapy may also be helpful. Although psychological problems do not cause TS, such problems may result from TS. Psychotherapy can help the person with TS better cope with the disorder and deal with the secondary social and emotional problems that sometimes occur. More recently, specific behavioral treatments that include awareness training and competing response training, such as voluntarily moving in response to a premonitory urge, have shown effectiveness in small controlled trials. Larger and more definitive NIH-funded studies are underway.
Is TS inherited?
Evidence from twin and family studies suggests that TS is an inherited disorder. Although early family studies suggested an autosomal dominant mode of inheritance (an autosomal dominant disorder is one in which only one copy of the defective gene, inherited from one parent, is necessary to produce the disorder), more recent studies suggest that the pattern of inheritance is much more complex. Although there may be a few genes with substantial effects, it is also possible that many genes with smaller effects and environmental factors may play a role in the development of TS. Genetic studies also suggest that some forms of ADHD and OCD are genetically related to TS, but there is less evidence for a genetic relationship between TS and other neurobehavioral problems that commonly co-occur with TS. It is important for families to understand that genetic predisposition may not necessarily result in full-blown TS; instead, it may express itself as a milder tic disorder or as obsessive-compulsive behaviors. It is also possible that the gene-carrying offspring will not develop any TS symptoms.
The sex of the person also plays an important role in TS gene expression. At-risk males are more likely to have tics and at-risk females are more likely to have obsessive-compulsive symptoms.
People with TS may have genetic risks for other neurobehavioral disorders such as depression or substance abuse. Genetic counseling of individuals with TS should include a full review of all potentially hereditary conditions in the family.
What is the prognosis?
Although there is no cure for TS, the condition in many individuals improves in the late teens and early 20s. As a result, some may actually become symptom-free or no longer need medication for tic suppression. Although the disorder is generally lifelong and chronic, it is not a degenerative condition. Individuals with TS have a normal life expectancy. TS does not impair intelligence. Although tic symptoms tend to decrease with age, it is possible that neurobehavioral disorders such as depression, panic attacks, mood swings, and antisocial behaviors can persist and cause impairment in adult life.
What is the best educational setting for children with TS?
Although students with TS often function well in the regular classroom, ADHD, learning disabilities, obsessive-compulsive symptoms, and frequent tics can greatly interfere with academic performance or social adjustment. After a comprehensive assessment, students should be placed in an educational setting that meets their individual needs. Students may require tutoring, smaller or special classes, and in some cases special schools.
All students with TS need a tolerant and compassionate setting that both encourages them to work to their full potential and is flexible enough to accommodate their special needs. This setting may include a private study area, exams outside the regular classroom, or even oral exams when the child's symptoms interfere with his or her ability to write. Untimed testing reduces stress for students with TS.
What research is being done?
Within the Federal government, the leading supporter of research on TS and other neurological disorders is the National Institute of Neurological Disorders and Stroke (NINDS). The NINDS, a part of the National Institutes of Health (NIH), is responsible for supporting and conducting research on the brain and central nervous system.
NINDS sponsors research on TS both in its laboratories at the NIH and through grants to major medical institutions across the country. The National Institute of Mental Health, the National Center for Research Resources, the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders also support research of relevance to TS. And another component of the Department of Health and Human Services, the Centers for Disease Control and Prevention, funds professional education programs as well as TS research.
Knowledge about TS comes from studies across a number of medical and scientific disciplines, including genetics, neuroimaging, neuropathology, clinical trials (medication and non-medication), epidemiology, neurophysiology, neuroimmunology, and descriptive/diagnostic clinical science.
Genetic studies. Currently, NIH-funded investigators are conducting a variety of large-scale genetic studies. Rapid advances in the technology of gene finding will allow for genome-wide screening approaches in TS, and finding a gene or genes for TS would be a major step toward understanding genetic risk factors. In addition, understanding the genetics of TS genes will strengthen clinical diagnosis, improve genetic counseling, lead to the clarification of pathophysiology, and provide clues for more effective therapies.
Neuroimaging studies. Within the past 5 years, advances in imaging technology and an increase in trained investigators have led to an increasing use of novel and powerful techniques to identify brain regions, circuitry, and neurochemical factors important in TS and related conditions.
Neuropathology. Within the past 5 years, there has been an increase in the number and quality of donated postmortem brains from TS patients available for research purposes. This increase, coupled with advances in neuropathological techniques, has led to initial findings with implications for neuroimaging studies and animal models of TS.
Clinical trials. A number of clinical trials in TS have recently been completed or are currently underway. These include studies of stimulant treatment of ADHD in TS and behavioral treatments for reducing tic severity in children and adults. Smaller trials of novel approaches to treatment such as dopamine agonist and GABAergic medications also show promise.
Epidemiology and clinical science. Careful epidemiological studies now estimate the prevalence of TS to be substantially higher than previously thought with a wider range of clinical severity. Furthermore, clinical studies are providing new findings regarding TS and co-existing conditions. These include subtyping studies of TS and OCD, an examination of the link between ADHD and learning problems in children with TS, a new appreciation of sensory tics, and the role of co-existing disorders in rage attacks. One of the most important and controversial areas of TS science involves the relationship between TS and autoimmune brain injury associated with group A beta-hemolytic streptococcal infections or other infectious processes. There are a number of epidemiological and clinical investigations currently underway in this intriguing area.
"Tourette Syndrome Fact Sheet", NINDS. Publication date April 2005.
NIH Publication No. 05-2163
Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient's medical history.
All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.
Last updated January 25, 2006
Tuesday, March 24, 2009
Teaching Friendship Skills
Making and keeping friends is a central part of entering school. Teaching your child prosocial friendship skills is a valuable part of your relationship with your children.
Where do you begin?
A. A few great books have been written on friendship skills. Ones from the American Girls library include: Friends: Making them and keeping them; The Feelings Book, and Stand Up For Yourself and Your Friends. For middle school children and teens Queen Bees and Wanna Bees is a must-read for parents. For parents who wish to coach their teens to health and wellness, The Parent as Coach by Diana Sterling is amazing for parents of teens.
B. Healthy friendship skills begin with confidence and self-respect. Children who have self-esteem are able to be kind, share, and include others in their friendship circles.
C. Knowing your own social style and what is unique about your child is another fine starting point. Emphasizing that everyone is different and we are all special in our own ways enhances acceptance and tolerance among children.
Here are a few, little discussed, tips on helping your children develop their friendship skills.
1. As young as age four you can begin to help your child discover his or her personal style. What kind of child is yours? Help her see that she is bright, funny, articulate, caring or thoughtful. Teach her how to recognize positive social skills in others so she chooses skillful friends who are likely to share her values.
2. In order to help your child see when she is using prosocial friendship skills, comment specifically on what your child does in her friendships that shows she cares.
“When Jose hurt his arm and you offered to sit with when he could not play, that was a kind thing to do.”
“Offering your sister your sweater at the skating rink when she was cold was a thoughtful thing to do.”
3. Teach your child to observe the behavior of others non-judgmentally in a manner that helps her to see how other people behave. Talk with her about how other people respond to that behavior.
4. As your child gets older help her develop the ability to observe the impact of her behavior on others.
5. Giving your children the words and actions to: a. enter into and exit social groups, b. include other people in their group and c. recognize what characteristics your child wants in his or her friends is invaluable.
Talk with your children about what makes a good friend. Write a short story or a book on what one does to show respect, integrity and honesty. If there is a school-mate who criticizes others or mocks others, that is not a friend you wish for your child to choose as a close mate. Draw distinctions between kids who are willing to lift one another up and those who desire to feel powerful by cutting others down.
Here are some sample social skills you might wish to introduce to your children one skill as a time. Role-play with your children, create positive conversations with your children and teach them the importance of learning these skills.
Sample List of Skills
• Accepting "No"
• Accepting Consequences
• Apologizing
• Arguing Respectfully
• Asking a Favor
• Asking Questions
• Being a Good Listener
• Being in a Group Discussion
• Conversational Skills
• Declining an Invitation
• Expressing Empathy
• Following Rules
• Good Sportsmanship
Developing friendship skills can be fun. So practice, play and enjoy with your children. Friendship will follow.
Where do you begin?
A. A few great books have been written on friendship skills. Ones from the American Girls library include: Friends: Making them and keeping them; The Feelings Book, and Stand Up For Yourself and Your Friends. For middle school children and teens Queen Bees and Wanna Bees is a must-read for parents. For parents who wish to coach their teens to health and wellness, The Parent as Coach by Diana Sterling is amazing for parents of teens.
B. Healthy friendship skills begin with confidence and self-respect. Children who have self-esteem are able to be kind, share, and include others in their friendship circles.
C. Knowing your own social style and what is unique about your child is another fine starting point. Emphasizing that everyone is different and we are all special in our own ways enhances acceptance and tolerance among children.
Here are a few, little discussed, tips on helping your children develop their friendship skills.
1. As young as age four you can begin to help your child discover his or her personal style. What kind of child is yours? Help her see that she is bright, funny, articulate, caring or thoughtful. Teach her how to recognize positive social skills in others so she chooses skillful friends who are likely to share her values.
2. In order to help your child see when she is using prosocial friendship skills, comment specifically on what your child does in her friendships that shows she cares.
“When Jose hurt his arm and you offered to sit with when he could not play, that was a kind thing to do.”
“Offering your sister your sweater at the skating rink when she was cold was a thoughtful thing to do.”
3. Teach your child to observe the behavior of others non-judgmentally in a manner that helps her to see how other people behave. Talk with her about how other people respond to that behavior.
4. As your child gets older help her develop the ability to observe the impact of her behavior on others.
5. Giving your children the words and actions to: a. enter into and exit social groups, b. include other people in their group and c. recognize what characteristics your child wants in his or her friends is invaluable.
Talk with your children about what makes a good friend. Write a short story or a book on what one does to show respect, integrity and honesty. If there is a school-mate who criticizes others or mocks others, that is not a friend you wish for your child to choose as a close mate. Draw distinctions between kids who are willing to lift one another up and those who desire to feel powerful by cutting others down.
Here are some sample social skills you might wish to introduce to your children one skill as a time. Role-play with your children, create positive conversations with your children and teach them the importance of learning these skills.
Sample List of Skills
• Accepting "No"
• Accepting Consequences
• Apologizing
• Arguing Respectfully
• Asking a Favor
• Asking Questions
• Being a Good Listener
• Being in a Group Discussion
• Conversational Skills
• Declining an Invitation
• Expressing Empathy
• Following Rules
• Good Sportsmanship
Developing friendship skills can be fun. So practice, play and enjoy with your children. Friendship will follow.
Monday, March 16, 2009
Books For New Dads!
Crash Course for New Dads
Greg Bishop wasn’t your typical boy growing up. With twelve brothers and sisters, he was expected to help out with his siblings, and he had changed plenty of dirty diapers by the time he became a father of four himself. But Greg knew that most expectant and new fathers didn’t have the same confidence in their parenting abilities as he did. So, on Father’s Day 1990, he got four dads and their babies (aka, the veteran dads) in a room with a dozen men who were soon to be daddies (aka, the rookies), and they talked for three hours. The veterans shared their experiences—and their babies—with the rookies, and a great idea was born. Boot Camp for New Dads has been a hit ever since. It has graduated more than 200,000 veterans in 260 communities across 43 states and in the US Navy, Army and Air Force. (To find a location near you, go to http://www.bootcampfornewdads.org/.)
In the process of educating fathers-to-be, Greg has also written many books and articles. His newest book is Crash Course for New Dads: Tools, Checklists & Cheat-Sheets. This amazing book is filled with guy-friendly lists, forms and charts to prepare men for fatherhood. I can’t even begin to tell you all the great information contained in this book, but some of the highlights include:
What You Need for the Hospital
Handling an Emergency Birth
Learning to Care for Your New Baby
Troubleshooter’s Guide to Crying Babies
How to Support a Mom-to-Be
Baby Blues & Postpartum Depression
Getting Your Love Life Back
When You Become Overwhelmed or Close to It
Infant CPR & Choking Basics
Preparing for Your Family’s Future
…and much, much more
Every father-to-be should read this book. (If he can attend a Boot Camp for New Dads program, that’s even better!) Even moms-to-be will benefit from its practical and organized tips and advice for handling the demands of new parenthood. Greg’s books and programs can’t be beat for the quality of information they provide and the reassurance they offer future parents.
Greg and his wife Alison have generously offered a copy of Crash Course for New Dads to one lucky reader of this blog, PLUS a copy of Greg’s book, Hit the Ground Crawling: Lessons from 150,000 New Fathers.
Greg Bishop wasn’t your typical boy growing up. With twelve brothers and sisters, he was expected to help out with his siblings, and he had changed plenty of dirty diapers by the time he became a father of four himself. But Greg knew that most expectant and new fathers didn’t have the same confidence in their parenting abilities as he did. So, on Father’s Day 1990, he got four dads and their babies (aka, the veteran dads) in a room with a dozen men who were soon to be daddies (aka, the rookies), and they talked for three hours. The veterans shared their experiences—and their babies—with the rookies, and a great idea was born. Boot Camp for New Dads has been a hit ever since. It has graduated more than 200,000 veterans in 260 communities across 43 states and in the US Navy, Army and Air Force. (To find a location near you, go to http://www.bootcampfornewdads.org/.)
In the process of educating fathers-to-be, Greg has also written many books and articles. His newest book is Crash Course for New Dads: Tools, Checklists & Cheat-Sheets. This amazing book is filled with guy-friendly lists, forms and charts to prepare men for fatherhood. I can’t even begin to tell you all the great information contained in this book, but some of the highlights include:
What You Need for the Hospital
Handling an Emergency Birth
Learning to Care for Your New Baby
Troubleshooter’s Guide to Crying Babies
How to Support a Mom-to-Be
Baby Blues & Postpartum Depression
Getting Your Love Life Back
When You Become Overwhelmed or Close to It
Infant CPR & Choking Basics
Preparing for Your Family’s Future
…and much, much more
Every father-to-be should read this book. (If he can attend a Boot Camp for New Dads program, that’s even better!) Even moms-to-be will benefit from its practical and organized tips and advice for handling the demands of new parenthood. Greg’s books and programs can’t be beat for the quality of information they provide and the reassurance they offer future parents.
Greg and his wife Alison have generously offered a copy of Crash Course for New Dads to one lucky reader of this blog, PLUS a copy of Greg’s book, Hit the Ground Crawling: Lessons from 150,000 New Fathers.
The Family Coach on Channel 12 LIVE March 24, 2009 Arizona Midday
Tune in to discuss - What is a blended family?
In a blended family, or stepfamily, one or both partners have been married before and one or both spouses has children from another relationship.
Blending is the process of redefining the family unit to include new parents and or new children. New grandparents, step-parents, aunts, uncles etc may also be involved. The processes of blending a family grows it exponentially.
The blending process includes many unanswered questions: Will we like each other? Who will make the rules? Who will enforce the rules? Will we all get along? Who will tuck me in at night? Will my parents still fight... on and on. It will help you and your children to feel safe and secure if you talk, communicate, share and explore the meaning of your new family, in your home and in the other homes involved.
It is your job as newly evolving blended parents to define for your children will be the family playing field. Defining the kind of family you wish to be will be a joint decision for all, even if the children are quite young.
So get ready for a democracy and begin with a mission statement, clarification of your values and family rules agreed on by all.
As expand your family, a few important things to remember are:
* Have a mission, a method and a plan. Talk with your new spouse about the kind of family you hope to be. Your expectations might differ.
* Discuss division of child-care teen-care responsibilities. Are you marrying someone who wants you care for their kids, how much, how, why etc.
* Be your most grown-up self. If you are becoming a blended family be ready to be the calmest, most mature, most patient adult possible because you will get tested and it is your job to stay calm and mature.
* Be patient . Good relationships take time and trust. Be ready to wait things out, be patient and keep circling back in your new relationships to build trust-filled experiences.
* Limit your expectations. Know that you will probably give a lot of time, energy, love and affection that will not be returned immediately. Think of it as making small investments that may one day yield a lot of interest, but don’t expect anything in return for now.
Given the right support, kids should gradually adjust to their new family members. It is your job to communicate openly, meet their needs for security and give them plenty of time to make a successful transition. If the transition remains bumpy for a long-time seek consultation there are many excellent books and clinicians experienced with blended families.
Resources on Amazon.com
Parenting Essentials ~ Dr. Lynne Kenney DVD
Stepcoupling: Creating and Sustaining a Strong Marriage in Today's Blended Family by Susan Wisdom and Jennifer Green
Blended Families: Creating Harmony as You Build a New Home Life by Maxine Marsolini
Smart Stepfamily, The: Seven Steps to a Healthy Family by Ron L. Deal
Parachutes for Parents: 12 New Keys to Raising Children for a Better World by Bobbie Sandoz-Merrill
In a blended family, or stepfamily, one or both partners have been married before and one or both spouses has children from another relationship.
Blending is the process of redefining the family unit to include new parents and or new children. New grandparents, step-parents, aunts, uncles etc may also be involved. The processes of blending a family grows it exponentially.
The blending process includes many unanswered questions: Will we like each other? Who will make the rules? Who will enforce the rules? Will we all get along? Who will tuck me in at night? Will my parents still fight... on and on. It will help you and your children to feel safe and secure if you talk, communicate, share and explore the meaning of your new family, in your home and in the other homes involved.
It is your job as newly evolving blended parents to define for your children will be the family playing field. Defining the kind of family you wish to be will be a joint decision for all, even if the children are quite young.
So get ready for a democracy and begin with a mission statement, clarification of your values and family rules agreed on by all.
As expand your family, a few important things to remember are:
* Have a mission, a method and a plan. Talk with your new spouse about the kind of family you hope to be. Your expectations might differ.
* Discuss division of child-care teen-care responsibilities. Are you marrying someone who wants you care for their kids, how much, how, why etc.
* Be your most grown-up self. If you are becoming a blended family be ready to be the calmest, most mature, most patient adult possible because you will get tested and it is your job to stay calm and mature.
* Be patient . Good relationships take time and trust. Be ready to wait things out, be patient and keep circling back in your new relationships to build trust-filled experiences.
* Limit your expectations. Know that you will probably give a lot of time, energy, love and affection that will not be returned immediately. Think of it as making small investments that may one day yield a lot of interest, but don’t expect anything in return for now.
Given the right support, kids should gradually adjust to their new family members. It is your job to communicate openly, meet their needs for security and give them plenty of time to make a successful transition. If the transition remains bumpy for a long-time seek consultation there are many excellent books and clinicians experienced with blended families.
Resources on Amazon.com
Parenting Essentials ~ Dr. Lynne Kenney DVD
Stepcoupling: Creating and Sustaining a Strong Marriage in Today's Blended Family by Susan Wisdom and Jennifer Green
Blended Families: Creating Harmony as You Build a New Home Life by Maxine Marsolini
Smart Stepfamily, The: Seven Steps to a Healthy Family by Ron L. Deal
Parachutes for Parents: 12 New Keys to Raising Children for a Better World by Bobbie Sandoz-Merrill
Tuesday, March 10, 2009
Parenting High Ability Children: AAGT Parent Institute on March 28, 2009
This one-day, budget friendly conference on parenting high ability children will provide information, reassurance, and new friends for families trying to make sense of it all. People from all over Arizona come to this informative, positive event.
Arizona Association for Gifted and Talented
2009 Parent Institute: Parenting High Ability Children
Who: Parents, Grandparents, & Educators from all over Arizona
What: Seminars on parenting gifted children
Where: Sandra Day O’Connor College of Law at ASU
Date: Saturday, March, 28th, 2009
Time: 9:00 AM – 4:00 PM
Price: $25, pre-registration required. Go to www.aagtparentday.com
See you there.
Arizona Association for Gifted and Talented
2009 Parent Institute: Parenting High Ability Children
Who: Parents, Grandparents, & Educators from all over Arizona
What: Seminars on parenting gifted children
Where: Sandra Day O’Connor College of Law at ASU
Date: Saturday, March, 28th, 2009
Time: 9:00 AM – 4:00 PM
Price: $25, pre-registration required. Go to www.aagtparentday.com
See you there.
Monday, March 9, 2009
Routines And Chores For Kids
Routines, Tasks and Chores Teach Independence and Responsibility
Getting kids to complete tasks of every day living is important to their development.
If each morning you hear yourself saying, "I said, brush your teeth," or "I said, make your bed," consider the value of clear expectations.
Instead of making a battle out of it, consider your approach. Are you clear in what you expect? Have you clarified if the expected action is a personal or family contribution? Do you assert your expectations modeling peace not anger? Are you enhancing family relationships over asserting control?
Teach your children the value of contributions early on by teaching daily routines, tasks and chores. Be clear, be concrete and be consistent.
Teach, model and expect peacefully and calmly, your expectations, posture and tone will guide the outcome.
STEP #1 Identify Daily Routines For Your Children
Helping your children to identify the components of their daily routine is one step toward practicing independence and responsibility.
"We use task lists to keep the children focused on their brief responsibilities each morning," says Diana from Chicago.
Developing independence take 1) Knowing the expectation 2) Having the skills to exhibit the expected behavior and 3) Being recognized for the success in order to increase the likelihood of exhibiting the behavior next time.
Establish a daily task routine. Make play dates, sports and family fun dependent on their accomplishing specific tasks. It's very simple, you give to the family and the family gives back. Make each child a task list and hang them on the bathroom mirror. These are tasks of daily living and do not confer money they are just a part of being a responsible family member.
Write the tasks down.
JAMES, age 9
Get up
Make bed
Get dressed
Put PJs under pillow
Eat breakfast
Clear the table
Brush teeth
Brush hair
Get backpack
Out the door
Place a 4 x 6 task card on the mirror in the bathroom for each child to check off daily.
"The index card helps the children feel some mastery over their daily activities, they don't have to keep checking with me to guide their responsibilities, they know clearly what they are," offers Diana.
STEP #2 Assign Daily and Weekly Chores
Chores are separate from personal tasks (part of a daily routine) as they are done for the good of the community. Chores teach children the value of living in a group, a community, a family.
I look at chores as valued family contributions. When you live in a home where everyone contributes it is a clean, happy well-run home that is enjoyed by all.
Chores are a part of making expected contributions to the household. Children do not earn money for doing what is expected. They are expected to be a productive part of the family, their tasks are a piece of that, just as listening respectfully and being kind are expected.
Susan from Milwaukee offers this advice, "At our house, the kids are expected to help the “family community” for which they do not get paid money. Just as I make their breakfast or dinner and do their laundry, they have ways in which they contribute to the community. Making their bed, wiping the sink after they brush their teeth, setting the dinner table, and clearing their plates from the table are typical every day expectations."
Jane from Scottsdale agrees. "We have “chores” listed on our fridge, the kids do some each day and some weekly. If we have a big project or something outside the chore list we need done we might offer $2-$5 for that extra activity mostly to support the children's piggy banks.
"On Saturday there is a pretty good chance that our preschool and school-age children will help out, as they can earn valuable spending money for their participation. This money goes to things they care about like horseback riding, going to the water park and having movie night at home. Without hard work there are no horses and there are no trips to the mall, that's just the way it is," Jane says confidently.
STEP #3 Model Your Values
If you are going to give allowance for everyday household tasks, make sure you establish a specific amount, be consistent in giving it out each week and make sure the children complete the tasks assigned to earn allowance.
It is important to also suggest that children do not need to "consume" everything they like. Children can enjoy things in a store and leave them in a store. Life is not about accumulating stuff it's about caring for people.
Kim from Boston offers some clear advice, "When we go to the store, I do not agree to buy the kids small toys or objects that they can purchase with their allowance. We have a ten dollar per week maximum of allowance earned=2 0and they can use that to buy the newest Polly Pocket or Lego toy."
"Further, they are encouraged to put one dollar in savings and one dollar in our “community jar” to give away at the holidays to families in need. If every child contributes, they often have more than one hundred dollars to give away at the holidays, which teaches them to be compassionate as well as generous. They learn the value of hard work early with a spend, save, and donate system," asserts Kim.
Consider delineating what are expected family contributions in your home. Create a morning and evening task list for each child. Keep it simple with (3-8) discrete tasks. If you wish to help your children learn about money management, develop a chore list, assign fees, and encourage your children to spend, save and give. Teach your children the value of contributing to the family in the early years.
Getting kids to complete tasks of every day living is important to their development.
If each morning you hear yourself saying, "I said, brush your teeth," or "I said, make your bed," consider the value of clear expectations.
Instead of making a battle out of it, consider your approach. Are you clear in what you expect? Have you clarified if the expected action is a personal or family contribution? Do you assert your expectations modeling peace not anger? Are you enhancing family relationships over asserting control?
Teach your children the value of contributions early on by teaching daily routines, tasks and chores. Be clear, be concrete and be consistent.
Teach, model and expect peacefully and calmly, your expectations, posture and tone will guide the outcome.
STEP #1 Identify Daily Routines For Your Children
Helping your children to identify the components of their daily routine is one step toward practicing independence and responsibility.
"We use task lists to keep the children focused on their brief responsibilities each morning," says Diana from Chicago.
Developing independence take 1) Knowing the expectation 2) Having the skills to exhibit the expected behavior and 3) Being recognized for the success in order to increase the likelihood of exhibiting the behavior next time.
Establish a daily task routine. Make play dates, sports and family fun dependent on their accomplishing specific tasks. It's very simple, you give to the family and the family gives back. Make each child a task list and hang them on the bathroom mirror. These are tasks of daily living and do not confer money they are just a part of being a responsible family member.
Write the tasks down.
JAMES, age 9
Get up
Make bed
Get dressed
Put PJs under pillow
Eat breakfast
Clear the table
Brush teeth
Brush hair
Get backpack
Out the door
Place a 4 x 6 task card on the mirror in the bathroom for each child to check off daily.
"The index card helps the children feel some mastery over their daily activities, they don't have to keep checking with me to guide their responsibilities, they know clearly what they are," offers Diana.
STEP #2 Assign Daily and Weekly Chores
Chores are separate from personal tasks (part of a daily routine) as they are done for the good of the community. Chores teach children the value of living in a group, a community, a family.
I look at chores as valued family contributions. When you live in a home where everyone contributes it is a clean, happy well-run home that is enjoyed by all.
Chores are a part of making expected contributions to the household. Children do not earn money for doing what is expected. They are expected to be a productive part of the family, their tasks are a piece of that, just as listening respectfully and being kind are expected.
Susan from Milwaukee offers this advice, "At our house, the kids are expected to help the “family community” for which they do not get paid money. Just as I make their breakfast or dinner and do their laundry, they have ways in which they contribute to the community. Making their bed, wiping the sink after they brush their teeth, setting the dinner table, and clearing their plates from the table are typical every day expectations."
Jane from Scottsdale agrees. "We have “chores” listed on our fridge, the kids do some each day and some weekly. If we have a big project or something outside the chore list we need done we might offer $2-$5 for that extra activity mostly to support the children's piggy banks.
"On Saturday there is a pretty good chance that our preschool and school-age children will help out, as they can earn valuable spending money for their participation. This money goes to things they care about like horseback riding, going to the water park and having movie night at home. Without hard work there are no horses and there are no trips to the mall, that's just the way it is," Jane says confidently.
STEP #3 Model Your Values
If you are going to give allowance for everyday household tasks, make sure you establish a specific amount, be consistent in giving it out each week and make sure the children complete the tasks assigned to earn allowance.
It is important to also suggest that children do not need to "consume" everything they like. Children can enjoy things in a store and leave them in a store. Life is not about accumulating stuff it's about caring for people.
Kim from Boston offers some clear advice, "When we go to the store, I do not agree to buy the kids small toys or objects that they can purchase with their allowance. We have a ten dollar per week maximum of allowance earned=2 0and they can use that to buy the newest Polly Pocket or Lego toy."
"Further, they are encouraged to put one dollar in savings and one dollar in our “community jar” to give away at the holidays to families in need. If every child contributes, they often have more than one hundred dollars to give away at the holidays, which teaches them to be compassionate as well as generous. They learn the value of hard work early with a spend, save, and donate system," asserts Kim.
Consider delineating what are expected family contributions in your home. Create a morning and evening task list for each child. Keep it simple with (3-8) discrete tasks. If you wish to help your children learn about money management, develop a chore list, assign fees, and encourage your children to spend, save and give. Teach your children the value of contributing to the family in the early years.
Friday, March 6, 2009
Spring Project Management
You have probably already started mentally making notes about some of the projects that require warmer weather. Whether we wait until spring because of the necessity of working outside to get things done or because we lack the stamina to complete tasks in the winter, spring projects have long been a tradition. It could be as small as changing out lightbulbs or batteries to as big a project as finishing a basement. Making home improvements, no matter the size, helps to restore both our spirits and our homes. Projects can be a way for a family to spend quality time together on a Saturday morning. They also have the potential to improve the value of your home.
Begin to move your projects from your mind to paper. Not only does this help you remember what needs to be done, but it is also one more step in holding yourself accountable. Print out ListPlanIt.com's Seasonal Project List for Spring and hang it on your refrigerator or tack it up on the family bulletin board. As you think of things that would be good to work on, be sure to list them. Include supplies you might need and the steps to accomplish them. Visit listplanit.com for the lists you need to manage your home thoughtfully www.listplanit.com.
Begin to move your projects from your mind to paper. Not only does this help you remember what needs to be done, but it is also one more step in holding yourself accountable. Print out ListPlanIt.com's Seasonal Project List for Spring and hang it on your refrigerator or tack it up on the family bulletin board. As you think of things that would be good to work on, be sure to list them. Include supplies you might need and the steps to accomplish them. Visit listplanit.com for the lists you need to manage your home thoughtfully www.listplanit.com.
Thursday, March 5, 2009
Monday March 9, 2009 MOM COACHING CALL
Join The Circle of Moms Coaching Calls
March 9-30, 2009
Attend the MONDAY Mom Coaching Call For Free. It only takes One Hour to change your family. March 9, 2009 11 am MT 1 ET 10 PT and learn to help your children to follow your family rules.
To enter the call you dial 712-429-0690 and enter the Participant PIN 884068. You may announce yourself or simply listen in, creating a comfortable learning environment depending on your needs and wishes.
These calls are designed to provide moms of children ages 3-8 strategies to:
Create Your Extraordinary Family.
Communicate your expectations to your children.
Help your children to comply with family expectations.
Provide you with the words and actions to help you raise confident, ethical, caring children.
Teach you strategies to distinguish between skill deficits and willful non-compliance.
Help you use your family values to encourage peaceful interactions at home.
Establish bite-sized expectations so that your children become skillful and accomplished at home and at school.
Hear you there!
March 9-30, 2009
Attend the MONDAY Mom Coaching Call For Free. It only takes One Hour to change your family. March 9, 2009 11 am MT 1 ET 10 PT and learn to help your children to follow your family rules.
To enter the call you dial 712-429-0690 and enter the Participant PIN 884068. You may announce yourself or simply listen in, creating a comfortable learning environment depending on your needs and wishes.
These calls are designed to provide moms of children ages 3-8 strategies to:
Create Your Extraordinary Family.
Communicate your expectations to your children.
Help your children to comply with family expectations.
Provide you with the words and actions to help you raise confident, ethical, caring children.
Teach you strategies to distinguish between skill deficits and willful non-compliance.
Help you use your family values to encourage peaceful interactions at home.
Establish bite-sized expectations so that your children become skillful and accomplished at home and at school.
Hear you there!
Friday, February 27, 2009
Stress-Free Potty Training
Successful potty-training starts with understanding a child’s individual personality. Stress-Free Potty Training, offers thoughtful planning and effective communication techniques to help parents tailor their training techniques and avoid stress during this major milestone of their child's life. Written with Dr. Pete Stavinoha, a pediatric neuropsychologist at Children's Medical Center Dallas.
Check it out today: www.StressFreePottyTraining.com
New & Notable: "The Real Parenting Show with Dr. Pete & Sara" podcast via the Parents Everywhere Network. Straightforward advice and practical tips for real parents raising real kids in the real world. www.TheRealParentingShow.com or check us out on iTunes!
Check it out today: www.StressFreePottyTraining.com
New & Notable: "The Real Parenting Show with Dr. Pete & Sara" podcast via the Parents Everywhere Network. Straightforward advice and practical tips for real parents raising real kids in the real world. www.TheRealParentingShow.com or check us out on iTunes!
Wednesday, February 18, 2009
The Skinny on Raising Happy Skillful Kids 3-8
At the request of several moms, in March I am launching four one hour mom coaching calls for parents wishing to raise happy, ethical, skillful kids. The series is $129 and is always enjoyed by all. Please let the moms with whom you work know about this opportunity.
Join The Circle of Moms Coaching Calls
March 9-30, 2009
Mondays at 11 am Mountain Time
Americans are good at parenting their young children, but teaching your children mastery and accountability in the KANGAROO YEARS ages 3-8 is a new experience. To help you -The Family Coach has set up a series of four coaching calls in MARCH for moms like you!
These calls are designed to provide moms of children ages 3-8 strategies to:
Create Your Extraordinary Family.
Communicate your expectations to your children.
Help your children to comply with family expectations.
Provide you with the words and actions to help you raise confident, ethical, caring children.
Teach you strategies to distinguish between skill deficits and willful non-compliance.
Help you use your family values to encourage peaceful interactions at home.
Establish bite-sized expectations so that your children become skillful and accomplished at home and at school.
www.lynnekenney.com
www.twittermoms.com/profile/LynneKenney
Join The Circle of Moms Coaching Calls
March 9-30, 2009
Mondays at 11 am Mountain Time
Americans are good at parenting their young children, but teaching your children mastery and accountability in the KANGAROO YEARS ages 3-8 is a new experience. To help you -The Family Coach has set up a series of four coaching calls in MARCH for moms like you!
These calls are designed to provide moms of children ages 3-8 strategies to:
Create Your Extraordinary Family.
Communicate your expectations to your children.
Help your children to comply with family expectations.
Provide you with the words and actions to help you raise confident, ethical, caring children.
Teach you strategies to distinguish between skill deficits and willful non-compliance.
Help you use your family values to encourage peaceful interactions at home.
Establish bite-sized expectations so that your children become skillful and accomplished at home and at school.
www.lynnekenney.com
www.twittermoms.com/profile/LynneKenney
Tuesday, February 17, 2009
Literature Review: Treatment of PTSD in Children
From Efficacy to Effectiveness: The Trajectory Of The Treatment Literature For Children With PTSD
Valentina Nikulina; Jeanean M Hergenrother; Elissa J Brown; Megan E Doyle; Beryl J Filton; Gabrielle S Carson
This review summarizes efficacious treatments for preschoolers, children and adolescents with post-traumatic stress disorder, with a focus on the advances made within the last 5 years.
There is considerable support for the use of trauma-specific cognitive-behavioral interventions, in both individual and group formats. The research on psychopharmacological treatments lags behind that of psychotherapy and is currently inconclusive.
Limitations of the studies are discussed and treatments that warrant further consideration are reviewed. The authors also review current advances in effectiveness and suggest future directions that are important in generalizing the interventions to underserved and hard to reach populations. The article concludes with the authors' projections for the evolution of the field within the upcoming 5 years.
Introduction
In the USA, approximately two thirds of children experience one or more traumatic events by the time they are 16 years of age.[1] Traumatic events include child sexual abuse (CSA), child physical abuse (CPA), community violence, witnessing domestic violence and natural/manmade disaster. Childrens' trauma-related mental health problems include post-traumatic stress disorder (PTSD), other anxiety disorders, depression and disruptive behavior disorders.[2] PTSD is the most common response to a traumatic event and is associated with later interpersonal, vocational and physical problems.[3-5]
The awareness of these pervasive consequences of PTSD has resulted in empirical advances in our understanding of its treatment. From randomized controlled trials, investigators have examined and found individual trauma-focused cognitive-behavioral interventions to be efficacious at reducing PTSD symptoms and other trauma sequelae. Current research is moving towards enhancing generalizability, or effectiveness, of treatments when applied to real-world settings.
This paper examines current literature on the treatment of PTSD in preschoolers, children and adolescents. First, we review the diagnostic criteria for PTSD and its prevalence in youth. Second, we discuss psychosocial and pharmacological treatments that demonstrated efficacy in treating PTSD, as well as other outcomes of trauma exposure. Third, we discuss effectiveness, including barriers to mental health, cultural background, trauma characteristics and psychiatric comorbidity. We conclude the paper with a discussion of the current status of research on PTSD treatment and a projection of the field's progress over the next 5 years. For full article see Expert Rev Neurother. 2008;8(8):1233-1246.
Valentina Nikulina; Jeanean M Hergenrother; Elissa J Brown; Megan E Doyle; Beryl J Filton; Gabrielle S Carson
This review summarizes efficacious treatments for preschoolers, children and adolescents with post-traumatic stress disorder, with a focus on the advances made within the last 5 years.
There is considerable support for the use of trauma-specific cognitive-behavioral interventions, in both individual and group formats. The research on psychopharmacological treatments lags behind that of psychotherapy and is currently inconclusive.
Limitations of the studies are discussed and treatments that warrant further consideration are reviewed. The authors also review current advances in effectiveness and suggest future directions that are important in generalizing the interventions to underserved and hard to reach populations. The article concludes with the authors' projections for the evolution of the field within the upcoming 5 years.
Introduction
In the USA, approximately two thirds of children experience one or more traumatic events by the time they are 16 years of age.[1] Traumatic events include child sexual abuse (CSA), child physical abuse (CPA), community violence, witnessing domestic violence and natural/manmade disaster. Childrens' trauma-related mental health problems include post-traumatic stress disorder (PTSD), other anxiety disorders, depression and disruptive behavior disorders.[2] PTSD is the most common response to a traumatic event and is associated with later interpersonal, vocational and physical problems.[3-5]
The awareness of these pervasive consequences of PTSD has resulted in empirical advances in our understanding of its treatment. From randomized controlled trials, investigators have examined and found individual trauma-focused cognitive-behavioral interventions to be efficacious at reducing PTSD symptoms and other trauma sequelae. Current research is moving towards enhancing generalizability, or effectiveness, of treatments when applied to real-world settings.
This paper examines current literature on the treatment of PTSD in preschoolers, children and adolescents. First, we review the diagnostic criteria for PTSD and its prevalence in youth. Second, we discuss psychosocial and pharmacological treatments that demonstrated efficacy in treating PTSD, as well as other outcomes of trauma exposure. Third, we discuss effectiveness, including barriers to mental health, cultural background, trauma characteristics and psychiatric comorbidity. We conclude the paper with a discussion of the current status of research on PTSD treatment and a projection of the field's progress over the next 5 years. For full article see Expert Rev Neurother. 2008;8(8):1233-1246.
Sunday, February 15, 2009
Excessive Television Exposure in Teens Linked to Depression in Adulthood
February 5, 2009 — Excess exposure to television in teens has been linked to an increased risk for depression in early adulthood, particularly among young men.
A large longitudinal study from investigators at the University of Pittsburgh, in Pennsylvania, shows that each extra daily hour of television use was associated with an 8% increase in the odds of developing depressive symptoms by young adulthood.
"We looked at the development of depression over a 7-year period and found that the amount of television exposure was significantly associated with the development of depression," principal investigator Brian A. Primack, MD, told Medscape Psychiatry.
The study is published in the February issue of Archives of General Psychiatry.
Leading Cause of Morbidity Worldwide
Although previous studies have investigated the relationship between electronic media and mental health, this research has largely been cross-sectional and has primarily focused on anxiety.
Findings from these studies have shown a link between excessive use of certain media, social anxiety, and a decline in interpersonal relationships.
Researchers wanted to explore the relationship between media exposure and depression, which has been cited by the World Health Organization as the leading cause of morbidity worldwide and is very common in adolescence.
They hypothesized that an excessive amount of television watching during adolescence would increase depression in young adulthood and would have a greater impact on young females than their male counterparts.
They also theorized that television exposure would turn out to be more potent than other types of electronic media, including videocassettes, computer games, or radio. (The data for the study were collected before Internet use was widespread and prior to the introduction of DVDs).
Males at Greater Risk
Using data from the National Longitudinal Survey of Adolescent Health, investigators looked at the relationship between electronic media exposure in 4142 adolescents who were not depressed at baseline and the subsequent development of depression at 7-year follow-up from 1995 to 2002.
At baseline, teens were asked about the number of hours they had spent during the previous week watching television or videocassettes, playing computer games, or listening to the radio.
Subjects reported an average of 5.68 hours of media exposure per day, including 2.3 hours of television, 0.62 hours of videocassettes, 0.41 hours of computer games, and 2.34 hours of radio.
At follow-up, 308 (7.4%) participants reported symptoms consistent with depression, and researchers found these individuals had watched more television than nondepressed individuals at baseline — 2.64 hours vs 2.28 hours per day — and that this association was statistically significant. However, there was no association between these symptoms and exposure to other media types.
Surprisingly, in contrast to their original hypothesis, the researchers found that, compared with young men, young women were less likely to develop depression given the same total media exposure.
"At study outset, we felt females were more likely to be affected because of all the images that are pervasive in the media of the 'feminine ideal' of thin, beautiful women. However, the study showed the opposite was true," said Dr. Primack.
Greater "Social Reserve" in Girls?
One possible explanation for this finding, he said, is that the impact of media content that presents idealized masculinity and sex roles on the psychological development of young males has been underappreciated.
"The bottom line is that males are also held to a high standard in the media, and it is possible that, for a number of reasons, those portrayals might be more powerful that we had previously thought," he said.
Another possible explanation is that young females have more "social reserve" than young males, which increases their resilience.
"We know that during adolescence and even in early adulthood females have closer relationships than young males. So if a boy watches several hours of television a day, this may substantially displace social interaction. Girls, however, may be able to watch the same amount of television while still maintaining their social relationships," said Dr. Primack.
More research is needed to better understand the mechanisms at play and whether it is the amount of media exposure, the type of media content adolescents are exposed to, or some other mechanism that underlies this association.
Need for Media Literacy
In the meantime, said Dr. Primack, the study has implications for clinicians, including psychiatrists, pediatricians, family physicians, internists, and other health providers who work with adolescents, to ask about television and other media exposure. It also has implications for researchers and research funding agencies.
"At this point, we have enough substantial data from studies like this linking large amounts of media exposure to major health concerns such as substance use, obesity, and aggression. So moderating the amount of media an individual consumes is certainly something physicians can and probably should suggest," he said.
Teaching media literacy, the critical analysis of media content, is also something that should be considered on a widespread basis, he added. "Individuals who are media literate should be better equipped to navigate the modern world. They may be less susceptible to the messages from the barrage of media that are all around us these days. They may even be more psychologically fulfilled because they will set their own goals instead of allowing advertisers and marketers to set their life goals for them," said Dr. Primack.
Arch Gen Psychiatry. 2009;66:181-188. Abstract
Written by Caroline Cassels from Medline
A large longitudinal study from investigators at the University of Pittsburgh, in Pennsylvania, shows that each extra daily hour of television use was associated with an 8% increase in the odds of developing depressive symptoms by young adulthood.
"We looked at the development of depression over a 7-year period and found that the amount of television exposure was significantly associated with the development of depression," principal investigator Brian A. Primack, MD, told Medscape Psychiatry.
The study is published in the February issue of Archives of General Psychiatry.
Leading Cause of Morbidity Worldwide
Although previous studies have investigated the relationship between electronic media and mental health, this research has largely been cross-sectional and has primarily focused on anxiety.
Findings from these studies have shown a link between excessive use of certain media, social anxiety, and a decline in interpersonal relationships.
Researchers wanted to explore the relationship between media exposure and depression, which has been cited by the World Health Organization as the leading cause of morbidity worldwide and is very common in adolescence.
They hypothesized that an excessive amount of television watching during adolescence would increase depression in young adulthood and would have a greater impact on young females than their male counterparts.
They also theorized that television exposure would turn out to be more potent than other types of electronic media, including videocassettes, computer games, or radio. (The data for the study were collected before Internet use was widespread and prior to the introduction of DVDs).
Males at Greater Risk
Using data from the National Longitudinal Survey of Adolescent Health, investigators looked at the relationship between electronic media exposure in 4142 adolescents who were not depressed at baseline and the subsequent development of depression at 7-year follow-up from 1995 to 2002.
At baseline, teens were asked about the number of hours they had spent during the previous week watching television or videocassettes, playing computer games, or listening to the radio.
Subjects reported an average of 5.68 hours of media exposure per day, including 2.3 hours of television, 0.62 hours of videocassettes, 0.41 hours of computer games, and 2.34 hours of radio.
At follow-up, 308 (7.4%) participants reported symptoms consistent with depression, and researchers found these individuals had watched more television than nondepressed individuals at baseline — 2.64 hours vs 2.28 hours per day — and that this association was statistically significant. However, there was no association between these symptoms and exposure to other media types.
Surprisingly, in contrast to their original hypothesis, the researchers found that, compared with young men, young women were less likely to develop depression given the same total media exposure.
"At study outset, we felt females were more likely to be affected because of all the images that are pervasive in the media of the 'feminine ideal' of thin, beautiful women. However, the study showed the opposite was true," said Dr. Primack.
Greater "Social Reserve" in Girls?
One possible explanation for this finding, he said, is that the impact of media content that presents idealized masculinity and sex roles on the psychological development of young males has been underappreciated.
"The bottom line is that males are also held to a high standard in the media, and it is possible that, for a number of reasons, those portrayals might be more powerful that we had previously thought," he said.
Another possible explanation is that young females have more "social reserve" than young males, which increases their resilience.
"We know that during adolescence and even in early adulthood females have closer relationships than young males. So if a boy watches several hours of television a day, this may substantially displace social interaction. Girls, however, may be able to watch the same amount of television while still maintaining their social relationships," said Dr. Primack.
More research is needed to better understand the mechanisms at play and whether it is the amount of media exposure, the type of media content adolescents are exposed to, or some other mechanism that underlies this association.
Need for Media Literacy
In the meantime, said Dr. Primack, the study has implications for clinicians, including psychiatrists, pediatricians, family physicians, internists, and other health providers who work with adolescents, to ask about television and other media exposure. It also has implications for researchers and research funding agencies.
"At this point, we have enough substantial data from studies like this linking large amounts of media exposure to major health concerns such as substance use, obesity, and aggression. So moderating the amount of media an individual consumes is certainly something physicians can and probably should suggest," he said.
Teaching media literacy, the critical analysis of media content, is also something that should be considered on a widespread basis, he added. "Individuals who are media literate should be better equipped to navigate the modern world. They may be less susceptible to the messages from the barrage of media that are all around us these days. They may even be more psychologically fulfilled because they will set their own goals instead of allowing advertisers and marketers to set their life goals for them," said Dr. Primack.
Arch Gen Psychiatry. 2009;66:181-188. Abstract
Written by Caroline Cassels from Medline
Saturday, February 14, 2009
Wednesday, February 11, 2009
What Is Serotonin?
Serotonin is a hormone that is found naturally in the human brain; it is also found in the digestive tract and platelets of some animals, including human beings. It is also found in a variety of plant sources, including vegetables, fruits, and even mushrooms. Categorized as a neurotransmitter, it is important in transmitting nerve impulses. It is also described as a vasoconstrictor, which is a substance that can cause narrowing of the blood vessels. The amino acid tryptophan is credited with producing serotonin in the body.
Serotonin can be considered a "happy" hormone, as it greatly influences an overall sense of well-being. It also helps to regulate moods, temper anxiety, and relieve depression. It is also credited with being a natural sleep aid. It even plays an important role in regulating such things as aggression, appetite, and sexuality. It also helps with regulating body temperature and metabolism and plays a role in the stimulation of vomiting.
Since serotonin is so important in regulating moods and feelings of well-being, it is often targeted in drugs that are used to affect the mood, such as antidepressants. A class of medications called monoamine oxidase inhibitors (MAOIs), such as Marplan and Nardil, works to prevent the breaking down of neurotransmitters, allowing them to increase in the brain and relieve depression. Unfortunately, these drugs have many serious side effects, and they tend to react dangerously with some other types of medication.
Selective serotonin re-uptake inhibitors (SSRIs), such as Celexa, Zoloft, Lexapro, and Prozac, are also used to fight depression, yet they have fewer side effects, and they tend to react better than other medications. Not all antidepressants work to increase serotonin in the brain, however. Some, like tricyclic antidepressants, such as Elavil, actually work against neurotransmitter reuptake.
Serotonin can be considered a "happy" hormone, as it greatly influences an overall sense of well-being. It also helps to regulate moods, temper anxiety, and relieve depression. It is also credited with being a natural sleep aid. It even plays an important role in regulating such things as aggression, appetite, and sexuality. It also helps with regulating body temperature and metabolism and plays a role in the stimulation of vomiting.
Since serotonin is so important in regulating moods and feelings of well-being, it is often targeted in drugs that are used to affect the mood, such as antidepressants. A class of medications called monoamine oxidase inhibitors (MAOIs), such as Marplan and Nardil, works to prevent the breaking down of neurotransmitters, allowing them to increase in the brain and relieve depression. Unfortunately, these drugs have many serious side effects, and they tend to react dangerously with some other types of medication.
Selective serotonin re-uptake inhibitors (SSRIs), such as Celexa, Zoloft, Lexapro, and Prozac, are also used to fight depression, yet they have fewer side effects, and they tend to react better than other medications. Not all antidepressants work to increase serotonin in the brain, however. Some, like tricyclic antidepressants, such as Elavil, actually work against neurotransmitter reuptake.
Monday, February 9, 2009
A link between food and serotonin?
Just what is the link between food and serotonin, and can a change in your diet make a difference?
Serotonin is a neurotransmitter, which has gotten a lot of attention in the last few years. The reason is that low serotonin levels have been linked to depression, lack of concentration, obesity, sleeplessness, and, of course, migraine.
But the food and serotonin link is more complicated than just eating foods containing serotonin. Your body doesn't get serotonin from foods, but makes serotonin from tryptophan. Tryptophan is an amino acid which is essential for the body to get. It is the precursor to more than one neurotransmitter.
You may be able to increase levels of tryptophan by eating foods like breads, pastas, candy ... but wait! That's no good. It may temporarily help if you're depressed (or it may not!), but it's not going to really help anything in the long run.
Is there another way?
Yes, there are a couple other ways. You can find the food and serotonin link in items that are somewhat healthier. Try turkey, black eyed-peas, black and English walnuts, almonds, sesame or pumpkin seeds, and cheddar, gruyere or swiss cheese. Also helping to a lesser extent are whole grains, rice, and other dairy products (grandma was right – drink a glass of warm milk before bed!).
Examples of food with tryptophan:
wheat germ - 0.4g/1cup
granola - 0.2g/1cup
cottage cheese - 0.4g/1cup
egg - 0.1g/1
duck - 0.4g/quarter lb
turkey - 0.37g/quarter cup
chicken - 0.28g/quarter cup
* list from The Healing Nutrients Within by Dr Eric R Braverman.
Serotonin is a neurotransmitter, which has gotten a lot of attention in the last few years. The reason is that low serotonin levels have been linked to depression, lack of concentration, obesity, sleeplessness, and, of course, migraine.
But the food and serotonin link is more complicated than just eating foods containing serotonin. Your body doesn't get serotonin from foods, but makes serotonin from tryptophan. Tryptophan is an amino acid which is essential for the body to get. It is the precursor to more than one neurotransmitter.
You may be able to increase levels of tryptophan by eating foods like breads, pastas, candy ... but wait! That's no good. It may temporarily help if you're depressed (or it may not!), but it's not going to really help anything in the long run.
Is there another way?
Yes, there are a couple other ways. You can find the food and serotonin link in items that are somewhat healthier. Try turkey, black eyed-peas, black and English walnuts, almonds, sesame or pumpkin seeds, and cheddar, gruyere or swiss cheese. Also helping to a lesser extent are whole grains, rice, and other dairy products (grandma was right – drink a glass of warm milk before bed!).
Examples of food with tryptophan:
wheat germ - 0.4g/1cup
granola - 0.2g/1cup
cottage cheese - 0.4g/1cup
egg - 0.1g/1
duck - 0.4g/quarter lb
turkey - 0.37g/quarter cup
chicken - 0.28g/quarter cup
* list from The Healing Nutrients Within by Dr Eric R Braverman.
Gene Variants in Adolescent Anxiety and Major Depressive Disorder
Anxious and Depressed Teens and Adults: Same Version of Mood Gene, Different Brain Reactions
An NIMH study using brain imaging shows that some anxious and depressed adolescents react differently from adult patients when looking at frightful faces. This difference occurs even though the adolescent and adult patients have the same version of a mood gene. Researchers in the NIMH Mood and Anxiety Disorders Program and colleagues reported these findings online October 31, 2008, in the journal Biological Psychiatry.
Background
Anxiety and depression are influenced by the processing of the mood-regulating brain chemical called serotonin. A protein known as the serotonin transporter directs serotonin from the space between nerve cells back into the cells, where it can be reused. Changes in the gene that codes for the serotonin transporter can lead to decreased transport of serotonin back into the brain’s nerve cells. Abnormalities in the serotonin system are associated with anxiety and depression.
Everyone inherits two copies of the serotonin transporter gene—one from each parent. The gene has various versions—one version is short, and one version is long. A person may have two copies of the same version or one copy each of two different versions. Previous studies in adults have linked versions of the gene to increased risk for mood and anxiety disorders. Adults who have one copy of the short version tend to be more anxious and depressed than adults who have two copies of the long version.
Previous brain imaging studies in adults linked gene versions to different responses of the brain’s fear hub—the amygdala—to frightful faces. In both healthy and affected adults who have at least one copy of the short version, the amygdala reacts more than it does in healthy or affected adults who have two copies of the long version of the gene. Whether these findings in adults also hold true for adolescents was unknown.
Using functional magnetic resonance imaging (fMRI), Jennifer Y. F. Lau, Ph.D., then at NIMH and now at the University of Oxford, U.K., and colleagues at NIH scanned the brains of 33 healthy teens and 31 teens with depression and anxiety disorders while they viewed pictures of frightful faces. Then the investigators compared the amygdala reactions in the two groups.
Findings of This Study
Lau and colleagues found that in healthy adolescents who have at least one copy of the short version of the gene, the amygdala reacts more than it does in healthy adolescents who have two copies of the long version. This result is the same in healthy adults. However, in anxious or depressed adolescents, the opposite results were found. In affected adolescents who have at least one copy of the short version, the amygdala reacts less than it does in affected adolescents who have two copies of the long version.
Significance
This finding in affected teens with two long version genes is the opposite of that observed in anxious or depressed adults. It is surprising because anxiety and depression during adolescence tend to predict these disorders during adulthood.
What’s Next?
The unexpected finding may be explained by the fact that anxious adults and anxious adolescents react differently when presented with threats. But further research is needed to fully understand the difference, the investigators say.
Reference
Lau JY, Goldman D, Buzas B, Fromm SJ, Guyer AE, Hodgkinson C, Monk CS, Nelson EE, Shen PH, Pine DS, Ernst M. Amygdala Function and 5-HTT Gene Variants in Adolescent Anxiety and Major Depressive Disorder. Biological Psychiatry. 2008 Oct 23. Source: Medline
An NIMH study using brain imaging shows that some anxious and depressed adolescents react differently from adult patients when looking at frightful faces. This difference occurs even though the adolescent and adult patients have the same version of a mood gene. Researchers in the NIMH Mood and Anxiety Disorders Program and colleagues reported these findings online October 31, 2008, in the journal Biological Psychiatry.
Background
Anxiety and depression are influenced by the processing of the mood-regulating brain chemical called serotonin. A protein known as the serotonin transporter directs serotonin from the space between nerve cells back into the cells, where it can be reused. Changes in the gene that codes for the serotonin transporter can lead to decreased transport of serotonin back into the brain’s nerve cells. Abnormalities in the serotonin system are associated with anxiety and depression.
Everyone inherits two copies of the serotonin transporter gene—one from each parent. The gene has various versions—one version is short, and one version is long. A person may have two copies of the same version or one copy each of two different versions. Previous studies in adults have linked versions of the gene to increased risk for mood and anxiety disorders. Adults who have one copy of the short version tend to be more anxious and depressed than adults who have two copies of the long version.
Previous brain imaging studies in adults linked gene versions to different responses of the brain’s fear hub—the amygdala—to frightful faces. In both healthy and affected adults who have at least one copy of the short version, the amygdala reacts more than it does in healthy or affected adults who have two copies of the long version of the gene. Whether these findings in adults also hold true for adolescents was unknown.
Using functional magnetic resonance imaging (fMRI), Jennifer Y. F. Lau, Ph.D., then at NIMH and now at the University of Oxford, U.K., and colleagues at NIH scanned the brains of 33 healthy teens and 31 teens with depression and anxiety disorders while they viewed pictures of frightful faces. Then the investigators compared the amygdala reactions in the two groups.
Findings of This Study
Lau and colleagues found that in healthy adolescents who have at least one copy of the short version of the gene, the amygdala reacts more than it does in healthy adolescents who have two copies of the long version. This result is the same in healthy adults. However, in anxious or depressed adolescents, the opposite results were found. In affected adolescents who have at least one copy of the short version, the amygdala reacts less than it does in affected adolescents who have two copies of the long version.
Significance
This finding in affected teens with two long version genes is the opposite of that observed in anxious or depressed adults. It is surprising because anxiety and depression during adolescence tend to predict these disorders during adulthood.
What’s Next?
The unexpected finding may be explained by the fact that anxious adults and anxious adolescents react differently when presented with threats. But further research is needed to fully understand the difference, the investigators say.
Reference
Lau JY, Goldman D, Buzas B, Fromm SJ, Guyer AE, Hodgkinson C, Monk CS, Nelson EE, Shen PH, Pine DS, Ernst M. Amygdala Function and 5-HTT Gene Variants in Adolescent Anxiety and Major Depressive Disorder. Biological Psychiatry. 2008 Oct 23. Source: Medline
Thursday, February 5, 2009
The GODDARD SCHOOL comes to Scottsdale
Welcome to The Goddard School® located in Scottsdale at 13940 N. Frank Lloyd Wright Blvd! We will be opening soon.
The Goddard School® can make a positive difference in your child's life. Our warm, loving atmosphere features a year round extended day program from 7 AM to 6 PM, Monday through Friday. Our program is designed to enhance the emotional, social, intellectual, and physical development of your child from six weeks to six years of age. We also offer after-school enrichment and a summer program for children up to seven years of age.
We take great pride in our faculty. Our experienced and degreed teachers provide a loving and nurturing environment for your children. Areas of growth and development are highlighted on our daily lesson plans, which our faculty brings to life in appropriate and attainable ways. Children are encouraged to progress at their own pace according to their individual needs and abilities. We are continually adding exciting curricular resources such as Music Appreciation, Apple Blossom Yoga, Time to Sign™, American Sign Language for children, Art History, Foreign Language Program, B.A.S.E. Fitness, and the Goddard Guide to Getting Along™! All of these enrichment programs are included in the tuition - there are no extra fees for participation.
To learn more about The Goddard School® please call (480) 451-5512.
Natalia Elfimova is the owner of the new Goddard School in Scottsdale. As a parent of a young daughter, Natalia recognizes the importance of a safe and nurturing learning environment. Her family is the basis for the reason that she chose Goddard. She has been a resident of the Scottsdale are for over ten years and is happy to be able to provide Goddard’s outstanding program to the children in the community.
The Goddard School® can make a positive difference in your child's life. Our warm, loving atmosphere features a year round extended day program from 7 AM to 6 PM, Monday through Friday. Our program is designed to enhance the emotional, social, intellectual, and physical development of your child from six weeks to six years of age. We also offer after-school enrichment and a summer program for children up to seven years of age.
We take great pride in our faculty. Our experienced and degreed teachers provide a loving and nurturing environment for your children. Areas of growth and development are highlighted on our daily lesson plans, which our faculty brings to life in appropriate and attainable ways. Children are encouraged to progress at their own pace according to their individual needs and abilities. We are continually adding exciting curricular resources such as Music Appreciation, Apple Blossom Yoga, Time to Sign™, American Sign Language for children, Art History, Foreign Language Program, B.A.S.E. Fitness, and the Goddard Guide to Getting Along™! All of these enrichment programs are included in the tuition - there are no extra fees for participation.
To learn more about The Goddard School® please call (480) 451-5512.
Natalia Elfimova is the owner of the new Goddard School in Scottsdale. As a parent of a young daughter, Natalia recognizes the importance of a safe and nurturing learning environment. Her family is the basis for the reason that she chose Goddard. She has been a resident of the Scottsdale are for over ten years and is happy to be able to provide Goddard’s outstanding program to the children in the community.
Wednesday, February 4, 2009
Join The Circle of Moms Coaching Calls
Join The Circle of Moms Coaching Calls
March 9-30, 2009
Americans are good at parenting their young children, but teaching your children mastery and accountability in the KANGAROO YEARS ages 3-8 is a new experience. To help you -The Family Coach has set up a series of four coaching calls in MARCH for moms like you!
These calls are designed to provide moms of children ages 3-8 strategies to:
Create Your Extraordinary Family.
Communicate your expectations to your children.
Help your children to comply with family expectations.
Provide you with the words and actions to help you raise confident, ethical, caring children.
Teach you strategies to distinguish between skill deficits and willful non-compliance.
Help you use your family values to encourage peaceful interactions at home.
Establish bite-sized expectations so that your children become skillful and accomplished at home and at school.
To sign-up for The Circle of Moms Coaching Series email Lynne at thefamilycoach@aol.com.
The series is $129 for four one hour classes.
This is an educational service provided by The Family Coach.
Tuesday, February 3, 2009
How Ritalin Works In Brain To Boost Cognition, Focus Attention
ScienceDaily (June 25, 2008) — Stimulant medications such as Ritalin have been prescribed for decades to treat attention deficit hyperactivity disorder (ADHD), and their popularity as "cognition enhancers" has recently surged among the healthy, as well.
What's now starting to catch up is knowledge of what these drugs actually do in the brain. In a paper publishing online this week in Biological Psychiatry, University of Wisconsin-Madison psychology researchers David Devilbiss and Craig Berridge report that Ritalin fine-tunes the functioning of neurons in the prefrontal cortex (PFC) - a brain region involved in attention, decision-making and impulse control - while having few effects outside it.
Because of the potential for addiction and abuse, controversy has swirled for years around the use of stimulants to treat ADHD, especially in children. By helping pinpoint Ritalin's action in the brain, the study should give drug developers a better road map to follow as they search for safer alternatives.
At the same time, the results support the idea that today's ADHD drugs may be safer than people think, says Berridge. Mounting behavioral and neurochemical evidence suggests that clinically relevant doses of Ritalin primarily target the PFC, without affecting brain centers linked to over-arousal and addiction. In other words, Ritalin at low doses doesn't appear to act like a stimulant at all.
"It's the higher doses of these drugs that are normally associated with their effects as stimulants, those that increase locomotor activity, impair cognition and target neurotransmitters all over the brain," says Berridge. "These lower doses are diametrically opposed to that. Instead, they help the PFC better do what it's supposed to do."
A behavioral disorder marked by hyperactivity, impulsivity and the inability to concentrate, ADHD has been treated for more than a half-century with Ritalin, Adderall and other stimulant drugs. New reports also indicate these meds have lately been embraced by healthy Americans of all ages as a means to boost mental performance.
Yet, despite their prevalence, we know remarkably little about how these drugs work, especially at lower doses that have been proven clinically to calm behavior and focus attention in ADHD patients, says Berridge. In 2006, his team reported that therapeutic doses of Ritalin boosted neurotransmitter levels primarily in the PFC, suggesting a selective targeting of this region of the brain. Since then, he and Devilbiss have focused on how Ritalin acts on PFC neurons to enhance cognition.
To answer this, the pair studied PFC neurons in rats under a variety of Ritalin doses, including one that improved the animals' performance in a working memory task of the type that ADHD patients have trouble completing. Using a sophisticated new system for monitoring many neurons at once through a set of microelectrodes, the scientists observed both the random, spontaneous firings of PFC neurons and their response to stimulation of an important pathway into the PFC, the hippocampus.
Much like tiny microphones, the electrodes record a pop every time a neuron fires, Devilbiss explains. Analyzing the complex patterns of "voices" that emerge is challenging but also powerful, because it allows study of neurons on many levels.
"Similar to listening to a choir, you can understand the music by listening to individual voices," says Devilbiss, "or you can listen to the interplay between the voices of the ensemble and how the different voices combine."
When they listened to individual PFC neurons, the scientists found that while cognition-enhancing doses of Ritalin had little effect on spontaneous activity, the neurons' sensitivity to signals coming from the hippocampus increased dramatically. Under higher, stimulatory doses, on the other hand, PFC neurons stopped responding to incoming information.
"This suggests that the therapeutic effects of Ritalin likely stem from this fine-tuning of PFC sensitivity," says Berridge. "You're improving the ability of these neurons to respond to behaviorally relevant signals, and that translates into better cognition, attention and working memory." Higher doses associated with drug abuse and cognitive impairment, in contrast, impair functioning of the PFC.
More intriguing still were the results that came from tuning into the entire chorus of neurons at once. When groups of neurons were already "singing" together strongly, Ritalin reinforced this coordinated activity. At the same time, the drug weakened activity that wasn't well coordinated to begin with. All of this suggests that Ritalin strengthens dominant and important signals within the PFC, while lessening weaker signals that may act as distractors, says Berridge.
"These results show a new level of action for cognition-enhancing doses of Ritalin that couldn't have been predicted from single neuron analyses," he says. "So, if you're searching for drugs that might replace Ritalin, this is one effect you could potentially look for."
He and Devilbiss also hope the research will help unravel an even deeper mystery: exactly how neurons encode complex behavior and cognition.
"Most studies look at how something that impairs cognition affects PFC neurons. But to really understand how neurons encode cognitive function, you want to see what neurons do when cognition is improved," says Berridge. "So this work sets the stage for examining the interplay among PFC neurons, higher cognition, and the action of therapeutic drugs."
The work was funded by the National Institute on Drug Abuse, the National Institute of Mental Health and the UW-Madison Discovery Seed Grant Program.
What's now starting to catch up is knowledge of what these drugs actually do in the brain. In a paper publishing online this week in Biological Psychiatry, University of Wisconsin-Madison psychology researchers David Devilbiss and Craig Berridge report that Ritalin fine-tunes the functioning of neurons in the prefrontal cortex (PFC) - a brain region involved in attention, decision-making and impulse control - while having few effects outside it.
Because of the potential for addiction and abuse, controversy has swirled for years around the use of stimulants to treat ADHD, especially in children. By helping pinpoint Ritalin's action in the brain, the study should give drug developers a better road map to follow as they search for safer alternatives.
At the same time, the results support the idea that today's ADHD drugs may be safer than people think, says Berridge. Mounting behavioral and neurochemical evidence suggests that clinically relevant doses of Ritalin primarily target the PFC, without affecting brain centers linked to over-arousal and addiction. In other words, Ritalin at low doses doesn't appear to act like a stimulant at all.
"It's the higher doses of these drugs that are normally associated with their effects as stimulants, those that increase locomotor activity, impair cognition and target neurotransmitters all over the brain," says Berridge. "These lower doses are diametrically opposed to that. Instead, they help the PFC better do what it's supposed to do."
A behavioral disorder marked by hyperactivity, impulsivity and the inability to concentrate, ADHD has been treated for more than a half-century with Ritalin, Adderall and other stimulant drugs. New reports also indicate these meds have lately been embraced by healthy Americans of all ages as a means to boost mental performance.
Yet, despite their prevalence, we know remarkably little about how these drugs work, especially at lower doses that have been proven clinically to calm behavior and focus attention in ADHD patients, says Berridge. In 2006, his team reported that therapeutic doses of Ritalin boosted neurotransmitter levels primarily in the PFC, suggesting a selective targeting of this region of the brain. Since then, he and Devilbiss have focused on how Ritalin acts on PFC neurons to enhance cognition.
To answer this, the pair studied PFC neurons in rats under a variety of Ritalin doses, including one that improved the animals' performance in a working memory task of the type that ADHD patients have trouble completing. Using a sophisticated new system for monitoring many neurons at once through a set of microelectrodes, the scientists observed both the random, spontaneous firings of PFC neurons and their response to stimulation of an important pathway into the PFC, the hippocampus.
Much like tiny microphones, the electrodes record a pop every time a neuron fires, Devilbiss explains. Analyzing the complex patterns of "voices" that emerge is challenging but also powerful, because it allows study of neurons on many levels.
"Similar to listening to a choir, you can understand the music by listening to individual voices," says Devilbiss, "or you can listen to the interplay between the voices of the ensemble and how the different voices combine."
When they listened to individual PFC neurons, the scientists found that while cognition-enhancing doses of Ritalin had little effect on spontaneous activity, the neurons' sensitivity to signals coming from the hippocampus increased dramatically. Under higher, stimulatory doses, on the other hand, PFC neurons stopped responding to incoming information.
"This suggests that the therapeutic effects of Ritalin likely stem from this fine-tuning of PFC sensitivity," says Berridge. "You're improving the ability of these neurons to respond to behaviorally relevant signals, and that translates into better cognition, attention and working memory." Higher doses associated with drug abuse and cognitive impairment, in contrast, impair functioning of the PFC.
More intriguing still were the results that came from tuning into the entire chorus of neurons at once. When groups of neurons were already "singing" together strongly, Ritalin reinforced this coordinated activity. At the same time, the drug weakened activity that wasn't well coordinated to begin with. All of this suggests that Ritalin strengthens dominant and important signals within the PFC, while lessening weaker signals that may act as distractors, says Berridge.
"These results show a new level of action for cognition-enhancing doses of Ritalin that couldn't have been predicted from single neuron analyses," he says. "So, if you're searching for drugs that might replace Ritalin, this is one effect you could potentially look for."
He and Devilbiss also hope the research will help unravel an even deeper mystery: exactly how neurons encode complex behavior and cognition.
"Most studies look at how something that impairs cognition affects PFC neurons. But to really understand how neurons encode cognitive function, you want to see what neurons do when cognition is improved," says Berridge. "So this work sets the stage for examining the interplay among PFC neurons, higher cognition, and the action of therapeutic drugs."
The work was funded by the National Institute on Drug Abuse, the National Institute of Mental Health and the UW-Madison Discovery Seed Grant Program.
Thriving with ADHD
For all you who asked, here is the outline for the February 3, 2009 Teleconference Thriving with ADHD
What is ADHD
• A medical condition characterized by inattention, impulsivity and or hyperactivity
• Approximately 5-7 percent of school-aged children have ADHD
• 2 million children in US
• 5 million adults US
ADHD is not
• Lack of motivation
• Poor parenting
• A result of parenting
• Laziness
• Low intelligence
• Uncommon
Executive Function
• "Executive Function" refers to a set of mental processes that serve as the boss of our brain, the organizer, strategic planner and Chief Executive Officer of our brain.
• We use executive function when we perform activities such as planning, organizing, strategizing, paying attention to details and remembering information.
When The Boss is Out
• Difficulty with
– Problem solving
– Organization
– Managing behavior
– Mood modulation
– Starting and stopping behaviors
– Staying on task
EF Observable Behavior
• TIME MANAGEMENT
– Finish work on time
– Keep track of time
– Make and keep plans
• ATTENTION
– Stay on task
– Make and act on corrections while speaking, thinking, reading and writing
• ORGANIZING THOUGHTS TO COMMUNICATE THEM
– Ask for what one needs
– Communicate ides in a relevant sequential manner
– Express emotional state thoughtfully
– Act on self-corrections while speaking, thinking, reading and writing
EF Observable Behavior
• PLANNING
– Initiating relevant tasks
– Acting on independently generated ideas or plans
– Planning a project
– Projecting how much time is needed for a project
• MEMORY
– Holding information in working memory
– Retaining and using information in the moment
– Retrieving information from memory
– Keeping track of more than one thing at once
Additional Domains
• IMPULSIVITY
• MOOD MODULATION
• SENSORY STIMULATION
Co-morbid Issues
• ODD
• CD
• Tics
• Anxiety
• Depression
• Social issues
• Self-esteem
Managing ADHD
• Structure
• Organization
• Planning
• Mastery
• Family mission
• Family values
• Clear rules
• Clear expectations
• Clear consequences
Hear You Then.
Time: 11 am in Phoenix 1 pm ET 10 am PT
Cost: First class Free
Call in line: 712-429-0690 pin 884068#.
What is ADHD
• A medical condition characterized by inattention, impulsivity and or hyperactivity
• Approximately 5-7 percent of school-aged children have ADHD
• 2 million children in US
• 5 million adults US
ADHD is not
• Lack of motivation
• Poor parenting
• A result of parenting
• Laziness
• Low intelligence
• Uncommon
Executive Function
• "Executive Function" refers to a set of mental processes that serve as the boss of our brain, the organizer, strategic planner and Chief Executive Officer of our brain.
• We use executive function when we perform activities such as planning, organizing, strategizing, paying attention to details and remembering information.
When The Boss is Out
• Difficulty with
– Problem solving
– Organization
– Managing behavior
– Mood modulation
– Starting and stopping behaviors
– Staying on task
EF Observable Behavior
• TIME MANAGEMENT
– Finish work on time
– Keep track of time
– Make and keep plans
• ATTENTION
– Stay on task
– Make and act on corrections while speaking, thinking, reading and writing
• ORGANIZING THOUGHTS TO COMMUNICATE THEM
– Ask for what one needs
– Communicate ides in a relevant sequential manner
– Express emotional state thoughtfully
– Act on self-corrections while speaking, thinking, reading and writing
EF Observable Behavior
• PLANNING
– Initiating relevant tasks
– Acting on independently generated ideas or plans
– Planning a project
– Projecting how much time is needed for a project
• MEMORY
– Holding information in working memory
– Retaining and using information in the moment
– Retrieving information from memory
– Keeping track of more than one thing at once
Additional Domains
• IMPULSIVITY
• MOOD MODULATION
• SENSORY STIMULATION
Co-morbid Issues
• ODD
• CD
• Tics
• Anxiety
• Depression
• Social issues
• Self-esteem
Managing ADHD
• Structure
• Organization
• Planning
• Mastery
• Family mission
• Family values
• Clear rules
• Clear expectations
• Clear consequences
Hear You Then.
Time: 11 am in Phoenix 1 pm ET 10 am PT
Cost: First class Free
Call in line: 712-429-0690 pin 884068#.
Saturday, January 31, 2009
Thrive with ADHD
There are an estimated 1.46 to 2.46 million children with ADHD in the United States, constituting 3 to 5 percent of the school student population.
It has been documented that approximately 25 to 30 percent of all children with ADHD also have learning disabilities. Likewise, children with ADHD have coexisting psychiatric disorders at a much higher rate.
These children and their parents need the skills to enhance attention, contain impulsivity, increase delay and manage their motors. Join a fruitful conversation as you learn to help your child thrive with ADHD and associated challenges.
Teleconference TUESDAY FEB 3, 2009 Thriving with ADHD - Whether your children are diagnosed with ADHD or not, this teleconference is for you if your children are overactive, impulsive or have executive function challenges.
Time: 11 am in Phoenix 1 pm ET 10 am PT
Cost: First class Free
Call in line: 712-429-0690 pin 884068#.
Hear you there!
It has been documented that approximately 25 to 30 percent of all children with ADHD also have learning disabilities. Likewise, children with ADHD have coexisting psychiatric disorders at a much higher rate.
These children and their parents need the skills to enhance attention, contain impulsivity, increase delay and manage their motors. Join a fruitful conversation as you learn to help your child thrive with ADHD and associated challenges.
Teleconference TUESDAY FEB 3, 2009 Thriving with ADHD - Whether your children are diagnosed with ADHD or not, this teleconference is for you if your children are overactive, impulsive or have executive function challenges.
Time: 11 am in Phoenix 1 pm ET 10 am PT
Cost: First class Free
Call in line: 712-429-0690 pin 884068#.
Hear you there!
Friday, January 30, 2009
Increase Fats Decrease Depression
The popular idea today is that omega-3 fats such as fish and flax oils are antidotes for depression. The truth is that there are many healthy, natural fats that work this way. Fats such as organic butter from grass-fed animals, unrefined coconut oil, and extra virgin olive oil help stabilize blood sugar while they enhance mental function and improve mood.
Fats are vitally important for neurological function and mood. The low-fat diet craze of recent years has done no favors for our brains or our emotional well-being. Like organic animal protein, fats provide substance and sustenance to deal with daily stress and emotional trauma.
One way to appreciate the vital role that fats play in neurological health is to consider the ketogenic diet, a medical dietary therapy that is sometimes used in hospitals for people with neurological disorders. The diet calls for 80% of calories to come from high-quality fats, such as organic butter, ghee, unrefined coconut oils, extra virgin olive oil, and fish oils. Such quality fats help to protect both the myelin lining of the central nervous system and also the brain, which is mostly fat and cholesterol.
The high-fat ketogenic diet is used especially for children and the elderly. It is a quick remedy for nervous system disorders that may stem from reactions to vaccines. It can also be used for neurological issues such as epilepsy, multiple sclerosis, and Parkinson’s Disease. Some scientists believe that a high-fat diet can actually help repair the myelin lining around the nerves that are affected by a variety of chronic neurological diseases.
More evidence for the role of fats in mental health comes from the most recent, Winter 2008 issue of Wise Traditions, published by the Weston Price Foundation. In The Pursuit of Happiness: How Nutrient-dense Animal Fats Promote Mental and Emotional Health, Chris Masterjohn states, “Modern science has now elucidated the role of nutrient-dense animal fats in preventing mental illness and supporting the focused, goal-oriented behavior needed to confront challenges and pursue a happy, satisfying, and successful life.” Source: Health Counselor, Carol Kenney www.pathways4health.com.
Fats are vitally important for neurological function and mood. The low-fat diet craze of recent years has done no favors for our brains or our emotional well-being. Like organic animal protein, fats provide substance and sustenance to deal with daily stress and emotional trauma.
One way to appreciate the vital role that fats play in neurological health is to consider the ketogenic diet, a medical dietary therapy that is sometimes used in hospitals for people with neurological disorders. The diet calls for 80% of calories to come from high-quality fats, such as organic butter, ghee, unrefined coconut oils, extra virgin olive oil, and fish oils. Such quality fats help to protect both the myelin lining of the central nervous system and also the brain, which is mostly fat and cholesterol.
The high-fat ketogenic diet is used especially for children and the elderly. It is a quick remedy for nervous system disorders that may stem from reactions to vaccines. It can also be used for neurological issues such as epilepsy, multiple sclerosis, and Parkinson’s Disease. Some scientists believe that a high-fat diet can actually help repair the myelin lining around the nerves that are affected by a variety of chronic neurological diseases.
More evidence for the role of fats in mental health comes from the most recent, Winter 2008 issue of Wise Traditions, published by the Weston Price Foundation. In The Pursuit of Happiness: How Nutrient-dense Animal Fats Promote Mental and Emotional Health, Chris Masterjohn states, “Modern science has now elucidated the role of nutrient-dense animal fats in preventing mental illness and supporting the focused, goal-oriented behavior needed to confront challenges and pursue a happy, satisfying, and successful life.” Source: Health Counselor, Carol Kenney www.pathways4health.com.
Dr. Michele Borba on Manners
Simple Mom-Tested Secrets to Raising Well-Mannered Kids
By Dr. Michele Borba, www.simplemommysecrets.com
Excerpt from 12 Simple Secrets Real Moms Know: Getting Back to Basics and Raising Happy Kids by Michele Borba (Jossey-Bass Publishers, 2006)
All three of my sons attended a wonderful cooperative nursery school led by an incredibly caring teacher, Jeanette Thompson. The very first impression I had of the school was how well-mannered the children were. And, through the years as I put in my "coop" hours, I understood why her students were so polite: Mrs. Thompson never taught manners at a special time, instead she taught students manners all day long through her own example. Every sentence she ever uttered contained the word "please," "thank you," or "excuse me." It was impossible for her students not to be polite. She used to always tell the moms, "Manners are caught, not taught." Was she ever right! I also learned an important secret from my children's teacher: The first step to teaching kids good manners is to make sure you model them yourself.
Make no mistake, Mom: Courtesy does enhance our kids' chances of success! Scores of studies find that well-mannered children are more popular and do better in school. Notice how often they're invited to others' homes? Kids like to be around kids who are nice. Listen to teachers speak about them using such positive accolades. Courteous children have an edge later in life: the business world clearly tells us their first interview choices are those applicants displaying good social graces. They also get more "second" job interviews, and usually even the job. You just can't help but react positively to people who are polite and courteous. By prioritizing polite behaviors with our children, we can enhance their social competence and give them a big boost towards success. Here are five simple secrets to enhance good social graces in your children and give them that edge for a better life.
* Reward Courtesy. Good manners are among the simplest skills to teach children because they are expressed in just a few very specific behaviors. We can instantly point out good or poor manners to our kids: "Wow, nice manners! Did you notice the smile on Grandma's face when you thanked her for dinner?" or "Eating before waiting for the others to sit down wasn't polite," We can modify our children's manners: "Next time, remember to say 'Excuse Me' when you walk in front of someone." And we can always tune them up: "Before you ask for the dish, say "Please."
* Point Out the Value of Manners. Discuss with your children the value of good manners. You might say, "Using good manners helps you gain the respect of others. It's also a great way to meet new friends. Polite people just make the world a kinder place." Once kids understand the impact good manners have on others, they're more likely to incorporate courtesy in their own behavior.
* Teach a Manner a Week. When my children were young I taught them a jingle, "Hearts, like doors, will open with ease, if you learn to use these keys." We'd then print a manner a week on a large paper key and tape it on our kitchen door as a reminder. Every child in the neighborhood could recite not only our jingle, but name the manners that are the "keys to opening hearts." It helped me recognize "catching new manners" doesn't happen overnight: it takes consistency and effort to enhance them in our kids. So, how about teaching a "Manner a Week"? Write the manner on an index card, post it on your refrigerator, and then hold a contest to see how many times family members hear another member use the word. Here's a few to get you started: "Please., Thank you., May I?, Excuse me, I'm sorry., Pardon me., I'm glad to meet you,, You go first., and May I introduce....?"
* Correct Impoliteness Immediately. When your child uses an impolite comment, immediately correct the behavior by using the three "Bs" of discipline: "Be Brief, Be Private so no one but you and your child is aware you're correcting your child, and Be Specific." Here's how two parents used the three "Bs": Juan's mom waited for a private moment to point out his poor manners to him, "Starting your dinner without waiting first for Grandma to sit down, was impolite. Being polite means always respecting older people." Waiting for the right time when only Juan could hear his mom's correction, preserved his dignity but still let him know his behavior was unacceptable. When Kevin used a racist comment, his father immediately used the three Bs letting him know it was unacceptable: "That was a bigoted comment and could hurt someone's feelings. Please, don't ever use that word again."
* Practice Table Manners. A friend of mine who really wanted to make sure her children "caught good manners" started a unique family tradition: Once a month, she asks her children to help her plan a party. The children plan the menu, set their table--with only their "company dishes"--arrange a centerpiece of hand-picked flowers, and then sit in their "Sunday best." The party is just for their family, and it's the time my friend helps her children practice table manners such as "please pass," "thank you," "May I be excused?" (as well keeping your napkin on your lap, chewing with your mouth closed, waiting for others to speak, and learning which fork to use with each course). Yes, it takes a lot of work, but she swears it's worth it, especially when so many people comment on how well-behaved her children are.
A recent survey conducted by US News & World Report found nine out of ten Americans felt the breakdown of common courtesy has become a serious problem in this country. A huge seventy-eight percent of those polled said manners and good social graces have significantly eroded over past ten years, and is a major contributor to the breakdown of our values in this country. What a sad commentary! Using good manners will enhance your child's reputation in all arenas-home, school, and the community. Besides, kids like to be around other kids who are courteous and nice. So start boosting your child's social graces by using these simple secrets in your family.
Michele Borba, Ed.D. is a mom of three, a former teacher, and renowned educational consultant who has presented workshops to one million parents and teachers worldwide. Dr. Borba is the author of 12 Simple Secrets Real Moms Know: Getting Back to Basics and Raising Happy Kids (Jossey-Bass, April 2006).She is a frequent guest on Today, The Early Show, The View, and Fox & Friends. She is also the award-winning author of over 20 books including Parents Do Make a Difference, Don't Give Me That Attitude!, No More Misbehavin': 38 Difficult Behaviors and How to Stop Them, and Nobody Likes Me, Everybody Hates Me. Dr. Borba is an advisory board member for Parents. For more strategies and tips visit www.simplemommysecrets.com.
© 2006 by Michele Borba www.simplemommysecrets.com.
By Dr. Michele Borba, www.simplemommysecrets.com
Excerpt from 12 Simple Secrets Real Moms Know: Getting Back to Basics and Raising Happy Kids by Michele Borba (Jossey-Bass Publishers, 2006)
All three of my sons attended a wonderful cooperative nursery school led by an incredibly caring teacher, Jeanette Thompson. The very first impression I had of the school was how well-mannered the children were. And, through the years as I put in my "coop" hours, I understood why her students were so polite: Mrs. Thompson never taught manners at a special time, instead she taught students manners all day long through her own example. Every sentence she ever uttered contained the word "please," "thank you," or "excuse me." It was impossible for her students not to be polite. She used to always tell the moms, "Manners are caught, not taught." Was she ever right! I also learned an important secret from my children's teacher: The first step to teaching kids good manners is to make sure you model them yourself.
Make no mistake, Mom: Courtesy does enhance our kids' chances of success! Scores of studies find that well-mannered children are more popular and do better in school. Notice how often they're invited to others' homes? Kids like to be around kids who are nice. Listen to teachers speak about them using such positive accolades. Courteous children have an edge later in life: the business world clearly tells us their first interview choices are those applicants displaying good social graces. They also get more "second" job interviews, and usually even the job. You just can't help but react positively to people who are polite and courteous. By prioritizing polite behaviors with our children, we can enhance their social competence and give them a big boost towards success. Here are five simple secrets to enhance good social graces in your children and give them that edge for a better life.
* Reward Courtesy. Good manners are among the simplest skills to teach children because they are expressed in just a few very specific behaviors. We can instantly point out good or poor manners to our kids: "Wow, nice manners! Did you notice the smile on Grandma's face when you thanked her for dinner?" or "Eating before waiting for the others to sit down wasn't polite," We can modify our children's manners: "Next time, remember to say 'Excuse Me' when you walk in front of someone." And we can always tune them up: "Before you ask for the dish, say "Please."
* Point Out the Value of Manners. Discuss with your children the value of good manners. You might say, "Using good manners helps you gain the respect of others. It's also a great way to meet new friends. Polite people just make the world a kinder place." Once kids understand the impact good manners have on others, they're more likely to incorporate courtesy in their own behavior.
* Teach a Manner a Week. When my children were young I taught them a jingle, "Hearts, like doors, will open with ease, if you learn to use these keys." We'd then print a manner a week on a large paper key and tape it on our kitchen door as a reminder. Every child in the neighborhood could recite not only our jingle, but name the manners that are the "keys to opening hearts." It helped me recognize "catching new manners" doesn't happen overnight: it takes consistency and effort to enhance them in our kids. So, how about teaching a "Manner a Week"? Write the manner on an index card, post it on your refrigerator, and then hold a contest to see how many times family members hear another member use the word. Here's a few to get you started: "Please., Thank you., May I?, Excuse me, I'm sorry., Pardon me., I'm glad to meet you,, You go first., and May I introduce....?"
* Correct Impoliteness Immediately. When your child uses an impolite comment, immediately correct the behavior by using the three "Bs" of discipline: "Be Brief, Be Private so no one but you and your child is aware you're correcting your child, and Be Specific." Here's how two parents used the three "Bs": Juan's mom waited for a private moment to point out his poor manners to him, "Starting your dinner without waiting first for Grandma to sit down, was impolite. Being polite means always respecting older people." Waiting for the right time when only Juan could hear his mom's correction, preserved his dignity but still let him know his behavior was unacceptable. When Kevin used a racist comment, his father immediately used the three Bs letting him know it was unacceptable: "That was a bigoted comment and could hurt someone's feelings. Please, don't ever use that word again."
* Practice Table Manners. A friend of mine who really wanted to make sure her children "caught good manners" started a unique family tradition: Once a month, she asks her children to help her plan a party. The children plan the menu, set their table--with only their "company dishes"--arrange a centerpiece of hand-picked flowers, and then sit in their "Sunday best." The party is just for their family, and it's the time my friend helps her children practice table manners such as "please pass," "thank you," "May I be excused?" (as well keeping your napkin on your lap, chewing with your mouth closed, waiting for others to speak, and learning which fork to use with each course). Yes, it takes a lot of work, but she swears it's worth it, especially when so many people comment on how well-behaved her children are.
A recent survey conducted by US News & World Report found nine out of ten Americans felt the breakdown of common courtesy has become a serious problem in this country. A huge seventy-eight percent of those polled said manners and good social graces have significantly eroded over past ten years, and is a major contributor to the breakdown of our values in this country. What a sad commentary! Using good manners will enhance your child's reputation in all arenas-home, school, and the community. Besides, kids like to be around other kids who are courteous and nice. So start boosting your child's social graces by using these simple secrets in your family.
Michele Borba, Ed.D. is a mom of three, a former teacher, and renowned educational consultant who has presented workshops to one million parents and teachers worldwide. Dr. Borba is the author of 12 Simple Secrets Real Moms Know: Getting Back to Basics and Raising Happy Kids (Jossey-Bass, April 2006).She is a frequent guest on Today, The Early Show, The View, and Fox & Friends. She is also the award-winning author of over 20 books including Parents Do Make a Difference, Don't Give Me That Attitude!, No More Misbehavin': 38 Difficult Behaviors and How to Stop Them, and Nobody Likes Me, Everybody Hates Me. Dr. Borba is an advisory board member for Parents. For more strategies and tips visit www.simplemommysecrets.com.
© 2006 by Michele Borba www.simplemommysecrets.com.
Thursday, January 29, 2009
Family-Based Lifestyle Interventions May Help Obese Children Lose Weight
Family-Based Lifestyle Interventions May Help Obese Children Lose Weight
Laurie Barclay, MD From Medscape Today
January 26, 2009 — Family-based lifestyle interventions that modify diet and physical activity and that include behavioral therapy can help obese children lose weight and maintain that loss for at least 6 months, according to the results of a Cochrane systematic review posted online January 21 in the Cochrane Database of Systematic Reviews.
"Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences," write Hiltje Oude Luttikhuis, from Beatrix Children's Hospital and University Medical Center Groningen, in Groningen, the Netherlands, and colleagues. "In order to support clinicians in determining the most appropriate form of treatment, paediatric weight management guidelines exist in many countries to promote best practice, but at present many of these recommendations are based on low grade scientific evidence."
The goal of this systematic review was to evaluate the efficacy of lifestyle, drug, and surgical interventions to treat obesity in childhood. The reviewers searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE, and NHS EED from 1985 to May 2008 without language restrictions. Bibliographies of retrieved articles were also consulted.
Inclusion criteria for the review were randomized controlled trials of lifestyle interventions (eg, dietary, physical activity, and/or behavioral therapy interventions) and drug and surgical interventions to treat obesity in children younger than 18 years. The interventions could have been conducted with or without the support of family members. A minimum of 6 months of follow-up was required or 3 months for actual drug therapy.
Exclusion criteria were interventions that specifically addressed the treatment of eating disorders or of type 2 diabetes or that included participants with a secondary or syndromic cause of obesity. Using criteria in the Cochrane Handbook, 2 reviewers independently evaluated trial quality and extracted data, and they also contacted study authors for additional information when needed.
The 64 randomized controlled trials identified that met criteria enrolled a total of 5230 participants. In 12 studies, lifestyle interventions were directed at physical activity and sedentary behavior, whereas 6 studies addressed diet and 36 evaluated behaviorally oriented treatment programs. Ten studies looked at drug interventions with metformin, orlistat, or sibutramine. None of the identified studies of surgical intervention met inclusion criteria. Intervention design, outcome measurements, and methodologic quality varied considerably in the included studies.
Meta-analyses showed that lifestyle interventions involving children and lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine were associated with a reduction in overweight at 6 and 12 months of follow-up. Randomized controlled trials of drugs showed a range of adverse effects.
Limitations of this review include those of the reviewed studies, such as insufficient power, publication bias, failure to account for missing data in analyses, analysis not based on intent-to-treat, variations in the definitions of fatness in children, and limited duration of follow-up.
"While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents," the study authors conclude. "In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician family interaction, and cost-effective programs for primary and community care is required."
The University Medical Center, Groningen, Netherlands; The Children's Hospital at Westmead, Sydney, Australia; the Centre for Food Physical Activity and Obesity Research, University of Teesside, United Kingdom; the Wolfson Research Institute, University of Durham, United Kingdom; and the Australian National Health & Medical Research Council, Australia, supported this study. One of the review authors is a coauthor on 3 of the studies included in the Cochrane Review. Two other authors are involved in the design and conduct of a potentially eligible study for this review.
Cochrane Database Syst Rev. Published online January 21, 2009.
Laurie Barclay, MD From Medscape Today
January 26, 2009 — Family-based lifestyle interventions that modify diet and physical activity and that include behavioral therapy can help obese children lose weight and maintain that loss for at least 6 months, according to the results of a Cochrane systematic review posted online January 21 in the Cochrane Database of Systematic Reviews.
"Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences," write Hiltje Oude Luttikhuis, from Beatrix Children's Hospital and University Medical Center Groningen, in Groningen, the Netherlands, and colleagues. "In order to support clinicians in determining the most appropriate form of treatment, paediatric weight management guidelines exist in many countries to promote best practice, but at present many of these recommendations are based on low grade scientific evidence."
The goal of this systematic review was to evaluate the efficacy of lifestyle, drug, and surgical interventions to treat obesity in childhood. The reviewers searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE, and NHS EED from 1985 to May 2008 without language restrictions. Bibliographies of retrieved articles were also consulted.
Inclusion criteria for the review were randomized controlled trials of lifestyle interventions (eg, dietary, physical activity, and/or behavioral therapy interventions) and drug and surgical interventions to treat obesity in children younger than 18 years. The interventions could have been conducted with or without the support of family members. A minimum of 6 months of follow-up was required or 3 months for actual drug therapy.
Exclusion criteria were interventions that specifically addressed the treatment of eating disorders or of type 2 diabetes or that included participants with a secondary or syndromic cause of obesity. Using criteria in the Cochrane Handbook, 2 reviewers independently evaluated trial quality and extracted data, and they also contacted study authors for additional information when needed.
The 64 randomized controlled trials identified that met criteria enrolled a total of 5230 participants. In 12 studies, lifestyle interventions were directed at physical activity and sedentary behavior, whereas 6 studies addressed diet and 36 evaluated behaviorally oriented treatment programs. Ten studies looked at drug interventions with metformin, orlistat, or sibutramine. None of the identified studies of surgical intervention met inclusion criteria. Intervention design, outcome measurements, and methodologic quality varied considerably in the included studies.
Meta-analyses showed that lifestyle interventions involving children and lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine were associated with a reduction in overweight at 6 and 12 months of follow-up. Randomized controlled trials of drugs showed a range of adverse effects.
Limitations of this review include those of the reviewed studies, such as insufficient power, publication bias, failure to account for missing data in analyses, analysis not based on intent-to-treat, variations in the definitions of fatness in children, and limited duration of follow-up.
"While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents," the study authors conclude. "In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician family interaction, and cost-effective programs for primary and community care is required."
The University Medical Center, Groningen, Netherlands; The Children's Hospital at Westmead, Sydney, Australia; the Centre for Food Physical Activity and Obesity Research, University of Teesside, United Kingdom; the Wolfson Research Institute, University of Durham, United Kingdom; and the Australian National Health & Medical Research Council, Australia, supported this study. One of the review authors is a coauthor on 3 of the studies included in the Cochrane Review. Two other authors are involved in the design and conduct of a potentially eligible study for this review.
Cochrane Database Syst Rev. Published online January 21, 2009.
Tuesday, January 27, 2009
Getting Your Children To Do As They Are Told
Why Do Children Misbehave?
If you attend a workshop or parenting class, you are likely to hear that children misbehave for four common reasons: attention, power, revenge, or inadequacy. Yet, when I ask parents the meanings behind behavior, they often come up with a broader range of reasons children misbehave.
Children may misbehave due to:
1. Illness: When we don’t feel well, we often don’t have the skills, patience, calming power, or thinking ability to do the right thing.
2. Boredom: This is common in school when topics and activities do not stimulate the brain enough to keep it engaged.
3. Frustration and anger: When tasks, people, or experiences lead us to frustration or anger, we are unlikely to do the right thing or make a good choice.
4. A need for attention: Most people enjoy attention, but there is likely a critical mass below which children seek the stimulation and comfort of attention, love, and nurturance.
5. Anxiety: Anxiety is simply fear turned on its side. They both come from the same biological brain system, the limbic system. Many times children misbehave because they are anxious, afraid, or both, even if they don’t have the language skills to communicate their concerns or fears.
6. Low self-esteem: When children do not regard themselves very highly, part of them figures, “Who cares. Whatever. Things are no good for me now so why should I comply?”
7. Misunderstanding: Sometimes children misunderstand what is expected of them. This can be due to communication, listening, or attention challenges.
8. Pacing problems: The internal motor of some children runs too high, making their internal pacing and speed a difficulty to manage themselves.
9. Communication challenges: Due to receptive and or expressive language issues, some children do not have the foundational communication skills to exhibit appropriate behaviors.
10. Sabotage: While parents are generally well-meaning, they can miscommunicate with their children, expect skills beyond the child’s ability, or interfere with learning because of their own anger and skill deficits.
11. Sensory overload: Some children experience overloads to their nervous system that lead to acting up and acting out. Sensory calming skills need to be employed.
_______________________________________________________________________________________
One method for stepping back and collecting data before you form an opinion or intervene is to ask yourself: “What is the meaning of the behavior?” “What underlies this behavior?” “Why is it occurring?” and “What factors are reinforcing this behavior?” In fact, there are three steps to intervening: Data collection, decision-making and intervention.
The method we explore today at the teleconference is "Can He Do It?" differentiating willful non-compliance from a skill deficit. Let's look at a sample behavior:
Identify “Can He Do It?”
Many times children may not be able to exhibit desired behaviors because they do not possess the skills to do as you ask. A simple evaluation tool I use in my office is “Can He Do It?” The tool works like this: write down a specific behavior your child had difficulty with in the past 48 hours. Then ask yourself if your child possessed the skills necessary to complete the desired behavior? If yes, expect it. This is when we use simple behavioral compliance strategies. If no, teach it. It’s that simple. Let’s look at one specific behavioral challenges.
Behavior #1: Sharing Toys
Step #1: What is the expected behavior?
Answer: I expect my five-year-old son to share his toys with his sister.
Step #2: “Can he do it?”
• Did I discretely define one behavior I am seeking my child to exhibit?
• Does my child have the requisite skills to exhibit this behavior?
• Are there any roadblocks that inhibit my child’s ability to exhibit the behavior? For example, did my child sleep well and eat well?
• Have I defined which toys are for sharing and which are personal and will not be played with by others?
• If my child will share another toy, but not the requested toy, did I offer an alternative solution for the children?
Step #3: If yes, expect it. Help your child learn to share by clarifying expectations and establishing a time-frame for sharing.
Step #4: If no, teach it. Help the child to choose an alternate toy, model sharing, and practice sharing.
Bring your own examples to the call, look forward to hearing you there.
http://www.lynnekenney.com/teleconferences.php
If you attend a workshop or parenting class, you are likely to hear that children misbehave for four common reasons: attention, power, revenge, or inadequacy. Yet, when I ask parents the meanings behind behavior, they often come up with a broader range of reasons children misbehave.
Children may misbehave due to:
1. Illness: When we don’t feel well, we often don’t have the skills, patience, calming power, or thinking ability to do the right thing.
2. Boredom: This is common in school when topics and activities do not stimulate the brain enough to keep it engaged.
3. Frustration and anger: When tasks, people, or experiences lead us to frustration or anger, we are unlikely to do the right thing or make a good choice.
4. A need for attention: Most people enjoy attention, but there is likely a critical mass below which children seek the stimulation and comfort of attention, love, and nurturance.
5. Anxiety: Anxiety is simply fear turned on its side. They both come from the same biological brain system, the limbic system. Many times children misbehave because they are anxious, afraid, or both, even if they don’t have the language skills to communicate their concerns or fears.
6. Low self-esteem: When children do not regard themselves very highly, part of them figures, “Who cares. Whatever. Things are no good for me now so why should I comply?”
7. Misunderstanding: Sometimes children misunderstand what is expected of them. This can be due to communication, listening, or attention challenges.
8. Pacing problems: The internal motor of some children runs too high, making their internal pacing and speed a difficulty to manage themselves.
9. Communication challenges: Due to receptive and or expressive language issues, some children do not have the foundational communication skills to exhibit appropriate behaviors.
10. Sabotage: While parents are generally well-meaning, they can miscommunicate with their children, expect skills beyond the child’s ability, or interfere with learning because of their own anger and skill deficits.
11. Sensory overload: Some children experience overloads to their nervous system that lead to acting up and acting out. Sensory calming skills need to be employed.
_______________________________________________________________________________________
One method for stepping back and collecting data before you form an opinion or intervene is to ask yourself: “What is the meaning of the behavior?” “What underlies this behavior?” “Why is it occurring?” and “What factors are reinforcing this behavior?” In fact, there are three steps to intervening: Data collection, decision-making and intervention.
The method we explore today at the teleconference is "Can He Do It?" differentiating willful non-compliance from a skill deficit. Let's look at a sample behavior:
Identify “Can He Do It?”
Many times children may not be able to exhibit desired behaviors because they do not possess the skills to do as you ask. A simple evaluation tool I use in my office is “Can He Do It?” The tool works like this: write down a specific behavior your child had difficulty with in the past 48 hours. Then ask yourself if your child possessed the skills necessary to complete the desired behavior? If yes, expect it. This is when we use simple behavioral compliance strategies. If no, teach it. It’s that simple. Let’s look at one specific behavioral challenges.
Behavior #1: Sharing Toys
Step #1: What is the expected behavior?
Answer: I expect my five-year-old son to share his toys with his sister.
Step #2: “Can he do it?”
• Did I discretely define one behavior I am seeking my child to exhibit?
• Does my child have the requisite skills to exhibit this behavior?
• Are there any roadblocks that inhibit my child’s ability to exhibit the behavior? For example, did my child sleep well and eat well?
• Have I defined which toys are for sharing and which are personal and will not be played with by others?
• If my child will share another toy, but not the requested toy, did I offer an alternative solution for the children?
Step #3: If yes, expect it. Help your child learn to share by clarifying expectations and establishing a time-frame for sharing.
Step #4: If no, teach it. Help the child to choose an alternate toy, model sharing, and practice sharing.
Bring your own examples to the call, look forward to hearing you there.
http://www.lynnekenney.com/teleconferences.php
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