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May 15, 2010

Rituals and Alcoholism in the Family

Posted by Nathen under alcohol abuse, children, family, family therapy, marriage and family therapy, parenting, psychology, rituals, Uncategorized
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I just read in Brock & Barnard’s Procedures in Marriage and Family Therapy about Wolin and colleagues’ research into rituals in alcoholic families. Apparently, the negative effects of an alcoholic parent were predicted better by the amount that family rituals were disrupted by the alcoholism than by the presence of alcoholism itself. For example, if the family continued to eat dinner together every night, continued with their bedtime rituals, etc, children remained about as well off as those in non-alcoholic households. But if the family rituals were destroyed, the children were much worse off, including much more likely to become alcoholic or marry an alcoholic themselves.

I haven’t read any of the original research, so I don’t know for sure if it is that these rituals actually provide resiliency or if the presence or lack of rituals served as a proxy measure for how bad the alcoholism was. It could also be a combination of the two. It does look like the family therapy literature considers that rituals promote resiliency in general, providing structure and comforting predictability for kids, and resulting in better outcomes. (I doubt they are bad for the adults, either.)  Something to think about, parents!

 

May 14, 2010

Diagnostic Criteria for Oppositional Defiant Disorder

Posted by Nathen under adolescents, antidepressants, Attention-Deficit/Hyperactivity Disorder, children, diagnostic criteria, drugs, DSM-IV-TR, family assessment, family therapy, insurance companies, lists, mental disorders, obedience, Oppositional Defiant Disorder, practicum, psychopathology, psychotropic medication, SSRIs, stimulants
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According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR), there is a mental disorder that is usually diagnosed in childhood or adolescence called Oppositional Defiant Disorder. It afflicts somewhere between 2-16% of people, more boys than girls before puberty, but equal numbers of boys and girls after puberty. Family therapists are not into giving medical-model diagnoses in general, but in many cases, a DSM diagnosis is the only way for a family to get their insurance companies to pay for them to get help. In one of my internship sites, for example, I will need to provide a DSM diagnosis after the first session with a family in order to get the clinic paid for our work. As I understand it, this is a common diagnosis for kids who are giving their parents and teachers a hard time.

Note that the word “often” is used to mean something like “more than usual,” so whichever kids who are most like this will qualify for this Disorder, as long as someone important believes that their behavior is significantly impairing their social or academic functioning. Note also that these symptoms could be occurring in just one setting (say, just at school) and the kid will still qualify for ODD, unlike the symptoms for ADHD, which have to occur in at least two settings to qualify for the diagnosis.

Outside of family therapy, ODD is very commonly treated with Ritalin for “comorbid” ADHD. Kids diagnosed with ODD are also fairly commonly given antidepressant and/or antipsychotic medication, on the guess that they have an underlying Mood Disorder or Bipolar Disorder, though there is little to no research on these medications for children, especially in combination.

The following is word-for-word from the DSM-IV-TR, page 102:

Diagnosis criteria for 313.81 Oppositional Defiant Disorder

A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:

(1) often loses temper

(2) often argues with adults

(3) often actively defies or refuses to comply with adults’ requests or rules

(4) often deliberately annoys people

(5) often blames others for his or her mistakes or misbehavior

(6) is often touchy or easily annoyed by others

(7) is often angry or resentful

(8) is often spiteful or vindictive

Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.

D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 or older, criteria are not met for Antisocial Personality Disorder.

 

May 9, 2010

The Adverse Childhood Experiences Study

Posted by Nathen under alcohol abuse, battering, children, death, depression, disease, divorce, drug abuse, family assessment, lists, mental illness, neglect, parenting, physical abuse, predicting the future, rape, sexual assault, sexually transmitted disease, smoking, suicidality, unintended pregnancy
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I’m learning about child abuse and neglect in my Child and Family Assessment class. Today I read about the ACE study, by the US Center for Disease Control. It is a huge study, with over 17,000 participants, where they gathered information about childhood abuse, neglect, and household dysfunction, and then proceeded to see what health outcomes and behaviors they could predict with that information. It turns out they can predict a lot. They’ve published 50 articles on the study and the research is ongoing–they are continuing to collect health information as the participants in the study age. I’ll present a few of their findings below. For more, see the ACE Study.

Here are some of their findings. I’ll paste in the definitions of the categories of adverse childhood experiences below. Strong correlations were found with the following:

  • alcoholism and alcohol abuse (4 or more categories of ACE meant 4-12 times increase)
  • chronic obstructive pulmonary disease (that is, lung disease)
  • depression (4 or more categories of ACE meant 4-12 times increase)
  • fetal death
  • health-related quality of life (way more inactivity, severe obesity, bone fractures)
  • illicit drug use
  • ischemic heart disease (IHD)
  • liver disease
  • risk for intimate partner violence
  • multiple sexual partners (4 or more categories of ACE correlated with 50 or more sexual partners)
  • sexually transmitted diseases (STDs) (4 or more categories of ACE meant 4-12 times increase)
  • smoking
  • suicide attempts (4 or more categories of ACE meant 4-12 times increase)
  • unintended pregnancies

Here are the kinds of abuse, neglect, and dysfunction they asked about, quoted from the site:

Abuse

Emotional Abuse:
Often or very often a parent or other adult in the household swore at you, insulted you, or put you down and/or sometimes, often or very often acted in a way that made you think that you might be physically hurt.

Physical Abuse:
Sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at you and/or ever hit so hard that you had marks or were injured.

Sexual Abuse:
An adult or person at least 5 years older ever touched or fondled you in a sexual way, and/or had you touch their body in a sexual way, and/or attempted oral, anal, or vaginal intercourse with you and/or actually had oral, anal, or vaginal intercourse with you.

Neglect

Emotional Neglect1

Respondents were asked whether their family made them feel special, loved, and if their family was a source of strength, support, and protection. Emotional neglect was defined using scale scores that represent moderate to extreme exposure on the Emotional Neglect subscale of the Childhood Trauma Questionnaire (CTQ) short form.

Physical Neglect1

Respondents were asked whether there was enough to eat, if their parents drinking interfered with their care, if they ever wore dirty clothes, and if there was someone to take them to the doctor. Physical neglect was defined using scale scores that represent moderate to extreme exposure on the Physical Neglect subscale of the Childhood Trauma Questionnaire (CTQ) short form constituted physical neglect.

Household Dysfunction

Mother Treated Violently:
Your mother or stepmother was sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at her and/or sometimes often, or very often kicked, bitten, hit with a fist, or hit with something hard, and/or ever repeatedly hit over at least a few minutes and/or ever threatened or hurt by a knife or gun.

Household Substance Abuse:
Lived with anyone who was a problem drinker or alcoholic and/or lived with anyone who used street drugs.

Household Mental Illness:
A household member was depressed or mentally ill and/or a household member attempted suicide.

Parental Separation or Divorce:
Parents were ever separated or divorced.

Incarcerated Household Member:
A household member went to prison.

 

May 4, 2010

Diagnostic Criteria for Conduct Disorder

Posted by Nathen under adolescents, children, Conduct Disorder, crime, cruelty, diagnostic criteria, DSM-IV-TR, lists, mental disorders, psychology, rape, sexual assault, violence
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This is another DSM-IV-TR Mental Disorder diagnosis that is commonly given to children. The DSM says that its prevelence has been increasing for a few decades now and that up to 10% of kids, mostly boys in “urban settings”, have it. It’s a pretty serious label to give a kid. It’s linked with suicide, homicide, various criminal acts, and is thought of as a precursor to Antisocial Personality Disorder. Here are the criteria, quoted word-for-word from the DSM-IV-TR (pp. 98-99):

Diagnostic criteria for Conduct Disorder

A. A repetitive and persistent pattern of behavior in which the basioc rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months.

Aggression to people and animals

(1) often bullies, threatens, or intimidates others

(2) often initiates physical fights

(3) has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)

(4) has been physically cruel to people

(5) has been physically cruel to animals

(6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)

(7) has forced someone into sexual activity

Destruction of property

(8) has deliberately engaged in fire setting with the intention of causing serious damage

(9) has deliberately destroyed others’ property (other than by fire setting)

Deceitfulness or theft

(10) has broken into someone else’s house, building, or car

(11) often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)

(12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules

(13) often stays out at night despite parental prohibitions, beginning before age 13 years

(14) has run away from home overnight at least twice while living in parental or parental surrogate (or once without returning for a lengthy period)

(15) is often truant from school, beginning before age 13 years

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Code based on age at onset:

312.81 Conduct Disorder, Childhood-Onset Type: onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years

312.82 Conduct Disorder, Adolescent-Onset Type: absence of any criteria characteristic of Conduct Disorder prior to age 10 years

312.89 Donduct Disorder, Unspecified Onset: age at onset is not known

Specify severity:

Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to others

Moderate: number of conduct problems and effect on other intermediate between “mild” and “severe”

Severe: many conduct problems in excess of those required in excess of those required to make the diagnosis or conduct problems cause considerable harm to others

 

May 3, 2010

Predictors of Divorce, According to Elizabeth Gilbert

Posted by Nathen under age, alcohol abuse, battering, children, divorce, education, Elizabeth Gilbert, infidelity, lists, marriage, mental illness, relationships, statistics, violence
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Elizabeth Gilbert, in her book about marriage, Commitment, lays out her interpretation of a Rutgers report on divorce statistics. Here’s her list of things that correlate with divorce, in the order she mentions them. She lays them out with a lot more subtlety, humor, and personality, but read the book if you want that.

Your parents are divorced

You are alcoholic

You are mentally ill

You cheat on your spouse

You gamble compulsively

You are violent

You are younger than 25

You have not gone to college (especially the woman)

You have children

You lived with your spouse before marriage

You have different racial backgrounds

You are different ages

You have different religions

You have different ethnic backgrounds

You have different cultural backgrounds

You have different careers

You don’t know your neighbors

You don’t belong to social clubs

You don’t live near your families

You are not religious

The man does not do housework

 

May 2, 2010

My Mom’s Prescription for Hyperactivity

Posted by Nathen under advice, affection, Attention-Deficit/Hyperactivity Disorder, Benjamin Lester, children, Darlene Lester, family, nature, parenting, reading, stimulants, sugar, television
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My mom sent me this in response to my posting the diagnostic criteria for AD/HD yesterday. She’s not a health care professional, but she did raise five boys. Since I’m the oldest I got to see her do it. I also got to benefit from her love of nature (and sending us out into it), reading to her kids, being affectionate with her kids, making nutritious food, and her skepticism of TV and traditional schooling. And many, many other things, like her faith in her kids. The first thing they told us in my class on psychopathology was that we were not to diagnose ourselves, our friends, or family, so I won’t, but I suspect that all of us (except perhaps Ben) fit the diagnostic criteria for AD/HD for periods of our young lives. She wouldn’t even feed us sugar, much less amphetamines, so it’s not like it was a close call, but thanks, Mom, for not feeding us stimulants!

Here it is:
“Be forewarned, this takes effort on the parent’s part!

“Here is my humble prescription for hyperactivity in children (who, by the way, are usually boys): First, TAKE HIM OUT OF SCHOOL!! Live in, or move to, a rural area. (Or at least make sure there is a wild area, like woods or a meadow, nearby). Each day, after he has slept as late as he wants to, feed him a highly nutritious breakfast that contains no sugar, no additives, no colorings. Just whole foods. Then, send him outside to play in nature. Make sure he gets plenty of sun exposure. Make sure he has some of these things: trees to climb, grass to lie in, rocks to scramble on, water to swim or wade in, wildlife to watch, dirt to dig in, and bushes to hide in. (Create a beautiful outdoor environment for him if your outdoor area is naturally very stark.) Make sure he has plenty of water to drink. Let him roam freely. At lunchtime have him come in for another nutritious meal of whole foods. No sugar. Only water to drink. After a cuddle and as much attention as he wants from you, send him back outside to play in nature. Let him play as long as he wants. When he wants to come back inside, he can be read to or told stories, he can play or read quietly, or he can just rest while listening to soft classical music, or take a nap. No TV. No computers. No gameboys… no screens of any kind. Nothing with headphones. Then, back outside to play until the sun goes down. Back in for another nutritious meal, and then he is put in the bathtub. He plays in the bathtub for as long as he wants (an hour or more in very warm water is good). Then, he has a bedtime routine (thorough teeth brushing and flossing- you do it if necessary- and then jammies). After that he gets read to for a LONG TIME in bed…an hour or more is good… until he is sleepy. Make sure he has plenty of hugs and cuddles and kisses and loving words as he drifts off. Follow this prescription every day until his hyperactivity is cured. By the way, this routine could be of benefit to “normal” children, as well. It works for calming and soothing and centering and bringing color to their cheeks, and a more cheerful attitude in general. And, I’d go so far as to say, adults should try it, too… to cure whatever ails them.”

 

March 16, 2010

10 Things Parents Can Do to Help Prevent Eating Disorders

Posted by Nathen under advice, bodies, children, DSM-IV-TR, eating disorders, exercise, food, lists, parenting, sexism, weightism
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This is a handout I got in my Medical Family Therapy class. The copyright at the bottom says “(c) 2005 National Eating Disorders Association. Permission is granted to copy and reprint materials for educational purposes only. National Eating Disorders Association must be cited and web address listed. www.NationalEatingDisorders.org Information and Referral Helpline: 800.931.2237.” I think that covers me. I’m willing to take the risk, anyway, because eating disorders are a huge problem. The most conservative estimates, using the most strict definitions, are that six million people in the US struggle with disordered eating. Estimates using less strict definitions (including Eating Disorder Not Otherwise Specified in the DSM-IV-TR), but still very realistic, are at about 20 million. And eating disorders are the most deadly mental disorder. If not treated, 20-25% of those with serious eating disorders die from them. You won’t find that statistic in many official sources, though, because for some very strange reason, coroners will not list Anorexia or Bulimia Nervosa as a cause of death. They prefer “Cause of death unknown” in those cases. Plus, eating disorders are learned behavior. Don’t let your kids learn the values that encourage disordered eating from you!

OK, here it is. It’s by Michael Levine, PhD:

1. Consider your thoughts, attitudes, and behaviors toward your own body and the way that these beliefs have been shaped by the forces of weightism and sexism. Then educate your children about (a) the genetic basis for the natural diversity of human body shapes and sizes and (b) the nature and ugliness of prejudice.

*Make an effort to maintain positive attitudes and health behaviors. Children learn from the things you say and do!

2. Examine closely your dreams and goals for your children and other loved ones. Are you overemphasizing beauty and body shape, particularly for girls?

*Avoid conveying an attitude which says in effect, “I will like you more if you lose weight, don’t eat so much, look more like the slender models in ads, fit into smaller clothes, etc.”

*Decide what you can do and what you can stop doing to reduce the teasing, criticism, blaming, staring, etc. that reinforce the idea that larger or fatter is “bad” and smaller or thinner is “good.”

3. Learn about and discuss with your sons and daughters (a) the dangers of trying to alter one’s body shape through dieting, (b) the value of moderate exercise for health, and (c) the importance of eating a variety of foods in well-balanced meals consumed at least three times a day.

*Avoid categorizing and labeling foods (e.g. good/bad or safe/dangerous). All foods can be eaten in moderation.

*Be a good role model in regard to sensible eating, exercise, and self-acceptance.

4. Make a commitment not to avoid activities (such as swimming, sunbathing, dancing, etc.) simply because they call attention to your weight and shape. Refuse to wear clothes that are uncomfortable or that you don’t like but wear simply because they divert attention from your weight or shape.

5. Make a commitment to exercise for the joy of feeling your body move and grow stronger, not to purge fat from you body or to compensate for calories, power, excitement, popularity, or perfection.

6. Practice taking people seriously for what they say, feel, and do, not for how slender or “well put together” they appear.

7. Help children appreciate and resist the ways in which television, magazines, and other media distort the true diversity of human body types and imply that a slender body means power, excitement, popularity, or perfection.

8. Educate boys and girls about various forms of prejudice, including weightism, and help them understand their responsibilities for preventing them.

9. Encourage your children to be active and to enjoy what their bodies can do and feel like. Do not limit their caloric intake unless a physician requests that you do this because of a medical problem.

10. Do whatever you can to promote the self-esteem and self- respect of all of your children in intellectual, athletic , and social endeavors. Give boys and girls the same opportunities and encouragement. Be careful not to suggest that females are less important than males, e.g., by exempting males form housework or childcare. A well-rounded sense of self and solid self-esteem are perhaps the best antidotes to dieting and disordered eating.

 

March 8, 2010

Grace and Yared

Posted by Nathen under children, family, Grace Llewellyn, photography, Rahmiel Yared
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My good friend Grace has adopted a boy from Ethiopia, Rahmiel Yared Llewellyn. I got to meet him for the first time last week. He was immediately friendly with me and we had fun throwing a bouncy-ball around. It’s just wonderful to see how much he and Grace have bonded already. They seem just right for each other.

Yared and Grace, 2/20/2010

 

March 4, 2010

Headlines From Psychology, Part 5

Posted by Nathen under advice, behavior reinforcement, children, conformity, decisions, ethics, family, headlines, identity, intelligence, lists, obedience, parenting, psychology, punishment, reading, Solomon Asch, Stanley Milgram, video
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Here’s part 5 of the stuff I learned in my undergrad in psychology that I thought should have been headlines. If you missed them, here are part 1, part 2, part 3, & part 4. As always, if you are interested or skeptical, leave me a comment and I’ll give you my sources.

If You Punish Your Kids, Use the Mildest Effective Punishment: Do the mildest thing you can that stops the behavior you don’t want. The reason is that a punishment that is harsher than necessary takes the child’s initiative for stopping the behavior out of the picture. If you say “Hey, don’t do that,” and the child responds, they come to think that they didn’t really want to do that thing anyway, since such a mild rebuke got them to stop. Psychologists call these principles “insufficient punishment” and “self-persuasion.” These are research findings, not just speculation. If you sit on and beat your child to get them to stop doing something (as suggested by Mike & Debi Pearl), they will believe something more like “That activity was so great that I’ve only stopped because of that horrible punishment.” In other words, the form of the punishment affects the identity of the child–do they behave well because they think of themselves as well-behaved, or do they behave well only because they fear punishment?

You May Want Your Kids To Be Less Blindly Obedient Than Most People: One of the most famous psychological experiments of all time found that most people risked killing someone they barely knew, given an institutional setting and an authority telling them to do it. The Nazis were mostly not evil, just obedient, like most of us.

Humans Can Be Conformist to the Point of Doubting Their Own Senses:

Each Ethical Decision You Make Affects Your Future Ethical Decisions and Your Identity: If you, say, decide to cheat on a test, you will be more likely to cheat on tests in the future, think of yourself as someone who cheats on tests, and form permissive attitudes about cheating. The opposite is true if you decide not to cheat on a test.

Complement Your Kids For the How Hard They Work, Not How Smart They Are: Getting attention for being smart tends to make kids want to appear smart, which makes them choose easier challenges and lighter competition; it’s the success that matters. Getting attention for hard work does the opposite. This means that these kids will end up smarter than the kids who got attention for being smart.

Teach Your Kids to Think About Intelligence as a Fluid Property: That is, teach them that they can become more intelligent by trying. The more they believe it, the more it will be true for them.

If Your Kids Read, Don’t Reward Them For Reading: They will be more likely to stop, if you do, because they will start to think of reading as something they do to be rewarded, not because they like it. If they don’t read, reward them for reading. This goes for other activities, too.

 

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