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  1. Dealing with Distress- How to Talk to Children about School Shooting

    How can you explain the tragedy that took place last week at Sandy Hook Elementary in Newtown, Conn.? Parents across the country are searching for words to say to their young children. As we try to understand this unthinkable violence, it is important to inform and comfort our children. sad child

    Listen and Communicate Simply

    Children look to their parents for safety. Your children, at age 3 and at age 18, trust you to ensure their safety. At this time of instability, it is your responsibility to communicate with and support your children. The first step is to talk with your children about what they have heard and what they know. Let them express their opinions and worries completely- don’t interrupt. Use age-appropriate phrases to explain what happened if they ask you. For younger kids, keep the explanation simple and avoid unnecessary details. They do not need to hear excessive details that may scare them more.

    Take Care of Yourself

    To take care of your kids better, take care of yourself. You may be so overwhelmed occasionally that your children see you cry or talk about the shooting. Be honest, telling your children that you are sad for the other families. However, make sure you handle your emotions effectively and reach out to other adults for support. By keeping up your mental health in this unstable time, you can better help your children.

    Watch for Signs of Fear or Anxiety

    It is normal for children to experience a range of emotions following a tragedy. Be aware of their behavior as changes could indicate a change in mood or presence of grief or fear. Encourage your children to put their feelings into words by journaling or talking with you.

    Keep Home a Safe Place

    Your home is a safe haven for your children, especially when things seem chaotic in their world. Help them find peace at home by scheduling favorite family activities and making yourself available. These strategies should help you prepare to help your children manage their distress and fear. Remember that your children need to be comforted by you. If you feel that you or your children are suffering extensively or you notice a lasting behavioral change in your children, consider speaking with a health professional.
  2. The Doctor-Patient Relationship

    The Doctor-Patient Relationship

    A successful doctor-patient relationship starts with good communication and a partnership where both work toward the best outcome. With preparation, you can become an active partner in your health, making sure that you leave each appointment well informed and satisfied with the care received. Below are some tips you can use to prepare and participate fully during each doctor’s appointment. These research-based suggestions also apply to other healthcare professionals, including counselors, physician assistants, nurse practitioners, and other healthcare providers.

    Before the Visit

    Gather your information and identify key goals for your visit. It may help to make lists that cover important details: your goals for the visit, your symptoms and current medications.

    Make Lists

    Your Goals
    Are you going to the doctor to solve a problem? If so, be prepared to explain that to your physician. If you’re trying to make sure you’re up to date on screenings, immunizations or other health preventative procedures, be sure to outline those concerns. You’ll want to clearly convey this to the receptionist when making the appointment so that he/she can recommend more appointment time, if needed.
    Your Symptoms
    When describing your symptoms, try to anticipate the types of questions a doctor might ask to better prepare. For example, below are questions a doctor might ask:
    • How would you describe the symptom?
    • When did you start to feel this?
    • How long does it last?
    • What seems to bring it on?
    • Have there been any changes in your life that might have something to do with your symptom?
    • What have you tried to do, and has it helped?
    • Has anyone else in your family experienced this problem?
    For recurrent symptoms, you may want to consider keeping a journal noting to record the frequency of the condition, your diet and other factors occurring that might be affecting you.

    Don’t Be Afraid to Discuss Sensitive Issues

    Be prepared to be absolutely honest with the doctor about your lifestyle, including mental health, diet, sexual history, alcohol intake, smoking history, supplements taken, and other care received. Although it may be awkward at first, just remember that the doctor is collecting all of the information needed to help you become healthier. By discussing difficult issues, you’ll learn more about your health and your doctor will obtain the information he or she needs to help recommend the best treatment. If you feel you can’t talk with your doctor or your doctor doesn’t take your concerns seriously, don’t be afraid to seek out another one.

    Your Medications

    Make a list of all the medications you take. Your doctor may even ask you to bring them with you. Be sure to list all your prescription drugs. Write down any over-the-counter medicines, herbs, or supplements you take. Write down medicines you’ve stopped taking and the reason you or your doctor stopped them. For each drug, note:
    • The name of the drug
    • How often you take it
    • When you take the drug
    • The strength of the drug
    • What the drug is for
    • The last time you took it

    During the Visit

    Start the conversation by asking your doctor when the best time would be to discuss your concerns and indicate that you have prepared a list of symptoms and goals you’d like to review with him/her. This will enable your doctor to determine how much time he or she will need to spend on each issue and whether a separate appointment is needed to discuss all of your concerns. During the visit, it’s also important to ask questions until you feel you completely understand the information and terms your doctor is discussing. Some questions you might consider asking are: When tests, treatments, or other procedures are recommended:
    • What happens during this procedure and why is it necessary?
    • How long will it last?
    • Are there risks with this procedure?
    • How much will it cost and will my insurance cover it?
    • Are there any other treatment options available?
    When a diagnosis is made:
    • How is this condition treated or managed and how long will it last?
    • What long-term effects will the condition/illness/diagnosis have on me?
    When medications are prescribed:
    • When should I take this medicine and should it be taken with food or milk?
    • What potential side effects could there be?
    • Will it interact with other medications?
    • What if I miss a dose?
    • Is there a less-expensive, generic brand of the same drug available?
    When discussing your concerns, it may be helpful to repeat back what you heard and ask, “Is that correct?” This will help establish that you are correctly interpreting information and will clarify any confusion you might have with terms or instructions.

    Follow Up Appointments

    Note that chronic conditions should be managed in doctor visits over the length of the condition. It is important to follow up as instructed. In other circumstances, you will need to follow up in a way agreed upon by both you and your doctor. Remember, you have a right and a responsibility to ask as many questions as needed to make sure you understand your condition and treatment.

    Write Down Instructions

    Be sure to ask the doctor to write down any instructions concerning medication or treatment. Also, ask for materials about your condition, which can help further educate you about your treatment. It’s also a good practice for you to write down details during your visit. Many times, it is very helpful to bring family members, care-givers, and/or other advocates to the actual appointment.

    After the Visit

    Be consistent in following the doctor’s orders and take steps to maintain good health.
    • Fill your prescriptions consistently — Make sure you use your pharmacist as a resource. The pharmacist can clarify your doctor’s instructions and may offer additional information. Don’t be afraid to ask about your medication.
    • Take drugs as directed — For your medications to work, you should take them at the same time every day. Make it a habit.
    • Exercise — You’ve got to exercise to keep your body healthy. When you exercise you will:
      • Help your heart pump better
      • Get more energy
      • Look and feel your best
      • Reduce stress
      • Increase self-esteem
      Be sure to discuss with your doctor the appropriate fitness program for you before you get started.
    • Eat healthy — If you don’t have dietary restrictions, you don’t have to give up fried chicken or ice cream completely. Just be smart about how often and how much you eat. Try using the “80/20” rule. Eat healthy foods 80 percent of the time. Then you can indulge – in moderation – 20 percent of the time.
    Most importantly be sure to discuss your daily diet with your doctor to make sure you understand the foods that you may need to avoid, due to existing conditions.   Source: LifeSynch. a Humana company
  3. Ten Reasons to Include Family Therapy

    Ten Reasons to Include Family Therapy in the Initial Treatment of Children and Adolescents

    Practitioners use many different strategies to engage parents early in the treatment process because: 1. The parent/guardian has an important story to share about the child and his/her target behaviors. 2. The parent/guardian’s perspective about the child’s behavior affects the child’s perception about his/her behavior. 3. Family strengths affect the child’s strengths and resources for change. 4. Family limitations also limit the child’s capacity for functioning and growth. 5. Important cultural considerations may only be available through contact with the parent/guardian. 6. Commitment of the parent/guardian to changing the child’s target behaviors affects the degree of change the child will make. 7. The parent/guardian can tell the practitioner how much progress the child has made and whether target behaviors are improving. 8. The parent/guardian’s behavior can accelerate positive changes in the child through active participation in treatment. 9. The parent/guardian may sabotage treatment gains unwittingly without input from the provider. 10. The parent/guardian can reinforce gains made in treatment with input from the practitioner. Source: LifeSynch. a Humana company
  4. Oppositional and Defiant Behavior By Mary Ann Grochowski

    Mary Ann Grochowski

    Mary Ann Grochowski

    Definition of Oppositional Defiant Disorder as outlined in DSM IV: A recurrent pattern of negativistic, disobedient, and hostile behavior towards authority figures that persists for at least six months and is characterized by the frequent occurrence of at least four of the following behaviors:
    • losing temper
    • arguing with adults
    • actively defying or refusing to comply with the requests or rules of adults
    • deliberately doing things that will annoy other people
    • blaming others for his or her own behavior or mistakes
    • being touchy or easily annoyed by others
    • being angry or resentful
    • being spiteful or vindictive.
    The behavior must occur more frequently than is typically occurring in children of comparable age and developmental level and must lead to significant impairment in social, academic, or occupational functioning. Most typically the negativistic and defiant behavior is present in the child’s home but is not always present in school or with other social settings. There is often a vicious cycle in which the parent and child persistently provoke each other. It is more common in families in which there has been inconsistent childcare or harsh or neglectful child rearing practices. Normal Developmental Behaviors Periods of oppositional, defiant behavior are very common around ages 2-5 and again in early adolescence. Boys typically show more behavior problems before puberty. But after puberty, the ratio of boys to girls with oppositional behavior appears about equal. Many children who are oppositional, hostile or defiant may be suffering from a temporary adverse situation in their environment, low self-esteem, depression, anxiety, or some other difficulty such as Attention Deficit Hyperactivity Disorder (ADHD). Referral to a therapist familiar with childhood disorders is advisable if:
    1. The oppositional behavior has begun to affect the child’s school performance.
    2. The child’s behavior seriously disrupts the family milieu to the point siblings are also impacted or parental schedules are routinely ineffective.
    3. The child’s behavior changes from oppositional to aggressive.
    4. The child becomes isolated from family and friends.
    5. Parents are feeling overwhelmed, vulnerable or fearful of their own interaction with the child.
    Ways to Help Your Child Improve
    1. Try to understand the feeling behind the behavior.
    2. Pay attention to your child’s interests and play.
    3. Use praise and positive attention to promote compliance.
    4. Offer rewards for good behavior.
    5. Use discipline that is a direct consequence of the misbehavior.
    6. Use time outs to promote emotional control.
    7. Plan ahead for public activities and events your child may find uncomfortable.
    8. Work with your child’s school to encourage understanding.
    9. Get support for yourself. Parents need to work together. If you are a single parent, find a friend or other relative to give you outlets.
    10. Take time to set your own priorities and goals.
    Always try to use positive statements when relating to your child rather than negative. Use Power Talk to communicate using ”I” statements rather than blaming “You statements.” Power Talk Formula: I feel: When you:_______________________________ Because:_____________________________________ Please:______________________________________ If you must approach your child with a negative criticism, try the “Sandwich” approach by first making a positive statement about your child; then state the negative, and follow with another positive statement. Example: “John, that was very generous of you to share your computer time with your brother. I’ve noticed that your homework has not gotten much attention lately, though. I am sure that from now on you are going to be more conscientious of making your homework a priority.” Remember, flexibility within a structure is also important There are no universal tried and true parenting rules other than love and understanding. Being a good parent is hard work so praise yourself for trying and acknowledge your successes. Learn to laugh at your imperfections and get lots of hugs! For additional information or to make an appointment with Mary Ann contact: Mary Ann Grochowski American Behavioral Clinics 7330 West Layton Avenue Milwaukee, Wisconsin 53220 Phone: (414) 281-1677   References Gordon, Thomas PET Parent Effectiveness Training NY Plume/Penguin 1975 Faber, Adele and Mazlish, Elaine Siblings Without Rivalry NY Avon Books, 1998 Greene, Ross The Explosive Child NY Harper Collins 1998 Barkley, Russell Your Defiant Child NY Guilford 1998
  5. Saving Our Daughters By Dr. Stacey Nye, PhD, FAED

    I am often asked how to prevent eating disorders in our children, for it is quite common that weight and body image issues plague our kids, especially girls, at a younger and younger age. The ever-growing exposure to media images of thin, beautiful, perfect-looking women set a standard that most women cannot achieve, and all our girls should not strive for. Below you will find a list of suggestions of how you can help prevent these issues from hurting a girl that you love.
    1. Be aware of your own weight issues. Kids learn by modeling, and if they see a parent dieting, whether or not they are told directly, they will get the message that one needs to lose weight to be beautiful or accepted. Stop weighing yourself and get rid of the scale if you have one.
    2. Help your daughter develop criteria for self esteem that go beyond appearance, such as relationships, academic successes, or hobbies. If she has a solid sense of self (identity) and a stable self-esteem, research shows she will be more resilient to society’s destructive influences to conform.
    3. Reduce exposure to negative media images. Research shows that looking at pictures of emaciated fashion models results in lowered self esteem among girls and women. Look for magazines or television shows with more realistic images. When this is not possible, help your daughter to discern the difference between fantasy (few people look like Jennifer Aniston; most magazine photos are airbrushed or digitally perfected) and reality (the average women is 5’4″ and weighs 145lbs).
    4. Teach your daughter how to exercise for strength, fitness and health, not just weight control.  Help her to find team sports, yoga classes or self-defense training as a way to have fun, feel good and take care of herself.
    5. Help your daughter to expand her definition of beauty and accept differences amongst people in general. Being unique is special and diversity is necessary for survival.
    6. If there are weight issues, review the family tree. Weight is 3/4 genetics, and it would be unrealistic to expect a child to be significantly thinner than most of her family. Otherwise, try to evaluate if your child is eating for more reasons than just hunger. While it is common to occasionally overeat at holidays or special occasions, normal eaters tend to eat when they’re hungry and stop when they’re full. If she is not doing this, she may have a problem with emotional eating.
    7. Familiarize yourself with the risk factors and warning signs of negative body image and eating disorders. Perfectionistic, people-pleasing girls are at risk for demanding perfection in their appearance and swallowing their negative feelings, resulting in obsessing about food and weight as a way to feel in control.  Watch for preoccupation with food and/or weight, avoidance of eating, binge eating, disappearing after meals, or extreme weight loss as potential indicators of an eating disorder.
    8. Finally, if your daughter shows signs of depression, emotional eating or extreme dieting or weight loss, seek professional help.  Eating disorders and body image issues are easier to treat in the early stages, before they develop into long-standing, fixed patterns of coping that are resistant to intervention.
    American Behavioral Clinics
    (262) 241-3231
    Recommended reading: Reviving Ophelia. Saving The Selves of Adolescent Girls. Mary Pipher, Ballantine Books, 1994. The Body Project. An Intimate History of American Girls. Joan Jacobs Brumberg, Random House, 1997. Am I Fat?  Helping Young Children Accept Differences in Body Size. Joanne Ikeda & Priscilla Naworski, ETR Associates, 199 “Treatment will make you “weller than well”.  It will not cure all of life’s ills.  Instead, it helps one deal with issues so adaptively and constructively that the improved functioning is even better than what is considered normal” – Karl Menninger

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