Teenagers, ADD and Tantrums

Seems that this is what your life is like once your child hit those irrepressible teen years. They put parents on “mute” and “yada-yada”.  Both of you wind up frustrated and weary.

Each of you feels like you are walking on cracked glass and almost every encounter winds up in someone yelling and the other person slamming a door.

It doesn’t have to be this way. Because both of you want the same things!  Communication, respect and acknowledgement.

Parents feel like they are living in a warp-speed zone, one minute their child is a child and the next their child is shouting for independence and for you to more or less ‘get out of their face’.

Like the phases of the moon, we all live within habitual cycles. Teens are even more so with hormones flaring and confidence waxing and waning.  Complicating this are teens who are on ADD medications. These medications have an internal “self-life” and when they are wearing down is usually when you are seeing them at the end of the day.

This produces a chaotic atmosphere that seems to naturally lend itself to meltdowns and tantrums.  Digging ones heels in and just saying “no” is but one way to control the chaos and get things what seem to be swirling under control.

But there is another way and no one has to be the “loser” and no one gets to be the “winner”.  Just remember your struggles with your teen are really about POWER. Who has it, who wants it, and who is going to defeat whom?

How about starting with changes the communication patterns.  This will take time, and it will not happen over night but over time this can be a great way for each side to get heard, no one get negated and for compromise to occur.

Here is an example scenario:

Jake a 15 year old with a diagnosis of ADHD has a horrible time getting started with homework. He has master procrastination to an ‘art form’. His younger sister, Alice, aged 10 still sees Jake as a play-pal, and expects him to come and be with her when he gets home. He gets frustrated with the interruptions. Alice gets her feelings hurt and pouts, Jake yells and mom gets into the fray and everyone winds up upset and unhappy and angry.

Because things seem to be happening in a repeat pattern –change the pattern.  Learned responses are not easily changed so do not expect instant harmony.

Set the “ground rules” (after discussion with both children).

This can be done on a simple chart and after a while the question can be not “what is the matter” but did you work it out on the chart”?

Before you start however, acknowledge that Jake's feelings are real and that you really understand that he feels like he is between a "rock and hard place".  Empathy counts and you can even talk about some school issues you had (didn't we all??).

The first time you talk about planning reactions and actions the chart may look like this:

Jake

What is upsetting you	What do I know about what has to happen	What do I need to get homework done and not be angry	What out come do you want RIGHT NOW	What outcome would make you feel good about yourself
I hate homework			Not have homework
I can’t do it			Someone to be with me or do it for me
Alice keeps interrupting me			Keep Alice out of my room
I’ll never get it done			Just go to bed

Then together the both of you think it through, talk it out and fill it in: (maybe not all in one session)

What is upsetting you	What do I know about what has to happen	What do I need to get homework done and not be angry	What out come do you want—RIGHT NOW	What outcome would make you feel good about yourself
I hate homework	I have to do the homework	Organize it and do one piece at a time and take breaks between subjects	Not have homework	Getting the homework done neatly and not worrying if I got it “right”
I can’t do it	I can take breaks and ask for Mom or Dad to check it piece by piece	I can find a time to ask the teacher during school if I don’t understand what I am to do Or I can call a classmate and ask about it	Someone to be with me or do it for me	Repeat and repeat and repeat, “I am learning…I am not supposed to know it all” and just do my best.
Alice keeps interrupting me	I like playing with Alice but my homework makes me nervous	Set a time with a timer (10-15 minutes maybe during a break) to play with Alice and when that time is over we will both agree that playtime is over	Keep Alice out of my room	Tell Alice I really like playing with her but I need her to help me stay on track with time because it is so hard for me to do it alone.
I’ll never get it done	Why do I have to be the stupidest person in the class?	This is fortune telling you do not know everyone’s grades or how they understand the assignments. But being organized, asking questions and letting mom/dad check it will help with getting it done with your best possible effort and not doing it to get it over with.	Just go to bed	Being organized and doing one subject at a time and putting each subject in separate piles helps me in getting homework done~ it is less overwhelming than dumping everything onto the floor of my room and just staring and “monster” on my floor. And I will sleep better!

Now when Jake gets upset his mom is not the Master Solution Maker, he is! He gets to be in charge, figure it out and choose what he wants to do.  With support and encouragement, Jake learns to make difficult decisions in frustrating situations by creating a visual of his thoughts, ideas and feelings. Eventually, the goal is for Jake to make his own chart, recognize when his frustration is getting the best of him and create personal pathways for self-regulation.

This allows Jake to be the “grown up” (independence), talk rationally about what is going on with him (communication) and feel like he is no longer being treated like a baby, he has more self-control (self-esteem).

Learning to do this is a process, this is not a race there are no time limits. But the more charting out one’s actions, reactions and feelings are done, the less chaos, the less frustration and the less fall back into temper tantrums.

No one said growing up was easy, and even though there are “Blessings in a Skinned Knee”; you don’t need one everyday.

Learning "Sculpts" Brain Connection


Spontaneous brain activity measurably changes after a person learns a new task.




Spontaneous brain activity formerly thought to be "white noise" measurably changes after a person learns a new task, researchers at Washington University School of Medicine in St. Louis and the University of Chieti, Italy, [Proceedings of the National Academy of Sciences, 106:17558-17563].

Scientists also report that the degree of change reflects how well subjects have learned to perform the task.

"Recent studies have shown that in the absence of any overt behavior, and even during sleep or anesthesia, the brain's spontaneous activity is not random, but organized in patterns of correlated activity that occur in anatomically and functionally connected regions," stated senior author Maurizio Corbetta, MD, Norman J. Stupp Professor of Neurology. "The reasons behind the spontaneous activity patterns remain mysterious, but we have now shown that learning causes small changes in those patterns, and that these changes are behaviorally important."

At the start of the experiment, Corbetta, graduate students Chris Lewis and Antonello Baldassarre and their colleagues in Italy used functional connectivity magnetic resonance imaging to scan the spontaneous brain activity of 14 volunteers as they sat quietly.

Next, researchers scanned the subjects as they spent one to two hours a day for five to seven days learning to watch a display inside the MRI scanner for the brief presence of an inverted "T" in a specific part of the screen. Two sets of brain areas were particularly active during the task: part of the visual cortex that corresponded to the portion of the visual field where subjects were looking for the "T", and areas in the dorsal part of the brain involved in directing attention to the location on the screen.

After the visual training, scientists again scanned the subjects' brains while they did nothing.

When the subjects rested at the start of the experiment, spontaneous activity in the two parts of the brain that are important to the visual task was either not linked or weakly correlated, with the two regions involved in the upcoming task only occasionally being active at the same time. After learning, though, each region was more likely to be active when the other region wasn't. Subjects who were more successful at the task exhibited a higher degree of this "anti-correlation" between the two regions after learning.

Corbetta suggested this learning-induced change in the brain's spontaneous activity may reflect what he calls a "memory trace" for the new skill. The trace makes it easier to use those parts of the brain together again when the same challenge recurs.

"It's as though these two brain systems are learning to get out of each other's way," he said. "After learning, the brain can identify the targets at a glance in a way that requires less direct attention and thus less interaction between the regions involved in the task."

In addition to helping "grease" anatomical connections between different brain regions, Corbetta speculates that the changes in spontaneous brain activity may maintain a record of prior experience that constrains the way the same circuitries are recruited at the time of a task.

"This suggests that disruption of spontaneous correlated activity may be a common mechanism through which brain function abnormalities manifest in a number of neurological, psychiatric or developmental conditions," he said.

Funding from the European Community's Seventh Framework Programme, the National Institute of Mental Health, the National Institutes of Health, and the Third PhD Internationalization Program of the Italian Ministry of University and Research supported the research.

 From Advance for OT 2009

Happiness ~What Every Parent Wants: Mission OT

Susan N. Schriber Orloff, OTR/L, FAOTA

Every parent just wants his or her child to be “happy”.  That is their bottom line.  Therapy, academics, home life, whatever, “just makes my child happy”.  Anyone who has worked with children for any length of time has had this said to them repeatedly over and over again.

It is really not their fault.  Ingrained in the American psyche and in our Declaration of Independence is the “right to pursue happiness”.

Aristotle had it even more precise, he wrote, “happiness…is at the end of action”.

And so in helping children is all about action in the pursuit of happiness.  But as Dennis Prager wrote in his book, “Happiness is a Serious Problem”.

Those actions that we ask of the children are often fraught with frustration and in the pursuit of the happiness derived from increased skills that are not easily achieved.  Along the way it just plain gets “too hard”, the struggle too intimidating and the progress seemingly too slow coming.

We often attribute this to low self-esteem, fragile coping skills, processing issues, etc. In truth it could be related to the definition one is using for Happiness.

What Moms Want

The main goal of most all parents is to have a child who can meet life challenges with confidence. In other words, she wants a happy child in school and out in his/her world.

Meeting the Happiness Goal

Helping both parent and child understand that happiness, while most Americans feel the right to pursue it, is and elusive moving target and is really a by-product of the very hard, and sometimes-slow work of meeting challenges.

As OT’s and teachers we need to brace ourselves when a parent says, “He just isn’t happy in OT”.  Our response needs to convey that our goal is to  “make him/her happy after OT (learning interventions)”.   I often use the analogy about diets: no one goes on one unless their clothes get tight and that is not a happy feeling. Dieting is not fun. But the results are gratifying.

It is also important to help our clients understand what “happy people” do differently so that we can help them modify their behaviors to get to a less fearful place.  Todd Kashdan and Robert Biswas-Diener in a recent Psychology Today (July/August 2013) research article stated that, “ one of life’s sharpest paradoxes is that the key to satisfaction is doing things that feel risky, uncomfortable and occasionally bad”.  In addition, they state that curiosity is another important factor. “…Curious people knowingly invest in activities that cause them discomfort as a springboard to higher psychological peaks”.   The authors continue that, “…good life…is a matrix that includes happiness, occasional sadness, a sense of purpose, playfulness and psychological flexibility…mastery…belonging.” 

The take away here is that part of therapy should be about helping children embrace the unknown and the process of figuring “it” out.  OT as a part of this “life matrix of being” encompassing all the range of feelings, is not about having fun each session, but about getting to brave.

Getting to happy is not a destination, it is a process and OT’s are the guides for each child’s individual pursued journey.

Keeping "it" a secret…NO!!

No parent wants their child labeled, made fun of by peers, or ostracized in any way.  But when does “protection” go too far?  When is “keeping the secret” more harmful than helpful?

Being an occupational therapist is a commitment to life-long learning.  So in my 35+ years of practice I had not encountered a child with XXX Syndrome until  recently.  I had to get a handle on what it was, prognosis, treatment and life consequences. 

I have chosen this scenario because it was new to me, and perhaps is to my readers as well.

So what is it? It is a chromosomal variation that puts an extra X chromosome in each cell of the human female.  It is not inherited and is caused by an error in cell division in utero.  Generally speaking, these children are usually within normal IQ but may be lower than their genetic siblings, have speech delays and/or poor language skills, and have delayed motor skills with specific coordination and generalized clumsiness.  There are also some slight physical differences but nothing too pronounced that would set them remarkably apart from their peers.

So here I am working with a parent who wants “all of this kept quiet’; not allowed to share with the teachers or the head of school, I am in a therapeutic communication no-man’s land. 

During the evaluation, when trying to help the mother feel less anxious, I said “as one parent to another, our children are who they are and what they are we cannot take blame or credit”.  At this she promptly replied, “oh but it is my fault, it was my egg that did not split right, this is all my fault”.  Stunned and incredibly saddened all I could do is take her hand.

How many of our parents are in this situation?  How many parents live the with misplaced burden of blame (about their children)?  How often do we get so caught up helping the child that we miss what is going on inside the parent that lives daily with these overwhelming feelings? 

As parents, and particularly moms, we (myself included) are in charge of “making it right”, “fixing it” and “kissing away the hurts”.  When hurts just cannot be made right or kissed away, when the diagnosis is devastating, when the earth starts moving under their feet, parents become our patients too.

How we deal with the families is equally as important as making sure that the child is achieving developmental gains.

This is something parents cannot “just get over”; it is a seismic life shift that impacts them, their child, and their other children.  Below is a list of ideas that my be helpful for the family and that can easily be incorporated into OT sessions and/or therapy.

1.     Including siblings during some of the therapy sessions

2.     Cooking cookies during a session with siblings and then having a “party/snack” together—letting the child in TX be the “leader”

3.     Helping families structure homework or quiet time (if not homework, drawing, reading, etc.)

4.     Talk about it, and then talk some more, there is no monster in the closet it is a fact that just is—keeping it natural makes it OK.

5.     If needed suggest a support group for the parents/family if there is not one, contact a psychologist or a counselor and with respecting privacy, ask for resources

6.     Former client’s families that have been through similar situations are often a great resource for both information and support.

7.     Encourage the parents to share confidentially with the school, so that accommodations and modifications can be offered and learning stresses decreased.

8.     Celebrate each other:  make a “WOW Board” and each week each person in the family gets to post at least one thing that they are really proud of.

Keep sharing with the family all the wonderful things their child can do. Shine “light” on the achievements.  If they haven’t shared the child’s issues with grandparents, or a close trusted extended family member or friend, encourage them to do so.  Sharing this information allows the parent to not be alone and creates for them a caring community of support.

So, shhh no more, and shoo away the guilt—my daughter (now 34 years old) wrote a song when she was in 7^th grade; the refrain was:  “Kids don’t come with instruction books, and they don’t come with guarantees, I’d like to thank you Mom and Dad for taking care of me”. 

And that is what parents do …they take care of their child…and OT's can help not just the child but parents and siblings as well.