“Will you come with me to the next meeting?” Another parent has called. “Whenever I get in one of those meetings, I get overwhelmed. I get so upset by what the teacher and principal are saying that I end up not saying all I want to say. I don’t think they really do it on purpose but it seems I can’t get a word in.”

“I’ve got to get my son to a residential program. We just can’t handle his behaviors anymore. The school says it’s not their problem. Their problem is only providing an education. But my wife and I need relief. We want the school to help us find a place where his mental health issues can be managed and his behaviors can be controlled so he can actually learn something.” This dad was at the end of the proverbial rope.

Maybe one of these conversations — or a part of one — sounds familiar. Your child is having difficulty in school. Perhaps he has been diagnosed with ADHD or a learning disability. Maybe she has autism, a developmental disability or a significant behavior problem. You know your child is entitled to additional support but the school doesn’t respond as you had hoped to your requests for services. With every passing month, you know that opportunities to ameliorate the situation are being lost and the behavior may be growing worse or more entrenched. You are frustrated, upset for your child and just upset. What can you do?

While trying to manage a challenging or troubled child, we parents are somehow also expected to know how to navigate the complicated legal and social systems that could provide help. The school is often our first point of entry to getting the extra supports our child needs. But it isn’t easy. Often it’s contentious. We’re rank beginners while the school personnel have knowledge and experience from working with other families. Even when everyone is well-intended, it can feel like a conflicted situation from the start.

Tips for becoming a successful advocate:

• A little understanding goes a long way. Like everyplace else, schools are straining to stay within budgets and to stretch their money the best they can. Yes, we all understand that. But when it’s our own child who is suffering or whose learning is falling behind, it’s hard to stay compassionate. One parent I know was told by a distressed special education director, “If we send your child to a residential school, it means that we may have to let go of a kindergarten teacher next year.” It wasn’t legal or helpful for her to say it. But that doesn’t mean that it wasn’t the truth. Kids with big needs cost the community big bucks. Services for one child can mean that 20 other kids are in an overcrowded classroom. We do have to advocate well for our children, but it helps us be more collaborative when we can also appreciate the position it puts school officials in.
• Get support for yourself. Joining a parent support group or talking with other parents who have kids with special needs can be both a relief and a help. Some of those parents are way ahead of you in the process. They know the ropes. They can provide you with important factual information and they can give you emotional support when you need it. Many communities also have volunteer and professional advocates who can explain the law to you and go with you to meetings to make sure you get heard and that the school responds as it should. If it’s a paid service, consider whether some money spent now can prevent higher-cost legal help later.
• Know your child’s rights. It’s very important to be conversant with your state’s education laws and the policies of the local school system. That way you won’t waste people’s time by asking for things that you aren’t entitled to. You will be taken more seriously by administrators if you have taken the time to learn and understand what you have to work with.
• Always prepare for meetings. Take along a list of talking points and questions. Your time is valuable. So is the time of the people convened to meet with you. You want to use the time you have as best as you can.
• Always take your partner or a friend with you to meetings. Often there are six or more professionals arrayed around the table. It can be daunting. It’s very difficult to take in everything that is said in a meeting when you are emotionally invested. When you have an ally with you, it’s easier to stay focused and to make sure you cover everything you want to cover.
• Leave younger children at home. Small children aren’t always cooperative when parents need to be focused. If you can’t afford a sitter, ask a neighbor or relative for a child care swap. If you really, truly can’t find someone to take care of your younger child, make sure you bring a snack and something to keep the child busy while you talk.
• Work with the school personnel, not against them. That means being open-minded as they try to find ways to meet both your child’s needs and the needs of the other children they serve. Sometimes there are creative, less expensive ways to provide support beside adding staff or sending a child to an out-of-school placement. Interns from local colleges, some parent participation, or in-home support are options that should at least be explored. There is usually more than one way to help a child be successful.
• Keep your cool. It is never helpful to approach with anger and threats people who have something we need. It only makes the other person defensive and resistant. Keep your sense of humor. If you find yourself reaching the boiling point, end the phone call or meeting before you say something you’ll regret or that may backfire on your child. You don’t want to have school personnel running for cover when you want to talk to them. You want their willing participation in solving your child’s problem.
• When following up, don’t wear out your welcome. Yes, you do need to have regular contact about how your child is doing and whether supports are in place. But if you attempt to micro-manage, school personnel are going to become “deaf” to your requests. Keep calls to a minimum. Always have a clear idea of what you want to accomplish before you call or ask for a meeting. School staff are legitimately busy with often a dozen or more other parents who have equally compelling needs.

Before reaching a tipping point, people often are able to balance known or unknown ADHD challenges with strategies they may not have even realized they were using. They had been able to adapt and cope well with their symptoms. Their symptoms may not have interfered with their functioning, so that they avoided an official ADHD diagnosis.

But for some reason a life change — a job promotion, relationship change, school change, or myriad other things — renders the current strategies ineffective. Over time there is a sense that things are no longer going well and in fact, life seems to be falling apart in a big way.

Here are some life situations that could be possible tipping points::

1. New problems at school.

Often, when higher elementary or middle school hits, students begin unraveling. They experience more responsibility in juggling multiple classrooms, more homework and larger classes. Suddenly it seems like nothing is working anymore. They can’t get things done that they want to get done, everything becomes chaotic, things start to come undone. Their schoolwork starts to suffer; they may have trouble concentrating in class, forget to hand in homework or start to experience difficulties with old friendships.

Often, no one recognizes these warning signs as being ADHD-related because the students previously had managed or were able to compensate for their challenges. Parents and educators start to feel helpless when a previously successful student seems to become unmotivated. Students are told they just need to try harder. Everyone is unsure how to get the child back on track and the students begin to feel stupid, lazy and incapable.

2. Inability to cope after significant life changes.

Some people with ADHD experience their first tipping point after a significant life change, even a positive one such as getting married or moving into a new home. These major life celebrations are anticipated with great joy, but often may be a change that tips the balance. Perhaps you’ve been able to balance your own life and your own schedule and where you put things up until now. But then you get married and now your spouse has a different way of doing things or expectations of the way things should be organized that differ from your views. That’s not to mention having to deal with the extra stuff in your space.

Slowly you notice that things are not working as well as they had before, and because this is supposed to be the happiest time of your life, you think there must be something wrong with you — right? Wrong! Significant life changes such as getting married, having another child or moving homes often can upset an unknown balance.

3. Unable to transition successfully into a new role at work.

Up until your “tipping point” you have been performing really well in your job — so well, in fact, that you are promoted. Slowly you may start to notice that you are not doing this new job as well as everyone expected, and you begin to isolate yourself, dread going to work and may eventually get fired.

What happened? You reached your tipping point. Not because you didn’t deserve the job, but because changes in work often come with changes of staff, support, work space, etc. that throw you off.

4. Change in family dynamics.

If you find yourself with new responsibilities and changes in your family, such as taking in an elderly parent, adding members to your family, or getting a new roommate, the additional responsibilities, change in routine and stress can gradually sink in and leave you overwhelmed and unable to cope as you have previously. It is so easy to begin to think you are a terrible mom, unfit for the responsibilities of a family or that you may be destined to live alone.

It’s not you. You were thrown off-balance, and your ability to compensate for your ADHD with your old routine, structures or systems is no longer working. But instead of seeing the truth, that it isn’t anything you’ve done wrong, or knowing that you can fix this, you’re filled with undeserved guilt and shame.

5. Physical injury.

People often experience their tipping point when an ADHD-management strategy such as exercise decreases or activity level changes. Unbeknownst to many people with ADHD, participation in sports or daily exercise provides some additional dopamine to our brain and helps to create structure and routine in our lives that help to better manage ADHD symptoms.

Tipping points are common for high school athletes who have earned success not only in their sports but academically, only to go off to college and experience failure for the first time. Without the rigorous physical training and structure of high school, they begin slowly to fall apart. Another common tipping point for people with ADHD is when they have experienced an injury and have to decrease their activity or exercise level. This change in routine and absence of daily dopamine boosts can challenge previous steadiness, energy levels and ability to focus. Life begins to wobble.

As you can see, there are many reasons, often beyond your control, that might lead you to your tipping point. A tipping point means that you are at a crossroads. You have a choice which way you will react. You can continue down that path to chaos and overwhelm, or you can get restructured and relearn ways to to cope and get back on track.

The authors explain concepts clearly and provide concrete tips to help kids get through everyday activities. Most important, perhaps, is that their approach shows respect for children’s autonomy. The emphasis is on how to help children calm themselves down through self-soothing, as well as how to provide kids with the tools to help them further their own capacities — all of which fosters independence at a young age.

The first part of the book answers the question “What is executive function?” Simply put, it’s what allows you to complete tasks and survive in society. Marcie and Daniel Yeager explain that psychologists credit executive function with anywhere from three to 36 abilities, but that they’ve chosen to simplify the list of abilities into four categories.

The first ability of executive function they name, working memory, refers to how much we can keep track of in our heads at any given time. For instance, to “get ready to leave the house for school” a child probably has to eat breakfast, drink water, get dressed, brush his teeth, comb his hair, feed the dog, find his lunch box, find his homework, pack his school bag, and keep track of the time. Remembering all those tasks is the job of working memory.

The ability to shift focus, meanwhile, allows us to put our attention on tasks that we need to do while shifting away from distractions. Imagine that you’re folding and putting away the laundry and your cell phone rings. Your real intention is to finish the laundry. If you can ignore the phone, you’ve successfully shifted your focus back to the task you meant to do and worked toward your goal.

Inhibition is another capacity: It gives us the ability to stop and think of a second or third way of dealing with a situation after an initial plan pops into our mind. For instance, you might want to hit someone when he steals your favorite toy, but you’re able to stop and realize that you need a plan B.

Creating and carrying out the steps necessary to complete a goal form the fourth executive function, the authors tell us. To get ready for a vacation, for instance, you need to get your daily life settled and take steps to prepare for the trip. Maybe you need to kennel the dogs, contact someone to pick up your mail, set the sprinklers to automatically water your lawn, get the oil changed in the car, and lock the windows in the house. This goal-setting function involves understanding the big picture and also figuring out what all the little parts of the picture are.

After explaining these four capacities, the authors go on to explain childhood development, using case studies that demonstrate both “normal” and not-so-normal development, and then offer tools to help children who are struggling in one of the executive function areas. One tool in particular appealed to me, so I tried it with my kids. It’s what the authors call a “wrist list,” which can be used in place of a regular to-do list and which is meant to problems with working memory.

Because  to-do lists only work if you remember to look at them, they’re easy to forget. A child who gets distracted from his morning routine by a dog asking to play ball won’t remember to look at a list. Instead, the authors suggest that the child write each task on a thin strip of paper and attach it to his or her wrist. This acts as a visible, physical reminder that he or she carries around.

My kids both seemed amused by the concept. Regardless, when they used the wrist list they completed their chores and schoolwork in record time, without any arguments. From a parenting perspective, the tool was a win. From my kids’ perspectives, they finished everything they needed to and got to spend more time playing on the computer—so it was a win for them as well.

The wrist list tool worked so well, I tried a few others from the book. I had my husband and kids do what the authors call an “Angel Wings” exercise. To do angel wings, you put your hands high above your head, stretch, and take in a big breath. Then, you slowly exhale as you lower your arms in a slow and controlled fashion. The exercise is meant to promote physical calmness and reduce anxiety, nervousness, and anger. It didn’t work as well for my family as the wrist list did, but I can see how it would work with some kids.

In addition to finding some of these concrete suggestions helpful, I found that the book’s case studies were of great use, too. In particular, they helped me gain perspective on children I’ve encountered. In fact, one case seemed to perfectly describe a friend of my son’s. I think I now have a better idea of why that child seems to fib a lot and start fights. Maybe I’ll be a little more understanding with him, and perhaps even able to help.

Another aspect of the book I appreciated was that the authors write in more-or-less everyday speech—no academic language, with its over-reliance on passive sentences. The writers don’t use “one” as a subject very often, and they don’t cram in too many footnotes.

Finally, I appreciated the attitude of “teach independence” that the authors convey. External aids and tools, like the wrist list, are okay, because a child can make those aids on her own and take responsibility for her actions. After all, one of my goals as a parent is to help my kids become adapted, independent citizens. And as Marcie and Daniel Yeager believe, that should be the goal of anyone who works with kids, too.

Executive Function & Child Development
W. W. Norton & Company, February, 2013
Hardcover, 272 pages
$24.95

A week of fun in the sun can sound innocent enough, but watch some of the videos of the spring break bacchanals on Youtube or the images on TV shows and in the movies and a darker scene emerges. Thousands of young people, most with a drink in their hands and barely dressed, crowd the beaches and bars. They look like they are having the time of their lives. The women are young and beautiful. The men are hot. The music is loud and the dancing is sexy.

Those images suggest that if you’re not getting wasted and having sex on the beach, you’re missing out. Sadly, going along with the hype means that some young people will lose their self-respect, their idea of their futures, and even their lives on what was supposed to be a fun vacation.

Why? Because what goes on in the hot spots for spring break is often far from innocent. According to a 2006 survey by the American Medical Association, 83 percent of the college women and graduates said that spring break involved heavier-than-usual drinking and 74 percent said the partying often ended up with sexual activity.

Large numbers of students reported getting sick from alcohol and having unprotected sex, sex with more than one partner, or group sex. A night of wild, unprotected sex with a stranger or two may sound like an adventure, but for too many it leads to a lifelong disease (like herpes or hepatitis) or an unwanted pregnancy. Alcohol poisoning can result in a trip to the local hospital and an unpleasant, highly dangerous end to the vacation.

In the last few years more and more students have been traveling to Mexico or Jamaica. The State Department estimates that 100,000 will travel out of the country. The beaches are beautiful. The sun is warmer. The drinking age is lower. But the apparently easy availability of drugs adds another element of danger for the American student. What starts with what seems like an innocent buy of some party drug on the beach may end with time in a foreign jail. Mexican jails are particularly unforgiving. Mexican drug cartels are even less so. Penalties for possession in Jamaica are inflexible and harsh.

Why do otherwise sensible, bright young people end up in trouble on what is supposed to be a dream vacation in the spring? Chalk it up to mob psychology, peer pressure, and the mythology that surrounds spring break. It’s hard to be responsible when all around you seem to be letting loose. It’s tough to be the person who stops at one shot when everyone else is downing 10 or to put on a shirt when the rest of the crowd is baring butts and breasts. It’s hard to leave the mob to saunter down the beach and hang out in a beach chair with the old folks who have fled to a less popular (but still warm) spot. And who wants to be the only one who doesn’t have great stories of unbridled partying when you get home? Partying is what the spring break is all about, isn’t it? Or is it?

It really isn’t a rule that to have a complete college experience, a student has to engage in irresponsible and dangerous behavior during spring break. In fact, despite the scenes on MTV and Youtube, it isn’t even the norm. Participants in a 2009 study of students’ motivations for going on spring break that was done at Penn State showed that most didn’t go to get wasted or to have uninhibited sex. Most students, in fact, reported that they go to vacation spots simply to get away from the usual routine of school, to have a relaxed vacation, to spend time with friends and family or just because they have nowhere else to spend the week their schools shut down.

Safety Tips from Students Who Have Been There

Tips from students who have gone on spring break and had a good time without getting into trouble sound terribly like what any good parent will tell you. Don’t let that stop you from taking care of yourself.

1. Tell your parents or other people at home where you are going, who you’ll be with, and when to expect you back. Let them know how to reach you if necessary. Stay in touch to let them know you’re okay. They will worry less. You will be safer. Hopefully you won’t be one of those who drop out of sight. But if you are, it’s important that someone knows where you were supposed to be and who was with you.
2. Use the buddy system. When you are in a bar or in a partying crowd, take care of each other. Don’t let yourselves get separated.
3. Don’t go anywhere with strangers. No exceptions. See number 2. If you meet up with people who want to show you the town or take you to their homes, don’t.
4. Be aware of your surroundings. Take a moment to assess the scene and to decide if it’s where you really want to be. Know where the exits are. Don’t let yourself get isolated.
5. Know the local laws, especially if you are traveling outside the U.S.
6. Don’t drink to the point that you’re out of control. Don’t drink anything given to you by someone you don’t know.
7. Stay hydrated. Alcohol and sun are a bad mix that can result in dehydration and sun poisoning. Use sunscreen and drink plenty of water to keep yourself hydrated. (No, beer doesn’t count for hydrating.)
8. Be firm and clear about boundaries. Stay out of situations where your intentions about sex can be misunderstood.
9. Don’t have unprotected sex or do anything sexual that is against your own moral principles. When you get home, you’ll still be with the you that was there.
10. Don’t carry all your money. Keep your return ticket and some cash in the hotel safe so you are certain you can get home.

And, yes, have fun. Just use the good sense you were born with while you do it and you’ll go home with a nice tan and no regrets.

This is Pepperdine University Professor of Psychology and private practitioner Cozolino’s fourth “Neuroscience of” book, following The Neuroscience of Pscyhotherapy’s first and second editions (2002, 2010, Norton) and The Neuroscience of Human Relationships (2006, Norton). The Social Neuroscience of Education shares the most current neurological and sociological intelligence about creating classrooms that offer and reward emotional empowerment, where brains are “turned on” so that students can connect and enjoy learning. And just as important as turning on students’ brains, Cozolino points out, is supporting educators: Attachment learning provides the same fertile foundation to excite and challenge teachers.

The book falls into four sections: the evolution of our brain and its relevance to relationships, how to turn brains off, how to turn brains on, and how to apply the concepts of social neuroscience in the classroom. Throughout, Cozolino cites scientific evidence, anecdotal narratives, and the wisdom of the ages through short, relevant quotes that help clarify the hefty propositions he presents to readers.

Page after page, his research returns the same finding: that how we socialize affects how we learn. It’s buttressed by the study of evolution, which teaches us that we forever adapt and re-adapt to an ever-changing world. It’s also supported by our understanding of neurology. As Cozolino writes, “We have an estimated 100 billion neurons with between 10 and 10,00 connections each, creating limitless networking possibilities.” These neurotransmitters form synaptic connections and combine new learning with our existing memory. Recent research confirms that, in humans, new neurons reshape, rather than replace, networks containing existing knowledge.

“In other words, instead of being replaced by new neurons as they are in many other animals,” the author explains, “existing neurons are preserved, modified, and expanded in ways that support the retention of memory, deepen existing skills, and further the development of expert knowledge.” Thus, as we grow, live, and learn, we have the capacity to change, to create new memories while holding on to the truths that form the essence of ourselves.

Because of this, we need not be defined solely and for a lifetime by our earliest experiences. In fact, educators who take a special interest in at-risk children and who are supported by school administrators and curricula are able to improve the students’ emotional and cognitive learning. Supportive and encouraging classroom environments can stimulate, enhance, and rewrite emotional communication and brain development, Cozolino tells us.

I’m comforted to learn I can line my daughters’ and even their daughters’ minds with reassuring feelings that remain with them, knowing that the social brain has the flexibility to inherit new emotional connections while holding on to old ones as well.

Cozolino points out, however, that his theory works both ways. Currently, educational models and classroom environments are turning brains off at an alarming rate. From student fear to teacher burnout, the endless ways emotion and socializing alter the success of both students and educators is evident in the increasingly poor perception of public schools as well as rocketing dropout rates. In countless schools across the country, teacher burnout is considered inevitable, given the sheer number of at-risk students entering the classroom. Educators facing unrelenting stress have poorer health. Lack of sleep and absenteeism in turn lessens quality of life, dedication to the classroom, and student tolerance and performance.

But, says Cozolino, count on a Jewish proverb to address such issues: “One mother can achieve more than a hundred teachers.” The human touch, those healthy and secure attachments found in loving homes, are the chicken soup ingredients of a successful classroom as well. In one situation after the next, Cozolino conveys how caring parents or caring educators are fundamental to the healthy emotional communication required for learning — an ability hard-wired into our brains if it’s tapped.

Educator Marva Collins is one example of what happens with “unteachable” students when teacher burnout is no longer present. In the 1970s, out of sheer frustration with the Chicago’s public school system, Collins started a charter school for children considered unteachable. According to Cozolino,

“Ms. Collins’s message is as simple as it is profound: There are no miracles in successful education…. She recognizes the devastating effects of shame, rejection, and isolation reflected in the faces of the students who came to her for help. Her antidote to shame is love and total dedication to each student. Her philosophy of education is grounded in compassion, and an appreciation of the total child.”

Collins also supports physical contact, Cozolino tells us, from hand-holding to hugs, turning the classroom into the ideal nurturing family environment filled with positive support.  “Although the brain is not a muscle,” the author writes, “it responds like a muscle by growing when stimulated and shrinking when unstimulated.”

The book concludes with an emphasis on emotional security. A quote from Lao Tzu — “Being loved gives you strength, loving someone gives you courage” — speaks to the benefits of a caring environment where attachment-based thinking allows students and educators to thrive without fear, shame, or bullying. Ultimately, successful learning resides in humanity and in the hearts of parents and educators who allow students to blossom into curious and creative minds. These students in turn become the mothers, fathers, and educators who can make our world a place where the quest to learn turns into a lifelong ambition paid forward. Its benefits, Cozolino says, are abundant and enduring.

The Social Neuroscience of Education:  Optimizing Attachment and Learning in the Classroom
W. W. Norton & Company, January, 2013
Hardcover, 440 pages
$37.50

He’d get stuck sitting in one particular chair, hunched over with his head in his hands for hours at a time, was tied to the clock for all activities of daily living, and totally isolated himself from his friends and peers.

I’ve always found it amazing that even though things were this difficult for him the last few weeks of his freshman year in college, he still attended classes and managed to successfully complete the semester.

After connecting with many OCD sufferers over the last few years, I’ve come to realize that Dan’s ability to continue on with his life is not that unusual. Of course, everyone’s circumstances are unique, but it seems to me that many people who suffer from severe OCD still get up in the morning and either go to school, work, or run a household. They are incredibly brave, doing this while often dealing with nonstop obsessions and hours and hours of compulsions. And while they may seem okay to the outside world, inside they are truly tormented.

How can those with OCD be so debilitated and yet so “functional?”

OCD sufferers know their obsessions and compulsions aren’t rational; they just can’t control them. Couple this with the very real stigma that still exists around obsessive-compulsive disorder and you have people who live in fear of being “found out.” A mom with OCD who has harming obsessions may be terrified that her children will be taken away from her if her OCD is discovered. Someone else may be afraid of losing his or her job. These are just two examples of why those with OCD may use every ounce of energy they have to appear “normal.” While outwardly they may be smiling, inwardly they are tortured.

There’s Little Benefit in Hiding OCD

Unfortunately, hiding OCD rarely benefits anyone. Something as basic as receiving a proper diagnosis and treatment is delayed if the sufferer does not seek help or is not honest with his or her therapist. A diagnosis of OCD involves the disorder causing significant disruption in the sufferer’s life. If a person gets up and goes to work, or fulfills whatever his or her daily obligations might be, then the consensus might be that his or her mental health issues can’t be “that bad.” Indeed, the sufferer may believe that also. “If I can work (or go to school, or run a household), I must be okay.” But being able to function does not mean that your life is not significantly affected. And so valuable time that could be used working toward recovery is spent suffering instead.

Another drawback of keeping severe OCD a secret is that it perpetuates the misconception that it is a “cute, quirky disorder.” While inaccurate media portrayals definitely play a role in this misunderstanding of OCD, the fact that so many of those with the disorder mask their suffering so well might also be a factor. Even if an OCD sufferer’s compulsions are visible to others (a need for symmetry at work, for example), what is obvious is their odd behavior, not the depth of their pain.

Additionally, for those seeking accommodations either at school or in the workplace, the belief that OCD is “no big deal” can be a roadblock to receiving the assistance for which you are entitled. Dan experienced this firsthand when the academic resource director at his school remarked at how well he seemed to be functioning. Why should he need any accommodations?

While I believe we have made some headway in reducing the stigma associated with all mental illness, we still have so far to go. If people feel the need to hide their disorder, then we obviously still have a lot of work to do. We have to continue advocating for OCD awareness and spread the word as to what OCD really is and is not. Also, we need to remember that things are not always what they seem. Your smiling co-worker may actually be severely debilitated by obsessive-compulsive disorder; you’d just never know it by looking at him or her.

Among those who aren’t comfortable with it is Dr. Marilyn Wedge. A family therapist and child advocate, Wedge has written Suffer the Children: The Case against Labeling and Medicating and an Effective Alternative, which features her own child-focused family therapy based on more than two decades of experience. Her book provides a number of excellent creative strategies that help children cope with stress, sadness, aggressiveness, anxiety, and compulsive behaviors without the negative effects of being labeled or the possibly harmful use of drugs.

Wedge writes, “I am confident that the therapeutic strategies I bring to life on these pages will empower you to deal with the most thorny of problems, the most difficult of challenges. My goal is always to help families help themselves without the use of drugs or stigmatizing diagnoses.” Her book provides not only a coherent discussion of the basis of her therapy but demonstrates, through her many stories of success with her own patients, that there truly is an effective alternative.

The epidemic of child diagnosis has increased dramatically in recent years. As the author notes, “More than four and a half million children in the United States have been diagnosed with ADHD. The number of children diagnosed with bipolar disorder is also exploding; by 2009, more than one million youngsters had been labeled with this serious affliction, which in the past had been thought to strike only adults.” What rightfully troubles Wedge is the labeling of children with such disorders and the application of drugs that were originally used only for adults.

She observes, “There is no doubt that pharmaceutical treatment has helped millions of seriously disturbed adults lead normal lives; but when it comes to children, there is no indication at all that either the diagnoses or treatments that work for adults apply to kids. Moreover, as I show in the chapters that follow, since the turn of the twentieth century, alarming evidence has accumulated that psychiatric drugs hold real dangers for children, including hallucinations, abnormal breast growth in boys, weight gain, and cardiovascular problems.” On the other hand, her techniques, she notes, can be done without reservations or fear because they do no harm.

Wedge’s strategy doesn’t seem as reductionist as those found in mainstream psychiatry. Instead, it’s based upon systems theory as espoused by the English anthropologist and social scientist Gregory Bateson.

Rather than isolating a problem within an individual, Wedge views it as existing in the relationships within a family, the entirety of which may be viewed as a living organism. In fact, as she points out in her own case studies, when families try to treat problems as if they were located within children but do not treat the family as a whole, the child may improve but problems often reappear in others within the same family.

To begin to see the root of a problem, Wedge often begins her therapy by asking the troubled child, “Are you more worried about your mother or your father?” Often, Wedge says, the child manifests symptoms in an attempt to protect the parent they worry the most about. To combat this tendency, Wedge tells the child that she is now in charge of taking care of the adults — removing the child from what they would otherwise see as their duty. Because of the importance of relationships in her treatment approach, Wedge often recommends parents not fight or discuss their problems in front of their children who often imagine these worse than they actually are.

Wedge combines this family systems theory with narrative therapy. Narrative therapy is based on the ideas and practices of Michael White, David Epston, and other practitioners who have built upon their work. It holds that our identities are formed through the stories we tell of our own life. Through questioning and collaborating with patients, Wedge helps people “reframe” their life story and rewrite it so that the relationships within the whole of the family regain a healthy homeostasis.

An important idea in narrative therapy is the separation of persons from their problems — a reason Wedge gives for opposing labels or diagnoses, which can stigmatize. Rather than letting individuals identify themselves with their ADHD, suicidal, autistic, bipolar, or other label, she uses a technique called “strategic dialogue” to work directly with the difficulties themselves.

The author believes that strategic dialogue is one of her most valuable interventions. While it appears to be simple dialogue between the child and the therapist it is in fact much more involved. She writes,

It is a gentle strategy, seemingly simple on the surface but actually complex. The questions are not aimless. As in the ancient Socratic dialogues, or the hypnotic techniques of Milton Erickson, the questioner has a final goal in mind and carefully sculpts her questions to reach that goal. By giving the illusion of alternatives, the questioner creates a new feeling right in the session that will be the beginning of a change in the child’s perceptions of herself and her world.

Through examples, Wedge shows how the subtleties of metaphor and multiple levels of meaning are embedded within these narratives. She writes, “If a child is angry and explosive, I immediately ask who else in his family might be angry and explosive, even though the other family member may express those feelings in a different fashion.”

She reports seeing this with her client Joey, whose outward anger was a reflection of his father’s inner rage about his job. “Just as patients speak on two levels of meaning at once,” she tells us, “therapists must be able to move from the literal to the metaphorical and sometimes vice versa.”

She describes an example from family therapist Milton Erickson, concerning a schizophrenic patient who insisted he was Jesus Christ. Erickson approached this patient on hospital grounds and said, “I understand you have had experience as a carpenter.” Based on his story, of course the patient had to say that he had.

Erickson used this to involve him in building a bookcase and later in more productive work, which turned out to be quite therapeutic. By moving from the metaphor of the suffering Jesus Christ to a literal interpretation, Wedge says, Erickson was able to provide help.

Wedge’s respectful, non-harming, child-focused family therapy is brief; supposedly, it often brings profound results within eight sessions. Her book presents a bold, informative critique of the often unscientific and harmful techniques of contemporary, pharmaceutical-based psychiatry. Based on research, clinical theory, and years of practice, it can help children and their families rewrite their narratives for a happier life.

Suffer the Children: The Case against Labeling and Medicating and an Effective Alternative
W. W. Norton & Company, March, 2011
Hardcover, 243 pages
$26.95

Online opportunities for learning and for earning college degrees have become pervasive in the last 10 years. Most two- and four-year colleges now offer online options. For-profit colleges that exist solely online now offer both undergraduate and graduate degrees.

Consortiums such as Coursera, a tech company that partners with universities worldwide, offer non-degree oriented, free classes for people who simply want to learn new things. This is a sea change in education.

And yet… Only 50 percent of students who register for online classes succeed. (This is compared to an average of 70 percent of students in traditional campus classes.) It’s not because those who fail aren’t smart. It’s not because they don’t have good intentions. Research has identified factors that have more to do with a student’s psychology than intelligence. My own experience as a teacher of online classes leads me to the same conclusion.

If you are considering taking online courses and want to be in the 50 percent who make it through (and with good grades), here are at least some of the variables that make a difference:

Be realistic about what you are taking on.

There seems to be a myth among at least some students that online classes are easier than campus classes. Generally they aren’t. You are signing on to wrestle with new material, to master new skills, or to increase your own knowledge base. A good online class will be as challenging as any course you’ve taken in a brick building.

Be realistic about your reality.

Most online students are adults with adult lives. That means families, jobs, and complicated schedules. Be sure you really have the time and energy to put eight to 10 hours a week into reading, researching and responding. Often the students who have had to drop my class have found it overwhelming to fit class work into already over-stressed lives. One man who did very well for the first few weeks found to his dismay that he had underestimated the effect of a new baby in the house. The needs of the baby and his need for sleep overwhelmed his ability to focus on the class.

Whatever your good intentions and optimism, there are only so many hours in a day and you only have so much energy. Before writing the check to take a class, be sure you can fit it into your schedule.

Be realistic about your own motivation and maturity.

Online learning requires that you “show up” and show up regularly. Often you will be responsible for making submissions that other students need in order to keep a discussion going. Since there is no set time to participate in class, it’s easy to let a day or two or four go by because of other obligations. That’s a setup for failure.

More than a few of my students have fallen by the wayside due to major issues with procrastination. If you procrastinate and get behind, it becomes harder and harder to get caught up. If you are irresponsible about doing your share of group work or getting assignments done on time, you risk alienating your classmates and annoying your teacher, who doesn’t have the time or the responsibility to chase you.

Be realistic about your time management skills.

Succeeding online means logging in every day or at least 5 days a week. It means doing the reading so you can do the assessments and assignments. It means taking the time to participate in the class discussions. Students in my classes who succeed treat the online course very much like a part-time job. They set aside regular, predictable time to do the work. They keep a calendar to make sure they meet deadlines and immediately do makeup work if they had to be “absent” for a day.

Be realistic about your willingness to engage with others.

Ironically, your professor and classmates will get to know you online at least as well, and often better, than if you were sitting together in class. Campus students can be virtually invisible by not volunteering in class. Online learning requires that you be out there, visible and engaged. Success comes to those who post regularly, who show that they have thought hard about the readings, and who contribute novel and interesting ideas to discussions.

Success also comes from encouraging others, from asking good questions, and from being willing to be challenged. When people engage in discussions without attacking others and without being defensive about their own contributions, discussions can be very rich and meaningful. One of my classes only requires three posts a week. The students who do best in terms of mastering the material are often showing up 10 – 12 times, sometimes with just a word or two of encouragement for a classmate, sometimes with a new insight into the material, sometimes with an anecdote from their own life that highlights something we’re talking about. These are the students who breathe life into the class. Often they are also the students who truly master the course.

Be realistic about your skill with words.

For now, at least, online learning generally requires communicating well in writing. “Discussions” are all by posts. Group work is through written chats within the class. Your words represent you. Poor grammar, spelling mistakes, rambling prose, or confusing paragraphs will get in the way of success, no matter how good your ideas may be. Teachers and peers don’t have the energy and patience to decipher your meaning. If you aren’t confident about your ability to communicate well in writing, it would be wise to get a tutor to help you hone your skills before tackling a course online. Another option is to first take an online course in expository writing.

Be realistic about your skill on a computer.

If you aren’t a reasonably competent typist, if you don’t know your way around Word or have difficulty learning how to navigate a platform, you’ll quickly become frustrated with the whole enterprise. Frustrated people tend to get anxious and annoyed. Often they fall behind and then get so discouraged they drop out. And please: Don’t do as one of my students did and ask your mother to do your typing. He often lost points because she didn’t have time to be his typist when he had deadlines. More to the point, it made me question who was really writing the responses.

It’s a new world. I fully expect that the boundaries between campus and online learning will continue to blur as an inevitable outcome of technological advances. The best online students are those who find it exciting to be on the cutting edge of change and who engage in class with curiosity and enthusiasm. As for me, I thoroughly enjoy getting to know my online students and watching them stretch and grow through their interactions with the materials and with the class.

In this, his latest book, Elmore offers the culmination of his experience to advise parents, teachers, and leaders on how they too can empower the current generation of young people to become authentic adults and develop more than just an “artificial” maturity. Yet despite his decades in the field, Elmore may not be as reliable a guru as he’d have us believe.

To define the current generation, Elmore has coined the term “Generation iY,” which he explains as follows:

Because of the ubiquitous technology available on our phones and at our fingertips, we are raising, not Generation Y, but Generation iY. They have grown up online and have been influenced by the ‘iWorld.’ … In short, the artificial maturity dilemma can be described this way:

1. Children are overexposed to information, far earlier than they’re ready.
2. Children are underexposed to real-life experiences for later than they’re ready.

This overexposure-underexposure produces artificial maturity. It’s a new kind of fool’s gold. It looks so real because kids know so much, but it’s virtual because they have experienced so little.

This is the starting point of Elmore’s book, as he argues that today’s young adults have been denied the opportunities to truly develop their own personalities due to the perfect storm of spending too much time in the “virtual world” of technology, an increased dependency on prescription drugs, and being overprotected by their parents.

Elmore then summarizes four key areas to respond to this issue:

1. Provide autonomy and responsibility simultaneously.
2. Provide information and accountability simultaneously.
3. Provide experiences to accompany their technology-savvy lifestyles.
4. Provide community service opportunities to balance their self-service time.

These certainly make sense, and over the rest of the book Elmore offers a number of tips and techniques that can be used as interventions when working with these young adults. Every chapter is summarized in concise “Chapter In A Nutshell” segments. Elmore also provides “Talk It Over” suggestions, to encourage discussion over some of his suggestions, as well as real-life examples of “Exercises for Maturing Kids,” where various contributors offer their own stories and share what worked for them.

There is undoubtedly a lot of useful information in this book, and parents who are keen to see their children develop into “authentic” leaders may glean a great deal from Elmore’s wisdom. Many of the techniques and suggestions here could be applied to a variety of situations, rendering the book a potentially useful reference tool for those who regularly work with young people and are looking for a little help in how to control or guide them. Still, Elmore’s perspective is a narrow one.

One such example comes when he reminds us of the importance of using technology to involve young adults in activities and encourage them to work together. Unlike some social commentators, the author does not believe that Facebook, iPhones, and video games are the root of all evil; rather, that they are wonderful tools that need to be used appropriately and in the right measure. Elmore shares a story to illustrate this point:

“When faculty and staff at Conlee Elementary School in Las Cruces, New Mexico, started having students do five minutes of Just Dance (an active video game for Nintendo’s Wii) at the start of each new day, they noticed a trend: tardiness went down. Kids began getting to school on time. What’s more, they got some exercise every day playing the game. Students love it. Teachers love that they’re now engaged. Not a bad trade-off.”

This story may be true, but it’s also quite simplistic. Elmore doesn’t acknowledge the fact that enticing kids into school with a video game could in fact be seen as bribery, or indeed pandering to what the children want. And there are several occasions in the book where he suggests something that might seem to be simple common sense, but could equally be interpreted as patronizing, or condescending. He writes:

We all know that people need to find a career in an area of their personal strengths. When this happens, we come alive. We deepen our passion and tend to become the best versions of ourselves. I am suggesting, however, that before students take that plunge they may be served well to do something outside of that ‘fun’ area in order to build discipline:

• Waiting tables at a restaurant
• Inputting data in a computer program
• Washing and detailing cars
• Filing folders or shipping products
• Cleaning offices and restrooms

What Elmore is clearly saying here is that humility is important, and that we shouldn’t allow our young adults to become too self-serving or narcissistic, or to allow their egos to get out of control.  This is obvious. But I’m not convinced that cleaning restrooms, washing cars, or waiting tables is a fundamentally worthwhile activity for anyone, no matter how much of a character-building exercise it might seem.

Furthermore, the author doesn’t look into some of the systemic problems that often prevent our young people from moving into the careers they desire, or the hurdles along their journeys toward trying to achieve their own goals and dreams. It’s easy to point the finger at “Generation iY” and blame them for all of their flaws and foibles, but what about the society that puts them in that situation in the first place?

“This is actually a book of hope. I love kids,” Elmore says in his introduction. But much of the book comes across as being genuinely skeptical about the ability of young adults to make informed decisions of their own, and can as a result seem rather pessimistic and cynical. Headings such as “What the Next Generation Needs Most” left me feeling uncomfortable, almost as though Elmore were trying to dictate a cure-all panacea for everyone to follow, without pausing to think about what young people’s wishes might be, or whether he might have his own agenda.

The book does have plenty of commonsense tips and techniques, plus a large helping of real-life experience and information that could be put to use when working with young adults.

But I was ultimately left feeling that the world would be a much duller, less vibrant place if every child were raised to become the kind of carbon copy “authentic adult” Elmore has in mind. I have faith that the children of today can become the successful and independent young adults of tomorrow. But I believe they can get there of their own accord, using their own unique skills and abilities — and that they’ll be able to do it without cleaning toilets.

Artificial Maturity: Helping Kids Meet the Challenge of Becoming Authentic Adults
Jossey-Bass, 2012
Hardback, 272 pages
$24.95

When my three children were young, we homeschooled off and on throughout the elementary school years. My son Dan, in particular, loved the freedom of being able to explore his interests as he pleased. He continued homeschooling throughout high school, and received his diploma from a nontraditional school that works with homeschoolers. Always bright and self-motivated, he was truly born to homeschool. He has since graduated college.

His diagnosis of obsessive-compulsive disorder didn’t come until after he graduated high school, and while he had known something was wrong for “a while,” his father and I didn’t have a clue. So the decision to homeschool, on our part, had nothing to do with the fact that Dan has OCD. From Dan’s point of view, it was how he learned best. He did give high school a try for a few months in ninth grade, but decided to leave so he could “continue his education.” Whether his OCD played a part in that decision or not, I don’t really know. But I do know that Dan genuinely loves learning, and he and homeschooling were a great fit.

Over the years, I’ve noticed, mostly from talking with people and reading blogs, that a considerable number of children with OCD are homeschooling. This is a totally unscientific observation; I don’t have any statistics. But I do have a question: Why? No doubt everyone has their own reasons, but some possible explanations might include:

• OCD often is associated with above-average intelligence, as well as creativity, and these two attributes do not always mesh well with traditional schooling.
• The school is unable or unwilling to meet the child’s special needs (even though they are legally bound to do so).
• The child refuses to attend school. This might be directly related to the OCD (for example, he or she may believe the school is contaminated), or indirectly related (the child is being bullied because of his or her odd behaviors).
• The child is willing to attend school but parents feel it is advantageous (in reference to OCD) to keep the child home.
• The parents or child believe homeschooling is the best way for this particular child to learn (independent of any issues with OCD).

I believe in homeschooling. While I know it’s not for everyone, it can be a rewarding experience for parents and children who undertake it for the right reasons.

But if your child has left school or has never attended solely because he or she has obsessive-compulsive disorder, it may be a good idea to reevaluate the situation. It’s true that school might be a fervent breeding ground for OCD triggers, but is avoiding it the right thing to do?

To complicate matters more, for those also dealing with social anxiety and perfectionism, school can be torturous. I know it’s easy to say “avoidance is never the answer,” but when you have a child who is terrified of going to school, what do you do? Sometimes, could it be that avoiding certain situations is the right thing to do?

As with everything related to OCD, there are no easy answers. Parents, therapists, teachers, and students all need to become as educated as possible about the disorder. If it’s decided the child will attend school, the appropriate support network should be put in place. Of course, a support system is also necessary if the child is homeschooling.

Either way, the child must receive proper treatment. Exposure Response Prevention (ERP) Therapy, the frontline treatment for OCD, is actually based on facing one’s fears, and is therefore the opposite of avoidance. So the actual location of the battleground (school or home) isn’t so important. What matters is that the war against OCD is faced head-on.

They aren’t feeling motivated to study. They don’t like their classes or they like their classes okay but still can’t find the time or energy to do the assignments. They sleep through their alarm clock. Even if they do get to class, they nod off or forget to take notes. They report feeling anxious or depressed or overwhelmed or sick or just all-around miserable.

Why, they ask, are they in school? What’s the point?

There are times that asking a question implies the answer. If you wonder if it would be a good idea to take time out from school, you probably already know the answer. You know you aren’t being the student you could be. You know you are wasting a substantial amount of money. You wish you could find the motivation and ambition you once had but now clearly don’t. It’s probably time to take time out.

Taking a break doesn’t have to mean you are giving up. A break is just that – a break. Sometimes there are good and respectable reasons for taking a year or two or more away from academics. College won’t go away. Your credits usually won’t evaporate. Going home doesn’t mean you are stupid or inadequate or crazy. There just may be other priorities or other issues that make leaving school a smarter, wiser idea than staying in.

5 Good Reasons to Take a Break

• When you’re not sure why you’re there. College these days is an enormous financial investment. If you don’t have clear goals, it’s reasonable to ask yourself why you are taking loans and using up your parents’ savings to be there. A “gap year” program or a couple of years of work experience might help you set clearer goals for yourself, including your goals for your schooling.
• When you find you’re unprepared for higher-level work. Sadly, not every high school adequately prepares its students for college-level work. Even if you got all As you may not have the education you need to compete at the college level. If you find the work too challenging, it may well be that the problem isn’t your IQ. You may not have the fundamental information and skills needed to understand the material or to express yourself adequately in writing. If that’s the case, it makes sense to take time out to take some remedial classes at your local community college or to get a tutor to bring you up to speed.
• When a family crisis distracts you. Some people are able to compartmentalize their life at school from their life at home. But many more can’t. If someone you love is fighting cancer; if your parents are going through a divorce or are in some other crisis themselves; if one of your siblings is in serious trouble or ill or a much-loved relative has recently died, you may find it difficult to concentrate on classes and assignments. It might be better to go home than to be constantly distracted by worry or overwhelming feelings of loss. Feeling helpless to help or feeling guilty for being away isn’t going to do much for your GPA. Take a semester to put things in order or to feel like you’ve done what you could and you’ll do much better when you return.
• When you are making a major life decision. Big decisions sometimes need all of our attention, not a distracted part of it. The decision to marry or to break up, the decision to change your major when you’ve already invested three years, the decision to leave school and to take a big opportunity instead – whatever life-changing matter is before you may matter so much that you need time to figure it out without academic demands pulling for your attention.
• When you are so stressed out by school that you are miserable. If the idea of studying gives you a panic attack; if the thought of going to the library makes you so depressed you can’t leave your room; if you get no joy out of reading the materials or listening to the lectures but only feel scared, anxious, or generally irritable, you may be in no shape to take on school for now. By all means, talk to your teachers and take advantage of any counseling services available to you. Sometimes a little help can send someone in a more positive direction. But if every attempt at getting help isn’t helpful, maybe you need to go home to take stock, to get involved in some therapy, or maybe just to mature a little more before starting college.

Know Yourself

Yes, there are some people who can manage 18 credits, active participation on a varsity team, a lively social life and a deeply meaningful love relationship without missing a beat. Good for them. Would that everyone was so lucky. But many people need to take life in smaller chunks. It doesn’t have to be seen as a failure or as a character flaw. Different people are just different.

If you do go home, use the time wisely. It’s not a time to hole up in your old bedroom feeling sorry for yourself and sucking your thumb. It’s a time to rest, regroup, and reconsider your options. Get some experience, training, or remedial education. Get a job and pay down some of your loans or save up for your return to school. If time management was part of the problem, then get some practical coaching. Depressed or anxious? Get yourself into counseling to learn better coping skills. By taking care of yourself, you’ll be in a better position to decide when and if higher education is for you.

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After the third or fourth nagging requests, she would get irritated and say, “I am done! This is the last one. Good night!” Johnny would cry and ask for more “good nights.”

Mom didn’t know it at the time, but she was reinforcing Johnny’s need for reassurance. One “goodnight” was not enough, but neither were ten.

Ritualized hand-washing or other grooming compulsions were absent. There didn’t seem to be any checking compulsions. If there had been, Johnny’s parents probably would have sought professional help sooner than they did. They only noticed his “neatness habits” were getting in the way of completing his math homework in a timely manner. He would erase the numbers several times until they felt just right.

Sometimes, too, he would get into arguments with his siblings and he always wanted the last word. He felt the desperate need to be “right.” Temper tantrums occurred and his parents attributed them to his stubborn personality. There were occasions when he would ask a lot of questions, and his parents would reassure him — unwittingly reinforcing his obsessive-compulsive disorder (OCD).

Little signs popped up as Johnny grew up. His parents worried at times, but those would dissipate as they noticed all of Johnny’s positive behaviors. He was a straight-A student. He not only showed self-discipline but also self-motivation to excel in school. He enjoyed Little League soccer, baseball, basketball, and other activities.

Then, Johnny became depressed. His mental obsessions and compulsions had finally taken hold, and his parents found professional help. Johnny had been suffering in silence for years. He was too embarrassed to tell his parents what was really going on in his head. He had kept his ordeal a secret. He didn’t want his parents, siblings, or other relatives to think he was “crazy,” even though he really did feel like he was going crazy. The anxiety-inducing thoughts would not go away. The more he tried to stop them, the stronger they became.

So why didn’t Johnny’s parents do something before he got depressed? Were they careless, uneducated, and unaware? The answer to these questions is important.

In short, there are two conditions in the OCD experience: the obsessions (thoughts the individual has) and the compulsions (what the person does in order to decrease the anxiety he or she is experiencing). This is where the misunderstanding occurs.

For example, you may guess or believe a friend has OCD when she compulsively washes or cleans. You may think a relative has OCD when he excessively checks the locks, stoves, and appliances to ensure there won’t be a fire or a robbery. Repetitive rituals such as rereading or rewriting and counting are also types of OCD most people recognize. But what about those who have obsessions, and neutralize the initial disturbing thought with a thought that relieves anxiety? Do they have OCD? Not from the outside, which can lead to confusion and misdiagnosis.

In Johnny’s case, most of his compulsions were silent. His parents couldn’t possibly be aware of them. He felt ashamed, guilty and embarrassed about his thoughts. Research indicates one in 200 children suffer Obsessive Compulsive Disorder. This is according to the reported and correctly diagnosed cases. Unfortunately, there are still many adolescents and children suffering in silence or being misdiagnosed.

OCD Signs in Children: How to Help

It is essential for parents to be involved in helping their children. Unfortunately, sometimes parents believe they are helping when they are actually enabling. For instance, does your child get really upset because she wants you to stand in a certain spot while she brushes her teeth? If you move, does she become unglued? What will you do? Do you do what she’s asking so she can go to bed in peace?

There are instances when the whole family gets sucked into the rituals, and the whole family suffers. There is resentment and stress in the home. Often, parents are not even aware that their child needs help. They may believe they child just has a strong, stubborn personality, like Johnny’s parents did.

Below is a list of typical behaviors of children with OCD. It is always recommended that you consult a professional experienced in working with children and specifically trained to treat OCD.

• Excessive temper tantrums when interrupted from an activity.
• Wearing certain clothing or objects all the time. Does he believe it keeps him or others safe from harm?
• Ordering and arranging rituals driven by need to have things even, balanced, or “just so.”
• Average or above-average intelligence.
• Obsession with or avoidance of certain numbers.
• Showing certain rituals when separating from parents.
• Following certain rituals at bedtime and excessively upset if interrupted or not allowed to follow them.
• Involving parents or siblings in rituals and getting upset if they don’t do them as instructed.
• Having the need to “be right” or “win” arguments.
• Tries to continue the topic even when others have moved on to another subject.
• May not necessarily show washing, cleaning or checking rituals.
• Asking questions and trying to ‘figure things out’ and not feeling satisfied with the answers given.
• Whispering compulsions while watching TV; appearing preoccupied and distracted when talking to you.
• Too neat or too messy.

Children experiencing OCD may also exhibit other disorders such as ADHD/ADD, Tourette’s Disorder, autism, depression, separation anxiety or generalized anxiety disorder.

Consult a mental health professional, medical provider or a psychotherapist so they can help you find the right treatment for your child.

I believe what happened to Dan could have been prevented if he’d had the proper support systems in place. Ideally, parents and students can work together to begin establishing these important relationships, even before arriving on campus. In my opinion, your support system, at the very least, should include a mental health professional, appropriate school personnel, and family.

The logical place to begin your search for a mental health professional is at the counseling center on campus. A word of caution, however: Many therapists at college and university mental health centers are not trained in cognitive-behavioral therapy. Even if they are, the number of appointments each student is allowed per semester often is quite limited. Staff at a good college counseling center will be able to give you local referrals to area therapists who specialize in treating OCD with Exposure Response Prevention Therapy.

Even if you feel that a therapist won’t be necessary at school, I encourage you to at least make an initial contact with one. That way, if problems do arise, you will already have a therapist in place. If you currently have a therapist at home that you are happy with, talk with him or her about the possibility of scheduling phone (or Skype, etc) sessions with you, either on a regular basis, or as needed. The most important thing is that you have a therapist available to you. Additionally, if you are taking medication, talk with your psychiatrist at home about getting any necessary prescriptions, and what the plan will be for communicating with him or her. If you or your doctor feels it would be beneficial to have a psychiatrist closer to school, you can get referrals from your current doctor or your campus counseling center.

Next, I recommend connecting with the appropriate school personnel, as mentioned above. Most colleges have an academic support center that assists students in need of accommodations. Again, a word of caution: Accommodations for obsessive-compulsive disorder can be a tricky business. There is a fine line between helping and enabling those with OCD. Also, it is not always clear what accommodations might be helpful to each OCD sufferer. For example, the common accommodation of untimed testing may not help students with OCD, and actually could make matters worse. More time for testing and handing in assignments means more opportunity to ritualize, and more ritualizing may intensify the OCD.

In Dan’s case, the staff at his academic support center had little to no understanding of what OCD really is, and while they seemed willing to help him, they had no idea how. A letter written by your current therapist outlining appropriate accommodations can be extremely helpful, but what might even be more important is the open-mindedness and flexibility of the college support staff. This is because the truth of the matter is that sometimes those with OCD don’t even know what they need until after the fact.

Though we didn’t realize it when Dan started college, he, like many OCD sufferers, often had trouble with time management, the balance of details within the big picture, and over-thinking. Once this became evident, we requested regular, detailed feedback on his work (he is an artist). Another example could be a new college student who might not anticipate getting “stuck” while reading a textbook. Because the OCD sufferer’s needs will likely evolve as the semester gets underway, periodic communication is essential. Again, even if you don’t think accommodations are necessary, you should have them in place. Better safe than sorry.

Other appropriate school personnel to connect with might include your dean of students, academic advisor, and professors. The more people who are aware of your OCD, the more overall support you will have.

The final support system, family, can make all the difference in the world. It is crucial to keep the lines of communication open with your parents and other family members who have been helpful to you in the past. Aside from regular contact with them, consider allowing (through written consent required by law) your parents access to your academic records. This will help assure them that you are on track with your classes, and also alert them early on to any potential academic issues which could be related to your OCD. If this is something you’d rather not do, talk with your family about how much you are willing to share with them.

A final word of caution: While the advent of college often is associated with independence, it is a sign of maturity to ask for help when you need it, and then be willing to accept it. I was fortunate that Dan allowed me to advocate for him when necessary. I believe this is especially important when you are in a new environment where people do not know you well. If you are having problems, an advocate who knows you and understands your OCD can be invaluable.

There is no question college can be stressful, but if you have your support systems in place and address any issues (OCD-related or not) sooner rather than later, chances are your experience will be positive. Here’s to a great year at school!

At this time of year in 2011, those of us in the northeastern U.S. were all reminded that nature can play terrible tricks. We had a blizzard resulting in power outages so severe some lasted for weeks. Halloween was cancelled. We went into survival mode.

We certainly weren’t alone in this. Any family that has dealt with the devastation of tornado, earthquake, blizzard, hurricane, flood or wildfires knows that life can change dramatically in a matter of hours. During such times, people can experience tremendous challenges to their sense of security, their sense of home, and their sense of personal strength. They also can experience what it means for family and community to come together to help and support one another.

The UN General Assembly established the International Day for Disaster Reduction in December 1989. Its purpose is to raise awareness of ways to reduce trauma following disasters. Governments are encouraged to set up systems to prepare for inevitable disasters. Parents and teachers are encouraged to be proactive in their efforts to protect their students and families.

We can’t prevent the unexpected. But we can build our capacity, and that of our family, to cope. Personal strength is only partially a result of genetics and temperament. It is primarily a function of the coping skills we’ve learned and our willingness to put some time into strengthening our inner resources and outer connections. Parenting well in danger zones means becoming an emotional rock our children can cling to and giving them the resources they need to come through hard times.

But preparing for emergencies is most effective when everyone in the family is involved. An international day is as good a time as any for parents to put good intentions about preparedness into action:

• First, deal with your own anxieties and fears about weather events. Kids pick up our feelings, no matter what we say. If you have fears grounded in something that happened to you when you were young, do the psychological work you need to do to heal. You deserve to feel more secure. Your kids need you to be someone they can hang onto if there is an emergency.
• Talk to kids about weather events that historically have happened in your area. Read young children stories as a low-key way to introduce the topic. If you need some help with finding titles, take a look at the University of North Carolina Extension Service list of age-appropriate books that talk about how kids dealt with natural disasters.
• Open a discussion about what your family could do. Strike a balance between being honest with kids about possibilities and reassuring them that there are usually people around to help. Validate their fears and feelings. Then move the discussion to how they can get help and how they can use their own good skills to manage if a disaster happens. Listen to their ideas and support their sense of personal strength.
• Prepare an emergency supply kit. We all know what we should do: Stock up on nonperishable food and water; keep a supply of prescription medications on hand; have a plan for reaching those we need to reach. (See a checklist here.) Many of us become inured to the reality that a disaster may happen here, to us. It’s time we all get busy and just do the tasks of emergency preparedness that we all intend to get around to and don’t. An emergency is far easier to handle when we can reach our loved ones and basic creature comforts are taken care of.
• Involve the children in making the emergency supply kit. Even preschoolers can help put together a first-aid kit and stock a shelf with nonperishable foods. Make sure everyone knows where the flashlights and extra batteries are kept. Post phone numbers for fire, police, and ambulance in a central place. Post phone numbers of relatives and neighbors who need to know you’re okay there too.
• Make sure your children understand whether they should come home or stay put if there is a natural emergency. It is likely that they’ll be at school or daycare if the unexpected happens. Make sure the children know who to call and where to go if they are caught outside.
• Promise to use your own good sense. Take the weather service seriously. Protect your home if you can but put people’s safety first. Stay home or evacuate as the authorities advise. Inconvenience is better than trauma.

Be Prepared

Kids, like adults, do better when they have a plan. We don’t get as fearful if we have an idea of what to expect or what we’re supposed to do. It’s when we don’t know what to do that we get the most anxious and upset.

I wish International Day for Disaster Reduction had a snappier name. With a nod to the Boy Scouts, it would be more kid-friendly if it were called something simple like “Be Prepared Day.” But whatever we call it, having a special day can be just what we need to get us to build our family’s preparedness for the unexpected.

Yes, it’s September. Your children are back in school and it is time for my annual article urging parents to work toward creating a healthier and better-rounded education for their children.

In a recent three-week period, there were three newspaper articles underscoring how schools have increasingly become pressure cookers that may be harmful to your children. A few years ago, in the Boston Globe, there was an article about some local high schools trying to develop ways of reducing teen stress. I have reported in past columns about the epidemic of anxiety, depression, and eating disorders among high school students. Parents and high school staff, especially in affluent suburbs, have become obsessed with building resumes in order to get into the best possible colleges, even though the evidence continues to say that the college you go to is not a significant predictor of life success.

The Globe article described groups of parents and staff who are recognizing this and even report that college admissions offices are accepting some responsibility for this trend. The admissions staff are concerned about a rise in the number of new students who are arriving on campuses in poor physical and mental health. (Again, I have reported before about the epidemic of mental health problems among college students that are simply overwhelming the inadequately staffed college counseling centers.)

Small steps being taken by some schools include eliminating homework over vacations, eliminating mid-year exams, and adding yoga to phys ed. (Of course phys ed is disappearing from our schools!) I love the idea of yoga classes in high schools. There is an abundance of evidence that teaching some form of stress management is essential for reducing the negative impact of excessive stress. In turn, learning to manage stress is a critical component in developing problem-solving skills and boosting self-confidence.

Of course, some administrators see this as psychobabble and talk about asking more of their students rather than less. I think these administrators are more concerned with the ranking of their high schools than the needs of their students. In our country’s obsession with getting results now, we are turning high schools into junior colleges with an ever-increasing focus on having students taking honors and advanced placement courses. Meanwhile, high schools continue to ignore the plea by physicians that our teens are suffering from sleep deprivation, noting that high school schedules (early morning starts) ignore the changing sleep patterns of teens. Research has shown that students learn more when they have had a good night’s sleep and have eaten a reasonable breakfast and lunch. Such obvious needs are being ignored. And we trust our children’s welfare to these people?

On August 6th, a Boston Globe article reported that elementary school lunches are shrinking. In just the past two years, lunch periods, on average, have been reduced from 30 minutes to 24 minutes. That’s the lunch period. Subtract the time it takes to get to the cafeteria, assuming the students leave class exactly on time (which, reportedly is often not the case), and children generally have less than 20 minutes to eat. Much too rushed.

It’s not only about having time to eat. Lunch period is an important socializing time as well as a break from the rigors of the classroom. When you add to this, reports of shrinking recess as well, there is a clear pattern of schools increasing anxiety about statewide test scores and trying to cram more academics into the school day. The school day unfortunately has become increasingly focused on teaching to the tests and less on teachers being able to introduce creative curriculum.

If there really isn’t enough time in the school day to address all these needs, why not lengthen the school day? When did six hours become the golden rule? The best of our schools, highly rated private day schools, keep children all day and add mandatory participation in sports as well as providing increased access to teachers and smaller classes so education can be more individualized. No reason public schools can’t do this. Except for unions. Private school teachers do this for less pay and benefits. It shouldn’t be about the money. Most teachers spend hours at home correcting papers and planning classes. If they had a longer day at work, time could be made available for their “homework” to be done at school.

The distorted expectations just keep creeping downward. The pressure to achieve academically is increasingly dominating our model of education, ignoring the old saying about teaching the total child – cognitive, social and emotional aspects need to be balanced for a healthy life. Schools are failing our children by ignoring the social and emotional needs and parents have unfortunately become their accomplices in this process. In fact, parents are often the driving force.