The article touches on various issues that arise as a result of so many students needing services. Schools are left to figure out how much and how best to accommodate students with documented disabilities. Who should make these decisions? Faculty? Individual teachers? Counselors? Disability coordinators? And what about those students without documented disabilities who request help? Most likely some of them are indeed suffering from some form of mental illness and have not yet been officially diagnosed. It is also likely that some students are just trying to take advantage of the system: Get a slip from the counseling center and avoid taking that exam for which you neglected to study. There are lots of different scenarios and it is up to individual colleges to develop policies to deal with them.

While laws governing special accommodations in public elementary and secondary schools can be quite detailed, colleges and universities are left to develop their own guidelines within the framework of the Americans with Disabilities Act (ADA), which basically states that these students cannot be discriminated against.

Obsessive-Compulsive Disorder and Students

So where does this leave those with OCD? We already know that OCD is complicated and often misunderstood. While therapists can make recommendations for accommodations, the truth is that sometimes those with OCD don’t know what they need until after the fact.

My son Dan, like many OCD sufferers, often has trouble with time management, the balance of details within the big picture, and over-thinking. All of these issues have hampered him in college at one time or another. He now knows that he needs to be accommodated with regular, detailed feedback on his projects (he is an artist). Really, that is all he needs to redirect his focus appropriately. But it was an arduous process just to get these simple, yet vital, accommodations in place.

“Typical” accommodations for those with other disabilities often are not helpful to those with OCD. Indeed the results can be just the opposite. Extended time for testing and handing in assignments, for example, can wreak havoc on OCD sufferers. More time means more opportunity to ritualize, and more ritualizing may intensify the OCD. So this “helpful” accommodation can end up hurting students who struggle with the disorder.

To make matters even more difficult, students with OCD are often reluctant to take the initiative to discuss what they need. It is extremely difficult to explain OCD to those who either have preconceived notions or know little about the disorder. Telling a teacher that it takes you much longer to read a book than most people because you have to reread every page multiple times, or admitting that you are so afraid of not doing an assignment perfectly that you don’t do it at all, can be embarrassing and anxiety-provoking for the student with OCD. Again, these situations can be hard to anticipate and may come across as made-up excuses to faculty and staff who do not understand the disorder.

As more students with documented cases of OCD are sure to arrive on campuses, this problem likely will get worse before it gets better. So what can be done to help these students? How can we be sure that they are afforded the chance for a “level playing field” in their education?

We need to continue advocating for OCD awareness. We need to spread the word as to what OCD really is and isn’t. The more we talk about obsessive compulsive disorder, the more we can help people understand how this illness may affect students. And my hope is that the more educated we all become, the more comfortable we will be about talking about OCD and other mental health disorders, thereby reducing the stigma of these illnesses. The more we understand about OCD, the clearer it will be that the best accommodations for students suffering from this insidious disorder just may come in the form of open-mindedness, support, flexibility, and trust.

A total of 141 students completed anonymous questionnaires on their self-esteem, well-being and stress levels, and their Facebook use. This showed that students who interacted more on Facebook in their first semester reported being happier and less stressed and had higher self-esteem. However, a greater number of Facebook friends did not appear to be beneficial.

The second part of the study involved 169 students completing the same questionnaire halfway through their first year. At this point, the frequency of their Facebook use was not linked to stress, self-esteem or well-being, but having more Facebook friends was linked to higher self-esteem and well-being.

In the first semester, students who have a tight support network surrounding them are likely to feel more confident and appreciated, say the researchers. By the second half of the year, those with more friends on Facebook are likely to be the ones who have been happier, interacted more, and have therefore made more new friends.

Dr. Stiff presented his findings last September at the British Psychological Society annual conference in Cambridge, UK. He believes that receiving frequent messages on Facebook could help students who are about to begin college and are feeling in need of support.

“When teenagers come to university for the first time, they may find this significant life transition extremely stressful. Moreover, as the new student’s local support network is no longer available due to their geographical displacement, stress and associated maladies may be exacerbated.

“Facebook is not just a tool for superficial social networking,” he said, “it is also a highly effective conduit for social support during students’ first few dizzying months at university.”

However, more recent research suggests that people who spend more time on Facebook have a relatively worse self-image. Dr. Hui-Tzu Chou of Utah Valley University and colleagues explain that Facebook “provides a platform for people to manage others’ impressions of them.” Because people tend to present themselves in a favorable way on their Facebook profile, reading these profiles may have an impact on others’ perceptions of their own lives.

In the journal Cyberpsychology, Behavior and Social Networking, the team reports on their study of 425 undergraduates at a state university in Utah. The students were given questionnaires on the duration of their Facebook use, time spent on Facebook each week, number of Facebook friends, and perceptions about others’ lives.

Those who had used Facebook longer and who spent more time on Facebook believed that others were happier, and were less likely to believe that life is fair. Having more people who they did not personally know as Facebook “friends” was also linked to believing that others had better lives.

Dr. Chou states that Facebook users “tend to attribute the positive content presented on Facebook to others’ personality, rather than situational factors, especially for those they do not know personally.”

It seems that the impact of Facebook on self-esteem is a mixed bag. A 2011 Kent State University study concluded that having a greater number of Facebook friends is positively linked to well-being.

The 391 college students in the survey described their “self-presentation strategies” as either positive or honest. Analysis showed that positive self-presentation had a direct effect on well-being. But honest self-presentation had an indirect effect on well-being via perceived social support from Facebook friends. The researchers say that self-disclosure plays an important role in signaling one’s need for social support.

Finally, a team from Assumption College, Worcester, Massachusetts looked at how Facebook relates to self-esteem and adjustment to college among 70 students. Their survey implied that the number of Facebook friends “potentially hinders academic adjustment, and spending a lot of time on Facebook is related to low self-esteem.”

Number of Facebook friends was negatively linked to emotional and academic adjustment among first-year students. However, the relationship became positive later in college life, “when students use Facebook effectively to connect socially with their peers.”

These researchers, led by Dr. Maria Kalpidou, write that their findings point to “the value of studying further the notion of Facebook friends.”

References

Facebook as a Means of Managing Stress Associated with Life Transitions. Can Social Networking Help New University Students? Presented by Dr Chris Stiff of Keele University at the British Psychological Society Social Psychology Section annual conference in Cambridge, UK, from September 6-8, 2011.

http://www.bps.org.uk/events/social-psychology-section-annual-conference-2011

“They Are Happier and Having Better Lives than I Am:” The Impact of Using Facebook on Perceptions of Others’ Lives. Chou, H. T. and Edge, N. Cyberpsychology, Behavior and Social Networking, published online December 14, 2011.

The Facebook Paths to Happiness: Effects of the Number of Facebook Friends and Self-Presentation on Subjective Well-Being. Kim, J. and Lee, J. E. Cyberpsychology, Behavior and Social Networking, published online November 30, 2011.

The Relationship between Facebook and the Well-Being of Undergraduate College Students. Kalpidou, M., Costin, D. and Morris, J. Cyberpsychology, Behavior and Social Networking, published online December 30, 2010.

They may be diagnosed with complex disorders such as Autism, Asperger’s, Pervasive Developmental Disorders, Bipolar Disorder, Tourette’s, or Mental Retardation. All are challenging to identify reliably, and even more challenging to treat effectively. We can add the physical disabilities of blindness, deafness, and a multitude of serious medical disorders that strike children and significantly limit their ability to function.

Each of these disorders has books, websites, and national organizations devoted to them. Parents often know more about the specific disorder than any individual professional involved in treating the child because they devote hours to researching out all available information. The Internet has made much more available including the ability to contact other parents with similar concerns.

Yet, as I recently listened to a group of such parents share their pain and frustration, I could hear some common issues being expressed repeatedly: the need for parental support systems, the reality that in many situations nothing really works to resolve the challenges their children present, the lack of social opportunities for their children, the impact on marriage, the impact on siblings, and fears about the future.

Parent Support Groups

As I sat and listened to these parents share their painful stories, I felt particularly powerless. I had no magic solutions and rarely an idea that they hadn’t already heard from some other professional. Yet, as the meeting drew to a close they were so thankful! The process of sharing their struggles face-to-face with other parents who understood them best made a difference. Some actually exchanged phone numbers and planned to meet again.

The main plea was the need to have ongoing support groups. There was talk about the lack of respite from the 24/7 challenge of caring for these children. Finding someone to watch their child for a few hours so they could have time for personal, marital, or family activities was a universal challenge. The typical sitter lacks the skills and even if one lives near family, they too often lack the understanding or patience required to help. In fact extended family non-support was a key issue. Too often these parents are criticized by their own extended family for not being able to better manage the behavior of their child with severe special needs. The frequent result is avoiding attending family and community events.

These parents need a level of support that is difficult to give if you haven’t been in their shoes. The understanding that was shared within the group was very powerful. It was especially helpful because these parents are very isolated and despite information that may be available, still end up feeling as if their struggles are unique and represent their failures as parents.

But the emotional support and social connection was only part of the group’s value. These parents knew so much that they were terrific resources about the latest information as well as being able to share what strategies or services had proven helpful with their child. So there was a practical, informational aspect to the value of the group.

It was obvious in reflecting on this meeting that more community agencies need to commit to providing an opportunity for these focused parent support groups. Online chat rooms help but talking to other parents in a real room, especially parents who live in the area and can become a true personal connection, is essential to the coping ability of these parents.

Impact on Family

Children with severe special needs drain enormous amounts of time, energy, and money. Marital problems are reported to be present to a greater degree because of the lack of time for nurturing the marriage plus the frequent problem of parents disagreeing on what needs to be done for the child.

Another source of tension is that often one parent is more effective in managing the difficult behaviors. The reduced couple’s time is especially important because there is more that needs to be discussed and dealt with including the feelings of grief and disappointment that sometimes never get processed. The ability to learn to enjoy the positive aspects of the child and to take a more spiritual perspective about what all family members gain from having to address these challenges can only take place after having grieved the loss of what the parents had expected from that child at birth.

Sibling issues need attention. Parents and professionals alike often lose sight of the need to help siblings understand the problem that is affecting their brother or sister. Then there is the challenge of trying to reduce the jealousy that results when so much attention is focused on one child as well as the frequent limitations on doing common family activities. It is clear that siblings need an opportunity to voice their questions, concerns, and feelings.

A particularly important issue is helping them identify their negative feelings as normal and reduce the guilt that often complicates their behavior within the family and toward their sibling. Once again we are talking about the need for support groups. To learn that they are not alone in their situations and in their feelings is critical to a healthy attitude and the ability to cope. Communities need to provide these opportunities.

This latter issue really stirs my juices. I have complained for decades that public education is a passive process and fails to stimulate creativity and teach the kind of problem solving and teamwork that the real world requires for success. I wish the American Academy of Pediatrics would produce a statement that public education is bad for our children’s health!

Sorry to digress but it’s hard for me to ignore the narrow vision of those who are trying to advise parents especially when they rely on limited research data and a myopic perspective of what the relationship is between childhood experience and adult success in work and family life. An example of the latter would be a follow-up to my last column about the effects of too much day care. The increased social aggressiveness found in 6th graders who had spent more time in day care might be a mild concern in the 6th grade (those children, as I pointed out, were not identified as behavioral problems), but we have no idea if that increased aggressiveness proves to be a valuable asset in their adult lives when such behavior may actually prove helpful.

That’s one of the pitfalls of experts giving rather simplistic advice when the actual long term outcomes are very complex. Suppose it turns out that, by adulthood, those same “more aggressive” 6th graders are more successful in their personal and work lives. Will the headline then read, “Preschoolers who spend limited time in day care grow up to be too passive”?

In my opinion, the main problem with all these dire warnings is that it is stimulated by research that is very limited in focus and which uses a backward view of the lives of our children. What I mean by this last point, and the key theme of this article, is that it places those lives in the context of what our world has been rather than what it is going to be.

The pace of change in our global society is increasing at a geometric rate. Faster and faster, technology spurs an ever more rapid impact on our lives. I cannot count the number of times that my friends and I have commented on how much cell phones have changed our lives. Yet, just look at this one device. Every few months it morphs into something new and more dynamic. Now one can not only take pictures and videos with a cell phone, one can download TV shows, access the internet, and listen to your favorite music. Activities that were once the province of large, stationary desk top computers can now be duplicated on a small, hand held “phone.”

This is but one example, albeit a very visible example, of how our lives are impacted by technological change. But cell phones represent only a tiny fraction of what is happening.

I think about the ways in which my life has changed in the first year of my retirement. (Keep in mind I am a very limited technophile.) I have been tutored in using Adobe Photoshop and have learned to edit digital images in ways that boggle my mind. Now I’m scanning slides accumulated over a period of 40 years, editing and organizing them. Soon I will be able to send those images to my TV screen! I already can share my pictures using online websites such as Kodakgallery. Or, I can share pictures using a free IM-type program called Skype, which allows me to talk to my grandson on the other side of the world, send pictures, or just type messages back and forth. Then there is Vonage, which allows my son who lives overseas to call me on a local number as if he lived around the corner!

Meanwhile, using Linksys, Sling Box, and our digital cable box, my son is able to watch and record shows as if he was living in our guest bedroom. Naturally we are also making extensive use of our cable company’s DVR system to record shows and watch them on our schedule. Meanwhile, my wife and I entered the iPod age, downloading our hundreds of CDs (over 9000 songs), organizing them into an extensive group of playlists, and listening to music more than ever. And I don’t even have a blog!

Children Today Are Being Raised in a Digital Environment

My point in sharing all this, again, is how much our lives are changing so rapidly in so many ways, all due to technology. And I haven’t even touched on the amazing advances in medicine! Or how about a printing company that I just read about, developed and run by two young men, which has reduced the cost of printing by 90% for a host of tasks! Amazing. Now I would love to ask how much time these guys spent playing video games as teens or were creating videos on Youtube.com or MySpace.com? Oh, that’s right. Probably didn’t have these latter activities when they were teens! Well, I’m sure you get my point.

I believe that from infancy on, allowing our children to watch stimulating videos or playing interactive video games or learning to create their own blogs is actually preparing them for a world that we can barely imagine, yet it will be their world by the time they are adults. I believe that their world will be less language based, less face-to-face based but, instead, much more of a visual-analytical world, one that is more hands on and filled with opportunity for incredibly creative adventures and discoveries.

At the same time, I am not afraid that our children will become socially backward and relationship deprived. I believe the desire for social connection is an integral part of the biochemical make-up of the human species. Look at how much of the internet-based activity is focused on connecting to others, sharing information, developing one’s identity through creative expression. While children are not outside playing as much as they did in past generations, that change is not about TV and computers as much as it is about the disconnected lives of families and the greater concerns about the safety of our children. Still, children have their best friends and their groups and children continue to be very concerned, at all ages, about not belonging or fitting in. So all the old social dynamics are still there.

What is fascinating, at the same time, is that this generation of children are forming connections with peers literally on the other side of the world. They may know more about a child in South East Asia than a child next door. Long term, this can become a critical factor in improving the understanding of those who are different from them and contribute to the whole shrinking world phenomenon. Keep in mind that the global economy is booming, that emerging countries are truly emerging and the gap between the U.S. and much of the rest of the world is diminishing. This is resulting in a steady shift in the nature of our economy and what job skills will be needed going forward.

We are already seeing shifts in marital and parenting data. Fewer percentage of marriages, increase in percentage of married couples who choose not to have children, and a steady decrease in the divorce rate. People are exercising more choice and, with the steady rise in interfaith and interracial marriages, we are constantly becoming a more blended society.

I include these observations in an article about the effects of TV and video viewing on our children’s development because it provides further evidence of how much the world is changing and how difficult it is to predict what is good or bad for our children or what the world will look like when they are adults.

It is my belief that those who are making negative judgments about too much exposure to video, TV, and computer screens are basing those conclusions on a 20th century model of a more language-based, face-to-face society with more rigid life roles and a world of more separated societies.

I think it is necessary to use a very different yardstick to attempt to measure what is good and bad for our children and that requires trying to project, based on the rapid changes in our current world, what the world will look like and demand from them when they re adults. While this is a daunting task, and requires a lot of speculation, I believe it is better to use this more creative model than an outdated one. Meanwhile, for parents, as always, I recommend emphasizing building intimate relationships with your children and relying on your instincts about what is best for each child and your family.

Q: What is ADD?

A: ADD stands for “attention deficit disorder.” It is a neurological syndrome characterized by distractibility, impulsivity, and restlessness. “Neurological” means having to do with the brain and nervous system. ADD is a label for how the brain and nervous system of people with ADD works. People with ADD tend to think quickly and creatively. They are usually smart, intuitive, and full of new ideas and plans. They like to try out new things and they like to have fun. Sometimes they procrastinate, have trouble staying on task, completing projects, or following through on ideas. Sometimes they are hot-tempered, tactless, or loud. Sometimes they underachieve in school or unintentionally disrupt social occasions. All these problems relate to their brain having trouble focusing attention and regulating impulses. The problems do not relate to their being lazy, stubborn, stupid, or subversive. In other words, ADD is not their fault; it is just how their brains are wired. Furthermore, there is nothing wrong with having ADD. A lot of great people in history have had ADD, like Benjamin Franklin and Thomas Edison, and many highly successful adults have ADD.

For a young person to have the best chances of success in dealing with ADD, the trick is to get the diagnosis and treatment as soon as possible. It is never too late to treat ADD, however. And with treatment the negative aspects of ADD can usually be contained. This allows the many positive aspects to really flourish. There is no limit to the amount of success an individual with ADD can achieve.

Q: How can I believe this diagnosis is real and not just another way to try to get me to do what my parents want?

A: Look at the scientific evidence. Satisfy yourself. Question your doctor as to how you were diagnosed. Pin him or her down aggressively. Say that you are worried this is all a put-up job. The only way the treatment will ever work is for you to get behind it, and you will never get behind it if you think you are being duped.

Q: I don’t like having to rely on a drug to do my homework. It just doesn’t seem right. Either I can do the work, or I can’t. But to take a pill for it? It almost seems like cheating.

A: Does wearing eyeglasses seem like cheating? There’s really no difference except that in one case you swallow a pill and in the other you wear eyeglasses. Does taking a vitamin seem like cheating? All a vitamin does is replace a chemical that is missing or deficient; that’s exactly what the medication for ADD does.

Q: Some days I take the medicine and feel fine about it. Other days I just want to do it on my own. Problem is, that’s when I screw up. Any advice?

A: Keep taking the medicine as long as it works. Talk with your doctor and your parents about these feelings you have of wanting to do it on your own, but don’t stop the medicine because of them. Don’t feel alone. Most young people feel as you do, especially young men. It becomes an issue of self-reliance. What you have to understand is that you are still doing the work, not the medicine. The medicine won’t read the book for you or write the paper, anymore than another person’s eyeglasses will. The medicine simply makes it possible for you to read the book or write the paper as well as you can. It evens the playing field.

Q: How do you know the medicine isn’t dangerous?

A: Because medical research has given us much information about it, if you’re referring to Ritalin, which is the most common medicine used to treat ADD. But don’t just take my word for it. Ritalin has been studied by hundreds of scientists over decades. It is one of the most thoroughly studied medications we use. What side effects there are&emdash;agitation, appetite suppression, sleep loss&emdash;are easily controlled most of the time. The most annoying side effect is that Ritalin wears off in a few hours, and so you have to remember to take another. Of ominous side effects, growth suppression is probably the worst, and this is reversible by stopping the medicine. It is also very rare. On the whole, Ritalin is an extremely safe, well-investigated medication. Of course, it, like all prescription drugs, should be used only under a doctor’s supervision.

Q: Does the medicine interfere with sex?

A: Stimulant medication can make getting an erection moreÝdifficult. For females, there is no interference. If you plan to have sex, you may plan not to take your medication that evening. The other medications used may, but usually do not, interfere with sexual function. If you have any problem in this sensitive domain, be sure to talk it over with your doctor. If you feel too embarrassed to bring it up, perhaps one of your parents could broach the subject with your doctor for you. Above all, do not rely on rumor and hearsay. There is a lot of damaging misinformation out there about what these medications can do to you. The misinformation I have heard would almost be funny if it weren’t that some kids believe it. So, get professional, informed advice, then make up your own mind.

Q: Should I tell my friends I have ADD or keep it a secret?

A: That is entirely up to you. It is your business. However, my advice is to be open about it if you can. There is nothing to be ashamed of. I myself have announced on national television that I have ADD, and no one has given me a hard time about it.Believe it or not, the biggest barrier is your own feelings, not other people’s. Once you feel OK about having ADD (or any sort of learning disorder), you will find it much easier to tell others. So what’s the big deal? So you have ADD? So what? So did Thomas Edison and Benjamin Franklin. So does Dustin Hoffman. John Irving has various severe learning disabilities. Not bad company. There is nothing to be ashamed of. Keeping it secret only perpetuates a feeling of shame within yourself.

Ashley’s Perspective

Ashley was 19. She had been away at college her freshman and sophomore years when her life unraveled again. In high school, she had struggled for several years with escalating depression, drinking, and marijuana use, and the painful feeling that her mother was ashamed of her. Her parents did not recognize the seriousness of the situation until she began to scratch and then cut her arms with sharp objects, at which point her mom got scared and sought help. During her senior year of high school, her mom forced her into treatment, and with intensive individual, family and group therapies she become sober and psychologically stable.

Before leaving for college, Ashley was much better. She felt strong, proud of herself, and grateful to her parents for the ways they changed and learned to support her. Ashley even seemed to rise above her past — becoming an informal spokesperson for treatment and sobriety and seeking out ways to help friends and others in trouble.

At college Ashley initially participated in the support system set up for her, but then her attendance at therapy became sporadic. She became absorbed with campus life and seemed to revel in her independence. Ashley told her parents she felt “fine,” and announced that she no longer needed any antidepressants and had gone off them.

Toward the end of first semester, Ashley tried to avoid her parents’ calls. When they did speak, she was short with them, refusing to talk about school or therapy. When Ashley came home during winter break, she spent much of her time sleeping and staying in her room on Facebook. Though having agreed to get a job, she became too anxious to follow through the process. When her grades arrived, she could no longer hide that she had failed a course and was on probation. Ashley felt ashamed but promised her parents she would do better next term and go to her therapy appointments.

Unfortunately, the same cycle occurred the following year, culminating in a mounting emotional crisis toward the end of spring semester which she attempted to hide from her parents. When they questioned her over the phone about how she was doing, she told them she didn’t want to talk about it and wanted space. Her parents complied and backed off. When she was home over the summer, however, the signs that she was sinking became harder for her parents to ignore. (The warning signs of her depression included poor grades and failure at school, avoidance, inertia, withdrawal, staying in bed too much, weight gain, lack of motivation, irritability, and depressed mood.) Though her words stated otherwise, Ashley had again fallen into the danger zone.

Parents’ Perspective

Ashley’s mom, Laura, was a successful surgeon. She struggled with tremendous guilt over her role in her daughter’s emotional problems and failure to heed warning signs that Ashley was in trouble until things were so bad that Ashley started cutting herself.

Laura recognized that, due to her own upbringing, she had been unable to be available emotionally to Ashley and, on top of that, was perpetually disappointed with her. She came to understand that she had tried to mold her daughter into someone more conventional and ambitious, pressuring Ashley to be more like her, thereby giving her the message that she was not good enough.

Ashley’s dad, Tom, was an easygoing guy who generally aimed to please. He loved Ashley very much and gave her whatever she wanted, but did not comprehend what was going on with her psychologically. Tom did not like conflict and feared Ashley’s anger. When she went to college and pulled away, he worried that if they upset her, they could lose her and she might no longer want to come home or no longer want a relationship with them.

Ashley’s mom made remarkable progress in her own therapy during Ashley’s senior year of high school, propelled by motivation and willingness to be honest with herself. This progress was noticeable and quite important to Ashley. By taking explicit responsibility for her own mistakes as a mom, learning to accept and appreciate her daughter as she was, and acting as a supportive presence and guide, Laura played an important role in her daughter’s recovery and helped mend their relationship. Before Ashley went off to college Laura felt good about herself as a mom for the first time, and her relationship with her daughter became more solid than ever.

Once Ashley went off to school, however, Laura began to feel pushed away, and their relationship changed. Laura sacrificed so much to help Ashley and it now seemed to have been wasted effort. As she became aware of Ashley’s failures at school, she wondered whether her daughter was just a slacker, capable of doing better but manipulating the situation to get away with whatever she could. Feeling angry, defeated, and unappreciated, Laura commented that being a mom was a thankless and hopeless job. She wanted to give up and, pulling away in anger, she decided she would stand back and not do anything.

Psychologically Speaking

Laura took it personally when she felt her daughter pull away, becoming consumed by an emotional reaction which obstructed perspective on what was really happening. For all of us, executive functions go “offline” when we are triggered into dysregulated emotional states and overreaction. When this happens, our capacity to respond flexibly, think clearly, and react with good judgment is compromised. When the part of our brain that allows for reflection is deactivated by intense emotion (often originating from unprocessed experiences from our own childhood), instead of being thoughtful about how to respond to children’s needs, we are driven to react automatically and reflexively, as Laura did in her hurt and anger.

When a child’s distress is not taken seriously, and responded to appropriately by the parent, it can fuel an increasingly dangerous situation in which the child feels unconsciously compelled to continue “upping the ante” until the parent shows that they feel something empathically on the child’s behalf. Laura’s failure to recognize Ashley’s state of mind and step in to help led to her daughter’s continued escalation and deterioration, just like in high school when Ashley’s experience of not being “seen” in her pain perpetuated her self-destructiveness. During family therapy in high school, Ashley told her mom that she had felt out of control and driven to cut herself to produce physical evidence of her suffering – desperately hoping her mom would “get it.”

Another problem here was that when Laura was able to step back from her anger, she felt scared and helpless in the face of her daughter’s fragility. She feared that if she took action to set limits, Ashley would be forced to face the truth about her own limitations and might then want to kill herself. The truth was that Ashley was, of course, already aware – at least unconsciously – of her limitations and forced to be alone in it. She needed her parents or someone to step in and take charge.

Attempting to shield children from what they know intuitively to be true usually backfires, impeding the possibility of growth and causing them to feel shame, confusion, and aloneness. Projecting her own anxiety onto Ashley and colluding in a family-wide denial, Laura in effect reinforced Ashley’s sense of shame — and left her feeling unseen again.

Having the courage to face children’s limitations with them and offer help lends courage, builds coping skills, and is reassuring. Despite fears to the contrary, shame is actually decreased when parents are not afraid to face their children in a nonjudgmental way, and do not feel compelled to pretend or hide what is really going on.

This is also the question on a parent’s mind.  What is the best way to handle outbursts, tantrums, or bad behavior?  There are myriad parenting books available to assist parents on the best way to respond.  Each of them touts a different method that is sure to help.  Dr. Claudia Gold’s Keeping Your Child in Mind delivers a single message to be used throughout a child’s development. Through anecdotes about patients struggling with their children, she explains how the method of “keeping a child in mind” can help alleviate issues the child may be experiencing.  Rather than focusing on “what to do” to help the child, keeping a child in mind focuses more on understanding why the child is acting out and using that information to comfort them and help them to control their emotions.

Dr. Gold practices behavioral pediatrics and, for years, has taught parents the method of keeping a child in mind.  Dr. Gold explains that “keeping a child in mind” has four parts:

• Understanding the behavior in terms of the level of development
• Empathizing with the child’s feelings about the situation
• Containing and regulating difficult emotions; disciplining that accepts the feelings but places limits on the behavior
• Controlling and regulating your own feelings so they do not hamper the work with the child

She elaborates on these concepts and how they are applied in each developmental phase: infancy, toddlerhood, preschool, school-age, and the teenage years.  Giving the reader many examples, Dr. Gold makes it is easy to see how this method is utilized and how it is effective in helping families with behavioral issues.  A quote from Dr. Charles Zeanah aptly describes how the focus is shifted when keeping a child in mind: “Instead of the problem or disturbance being understood as within the child or within the parent, the problem may be understood as between the child and caregiver.”

In the situation presented above, the mother first would recognize that her son is attempting to declare his independence in the only way he can at such a young age.  She would then calmly explain that she understood he was mad about having the pen taken away but that it is not okay to hit anyone.  At this point, she may even put him in timeout for a few minutes in order to discipline him for the hitting.  During this process, she would also be aware of her own emotions, making sure that her anger about the interruption and hit by her son did not overwhelm the situation.  Through this process, she is able to assist her child by recognizing his emotions but showing him that there are limitations to be put on these emotions.  He can then learn to cope with the intensity of his anger without lashing out at others.

Dr. Gold also addresses the emotional aspect of being a parent through each phase.  Whether it is a lack of sleep combined with frustration while raising an infant, or struggling with jealousy over the multitude of opportunities before a growing teenager, parents deal with their own baggage that may directly affect the way they discipline and raise their children.  In addition, the stress of the household could be manifesting in the child’s outbursts.  Dr. Gold points out that these issues should not be tossed aside but should be looked at in depth with the assistance of a therapist to see if, perhaps, they are causing the child greater levels of stress.

Finally, Dr. Gold addresses the question of medicating children.  I believe her stance on medicating children is best summed up in this quote:

When families rely primarily on medication, children do not have the opportunity to develop coping skills to adapt to new situations and frustrations.  Equally important, in medicating the symptom away, the underlying issues in relationships are not addressed.  Medication can have the effect of silencing everyone.

With little research on the long-term effects of medication on children’s development, Dr. Gold expresses concern that there may be dire consequences to using medication as a quick fix.  She states that she is not “against” medicating because there are situations where it can offer significant benefits.  However, the overall tone of this final chapter is definitely heavy on the argument against medicating.  She uses examples of patients who requested medication for ADHD and, after careful review and some work with the parents on keeping their child in mind, did not actually need the medication and the “symptomatic” behavior dissipated.  She also questions what it must be like for the child “to sit in a room once every three months and listen to a conversation about his behavior and its relation to a pill he takes every day.”  The child becomes the object of the conversation rather than an acting character.

Dr. Gold states in her final chapter that “we need to ask not ‘what is the disorder?’ but rather, ‘what is the experience of this particular child and family?’ and ‘what can we do to move things in a better direction?’”  This is one of the constant themes throughout her book.  As a new mother who has studied child development, Dr. Gold’s book was a breath of fresh air for me.  It was a relief to read a parenting book from the perspective of a behavioral pediatrician that addresses behavior issues at each stage.  Rather than have a parenting book for each individual phase, Dr. Gold provides a single resource that can be applied to all stages. 

There is the question of whether this method will work for all children with all problems at all phases.  However, that is unlikely.  Perhaps that would make parenting too easy.  Although, to be honest, what parent does not want the quick fix to end all problems they may be having with their children?

Keeping Your Child in Mind: Overcoming Defiance, Tantrums, and Other Everyday Behavior Problems by Seeing the World through Your Child’s Eyes
By Claudia M. Gold, MD
Da Capo Lifelong Books: August 30, 2011
Softcover, 240 pages
$15

More than anything, Dan wanted to return to school in the fall, and so he was thrilled to be accepted into a world-renowned, intensive residential program for the summer. The staff there assured him that he would have plenty of time to get back on track and return to school. Dan was so excited; he couldn’t wait to go. You’d have thought we were sending him to summer camp.

At the residential program, Dan was the model client. He committed himself totally to his Exposure Response Prevention Therapy and though it provoked panic attacks, he forged ahead. He did everything that was asked of him and never complained. He took his meds. He bonded with his therapist and other staff members. Everyone loved him. He was one of the easiest clients (in terms of temperament) with severe OCD ever to walk through the clinic’s doors. In short, he was a pleasure to have around.

In fact, he was such a pleasure to have around, nobody wanted him to leave. Though Dan was making serious progress, we began to hear concerns from his psychiatrist and therapist at the clinic about him not being ready to return to school. If he stayed in the program longer, he could make that much more progress. At this point even Dan, heavily influenced by the staff that he had grown so close to, wanted to stay. He was comfortable there, surrounded by people who understood him. Never mind that he would not go back to college. Never mind that Dan’s school did not grant leaves of absence in his major. Never mind that by not going back, he would be giving up his almost lifelong dream. Better he should stay at the clinic and conquer that OCD.

What happened? How could it be that my son, who had insisted on completing his freshman year of college in the midst of severe OCD, was now saying he wasn’t well enough to return to school? He had chosen this program specifically so that he could return to college, and now he was telling us that school wasn’t that important to him. In terms of his OCD, he was in much better shape at this point than when he arrived at the clinic, but his frame of mind was worse. It’s as if he didn’t realize how sick he was until he entered the treatment program.

So how long should you stay in a residential program: until your OCD is totally under control, and there is not an obsession or compulsion to be found? Or should you get back into the world and live your life, all the while continuing to fight your OCD? One of Dan’s arguments for wanting to stay in the program was, “If I go back to school I won’t have time to concentrate on my OCD.” Hmm. Isn’t that a good thing?

As with most things related to OCD, there are no easy answers. But there are some things to keep in mind. In my opinion, the longer you stay, the harder it is to leave. Dan was at his residential program for nine weeks, and toward the end of his stay he was saying things such as, “I’m so comfortable here, I could stay forever.” And he meant it. Also, while there is no question that the staff at this clinic knew everything there is to know about OCD and its treatment, there is also no question that they did not know my son. Their interactions with him took place during the worst time of his life. They knew nothing about Dan’s passions, hopes, or dreams. They did a great job treating his OCD and I credit the ERP therapy for literally saving his life. But they did not treat Dan, the whole person. They failed to look at the big picture.

In my heart, I knew the right thing was for Dan to leave the program and go back to school. It was time for him to get back to his life, which included so much more than OCD. But when you have a psychiatrist, therapist and social worker telling you otherwise, it can be intimidating. Thankfully, the same friend who helped Dan get through those last weeks of his freshman year came to our rescue again. If he hadn’t said, “get him out of there,” my husband and I may very well have let him stay.

Dan returned to school and a tumultuous year followed. I second-guessed our decision many times. But if I ever doubt that we did the right thing, I just look at Dan now. His OCD is practically nonexistent and his passion for life has returned. And he is a senior in college, following his dreams.

Fast-forward a few months and Dan has returned to college. Though he understands his OCD now, and has improved greatly thanks to Exposure Response Prevention Therapy, he is still battling the disorder. He is also taking three different medications. His program of study is intense, and his anxiety levels are high. He is having a hard time keeping track of his cell phone and glasses, and is quite disorganized. His room is a mess. He tells his therapist that he often has trouble focusing in class.

Given this information, Dan’s therapist and psychiatrist now think he may have attention deficit hyperactivity disorder (ADHD) in addition to OCD. I don’t know a lot about ADHD, but I do know that it doesn’t just appear. Throughout his schooling, before OCD made its appearance, Dan had been a teacher’s dream: obedient, attentive and engaged. He excelled academically and never once were there any issues of concern. In fact, we often marveled at how he could read, or stay focused on anything, for hours at a time. It seemed obvious to me that Dan’s disorganization and inability to focus were a byproduct of having to deal with OCD.

It is known that OCD sufferers are at risk of having one or more co-morbid conditions (meaning two or more disorders that co-exist together). According to one study, some of the more common co-existing conditions with OCD include major depression, social phobias, additional anxiety disorders, and Tourette syndrome.

There are also those who believe that OCD and ADHD often occur together. This site on ADHD states, “It is not uncommon for someone to have both ADHD and OCD.” I find this statement baffling, as the basic symptoms of ADHD (listed below), in my opinion, seem to be in direct contrast to those of OCD:

• Inattention: Having a short attention span and easily distracted. (Most people with OCD would love to be able to not pay attention to their thoughts.)
• Impulsivity: Causes a person to do dangerous or unwise things without thinking about the consequences. (Those with OCD do the exact opposite. They play it safe and obsess about the consequences.)
• Hyperactivity: Inappropriate or excessive activity. (Those with OCD often go out of their way to do what they feel is appropriate. Also, in Dan’s case, he often had very low energy as he was “wiped out” from struggling with his OCD.)

The fact that the symptoms of OCD and ADHD appear to be opposite should not really come as a surprise. Research has shown that both OCD and ADHD involve problems with the prefrontal cortex region of the brain. However, while OCD is associated with overactivity in this region, those with ADHD present with reduced activity in this area of the brain. So how can these disorders coexist?

In Dan’s case, there was no question in my mind that he did not have ADHD. But the psychiatrist and Dan wanted to try a stimulant, and because Dan was over 18, the decision was his.

Though Vyvanse definitely gave Dan more energy, he showed no improvement at all in his “ADHD-like” symptoms. As his new psychiatrist would later tell us, this should have been an immediate red flag. If Dan had indeed had ADHD, the medication should have helped.

My son should never have been prescribed this drug, and taking it was disastrous. We certainly didn’t know this at the time, but there is evidence to suggest that stimulants such as Vyvanse can not only exacerbate symptoms of OCD, they can precipitate the disorder as well.

Fast-forward again two and a half years and Dan is now a senior in college. He has been medication-free for over two years and his OCD, in his own words, is practically non-existent. His program of study is still intense but he is doing well academically. He is still somewhat disorganized and on occasion has been known to lose things.

So can someone truly suffer from OCD and ADHD at the same time? I’m not an expert, and I can only speak from my own experience. I will say that I know that things are not always what they seem, and if you or someone you care about have been diagnosed with both of these disorders, I recommend that you do your homework. Read, research, ask questions, and make sure the diagnosis makes sense to you. While the experts may know OCD and ADHD, you know yourself or your loved one better than anyone. Your thoughts, feelings, and insights should be considered. In the end, it really doesn’t matter so much what labels are assigned to all of our symptoms, as long as the treatment program in place is working.

For instance, most students lose focus easily. Some students with ADHD also have weaker working memories, according to Laurie Dietzel, Ph.D, a psychologist specializing in ADHD and developmental disabilities and co-author of Late, Lost, and Unprepared: A Parents’ Guide to Helping Children with Executive Functioning. She likens working memory to a brain scratch pad or storage area, which helps you briefly retain information in order to complete tasks.

Some students have difficulty completing boring or demanding tasks. They’re able to hyperfocus on tasks they find interesting, such as an avid reader whose attention never wanders with a book. But distractions are aplenty with tedious tasks. Procrastination also is pervasive among people with ADHD, and, not surprisingly, can sabotage school success.

The key to succeeding in school, whether it’s high school or college, is to determine your unique challenges and find specific solutions. “Everyone with ADHD is different, and finds different things that work for them,” Dietzel said. The best way to figure out what works is to experiment, she said. Here’s a list of strategies to get you started.

1. Have a planner. It doesn’t matter whether you use a paper planner, your cell phone or a calendar on your computer, every student needs to have a “central system” to record “what they’re supposed to be doing when,” Dietzel said.

2. Schedule everything in. Put everything in your planner, including your classes, library and study sessions and even breaks like exercise, relaxation and time with friends. This way you don’t even need to contemplate your next step (and possibly get distracted or interrupted).

For instance, every Tuesday and Thursday, you already know that you’re studying at the library for two hours. Eventually, your library sessions and other regular activities become as automatic as brushing your teeth. Dietzel also compared this to athletes on the field: When your teammate throws you the ball, you don’t need to think about catching it. You do it reflexively.

Dietzel also advises students to schedule in a lot of extra time, because tasks tend to take longer. Look at your track record, she said, and be honest with yourself about the time you spend writing a paper or studying for an exam.

3. Study in increments. Cramming the night before a test isn’t just stressful; it’s ineffective. “Our brains aren’t meant to absorb and retain information [that we] reviewed at the last minute,” Dietzel said. That’s because repetition is key to learning, and “last-minute stress can lead to anxiety that blocks our ability to readily understand and recall information.” Instead, Dietzel suggests starting a week ahead and studying in 15- to 20-minute increments.

4. Use whatever study tools work best. Consider what kinds of tools help you study effectively. Maybe you learn best by using flash cards, copying notes or talking with others about the material. Or maybe pacing helps you retain facts. In fact, some younger kids with ADHD prefer to move around while they’re doing their homework because it helps them focus. According to Dietzel, “Movement can stimulate some of the frontal lobe regions and attention control.”

Some students need to use a variety of techniques. They learn best with a multisensory approach, meaning they use techniques that involve more than one sense, Dietzel said.

5. Create a contingency plan. Setting up a system where you earn rewards for completing tasks may motivate some students. Here’s an example of how it might work: If you email your essay to the professor by next Wednesday, your reward is to attend a football game or do another activity you love. If you don’t, you stay home and work on your paper.

6. Have realistic expectations. Dietzel knows many bright and well-meaning students who load up their semester with challenging classes. Even though these students work incredibly hard and are highly motivated, they still struggle with paying attention and studying effectively.

Take the example of a high school student with ADHD, Dietzel said. A slow reader, she needs to re-read regularly, which doubles or triples her homework time. If she picks mostly heavy-reading courses, she’ll be stressed and won’t do as well. Instead of creating a needlessly tough situation, she can save one course for the summer.

Sometimes it can be hard to identify sensible expectations. Adolescents and young adults also might not admit they’re having trouble, Dietzel said. A consultation with a professional who specializes in ADHD can help. Dietzel regularly meets with parents and teens to help them create reasonable schedules and find solutions to common scholastic challenges.

In the first week or two of school, you quickly made a group out of the first few people you met. You all hung out between classes, went to dinner together, watched some movies in the dorm, checked out the welcoming dance in the Student Union, and drank too many beers on Saturday night. You compared notes about professors and classes; complained to each other about the food, the price of textbooks, and the dorm rules; helped each other find the obscure room in the engineering department where your English class got placed, went together to the school gym for the first time, and loaned each other quarters to do laundry.

For about a month, it seemed like you had a lot in common. For maybe even a semester, you thought these folks would be your friends for life. And then? . . . Then things began to fall apart. Although absolutely fine on the surface, the relationships didn’t have any depth. It turned out that once the newness settled, you didn’t really have much in common. What happened?

What happened is something that is absolutely normal. When people are in new surroundings and feeling a bit insecure, they turn to one another for support and reassurance. At that moment in time, we’re not looking for shared values or goals or good conversation. What we’re looking for is a fellow traveler. As long as the person isn’t aggressive, shares a taste in music or beer, and doesn’t scare the neighbors, it’s enough. Basic neediness only requires that people meet basic needs. When we’re together, we’re not alone.

But as soon as people start to feel comfortable, we also start to be comfortable enough to look around. Other people may seem more interesting than those in the original group. We find out that maybe our early buddies don’t want to spend as much time studying or don’t really share an interest in football. Often we feel both excited to meet people who share more of our personal interests but guilty that we kind of want out of the first friend group.

It’s not your fault. It’s not the fault of that first group of friends. It’s a natural evolution from falling into relationships based on neediness to choosing relationships based on shared ideals and interests. If you’re really lucky, some or even all of the first friends are able and eager to go to the next level as well. But most of the time, there are at least some people who can’t or won’t get beyond superficial palling around. It’s not that those original friends are bad or that you made bad choices. It’s that you – and they – have reached a new stage in your social development.

Getting To the Next Level: How To Find Lifelong Friends

The truth is you can just get along with almost anyone if you want to. Shallow relationships are good enough if you just want to party. Talking about nothing can be fine if all you want is to talk. At some point, though, shallow will feel exactly that – shallow. You will want to find people who “get” you; who will be there for you when you are feeling less than wonderful, and who will celebrate with you when good things happen in your life. True friends rarely just fall in your lap. Finding them takes some effort. If you find your first friend group unsatisfying, here are some things to consider:

1. By all means, be kind to those who have seen you through the first stage.

There’s no point in burning bridges with people you will undoubtedly see now and then. You don’t need to have a big fight or mega-drama to free yourself up to start developing other friendships. Just withdraw from the intense togetherness and start making room for other relationships. If someone confronts you about not spending enough time with them, it’s enough to tell them that you are getting involved in other activities. Invite them to come along if they want. Chances are they won’t. If they do, and genuinely get excited about what you’ve introduced them to, maybe there is more promise in the relationship than you thought.

2. Resist the temptation to hang out with people from your high school who are now attending the same college unless you really, really like them.

Yes, they are familiar. Yes, there is some comfort in sharing the same memories. But if you stay only in that circle, you close out the potential for new and enriching friendships.

3. Reach beyond the people who live next door or across the hall.

Now that you know how to get around campus, you probably know where people who share your interests hang out. Go there even if it’s raining, even if it’s a mile away, even if you don’t really feel like leaving your room.

4. Strike up some conversations with colleagues before and after class.

It’s often easiest to talk to people who are in the same major and who share the same passion for 13th century pottery shards or 20th century politics – whatever it is that you are studying because you love it. Ask them to go for coffee after class.

5. Join a club or organization or project that reflects your values – even if you’re not naturally a joiner.

People who like the same types of activities probably have other things in common with you as well.

6. Be willing to take the risk and initiate. Invite people to go with you to campus lectures, concerts, or games you want to attend. Those who accept your invitation are people who either like what you like or like you enough to want to spend time with you.

7. It’s a two-way street. Accept invitations and show up at events that stir you.

You’ll soon find that you are regularly bumping into the same people. This is the pool of folks you want to get to know.

8. People who go through something meaningful together often bond meaningfully.

If your school offers it, go on an alternative spring break that does service somewhere; take part in an outdoor adventure week; or challenge yourself in a ropes course.

Too scared to do any of this? Then it’s time to get some counseling to shore up your social skills. College can be a wonderful social as well as academic experience if you have the strength and skills to get into the social scene. But it can also be a very alienating experience for those too shy or anxious to take advantage of community opportunities. College is a perfect time to tackle your personal fears and to get practice in interacting more successfully with others. A college counselor will coach you in some practical skills and will give you the support you need to practice them.

Some people do fall right into a fantastic group of friends in the first few weeks of freshman year that sticks together right to graduation. But first friends aren’t necessarily the right friends. Lots of people go their separate ways, with or without some drama, after the first month, the first semester or the first year. The friends you will value and count on for a long time into the future are those you’ve chosen or re-chosen more thoughtfully and who connect with you in ways that really matter.

Jared, 14, was a bright and likeable 9th grader. Difficulties at school and at home were heightened this year. Fights at home centered around how often Jared was online and playing video games instead of doing homework.

Though Jared’s parents knew he had executive function deficits, they believed that Jared lacked ambition, was lazy, and maybe defiant. They were convinced that he didn’t care enough about his future. They commented that Jared seemed selectively disabled when it came to hard work (diagnostic of these children’s paradoxical ability to hyperfocus and be drawn in by activities which naturally attract their interest.)

Jared’s mom felt helpless and anxious on Jared’s behalf as she envisioned him failing. At times she feared for him, reacting out of anxiety and frustration. “If you continue on this path, you won’t get into college or amount to anything.” You are wasting your potential.” Jared’s parents monitored him frequently, walking past his room at regular intervals to ensure he was doing his homework. They used punishments including taking away his phone and privileges. Nothing worked.

Though Jared appeared unfazed and uninterested in how he was doing at school, privately he felt stupid, frustrated and mad at himself. He had trouble keeping track of homework, felt overwhelmed by research papers, and often lost points for careless mistakes. Fights at home stressed him, causing further distraction.

Jared confided that when he felt forced to comply as a result of his parents’ threats and attempts to scare him, he lost whatever motivation he had, as it no longer felt like his own. Jared comforted himself by doing things that distracted him and gave him a sense of mastery, such as “gaming” or socializing on Facebook.

The Importance of Executive Functioning

Jared’s story is typical in many ways. His difficulties include deficits in planning, staying on task, and inhibiting impulses and distractions – all issues of capacity having little to do with laziness, lack of values, or defiance. Further, the amount of effort children with executive function deficits have to expend to perform at a level that, in the end, is still below their true intelligence, is often demoralizing. The high cost/benefit ratio, and unconscious need to avoid repeated experiences of failure, leads to procrastination and falling short of their “best.”

Disciplinary approaches using fear, reasoning, lecture, or punishment are not only ineffective but backfire, creating additional stress in children already paralyzed by inability to meet expectations, and rupturing their experience of parents as allies. These approaches (reactions) cause children to feel they aren’t good enough, and they alternate between feeling bad about themselves and angry. Without accurately understanding children’s behavior, we may intervene in ways that compound the situation, creating a control struggle on top of the original problem.

To be effective in helping children, we must accurately diagnose the problem and be curious: What’s causing this behavior? Though they may look the same, a problem of defiance is handled differently than one of capacity.

Learning difficulties involving executive functioning are neurologically based, but executive functioning is sensitive to and impeded by stress. Parents’ reactions can, in this way, become an additional impediment to children’s executive functioning.

For all of us, executive functioning goes “offline” when we are triggered into dysregulated emotional states and overreaction. We know we have fallen into these states when we find ourselves overtaken by intense feelings and pressure to react. In such situations, our capacity to respond flexibly, think clearly, and react based on our true values and judgment is compromised. Without the mental space to reflect, instead of responding to children’s needs, we are driven to react automatically and impulsively.

Executive functioning, a conscious process of regulating thought, feeling, behavior, involves a capacity to step back, reflect and take perspective. By practicing such mindfulness with ourselves, we can become conscious of when we get triggered and more aware of our emotional states. When we are more regulated, our children internalize a sense of equilibrium, ultimately learning by example, and through words, to manage their own feelings, including frustration, anger, and discouragement, without becoming as overwhelmed.

Barbara Boroson holds an undergraduate degree in creative writing from Cornell and a masters degree in social work from Columbia University.  She has worked in autism spectrum education for 20 years in clinical, administrative and advisory capacities. She currently works as a consultant and supports teachers and school districts as they integrate their students on the spectrum into mainstream environments.  Her stated goal is in the development of inclusive classrooms where all students can learn and grow. 

Her writing is clear and accessible. It gives her readers an understanding of the complexity of ASD by using concrete examples and provides the instructor with the tools and techniques that help steer students towards success.  Autism Spectrum Disorders in the Mainstream Classroom: How to Reach and Teach Students with ASDs is highly recommended for all instructors and families wishing to teach and better understand individuals with ASDs.

The autistic spectrum, also called autism spectrum disorders is characterized by widespread abnormalities of social interactions and communication, as well as restricted interests and repetitive behavior.  The five forms of ASD are classic autism, Aspergerʼs syndrome, Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), Rett syndrome and Childhood Disintegrative Disorder.  The number of reported cases of autism increased dramatically in the 1990s and early 2000s.  This increase is largely the result of changes in diagnostic practices, availability of services and public awareness, although current research shows that unidentified environmental risk factors cannot be ruled out. 

Classic autism is a disorder of neural development and affects information processing in the brain by altering how neurons and their synapses connect and organize in ways not yet well understood.  While autism has a strong genetic basis, the genetics are complex and it remains unclear whether any of the disorders in the spectrum are explained more by rare mutations or rare combinations of genetic variants. 

Controversies surround other proposed environmental causes of ASD, such as pesticides, heavy metals or childhood vaccines, but no convincing scientific evidence has been presented for any of these proposed causes.  Borosonʼs work is valuable in that it offers tested preventive strategies that cooperatively build a classroom setting that includes students with ASDs.

Boroson begins by defining and explaining many of the terms and acronyms encountered while helping students across the autism spectrum.  She gives us the ill-defined and yet textbook characterization of ASDs stated by the U.S. Department of Health and Human Servicesʼ Center for Disease Control and Prevention Autism Information Center (2009):

[Autism spectrum disorders] include autistic disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS, including atypical autism), and Aspergerʼs Syndrome. These conditions all have some of the same symptoms, but they differ in terms of when the symptoms start, how severe they are, and the exact nature of the symptoms. The three conditions, along with Rett Syndrome and childhood disintegrative disorder, make up the broad diagnosis category of pervasive developmental disorders.

She points out this definition is remarkably consistent with the similarly befuddling explanation found in the current version of the APAʼs (American Psychiatric Associationʼs) Diagnostic and Statistical Manual (DSM) IV (1994).  Boroson clears away this confusion by writing, “In my work, I have encountered many children on the autism spectrum whose precise address along the spectrum is unclear or inconsistent.  And what Iʼve discovered is that the name of their diagnostic subtype does not dictate the details of their functioning, education or identity.”

Borosonʼs understanding, that sees each student as a unique human with his or her own strengths and weaknesses, patterns of action and reaction, potential and dreams, provides her book with multiple, detailed and realistic strategies that gives a deeper understanding of ASDs and thereby makes it a valuable reference.

Boroson holds off discussing the presentation of curriculum to children with ASDs until the last chapter and presents to us first several preventive and responsive strategies.  As she says, “Preventive strategies will be the most important tools in your box, both philosophically and practically.  They will guide you toward thinking in a proactive, positive way.  They will help you keep the heat down and keep problematic situations from occurring and recurring.  Thatʼs important because once a cycle of reaction has begun, it can be especially difficult or truly impossible to recover the day for your students on the spectrum.” 

Her strategies enable the instructor to look past the behavior of students with ASD to see what triggers their anxiety or anchors their comfort and to incorporate these unique specifics into the classroom.  For example, by using information gained from families, counselors and previous teachers instructors may prepare a toolbox that contains individualized affirmations, calming cues, and comfort objects that offer support and aid for the self-regulation of students on the spectrum. She looks at the many contextual challenges a student with ASD faces that involve anxiety, sensation, socialization, engagement, regulation, organization and communication and offers several strategies that can be tailored for these individuals.

Barbara Borosonʼs Autism Spectrum Disorders in the Mainstream Classroom: How to Reach and Teach Students with ASDs engages the reader with a well-thought-out discussion of how unique individuals on the autistic spectrum differ in their abilities and how these differences may be incorporated in reaching them and teaching them.  Her work is lucid and illuminates parts of my own life with students and friends with ASDs.  I highly recommend that her book be read cover to cover and kept as a reference on the bookshelf of anyone wishing to bring about Borosonʼs stated goal of developing inclusive classrooms where all students can learn and grow.

Autism Spectrum Disorders in the Mainstream Classroom: How to Reach and Teach
Students with ASDs
By Barbara Boroson
Scholastic Teaching Resources: June 1, 2011
Paperback, 224 pages
$24.99

“So what’s your name new kid in school
tell me something do you feel lonely “
– Song lyrics by The Donnas

Here comes September. You’ve been bracing yourself all summer. Here it is, the middle of your middle school or high school career and your folks have moved you halfway across the country – away from friends, away from your routines and teams and activities, away from all that’s familiar. Admit it. It’s kind of scary. Even if you’re cool, it’s still nervous-making. What’s the new school going to be like? Will the kids like you? Will you fit in? Will you like the teachers? Will they like you? OMG! There’s too much to think about! I can’t blame you a bit if you want to roll over and sleep.

Yeah. But avoiding it won’t help you deal with the inevitable first day. Even if you avoid the first day, there will be your first day. Going late will only make you more visible and obviously new. Might as well take a deep breath and figure out how to deal. Here are some tips that just might help you ease into your new school.

• Remember that the new place will give you a new chance. For at least the first day, you’re exotic. Especially in a school where there isn’t much coming and going, you’re someone special. Yes, it’s true you left what is familiar. But the new place is also a new opportunity. Nobody knows who you are, who you hung out with, or what to expect from you. If you didn’t quite like who you are or the reputation you had, you have a chance to start over. If you did like it, you can take that confidence with you and make a big splash.

• Get oriented. If at all possible, visit the school before school starts. It’s hard enough to start over without also getting lost all the time. Ask your folks to arrange a tour. Figure out where the principal’s office is and how to get to the library. Ask for a map of the layout of the school. No time for this? Well, asking for directions is one way to begin to get to know people.
• Do a little research. Get on the Internet and find out about the school. There’s probably a website. If there isn’t one for the school, look for the town’s site. You can find out about sports teams and events. You can learn what clubs are active and how the teams are doing. You can even check out what is usually served for lunch.
• Take the time to assess. When you’re lonely, it’s tempting to grab onto whoever grabs you. But you want to take the time to look things over and figure out who’s who. As you know, as soon as you start hanging with a particular group, it will be hard to change your mind.
• Dress for the group you want to join. For most teens, clothes are code for who you are. Wear a clean, neat, but kind of neutral outfit the first day. Get up in time to shower and do your hair. Jeans are generally fine as long as they’re clean and not flashy. Presenting yourself neutrally the first few days gives you time to figure out the informal rules for dress among the students. Once you’ve got it down, you can dress to fit in with the group you want to accept you.
• Avoid cafeteria stress the first day. Pack a lunch so you don’t have to stand in line wondering whether to accept someone’s invitation to join their table or, worse, to have to walk the long mile in front of everyone to an empty table. Confidently sit on the edge and watch for a few days. Sit in a way that broadcasts confidence. You’re not a reject. You’re taking the time to think about who you’ll choose to be with.
• Introduce yourself to teachers. First impressions do matter and you want to make a good one. Try to get to classes a bit early or to stay a few minutes after class to introduce yourself and to tell them where you’re from. A few minutes of politeness will get things off on the right foot.
• Join something. A fast way to get to know some people is to join a team, a club, the band, a service organization, or student activities. People who share the same interests are likely your kind of people. Even if you don’t make real friends at first, you’ll learn some people’s names and you’ll have a few people to say hi to in the halls.
• Take charge. Once you’ve got an idea who you want to meet, it’s up to you. Take a deep breath, pull up your big boy or big girl pants and start introducing yourself. Set a goal of meeting at least one new person a day. Say hello to the person who sits next to you in English class. Strike up a conversation with the person who has the locker next to yours. Remember – people like to talk about themselves. Think of a couple of questions you can ask each person and the conversation will take off almost by itself.
• Keep but don’t retreat to old friends. Skype and Facebook and Twitter and texting and email and even the phone can let you stay in touch with old friends. That’s all good. But it can also be quicksand. If you let yourself spend hours and hours communicating with old friends, you’ll make it less likely that you’ll find new ones. By staying so connected to people who live hours away, you might keep yourself lonely in your own backyard.

As tempting as it is to hang on tight to what is familiar, give yourself – and your new community – a fair chance. Spend afterschool time involved with the new. Allow an hour at night for reunions as a reward for getting your assignments done. As hard as it is, this also applies to boyfriends or girlfriends left behind. Give each other permission to see other people and to be fully involved in your own schools. If your romance was meant to be, you’ll reconnect in the future.

Feeling uprooted during the teen years can feel unfair and really, really hard. But It’s also a chance to reinvent yourself, to expand your network of friends and to enjoy new experiences. With some thought and effort, you can make it work for you.

“it ain’t that bad you know it really ain’t that bad
you can’t avoid it you might as well enjoy it ’cause i do
well you’re the new kid in school.”
–The Donnas

The purpose of Dr. Barnhill’s book is to educate the reader as to other diagnoses, which he calls “zebras,” that have very similar symptoms to ADHD. The author goes on to explain some of the short- and long-term side effects of being misdiagnosed. As a teacher and a person who was diagnosed with ADHD as a child, I really found this book to be helpful, well written and easy to understand. Dr. Barnhill not only gets his point across, but also directs readers to other venues to help them understand what some of these “zebras” are and how they can be treated.

Has ADHD become a fad diagnosis thanks to the media and pharmaceutical industry hype?

I think so. When a parent can’t control a child, or when a teacher sees disruptive behavior in the classroom, the easy answer is, “This kid has ADHD. Put him on medications, and our problems will be solved.” The book does a really good job at explaining how and why so many children are misdiagnosed with ADHD. So many children are put on medications that could have side effects leading to health problems, poor performance in school and behavioral issues. (e.g., when I took Ritalin as a child I became very withdrawn from others.) Treating a child with ADHD medication may work wonders if that child actually has the disorder. The problem is that many doctors, not sufficiently trained in diagnosing ADHD, will make the assessment and prescribe medication in one visit, sometimes without even seeing the child. Sometimes children don’t even get an evaluation; according to the author, many parents take their children to a doctor and the doctor will ask some questions and prescribe medicines.

Dr. Barnhill also mentions in his book that when children are diagnosed as ADHD they are often “labeled” as ADHD and tend to suffer self-esteem issues. Many of these children develop poor social skills that could affect them all the way into adulthood. Sometimes these children seek outlets such as substance abuse and eventually commit criminal behaviors. Some of the other effects of misdiagnosis are financial burdens on the parents such as  paying for unnecessary doctor visits and medications.

Dr. Barnhill mentions the cost educators must pay to revamp school programs and curriculums to deal with ADHD. So not only does misdiagnosis affect children and their families, it can also create schools spending large amounts of money they could use to fill teacher shortages.

According to the author, there are over 40 “zebras” or other diagnoses out there that children could be suffering from. Some of these diagnoses range from poor nutrition to mental illnesses. He states in this book that with the proper diagnosis we can put the children on the right medications (if needed), have the right assistance in schools (misdiagnoses can lead to incorrect learning plans) and avoid the stereotypes of having ADHD.

Even though there are some similarities with some of these other diagnoses, Dr. Barnhill says that it only takes some minor factors to distinguish ADHD from other diagnoses, such as a child suffering from a head trauma from an early accident. Dr. Barnhill shares countless cases of children whose parents came to him for help. Most of these cases, according to the author, the previous doctors did not take the time to perform proper test and exams. Without these procedures, most children will be misdiagnosed and not able to receive the proper treatment and care they need.

Overall, I feel that this book is thorough, easy to understand, well organized, enlightening, and hard to put down. I recommend that every parent, teacher, clinician, and counselor who works with children read this book. It is of vital importance. It can make the difference between a child’s happiness and misery, between his future success and failure.

Growing up diagnosed with ADHD and having to take medications, I found that if my parents had known some of the information in this book I could have avoided the doctor visits, wrong medicines and being “labeled” in the classroom. This is a must read for parents and any professionals out there who work with children on a daily basis.

Mistaken for ADHD: How You Can Prevent Mislabeling Your Child As a Failure in Life in the Face of a Looming ADHD Misdiagnosis
By Frank Barnhill, MD
iUniverse.com: March 22, 2010
Paperback, 380 pages
$24.95