Both parents need to nurture children. Healthy parenting helps the grown child be his or her own best mother and father. A child must not only feel loved, but also that he or she is understood and valued by both parents as a separate, unique individual and that both parents want a relationship with him or her. Although we have many needs, I’m focusing on nurturing emotional needs.

Emotional Needs

In addition to physical nourishment, including gentle touch, care, and food, emotional nurturing consists of meeting a child’s emotional needs. These include:

• Love
• Play
• Respect
• Encouragement
• Understanding
• Acceptance
• Empathy
• Comfort
• Reliability
• Guidance
• The importance of empathy

A child’s thoughts and feelings need to be taken seriously and listened to with respect and understanding. One way of communicating this is by mirroring or reflecting back what he or she is saying. “You’re angry that it’s time to stop playing now.” Instead of judgment (“you shouldn’t be jealous of Cindy’s new friend”), a child needs acceptance and empathic understanding, such as: “I know you’re hurt and feel left out by Cindy and her friend.”

Empathy is deeper than intellectual understanding. It’s identification at an emotional level with what the child feels and needs. Of course, it’s equally important that a parent appropriately meets those needs, including giving comfort in moments of distress.

Accurate empathy is important for children to feel understood and accepted. Otherwise, they may feel alone, abandoned, and not loved for who they are, but only for what their parents want to see. Many parents unwittingly harm their children by denying, ignoring, or shaming their child’s needs, actions, and expressions of thoughts or feelings. Simply saying, “How could you do that?” may be felt as shaming or humiliating. Responding to a child’s tears with laughter, or “That’s nothing to cry about,” or “You shouldn’t be (or ‘Don’t be’) sad,” are forms of denying and shaming a child’s natural feelings.

Even parents who have sympathetic intentions may be preoccupied or misunderstand and misattuned to their child. With enough repetitions, a child learns to deny and dishonor natural feelings and needs and to believe that he or she is unloved or inadequate.

Good parents are also reliable and protective. They keep promises and commitments, provide nourishing food and medical and dental care. They protect their child from anyone who threatens or harms him or her.

Tips for Self-Love & Self-Nurturing

Once grown, you still have these emotional needs. Self-love means meeting them. If fact, it’s each person’s responsibility to be his or her own parent and meet these emotional needs, irrespective of whether you’re in a relationship. Of course, there are times you need support, touch, understanding, and encouragement from others. However, the more you practice self-nurturing, the better your relationships will be.

All of the things a good mother does, you have the superior capacity to do, for who knows your deepest feelings and needs better than you?

Here are some steps you can take:

• When you have uncomfortable feelings, put your hand on your chest, and say aloud, “You’re (or I’m) ____.” (e.g., angry, sad, afraid, lonely). This accepts and honors your feelings.
• If you have difficulty identifying your feelings, pay attention to your inner dialogue. Notice your thoughts. Do they express worry, judgment, despair, resentment, envy, hurt, or wishing? Notice your moods. Are you irritable, anxious, or blue? Try to name your specific feelings. (“Upset” isn’t a specific feeling.) Do this several times a day to increase your feeling recognition. You can find lists of hundreds of feelings online.
• Think or write about the cause or trigger for your feeling and what you need that will make you feel better. Meeting needs is good parenting.
• If you’re angry or anxious, practice yoga or martial arts, meditation, or simple breathing exercises. Slowing your breath slows your brain and calms your nervous system. Exhale 10 times making a hissing (“sss”) sound with your tongue behind your teeth. Doing something active is also ideal for releasing anger.
• Practice giving yourself comfort: Write a supportive letter to yourself, expressing what an ideal parent would say. Have a warm drink. Studies show this actually elevates your mood. Swaddle your body in a blanket or sheet like a baby. This is soothing and comforting to your body.
• Do something pleasurable, e.g., read or watch comedy, look at beauty, walk in nature, sing or dance, create something, or stroke your skin. Pleasure releases chemicals in the brain that counterbalance pain, stress, and negative emotions. Discover what pleasures you. (To read more about the neuroscience of pleasure, read my article, “The Healing Power of Pleasure”.)
• Adults also need to play. This means doing something purposeless that fully engages you and is enjoyable for its own sake. The more active the better, i.e., play with your dog vs. walking him, sing or collect seashells vs. watching television. Play brings you into the pleasure of the moment. Doing something creative is a great way to play, but be cautious not to judge yourself. Remember the goal is enjoyment – not the finished product.
• Practice complimenting and encouraging yourself – especially when you don’t think you’re doing enough. Notice this self-judgment for what it is, and be a positive coach. Remind yourself of what you have done and allow yourself time to rest and rejuvenate.
• Forgive yourself. Good parents don’t punish children for mistakes or constantly remind them, and they don’t punish willful wrongs repeatedly. Instead, learn from mistakes and make amends when necessary.
• Keep commitments to yourself as you would anyone else. When you don’t, you’re in effect abandoning yourself. How would you feel if your parent repeatedly broke promises to you? Love yourself by demonstrating that you’re important enough to keep commitments to yourself.

A Word of Caution

Beware of self-judgment. Remember that feelings aren’t rational. Whatever you feel is okay and it’s okay if you don’t know why you feel the way you do. What is important is acceptance of your feelings and the positive actions you take to nurture yourself. Many people think, “I shouldn’t be angry (sad, afraid, depressed, etc.). This may reflect judgment they received as a child. Often it’s this unconscious self-judgment that is the cause of irritability and depression. Learn how to combat self-criticism in my ebook, “10 Steps to Self-Esteem,” available in online bookstores.

It follows a mom through her day with a little boy who appears to have some kind of developmental delay. The voice-over tells us he was in the neonatal intensive care unit for over 100 days. Now he looks somewhere between 3 and 4 years old. She makes him a peanut butter sandwich and laughs when he spills the milk. She plays with him and keeps a watchful eye while she goes about daily chores. She washes his hair as he kicks and squirms. She struggles to brush his teeth. Then there’s story time and a kiss good night. All the while, she is the epitome of patience and all smiles.

Then the ad gets real. Having tucked her little boy in, having said she wouldn’t trade him for any other kid, she has a moment alone on the front porch. In that moment we see “the look.”

Anyone who has been there knows what it means. To see it cross another’s face is to feel it in the gut. It’s the shadow that passes through in a moment of exhaustion. It’s the small piece inside that does wish, if only for a moment, that she did have another kid; one who didn’t need her every single minute of every single day.

Then she does what loving parents do: She takes a breath, remembers the blessings of being a mom to this special child, and goes in to get ready for another day and another round of constant care.

Moms, and dads with kids who are disabled or chronically ill know that look and the feelings that create it. They also know the moment that comes next: the moment of renewed commitment that is born of love and hope and determination. Raising a disabled or chronically ill child is not for sissies. If parents weren’t strong before this special child became theirs, they’ve developed strength they never knew they had in them.

Mother’s Day is almost here. Let’s all take a moment to appreciate the mothers who do everything every other mom does plus a whole lot more.

They are the moms for whom the first months of sleeplessness extend into years. They are the moms who become experts on their child’s diagnosis and therapies and education plans. They have learned to manage endless appointments with medical specialists and endless meetings with educational experts. They have learned an awesome vocabulary of medical terminology, education jargon and insurance codes.

Complicated schedules and routines and star charts have become second nature. Those who have kids with special diets know how to spot dangerous ingredients in a cupcake from a hundred yards away. Those with behaviorally challenging kids can handle a tantrum while folding laundry and planning dinner. Many even find the energy to organize support groups, get involved with agencies that offer activities for their kids, and advocate for other families as well as their own.

Contrary to conventional wisdom, most of their marriages are strong. Sure, the demands on these couples are many and constant. But most do better than just cope. They succeed as partners and as parents and develop positive feelings and values about raising a child who is challenged and challenging. The birth or adoption of a child with special needs has taken their lives in unexpected directions that aren’t always pleasant but are nonetheless meaningful and important. When asked, most will say that parenting their child has made them better people.

That strength and love and commitment extends to their nondisabled kids as well. If they thought about it, they could take enormous pride in their success in raising compassionate, competent kids whose experience with their brother or sister with a difference has made them sensitive to the needs of others. Most moms don’t think about it. They are just doing what feels right and good for their families.

For mothers of children with special needs, Mother’s Day rarely means a dinner out or diamonds. A qualified babysitter is hard to find. Money is more likely to go to bills than jewelry. Often the child who made her a mother can’t understand a holiday, can’t carry a tray to give her breakfast in bed and won’t be bringing her a bunch of violets or a card made all by himself. These moms celebrate their day with their different child in a different way.

And celebrate they do. They find joy in the knowledge that they are nurturing a child’s spirit as well as her health. They take satisfaction in knowing that each accomplishment, however small it may look to others, is a major victory. Each of her child’s achievements is at least partly her own. She knows the value of her efforts and the importance of keeping a positive attitude and counting the blessings of every day.

Still, it never hurts to hear all this acknowledged. Loving words of appreciation from a partner, spouse, friend or extended family members do mean a lot. If you know such a mom, reach out this Mother’s Day and let her know that you see her for the amazing person she is. A phone call or visit or card may seem like a small thing but for a mom in the special needs trenches, it can really make her day. The support of others added to her own commitment is what makes it possible for her to take that breath and get ready for another day.

“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.

Somebody, somewhere, declared April to be Autism Awareness Month. I’m all for it. We need to be more aware of it so that children are diagnosed early and accurately to make sure that they get the treatment they need.

What is Autism?

Autism is a neurological disorder that usually becomes apparent by the age of 3 if people know what to look for. Part of the problem in diagnosing autism is the wide range of possible behaviors and abilities. However, there is usually a distinct pattern of significant impairment in three major areas:

• Impairment in reciprocal social interaction. Children who are on the autism spectrum don’t get the give and take of conversation and sharing of experience. Even when very little, neurotypical kids will point to things that interest them so that others will see it too. They will babble back and forth, imitating conversation. Autistic kids seem to be in their own world, uninterested in sharing it with others or unable to understand that other people aren’t as interested as they are in their obsession of the moment. Higher-functioning kids with autism may come off as rude, clueless, or self-centered because of their apparent inability to read what is socially appropriate at any given time.
• Impairment in communication skills. Their language may be unusual, stilted, or limited. High-functioning kids on the spectrum may have large vocabularies but may use words incorrectly or idiosyncratically. Lower-functioning kids may not speak at all.
• Presence of stereotyped behaviors, interests, and activities.Spinning, flapping, and finger-flicking are common in young kids and even in some autistic adults. Many rock to comfort themselves. Children may develop an intense obsessive interest in just about anything. I’ve known kids who are walking encyclopedias about pirates or fishing or who know every detail of every one of the Star Wars movies. They can talk for hours about their “thing” but are unable to have even a brief conversation about almost anything else.Some of the more disabled kids with autism I’ve known have been obsessed with things such as different kinds of tires, ceiling fans or string. They are happiest when they can watch or play with their particular interest. High-functioning autistic adults may become experts in arcane academic or technical areas, again to the exclusion of almost everything else.

  In addition, many of these children show sensory processing disorders. They can be intensely over- or under-sensitive to sensory stimulation (lights, sounds, smells, or touch). Some are unable to stand the buzz of fluorescent lights or the smell of certain foods, the sensation of certain fabrics or changes in temperature, to name only a few examples. Some have a very high tolerance for pain. (A school program called me recently because a teenaged girl seemed to feel no pain when she pulled off fingernails.) Some can’t manage any discomfort at all. I know one preschooler who walks on tip-toe whenever he is barefoot because he can’t tolerate how grit feels on his feet.

Autism is associated with a known medical condition in only 10 to 20 percent of cases. It is thought to be genetic since 60 to 90 percent of identical twins both have it while in fraternal twins it is less than 5 percent. As yet, there is no genetic test or brain scan or medical test to use for diagnosis. We rely on observation and the experience of professionals.

Why Does the Prevalence Rate Keep Growing?

In my professional lifetime, the odds of a child having autism have kept growing. In the 1970s, the statistic worldwide was 4 in 10,000. Between 1985-1995, the number tripled to 12 in 10,000. The rate was estimated to be 1 in 155 by 2002; 1 in 110 in 2006 and 1 in 88 in 2008. Some studies are now suggesting that it afflicts 1 in 50 kids in the U.S.

What happened? Partly it’s about a change in the acceptance of autism as a genuine, distinct disorder. Partly it’s due to a change over time in the description of criteria and the number of criteria that need to be met to make a diagnosis.

When I was in graduate school in the early 1970s, we were using the DSM-II. Autism isn’t mentioned except as a subset of childhood schizophrenia. Frankly, back then, I’d never heard of it. When DSM-III came along in 1980, a section on infantile autism was added and the first effort was made to delineate criteria. It took until the DSM-IIIR in 1987 for autism disorder to appear with a well-articulated set of 16 criteria, 8 of which had to be present to warrant a diagnosis. By the time the DSM-IV (1994) and DSM-IVR (2000) came out, the number of criteria had been reduced to 12, with 6 being needed for a diagnosis. With each succeeding edition, mental health professionals became more aware of autism as a possible diagnosis.

At least some of the increase in prevalence is due to that awareness on the part of professionals. Some of it is probably because kids who at one time might have been diagnosed with psychosis or retardation or hyperactivity are now being assigned the diagnosis of autism. And some of it is due to the fact that parents and teachers have become much more attuned to the possibility that a child is on the autism spectrum, so evaluations are occurring at a much earlier age. Finally, it’s possible that there is something going on in our environment or in genetics that is causing an increase in the disorder. That last one remains a mystery.

What if You Suspect Your Child Has Autism?

With the increase in autism prevalence and awareness has come an increased sophistication in screening. A diagnosis of autism is rarely assigned before 15 to 18 months of age. If by then you suspect that your child isn’t developing as he or she should, you can first go to one of the many websites that have quizzes and checklists for the symptoms of autism for the age of your child. But please don’t go on the results of those websites alone. There are many reasons why a child may not be keeping up with peers. It’s just a good, if crude, first effort.

The next step is to ask your pediatrician to take a look at your web-based checklists and to decide if a referral to an autism screening team is advisable. There are early childhood interventions (EI) teams all over the U.S. who can make a more refined diagnosis and who can offer treatment if it is needed. If there is no EI team nearby, there is probably a diagnostic team in a mental health clinic or children’s hospital near you. An accurate diagnosis is essential. Diagnosis is what determines what types of treat may be the most helpful for your child.

Early Intervention Matters

There is no cure for autism but when children get intense and appropriate treatment early on, preferably before age 3, many can and do learn compensatory skills. Excellent programs provide physical, occupational and speech therapy as well as coaching in social and language skills for the child. They also provide coaching and support for parents so they can reinforce and continue the treatment at home. If there is no comprehensive program nearby, there is often a resource center connected with a school or with a medical center that can help families get the services the child 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

I’m just getting to know Michelle. She had her first baby 3 weeks ago and has been sad and irritable ever since. Her pediatrician was worried about her at the well-baby visit this week and sent her to me. She’d had a tough pregnancy (morning sickness that wouldn’t quit for what felt to her like forever), made tougher by the financial stress that came from her husband being out of work for several months. The doctor is worried that she and her baby aren’t getting off to a good start.

Sadly, moms like Michelle often feel alone and guilty. Not feeling what they think they are supposed to feel, they are embarrassed to admit to themselves and others that things aren’t going well. Just when they need help the most, many don’t reach out. Some start to resent their babies and begrudge them time and attention. They force themselves to do what needs to be done but don’t provide their newborns with the nurturing they need.

Still others give up on nursing, or holding their babies when bottle feeding, depriving themselves and their babies with the closeness that comes with the quiet feeding times. Propping a bottle is the best they can do. Overtired, irritable, and sinking into depression, life after birth isn’t at all what they expected.

As hormones shift and settle, it’s absolutely normal to feel what is commonly known as the baby blues in the weeks following birth. One of my clients described the first couple of weeks after her first child was born as PMS times ten. Others feel more emotionally fragile than usual and maybe a little weepy. Still others are surprised that they are on an emotional roller coaster, feeling great one minute and set off into tears by something that normally wouldn’t bother them the next. It’s all because the endorphins from delivery are leaving the new mother’s system and the body is resetting itself.

Different women react differently but normal baby blues are usually accompanied by moments of joy and wonder and happiness about the baby and motherhood. The emotions settle down after a couple of weeks and the routines and rhythms of new parenting get established.

But when those up and downs last more than a few weeks, and especially if they get worse, it may indicate that the new mom is developing postpartum depression (PPD). This happens to between 11 and 18 percent of new mothers, according to a 2010 survey by the Centers for Disease Control (CDC). Surprisingly, it can last anywhere from a couple of months to a couple of years.

Symptoms of Postpartum Depression

Postpartum depression looks like any major depression. Things that once gave the mother pleasure are no longer fun or interesting. She has trouble concentrating and making decisions. There are disturbances in sleep, appetite, and sexual interest. In some cases, there are thoughts of suicide. Many report feeling disconnected from their baby and some worry that they will hurt their baby. Feelings of hopelessness, helplessness and worthlessness immobilize them. Many feel guilty that they can’t love their child, which makes them feel even more inadequate.

In some cases, women develop psychotic delusions, thinking their baby is possessed or has special and frightening powers. Sadly, in some cases, the psychosis includes command hallucinations to kill the child.

Who Develops Postpartum Depression?

There are a number of issues that contribute to a woman’s risk of developing PPD:

• A prior diagnosis of major depression. Up to 30 percent of women who have had an episode of major depression also develop PPD.
• Having a relative who has ever had major depression or PDD seems to be a contributing factor.
• Lack of education about what to realistically expect of herself or the baby. Teen mothers who idealized what it would mean to have a baby to love with little appreciation for the work involved are especially vulnerable.
• Lack of an adequate support system. Unable to turn to someone for practical help or emotional support, a vulnerable new mom can become easily overwhelmed.
• A pregnancy or birth that had complications, especially if mother and baby had to be separated after the birth in order for one or the other to recover. This can get in the way of normal mother-child bonding.
• Being under unusual stress already. New mothers who are also dealing with financial stress, a shaky relationship with the baby’s dad, family problems, or isolation are more vulnerable.
• Multiple births. The demands of multiple babies are overwhelming even with substantial support.
• Having a miscarriage or stillbirth. The normal grieving of loss is made worse by the shifting hormones.

What to Do

In cases of the normal “baby blues,” often all a new mom needs is reassurance and some more practical help. Engaging the dad to be more helpful, joining a support group for new parents, or finding other sources of support so the mom can get some rest and develop more confidence in her mothering instincts and skills can put things back on track. As with any other stressful or demanding situation, new parenthood goes better when the parents are eating right, getting enough sleep, and getting some exercise. Friends and family can help by bringing some dinners, offering to take over with the baby for an hour or so so that the parents can get a nap, or by babysitting siblings to give the parents time to focus on the infant without feeling guilty or pulled in multiple directions.

Postpartum depression, however, is a serious condition that requires more than naps and caring attention. If the problem has persisted beyond a few weeks and has been unresponsive to support and help, the mother should first be evaluated for a medical condition. Sometimes a vitamin deficiency or another undiagnosed problem is a contributing factor.

If she is medically okay, those who care about her and her baby need to encourage her to get some counseling, both for the emotional support counseling offers and for some practical advice. Cognitive-behavioral treatment seems to be especially helpful. Since women who have experienced postpartum depression are vulnerable to having another episode of depression in their lives, it is wise to establish a relationship with a mental health counselor to make it easier to seek help if it is needed in the future. If the mom has had thoughts of suicide or infanticide, the therapist can help the family learn how to protect them both. If the birthing center or hospital offers a PPD support group, the new mom and dad should be encouraged to try it. Finally, sometimes psychotropic medications are indicated to alleviate the depression.

The baby blues are uncomfortable. Postpartum depression is serious. In either case, a new mom deserves to get practical help from family and friends. When that alone doesn’t help a new mom adjust, it’s time to seek out professional help as well.

Other factors, including cultural context and faith, play an enormous role in implementing crisis interventions. This paper will compare and contrast some of these elements and models to examine how crisis interventions can be best handled now and in the future.

Crisis Intervention

Crisis management after a natural disaster is critical. Going about it properly is key to the success of crisis aversion.

There are many elements to examine when looking at a natural disaster. These include: disaster type; disaster zone environment; available resources; and delivery of resources to the area in which the disaster occurred.

Psychological First Aid

It is important to consider psychological first aid when talking about crisis management for natural disasters. This model examines the needs of the first responders and those involved with crisis recovery and management. Such people can include rescue workers, police officers, firefighters, humanitarian relief workers and any others who are in a position to help out during a natural disaster. This model includes key aspects such as education, providing support of peers, speedy recovery, mental health accessibility and a continuum of care (Castellano & Plionis, 2006).

As Castellano and Plionis (2006) discuss, first responders view themselves as having to be strong for others. Showing emotion is considered a type of weakness. This often develops into a hesitancy to seek help, which ican lead to worsening mental health. This creates a domino effect. The first responder needs to be psychologically and physically healthy enough to assist others. However, if their own physical and psychological health is ignored, the person in need may not be taken care of either (Kronenberg, Osofsky, Osofsky, Many, Hardy, & Arey, 2008).

However, psychological first aid is not applicable only to the first responder. It also is a model of how the first responder is able to help those in need. Providing compassionate engagement is key to helping those who are faced with a natural disaster, as well as allowing those in need to know that the first responder’s purpose is to provide safety and emotional comfort (Vernberg, Steinberg, Jacobs, Brymer, Watson, Osofsky, et al., 2008).

The first responder also must be able to collect information pertinent to disaster victims’ immediate needs. The first responder must be clear-headed enough to recognize the population’s needs and resources available to meet those needs. This requires the first responder to maintain psychological steadiness (Vernberg, Steinberg, Jacobs, Brymer, Watson, Osofsky, et al., 2008).

Stabilization is another key to psychological first aid. A first responder must be able to calm those who are in crisis due to a recently experienced trauma. This is applicable to those who are helping the first responders as well. However, the level and immediacy of stabilization may be different according to the different scenarios and to the needs of a crisis victim vs. those of a first responder. (Vernberg, Steinberg, Jacobs, Brymer, Watson, Osofsky, et al., 2008).

Cultural Considerations

As with most other topics, cultural considerations come into play when looking at crisis management for natural disasters. For instance, within an Asian setting, emphasis may be placed in different areas of a crisis intervention model than it would in a Western one (Udomratn, 2008).

In India, the Nitte Rural Psychiatric Project was adapted for those with limited access to resources. This project offers free care. Its goal is to overcome the stigma of mental health care by utilizing respected community members of, such as religious leaders and local doctors. Education, lectures and awareness are components to mental health care and crisis management. (Akiyama, Chandra, Chen, Ganesan, Koyama, Kua et al., 2008).

However, in another part of Asia, Senior Peer Counseling may be viewed as important in crisis intervention. In Singapore, the respect given to elders may play a valuable role in developing models of overcoming crises after a natural disaster (Akiyama, Chandra, Chen, Ganesan, Koyam, Ku., et al., 2008). In Korea, the Seoul Mental Health 2020 project offers a review of key components of the community mental health resources available to those in the area. This includes looking at adequate coverage, diversifying services in particular areas and also an integration of services. This model is looks at the overall structure of mental health and crisis intervention and aims to improve it (Akiyama, Chandra, Chen, Ganesan, Koyam, Ku., et al., 2008).

Holistic support also may be an important consideration in crisis intervention needs within an Asian population, as discussed in the Yuli psychiatric rehabilitation model for Taiwan.

Faith-based Interventions

Faith-based models also may be considered when dealing with crisis intervention following natural disasters. One model in particular, called the Camp Noah model, focuses mainly on children who have been affected by natural disasters. It is a week-long camp that allows children to express their trauma and be in an environment that supports their faith. It also relies on fun activities to provide therapeutic relief of trauma for these children (Zotti, Graham, Whitt, Anand, & Replogle, 2006).

The Camp Noah model is similar to some of the culturally-based Asian models in that it takes the context of the individual and community to heart. However, its format differs. It does not take on the viewpoint of therapy, but of a therapeutic means of expression. The Camp Noah model is more of a strategy, whereas the Asian-based models are more of an implementation. The Camp Noah model utilizes Bible study, therapist consultation, music, games and crafts. It also has the elements of low participant ratios for quality care and highly trained staff to provide adequate care for children (Zotti, Graham, Whitt, Anand, & Replogle, 2006).

Camp Noah seeks to improve disaster trauma processing and coping skills related to natural disasters. Most of the Asian-based models focus on reducing the stigma of seeking mental health care when a natural disaster does occur. There also are similarities between these models: the community setting is taken into account, and the community and its available resources are included.

Integrative Reviews

An examination of the purpose, sample, method, procedure and results of differing models is a good means of conducting an integrative review for crisis intervention models. Walsh (2009) examined different means of cultural crisis interventions for relief workers after natural disasters had occurred. A cross-cultural sample was examined in-depth to see what governmental and non-governmental agencies could do to intervene.

Walsh (2009) focused primarily on the incidence of reducing post-traumatic stress disorder and how each model worked within the context of cultures such as New Zealand, Germany, the United States, Australia, Turkey, Taiwan, Israel and Iran. Walsh found that three key elements in the data reduction model were relevant to each culture. These three elements included: debriefing, team building and preparation. These elements were different according to the cultural context; however, each proved effective in each of the cultures (Walsh, 2009). Walsh notes that long-term effects on relief workers should be further researched for future crisis intervention models (Walsh, 2009).

Conclusion

Crisis intervention has many elements in the context of a natural disaster. There are the considerations toward the population involved in the natural disaster and the aftercare of not only this population, but the relief workers as well. Models based on cultural contexts are necessary to provide effective intervention and treatment to particular populations. There is also the element of faith when developing crisis intervention models, so as to look at ways of coping with and overcoming trauma. And finally, there is the relevance of examining a model within the cross-cultural context that integrates key elements so as to be globally applicable and efficient in reducing such traumas as post-traumatic stress disorder and other mental health concerns.

References

Akiyama, T., Chandra, N., Chen, C., Ganesan, M., Koyama, A., Kua, E., et al. (2008). Asian models of excellence in psychiatric care and rehabilitation. International Review of Psychiatry, 20(5), 445-451. doi:10.1080/09540260802397537.

Castellano, Cherie, and Elizabeth Plionis. 2006. “Comparative analysis of three crisis intervention models applied to law enforcement first responders during 9/11 and Hurricane Katrina.” Brief Treatment and Crisis Intervention 6, no. 4: 326-336. PsycINFO, EBSCOhost.

Kronenberg, M., Osofsky, H., Osofsky, J., Many, M., Hardy, M., & Arey, J. (2008). First responder culture: Implications for mental health professionals providing services following a natural disaster. Psychiatric Annals, 38(2), 114-118. doi:10.3928/00485713-20080201-05.

Udomratn, P. (2008). Mental health and the psychosocial consequences of natural disasters in Asia. International Review of Psychiatry, 20(5), 441-444. doi:10.1080/09540260802397487.

Vernberg, E., Steinberg, A., Jacobs, A., Brymer, M., Watson, P., Osofsky, J., et al. (2008). Innovations in disaster mental health: Psychological first aid. Professional Psychology: Research and Practice, 39(4), 381-388. doi:10.1037/a0012663.

Walsh, D. (2009). Interventions to reduce psychosocial disturbance following humanitarian relief efforts involving natural disasters: An integrative review. International Journal of Nursing Practice, 15(4), 231-240. doi:10.1111/j.1440-172X.2009.01766.x.

Zotti, M., Graham, J., Whitt, A., Anand, S., & Replogle, W. (2006). Evaluation of a Multistate Faith-based Program for Children Affected by Natural Disaster. Public Health Nursing, 23(5), 400-409. doi:10.1111/j.1525-1446.2006.00579.x.

Neurobiology of Breaking Habits

Self-destructive behavior patterns, such as addictions, are hard to break because they provide immediate relief. But their aftermath makes people defeated and ashamed, requiring more relief, and the cycle continues. These habitual, compulsive behavior patterns limit new learning and connections in the brain by obstructing opportunities to experience the positive rewards from sustainable, effective coping strategies.

Kaitlyn, 17, was bright, vibrant and charismatic. She was adopted at birth (and knew this all along), then struggled from early childhood with both epilepsy and an unbearable sense of psychological pain and inner isolation she could not articulate.

Kaitlyn’s shame and sense of herself as unlovable had its origins in feeling unwanted and abandoned. She was naturally outspoken, gregarious and likable, but developed an early pattern of self-consciousness and inhibition with peers, driven by fear of rejection. She learned to act according to what she thought friends and boys wanted – anxious to be liked and secure her relationships.

Shame, Rage and Self-Harm

Kaitlyn had a history of self-harm, typically provoked by real or imagined rejection. She harbored a secret fantasy of being hurt and then rescued, and impulses to make her pain visible and have it validated by others. This dynamic was an unconscious attempt to manage overpowering feelings. It brought others close enough so she wasn’t alone, while reassuring her she was still loved.

Shame is a terrible feeling of badness associated with wanting to hide one’s head and disappear. Kaitlyn’s feeling of shame and badness was fueled by episodes of rage at home, confirming her fear that she was a “monster” who drove people away and didn’t deserve love and happiness. Rage can be a defense against intolerable shame, when shame turns into blame and is projected onto others. In this way, the bad feeling is passed on like a hot potato, providing temporary respite from feeing terrible, but propelling the cycle of shame and self-destructive behavior.

Self-Fulfilling Prophecy and Self-Sabotage

Shame-based self-perceptions that are acted out through self-destructive fantasies and behavior create a self-fulfilling prophecy, providing rigged evidence of badness. Feelings such as worthlessness, badness, and inferiority have various origins in early experience when we are developing a sense of self. These feelings may later be experienced as factual — as if they represent the truth about who we are. When such compartmentalized experiences of oneself remain secret and unarticulated they can lead to unconscious pressure to make this inner “truth” a reality, leading to self-sabotage.

Dysfunctional behavior patterns are habits with psychological, often unconscious, motives. Breaking them requires insight into what function they serve and the discipline to stop them. It also requires courage and initiative to try out new behaviors and allow a different chain of events to occur. On a neurobehavioral level, new behaviors that generate positive feedback create new pathways in the brain, allowing momentum for psychological growth and change.

Kaitlyn had been caught in waves of powerful feelings and a difficult cycle of self-defeating patterns. But she wanted more than anything to be strong, self-respecting and independent and began to use her determination to work toward these positive goals, instead of hurting herself.

Kaitlyn’s first step was talking in family therapy about being secretly drawn to videos about suicide and self-harm on YouTube, especially when feeling sad or alone. She initially feared being judged and was scared that access to the videos would be taken away. However, as she trusted that it was safe to talk about these secrets without being judged and could make her own decision, Kaitlyn was able to evaluate what she wanted to do.

When taking a neutral step back to assess her thoughts and feelings, Kaitlyn recognized that exposing her mind to this content fed her fantasies, pulling her deeper into darkness, and created a cycle of regression which impeded independence and forward motion. Just as she could choose what food to put into her body based on its effect, she could decide whether she wanted to expose her mind to stories and images that made it harder to resist being self-destructive.

Trying Out New Behaviors

With encouragement, Kaitlyn became motivated to try out new ways to comfort herself. Learning better ways to regulate and take charge of her feelings gave Kaitlyn a jumpstart to taking healthy risks in the world.

Kaitlyn enrolled in a Saturday class in public speaking at a local college to develop her confidence. Having had a seizure at home after the first class, she missed the following class. She felt alienated and experienced a familiar sense of herself as defective, followed by the temptation to hide. In therapy she talked about the isolation and sadness she felt.

A week later, right after the next class, Kaitlyn burst with glee into the family therapy session, followed by her mom and dad. Grabbing the feelings list, she began the meeting as always — naming the feelings that fit her state at the moment: “Alive, amazed, confident, exuberant, happy, hopeful, proud,” she said. The excitement was contagious, but we glanced at each other curiously, waiting to find out what changed.

Kaitlyn went on to describe the class. The teacher asked for improvisational introductions by each student. Inspired by another student who made himself vulnerable, Kaitlyn bravely went up in front of the class and spontaneously spoke to her experience with epilepsy, telling her story in public for the first time. Looking around the classroom as she spoke authentically, Kaitlyn noticed people listening and completely engaged. Invigorated, she was fully present and one with herself. Everything felt natural. The class was mesmerized, responding with tears and applause.

Pride – the Antidote to Shame

Kaitlyn could barely contain the exhilaration brought on by this new feeling of pride (the antidote to shame) which emerged from a new experience of herself in relation to others. She took action that transformed her loneliness and alienation into a feeling of mastery and power. But the feeling of pride came not only from challenging herself with something meaningful to her and succeeding, but from something deeper.

Healthy Risk-Taking and Changing Behavior Patterns

Kaitlyn resisted the impulse to hide or pretend that typically escalated her feeling of being alone and ignited a self-destructive cycle. Instead, she took a healthy risk to let herself be seen, acting confidently from a position of strength and self-respect rather than a wish to be rescued.

Kaitlyn’s behavior created an opportunity for interpersonal feedback that challenged her sense of herself as defective and the belief that she could feel connected and affirmed only through pain. The key element here was that this challenge occurred experientially, not intellectually.

Healthy behaviors that foster connection and affirmation from a position of self-acceptance and self-respect offer the possibility of sustainable attachments. Here, Kaitlyn broke the cycle of feeling connected and affirmed only through darkness, potentially releasing herself from a treadmill of pain.

Choosing Happiness over Suffering: the Results

As she basked in the fact that people seemed to not only like her, but respect her and admire her courage, I said, “You see — you don’t have to hurt yourself to get people to see and care about you.” “ I like being happy!” Kaitlyn exclaimed, with a sense of wonder alongside awareness of the irony of this statement. She glance at her dad and they both smiled knowingly, “Who knew?!” her dad piped up in his good-humored way.

Disclaimer: The characters from these vignettes are fictitious. They were derived from a composite of people and events for the purpose of representing real-life situations and psychological dilemmas that occur in families.

So many times we think we know where we’re headed; then we’re taking an unexpected turn.
~ Hopping Roller Coasters

Rachel Pappas’s memoir, Hopping Roller Coasters, details the unpredictable story of a mother and daughter who must cope with their mood disorders, until they can reach a place of mutual understanding that gives way to a stronger relationship with each other. Though I found the content to be emotionally painful at times, I think it’s an insightful read. Pappas provides us with an important takeaway message that revolves around genuine forgiveness and a path for healing.

Rachel’s story highlights her trials with bipolar disorder and how it affected her daughter, Marina. She transports the reader into their private moments, showcasing intimate arguments, where Rachel took out her frustrations on Marina in a raw and angry fashion. She didn’t mean the sentiments that came forth during the heat of an altercation, but biting words circulated between them. Rachel’s therapist ultimately put her on medication to regulate her mood swings.

We then read how Marina went through a period of hard knocks during early childhood and into adolescence; she had trouble focusing at school (she was diagnosed with auditory deficits), and she inherited her mother’s bipolar disorder as well. In desperate need of help, Marina endured a period of hospitalization and even moved away to live with her grandparents, hoping for a finer environment.

During Marina’s stay at her grandparents’, at 13 years old, she was hospitalized for getting hold of her grandfather’s painkillers. After a stretch of time, Rachel received a phone call from her mom, relaying the news that they couldn’t keep their granddaughter with them any longer. As difficult as it was to hear, she knew her daughter needed something more.

Marina also unfortunately struggled with cutting as a way to deal with her emotional turmoil. One of the more heartbreaking lines I read was when Marina explained why she did what she did. “It hurts on the inside, so I figured I might as well hurt on the outside,” she told her mother.

Fast forward a few years later: Marina was 16, and she and Rachel were at it again. Hurtful remarks and threats flooded their fights. “Where was my little girl? The one with the pixie cut who let me hold her hand crossing the street?” Rachel wrote. “My good-natured ‘pipster’ who accepted my excessive hugs and kisses into early puberty. I was losing her. No, I had lost her.”

What really struck a chord (even though I’m only in my 20s) was looking at this situation from the mother’s perspective. I could only imagine a parent’s sense of loss, among other things, when you’re watching your child transition away from childhood and into young adulthood. Now throw in that kind of strife, and it takes that particular awareness to a different level.

After another hospitalization at 18 years old, Marina went back on her medication and was finding her stride with a new job. She also began her first serious romantic relationship (which was definitely enjoyable to read about), and facets of her life were beginning to fall into place after a rocky decade.

In the final chapters, Rachel faced additional obstacles, but through it all, she found a new outlook regarding her relationship with Marina; she realized she didn’t want any friction in the connections that she valued.

By some twist of fate, Rachel’s personal challenges mended her history with her daughter and paved the road for forgiveness in both directions. They both knew that they unintentionally caused the other pain in the past, but they were able to move forward, become unstuck and salvage what really mattered. For that, I recommend this narrative.

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

Shame involves an internalized feeling of being exposed and humiliated. Shame is different from guilt. Shame is a feeling of badness about the self. Guilt is about behavior — a feeling of “conscience” from having done something wrong or against one’s values.

Shame underlies self-destructive behaviors:

• Hidden shame often drives self-destructive behaviors and other psychological symptoms such as rage, avoidance, or addictions.
• Self-destructive behaviors often are an attempt to regulate overpowering, painful feelings but lead to more shame, propelling the self-destructive cycle.
• Secrecy, silence, and out-of-control behaviors fuel shame.
• Shame makes people want to hide and disappear, reinforcing shame.
• Shame is created in children through scolding, judging, criticizing, abandonment, sexual and physical abuse.

Breaking the Cycle of Shame

Breaking self-destructive habits requires action, not just willpower:

• Changing destructive behaviors requires trying out new, affirming behaviors to replace them.
• New behaviors that generate positive feedback and reward create new connections in the brain, creating the momentum for ongoing growth and change. (Learning on a neurobehavioral level)

Shame can be relieved and healed by:

• taking healthy risks to be seen and known authentically, acting from a positive motive and trying out new behaviors in a safe (nonjudgmental) setting.
• taking actions that generate pride — the antidote to shame.
• breaking secrecy with people who understand.

The Boy On The Lake: He Faced Down the Biggest Bully of His Life and Inspired Trevor’s Law tells the true story of Trevor Smith Schaefer, his fight to survive cancer, and his determination to find answers concerning the much higher than average rate of childhood cancer around the town of McCall. Penned by writer Susan Rosser with help from Trevor and his mother, Charlie Smith, the book chronicles the the pair’s battles with disease, with an emotionally abusive father and husband, and, finally, with the government’s lack of attention to environment problems.

When her twelve-year-old son’s malignant medullablastoma was discovered, Charlie Smith was trying to deal with a divorce. During Trevor’s surgery and chemotherapy, the author tells us, Charlie felt she practically lived in the hospital’s cancer unit. As she got to know the other mothers and cancer patients, she developed a sinking feeling that something wasn’t quite right in her town. She began her search to find out why so many children in the area were suffering from cancer. Through extensive research, good friends, nerves of steel, and the drive and optimism to keep going, Charlie came across shocking information about McCall and the surrounding area. The beautiful place she called home was actually a chemical cocktail, and the government seemed less than willing to help.

Along with the cancer, Trevor had to fight off a bully who should have been his most steady support through the whole ordeal: his own father. Ballard Smith was there for his son only when it was convenient, and often stood him up as he suffered through the effects of chemotherapy. Ballard’s lack of emotional support eventually led to emotional abuse, in the form of ridicule for walking funny (an effect of the chemo). Charlie and Trevor were finally able to escape from Ballard’s emotional abuse and control issues to team up for their next obstacle.

Once Trevor had beaten cancer, he and his mother embarked on a mission to raise awareness of the chemicals that infest many towns, with the goal of making the government do something about them. Through years of research, networking with the right people, and the unwavering courage to face down the people who attempted to belittle their quest, Charlie and Trevor were able to make extensive progress in discovering the secrets their town held. The calls began pouring in from all over the country from those suffering in towns like McCall, and Trevor’s Law was born.

The law, if passed, would direct federal funds to areas where the cancer level is particularly high among children so that testing can be done to find possible environmental influences. To help create the law, Trevor and Charlie worked to gain the backing of politicians in Idaho, including numerous state senators. They also worked with parents of children with cancer, people in other cancer clusters across the country, and even the famous Erin Brockovich. Their message gained momentum, eventually leading Trevor to Washington, D.C., to encourage lawmakers to support Trevor’s Law. While there, he pleaded with Congress to see that more effort needs to be made to figure out what’s going on in areas with high childhood cancer rates.

It must have taken Trevor and Charlie tremendous amounts of optimism and courage to not only get through cancer but then campaign to help others with similar problems. Trevor faced the prospect of death before he had the chance to become an adult, yet managed to turn his experience into something positive — something that still may affect the entire country. Charlie, meanwhile, helped the cause even at a time when her family life was falling apart. This perseverance, shown by both mother and son, makes “The Boy on the Lake” an inspiring read.

The Boy On The Lake: He Faced Down the Biggest Bully of His Life and Inspired Trevor’s Law
Morgan James Publishing, October, 2012
Paperback, 300 pages
$21.95

In Saving Each Other: A Mother-Daughter Love Story, Victoria Jackson and her daughter, Ali Guthy, tell the story of a child stricken with a deadly disease and a mother who fights best when the odds are the worst. Alternating mother/daughter commentary chronicles the fight against Ali’s rare diagnosis of the autoimmune disease NMO, or Neuromyelitis Optica. Due to their unusual status, the pair weaves a tale that is at once hopeful and utterly alien to most readers.

Victoria Jackson fought her way from a violent childhood to all the joy and promise that her life as a half-billion-dollar makeup maven allows — especially after she married Bill Guthy of Guthy-Renker infomercial fame. Bill, though not a co-author, is no less an interesting and positive player in this story. Early in the book, he has a rendezvous with cancer.

We are told that he lives solely within the borders of optimism that frame any tough situation — a trait learned from his family, who would apparently break out in songs from the Sound of Music during get-togethers. Then, Bill and Ali watch in awe as the Superwoman that is their wife and mother not only battles the deadly autoimmune disease that strikes the talented tennis-playing Ali, but also starts thinking about a foundation to bring research and better understanding to others struggling with the illness.

At first, Ali and her mother take two very different paths: While Ali doesn’t even want to know the name of her disease and certainly not the the prognosis as it first affects her vision at age 14, Victoria immerses herself in every detail. Her approach to success, she shows us, is in researching every aspect and every possible outcome to defeat any challenge that lies before her. She also speaks frequently of the “2% factor,” her concept that when the odds of something happening — good or bad — are incredibly low, they are likely to occur to her or those near her.

When she pulls herself out of an abusive past to create her Victoria Jackson makeup enterprise, it is a 2% factor example, she tells us. Her husband’s episode with cancer, another example. Next, when the structure is built for the Guthy-Jackson Charitable Foundation, Victoria meets the renowned physician Dr. Katja Van Herle of UCLA, who has recently launched the All Greater Good Foundation. The doctor welcomes the chance for her own organization, which supports education and outreach programs for underfunded public health issues, to partner with Victoria’s to conduct NMO research. Definitely filed under 2%.

Victoria and Ali’s challenge is daunting. Yet unless the reader is dealing with a potentially fatal disease and also has the kinds of monetary and social resources Jackson does, there are times when it is difficult to feel the real pathos of (or empathy toward) the family’s unquestionably frightening journey. One presumes that there had to have been some darker moments amid the positive “2%” ones. Perhaps had the authors included one or two in their book, they may have made it a little more accessible to Everyman.

However, the bright moments they cover do convey some universal lessons worth embracing. We read about Ali’s maturation from denial to advocacy — a change that is genuine and heartfelt. Her becoming the editor of a newsletter to help others better understand the daily challenges of the disease seals her growth into an empathic, involved young woman. Reading about a mother and daughter and caring dad working together under the most difficult of situations and emerging stronger and more united, when often it’s those very tough situations that tear families apart, is also especially gratifying. The “Resources” chapter that wraps up the book appears to be useful as well.

If you know going into it that this book is about not just an unusual disease but an exceptional family of great means, the story does not disappoint. It’s not often that hero-worshipping and the super powers of others play such a big part in real life, or life for the majority of us.

But while it may put some readers off, “Saving Each Other” is a reminder that worst-case scenarios don’t always result in worst-possible endings. Perhaps if people like Victoria Jackson create more foundations, we can bring better results to people suffering from the many misunderstood and under-researched medical issues afflicting those of limited resource. That may be one lesson. If nothing else, the book most certainly carries hope from the first page to the last. It just may not reflect the reader’s reality.

Saving Each Other: A Mother-Daughter Love Story
Vanguard Press, October, 2012
Hardcover, 288 pages
$25.99