ADHD and Family Relationships
ADHD takes a heavy toll on family relationships
Medscape Medical News 2008. © 2008 Medscape
October 31, 2008 — Attention-deficit/hyperactivity disorder (ADHD) in children not only poses significant challenges for the children themselves, but new research shows that it can also exact a significant toll on their families.
Two new studies report that having a child with ADHD doubles the likelihood of divorce, and ADHD has a significant negative impact on family routines and relationships.
In the first study to compare the durability of marriages of parents of children with or without ADHD and to identify divorce risk factors in this group, investigators at University at Buffalo, in New York, found that by the time children with ADHD are 8 years old, their parents are twice as likely to be divorced as parents of other children.
"This work highlights the importance of considering the whole family when you are treating a child with ADHD and not just treating the child and the symptoms," senior author William E. Pelham, Jr., PhD, told Medscape Psychiatry.
Parents need tools to learn how to cope with the stresses of having a child with ADHD, he added. In addition to treating the child, clinicians must ensure that parents get any needed behavioural parent training.
The study was published in the October issue of the Journal of Consulting and Clinical Psychology.
Antisocial Father, Poorly Educated Mother
Previous research has not consistently shown that childhood ADHD is linked to a greater risk for divorce, but these studies only looked at a single point in time, said Dr. Pelham.
To examine the rates and predictors of parental divorce among children with or without ADHD, the investigators analysed longitudinal data from parents of adolescents and young adults who participated in the Pittsburgh ADHD Longitudinal Study (PALS).
Children diagnosed with ADHD (n = 282) were compared with a control group of children without ADHD (n = 206). At study entry, subjects were 5 to 12 years old. Marital data were obtained from parents at 8-year follow-up. All parents had been married at some point during the study period.
Parents of children with ADHD were more likely than other parents to divorce when their child was between the ages of 1 and 8 years. By the time the children were 8 years old, 22.7% of the parents of children with ADHD were divorced, compared with 12.6% in the control parents. After age 8, the gap in the divorce rate did not widen between the 2 groups.
Risk for divorce was greatest if the father had a lifetime history of antisocial/criminal behaviour, and was also increased if the mother had substantially less education than the father.
In future studies, the group will investigate different ADHD treatments in children and their potential affect on parental divorce, said Dr. Pelham.
Strained Family Relationships
In a second study, David Coghill, MD, from the Centre for Child Health, in Dundee, Scotland, and colleagues also found that ADHD placed a significant strain on family relationships.
Based on responses to an online survey, almost three quarters of the parents of children with ADHD reported that the disorder had a negative impact on their relationship with the child, and just over 50% reported problems with relationships between the child with ADHD and his or her siblings or peers.
In contrast, fewer parents of children without ADHD reported problems in the relationships with their child (43%), or between their child and siblings (29%) or other children (12%).
The study was published online October 28 in Child and Adolescent Psychiatry and Mental Health.
To explore the impact of ADHD on children's everyday activities, behaviour, and relationships, as assessed by the parents, the group analysed data from a household survey of 910 parents of children with ADHD and 955 parents of children without ADHD living in 10 European countries.
The households included those with a child aged 6 to 18 years with a confirmed diagnosis of ADHD and those with a child with no ADHD. Most of the children with ADHD (62%) were not receiving medication at the time of the study. Children who were receiving the nonstimulant medication atomoxetine (Strattera, Eli Lilly) or who were receiving only 1 dose of an immediate-release stimulant were excluded from the study.
Parents of children with ADHD were much more likely than other parents to report that their children consistently exhibited demanding, noisy, disruptive, disorganized, and impulsive behaviour.
This type of behaviour had the most significant impact on homework, family routines, and playing with other children.
"Results from this parental survey demonstrate the breadth of problems experienced by children with ADHD [and also alert] physicians to a range of factors that should be considered in the management of children with ADHD," the authors write.
The study by Pelham et al was funded by grants from the National Institute of Mental Health, the National Centre for Education Research, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute of Environmental Health Sciences. The authors of that study have disclosed no relevant financial relationships.
The study by Coghill et al was sponsored by Janssen Cilag. Dr. Coghill has been an advisory-board member for Cephalon, Eli Lilly, Janssen Cilag, Shire, and UCB, and has received research funding from Eli Lilly and Janssen Cilag. The financial disclosures of the other authors are listed in the article. J Consult Clin Psychol. 2008;76: 735-744. Abstract Child Adolescent Psychiatry Mental Health. Published online October 28, 2008.
Young children's behaviour linked to parent deployment
Behavioural problems in very young children linked to parential wartime development
Medscape Medical News 2008. © 2008 Medscape
November 7, 2008 — Very young children (3 to 5 years old) with a parent deployed to a war zone exhibit more behavioural symptoms than their peers without deployed parents, even after any stress or depression in the non deployed parent was controlled for, new research suggests.
"This study is a wake-up call, in that it is easier to spot symptoms in school-aged children and think that younger children may be less affected," lead author Molinda M. Chartrand, MD, from Boston University School of Medicine, in Massachusetts, told Medscape Psychiatry.
"Clinicians need to be aware that young children from military families may present with behaviour problems related to their parents' deployment," she said.
Most often, the behaviour is expressed as externalizing symptoms, such as aggression or attention difficulties, but the children may have internalizing symptoms, such as eating disturbances, anxiousness and depression, somatic complaints, and withdrawal, which can be harder to detect.
The study, the first to demonstrate the effect of current wartime deployment on behaviour in very young children, was published in the November issue of the Archives of Pediatric & Adolescent Medicine.
More than 2 Million Children Affected
Although more than 2 million American children — 40% younger than 5 years — have had a parent deployed to Iraq or Afghanistan, little research has focused on the effects of parental deployment on the very young.
A previous study showed that school-aged children with parents deployed in Operation Desert Storm had increased behavioural symptoms. Current deployment to Afghanistan or Iraq lasts between 12 and 15 months, which is longer than Operation Desert Storm and represents a significant portion of a young child's life.
To assess the effect of parental deployment on the behaviour of very young children, the researchers surveyed both parents and childcare providers of children 18 months to 5 years old who were enrolled in an on-base military childcare centre from May to December 2007.
One in 5 Children Showed Clinically Significant Symptoms
A total of 55 children with a deployed parent and 114 children without a deployed parent were included in the study.
In 92% of the parental deployments, it was the child's father who was deployed. At the time of the study, the parents had been deployed for an average of only 3.9 months.
For each child, parents completed the Child Behaviour Checklist (CBCL) survey and the child's caregiver completed the Child Behaviour Checklist Teacher Report Form (CBCL-TRF) to assess externalizing and internalizing behaviour symptoms. The sample was stratified by age into 2 groups: younger than 3 years and 3 to 5 years.
Children 3 to 5 years with a deployed parent (n = 31) had significantly higher externalizing and total-symptom scores than their peers without a deployed parent (n = 65).
Among the 31 children 3 to 5 years with a deployed parent, approximately 1 in 5 had clinically significant scores on the CBCL and the CBCL-TRF. Among children 18 months to 3 years, there was a trend to lower CBCL externalizing-symptom scores.
The association was reported by both parents and caregivers and persisted even after researchers controlled for the non deployed parent's stress and depression symptoms.
"Larger longitudinal studies are needed to confirm these results and to fully describe the impact of parental deployments — from deployment to reunification — on young children," Dr. Chartrand said.
"Further research is also needed to ensure that we are providing the proper level of assistance to military families during deployments," she added.
Kudos to Investigators
In an accompanying editorial, David J. Schonfeld, MD, and Robin Gurwitch, PhD, from the Cincinnati Children's Hospital Medical Centre, in Ohio, say the study investigators should be applauded for their research efforts. "There is a pressing need for a systematic assessment and ongoing evaluation of how families, including young children, are adjusting to parents' deployment," they note.
"The observation that approximately 1 in 5 children was already demonstrating clinically relevant scores on behavioural measures completed by parents and childcare teachers an average of 3.9 months after parents were deployed should be seen as highly concerning," the authors write.
"Findings from this study highlight the need for increased attention to the mental-health concerns of young children of deployed soldiers as well as the mental-health concerns of the soldiers and non deployed spouses," they add. "They raise questions of how to best determine deployment length and what preventive measures can be taken to reduce stress and distress in the non deployed spouses and children left behind."
The study was supported by the Joel and Barbara Alpert Foundation and the Society for Developmental and Behavioral Pediatrics; Reach Out and Read provided books. The study authors and the editorialists have disclosed no relevant financial relationships.
PTSD and Depression
A diagnosis of ptsd and depression commonly co-occur
By Matthew Tull, PhD.
Updated: November 6, 2008
A diagnosis of PTSD and Depression commonly co-occur.
What is Depression
Everyone feels sad from time to time. Depression is different from just feeling unhappy or sad. Depression is more intense, lasts longer, and has a large negative impact on a person's life. The following are the symptoms of depression (also called a major depressive episode) as described in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV):
- Depressed mood for almost every day and for the majority of the day.
- Loss of interest or pleasure in activities.
- Considerable weight loss or weight gain.
- Difficulties falling asleep or sleeping too much.
- Feeling constantly on edge and restless or lethargic and "slowed down."
- Feeling worthless and/or guilty.
- Difficulties concentrating and/or making decisions.
- Thoughts of ending one's own life.
According to the DSM-IV, to be diagnosed with a major depressive episode, a person must experience 5 of these symptoms all within the same 2-week (or longer) period.
How Common is the Occurrence between PTSD and Depression?
Depression is one of the most commonly occurring disorders in PTSD. In fact, it has been found that among people who have or have had a diagnosis of PTSD, approximately 48% also had current or past depression. People who have had PTSD at some point in their life are almost 7 times as likely as people without PTSD to also have depression. Another study found that 44.5% of people with PTSD one month after experiencing a traumatic event also had a diagnosis of depression.
How are PTSD and Depression Connected?
PTSD and depression may be connected in a number of ways. First, people with depression have been found to be more likely to have traumatic experiences than people without depression, which, in turn, may increase the likelihood that PTSD develops.
A second possibility is that the symptoms of PTSD can be so distressing and debilitating that they actually cause depression to develop. Some people with PTSD may feel detached or disconnected from friends and family. They may also find little pleasure in activities they once enjoyed. Finally, they may even have difficulty experiencing positive emotions like joy and happiness. It is easy to see how experiencing these symptoms of PTSD may make someone feel very sad, lonely, and depressed.
A final possibility is that there is some kind of genetic factor that underlies the development of both PTSD and depression.
If you have PTSD, it is important to seek treatment as soon as possible. The sooner you address your PTSD symptoms, the less likely they will become worse and will in turn increase your risk for depression.
If you currently have PTSD and depression, it is still important to get treatment as soon as possible. Each disorder may make the other worse. PTSD and depression are very common co-occurring mental disorders. Therefore, mental health professionals trained in the treatment of PTSD are also usually well-trained in the treatment of depression. In addition, some treatments, such as behavioral activation, may be equally good in treating PTSD and depression.
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Breslau, N., Davis, G.C., Peterson, E.L., & Schultz, L. (1997). Psychiatric sequelae of posttraumatic stress disorder in women. Archives of General Psychiatry, 54, 81-87.
Jakupcak, M., Roberts, L.J., Martell, C., Mulick, P., Michael, S., Reed, R. et al. (2006). A pilot study of behavioral activation for veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 19, 387-391.
Kessler, R.C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.
Shalev, A.Y., Freedman, S., Peri, T., Brandes, D., Sahar, T., Orr, S.P., & Pitman, R.K. (1998). Prospective study of posttraumatic stress disorder and depression following trauma. American Journal of Psychiatry, 155, 630-637.
How to be happy in life
Happiness, we say, is a choice. happy people understand this
How to be Happy in Life
by Ronit Baras
Happiness, we say, is a choice. Happy people understand this, while unhappy people struggle with judging themselves for not being able to easily shift to a happy state of mind.
The first step towards moving into a happy state is to understand that happiness is something we need to learn and for some reason (that we will not discuss here), school teaches everything else but happiness. Use the “school of life” to practice happiness and remember that your “choice muscle” needs to be active all the time. Always notice you have options in everything you do, think or feel, and that you choose the things that are best for you.
Here are some specific tips you can blend into your every day:
Step 1 - SMILE
Smile a lot - If smiling is too hard for you, take a pencil and hold it with your teeth. There are enough smiling muscles involved for your brain to think you are smiling and start producing “happy” chemicals
Step 2 - SING
Sing! - Singing works just like smiling, causing your body to produce “feeling good” chemicals. Sing in the car, sing in the shower, sing when you prepare dinner and sing when you feel frustrated and notice how the negative feelings melt away.
Step 3 – HAPPY PEOPLE
Hang around positive people - Having happy people around you will make it easy to learn happiness. Happy people have fun around them and their ability to overcome challenges is higher than that of unhappy people who tend to lay blame and feel victimised. Choose the people you hang out with to suit your needs.
Step 4 - LAUGH
Laugh - Much like smiling, laughter is a great way to overcome physical and emotional challenges. If it does not happen naturally, try laughter therapy.
Step 5 - BE ACTIVE
Get a move on - Being physically active makes you happy. Find some activity you like to do and notice how it changes your mood: sex (yes, of course!), any kind of sport, dance and yoga. Make a habit of being active in any way you feel like.
Step 6 - GET CREATIVE
Get creative - Creativity is a great way to find happiness. Think of creative things people do for a living or as hobby and notice how much happiness it gives them. Paint, draw, dance, sculpt, do some craft, invent a gadget, cook something new, write poetry or tend the garden. Tap into your creative abilities and find your “happy spot”.
Step 7 - HUG
Hug - Hugging is a way to give and receive happiness. Physical touch is essential to your development and hugging is a great way to get that physical touch in a positive way. Hug a lot!
Step 8 - BE HAPPY
When in a conflict situation, remember that being happy and being right do not necessarily go hand in hand. When in doubt, choose happiness over being right.
Step 9 - IMAGINE A BRIGHTER FUTURE
When feeling down, recite to yourself “This too shall pass” and imagine a brighter future.
Step 10 - BE CHILDISH
Act like a child - Do childish things to feel young and fresh: jump on a trampoline, sit on a swing and skip. Remember, “We do not stop playing because we grow old. We grow old because we stop playing”.
Step 11- BE KIND
Be kind - Do random acts of kindness every day. It can be as simple as saying something nice, offering help, giving up your place in a queue or allowing another driver to enter a busy road.
Step 12 - BE GRATEFUL
Be grateful - Practice gratitude: say thank you for everything you have and appreciate in your life. Gratitude is a way to increase happiness and eliminate taking life for granted.
Step 13 - MEDITATE
Meditate! - Find a relaxation you feel comfortable with. Meditation relaxes the mind. You can listen to music, use crystals, take a bath, use candles or repeat a mantra. All of these do the same thing. to your mind. Take the time off every day to regenerate.