Every parent’s nightmare

All good parents – and most not-very-good-at-it parents – want what is good for their children. They would like them to grow up happy and healthy, to have a comfortable life, stay out of jail, etc. A few grandchildren and regular calls and visits would be nice.
Often unspoken, but definitely there, is the desire that their child not be what they might call “crazy.” It’s not my word – I’d use depressed or anxious, or having a psychotic episode – but for parents, one of the greatest fears of all is that their child grows up to be mentally ill, with hallucinations and delusional beliefs – to be out of touch with reality, to be, in short, psychotic.
Psychotic doesn’t mean “violent and crazy,” as it is so often misused. It means to be out of touch with reality, often with some sort of hallucination (hearing voices, seeing things that aren’t there, or some other sensory misinformation) and/or delusional beliefs (paranoia, which may mean being persecuted or it may mean an unrealistic arrogance, belief in one’s special powers, or that one is in fact someone of great power and importance).
And, it turns out, psychotic symptoms are a risk factor for two common substances in the lives of young people: methylphenidate, a commonly prescribed drug for ADD/ADHD, and cannabis.
The research on methylphenidate has been ongoing, in some cases for decades, and while you cannot do experiments to “prove it” (who would volunteer to try to have their child rendered psychotic just to see about a drug’s effects?), researchers scour multiple studies following up on children and teens prescribed methylphenidate, and find that 1 to 2.5% develop psychotic symptoms. That’s up to more than one in 50. The latest meta-analysis was published this summer in the Scandinavian Journal of Child Psychiatry and Psychology, using multiple studies with over 77,000 young people in all.
The link between cannabis and later psychotic symptoms, as well as anxiety, for young people has been known for years, but often studies began in the mid- to late-teen years and it was difficult to determine if those who were prone to mental disturbances were more attracted to cannabis than healthy teens, or if otherwise healthy teens were developing psychosis as a result of cannabis use. With studies beginning earlier – in 7th grade – researchers feel confident asserting there is an increased risk for psychotic symptoms within a year after a teen begins using cannabis. This is for all teens, not just those with family histories of psychotic illnesses such as schizophrenia.
What should parents and other caregivers do?
If your child is being treated with methylphenidate, work closely with the prescribing physician to monitor side effects, be honest about what you observe, and do not panic. Remember that counseling and neurofeedback, provided by experts, can help someone diagnosed with attention deficits develop skills and neurological adaptations to reduce symptoms. Seek a referral from your child’s physician.
In terms of illegal drug use…assume no “safe” amount of an illegal substance. The fact that many states have legalized or decriminalized marijuana has misled many people to believe it is “safe.” It is not. The American Medical Association and the American Psychiatric Association both have published strong positions warning about the use of marijuana.
Parents and caregivers also need to be mindful that the drugs used for ADD/ADHD, and methylphenidate as an illegal substance, are popularly misused, sold, or shared among young people. According to studies published as recently as last autumn, 5 to 10% of high school students and 5 to 35% of college students use, or have used, prescriptions for ADD/ADHD illegally as “smart” or “study” drugs. This may be regular use, or may be occasional to get through end-of-term crunches with minimal sleep. Side effects include sleeplessness, agitation, anxiety, dizziness, headache, sweating, appetite loss, elevated blood pressure, and psychosis.
Be alert for subtle changes in behavior and do not be afraid to be assertive about this. Your child’s physical and mental health may depend upon it.

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Go and Do, for Me and You

Verbs, like “go” and “do”
In a recent on-air segment, Jamie and I (he’s the afternoon radio talent for Spirit FM, the local Catholic radio station/Christian pop music station where I’ve been volunteering since 2009) were discussing various social protests. He had asked me how to handle the flood of social media, with people posting/re-posting/re-re-posting, and the pressure to have some sort of opinion/assert some stand on perpetually protesting celebrity.
I try, but don’t always succeed, in preferring action verbs. Like, “go” and “do.” I don’t much care for meetings. I don’t like sitting around talking about how we can help the homeless and severely mentally ill. I went and did (full time work, almost 5 years). Jesus didn’t say, sit around and have lots of committee meetings. He said, pretty much, Go… (He also had something to say about babbling on and on, so I will move along.) I would rather teach than talk about teaching, do art than sit around talking about art…you get the idea.
So my thoughts are, go and do. It would be far more helpful – if, for example, we are talking about the real and obvious pain in poor neighborhoods – to go and do. Mentor a kid. Be a Big Brother/Big Sister. Organize a community watch organization. Do pro bono work in your field. Provide free tutoring. Be a Guardian ad Litem. Etc., etc. Go and do. Standing around getting attention for taking a public position that costs nothing seems a little self-serving.
It reminds me of the time a woman I knew criticized me for failing to wear red on some arbitrary date publicly announced to be the day to wear red to support women’s heart health. The only woman whose heart I have much influence over is my own. I had already exercised, gone to church, had good conversation with my husband, eaten a healthy breakfast – in other words, it was 8 AM and I had done all I could for THIS woman’s heart health. Nothing I was going to do, besides pray and try to set a half-decent example, would help anyone else.
It also brings to mind the big test for reports of visions of the Blessed Virgin Mary. Such a report requires much evidence, but a primary benchmark requires that Mary points towards Jesus. There is no credibility if the reported vision does not direct people towards Jesus. Such an experience is not something from the Good side. It might be a well-intentioned, innocent delusion, but it is not Mary. Mary doesn’t showboat.
So…if terrible injustice moves you, go and do something concrete, specific and clearly helpful for one particular person. Keep the meme to yourself.
…and more on “Go” and “Do”
Teen and young adult mental health took a drastic, terrifying turn for the worse beginning in 2007 – and the stats keep worsening, especially since 2012. This, according to a lot of research, can be traced back to the smart phone, according to San Diego State University professor, researcher and author Jean Twenge. Her recent book, “iGen: Why Today’s Super-connected Kids are Growing Up Less Rebellious, More Tolerant, Less Happy – and Completely Unprepared for Adulthood – and What that Means for the Rest of Us,” provides the results of not just her original research but meta-analysis of generations of data on the pattern of mental health and activity for youth.
It seems like constant connectivity has led to less “go” and “do” and more detachment and isolation. It’s a double-dose of negative: the ineluctable distance created by screen-based communication and a deficit of direct experiences. We were not designed to sit and click; we are made to go and do.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

Posts are for entertainment and not meant to be construed as treatment or professional recommendations. If you need mental health assistance, please contact a licensed professional in your area.

Plan B

I am very, very hopeful that, when I leave the office this evening and get into my Ford Fiesta, it will start when I first turn the key and that all four tires will be inflated. It gets regular maintenance and I expect it to start. My plans, including the amount of time I schedule for various commutes, revolve around the expectation (Plan A, as it were) that the little car will be ready to roll.

Sometimes, she is NOT ready to roll. She might have a flat tire, or a dead battery (Florida heat is rough on batteries). So, just in case of various emergencies, I have a jack, spare tire, some tools, a can of tire-inflator, a quart of oil, some water, jumper cables, a fire extinguisher, an owner’s manual and my AAA card. I also have a Bible and Rosaries for other sorts of emergencies. I would vastly prefer not to resort to any of these Plan B’s alone in a parking lot at night, but every so often I have been happy to have them readily available.

On a much more critical scale, military and police personnel have to have plan B at the ready in case of a worst-case scenario. Let’s say you are a special operator and you and your comrades are supposed to slip in silently, extract an American hostage or two, and slip out with the same seamless, silent efficiency. That would be Plan A: no one on your side gets hurt and maybe not even too many of the enemy. If enemies have to be hurt, they cooperate by succumbing very, very quietly. Plan B, entailing air support and extra personnel and a whole lot of messiness, is far from optimal. Plan A is effective if nothing goes wrong. If anything goes wrong, then you need Plan Bs. Plan Bs have a higher likelihood of success in the case of an uh-oh situation than Plan A, but are far less desirable.

Most of us don’t have to worry about extracting hostages or inflicting deserved mayhem on an enemy. We have to muddle through, discerning our purpose and doing our best to live rightly. Do we, who don’t have any expectation of being caught in a gunfight, need a Plan B? It’s become quite popular, especially in the business school world, to assert that a Plan B is an excuse to let Plan A fail.

I would argue that Plan B is part of the backbone of successful planning. Consider, for example:

You have promised your small children that, if everyone cleans up their bedroom by 9 AM Saturday, you will all go to the zoo! Yay! You had better have a Plan B already presented to them, too, in case of rain (as in, if it rains, we will postpone the zoo and have lots of fun doing “X” at home). You do not have control over whether or not it rains on your zoo day, but you have control over creating alternatives that account for circumstances beyond your control. Would you rather have Plan A – a sunny, fun day at the zoo? Absolutely; but if it’s wet, cold and dreary, kids who are able to be disappointed but know that all is not lost are easier to deal with than children who are whining because “you promised we could go to the zoo,” and claim they care not that it is raining and all the animals will be hiding inside, out of the weather. You promised.

There are thousands of possible examples: the college application that is Plan B if the desired, and worked-for, scholarship at your Plan A school doesn’t materialize; the back-up work plan if it takes longer to get a job in your field than you’d expected; the gift you will get for your child if the most popular toy that holiday season is out of stock. Would you rather get a full scholarship to an Ivy League school, a great job that starts exactly two weeks after graduation and be able to score Tickle Me Elmo, the latest Transformer AND the talking pony? Yup, yup and giddy-yup…but those are not all within your control.

The business school model against Plan A, very interestingly researched by Doctors Shin and Milkman, focuses on short-term goals with brief time periods. One test, for example, was that some participants were asked to consider a Plan B if they failed at the brief task while doing the brief task. If you have 10 minutes to unscramble sentences, and the reward for success is a free snack and some are warned up front that, hey, you might want to think about where else on campus you can score some free food in case this doesn’t work out for you, those participants might be a bit distracted from the task at hand. You have given them two tasks. That doesn’t mean they were not motivated for Plan A (the free snack) but rather they had to do two tasks at once: the task for the free snack and figure out where to get free food if the buzzer went off before they finished the first task. This is one of several experiments in their research. Other business writers have emphasized the belief that asking people on a project to have a plan B is like giving them permission to fail at plan A.

This is an interesting perspective and very narrow in its focus. There are risks in over-generalizing the findings of any particular piece of research, something Doctors Shin and Milkman know. Unfortunately, readers who see a non-academic’s cheerful, “Hey, if you develop a plan B you plan to fail,” misstated summary of Doctors’ Shin and Milkman’s work might leap to the conclusion that Plan B means Bad Plan. That is not what the researchers concluded.

I would propose that there are a few common reasons for a bias against adequately thinking through a Plan B when preparing to execute Plan A. These are by no means comprehensive –

  1. “I have done everything that success requires and so I am entitled to success.” Ah, the entitlement myth, in which a benign and biased-towards-you universe bestows what you have earned even though there is far less of whatever you want available than there are hard-working and deserving candidates. Hundreds of people might apply for that scholarship, and all of them have great GPAs, hours of non-mandated community service and glowing endorsements from their local Mother Teresa. Yet the committee (and its computer program) can only give the scholarship to one applicant. Scholarship, job, internship…failing to achieve that one, ideal Plan A doesn’t mean you personally failed. It means that you didn’t get Plan A, probably for many reasons outside of your control.
  2. “I am terrified of not meeting the expectations of those close to me (parents, often) and so most pour everything into Plan A. Anything less than absolute success means I have failed them – and myself.” This speaks to the narcissistic parent (“I am a perfect parent and you, my ought-to-be-perfect child, are the Exhibit A in proof of my perfection”) projecting the need for boundless success and admiration onto the child. Spouses can do this to one another, and children might fall victim to Pygmalion coaches or teachers.
  3. “If I have a Plan B, it will surreptitiously make me turn into a lazy slug who will fail to put in the effort required for Plan A.” This is the, I can’t trust my own strength of character theorem, and one can only say in response to this, “Know thyself.” However, lack of a Plan B is not going to singlehandedly turn an unmotivated sloth into a laser-focused, goal-oriented powerhouse. If you know you need to work on your intrinsic motivation strength, now would be a good time to start.
  4. “Plan A is my heart’s desire and I cannot bear to consider life without it…so I will just not consider the fact that Plan B might be necessary.” This is idealistic and romantic, and if you are not a good-hearted male under age 21, you probably need to accept a teaspoon of reality. If you are a good-hearted male under age 21, I will cut you some slack. That is the healthy age range for passionate idealism with a dose of immortality myth. The rest of us have to deal with the reality that life changes constantly. Your robust good health, your vision and hearing, the career you love, your neighborhood…will all change. If there is not a Plan B, you will have the alternative of crushing despair on top of the burden of grief, time after time after time.

I began this essay, spurred by a friend’s report of an adult daughter who, failing to get the job she’d applied for after college, is moving back home without any particular plan. Apparently, there was no Plan B. This led to curiosity about the “Plan B” issue in general, and discovering Shin and Milkman’s research. Not long after I began this essay, the book Option B, by Sheryl Sandberg and Adam Grant was released. I am looking forward to reading Option B and have no idea of its contents other than it was born within the heartbreak of unexpected grief and the part of the grieving process that requires that we shift to an alternative vision of our future.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2017

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Practical Psychology

My second book, 31 Ways/31 Days: Practical Psychology for the Frazzled Faithful, has just been published and is available via Amazon and other retailers, in both softcover and eBook. In it, I present information from the field of psychology as clear, simple action items for normal, busy people who want to make positive changes.

I love to turn psychological research into something a non-therapist can use, right now, to make relationships and life better.

Sometimes, research sounds ridiculous by the time it hits your news feed. Gleaning the nuggets that can change your life – today – is challenging. Consider, for example, that a cluttered environment contributes to parental stress to the point where it interferes with consistent parenting styles. Of course work, chores and piles of stuff to do covering every flat surface are stressful…but who knew that the clutter added enough stress to interfere with parenting? It’s easier to reduce stress by cutting a little clutter than figuring out what other source of stress to eliminate (hmmm…change jobs? quit working? send the kids to boarding school in Antarctica?) Implementing a manageable, meaningful change makes psychology, with its seemingly arcane tidbits of scientific research, useful to you. It’s not magic or a complete overhaul, but it’s a step in the right direction.

Another useful application of psychological research: even looking at pictures of nature helps reduce stress for everyone, and can improve cognitive skills in people with dementia. Whether it’s you at work, or your beloved elderly family member at home, some photos of nature to fill the eyes from time to time can help. It’s not going to make a miserable job a happy job, or reverse dementia, but it can ease the burden a bit.

If psychology doesn’t make life better and improve our understanding and relationships, it’s not very practical…and if it’s not practical, what good is it?

 

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2017

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Internet Gaming Disorder? Is that a thing?

Yes, it’s a thing.

Are you (or someone you love) hooked on internet gaming?

An excellent recent article on parenting in Real Simple, “Parenting Against the Internet,” cited a statistic that the average adolescent male spends 20 hours a week playing internet games, and the average adolescent female spends 10 hours a week.

The internet can be great: I can look up all sorts of research, read the news, check the weather, contact family and friends around the world, find obscure used books in a mom-and-pop used book store somewhere across the country…

But for some people, the something good turns into a real problem. The American Psychiatric Association, in its 2013 update on diagnoses, the DSM-5, named Internet Gaming Disorder as a “condition for further study,” rather than an official diagnosis with its own billing code. Tune in within a few years; no doubt, that will change.

Twenty hours a week is a lot of time to spend doing something that teaches little, if any, useful knowledge; isolates a person from contact with real people and real life; is sedentary; and creates a world that is not real but full of very real gratification in terms of the brain’s dopamine system. That’s the average; that means for some people, there’s little or none and for some, it’s the equivalent of a full-time job, absorbing time, energy and mental space that could be dedicated to learning real-life skills, creativity, and other parts of life. Please don’t bother emailing me with examples of games where prosocial behavior is rewarded or you have to know useful stuff to be successful; I know. I also know that at some point it’s unhealthy to live in an artificial land of make-believe, instead of taking that pro-social behavior and useful knowledge and using it to make the world, and yourself, better.

What are the warning signs of this disorder that warrants further expert study? Persistent preoccupation; withdrawal symptoms such as irritability when the games are taken away; tolerance (more time playing games as time goes by); unsuccessful attempts to control the amount of time playing (for example, promising to cut back now that school has begun and sliding right back into excess); losing interest in other activities; continued excessive use of games in spite of problems in relationships, job, school, etc.; lying about how much time is spent playing; using games to deal with other problems (the game is a drug to feel better at this point); jeopardizing or already lost significant relationship, job, educational or career opportunities because of involvement in playing internet games (American Psychiatric Association, 2013). Note that these are games – gambling on the internet is already an official diagnosis when carried too far.

Most people can easily see the degree to which these signs are awfully similar to what we would use to assess a problem with alcohol or drugs: preoccupied with drinking? Cranky or shaky when they can’t get their “fix?” Unable to cut back; getting behind in life in all sorts of areas; lying about how much is used…so why are parents apparently turning a blind eye to how much time their kids spend in this world?

Some theories:

  1. Some parents are as active in gaming as their children and have convinced themselves that those excessive hours are better than other things their child might do. Well, yeah; I suppose you could also argue that it’s better for your child to get drunk than to inject heroin, but that doesn’t make getting drunk a desirable behavior.
  2. Some parents are unaware. They do not realize what their kids are doing in their rooms, on their phones, half the night, or when they’re supposedly doing homework, or when they are in a college classroom, not paying attention.
  3. Some parents think it will be outgrown…although the social skills deficits these young addicts have will often interfere with their ability to successfully navigate college, trade schools and work.

Of course, it’s not just teens. There are adults who sometimes work full time, or part-time, and spent 30+ hours gaming each week. They tend to have marital problems, job problems, or both. Perhaps they have neither a relationship nor a job, but do have angry parents who want very much to be empty-nesters, any decade now.

Don’t think this applies to your child, or to you? Try cutting it off for a week. A week’s not that long. No exceptions. Notice what happens. If you’re afraid to even bring it up because you “don’t want to deal with it,” you have just told yourself something very powerful, and somewhat frightening, about your confidence as a parent and your child’s relationship with gaming.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

 

Why is your child so unreasonable?

Kids! They’re so irrational! Unreasonable! They’re…well, kids.

Toddlers are usually not able to understand that the ideas in your head are different than the ideas in their head. Learning that other people don’t know/see/hear/think all the things you do is called developing a “theory of mind.” Before this, kids think everyone knows what they know. If you hide a toy with Joey while Sarah is out of the room, and invite Sarah back in, 3-year-old Joey will not understand how Sarah can not know where the toy is. Joey is still developing a theory of mind. You will know when your child has developed a theory of mind when he or she tries to lie. This usually happens relatively late in the preschool years. Until then, if they know what they want (and are regrettably incoherent) and you fail to understand and comply, they can only reasonably assume (from their perspective) that you are being mean on purpose. They know what they want – how can you NOT?

As children develop a theory of mind, they also develop other signs of brain maturity. One is the ability to “conserve.” This doesn’t mean the Greenpeace/Sierra Club type of conserving. It means that they understand that, whether you break it into four pieces or leave it whole, it’s the same puny graham cracker for snack. The golden days of breaking it in two so they think that there is now “more” are behind you.

As they develop their theory of mind and the ability to understand a bit more about the physical world, they stay very literal for a while, or what cognitive scientists call “concrete.” They are in the real world. This makes it difficult for them to consider multiple aspects of a problem at one time, and makes abstract concepts – like algebra – just about impossible. They might fixate on one aspect of a project or task despite your efforts to get them to consider other aspects. They might memorize things to make you happy, but until their brain reaches a certain point of development (and sooner doesn’t necessarily mean smarter, it just means sooner) algebra and other abstract concepts don’t really “click.”

While, for example, a 15-year-old can be on a debating team and argue in favor of a point with which he or she personally disagrees, a bright 7 or 8 year old would have a great deal of difficulty doing so. This is a function of brain maturation – a process that continues into the early 20s.

So…that’s why your child seems so unreasonable. It’s because their brain is a child’s brain – growing, amazing, absorbing information at lightning speeds. It’s our job to meet them where they are and go with them as they grow.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Too busy!

People brag about the strangest things.

Not getting enough sleep is one; are Americans in some sort of dysfunctional competition to see who can get by on the least possible sleep – regardless of the effect on their mental and physical health?

Another is being busy – so very, very busy – that one could not possibly do anything healthy, or creative, or refreshing in any way.

Is it real busy-ness? It’s hard to say, but I have my suspicions that it often comprises some combination of underestimating how much time is frittered away on time-wasters, taking on a lot of extra and unnecessary tasks, and, sometimes, more than a hint of pride. You know, the people who find out you actually read books in the evening or squeeze in a date night with your spouse and give that little smile and a hint of a sniff when they say, “Well, it must be nice…” Well, yes, actually, it is. Very nice.

Pride, or arrogance, aren’t necessarily obvious. Healthy humans have a normal, natural need to feel needed and wanted. This is a good, but the fear that somehow your absence will cause all of creation – or at least your workplace or the kitchen at home – to immediately crumble into dust is not good. Even Jesus and Moses sometimes sneaked off for some very necessary R&R, either to be alone with God or also with some of their most loved, trusted friends.

Some people are going through a stage of life that is very busy. People with school-aged kids who each  participate in one extra activity will indeed be temporarily overly busy, driving to practice or lessons. They check homework, look under the sofa for shin guards, and use their vacation time for pediatric appointments for yet another ear infection. This stage is transient. Even too-busy parents, though, often hide time-wasters into their day.

When someone asserts always being “too busy” to do things they claim they really want to do, then I suspect that perhaps they don’t actually want to do those things. It would be better to say, “Oh, no – last thing I want to do is be stuck in a gym five mornings a week,” then to dodge exercise by pretending they are just too, too busy. Once they are honest about the issue (apparently they would rather do something else than spend hours on the human version of a hamster wheel) they are free to figure out how to meet the essential need (enough exercise to stay healthy) and stop dodging reality with brag-worthy busy-ness.

It’s hard to give up the busy excuse to oneself. It might be a polite dodge to other people (but remember that “let your yes mean yes and your no mean no” admonition?) but it’s just pointless to lie to oneself.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.