Archives: Consumer Topics

What is panic disorder?

Panic is a rush of overwhelming anxiety that comes on very quickly. People use the word "terror" to describe the severity of the anxiety connected with panic. Sometimes the sudden episode is called a panic attack.

What characteristics are associated with panic disorder?

People who experience panic will have some of the following symptoms:

• Very rapid, pounding heartbeat (Often a feeling that their heart is going to beat out of their chest)
• Increased perspiration
• Shaking
• Feeling of smothering or choking
• Chest pains
• Nausea
• Dizziness
• Lightheadedness
• Numbness and tingling of extremities

Is there a genetic basis for panic disorder?

Yes, panic and panic attacks tend to cluster in certain families. In fact, of those people diagnosed with panic, about fifteen percent (15%) of their family members will also suffer from the disorder.

Does panic affect males, females, or both?

About twice as many women as men are diagnosed with panic.

At what age does panic disorder appear?

Although panic can happen at any age, it generally first occurs in early adulthood.

How common is panic disorder in our society?

Panic is quite common in the United States. About one to two percent (1%-2%) of our population experiences panic.

How is panic disorder diagnosed?

Panic is diagnosed by a mental health professional or by a physician after taking a careful personal history from the patient/client. The diagnosis can be made while the patient/client is having a panic attack, but it can also be made following such an episode.

Since people who are experiencing a panic attack often exhibit symptoms similar to those associated with a heart attack, it is important not to overlook a physical illness that might mimic or contribute to this disorder. If there is any question that the individual might have a physical problem, the patient/client should be examined by a medical doctor. Once the examining physician eliminates possible other medical problems, the diagnosis of panic attack can be made and the patient/client can be treated for anxiety and panic.

How is panic disorder treated?

In an emergency room, rapid acting, antianxiety medications can be given to a person with panic. The antianxiety medicine gives the person relief from his/her panic, and the feelings of terror subside. To prevent future attacks, some types of antianxiety and antidepressant medications can be prescribed.

Therapy, such as behavior, family, or insight-oriented therapy, is very helpful for individuals with a history of panic.

What happens to someone with panic disorder?

About fifty percent (50%) of those with panic disorder recover totally. About twenty percent (20%) of those with the disorder will have repeated panic attacks and suffer long-term. Research shows that more than fifty percent (50%) of those who experience severe anxiety or panic also have depression. For people with panic attacks and depression, treatment of the depression will generally cause the panic to diminish or stop.

What can people do if they need help?

If you, a friend, or a family member would like more information and you have a therapist or a physician, please discuss your concerns with that person.

Resources

For additional information on Panic Disorder, review the NIMH's Understanding Panic Disorder.

Reviewed by athealth on February 6, 2014.

What are paraphilias?

Paraphilias are sometimes referred to as sexual deviations or perversions. Paraphilias include fantasies, behaviors, or sexual urges focusing on unusual objects, activities, or situations. Paraphilias include:

• Sexual urges or sexual fantasies with non-human objects
• Sexual behaviors with non-human objects
• Sexual behaviors involving humiliation or suffering of oneself or another person
• Adult sexual behavior that involves children or nonconsenting adults

Some of the common paraphilias include:

• Exhibitionism
• Fetishism
• Frotteurism
• Pedophilia
• Masochism
• Sadism
• Transvestitism
• Voyeurism

• Exhibitionism: Exhibitionism is a tendency to sexually expose oneself to others. For example, a man's behavior is exhibitionistic when he exposes part his naked body, usually his genitals, to a total stranger. The sexual behavior is almost always limited to the genital exposure, and the person may make no further harmful advances toward the stranger. Most often exhibitionism begins during adolescence and continues into adulthood.
• Fetishism: People with a fetish experience sexual urges and behavior which are associated with non-living objects. For example, the object of the fetish could be an article of female clothing, like female underwear. Usually the fetish begins in adolescence and tends to be quite chronic into adult life.
• Frotteurism: Men have a paraphilia called Frotteurism when the focus of their sexual urges are related to the touching or rubbing of their body against a non-consenting, unfamiliar woman. Usually the male rubs his genital area against the female. Most commonly, the man chooses to attack in a crowded public location and then he disappears into the throng of people. Frotteurism usually begins in adolescence and the abnormal behavior tends to decrease when the man reaches his late twenties.
• Pedophilia: A pedophile is a person, most frequently a man, who focuses his sexual fantasies and behavior toward children. People who enjoy child pornography or "kiddie porn" are pedophiles. Some pedophiles are sexually attracted only toward children and are not at all attracted toward adults. Pedophilia is usually a chronic condition.When a pedophile becomes sexually active with a child he/she may:
  • Undress the child
  • Encourage the child to watch them masturbate
  • Touch or fondle the child's genitals
  • Forcefully perform sexual acts on the child
• Masochism: Masochism is the getting of pleasure, often sexual, from being hurt or humiliated. Sometimes the masochistic acts are limited to verbal humiliation or blindfolding. However, masochistic behavior might include being bound or beaten. Masochism may become even more harmful, however, when a person permits another to use arm or leg restraints accompanied by acts of beating, whipping, or cutting.
• Sadism: Sadism is deriving pleasure, often sexual, from mistreating others. Like other paraphilias, some people have fantasies which are sadistic, but they never act upon them. Also, some people have sexual urges of a sadistic nature, and they find a willing partner who agrees to participate in the sadistic activity. There are people, however, who have sadistic sexual urges who find others whom they victimize with their behavior. Some of the severe activities involved in sexual sadism include burning, beating, stabbing, raping, and killing. Usually the thoughts and/or behaviors of sexual sadism begin in adolescence or early adulthood. The behaviors are not only chronic, but they usually increase in severity with time.
• Transvestitism: Cross-dressing by heterosexual males is called transvestic fetishism or transvestitism. The male with this fetish usually has a variety of female clothes that he uses to cross-dress. While some males will wear only one special piece of female apparel, others fully dress as a female and use full facial make-up to achieve a total female appearance. Often this disorder begins in childhood. It tends to be chronic in nature.
• Voyeurism: Voyeurism is seeking sexual pleasure by secretly observing another. Another name for the behavior is "peeping" or "peeping Tom". The activity brings on sexual excitement and may conclude with masturbation by the voyeur. Voyeurism usually starts in adolescence and tends to persist into adulthood.

Do paraphilias affect males, females, or both?

Paraphilias are primarily male disorders.

At what age do paraphilias appear?

Most paraphilic fantasies begin in late childhood or adolescence and continue throughout adult life. Intensity and occurrence of the fantasies are variable, and they usually decrease as people get older.

How are paraphilias treated?

Cognitive, behavior, and psychoanalytic therapies are used to treat individuals with paraphilias. Some prescription medicines have been used to help decrease the compulsive thinking associated with the paraphilias. Hormones are prescribed occasionally for individuals who experience intrusive sexual thoughts, urges, or abnormally frequent sexual behaviors. Almost always the treatment must be long-term if it is to be effective.

What happens to someone with paraphilias?

The course of paraphilias is usually chronic in nature. The prognosis for complete recovery is generally considered to be guarded.

What can people do if they need help?

If you, a friend, or a family member would like more information and you have a therapist or a physician, please discuss your concerns with that person.

Reviewed by athealth on February 6, 2014.

Developmental psychologists have been interested in how parents influence the development of children's social and instrumental competence since at least the 1920s. One of the most robust approaches to this area is the study of what has been called "parenting style." This Digest defines parenting style, explores four types, and discusses the consequences of the different styles for children.

Parenting Style Defined

Parenting is a complex activity that includes many specific behaviors that work individually and together to influence child outcomes. Although specific parenting behaviors, such as spanking or reading aloud, may influence child development, looking at any specific behavior in isolation may be misleading. Many writers have noted that specific parenting practices are less important in predicting child well-being than is the broad pattern of parenting. Most researchers who attempt to describe this broad parental milieu rely on Diana Baumrind's concept of parenting style. The construct of parenting style is used to capture normal variations in parents' attempts to control and socialize their children (Baumrind, 1991). Two points are critical in understanding this definition. First, parenting style is meant to describe normal variations in parenting. In other words, the parenting style typology Baumrind developed should not be understood to include deviant parenting, such as might be observed in abusive or neglectful homes. Second, Baumrind assumes that normal parenting revolves around issues of control. Although parents may differ in how they try to control or socialize their children and the extent to which they do so, it is assumed that the primary role of all parents is to influence, teach, and control their children.

Parenting style captures two important elements of parenting: parental responsiveness and parental demandingness (Maccoby & Martin, 1983). Parental responsiveness (also referred to as parental warmth or supportiveness) refers to "the extent to which parents intentionally foster individuality, self-regulation, and self-assertion by being attuned, supportive, and acquiescent to children's special needs and demands" (Baumrind, 1991, p. 62). Parental demandingness (also referred to as behavioral control) refers to "the claims parents make on children to become integrated into the family whole, by their maturity demands, supervision, disciplinary efforts and willingness to confront the child who disobeys" (Baumrind, 1991, pp. 61-62).

Four Parenting Styles

Categorizing parents according to whether they are high or low on parental demandingness and responsiveness creates a typology of four parenting styles: indulgent, authoritarian, authoritative, and uninvolved (Maccoby & Martin, 1983). Each of these parenting styles reflects different naturally occurring patterns of parental values, practices, and behaviors (Baumrind, 1991) and a distinct balance of responsiveness and demandingness.

1. Indulgent parents (also referred to as "permissive" or "nondirective") "are more responsive than they are demanding. They are nontraditional and lenient, do not require mature behavior, allow considerable self-regulation, and avoid confrontation" (Baumrind, 1991, p. 62). Indulgent parents may be further divided into two types: democratic parents, who, though lenient, are more conscientious, engaged, and committed to the child, and nondirective parents.
2. Authoritarian parents are highly demanding and directive, but not responsive. "They are obedience- and status-oriented, and expect their orders to be obeyed without explanation" (Baumrind, 1991, p. 62). These parents provide well-ordered and structured environments with clearly stated rules. Authoritarian parents can be divided into two types: nonauthoritarian-directive, who are directive, but not intrusive or autocratic in their use of power, and authoritarian-directive, who are highly intrusive.
3. Authoritative parents are both demanding and responsive. "They monitor and impart clear standards for their children's conduct. They are assertive, but not intrusive and restrictive. Their disciplinary methods are supportive, rather than punitive. They want their children to be assertive as well as socially responsible, and self-regulated as well as cooperative" (Baumrind, 1991, p. 62).
4. Uninvolved parents are low in both responsiveness and demandingness. In extreme cases, this parenting style might encompass both rejecting-neglecting and neglectful parents, although most parents of this type fall within the normal range.

Because parenting style is a typology, rather than a linear combination of responsiveness and demandingness, each parenting style is more than and different from the sum of its parts (Baumrind, 1991). In addition to differing on responsiveness and demandingness, the parenting styles also differ in the extent to which they are characterized by a third dimension: psychological control. Psychological control "refers to control attempts that intrude into the psychological and emotional development of the child" (Barber, 1996, p. 3296) through use of parenting practices such as guilt induction, withdrawal of love, or shaming.

One key difference between authoritarian and authoritative parenting is in the dimension of psychological control. Both authoritarian and authoritative parents place high demands on their children and expect their children to behave appropriately and obey parental rules. Authoritarian parents, however, also expect their children to accept their judgments, values, and goals without questioning. In contrast, authoritative parents are more open to give and take with their children and make greater use of explanations. Thus, although authoritative and authoritarian parents are equally high in behavioral control, authoritative parents tend to be low in psychological control, while authoritarian parents tend to be high.

Consequences for Children

Parenting style has been found to predict child well-being in the domains of social competence, academic performance, psychosocial development, and problem behavior. Research based on parent interviews, child reports, and parent observations consistently finds:

• Children and adolescents whose parents are authoritative rate themselves and are rated by objective measures as more socially and instrumentally competent than those whose parents are nonauthoritative (Baumrind, 1991; Weiss & Schwarz, 1996; Miller et al., 1993).
• Children and adolescents whose parents are uninvolved perform most poorly in all domains.

In general, parental responsiveness predicts social competence and psychosocial functioning, while parental demandingness is associated with instrumental competence and behavioral control (i.e., academic performance and deviance). These findings indicate:

• Children and adolescents from authoritarian families (high in demandingness, but low in responsiveness) tend to perform moderately well in school and be uninvolved in problem behavior, but they have poorer social skills, lower self-esteem, and higher levels of depression.
• Children and adolescents from indulgent homes (high in responsiveness, low in demandingness) are more likely to be involved in problem behavior and perform less well in school, but they have higher self-esteem, better social skills, and lower levels of depression.

In reviewing the literature on parenting style, one is struck by the consistency with which authoritative upbringing is associated with both instrumental and social competence and lower levels of problem behavior in both boys and girls at all developmental stages. The benefits of authoritative parenting and the detrimental effects of uninvolved parenting are evident as early as the preschool years and continue throughout adolescence and into early adulthood.

Although specific differences can be found in the competence evidenced by each group, the largest differences are found between children whose parents are unengaged and their peers with more involved parents. Differences between children from authoritative homes and their peers are equally consistent, but somewhat smaller (Weiss & Schwarz, 1996). Just as authoritative parents appear to be able to balance their conformity demands with their respect for their children's individuality, so children from authoritative homes appear to be able to balance the claims of external conformity and achievement demands with their need for individuation and autonomy.

Sidebar:

Children with ADHD, ODD, and other behavioral disorders are particularly vulnerable to low self-esteem. They frequently experience school problems, have difficulty making friends, and lag behind their peers in psychosocial development. They are more likely than other children to bully and to be bullied. Parents of children with behavior problems experience elevated levels of child-rearing stress, and this may make it more difficult for them to respond to their children in positive, consistent, and supportive ways.

Influence of Sex, Ethnicity, or Family Type

It is important to distinguish between differences in the distribution and the correlates of parenting style in different subpopulations. Although in the United States authoritative parenting is most common among intact, middle-class families of European descent, the relationship between authoritativeness and child outcomes is quite similar across groups. There are some exceptions to this general statement, however: (1) demandingness appears to be less critical to girls' than to boys' well-being (Weiss & Schwarz, 1996), and (2) authoritative parenting predicts good psychosocial outcomes and problem behaviors for adolescents in all ethnic groups studied (African-, Asian-, European-, and Hispanic Americans), but it is associated with academic performance only among European Americans and, to a lesser extent, Hispanic Americans (Steinberg, Dornbusch, & Brown, 1992; Steinberg, Darling, & Fletcher, 1995). Chao (1994) and others (Darling & Steinberg, 1993) have argued that observed ethnic differences in the association of parenting style with child outcomes may be due to differences in social context, parenting practices, or the cultural meaning of specific dimensions of parenting style.

Conclusion

Parenting style provides a robust indicator of parenting functioning that predicts child well-being across a wide spectrum of environments and across diverse communities of children. Both parental responsiveness and parental demandingness are important components of good parenting. Authoritative parenting, which balances clear, high parental demands with emotional responsiveness and recognition of child autonomy, is one of the most consistent family predictors of competence from early childhood through adolescence. However, despite the long and robust tradition of research into parenting style, a number of issues remain outstanding. Foremost among these are issues of definition, developmental change in the manifestation and correlates of parenting styles, and the processes underlying the benefits of authoritative parenting (see Schwarz et al., 1985; Darling & Steinberg, 1993; Baumrind, 1991; and Barber, 1996).

For More Information

1. Barber, B. K. (1996). Parental psychological control: Revisiting a neglected construct. Child Development, 67(6), 3296-3319.
2. Baumrind, D. (1989). Rearing competent children. In W. Damon (Ed.), Child development today and tomorrow (pp. 349-378). San Francisco: Jossey-Bass.
3. Baumrind, D. (1991). The influence of parenting style on adolescent competence and substance use. Journal of Early Adolescence, 11(1), 56-95.
4. Chao, R. K. (1994). Beyond parental control and authoritarian parenting style: Understanding Chinese parenting through the cultural notion of training. Child Development, 65(4), 1111-1119.
5. Darling, N., & Steinberg, L. (1993). Parenting style as context: An integrative model. Psychological Bulletin, 113(3), 487-496.
6. Maccoby, E. E., & Martin, J. A. (1983). Socialization in the context of the family: Parent-child interaction. In P. H. Mussen (Ed.) & E. M. Hetherington (Vol. Ed.), Handbook of child psychology: Vol. 4. Socialization, personality, and social development (4th ed., pp. 1-101). New York: Wiley.
7. Miller, N. B., Cowan, P. A., Cowan, C. P., & Hetherington, E. M. (1993). Externalizing in preschoolers and early adolescents: A cross-study replication of a family model. Developmental Psychology, 29(1), 3-18.
8. Schwarz, J. C., Barton-Henry, M. L., & Pruzinsky, T. (1985). Assessing child-rearing behaviors: A comparison of ratings made by mother, father, child, and sibling on the CRPBI. Child Development, 56(2), 462-479.
9. Steinberg, L., Darling, N., & Fletcher, A. C. (1995). Authoritative parenting and adolescent adjustment: An ecological journey. In P. Moen, G. H. Elder, Jr., & K. Luscher (Eds.), Examining lives in context: Perspectives on the ecology of human development (pp. 423-466). Washington, DC: American Psychological Assn.
10. Steinberg, L., Dornbusch, S. M., & Brown, B. B. (1992). Ethnic differences in adolescent achievement: An ecological perspective. American Psychologist, 47(6), 723-729.
11. Weiss, L. H., & Schwarz, J. C. (1996). The relationship between parenting types and older adolescents' personality, academic achievement, adjustment, and substance use. Child Development, 67(5), 2101-2114.

Clearinghouse on Elementary and Early Childhood Education
Author: Nancy Darling, PhD, MS
EDO-PS-99-3

Reviewed by athealth on February 6, 2014.

Most parents worry about their child when he or she reaches adolescence. Will the child who was once easygoing and helpful become moody and disrespectful? Will the child who was fiercely independent when young become a teen who gives in to peer pressure? Will the child who has had a conventional style of dress suddenly color his or her hair purple?

When adopted children reach adolescence, their parents are likely to be anxious and have an additional set of questions. Will the child become confused about his or her identity? Will a sense of abandonment and rejection replace feelings of security and comfort? Is the child behaving in a way that reflects inner turmoil about the past? Each of these questions leads to a larger issue: Will being adopted make adolescence harder for the child?

These questions don't have simple answers. Only a few studies have compared the psychological well- being of adopted adolescents with that of nonadopted adolescents. Some of those studies conclude that having been adopted makes no difference in adolescent behavior. Others suggest that adopted teenagers are more likely than others to experience problems. Experts disagree about the relative importance of the role of parents, the "climate" of the family, and the natural temperament of the teenager as contributors to adolescent problems. There are two points on which they agree, however. (1) Being adopted is an undeniable part of a teen's history and should not be ignored. (2) Adopted adolescents can successfully confront and resolve their special developmental issues.

This factsheet is a guide to parents of adopted teenagers. It focuses on child development, typical adolescent behavior, the special issues of adopted teenagers, the times when parents should become concerned, and the steps parents can take to make these difficult years more manageable.

How Children Develop

From infancy on, children alternate between bonding with their caregivers and learning to become independent. Infants begin to gain independence by learning to crawl and then walk. As infants become toddlers, they start to give nonverbal and later verbal messages that express their wishes and opinions.

Up to about age 6, children absorb information rapidly, asking questions nonstop. They are able to think about being abandoned, getting lost, or no longer being loved by their parents. They often have trouble telling the difference between reality and fantasy. At the same time, they experience separation from loved ones as they attend preschool or daycare programs and broaden their interests and group of friends.

The inner lives of children take shape between the ages of 6 and 11. From the security of their families, children begin to expand their horizons and participate in more activities away from home. It can be a difficult time. Children must cement their sense of belonging to their family while mastering the knowledge and skills required for independence. It is no wonder that by the time they become teenagers their struggles to form an identity may feel overwhelming and may lead to perplexing, and sometimes troublesome, behavior.

Typical Adolescent Behavior

Adolescence is a trying time of life for both teenagers and their families. The physical aspects of adolescence - a growth spurt, breast development for girls, a deepening of the voice for boys - are obvious and happen quickly, whereas mental and emotional development may take years.

The main challenge for teenagers is to form their own identity - an achievement not nearly as simple as it sounds. It means, according to adoption experts Kenneth W. Watson and Miriam Reitz, that teenagers must define their values, beliefs, gender identification, career choice, and expectations of themselves.

In forming an identity, most adolescents try on a variety of personas. They look for, imitate, and then reject role models. They examine their families critically - idolizing some people, devaluing others. They shun or embrace family values, traditions, ideas, and religious beliefs. Sometimes they have enormous self-confidence; sometimes they feel at loose ends and think of themselves as utterly worthless. They may believe something one day, and then change their minds and think the opposite the next day. Ultimately, they must come to terms with the big questions: Who am I? Where do I belong?

Teenagers are acutely aware that they are growing away from their families. As they look for ways to demonstrate their individuality, they often take on the values, beliefs, and actions of others their age or of celebrities they admire. Even though they are trying to set themselves apart from their families, they often want to look, act, and dress just like their friends.

Teenagers are still dependent on their parents, however, and may veer back and forth between striking out and staying close. "Parents should realize," write Jerome Smith and Franklin Miroff in their book You're Our Child: The Adoption Experience, "that the adolescent is primarily a child and not an adult, except in the biological sense. Emotionally, he is still as dependent on his parents as always."

It is not surprising, therefore, that disagreements between parents and teenagers occur. Adolescents want independence, yet they are unsure how much freedom they can really handle. Parents want their teens to move toward self-sufficiency but often are reluctant to give up control. Teenagers are confused about their futures, and parents are anxious about who or what their sons and daughters will become.

Adolescents wrestle with issues of sexuality and spend time thinking about and wishing for romantic relationships. Parents worry about their teenagers' choices of partners and friends. Often, parents don't know what advice to give or how to give it.

Sidebar:

Children with ADHD and other behavioral disorders are particularly vulnerable to low self-esteem. They frequently experience school problems, have difficulty making friends, and lag behind their peers in psychosocial development. They are more likely than other children to bully and to be bullied. It is important that parents make themselves aware of their children's concerns and respond to them in positive, consistent, and supportive ways.

These kinds of tensions generally characterize the parent-teen relationship. There are additional issues for teens who came to their families through adoption.

Adoption and Adolescence

Adoption adds complexity to parenting adolescents. Adopted teenagers may need extra support in dealing with issues that take on special meaning for them - identity formation, fear of rejection and abandonment, issues of control and autonomy, the feeling of not belonging, and heightened curiosity about the past.

Identity Formation

Identity issues can be difficult for adopted teens because they have two sets of parents. Not knowing about their birthparents can make them question who they really are. It becomes more challenging for them to sort out how they are similar to and different from both sets of parents.

Adopted teenagers may wonder who gave them their particular characteristics. They may want answers to questions their adoptive parents may not be able to provide: Where do I get my artistic talent? Was everyone in my birth family short? What is my ethnic background? Do I have brothers and sisters?

Sixteen-year-old Jennifer explains, "I'm trying to figure out what I want to do in my life. But I'm so confused. I can't move ahead with my future when I don't know anything about my past. It's like starting to read a book in the middle. My big family with cousins and aunts and uncles only makes me aware that I'm alone in my situation. It never bothered me when I was younger. But now, for reasons I can't explain, I feel like a puppet without a string, and it's making me miserable."

Some teens may feel more angry at their adoptive parents than they have ever felt before. They may be critical of how their parents helped them adjust to their adoptive status. They may withdraw into themselves or feel they need to stray far from home to find their true identity.

Fear of Abandonment

Jayne Schooler, an adoption professional in Ohio and the author of Searching for a Past, writes that it is not unusual for adopted teenagers to fear leaving home. Leaving home is scary for most adolescents, but because adoptees have already suffered the loss of one set of parents, it is even more frightening.

Seventeen-year-old Caroline, for instance, who was adopted as an infant, seemed to have her future well in hand. She was offered a partial scholarship to play field hockey at an out-of-state university, and she planned to pursue a career in teaching. Her parents were eager to help their daughter move on to this next part of her life. However, perplexing changes occurred halfway through Caroline's final semester in high school. She began skipping classes. She was "forgetting" to do her homework. She spent more time than usual alone in her room. When her parents mentioned college, she ran into her bedroom and slammed the door.

At first her parents were puzzled. But they soon became alarmed when her grades dropped and her personality changed. They encouraged her to talk to a family friend who was a clinical psychologist. Several months of therapy helped Caroline and her parents understand that moving away from her family and familiar surroundings scared her. Perhaps if she were at school, her parents would forget about her. Maybe there would be no home to go back to. After all, it had happened before.

At her parents' suggestion, Caroline decided to put her college plans on hold for a year. She and her parents continued to participate in counseling to sort out the issues that were blocking her development.

The Badeaus of Philadelphia are the parents of 20 children, 18 of whom were adopted. They see a number of differences in the way their birth children and adopted children cope with separation. "Now that our birth children are adolescents - one's 12 and one's 14," says Sue Badeau, "we see that they are already talking about college...what they want to do when they grow up and how they can't wait to get out of the house! It's the complete opposite for our adopted kids. It seems really difficult for them to imagine themselves as independent people. They seem almost afraid to leave the security of the family."

Issues of Control

The tension between parents who don't want to give up control and the teenager who wants independence is the hallmark of adolescence. This tension may be especially intense for adopted teens who feel that someone else has always made decisions for them: the birthmother made the decision to place them for adoption; the adoptive parents decided whether to accept them. Parents may feel pressure to control their teens, sometimes motivated by concerns that their teens have a predisposition toward antisocial behavior - especially when their teens' birthparents have a history of alcoholism or drug abuse.

Parents worry, too, about their teens' sexual behavior. What if their son or daughter becomes sexually active, becomes or gets a partner pregnant, or gets AIDS? Adopted girls may have particular concerns about sexuality and motherhood. On the one hand, they have the adoptive mother, frequently infertile, and on the other, the birthmother, who had a baby but chose not to raise the child. How do adoptive parents help their daughters come to terms with these different role models?

Because of their fears, many adoptive parents tighten the reins precisely when their teenagers want more freedom. "Kids see it as - You don't trust me,'" says Anne McCabe, postadoption specialist at Tabor Children's Services in Philadelphia and a family therapist in private practice specializing in working with adoptive families. "It can strongly affect the trust level between parents and their teens." McCabe advises that parents and teens work together to identify options for building trust in important areas such as schoolwork, chores, choice of friends, choice of leisure time activities, and curfew. Parents and their teen can come to an agreement on what constitutes trustworthy behavior in each area. They can determine what privileges or consequences will be earned if the teen either demonstrates or doesn't demonstrate the behavior in an identified time frame. Both parties have input, and there are fewer power struggles.

The Feeling of Not Belonging

Teens raised in their birth families can easily see ways in which they are like their family members. Their musical talent comes from their grandmother...Their father also has red hair...Everyone in the family wears glasses. Sometimes adopted teens have no such markers, and, in fact, are reminded frequently that they are different from their nonadopted friends.

This feeling of being different often begins with their physical appearance. Friends frequently look like one of their parents or another relative. Teens who were adopted may not have a relative they resemble. Friends who comment, "You look like your sister," often make an adopted teen even more aware of his or her "outsider" status, even if he or she happens to look like the sister. Sometimes, adopted teenagers won't even correct friends who comment on a family resemblance. It is easier than having to answer the questions that are sure to follow: Who are your real parents? What do they look like? Why didn't they keep you?

"People who note a family resemblance are really trying to say that the child has taken on some of their parents' mannerisms," says McCabe. "In some families, it can become an inside joke. For other children, it can expose a raw nerve."

Teens who have been adopted into a family of a different race (transracial adoption) often feel more alienated from their families than they did when they were younger. They become highly conscious of the obvious physical differences between themselves and their families, and they struggle to integrate their cultural backgrounds into their perceptions of who they are. Some adopted teens may doubt their authenticity as "real" family members and, therefore, feel uncertain about their futures.

Adoptive parents can help transracially adopted teens to feel they belong by making sure that the family frequently associates with other adults and children of the same ethnic background as their teen. They should celebrate their own and their teen's culture as a part of daily life. They should talk about race and culture often, yet tolerate no ethnically or racially biased remarks from others. For further discussion of these and other suggestions for transracial families, see the National Adoption Information Clearinghouse factsheet, "Transracial and Transcultural Adoption." To increase the feeling of belonging for an adopted teen of the same race as his or her parents but who may look very different, parents should point out any similarities that exist between family members. Statements such as "Everyone in our family loves to sleep late on weekends" or "Dad and you are both such Rolling Stones fans, you're driving me crazy!" should be made whenever appropriate.

The Need to Connect With The Past

As adopted teens mature, they think more about how their lives would have been different if they had not been adopted or if they had been adopted by another family. They frequently wonder who they would have become under other circumstances. For them, the need to try on different personalities is particularly meaningful. In addition to all of the possibilities life holds, adoptees realize the possibilities that were lost.

For some adopted teenagers, the feelings of loss and abandonment cause them to think and want more information about their original families. Sometimes they are looking for more information about their medical history. Has anyone in their family had allergies? Heart disease? Cancer? Seventeen-year-old Sheila, who developed unexplained skin rashes, always wondered if others in her birth family had the same condition. As 18-year-old Christopher kept reading more articles about the genetic nature of mental illness, he worried that his mood swings might be an indication of manic-depressive illness that could have been present in his birth family. Adopted as a baby, Sally, now 15, says, "It's impossible for someone who has not been adopted to understand the vacuum created by not knowing where you came from. No matter how much I read or talk to my parents about it I can't fully explain the emptiness I feel."

Some teenagers want to search for their birthparents. Others say they would appreciate having access to medical information, but that they have made peace with their adoptions.

When Teens Were Adopted at an Older Age

Issues for teens adopted at an older age are even more complex. Often they endured abuse or neglect, lived in several foster homes, or moved from relative to relative before finding a permanent family. Their sense of loss and rejection may be intense, and they may suffer from seriously low self-esteem. They also can have severe emotional and behavioral difficulties as a result of early interruptions in the attachment process with their caregivers. It is no wonder that it is hard for them to trust adults - the adults in their early years, for whatever reason, did not meet their emotional needs.

Teens adopted at an older age bring with them memories of times before joining the adoptive family. It is important for them to be allowed to acknowledge those memories and talk about them. Parents of teens adopted at an older age can expect that they and their teens will require professional guidance at some point, or at several points, to help create and maintain healthy family relationships.

When Parents Should Become Concerned...What They Can Do

Adopted teens may experience strong emotions, especially related to their adoption. It would be unusual for their adopted status not to affect them. A teen's sense of abandonment, quest for identity, and need for control probably do not have their origin in poor parenting by the adoptive parents.

If a teen decides to search for his or her birthparents, it is not necessarily an indication of a problem. Research indicates that some adoptees simply have a strong need to know about their biological roots. "One of the misconceptions [that adoptive parents have]," says Marshall Schechter, M.D., professor emeritus in child and adolescent psychiatry at the University of Pennsylvania School of Medicine, "is that they have done something to make their child want to search. They haven't. Everyone needs to know that they are part of a continuum of a family ... As more is learned about genetics, scientists are discovering that many talents or personality traits have a genetic basis. So it should not be surprising that teenagers who focus on developing an identity should begin thinking about their origin."

It is more likely that a teen will have problems in families "where the parents insist that adoption is no different from the biological parent-child relationship," says Kenneth Kirby, Ph.D., from the Department of Clinical Psychiatry at Northwestern University School of Medicine in Chicago. Teens know that it is different. Teens do better when their parents understand their curiosity about their genetic history and allow them to express their grief, anger, and fear.

The following behaviors may indicate a teen is struggling with adoption issues:

• comments about being treated unfairly compared to the family's birth children;
• a new problem in school, such as trouble paying attention;
• a sudden preoccupation with the unknown;
• problems with peers; or
• shutting down emotionally and refusing to share feelings.

If your family style is one of open communication, you may be able to deal with these issues without professional help. Educate yourself through books or workshops run by agencies that provide postadoption services. Join an adoptive parent support group, which can be a valuable resource for families. The Clearinghouse can refer you to adoptive parent support groups in your area. Support groups also exist for adopted teenagers.

Chances are that if you have not been comfortable discussing adoption issues with your child in the past, it will be difficult to begin now. "The time to start talking about these issues is when children are younger," says MaryLou Edgar, postadoption specialist with Tressler Lutheran Children's Services in Wilmington, Delaware. "Otherwise, your kids know you aren't comfortable with the subject. It's like sex. One talk when your child is 12 isn't enough." Nonetheless, even if these discussions have not taken place earlier, it is up to the parents to initiate them with their teenagers, Edgar advises.

Many families benefit from seeing a therapist who specializes in working with adoptive families. Adoptive family organizations, adoption agencies in your area, and the Clearinghouse may be helpful in suggesting knowledgeable therapists. (See the Clearinghouse factsheet, "After Adoption: The Need for Services," for a discussion of the types of therapists. See Addendum II at the end of this factsheet for other tips.)

As with all teens, you should seek professional help if you see any of the following behaviors:

• drug or alcohol abuse;
• a drastic drop in grades or a sharp increase in skipping school;
• withdrawal from family and friends;
• risk taking; or
• suicide threats or attempt.

If adoption is part of the problem, openly addressing adoption issues will improve the chances that the treatment will be effective. Parents who recognize that their teens have two sets of parents and who don't feel threatened by that fact are more likely to establish a more positive environment for their teens, one that will make them feel more comfortable to express their feelings. "Kids know early on what subjects their parents are uncomfortable discussing and will avoid them," says McCabe. "Secrets take a lot of energy. When there is freedom to discuss adoption issues, there is much less of a burden on the family."

"There is a significant difference in the way teenagers perceive themselves when they have information about their birth families - ethnic heritage, abilities, education, or just what they looked like," says Marcie Griffen, postadoption counselor at Hope Cottage Adoption Services in Dallas, Texas. "When they know why they were placed for adoption, it tends to help their self-esteem and give them a better sense of who they are."

Sue Badeau understands her children's need to connect with their biological parents. She and her husband Hector agree that openness is important to the well-being of everyone in the adoption triad (adoptive parents, birthparents, and the adopted person). The Badeaus are committed to helping their children discover their roots if and when they want to. Recently, the Badeaus located the birthmother of four of their children: Flora, Sue Ann, Abel, and George. Flora, 13, was having trouble giving up the fantasy that her birthmother was going to come back for them so "they could live happily ever after." Sue and Hector persuaded their children's birthmother to assist them in helping Flora put her fantasies to rest. The birthmother helped Flora understand why she and her siblings were placed for adoption. Sue Ann was grateful for the chance to have some of her questions answered, but the boys wanted nothing to do with their birthmother at that time. "I keep telling all of my kids that their families did the best that they could," says Sue. "Birthmothers aren't the horrible monsters people make them out to be, but real people who make mistakes."

Conclusion

Adolescence can be a confusing time for teens. Adopted teens may have special issues connected to identity formation, rejection, control, and the need to connect with one's roots. It helps when parents are understanding and supportive. Questions surrounding these issues are not a reflection of adoptive parents' parenting style. Wanting to know about their birth family does not mean that adopted teens are rejecting their adoptive family.

If your family has a long-standing history of openness, honesty, and comfort with adoption, chances are that you will be able to help your teen work through adolescence. When openness has not been your family style, or if you see alarming behaviors such as drug use or withdrawal from enjoyable activities, you should seek professional help.

Mental health experts are confident that adopted teens can confront and resolve their developmental issues just as their nonadopted peers do. With the support and understanding of their parents, adopted teens can forge even stronger family bonds that will continue to nurture their future relationships.

Source:

National Adoption Information Clearinghouse

Author: Written by Gloria Hochman and Anna Huston of the National Adoption Center in Philadelphia, Pennsylvania, for the National Adoption Information Clearinghouse, 1995.

Reviewed by athealth on February 6, 2014.

Although all children can be strong-willed on occasion, some children are much more intensely so, and more often so, than others. Strong-willed children are not different in kind from other children; they differ only in the degree to which the need for self-determination rules their life. But degree makes an enormous difference. For most parents, occasional willfulness is tolerable, but continual willfulness can create a problem as it quickly gathers shaping power of its own. The more often a willful act achieves its objective, the more powerful the child's willfulness becomes.

What separates willful children from those who are not is how they manage not getting what they want. When children who are not generally willful don't get what they want, they may feel sad, shrug off the disappointment, and then go on to something else. Willful children, however, tend to have a different response: telltale anger.

The emotional hallmark of the willful child is getting angry when he doesn't get what he wants. His intense desire turns his aspiration into an imperative, and an imperative into a condition. "I want to have" turns into "I must have" turns into "I should have," and the result is anger when the willful child is denied what he now feels entitled to.

The strong-willed child often believes: "If I want it, then I should get it," "If I'm refused it, I should be given a good reason why," "If I don't want to do it, I shouldn't have to," "If I argue, then I should win." Then, when any of these beliefs are violated, the outcome seems unjust, and so he or she gets angry because a condition of assumed entitlement has not been met.

The parent's job is to help the willful child learn to disconnect "should" from "want," to let go of the conditional view through which he/she sees the situation. So the parent says something like this: "I know when you want something very much it feels like you should be allowed to get it, but life isn't like that. Wanting something very much doesn't mean we should get it. Wanting just means there's something we'd like to have or do, and maybe we'll get some of it, and maybe we won't. And if we don't, we'll still be okay."

Some willfulness seems naturally endowed. After all, children do not enter this world as a blank slate. They are endowed with genes that determine certain physical characteristics, personality, temperament, and aptitudes. Although some infants emerge complacent and compliant from the outset, others seem to be born strong-willed. These children are born intensely committed to satisfaction of their needs and desires, with a tenacious personality, and frustration that is easily aroused when what they want is not immediately forthcoming. Even children who are by nature willful usually increase that willfulness as a function of the parental response to willfulness they receive. Parents who engage in power struggles with their strong-willed child usually end up empowering the child's insistence and opposition.

The development of most willfulness, however, seems not just naturally endowed. It is learned from the experience of family life, often from the very parents who wish such willfulness would lessen or subside. For example, parents who grew up intimidated by their own critical, angry, or even violent parents are often fearful of taking hard stands and offending their own child. In response to their submissiveness, the child may then become extremely dominant and extremely willful because healthy social, emotional, and economic boundaries have not been clearly defined, firmly set, and consistently enforced.

When it comes to having a willful child, parents are often their own worst enemy because there are many direct parental behaviors that encourage strong will in a child. Consider just a few common examples.

There are the adoring parents who cater to their child so much that he comes to feel entitled to always being given what he wants (parental overindulgence is one major contributor to the willfulness of a strong-willed child.)

There are the permissive parents who give extreme freedom of self-determination to the child.

There are the insecure parents who can't say 'no' and who don't want to displease their child and so cannot deny a want or insist upon a limit.

There are the guilty parents who allow the child to exploit their feelings of remorse.

There are the neglectful parents who are too preoccupied with their own lives to adequately supervise their child.

There are the argumentative parents who, by example and interaction, teach their child to stubbornly argue back.

There are the enabling parents who continually rescue their child from the consequences of ill-advised decisions.

There are ambitious parents who, by insistence and example, instill a will to win and excel at all costs because anything less is deemed not good enough.

There are the inconsistent parents who don't stand by or follow through with what they say.

There are demanding parents who give grown up responsibility to a child, expecting the child to contribute to family and take charge of his/her life while very young.

In all these ways, and in many others, parents can be their own worst enemy, complicit in their child's growing willfulness.

It's at the parenting extremes that willfulness is most powerfully nurtured - by strong-willed parents and by weak-willed parents, by overindulgent parents and by neglectful parents, by oppressive parents and by permissive parents. Therefore, if parents have a continually willful child or have a child who is going through a willful phase, it is important that they do not get so preoccupied with their child's determined behavior that they ignore their own.

The critical question for parents of willful children to ask themselves is, "Are we, through our actions or inaction, inadvertently encouraging more inappropriate willfulness in our child?" Parents must continually assess their own complicit behavior so they are not acting to make a child's willfulness worse. How can you discover whether you are enabling your child's willful behaviors? Go through a simple exercise. List ten things you could do or not do to make the child's willful behavior worse. Then ask yourselves, "To what degree are we doing any of these things now?" This will help you see areas where you can start reducing your complicity in the willfulness of your child.

Finally, remember that although a strong-willed child is hard to handle, he or she is actually easy to manage. The child is hard to handle because the child's wants are so strongly felt, and delay or denial of wants creates so much frustration. But the strong-willed child is easily managed because parents control so much of what the child wants. Parents should learn to bargain accordingly. "For you to get what you want, you must do what we want first."

About the Author

Carl E. Pickhardt, PhD, is the author of numerous articles and books on parenting, including The Connected Father: Understanding Your Unique Role and Responsibilities During Your Child Adolescence; Keys To Developing Your Child's Self-Esteem; The Everything Parent's Guide to the Strong-willed Child; and The Future of Your Only Child: How to Guide Your Child to a Happy and Successful Life to be published in 2008. His books are available at amazon.com. © Carl Pickhardt, PhD 2005

Used with permission

Reviewed by athealth on February 6, 2014.

by James Lehman, MSW

Q: Why do parents tend to dismiss inappropriate behavior as "a phase?"

James: When a child is between 18 months and two years old, they'll start to walk away and say "no" to their parent. The child is practicing a new skill. Parents call it a phase because eventually, the "no" goes away and the child starts to operate within the guidelines of the family. When parents see things they can't explain, they call it a phase. Parents are very prepared to tolerate phases. But they're not prepared to tolerate inappropriate behavior. So they label it a "phase" because that makes it easier for them to accept it.

Parents tolerate phases in adolescents in order to accommodate their kids. The sort of phase we're talking about starts at around age twelve. There's more testing of authority and testing of limits. You hear, "I just wanna talk to my friends." "I just wanna stay in my room." Kids spend more time instant messaging and wanting a cell phone. Parents see this correctly as a phase. And at first, they accommodate this. Most parents who are secure about their parenting will understand this and accept it. We see enough of this in our culture-on TV and in magazines-for parents to understand that this is something adolescents and pre-adolescents go through.

What tends to happen, though, is that some kids start to violate family norms, and parents tend to deny that this is separate from the phase. Saying "This isn't fair," and stomping off to your room a couple of times is a phase. Calling your mother filthy names is not. Saying "I only wanna talk to my friends about this. They're they only ones who understand," is a phase. Getting high on drugs or alcohol is not.

Q: If the behavior is inappropriate, does it matter whether or not it's a phase?

James: No, it doesn't. I think the most important thing parents need to know about phases is it's important to the child as well as the parent to maintain appropriate standards and boundaries through the phase. So, we set up situations where the child can act out the need for independence or act out the challenge of authority without being destructive, abusive to others or self-abusive. So parents can say, "If you don't like what's going on, feel free to go to your room. Feel free to say what you don't like." Parents should even accommodate this by giving kids time to say it. I think one of the most effective techniques is to tell your kids that at 7 pm, we'll sit down and talk about the things you think aren't fair. And then we'll go from there. Because then when the kid starts to escalate, you can say, "Save it for seven o'clock." That way, you have a problem-solving time set aside.

But if the kid starts to call his mother and father all these disrespectful names or call his sister or brother foul, sexual names, I think that's not a phase. That's abusive behavior. And it needs to be stopped.

The task of adolescence is individuation. And sometimes adolescents are so uncomfortable with this task that they'll use hostility and abuse to accomplish that. Parents have to maintain the standards during those times. There's no excuse for abuse. That's not a phase. Deal with it as a violation of family rules. Not as a moral issue, not as something to panic about. It's a violation of family rules, and this is how we have to deal with it. Parents should have clear sets of consequences for this so they can manage it.

Q: How do you know when to address a certain behavior, instead of hoping the child grows out of it?

James: If it's hurting the person who's doing it or hurting other family members, people in society, teachers and other students in school, it needs to be addressed. Adolescence is a phase where you start out as a dependent child. It's called the "latency age, "and you end up as an adult, usually in college. Adolescence doesn't end with adolescence. That phase of development lasts into the early twenties, and there are different earmarks for the different parts of that phase. For instance: "I can only talk about this with my friends." "I wanna look hot." "I've gotta look cool." And then you'll see a slow shift to the next phase where they want to date and be popular. Then you'll see a slow shift to the next phase where they individuate themselves from other teenagers. So, at age twelve, it's me and all teens. At age seventeen, it's me and my group.

During this period, it's important for parents to understand that if kids gravitate toward a negative subculture, there's a problem there. In other words, if kids start hanging out with kids who get high all the time, they're getting high, and they'll lie to you about it. But worse than that, they're seeking a subculture that doesn't expect anything else out of them, except that they get high. If you hang out with people who play soccer, they expect you to practice. They expect you to stay healthy. They expect you to show up for games. They expect you to be a team player. There's a cluster of expectations that kids in other groups have. If you're part of the chess team, there's an expectation cluster. If you're part of the honor society, there's an expectation cluster. If you're part of a church group, there's an expectation cluster. When kids gravitate toward groups that don't have any other expectations for them, except that they're juvenile delinquents or they shoplift or they get high, parents should take alarm at that.

Q: So, if you've got a situation that is violating family norms, what's the best way to address it with your child?

James: If you want to talk to kids about these things, I think first you want to choose a time when things are going well. Not when they're going badly. And you want to choose a neutral setting. It shouldn't be at the dinner table. It shouldn't be in the kid's room. It shouldn't be in your bedroom. Pick some place quiet in the living room, where there aren't other kids around. Begin by telling your kids what you see. Not what you think or what you feel. What you see. "I see your grades going down. I found cigarette rolling papers in your room. I see that you're not hanging out with the kids who play soccer anymore, and you used to love soccer. And I'm wondering what's going on. What do you see?" And ask the kid what they see. That should start a discussion, and it should be an interview format, in which the parent is conducting an interview, not a sharing conversation like they would with one of their friends. This isn't, "I feel, you feel." This should be an interview: "This is what I see going on. What's up?"

The kid may turn away. The kid may say, "None of your business." The kid may run a lot of excuses. But the parent has to calmly keep the focus on what they're seeing and what they want to change. And how they can be helpful. Again, the kid may not change, but the parent has planted the seed and met their obligation. And they can have those conversations once or twice a week.

Your kids are going to accept a much wider range of differences than you will as a parent. For a lot of those, you just have to have it established with your kids that these are the rules, and whoever your friends are, this is how you have to behave, and this is what's appropriate in our home. "You can have friends with nose rings and eye rings, but you're not going to have any of those. And as long as we don't have to fight about that, there's no problem."

Is It A Phase? reprinted with permission from Empowering Parents. For more information, visit www.EmpoweringParents.com

Author: James Lehman is a behavioral therapist and the creator of The Total Transformation® Program for parents. He has worked with troubled children and teens for three decades. James holds a Masters Degree in Social Work from Boston University.

Reviewed by athealth on February 5, 2014.

by James Lehman, MSW

Q: Why do kids have behavioral meltdowns and tantrums? What goes on in a child's mind that makes him come unglued?

James: Kids have meltdowns and temper tantrums for two reasons. The first reason is that they have never learned how to manage or have run out of the tools it takes to manage their feelings in a new situation or event. The second reason they have tantrums is because it's been successful for them in the past. They've seen that when they have a tantrum, they get what they want pretty quickly.

It's all about learning and developing coping skills from day one with children. Here's why. If a child is confronted with a situation that he hasn't learned how to manage yet, his response is fight or flight. It's a survival response. Very often, they can't get out of the situation. It may be at the mall, in the car or at grandma's house. If they can't flee the situation, then they fight, and the way that they fight is by acting out or having a meltdown.

If the parents don't respond in an effective way, the child learns that having a meltdown or a temper tantrum will help him accomplish a goal. When a child is in a stressful situation, has a tantrum and the parent gives in to him, that's as far as he needs to go. He won't have to learn how to be patient, manage his anxiety and deal with stress. He just has to act out so that his parent takes care of all that. This is a skill that children learn. It's not because they're bad kids or good kids. It's simply what works for them. They learn a problem-solving skill that says "If I'm disruptive to other people, then it solves my problem." The child doesn't have to deal with the stress because everyone else is busy running around trying to calm him down and they eventually give in to him.

Tantrums are to be expected, but they're not to be rewarded. Parents develop a range of often ineffective ways of responding to and trying to manage the child's behavioral meltdown. They'll either go to one extreme and scream, yell, threaten, restrain, grab or spank the child. Or they go to the other extreme: they give in. The parent solves the problem, but not through the most effective means. In my experience, parents are very resistant to the idea of their kids being unhappy or uncomfortable. They learn what their child has taught them: if you make me uncomfortable, I'm going to make you uncomfortable. When a child throws a tantrum at the mall and kicks and screams on the floor, in effect, he's saying, "You have more to lose than me." You do have more to lose. You're embarrassed. You can't accomplish your goal of shopping in the mall. People are looking at you. You feel like a bad parent, and you think everyone around you considers you a bad parent. The kid has nothing to lose and everything to gain. He doesn't care what people think. He just wants to control you and get an ice cream cone. Inadvertently, parents teach kids that meltdowns work, and as long as something works, it's human nature not to change it.

I think that if meltdowns work for a child, you'll see them continue. But as the child gets older, meltdowns will start to look like abusive or intimidating behavior. It's a tantrum at age 5. At age 15, it's breaking things around the house, threatening physical violence and using abusive language. So those childhood meltdowns become very serious things.

Q: Are tantrums to be expected...or even accepted in children and adolescents? Is it just something they naturally go through?

James: Children are going to get overwhelmed, frustrated, angry and have temper tantrums. The way parents manage that will determine the frequency and intensity of the meltdown. Can we stop meltdowns? Absolutely not. This is a part of childhood development. This is how they get out some very painful or confusing feelings. But can we manage their frequency and can we manage their intensity? Absolutely. It all depends on how we respond to them. Tantrums are to be expected, but they're not to be rewarded. You have to set limits with your child, and teach him the skills to manage overwhelming feelings on his own. If you don't set up a situation where the child has to learn how to manage those overwhelming feelings and negative thoughts on his own, he's never going to learn.

The important thing to remember is that it's not whether tantrums are inevitable. It's how parents manage them that will determine their frequency and intensity.

Q: So, how should a parent manage these outbursts? What's the appropriate response for a parent to have when they see a tantrum so that they can stop the inappropriate behavior and prevent it from happening in the first place?

James: It's important to remember that there's a difference between what the child learns and what the parent says. When you say something to a child, that's not necessarily what he's going to learn. He's not going to learn from what you're saying. He's going to learn from what you're doing. Parents often give speeches about how kids have to behave appropriately. How a certain behavior is not fair to others. How difficult it is and what's going to happen next time. Then what the parent does is give in. Or the parent escalates their own behavior. These are natural responses, but they are ineffective. Kids learn from what parents do, not from what parents say. When you give in to a child after he acts out, then give him a speech about his behavior, you may think, "Good, I taught him a lesson. He understands now." But the kid thinks, "Good, I got the ice cream cone. I got my way." Or, "Good, I didn't have to do it again." Parents often know the right thing to say, but don't know the right thing to do. They're left scratching their heads saying, "I explained this to him a thousand times. I don't know why he doesn't understand." He doesn't understand because there's something in the parent's behavioral response that is reinforcing that behavior. It's a payoff for the kid. And as long as he gets paid off, he's going to keep doing it.

You have to not give into the meltdown, but you have to understand it and what starts it. Step one is to identify what triggers the child's behavior--through either you own observations, knowledge or insight, through what you can elicit from the child or what you observe in the environment. Step two is to teach the child that acting out is not the way to manage this. The key is not to listen to the excuse afterwards; it's getting the kid to understand that when a particular thing happens, he begins to get upset. And when he begins to get upset, there are things he has to do differently in order not to lose control.

The most effective way to do it is to intervene right when the child starts to lose control and say one of the following:

• "This is what seems to trigger you. Let's look at what you do when you get angry."
• "Let's look at what you do when you don't get your way."

Don't say: "How do you feel?" Say, "Let's look at what you do when you get angry."

Show the child what he does when he gets angry or doesn't get his way. Tell him that rolling on the floor or screaming at the top of his lungs won't solve his problem. Then say this:

• "What are you going to do differently the next time this happens?"

With younger children, parents should not give in. If your child has outbursts in the car while you're driving, talk to him before the next outing. Tell him, "Sometimes when we're in the car, you get upset and start screaming. When you do this, it's not safe for us. The next time that happens, I'm going to pull over to the side of the road, and I'm going to give you five minutes to get yourself under control. If you can't get yourself under control, I'm going to turn around, and we'll go home."

I tell parents that when a meltdown happens in a store, leave the store. Explain to the child in the car before you go into the store, "Sometimes when you don't get your way, you get upset and you yell and roll on the floor. If you do that, we're leaving the store. I just want you to know that." As a kid gets older, you can tell him, "I'm leaving the store, and if you resist me or fight me, I'll be in the car. You can find me. You know where the car is." Certainly you wouldn't leave a four-year-old in a store, but with a nine- or a ten-year-old, you might. If they try to play the game of "you can't make me" say, "You're right. I can't make you. I'm going out to the car and I'll call the security guard and maybe they can help you out." You're putting the pressure back on the child to behave appropriately. Is that risky? Of course, there's always risk. But on the other hand, it's risky to give in over and over again. I'm not advising every parent to do this. I'm saying it's an option and you can learn the situations for which it might be appropriate.

Parents need to focus on the fact that a tantrum is a power struggle your kid is trying to have with you. It's a strategy to try to get his way with the least amount of discomfort to him. Sometimes that means blowing up the most discomfort to the parent. Too often, parents forget that they have the power. This kid is trying to wrestle some power from you. As a parent, you hold the cards. You just have to play those cards well. Part of the hand you're dealt has to do with your own parenting skills, your background and your natural ability. But a big part of it is how you play those cards: learning how to use your child's natural skills and abilities, understanding their deficits, and then using your natural skills and abilities to help that child learn to manage situations and understand that acting out and misbehaving is not the way to solve the problem. Parents have this power and they can do this. I see it all the time. Believe me, the payoff to their family life and to their children is immeasurable.

Managing The Meltdown reprinted with permission from Empowering Parents. For more information, visit www.EmpoweringParents.com

Author: James Lehman is a behavioral therapist and the creator of The Total Transformation® Program for parents. He has worked with troubled children and teens for three decades. James holds a Masters Degree in Social Work from Boston University.

Reviewed by athealth on February 5, 2014.

When it comes to parenting after divorce, anger and jealousy are the most destructive emotions, perhaps causing you to hate your ex-spouse. You may be unable to let go of these feelings because you can't forgive your ex-spouse. It is especially difficult if you feel you were dumped for someone else, treated badly during your relationship, or no longer feel loved. When you can't forgive, you stay angry, and this anger is apparent to your child. If you can learn to forgive your ex, you will become less angry, and both you and your child will benefit.

Unfortunately, if you're like many divorced parents, your anger is likely to be expressed in front of your child. You don't want to hurt your child, but when your anger erupts, the fallout is damaging. Sometimes your anger is obvious - derogatory statements or arguing with the other parent in front of your child - or more subtle, such as when you tell your daughter that she doesn't have to listen to her mother. If you haven't learned to forgive, you may act in ways that are damaging to your child.

If you can forgive your ex-spouse, you will go a long way toward keeping your child out of the middle, and be better prepared to model skills of conflict resolution.

If you have truly forgiven your ex-spouse, you will be able to communicate without arguing and bringing up problems of the past. Getting past the "couple conflicts" you've experienced for many years will allow you to focus on your child's needs - and on your own. If you are a forgiving parent, you can say "hello" to the other parent in public places, and act in a business-like way when issues need to be discussed. Forgiving parents treat their ex-spouse just as they would treat other acquaintances and business partners. Divorced parents who have forgiven one another are able to be partners in raising their children. Forgiveness is an important step for responsible, post-divorce parenting.

It is important to remember that if you remain angry at your ex-spouse, you are likely to continue fighting. Whatever the dispute, you will try to win. You must do everything in your power to stop the fighting and reduce the conflicts in front of your child. Use your parenting plan and a different style of communication to avoid conflict. You can use professional mediators, evaluators, and special masters to talk about the issues away from your child. Learn to agree with each other and parent your child the best you can. The key element is to eliminate conflicts in front of your child.

Adapted from Parenting After Divorce: A Guide to Resolving Conflicts and Meeting Your Children's Needs, Philip M. Stahl, PhD. Available at online and local bookstores or directly from Impact Publishers, Inc., PO Box 6016, Atascadero, CA 93423-6016, http://www.bibliotherapy.com/ or phone 1-800-246-7228.

Reviewed by athealth on February 6, 2014.

What is Parkinson's Disease?

Parkinson's disease (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. PD usually affects people over the age of 50. Early symptoms of PD are subtle and occur gradually. In some people the disease progresses more quickly than in others. As the disease progresses, the shaking, or tremor, which affects the majority of PD patients may begin to interfere with daily activities. Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions. There are currently no blood or laboratory tests that have been proven to help in diagnosing sporadic PD. Therefore the diagnosis is based on medical history and a neurological examination. The disease can be difficult to diagnose accurately. Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases.

Is there any treatment?

At present, there is no cure for PD, but a variety of medications provide dramatic relief from the symptoms. Usually, patients are given levodopa combined with carbidopa. Carbidopa delays the conversion of levodopa into dopamine until it reaches the brain. Nerve cells can use levodopa to make dopamine and replenish the brain's dwindling supply. Although levodopa helps at least three-quarters of parkinsonian cases, not all symptoms respond equally to the drug. Bradykinesia and rigidity respond best, while tremor may be only marginally reduced. Problems with balance and other symptoms may not be alleviated at all. Anticholinergics may help control tremor and rigidity. Other drugs, such as bromocriptine, pramipexole, and ropinirole, mimic the role of dopamine in the brain, causing the neurons to react as they would to dopamine. An antiviral drug, amantadine, also appears to reduce symptoms. In May 2006, the FDA approved rasagiline to be used along with levodopa for patients with advanced PD or as a single-drug treatment for early PD.

In some cases, surgery may be appropriate if the disease doesn't respond to drugs. A therapy called deep brain stimulation (DBS) has now been approved by the U.S. Food and Drug Administration. In DBS, electrodes are implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed. DBS can reduce the need for levodopa and related drugs, which in turn decreases the involuntary movements called dyskinesias that are a common side effect of levodopa. It also helps to alleviate fluctuations of symptoms and to reduce tremors, slowness of movements, and gait problems. DBS requires careful programming of the stimulator device in order to work correctly.

What is the prognosis?

PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time. Although some people become severely disabled, others experience only minor motor disruptions. Tremor is the major symptom for some patients, while for others tremor is only a minor complaint and other symptoms are more troublesome. No one can predict which symptoms will affect an individual patient, and the intensity of the symptoms also varies from person to person.

What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS) conducts PD research in laboratories at the National Institutes of Health (NIH) and also supports additional research through grants to major medical institutions across the country. Current research programs funded by the NINDS are using animal models to study how the disease progresses and to develop new drug therapies. Scientists looking for the cause of PD continue to search for possible environmental factors, such as toxins, that may trigger the disorder, and study genetic factors to determine how defective genes play a role. Other scientists are working to develop new protective drugs that can delay, prevent, or reverse the disease.

Content source: National Institute of Neurological Disorders and Stroke

Reviewed by athealth on February 6, 2014.

Effect of ADHD on Relationships

One effect Attention-Deficit/Hyperactivity Disorder (ADHD) can have on a child's life is to make childhood friendships, or peer relationships, very difficult. These relationships contribute to children's immediate happiness and may be very important to their long-term development.

• Research suggests that children with difficulty in their peer relationships, like being rejected by peers or not having a close friend, may in some cases have higher risk for anxiety, behavioral and mood disorders, substance abuse and delinquency as teenagers.^1,2
• Parents of children with ADHD may be much less likely to report that their child plays with groups of friends or is involved in after-school activities, and half as likely to report that their child has many good friends. Parents of children with ADHD may be more than twice as likely than other parents to report that their child is picked on at school or has trouble getting along with other children.³

How does ADHD interfere with peer relationships?

Exactly how ADHD contributes to social problems is not fully understood. Several studies have found that children with predominantly inattentive ADHD may be perceived as shy or withdrawn by their peers. Research strongly indicates that aggressive behavior in children with symptoms of impulsivity/hyperactivity may play a significant role in peer rejection. In addition, other behavioral disorders often occur along with ADHD. Children with ADHD and other disorders appear to face greater impairments in their relationships with peers. ^1,2,4,5

Having ADHD does not mean a person has to have poor peer relationships.

Not everyone with ADHD has difficulty getting along with others. For those who do, many things can be done to improve the person's relationships. The earlier a child's difficulties with peers are noticed, the more successful intervention may be. Although researchers have not provided definitive answers, some things parents might consider as they help their child build and strengthen peer relationships are:

• Recognize the importance of healthy peer relationships for children. These relationships can be just as important as grades to school success.
• Maintain on-going communication with people from important areas of your child's life (such as teachers, school counselors, after-school activity leaders, health care providers, etc.). Keep up-dated on your child's social development in community and school settings.
• Involve your child in activities with his or her peers. Communicate with other parents, sports coaches and other involved adults about any progress or problems that may develop with your child.
• Peer programs can be helpful, particularly for older children and teenagers. Schools and communities often have such programs available. You may want to discuss the possibility of your child's participation with program directors and your child's care providers.

References

1. Woodward, Lianne J. and Ferguson, David M. Childhood Peer Relationship Problems and Psychosocial Adjustment in Late Adolescence. Journal of Abnormal Child Psychology, February 1999.
2. Hann, Della M. and Borek, Nicolette, Eds. Taking Stock of Risk Factors for Child/Youth Externalizing Behavior Problems. Department of Health and Human Services, Public Health Service, National Institute of Mental Health/NIH, 2001.
3. New York University Child Study Center. I.M.P.A.C.T. (Investigating the Mindset of Parents about ADHD & Children Today) Survey, 2001.
4. Hodgens, J. Bart; Cole, Joyce; and Boldizar, Janet. Peer-Based Differences Among Boys With ADHD. Journal of Clinical Child Psychology, 2000, 29(3):443-452.
5. Bagwell, Catherine L.; Molina, Brooke SG; Pelham, Jr., William E.; and Hoza, Betsy. Attention-Deficit Hyperactivity Disorder and Problems in peer Relations: Predictions From Childhood to Adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, November 2001, 40(11):1285-1292.

National Center on Birth Defects & Developmental Disabilities
Centers for Disease Control and Prevention
NCBDDD Pub. No. April, 2002

Reviewed by athealth on February 6, 2014.