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Marital infidelity often makes front page news, especially when it involves such notable public figures as former New York Governor Elliot Spitzer, South Carolina Governor Mark Sanford, and former Senator and Presidential candidate John Edwards.

Infidelity happens in the lives of ordinary people, too. According to a 2006 report on American Sexual Behavior by the National Opinion Research Center, 25% of married men and 13% of married women have had affairs. Affairs can be devastating to a marriage and can cause tremendous emotional distress to the offended spouse and children in the marriage.

An affair is based on deception and betrayal, and it is often, but not always, a symptom of marital issues that have not been faced. It can also involve intra psychic problems on the part of the offending spouse. Affairs can be emotional as well as sexual and can be long-lasting or one night stands. The emergence of Internet affairs is a recent phenomenon made possible by the development of technology.

Generally, emotional affairs with sexual relationships are the most devastating to the marital relationship.

Affairs may start with inappropriate self-disclosure to another person, as self-disclosure of highly personal issues can lead to intimacy. This often indicates that the married couple cannot effectively communicate feelings or needs. Psychiatric implications of affairs include depression, severe anxiety, and trauma on the part of the betrayed spouse. The offending souse can also become depressed and anxious if threatened with the loss of a valued relationship.

Warning signs are sometimes present and can include disinterest, lying, lack of transparency with financial matters, inappropriate travel or e-mails and cell phone calls. Treatment requires determining commitment to work on the marriage, rebuilding trust, complete transparency, recognizing that anger is often a reaction to being hurt, and taking responsibility for the affair. When the offending spouse is genuinely sorry for the affair, the hurt partner needs to verbalize the acceptance of the apology and a willingness to start the forgiveness process. Forgiveness and rebuilding trust can be a long, arduous process. The couple will need to identify and implement behavioral changes that enhance their relationship and provide self soothing techniques for the hurt spouse .Therapy often involves conjoint treatment with individual sessions for each spouse. Therapy can be difficult, and at times medication may be recommended to treat the severe distress that is experienced. In treatment, the couple will need to address the needs of their children, too.

Cheating does not have to end a relationship. It can lead to rebuilding the marriage, but there has to be commitment, a willingness to take full responsibility for offending behavior, and a readiness to learn and change on the part of both partners. Once the couple is back on track, they will need to be acutely aware of warning signs of future marital distress.

Author: Phillip L. Elbaum, LCSW, CADC
Phillip L. Elbaum, MSW, LCSW, CADC, is a licensed clinical social worker who has a clinical practice in Deerfield, Illinois.

Reviewed by athealth on February 5, 2014.

What are inhalants?

If you've ever come across a smelly marker, you've experienced an inhalant. They seem harmless, but they can actually be quite dangerous. Inhalants are chemical vapors that people inhale on purpose to get "high." The vapors produce mind-altering, and sometimes disastrous, effects. These vapors are in a variety of products common in almost any home or workplace. Examples are some paints, glues, gasoline, and cleaning fluids. Many people do not think of these products as drugs because they were never meant to be used to achieve an intoxicating effect. But when they are intentionally inhaled to produce a "high," they can cause serious harm.

Although inhalants differ in their effects, they generally fall into the following categories:

Volatile Solvents, liquids that vaporize at room temperature, present in:

• Certain industrial or household products, such as paint thinner, nail polish remover, degreaser, dry-cleaning fluid, gasoline, and contact cement
• Some art or office supplies, such as correction fluid, felt-tip marker fluid, and electronic contact cleaner

Aerosols, sprays that contain propellants and solvents, include:

• Spray paint, hair spray, deodorant spray, vegetable oil sprays, and fabric protector spray

Gases, which may be in household or commercial products, or used as medical anesthetics, such as in:

• Butane lighters, propane tanks, whipped cream dispensers, and refrigerant gases
• Anesthesia, including ether, chloroform, halothane, and nitrous oxide

Nitrites are a class of inhalants used primarily as sexual enhancers. Organic nitrites include amyl, butyl, and cyclohexyl nitrites and other related compounds. Amyl nitrite was used in the past by doctors to alleviate chest pain and is sometimes used today for diagnostic purposes in heart examinations. When marketed for illicit use, these nitrites are often sold in small brown bottles and labeled as "video head cleaner," "room odorizer," "leather cleaner," or "liquid aroma."

What Are the Common Street Names?

Common slang for inhalants includes "laughing gas" (nitrous oxide), "snappers" (amyl nitrite), "poppers" (amyl nitrite and butyl nitrite), "whippets" (fluorinated hydrocarbons, found in whipped cream dispensers), "bold" (nitrites), and "rush" (nitrites).

Who Abuses Inhalants?

Inhalants are often among the first drugs that young adolescents abuse. In fact, they are one of the few classes of substances that are abused more by younger adolescents than older ones. Inhalant abuse can become chronic and continue into adulthood.

Data from national and state surveys suggest that inhalant abuse is most common among 7th through 9th graders. For example, in the Monitoring the Future study, an annual NIDA-supported survey of the Nation's secondary school students, 8th graders regularly report the highest rate of current, past-year, and lifetime inhalant abuse compared to 10th and 12th graders. In 2011, 7 percent of 8th graders, 4.5 percent of 10th graders, and 3.2 percent of 12th graders reported abusing inhalants in the year prior to the survey. One of the reasons may be that, according to the 2011 survey, 41 percent of 8th graders don't consider the regular use of inhalants to be harmful, and 65 percent don't think trying inhalants once or twice is risky. Young teens may not understand the risks of inhalant use as well as they should.

How Are They Abused?

People who abuse inhalants breathe in the vapors through their nose or mouth, usually in one of these ways:

• "Sniffing" or "snorting" fumes from containers
• Spraying aerosols directly into the nose or mouth
• Sniffing or inhaling fumes from substances sprayed or placed into a plastic or paper bag ("bagging")
• "Huffing" from an inhalant-soaked rag stuffed in the mouth
• Inhaling from balloons filled with nitrous oxide

Because the intoxication, or "high," lasts only a few minutes, people who abuse inhalants often try to make the feeling last longer by inhaling repeatedly over several hours.

What Are the Common Effects?

Initial Effects

The lungs absorb inhaled chemicals into the bloodstream very quickly, sending them throughout the brain and body. Within minutes of inhalation, users feel "high." The effects are similar to those produced by alcohol and may include slurred speech, lack of coordination, euphoria, and dizziness. The high usually lasts only a few minutes.

With repeated inhalations, many users feel less inhibited and less in control. Some may feel drowsy for several hours and experience a lingering headache.

Effects on the Brain

Inhalants often contain more than one chemical. Some chemicals leave the body quickly, but others stay for a long time and get absorbed by fatty tissues in the brain and central nervous system.

One of these fatty tissues is myelin, a protective cover that surrounds many of the body's nerve fibers. Myelin helps nerve fibers carry their messages to and from the brain. Damage to myelin can slow down communication between nerve fibers.

Long-term inhalant use can break down myelin. When this happens, nerve cells are not able to transmit messages as efficiently, which can cause muscle spasms and tremors or even permanent difficulty with basic actions like walking, bending, and talking. These effects are similar to what happens to patients with multiple sclerosis - a disease that also affects myelin.

Inhalants also can damage brain cells by preventing them from receiving enough oxygen. The effects of this condition, also known as brain hypoxia, depend on the area of the brain affected. The hippocampus, for example, helps control memory, so someone who repeatedly abuses inhalants may lose the ability to learn new things or may have a hard time carrying on simple conversations. If the cerebral cortex is affected, the ability to solve complex problems and plan ahead will be compromised. And, if the cerebellum is affected, it can cause a person to move slowly or clumsily.

Inhalants can be addictive. Long-term use can lead to compulsive drug seeking and use, and mild withdrawal symptoms.

Other Health Effects

Regular abuse of inhalants can cause serious harm to vital organs besides the brain. Inhalants can cause heart damage, liver failure, and muscle weakness. Certain inhalants can also cause the body to produce fewer blood cells, which can lead to a condition known as aplastic anemia (in which the bone marrow is unable to produce blood cells). Frequent long-term use of certain inhalants can cause a permanent change or malfunction of peripheral nerves, called polyneuropathy.

What can you do to prevent inhalant abuse?

One of the most important steps you can take is to talk with your children or other youngsters about not experimenting even a first time with inhalants. In addition, talk with your children's teachers, guidance counselors, and coaches. By discussing this problem openly and stressing the devastating consequences of inhalant abuse, you can help prevent a tragedy.

If you suspect your child or someone you know is an inhalant abuser, what can you do to help?

Be alert for symptoms of inhalant abuse. If you suspect there's a problem, you should consider seeking professional help.

Content source: NIDA for Teens

Reviewed by athealth on February 5, 2014.

Intellectual disability is characterized both by a significantly below-average score on a test of mental ability or intelligence and by limitations in the ability to function in areas of daily life, such as communication, self-care, and getting along in social situations and school activities. Intellectual disability is sometimes referred to as a cognitive disability or mental retardation.

Children with intellectual disability can and do learn new skills, but they develop more slowly than children with average intelligence and adaptive skills. There are different degrees of Intellectual disability, ranging from mild to profound. A person's level of Intellectual disability can be defined by their intelligence quotient (IQ), or by the types and amount of support they need.

People with intellectual disability may have other disabilities as well. Examples of these coexisting conditions include cerebral palsy, seizure disorders, vision impairment, hearing loss, and attention-deficit/hyperactivity disorder (ADHD). Children with severe intellectual disability are more likely to have additional disabilities than are children with mild Intellectual disability.

How common is intellectual disability?

Intellectual disability is the most common developmental disorder. To learn just how common it is, CDC is tracking the number of children with intellectual disability in a five-county area in metropolitan Atlanta (Georgia). This activity is part of the Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP). For the purposes of tracking, MADDSP defines intellectual disabilities in 8-year-old children by the presence of a score of 70 or below on the most recent test of intellectual functioning. In 1996, an estimated 16 per 1,000 8-year-old children in metro Atlanta, or about 1 in 63, had an intellectual disability. In 2000, the prevalence was an estimated 12 per 1,000, or 1 in 83, 8-year-olds. In 1996 and 2000, respectively, 29% and 35% of children with intellectual disabilities also had one or more other developmental disabilities tracked by MADDSP.

CDC also studied how many children in metropolitan Atlanta had intellectual disability in the mid-1980s. This project was done as part of the Metropolitan Atlanta Developmental Disabilities Study (MADDS), which studied how common certain disabilities were in 10-year-old children. We found that 12 of every 1,000 10-year-old children had intellectual disability. Mild intellectual disability was 3 times more common than severe intellectual disability. As in MADDSP, intellectual disability was more common in boys than in girls, and more common in black children than in white children.

In another study, CDC used data from the U.S. Department of Education and the Social Security Administration to find the number of people with intellectual disability in the United States in 1993. The study showed that about 1.5 million children and adults (ages 6-64 years) had intellectual disability. The highest rate of intellectual disability was found in West Virginia and the lowest rate was found in Alaska.

• The Autism and Developmental Disabilities Monitoring (ADDM) Program tracked the number of children with autism spectrum disorders and intellectual disabilities in five sites in 2002 and four sites in 2006.
• Fetal alcohol syndrome surveillance programs track the number of children with FAS in five states.
• CDC works with vaccine programs to prevent infectious diseases that may cause intellectual disabilities.
• Community-based studies are exploring effective ways that parents can help improve developmental outcomes for their children.

What causes intellectual disability? Can it be prevented?

Intellectual disability can start anytime before a child reaches the age of 18 years. It can be caused by injury, disease, or a brain abnormality. These causes can happen before a child is born or during childhood. For many children, the cause of their intellectual disability is not known. Some of the most common known causes of intellectual disability are Down syndrome, fetal alcohol syndrome, and fragile X syndrome, all of which occur before birth. Other causes that take place before a child is born include genetic conditions (such as Cri-du-chat syndrome or Prader-Willi syndrome), infections (such as congenital cytomegalovirus), or birth defects that affect the brain (such as hydrocephalus or cortical atrophy). Other causes of intellectual disability (such as asphyxia) happen while a baby is being born or soon after birth. Still other causes of intellectual disability do not happen until a child is older. These may include serious head injury, stroke, or certain infections such as meningitis.

If you would like to learn more about a specific genetic condition that you think could cause intellectual disability, you can go to the National Library of Medicine's Genetics Home Reference Web site. Information on each genetic condition includes symptoms, how common it is, related genes, treatments, and links to resources where you can learn more about the condition. The Genetics Home Reference also can help you learn more about genetics, including genetic testing, genetic counseling, and gene therapy.

Right now, we do not know how to prevent most conditions that cause intellectual disability. However, there are some causes that can be prevented. Fetal alcohol syndrome (FAS) is one such cause. A woman can prevent FAS by not drinking when she is pregnant. CDC funds several projects to study how common FAS is, how to encourage women not to drink during pregnancy, and how to help people with FAS and their families.

Some metabolic conditions, such as phenylketonuria (PKU), galactosemia, and congenital hypothyroidism, can cause intellectual disability and other problems if babies with these conditions do not begin treatment soon after birth. Parents and doctors can find out if a child has one of these conditions through a simple blood test or heel prick. Newborns in the United States are tested soon after birth, but different states test for different conditions. Parents can request that their baby be tested for all conditions that have tests. Children that do have these conditions are usually treated with medicine or put on a special diet. If the correct treatment is started soon enough after the child is born and continues as long as needed, the child will not have intellectual disability.

It's also important for women with PKU to follow a special diet when they are pregnant. If they do not follow their diets, their babies are very likely to be affected by intellectual disability and other birth defects.

Another cause of intellectual disability that can be prevented is kernicterus, a kind of brain damage that happens when a newborn baby has too much jaundice. In some newborn babies, the liver makes too much yellow pigment called bilirubin. If too much bilirubin builds up in a new baby's body, the skin and whites of the eyes turn yellow. This yellow coloring is called jaundice. A little jaundice is not a problem. It is actually very common in newborn babies and usually goes away by itself. Some babies, however, have too much jaundice. If not treated, these high levels of bilirubin can damage a baby's brain. Kernicterus most often causes cerebral palsy and hearing loss, but in some children it can also cause intellectual disability. Kernicterus can be prevented by using special lights (phototherapy) or other therapies to treat babies.

What is the cost or economic impact associated with intellectual disability?

Many people with [intellectual disability] need long-term services or care. The average lifetime cost for one person with mental retardation is estimated to be $1,014,000 (in 2003 dollars). This represents costs over and above those experienced by a person who does not have a disability.

It is estimated that the lifetime costs for all people with mental retardation who were born in 2000 will total $51.2 billion (in 2003 dollars). These costs include both direct and indirect costs. Direct medical costs, such as doctor visits, prescription drugs, and inpatient hospital stays, make up 14% of these costs. Direct nonmedical expenses, such as home modifications and special education, make up 10% of the costs. Indirect costs, which include the value of lost wages when a person dies early, cannot work, or is limited in the amount or type of work he or she can do, make up 76% of the costs.

These estimates do not include other expenses, such as hospital outpatient visits, emergency department visits, residential care, and family out-of-pocket expenses. The actual economic costs of mental retardation are, therefore, even higher than what is reported here.

Where can I go to learn more about intellectual disability and mental retardation?

National Information Center on Children and Youth with Disabilities (NICHCY)

NICHCY provides information on disabilities and disability-related issues for families, teachers, and other professionals. NICHCY has a fact sheet about mental retardation that includes general information on topics such as diagnosis and causes as well as tips for parents and teachers. NICHCY staff will also give information and referrals over the phone (800-695-0285) or by email ([email protected]). Website: General Information about Mental Retardation

MEDLINEplus: Developmental Disabilities

MEDLINEplus is an online service of the National Library of Medicine. MEDLINEplus is designed to link you to information on specific health topics, including developmental disabilities. Information about mental retardation is included on the Developmental Disabilities page. MEDLINEplus brings together information from many sources and is updated every day. This page includes information on the latest news, general overviews, clinical trials, coping, diagnosis and symptoms, research, specific conditions, law and policy, organizations, children, seniors. Some materials are in Spanish. Website: MEDLINEplus Health Information: Developmental Disabilities

National Center on Birth Defects and Developmental Disabilities (NCBDDD) Publications

NCBDDD staff have written many scientific articles on mental retardation. These articles examine such topics as how common mental retardation is, and factors such as low birth weight or smoking during pregnancy that increase the risk that a child will have mental retardation. You can see a list of these papers (starting in 1990) by using the keyword search on the NCBDDD publications Web page. Choose "mental retardation" in the keyword box on the search page. You can choose whether you want the list to be sorted by author or by date. You can also choose to have the list appear with or without graphics. Click on the Submit button. You will see a list of papers that are about mental retardation. The list will include the complete reference for each paper and a link to an abstract of the paper or to the full text, when available. Website: NCBDDD publications keyword search page

Source:

National Center on Birth Defects and Developmental Disabilities
http://www.cdc.gov/ncbddd/dd/ddmr.htm

Reviewed by athealth on February 5, 2014.

What is intimate partner violence (IVP)?

Intimate partner violence (IPV) is abuse that occurs between two people in a close relationship. The term "intimate partner" includes current and former spouses and dating partners. IPV exists along a continuum from a single episode of violence to ongoing battering.

IPV includes four types of behavior:

• Physical abuse is when a person hurts or tries to hurt a partner by hitting, kicking, burning, or other physical force.
• Sexual abuse is forcing a partner to take part in a sex act when the partner does not consent.
• Threats of physical or sexual abuse include the use of words, gestures, weapons, or other means to communicate the intent to cause harm.
• Emotional abuse is threatening a partner or his or her possessions or loved ones, or harming a partner's sense of self-worth. Examples are stalking, name-calling, intimidation, or not letting a partner see friends and family.

Often, IPV starts with emotional abuse. This behavior can progress to physical or sexual assault. Several types of IPV may occur together.

Why is IPV a public health problem?

Many victims do not report IPV to police, friends, or family.¹ Victims think others will not believe them and that the police cannot help.¹

• Each year, women experience about 4.8 million intimate partner related physical assaults and rapes. Men are the victims of about 2.9 million intimate partner related physical assaults.¹
• IPV resulted in 1,544 deaths in 2004. Of these deaths, 25% were males and 75% were females.²
• The cost of IPV was an estimated $5.8 billion in 1995. Updated to 2003 dollars, that's more than $8.3 billion.^3,4 This cost includes medical care, mental health services, and lost productivity (e.g., time away from work).

How does IPV affect health?

IPV can affect health in many ways. The longer the abuse goes on, the more serious the effects on the victim.

Many victims suffer physical injuries. Some are minor like cuts, scratches, bruises, and welts. Others are more serious and can cause lasting disabilities. These include broken bones, internal bleeding, and head trauma.

Not all injuries are physical. IPV can also cause emotional harm. Victims often have low self-esteem. They may have a hard time trusting others and being in relationships. The anger and stress that victims feel may lead to eating disorders and depression. Some victims even think about or commit suicide.

IPV is linked to harmful health behaviors as well. Victims are more likely to smoke, abuse alcohol, use drugs, and engage in risky sexual activity.

What are some risk factors for IPV?

Several factors can increase the risk that someone will hurt his or her partner. However, having these risk factors does not always mean that IPV will occur.

Some risk factors for perpetration (hurting a partner) include:

• Using drugs or alcohol, especially drinking heavily
• Witnessing or experiencing IPV as a child or adolescent increases one's risk of both perpetrating IPV and becoming a victim of IPV
• Unemployment, which can cause feelings of stress
• Lack of communication skills, particularly in the context of problematic situations with their intimate partners

How can we prevent IPV?

The goal is to stop IPV before it begins. Strategies that promote healthy dating relationships are important. These strategies should focus on young people when they are learning skills for dating. This approach can help those at risk from becoming victims or offenders of IPV.

Traditionally, women's groups have addressed IPV by setting up crisis hotlines and shelters for battered women. But, both men and women can work with young people to prevent IPV. Adults can help change social norms, be role models, mentor youth, and work with others to end this violence. For example, by modeling nonviolent relationships, men and women can send the message to young boys and girls that violence is not okay.

Safety Tips for You and Your Family

• If you are the victim of intimate partner violence, do not blame yourself. Talk with people you trust and seek services. Contact your local battered women's shelter or the National Domestic Violence Hotline at 800-799-SAFE (7233), 800-787-3224 TDD, or http://www.ndvh.org. They can provide you with helpful information and advice. 

• If you are or think you may become a perpetrator of intimate partner violence contact the National Domestic Violence Hotline at 800-799-SAFE (7233), 800-787-3224 (TDD), or http://www.ndvh.org. They can provide you with helpful contact information.
• Recognize early warning signs for physical violence such as a partner's extreme jealousy, controlling behavior, verbal threats, history of violent tendencies or abusing others, and verbal or emotional abuse.
• Know what services are available for victims and perpetrators of intimate partner violence and their children in case you or a friend should need help.
• Learn more about intimate partner violence. Information is available in libraries, from local and national domestic violence organizations, and through the Internet. The more you know about intimate partner violence, the easier it will be to recognize it and help friends who may be victims or perpetrators.

References

1. Tjaden P, Thoennes N. Extent, nature, and consequences of intimate partner violence: findings from the National Violence Against Women Survey. Washington (DC): Department of Justice (US); 2000. Publication No. NCJ 181867. Available from: URL: www.ojp.usdoj.gov/nij/pubs-sum/181867.htm
2. Department of Justice, Bureau of Justice Statistics. Homicide trends in the United States [online]. [cited 2006 Aug 28]. Available from URL: www.ojp.usdoj.gov/bjs/homicide/intimates.htm.
3. Centers for Disease Control and Prevention (CDC). Costs of intimate partner violence against women in the United States. Atlanta (GA): CDC, National Center for Injury Prevention and Control; 2003. [cited 2006 May 22]. Available from: URL: www.cdc.gov/ncipc/pub-res/ipv_cost/ipv.htm.
4. Max W, Rice DP, Finkelstein E, Bardwell RA, Leadbetter S. The economic toll of intimate partner violence against women in the United States. Violence and Victims 2004;19(3):259-72.

Adapted from Understanding Intimate Partner Violence Fact Sheet 2006
Centers for Disease Control and Prevention
National Center for Injury Prevention and Control

Reviewed by athealth on February 5, 2014.

A key component to successful therapy is the relationship between the therapist and client, Drs. Bernard Schwartz and John V. Flowers suggest. The therapist and client must develop trust and a strong bond, and the therapist must communicate caring and empathy for the client.

"Techniques, though useful, are insufficient by themselves," Schwartz and Flowers insist, and they give an example that illustrates this problem:

"Adrian was the poster child of a graduate psychology student. He rarely did less than perfectly on papers and exams, and he had published several professional-level research papers by the time he graduated. But when he started practicing, one small problem arose - his client dropout rate was nearly as high as his grades had been. This was not a case of not being adroit at diagnosis and treatment planning; he knew what to do and how to do it.

"Adrian would have been a great therapist - if it hadn't been for the clients. He just didn't know how to connect with them. Reviewing Adrian's taped sessions, his supervisors determined that he approached therapy as if it were analogous to repairing an automobile - tell the customers (clients) what the problem is, what needs to be done to fix it, and when it will be finished. The human element was missing. For Adrian there was never any time for chitchat, for asking about how the client's favorite team did that week, where they were going to spend their upcoming vacation, or whether the kids had recovered from the flu. Instead it was 'How did the homework assignment go?' 'On a scale from zero to ten, where is the depression this week?' These are relevant questions but not the stuff of which bonds are made."

We can learn from Adrian's mistakes. The relationship between therapist and client must come first. Schwartz and Flowers offer some suggestions in their book, Thoughts for Therapists (Impact Publishers), for strengthening the therapist-client bond:

• Treat each session as an opportunity to bond with your client. "Warmly welcome the client- making eye contact, shaking hands and perhaps offering a beverage. All too often therapists wave in the next client much as an accountant does so at tax time - 'next victim?'" (Eve Lipchik)
• Ask the client periodically if they feel understood and respected.
• Voice your admiration for demonstrations of client strengths, survival skills, and personality characteristics.
• Convey to clients that their struggles, successes, and setbacks matter to you - that their wellbeing is a deep concern, not just as a professional, but on a personal level as well.

Focus on the quality of the therapeutic relationship, rather than on just the mechanics of therapy. You are treating a whole person, and empathy, the sense that the client is really being listened to, is a curative force. Not only will you probably enjoy your therapy sessions more, but you might also find that your patients stick around for years. After all, what else is more important in therapy than a friendly listening ear?

Patients who felt that their therapy was successful described their therapist as "warm, attentive, interesting, understanding, and respectful." (Hans Strupp and Ann Bloxom)

Adapted from Thoughts for Therapists, by Bernard Schwartz, PhD and John V. Flowers, 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 5, 2014.

Breaking Bad Habits for Good!

Constance found herself pulling her hair again. She had done so most of her life, but in the last few months had become aware that her hair was actually thinning. She knew she had to stop. But how could she break a fifteen-year-old habit?

A lot of people develop simple but annoying habits that they find very hard to break: nail biting, hair pulling, skin picking, knuckle cracking, and a host of other disturbing behaviors.

Regardless of the nature of the habits, the technique of habit reversal usually works very well in breaking them. Constance could have benefited from habit reversal's five main components.

• Recognize that the habit is a strong or persistent urge that is not rooted in deeper psychological problems. Unfortunately, there are still many mental health practitioners who maintain there is inevitably a deeper meaning behind simple habits, and that it is necessary to unearth and treat this underlying process in order to break the habit successfully. Recent evidence shows this to be untrue.
• Keep precise records of urges and count the number of times that you actually succumb to them. It has been shown that the very process of counting and record keeping tends to give one an immediate sense of control over the habit.
• Develop an awareness of the chain of events that leads to or results in the unwanted behavior. For instance, you may find that boredom, watching TV, talking on the telephone, driving in the car, and doing routine tasks that call for very little concentration set off the habit you wish to break.
• Learn relaxation methods as a means of combating the urges. As soon as you become aware of the desire to give in to the habit, it is a good idea instead to sit down or lie down and start breathing slowly and rhythmically while deliberately letting go of tension throughout your body.
• Substitute a response that is incompatible with the unwanted behavior. For example, brushing your teeth instead of eating a cookie; petting your cat instead of twirling or pulling your hair; using your hands - gardening, drawing, typing, and so forth - instead of biting your nails or cracking your knuckles.

If you really desire to quit the habit, this five-easy-step process really works.

Adapted from The 60-Second Shrink: 101 Strategies for Staying Sane in a Crazy World, by Arnold A. Lazarus, Ph.D. and Clifford N. Lazarus, Ph.D. 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 5, 2014.

What are learning disabilities?

Learning disabilities are caused by a difference in brain structure that is present at birth and is often hereditary. They affect the way the brain processes information. This processing is the main function involved in learning.

Learning disabilities can impact how someone learns to read, write, hear, speak, and calculate. There are many kinds of learning disabilities and they can affect people differently.

Learning disabilities do not reflect IQ (intelligence quotient) or how smart a person is. Instead, a person with a learning disability has trouble performing specific types of skills or completing a task.

Learning disabilities are not the same as mental or physical disabilities, such as intellectual and developmental disabilities, deafness, or blindness. But, learning disabilities may occur together with mental or physical disabilities.

Children with learning disabilities cannot be identified on the basis of acuity (such as vision or hearing) or other physical signs, nor can they be diagnosed solely based on neurological findings. Learning disabilities are widely regarded as variations on normal development and are only considered disabilities when they interfere significantly with school performance and adaptive functions.

What are the signs and symptoms of learning disabilities?

A delay in achieving certain developmental milestones, when most other aspects of development are normal, could be a sign of a learning disability. Such delays may include problems with language, motor delays, or problems with socialization.

If you think your child may have a learning disability, talk to your child's health care provider or educator to discuss options for evaluation and treatment. These professionals can screen for potential difficulties, but it is essential that someone specializing in the diagnosis of learning disabilities do a full evaluation to confirm the presence of a learning disability.

What are some types of learning disabilities?

The term "learning disabilities" includes a variety of disorders that affect the ability to learn. Some examples include (but are not limited to):

• Reading Disability is a reading and language-based learning disability, also commonly called dyslexia. For most children with learning disabilities receiving special education services, the primary area of difficulty is reading. People with reading disabilities often have problems recognizing words that they already know. They may also be poor spellers and may have problems with decoding skills. Other symptoms may include trouble with handwriting and problems understanding what they read. About 15 percent to 20 percent of people in the United States have a language-based disability, and of those, most have dyslexia.
• Dyscalculia (dis-kal-kyoo-lee-uh) is a learning disability related to math. Those with dyscalculia may have difficulty understanding math concepts and solving even simple math problems.
• Dysgraphia (dis-graf-ee-uh) is a learning disability related to handwriting. People with this condition may have problems forming letters as they write or may have trouble writing within a defined space.
• Information-processing disorders are learning disorders related to a person's ability to use the information that they take in through their senses - seeing, hearing, tasting, smelling, and touching. These problems are not related to an inability to see or hear. Instead, the conditions affect the way the brain recognizes, responds to, retrieves, and stores sensory information.
• Language-related learning disabilities are problems that interfere with age-appropriate communication, including speaking, listening, reading, spelling, and writing.

Sidebar: According to estimates based on data from a National Health Interview Survey (NHIS), which focused on 23,051 children 6-17 years of age in the child sample of the 2004, 2005, and 2006, about 5% of children had ADHD without learning disabilities (LD), 5% had LD without ADHD, and 4% had both conditions. Boys were more likely than girls to have each of the diagnoses (ADHD without LD, LD without ADHD, and both conditions). Children 12-17 years of age were more likely than children 6-11 years of age to have each of the diagnoses. Hispanic children were less likely than non-Hispanic white and non-Hispanic black children to have ADHD (with and without LD). Children with Medicaid coverage were more likely than uninsured children and privately insured children to have each of the diagnoses.

Children with each of the diagnoses were more likely than children with neither ADHD nor LD to have other health conditions. Children with ADHD were more likely than children without ADHD to have contact with a mental health professional, use prescription medication, and have frequent health care visits. Children with LD were more likely than children without LD to use special education services. The full report can be found at http://www.cdc.gov/ncbddd/adhd/data.html

What is the treatment for learning disabilities?

While there is no direct cure for a learning disability, early screening and intervention from specialists can often provide great benefits. Early intervention can prevent learning difficulties, thus reducing the number of children requiring special education services.

Under the 2004 reauthorization of the Individuals with Disabilities Education Improvement Act, legislators made significant changes in how people with learning disabilities could be identified as eligible for special education services. This reauthorization allows for the optional use of the Response to Intervention (RTI) approach to determine whether a child has a specific learning disability and may receive special education services. There is evidence that the IQ-discrepancy model normally used is ineffective in identifying all students with learning disabilities; therefore many schools are implementing an RTI approach.

RTI is a tiered approach to educational intervention; the most common is a 3-tier model. The first tier provides high quality reading instruction to all students, with careful progress monitoring by teachers in the classrooms. Tier 2 is the same high quality instruction but with increased intensity for those not progressing well enough. If students do not progress with this more intensive instruction, they are identified for Tier 3, which is targeted special education intervention. Tier 3 students would have full evaluations and the establishment of an Individualized Education Program (IEP).

Most children with learning disabilities are eligible for special assistance at school. An IEP should be developed for students who need special education and related services. An IEP includes specific academic, communication, motor, learning, functional, and socialization goals for a child based on his or her educational needs.

A number of parents' organizations, both national and local, provide information on therapeutic and educational services and how to get these services for a child. Visit http://www.nlm.nih.gov/medlineplus/learningdisorders.html for a listing of these organizations.

National Institute of Child Health and Human Development
Last Update: 03/24/2010

Reviewed by athealth on February 5, 2014.

What are learning disorders?

A student may have a learning disorder if his/her achievement in reading, writing, or mathematics falls below what is expected for the child's age, grade level, and intelligence. To be called a learning disorder, the problems must have a negative impact on the person's academic success or another important area of life requiring math, reading, or writing skills.

What are the different types of learning disorders?

There are three major types of learning disorders:

• Reading disorder
• Mathematics disorder
• Disorder of written expression

What signs are associated with learning disorders?
In addition to the problems associated with the specific type of learning disorder, many students also suffer from:

• Low self-esteem
• Socialization problems
• Increased dropout rate at school

Learning disorders may also be associated with:

• Conduct disorder
• ADD and ADHD
• Depression

Do learning disorders affect males, females, or both?

Learning disorders can affect both males and females. However, in the United States more boys than girls are diagnosed with learning disorders.

At what age do learning disorders appear?

Although learning disorders are most likely present when a child is quite young, the specific type of learning disorder is usually diagnosed in early elementary school when reading, math, and writing begin to be used in the classroom.

How prevalent are learning disorders in our society?

About five percent (5%) of students in the United States have learning disorders.

How are learning disorders diagnosed?

Because standardized, group testing is not accurate enough for this purpose, it is very important that special, psychoeducational tests be individually administered to the child to determine if he/she has a learning disorder. In administering the test, the examiner should give special attention to the child's ethnic and cultural background.

How are learning disorders treated?

Learning disorders are treated with specialized educational methods. In addition to special classroom instruction at school, students with learning disorders frequently benefit from individualized tutoring which focuses on their specific learning problem.

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.

Source: John L. Miller, MD

Reviewed by athealth on February 5, 2014.

Rewire Your Brain To Control Your Emotions, and Make Positive Life Choices

By Karen Sherman, PhD

Do You Seem to Get Caught Up in the Same Old Reactions?

Have you ever blown up at your spouse only to realize - after the smoke cleared - that you might have over-reacted just a tad? Maybe you learn that you haven't been invited to your uncle's friend's sister's birthday party and you behave as if it's the slight of the century.

Sometimes even the most minor snafu can send us storming out of the room, slamming down a phone, or just shutting down entirely. It's like we just can't help it - the reaction is as automatic as a mallet to the knee.

Science Reveals It May Not Be Your Fault

New research indicates that these habitual, knee-jerk responses go way back to our childhood. As youngsters, we learned to adapt to our families' idiosyncrasies as a way of survival. Psychologists used to refer to these coping mechanisms as our baggage - but what science has now shown us is that these responses are actually hard-wired into our brains. And because our responses are so ingrained, they have become our filtering system for future incidents. In other words, if something happens today that the brain reads as being similar to something that happened in the past, it will respond as if it were the first time, even though you may be in your 30's, 40's, 50's, 60's and beyond.

Bringing This to Life

For example, let's say a child comes from a home where the parents fight frequently. That child is going to associate yelling with bad feelings. In later years, if his spouse raises her voice, he's likely to shut down like when he was a kid - metaphorically running to his room, closing the door, and essentially blocking out the noise.

Does this mean if you come from a family of yellers you're doomed to hide under your bed every time someone raises a voice? Luckily, recent research indicates that the brain continues to grow throughout our lives - and old patterns can be released as new ones are formed in your boomer years.

Help Is On the Way

The way to managing your anger and knee jerk reactions is to establish new connections by refocusing your attention to a different outcome or possibility. But, before you can foster these new connections in your brain, you have to be aware of the old brain triggers.

When I try and distinguish whether someone's reaction is a past association, I look to see if their reaction to the situation is automatic and intense. Additionally, when I try and offer an alternative to why they're behaving that way, the person is resistant and reluctant to consider any other view or interpretation of the situation - other than their own.

In my practice, I work extensively with clients to help them rewire and rewrite their lives. Here is an easy exercise to get you started on rewiring your brain to control your anger and over-reactions that will bring about positive changes in your life-today!

1. Thinking of Alternatives:

• When you're projecting your past experience onto a present one, try and imagine alternative ways to handle the situation. For example, let's say you have lunch plans with a friend - who cancels at the last minute. Immediately, you feel an overwhelming sense of hurt and rejection. Which is how you always feel in similar situations - indicating - voila - a past pattern! Be conscious of this and take a step back to recognize it.
• Then, approach the situation from an entirely different perspective. Maybe you use humor to deflect the bad feelings, thinking to yourself, "Gee, I guess it's my deodorant." Or, you choose the direct approach and ask your friend if you've done something to upset her. Or, you take the practical route and figure your friend just overbooked, overextended, or over-promised - and give her a get-out-of-jail-free card. (Hint: If you have difficulty coming up with alternative ways to handle the situation, think about how someone else - your mother, a childhood friend, an admired acquaintance - might handle the same situation.)

2. Plugging in New Choices:

• Now, replay the actual situation as vividly as possible - the phone ringing, the sound of your friend's voice, the awkward goodbyes - and imagine yourself carrying out one of your new solutions. Maybe you decide that being understanding of your friend's busy schedule is the best choice.
• Replay the phone call and plug in your new behavior, the understanding you, rather than playing out your old behavior of feeling rejected and hurt.

Making it Last

Before long, you will begin to see a slight shift in how you feel. By doing this exercise again and again, you will refocus your attention on a new outcome. This will rewire your brain and make a new neural connection - a connection to positive change!

Finally, a psychologist who goes that extra mile and cares about the people she helps. Whether Karen Sherman, PhD, is giving a speech, offering a teleseminar, or offering a workshop - she's helping people become aware of their choices and connect to their full potential. Let Karen help you learn to make positive life choices both personally and in your relationships by signing up for her free newsletter at http://www.drkarensherman.com/newsletter.htm

Reviewed by athealth on February 5, 2014.

Loneliness is a significant problem that can predispose young children to immediate and long-term negative consequences. However, only recently have research and intervention in educational settings focused on young children who are lonely. It is becoming increasingly clear that many young children understand the concept of loneliness and report feeling lonely. For example, kindergarten and first-grade children responded appropriately to a series of questions regarding what loneliness is ("being sad and alone"), where it comes from ("nobody to play with"), and what one might do to overcome feelings of loneliness ("find a friend") (Cassidy & Asher, 1992). In a more recent study (Ladd, Kochenderfer, & Coleman, 1996), kindergarten children's loneliness in school was reliably measured with a series of questions such as, "Are you lonely in school?"; "Is school a lonely place for you?"; and "Are you sad and alone in school?" These studies suggest that young children's concepts of loneliness have meaning to them and are similar to those shared by older children and adults. This digest presents an overview of loneliness with suggestions for practitioners on how they can apply the research in early childhood settings.

Sidebar: Children with ADHD, ODD, and other behavioral disorders are particularly vulnerable to lack of confidence and low self-esteem. They frequently experience school problems, have difficulty making friends, and lag behind their peers in psychosocial development.

Consequences of Loneliness

Children who feel lonely often experience poor peer relationships and therefore express more loneliness than peers with friends. They often feel excluded - a feeling that can be damaging to their self-esteem. In addition, they may experience feelings of sadness, malaise, boredom, and alienation. Furthermore, early childhood experiences that contribute to loneliness may predict loneliness during adulthood. Consequently, lonely children may miss out on many opportunities to interact with their peers and to learn important lifelong skills. Given the importance placed on the benefits of peer interactions and friendships to children's development, this potential lack of interaction raises many concerns for teachers who work with young children. Peer relations matter to children, and lonely children place as much importance on them as do other children (Ramsey, 1991).

Contributing Factors of Loneliness

Several factors contribute to feelings of loneliness in young children. Some that occur outside of the school setting are conflict within the home; moving to a new school or neighborhood; losing a friend; losing an object, possession, or pet; experiencing the divorce of parents; or experiencing the death of a pet or significant person. Equally important are factors that occur within the child's school setting, such as being rejected by peers; lacking social skills and knowledge of how to make friends; or possessing personal characteristics (e.g., shyness, anxiety, and low self-esteem) that contribute to difficulties in making friends. Kindergarten children who are victimized by peers (e.g., picked on, or physically or verbally attacked or taunted) report higher levels of loneliness, distress, and negative attitudes toward school than nonvictimized children (Kochenderfer & Ladd, 1996).

Observing and Assessing Young Children

Participating in careful observation of children is a necessary first step to gain insights into children's loneliness. While observing children, teachers can focus on the following, which may suggest signs of loneliness: Does the child appear timid, anxious, unsure of himself or herself, or sad? Does the child show a lack of interest in the surroundings? Does the child seem to be rejected by playmates? Does the child avoid other children by choice? Does the child appear to lack social skills that might prevent him or her from initiating or maintaining interactions? Does the child have the necessary social skills but is reluctant to use them? Is the child victimized by peers? Does the child's apparent loneliness seem to be a consistent pattern over time, or is it a more recent phenomenon? In addition, because loneliness cannot always be observed in children (e.g., there are children who appear to have friends but report feeling lonely), teachers can spend time talking individually with children. They might ask children, "What does sad and lonely mean?"; "Are you sad and lonely?"; or "What would make you happier?" (Cassidy & Asher, 1992; Ladd, Kochenderfer, & Coleman, 1996).

When observing and assessing children, it is important to be sensitive to and aware of their developmental abilities and personal inclinations. For example, it has been suggested that young children who play alone may be at increased risk for later problems, both socially and cognitively. Many preschool and kindergarten children, however, engage in nonsocial activities that are highly predictive of competence. Therefore, over time, teachers need to observe children's interactions with their peers, talk to children about their feelings, and document their behaviors and responses to determine whether they are lonely or are happily and productively self-engaged.

Intervention Strategies and Recommendations

Although research in support of specific practices assisting lonely children in the classroom is weak, teachers might consider several approaches that may be adapted to individual children. Children who are aggressive report the greatest degrees of loneliness and social dissatisfaction (Asher, Parkhurst, Hymel, & Williams, 1990). Children are rejected for many reasons, and teachers will need to assess the circumstances that seem to lead to the rejection. Is the child acting aggressively toward others? Does the child have difficulty entering ongoing play and adapting to the situation? Does the child have difficulty communicating needs and desires? Once the problem is identified, teachers can assist the child in changing the situation. The teacher can point out the effects of the child's behavior on others, show the child how to adapt to the ongoing play, or help the child to clearly communicate feelings and desires. Children who are supported, nurtured, and cherished are less likely to be rejected and more likely to interact positively with peers (Honig & Wittmer, 1996).

Children who are neglected or withdrawn also report feelings of loneliness, although to a lesser extent than do aggressive-rejected children. Because these children often lack social skills, they have difficulty interacting with their peers. These children may also be extremely shy, inhibited, and anxious, and they may lack self-confidence (Rubin, LeMare, & Lollis, 1990). If children lack certain skills, the teacher can focus on giving feedback, suggestions, and ideas that the child can implement. Children who possess adequate social skills but are reluctant to use them can be given opportunities for doing so by being paired with younger children. This experience gives the older child an opportunity to practice skills and boost self-confidence.

Children who are victimized by others believe that school is an unsafe and threatening place and often express a dislike for school. Furthermore, these children report lingering feelings of loneliness and a desire to avoid school even when victimization ceases (Kochenderfer & Ladd, 1996). These findings point to the importance of implementing immediate intervention strategies to reduce victimization. Teachers can provide firm but supportive suggestions to the aggressor. For example, teachers might guide and assist children in developing the life skills they need, such as respecting others and self, engaging in problem solving, working together on skills and tasks that require cooperation, and expressing feelings and emotions in appropriate ways (Gartrell, 1997).

Teachers can think about how the curricula might be helpful to a child who is feeling lonely. Some children may benefit by being given opportunities to express their feelings of sadness or loneliness through manipulation, drawing, movement, music, or creative activities (Edwards, Gandini, & Forman, 1993). Arranging the dramatic play area with props may help some children act out or express their feelings and feel a sense of control. Use of crisis-oriented books with children, referred to as bibliotherapy, may assist a child in coping with a personal crisis. Sharing carefully selected literature with children may assist in facilitating emotional health. Children who are able to express and articulate their concerns may want to talk about their unhappiness.

Developing close relationships with children and communicating with their primary caregivers can give teachers valuable insights and guidance. When teachers become aware of children who are experiencing loneliness caused by a family situation, they can lend their support in a variety of ways. Spending extra time listening can be reassuring and helpful to some children. Suggesting to a parent the possibility of inviting a peer over to the child's home may be a good idea and may help the child to form a friendship. In addition, teachers can ask parents for their recommendations about what might make the child feel more comfortable at school, and they can share relevant resources with parents, such as literature or information on parent discussion groups.

Conclusion

The issues of loneliness were once considered relevant only to adolescents and adults. Research suggests that this notion is misguided and that a small but significant portion of young children do in fact experience feelings of loneliness (Asher, Parkhurst, Hymel, & Williams, 1990). As a result, the immediate and long-term negative consequences associated with loneliness in children are becoming apparent, and the need to observe children and to develop and implement intervention strategies is becoming critical. When teachers take time to focus on individual needs of children, build relationships, and assist them with their needs, children thrive (Kontos & Wilcox-Herzog, 1997).

For More Information

1. Asher, S. R., Parkhurst, J. T., Hymel, S., & Williams, G. A. (1990). Peer rejection and loneliness in childhood. In S. R. Asher & J. D. Coie (Eds.), Peer rejection in childhood (pp. 253-273). New York: Cambridge University Press.
2. Cassidy, J., & Asher, S. R. (1992). Loneliness and peer relations in young children. Child Development, 63(2), 350-365. EJ 443 494.
3. Edwards, C., Gandini, L., & Forman, G. (1993). The hundred languages of children. Norwood, NJ: Ablex. ED 355 034.
4. Gartrell, D. (1997). Beyond discipline to guidance. Young Children, 52(6), 34-42. EJ 550 998.
5. Honig, A. S., & Wittmer, D. S. (1996). Helping children become more prosocial: Ideas for classrooms, families, schools, and communities. Young Children, 51(2), 62-70. EJ 516 730.
6. Kochenderfer, B. J., & Ladd, G. W. (1996). Peer victimization: Manifestations and relations to school adjustment in kindergarten. Journal of School Psychology, 34(3), 267-283. EJ 537 306.
7. Kontos, S., & Wilcox-Herzog, A. (1997). Teachers' interactions with children: Why are they so important? Young Children, 52(2), 4-13. EJ 538 100.
8. Ladd, G. W., Kochenderfer, B. J., & Coleman, C. C. (1996). Friendship quality as a predictor of young children's early school adjustment. Child Development, 67(3), 1103-1118. EJ 528 230.
9. Ramsey, P. G. (1991). Making friends in school. New York: Teachers College Press.
10. Rubin, K. H., LeMare, L. J., & Lollis, S. (1990). Social withdrawal in childhood: Developmental pathways to peer rejection. In S. R. Asher & J. D. Coie (Eds.), Peer rejection in childhood (pp. 217-249). New York: Cambridge University Press.

Source: ERIC Clearinghouse on Elementary and Early Childhood Education
Publication Date: 1998-05-00
Author: Janis R. Bullock, PhD

Reviewed by athealth on February 5, 2014.