Does the sound of your loved ones chewing their food drive you crazy? Do you get irritated by the sound of a computer or a fan humming in the back ground? Do you find it difficult to sleep with the sounds of the sea outside your window? Do you avoid noisy cafes? Do you long for the peace and quiet of the countryside? Do you also notice smells or food textures or the feel of fabrics or bright light – when most other people don’t seem to?

If you’ve answered “yes” to most of these, and it’s always been like that for you (especially when you’re tired or unwell or upset), you’re one of the 15% to 20% of the population who were born with a “sensitive” brain, and can be called a Highly Sensitive person (HSP). It’s almost as though your brain notices sensations at a lower level than most other brains and sometimes you wish there was a thicker “skin” around your brain that could protect you from the world’s noisiness.

As you will know, there is a huge downside to being an HSP. From the time you were little, you were startled by loud noises, and put your hands over your ears when your mother was vacuuming or there were fireworks. After an hour or two at a child’s birthday party, you just wanted to go home or could lose the plot quite easily. You found it hard to get to sleep at night because it took you a long time to wind down at the end of the day. You could get overexcited easily in loud, busy situations, and either withdrew or became really boisterous and got into trouble. Hopefully, as you grew up, the people around you helped you to recognize what you need to keep your emotional states in balance, and not become overwhelmed by the intense stimulation of school and socializing or your workplace.

However, there’s also a huge upside to being an HSP. When you were young, people commented on your sophisticated awareness of other people and the world. You were drawn to the visual and auditory arts and had a vivid imagination. As an adult, you notice the subtleties in art and music and nature more easily than other people; you are attuned to other people’s emotions and can be a really good listener; and you have a natural curiosity about the world paired with creativity and conscientiousness, which means that you can be a high achiever. Your intuition can be really highly developed – although you may need to learn to resist the impulse to always share your insights with others…

So, next time you feel like yelling at someone who is chewing loudly, or feel like you have to leave the party “right now!”, or feel like you’re going to throw up at the smell of raw shrimp paste, remind yourself about the upside of being an HSP, and make sure that you get the rest and quiet that you need to make the most of your unique brain.
Dr Elaine Aron has published a number of books on the topic of HSPs (about adults and children) and you can find out more about her work at www.hsperson.com. She also writes a blog on the website called Comfort Zone, which provides insight and advice for people who struggle with the intensity of the world.

In spite of enormous changes in its structure and functioning, the family is still the main context in which most people are brought up. The family provides safety and nurturance for young people with opportunities for development and growth. The family also provides continuity from one generation to the next, passing down family traditions and beliefs. Finally, the family provides a connection between individuals and the society in which they live. All of these functions are steeped in culture, and are made all the more complex because of culture.

Each family has its own culture, made up of ethnic, religious, historical, educational, socio-economical, and racial aspects. The complexity of family culture is strongly affected by the coming together of people with different cultural identities. When two people from different cultural, ethnic, racial or religious backgrounds form a family, there are significant issues to be addressed. For example, concepts of family may be narrower for Pakeha (involving primarily the nuclear family) than for Maori (where kinship ties are broader and more extended), impacting on the ways in which a multicultural family might operate. So the sharing of personal information might be widespread within an extended Maori family, while a traditional Pakeha family may consider that the nuclear family should be separate from extended family when it comes to sharing personal information.

Christians and Muslims believe in one god, while Hindus and Buddhists believe in many gods, creating the potential for significant conflict and disruption within families with mixed beliefs. Even within a single religious group, there may be powerful differences in beliefs and practices. Catholic Christians and Protestant Christians have different ways of observing their Christian faith that have led to civil war, much less conflict within families!

In a country that is bicultural at its core, like New Zealand, there is an ongoing evolution of identity within individuals and families. Importantly, ethnic or racial stereotypes predict that any individual identifies with one particular culture, but as we have learned in the last fifty years from studies around the world, individuals’ cultural identity exists on a continuum – people relate to culture in a range of ways. There are some who relate strongly to a particular culture and its practices and beliefs, and there are others who relate weakly to, or even reject entirely, the idea of a particular culture for themselves. At the extreme, these people prefer to create a cultural identity that provides a good fit with their personality, life experiences, and goals.

The migration of families from one distinctive culture to another also puts enormous pressure on the family’s cultural beliefs and practices. While experiences differ between migrant families, they all have adjustment issues as they struggle with the loss of familiar country and culture, and the need to fit into the new environment, often with a language that is completely foreign to the migrants. Systems such as government agencies, legal structures, and educational institutions have a significant influence on the cultural practices of any family. For example, in a predominantly Judeo-Christian society, Muslim families may find practices and laws that are in direct conflict with those associated with their religion.

There is no doubt that migration is an extremely stressful process, and many families separate as a result of these stresses. In separation and divorce, religious and cultural differences between parents are highlighted once again, and can lead to protracted custody disputes. While the parents were together, they may have been tolerant of each another’s differences, and may have agreed on a particular cultural practice or combination of practices for the family. However, the anger and hurt caused by relationship breakdown and separation can make people return to their original beliefs and practices, and result in bitter arguments about parenting and childcare.

In some cases, a parent has walked away from a child forever because he or she could not tolerate the idea of the child being influenced by the other parent. It is also fairly common for children of immigrant families to want to fit in with their new cultural environment, and this can cause significant family distress as adolescents reject parental authority and belief systems and try to forge their own identities. While these processes occur in all cultures, they are exaggerated when the adolescent’s development is complicated by the differences between his or her parents’ culture and the culture of their adopted country.

It has been suggested that there are three qualities of family functioning that are common to all successful families, and that play a critical role in determining the ability of a family to cope with stress – irrespective of what that stress is.

The first quality is family flexibility – the ability of the family to adapt to changing demands from within the family and from the world outside the family.

The second quality is family communication. Open, straightforward discussion using positive communication strategies allows difficult issues to be resolved.

The third quality is family cohesion – the extent to which family members show their interest in each other, support each other, and enjoy each other’s company.

It is in the development of these three qualities that families are able to tolerate differences within their own systems and differences in the external world.

It’s the end of October 2010, and there have been over 2000 earthquakes since 4 September. If you’re not moving (e.g. in bed, sitting at a desk, eating dinner, watching TV), you certainly feel everything above about 3.5. But it’s only when it gets to about 4.5 that you stop what you’re doing and wait to see if it’s going to be another “big” one. At 5 or above, you get up (from the table, bed, your desk) and start moving towards the door frame/ big table/ desk as a precaution. If you’re moving (e.g. gardening, driving, doing exercise) you don’t notice it unless it’s 5 or above – and then you mostly notice the plants/whatever swaying and hear rattling of things on a table or the building’s groans.

Our lives are still being interrupted on a daily (or nightly) basis – that makes for lots of sleep-deprived, irritable people (domestic violence has increased exponentially since 4 September). Everyone I know talks about making little mistakes in all parts of their lives every day – that’s what trauma/sleep-deprivation/anxiety will do to you – and as long as the aftershocks continue, anxiety will remain high for everyone. We don’t know what the next minute/hour/day will bring in the way of danger. We are also very sensitive to any signals of earthquake – leaving town doesn’t guarantee peace as people are jumpy and startle at unexpected noises or trucks rumbling by.

One problem is that people (including Cantabrians) think that, because no-one died and the emergency services were so efficient that 90% of the greater Christchurch area had their essential services restored within a week, it’s a bit of a non-event. At the very least, we should be “over it” and back to normal. So people feel guilty about complaining – “but it’s not as bad as Haiti – no-one died! And we have water and power!” is a common cry. Cantabrians also have a reputation for being staunch – it’s shameful to admit that you’re afraid or anxious and not coping.

The fact is that there are many families whose homes have been evacuated – these people are still paying mortgages and having to rent elsewhere and live normal lives. There are also many people who are “camping” in their damaged homes – no water and no sewerage, so there is a Portaloo in the garden and water has to be collected. There are many people who have lost their jobs. Lots of businesses are no longer functioning – their premises have been demolished /are in the process of being demolished/ waiting for a decision from the Earthquake Commission/City Council about whether they should be demolished or restored, and they haven’t been able to set up in temporary premises. These people have lost their income and one of the mainstays of their identity.

There are also many people who were in some sort of transition (e.g. moving house or town or country) and the sale of their homes in Christchurch has been put off indefinitely because of the damage. They are now without jobs or somewhere to stay and cannot take up the new jobs/schools/lives they were looking forward to. Relatedly, people who had bought new homes and their new home is damaged now have to get out of their old homes for the new occupants and have nowhere to go. Lots and lots of plans are on hold, and people living in limbo.

For those people whose homes or livelihoods aren’t in jeopardy, just getting to work/school/the gym/the supermarket /friends/family/wherever takes longer and is harder because of many detours and the sight of familiar buildings and landmarks gone/being demolished/badly broken. Going to a business you’ve known for 20 years and finding that it’s gone, and having to find their temporary premises or find another business altogether is stressful. Collapsed chimneys and wall cracks, treasured objects that were broken, windows and doors that don’t open and close properly, the repeated falls of plaster-dandruff on the carpet as aftershocks loosen more plaster – these are constant reminders of how quickly life can be turned upside-down and just how helpless we can be.

The landscape of our lives has altered significantly, and change is always stressful for human beings. Every time there’s another strongly felt aftershock – and don’t be lulled by the word aftershock, lots and lots of these are of the impact that would previously have captured headlines in the media – the adrenalin and cortisol get pumping again. However, there are tremendous variations in how sensitive people’s brains are to the sensations of an earthquake – some people notice small sensations and others don’t notice sensations unless they’re really strong. This accounts, in part at least, for why some people become more upset than others when there is another aftershock.

Rather than pretend that everything is fine and that we can live as though there is no disruption, we have to acknowledge that we’re stressed and pay attention to the basics like sleeping, nutrition, exercise and good times. So, if you’re feeling too tired to start a big project – don’t; if you’re under pressure to make a big decision – don’t; if you don’t feel like going out partying – don’t. Sleep is a particularly common casualty of traumatic events, and many people (adults and children) have been struggling to get a decent night’s sleep. In particular, it’s the getting to sleep that’s hard.

So, here are ten basic things that can help with getting to sleep. One, try and go to bed at the same time most nights; two, have a bedtime ritual that includes things that are relaxing (e.g. making your preparations for going to bed, and then reading or listening to gentle music for 20 minutes); three, don’t watch television or play videogames or txt in bed – bed is for sleep; four, if you’re still awake after half an hour of trying to go to sleep, get up and do something boring until you feel sleepy again; five, don’t eat dinner or exercise close to bedtime (at least 2 hours before bed); six, cut down on alcohol – it might make you feel sleepy but it’s bad news for staying asleep; seven, make an appointment with someone else to do your worrying during the day – give yourself permission to worry, but not at night; eight, don’t drink coffee or tea (unless it’s decaf) at night; nine, make sure you do something that makes you happy every day – then think about that before you go to sleep; ten, try and get some exercise each day – preferably in the sunshine – a 20 minute walk will do nicely.

So, allow yourself and the people around you to prioritise taking care of your basic needs for physical and emotional safety and comfort, and life will get easier.

Anorexia nervosa is serious mental health problem marked by extreme weight loss and an excessive fear of weight gain. In children and adolescents as well as extreme weight loss it can also be seen as a failure to make expected gains in weight and height. Although it only affects a small number of individuals it can have serious effects on physical health and serious psychological consequences. For some people it is a lifelong problem. What we understand from research is the longer it goes untreated the harder it is to get better from. Adolescence is the most likely time to develop anorexia nervosa. This illness is more commonly seen in girls but it appears it is becoming more frequent in boys. The negative consequences of eating disorders on physical health are much stronger in children and adolescents than in adults because the eating and exercise behaviours can disrupt normal physical development. The causes of Anorexia Nervosa are unknown or at the very least unclear. This is important to state because families often believe they are in some way to blame for their child becoming unwell.
The key to treating anorexia nervosa is catching it early.
We know that families are good at detecting the signs and symptoms of anorexia nervosa. If you are worried that your child may be developing an eating disorder, you should observe their behaviour for any warning signs. These warning signs can include
 Gradual changes in behaviour and appearance occurring over months or years
 Dieting behaviours ,e.g. fasting, counting calories

• A narrowing of food choices or changes in food preferences e.g. refusing to eat certain ‘fatty’ or ‘bad’ foods, cutting out whole food groups such as meat or dairy, or claiming to dislike foods previously enjoyed
 Increasing absences from family meals
 Excessive exercise patterns which may include exercising when injured or in bad weather
 Gradual withdrawal from social activities, particularly involving eating or drinking
 Behaviours focused on food, e.g. preparing and cooking meals for others but not actually eating or increased interest in cookbooks, recipes and nutrition
 There may be an attempt to conceal noticeable weight loss or the evading of questions about eating and weight

If you suspect that a child or young person is developing an eating disorder seek professional help. The South Island has a specialist eating disorders service based in Christchurch at Princess Margaret Hospital. They provide specialist support to other mental health professionals based throughout the South Island about eating disorders. They offer a wide range of treatments for those aged 14 years of age upwards. For those aged up to 19 they offer a treatment called Maudsley Family Based therapy. This treatment is based on work from the Maudsley Hospital in London, The University of Chicago, and Stanford University which has demonstrated that families can be an important resource for younger patients suffering from anorexia when they are included in the therapeutic work. In this treatment families are empowered to take charge of the illness. This treatment has a success rate of around 70% for those young people who have had the illness for less than 3 years. If you have concerns about your family member contact your GP who can refer you onto the service.

Up to 90% of adolescents use one or more of the social networking sites – Bebo, My Space or Facebook are examples – and that’s a lot of young people socialising with a computer screen. So it’s not surprising that parents are asking whether their children’s social development is being compromised by having virtual friendships rather than real ones; whether they are missing out on important social opportunities by restricting themselves to online socialising; and whether they are exposing themselves to danger.

There seems to be a perception that adolescents use these sites primarily to make new friends – this isn’t backed up by the research. Therefore, it isn’t that teenagers are having virtual friendships in place of real friendships – they are simply using the online medium as well as face-to-face encounters to build their social networks. Without doubt, the vast majority of people use social networking sites to find out more about people who they have met offline, and interest in strangers is unusual.

While the media love to report dreadful stories of young people meeting up with predators they have met online, the incidence of this is extremely rare. Teenagers keep up to date with their friends’ relationship status, whereabouts, and activities and interests, build their social identities in very visual ways by describing themselves in their profiles and customising their pages, and share group activities by posting photographs or alerting each other to what’s going on in their world. They share music and film clips, play games, join groups of various kinds, and support their favourite organisations. This is in addition to their face-to-face, email, or telephone contacts with their friends. They also make links with friends of their friends whom they then go on to meet.

For example, one adolescent reported that she met her current boyfriend because he was a friend of her friend. Having linked to his profile via her friend’s webpage, she asked her friend about him. When her friend said her was really nice, the friend organised for them to meet at a gathering of their mutual friends. At least the adolescent had more information about him than if she’d been on an old-fashioned blind date!

Parents who have access to their adolescents’ sites voice concerns about the private information that seems to be shared indiscriminately by their children. What could be happening is that parents haven’t previously been aware of the quality or quantity of information that adolescents share with each other, because it has traditionally happened in private. However, there is lots of research showing that adolescents have always shared a tremendous amount of personal information with their friends – probably far more than their parents realised. In addition, surveyed adolescents are quite clear that they are aware of privacy issues.

For example, one 16-year old teenager said, “I don’t give stuff away that I’m not willing to share”. Adolescents report that they are in control of what they share online – they use more private communications (e.g. MSN, email or txting) when they want to disclose more private information. One teenager said, “…[MySpace] is good for making arrangements and stuff, but it’s not good if you want a proper chat”.

However, there is no doubt that teenagers (particularly the younger ones) do not comprehend the availability of their personal information to their peers (imagine the school bully knowing some of the things you’ve posted!) or adults (imagine the school principal seeing some of your postings!). Some research shows that they are hard-pressed to describe the privacy features on Facebook, much less use them. Therefore, it is probably sensible for parents to educate their adolescents about using social networking sites effectively and wisely. For their own education, parents can go to this website.

However well it goes, there are times when step-parenting presents a significant challenge, especially in the early years. Estimates suggest that roughly a quarter of families in NZ are remarriages with children, and that a great many of these remarriages dissolve within the first few years. Authors suggest it may take 7 years for the ‘new’, blended family to function effectively as a united team but many families do not last that long. However, there are principles worth following to improve the odds of a successful outcome.
A step-parent (SP) may enter the ‘new’ family with a mixture of fervour and trepidation. Determined to avoid the pitfalls of the archetypal ‘evil’ stereotype, the SP may strive hard and wonder why their efforts (with their step-children) sometimes fail. Reasons are complex. The step-children have undergone the loss by death or separation of a biological parent, and feel strong loyalties to that parent, so a sense of betrayal may accompany any positive feelings they experience toward the SP. Also, the child may view the SP with suspicion, or even as a threat to their ties with, and attention from, the biological parent (BP) partnered with the SP.

The new couple may share similar backgrounds and have similar views about parenting, but this is frequently not the case. Time taken to discuss values, early experiences and hopes provides a building platform for the ‘new’ parenting team. There may be aspects of parenting that each parent is wishing to avoid (from their own experience of being parented or how it was in the previous family) and aspects that they wish to repeat. The discussion of expectations for behaviour, and negotiation of plans for management of the inevitable pushing of boundaries, pays dividends. Then parents need to communicate these plans to the children. One critical principal is always to maintain respect for biological lines – the BP does the front-line parenting and the SP provides a solid support or back-up system. It is also important to allow time for biological ties to be honoured with rituals and memories and one-on-one time between the BP and his or her children.

Maintenance of a strong couple relationship may go some way to prevent biological children and their BP aligning against the SP. Plan strategies for positive discipline, and ensure that the children see a united team in the parents – especially when it comes to the maintenance of expectations. Decide on support, rules, consequences, and household tasks, and encourage adherence, noticing and reinforcing positive behaviour. When the hard stuff happens and punishments or consequences are required for defiance, or failure to comply, the BP must adopt the lead role with the SP in support (perhaps standing beside or just behind the BP and nodding, wordlessly). Difficulties escalate when the SP, in their fervour to get it right or be helpful or defuse conflicr between the BP and the child, moves in front of the BP to a ‘policing role’. Primarily, at least early on, the SP’s goal is to be a warm friend to the child – keeping a distance so that the child has a space in which to observe the SP and approach when comfort allows.

It is a mistake to try to compensate for the deficits you perceive it your partner’s parenting by adjusting your own style. For example, a parent who perceives their partner as unduly harsh may overlook behavioural transgressions and fail to maintain appropriate boundaries. Rather, each parent needs to address their own parenting strengths and weaknesses so they are able to confidently model calm and balance in their approach to the children. Expect the bumps in the road and welcome them as a chance to try out your well-rehearsed tools.

Be aware of the potential for the children suffering loyalty conflicts and maintain positivity towards the absent biological parent to minimise the children’s distress and anxiety. At all costs avoid the child witnessing hostility or conflict between any of their parents. Whatever the composition of the blended family, it is up to parents to take the role seriously and engage in planning. When the blended family works well, the rewards are immense for all members and children flourish. I commend The Step-Parents’ Parachute by Flora McEvedy as an excellent, practical resource for understanding the difficult the role of the SP, answering questions like: Who am I in all this? What am I supposed to do? What is my role? How can I contribute in a positive way? How can I help?

Sexual offending continues to be an emotive topic that elicits extensive discussion amongst the general public, scholars, and the legal system. While adult offenders are often exposed in the media, much less is reported and known about juvenile sex offenders.

While the majority of sexual offenders begin offending in adulthood, research suggests that 20 percent of all rapes and 30-50 percent of all child molestations are perpetrated by under 18’s. The challenge is to identify young people who display concerning characteristics before they offend and potentially launch into criminal careers. However, this is no simple task.

Not surprisingly, a high proportion of juvenile sex offenders have been sexually abused themselves. While most children who are sexually abused do not go on to become sexual offenders, some tend to model similar behaviour to that which they have been exposed to. In particular, those who offend against other male children are far more likely to have been sexually abused themselves.

A key task for adults is thus to identify as soon as possible whether a child has been sexually abused and to seek professional advice. Amongst younger children, warning signs include touching the genitals of other children or animals, rubbing their genitals against others, sexual innuendos, attempting to undress others, and inserting objects into the vaginas or rectums of others. These behaviours should occur repetitively, across varying situations, at an age younger than they appear in other children, and be unresponsive to adult intervention/supervision.

Adolescents who have been abused are more inclined to display poor school performance, drop out of high school, engage in delinquent acts (such as criminal behaviour and substance abuse), and take sexual risks (such as engaging in sex at a young age and not using condoms). In fact, juvenile sex offenders look a lot like juvenile general offenders. Juvenile sex offenders who offend against peers of a similar age or older tend to have early contact with the law, conduct problems, and as many as half have prior general offence histories. They are also 2-4 times more likely to be reconvicted of a new non-sexual offence than of a sexual offence. Their offending may be linked to a general antisocial attitude of abusing the rights of others, rule breaking, sensation seeking, self-serving acts at others’ expense, and acting impulsively (often under the influence of substances). However, as a group, they tend to have less extensive criminal histories than non-sexual offenders. One area of added concern amongst sexual offenders is a propensity to engage in fire setting.

A difference is often noted between general offenders and juvenile sexual offenders who commit offences against children much younger than them. They display fewer conduct difficulties and a more specific interest in sexual contact with young victims (much like adult paedophiles). Such individuals are more likely to compensate for negative emotions and seek self-comfort by engaging in sexual acts. Not surprisingly, such offenders often have poor self-esteem, few positive dating scenarios with same-age peers, and lack a “normalising” peer group.

The effects of being sexually abused for the victim are potentially extreme in nature. Unfortunately, when the victim becomes the perpetrator, the cycle is compounded.

Nine-year old James is never ready for school on time. It doesn’t matter how much his parents nag or threaten, he is always late. Fifteen-year old Holly has too many detention slips for being late to class or to sports practice. Thirty-year old Sam has a reputation for being late to work, keeping his dates waiting, and turning up to family dinners after everyone has started eating. Why is it that that these three people are such poor timekeepers?

I am of the strong belief that the vast majority of human beings want to stay onside with the important people in their lives. James ends up in tears when his parents yell at him in desperation; Holly’s grades are slipping because she is becoming disheartened abut the trouble she gets into; and Sam is tired of being told off by his boss, his girlfriends and his family. These people want to please their significant others, and end up blaming themselves harshly for being disorganised, or blaming others for their impossible expectations of timeliness.
Rather than attributing chronic tardiness to negative personality traits like laziness, arrogance or insensitivity to others’ feelings, my preference is to begin by exploring two other causal factors – understanding time, and distractibility. If I can exclude these information processing difficulties, then I might begin to think about difficult personality traits.

First, there is no doubt that some people’s brains struggle with the concept of time. Grasping the idea of thirty minutes isn’t easy for everyone. Most of us can imagine how long thirty minutes takes, and, more importantly, what can be accomplished in that time. However, for a particular group of people, it isn’t that easy. Not being able to gauge how long it takes to do all of the tasks necessary to get ready for school or work, or getting to a family dinner, means that there is always the risk of running late. The intention to be on time gets overwhelmed by misjudging how long it takes to do things, or not making allowances for unexpected events like heavy traffic or no clean socks. If I ask someone like this to tell me how long it takes to, say, make your bed or get dressed, or get ready for work, or get to hockey practice, they inevitably judge the time required to be about half the actual time. If I ask what other things need to be taken into consideration when timing an activity (like accommodating an unexpected telephone call when you’re hurrying, or remembering that you’ve left your homework at home when you’re already on the way to school), they generally haven’t thought about it. So, if the unexpected happens, they find it difficult to put that activity (like talking on the phone or going back to fetch the homework) to one side in order to achieve the primary goal – being on time. They become distracted by the unexpected task and spend time on that rather than having a strategy that will allow them to come back to that later and stay on track for the immediate goal of being punctual.

Second, some people start out with a clear idea of what needs to be done in order to be on time, but lose concentration on the tasks at hand and become distracted by other things like the TV or an intriguing thought or a cherished pet. That is not to say that goals, like being on time for school, getting somewhere at the appointed time, or finishing a chore, become less important. They simply disappear from view for a while. Unfortunately, the people involved in those goals (parents or an employer or the family waiting for dinner) take the tardiness as a sign that they aren’t important to the latecomer. This just isn’t the case – it is the activity (getting ready or travelling) that loses out to the distractor – the people always matter. Unfortunately, it’s the people who are inconvenienced by the lateness, and the people take the lateness personally, assuming that the latecomer “doesn’t care enough about me” to be on time.

People who struggle with the concept of time (and consequently struggle with time management) and people who are easily distracted from what they are doing (and consequently lose sight of the task at hand) need to recognise these information processing problems, and develop explicit organisational strategies to compensate for them. Preparation is a key here – planning for the next day’s school or work by having clothes and other necessities prepared the night before, or having a strategy for coping with the unexpected such as telling the unexpected caller you’ll get back to them later. You can become more on-time by doing trial runs (timing activities so that you know how long it actually takes to do something); having visual and auditory reminders of appointments and tasks to be done like leaving “notes to self” on the fridge or the bathroom mirror; using the appointment programme on your computer or cellphone; leaving more than enough time between tasks or appointments; and rewarding yourself when you get it right!

Myths
NOT TRUE Children with ADHD are deliberately naughty or bad children.
NOT TRUE ADHD is just youthful high spirits.
NOT TRUE Every child who displays some symptoms of ADHD has it.
There may be other reasons for children having symptoms which mimic ADHD. For example, children who have been abused either sexually or physically, or whose parents have recently separated often display some of the above behaviour. That’s why it is extremely important for the assessment and diagnosis to be thorough and done by qualified professionals who, as much as possible, try to rule out any other causes for a child’s symptoms
NOT TRUE Children with ADHD are incapable of concentrating at all.
Most children with ADHD are often able to concentrate for quite long periods of time on specific activities or hobbies – for example, watching videos they enjoy. In some, this ability to hyperfocus is extraordinary and has led some experts to comment that attention deficit might more accurately be called attention inconsistency.
NOT TRUE Everything that is wrong with the child is ADHD (e.g., all learning and behaviour problems are part of the ADHD).
NOT TRUE If you have ADHD you are not responsible for your behaviour and therefore can be excused for it (i.e., don’t have to face the consequences).
Causes of ADHD
Even though a lot of research into ADHD has gone on around the world, its exact cause is still unknown. It is likely that there are not one, but several causes, which, when they occur together, become ADHD.
Studies of computerised tomography or CT brain scans show that children with ADHD seem to have brain circuits which are wired a little differently from other people’s. This results in the brain having trouble processing the messages it receives – a little bit like a telephone exchange which gets overloaded with calls. This may happen to the infant’s brain in pregnancy, in babyhood, or it may just be an individual variation which has received more notice in the last 40 years. It does not seem to be caused just by a poor diet, yeast infections, allergies or food colourings as some people have thought, although these may be factors in the overall ADHD picture. It is also not caused by bad parenting although often a child’s behaviour will have earned plenty of negative attention in and outside of the family or whanau by the time ADHD is recognised.
Risks factors for developing ADHD
There is thought to be a genetic element to most ADHD, that is, it runs in families. Studies have shown that brothers or sisters of children with ADHD have two to three times the risk of having it as well.
ADHD often occurs with other child mental health problems. These may exist alongside or develop as a result of ADHD. For example, some children with ADHD will have Oppositional Defiant Disorder, Conduct Disorder or experience anxiety or depression. Learning difficulties which are unrecognised also present a risk for serious mental health problems, as they affect progress at school and self-esteem.
ADHD and its associated problems are serious if untreated because they can put young people at risk for accidents, drug or alcohol abuse problems, or suicide.
Living with Attention Deficit / Hyperactivity Disorder
The most important thing to remember about having a child with ADHD is that, like all children, they need love, affection, nurturing and clear rules. Sometimes this is hard to remember when whole days of nagging seem to be the rule rather than the exception at home and everywhere else.
A child with ADHD may have chalked up quite a lot of frustrations and failures before his/her problem is recognised. Some parents worry about the label ADHD and wonder if they have caused it to happen, or failed their child in some way. They may feel anger that this has happened to their family or whanau, or upset that other family or whanau members have dismissed the child’s behaviour as being normal. Others will be relieved that the problem they’ve lived with over a number of years finally has a name.
For the child, knowing he/she has ADHD can be a relief. Often though, children feel there is something really wrong with them. ADHD needs to be carefully explained to them in a way that they can understand and learn to handle. Brothers, sisters and friends, too, may need an explanation that can help them to stop teasing or provoking the child with ADHD.
Some children who have to take medicine to help their symptoms say it is like admitting that something scary is wrong with them and worry that they are retarded or crazy – labels they’ve probably heard before.
In two-parent homes it is important for parents to support each other with managing their child’s behaviour. Consistency is essential. Often one parent will say that the child is “perfectly all right when he is with me.” This can be infuriating for the other parent. For single parents, having a child with ADHD is even more difficult. Have at least one supportive friend outside the family or whanau that you can confide in.
Treatment of Attention Deficit / Hyperactivity Disorder
Summary of treatment options
There is no magic pill to make ADHD disappear, and medication should not be used as a substitute for other appropriate interventions, including educational and psychosocial. It is a complicated condition generally best managed by a mixed treatment programme which may include the following components.
Medication
The main kind of medication are used in the treatment of ADHD are stimulants; antidepressants are only very occasionally prescribed. The same medications are used for both children and adults. It is important that the progress of a child on medication for ADHD is checked and the treatment reviewed regularly with regular weight and height checks if stimulants are taken. You are entitled to know the names of any medicines prescribed; what symptoms they are supposed to treat; how long it will be before they take effect; how long they will have to be taken for and what their side effects (short and long-term) are.
Psychosocial treatments
Psychosocial treatments are non-medical treatments which look at the child or young person’s thinking, behaviour, relationships and environment, including their culture. The main psychosocial treatments for ADHD include behaviour management and social skills training to ensure encouragement and support for the child at home and at school. Other psychosocial treatments may include individual psychological therapy or family therapy to help young people and their families and whanau understand the condition and to make positive changes in their lives and relationships.
All types of therapy/counselling should be provided to children, adolescents and their families and whanau in a manner which is respectful of them, and with which they feel comfortable and free to ask questions. It should be consistent with and incorporate their cultural beliefs and practices.
Complementary therapies
Complementary therapies that enhance the young person’s life may be used in addition to psychosocial treatments and prescription medicines.

This article is an excerpt from www.mentalhealth.org.nz

Children with attention deficit /hyperactivity disorder (ADHD) are constantly distractible, impulsive and unusually active. They may also have other serious behavioural, emotional and learning problems which can get them into an awful lot of trouble if ADHD is not recognised and treated.
Children with ADHD often have poor self-esteem as a result of being constantly criticised by families, whanau and teachers who have not recognised their behaviour as a health problem. It is heartbreaking to hear such children refer to themselves as dumb, stupid or naughty.
Since the 1940s, ADHD has been given several names, including Minimal Brain Damage. Researchers knew that these were otherwise normal children whose brains received and processed information differently from others and resulted in the behaviour associated with ADHD.
By 1980 they agreed on the name Attention Deficit Disorder (ADD). This emphasised that attention was the major problem. A few years later the name was again changed to include hyperactivity – recognising that as an equally significant problem.
Nowadays most people talk about attention deficit hyperactivity disorder or ADHD (although you will also hear it being called ADD). This can still be confusing, because some children with extreme attention problems, may not be hyperactive. They are the more dreamy types who seem often to be away with the fairies. In a classroom these children are in danger of being overlooked because the children who have the ‘H’ in ADHD cannot fail to get noticed!
There is no absolute test for ADHD. The diagnosis needs to be made by expert doctors or specialists, such as child psychiatrists or paediatricians (doctors who specialise in child health) who have experience in treating ADHD. A medical check-up should be part of any assessment for ADHD.
There has been a huge increase in interest in ADHD recently and a lot of conflicting information being reported. It is therefore important that you get advice from your GP or specialist child and family service if you are concerned that your child may have ADHD.
Parents and teachers may be asked to fill out separate questionnaires on the child’s behaviour to see if there is overall agreement on the symptoms. Sometimes it may be suggested that the child do some psychological tests to find out if there are any specific problems with learning. There are two main errors in diagnosing ADHD: making the diagnosis too often, and missing it.

Signs of attention deficit / hyperactivity disorder

Children with ADHD have a characteristic pattern of development right from the time they are toddlers – this is one of the key indicators of the problem. Another clear sign of ADHD is that the child’s behaviour patterns are similar at home, school (or pre-school) and in all other situations. In addition, the signs of ADHD must be severe enough to cause major problems for the child in all of these places.
A child with ADHD will have several or all of the following difficulties.
• As babies they may be colicky, restless, hard to cuddle or hold
and poor sleepers.
• They may have crawled or walked earlier than other children.
• They talk a lot, interrupt others and can’t seem to wait their
turn.
• They have lots of energy and are constantly on the go. They
seem unable to sit still even if they are enjoying doing something.
• They have a short attention span and often don’t follow through
what they set out to do.
• They may tune out or appear to be daydreaming, especially
when being given instructions.
• At school they have trouble with the work and often give the
impression they have not heard the teacher’s instructions.
• They may frequently call out in class or a group and may be
known as the class clown.
• They do dangerous and impulsive things, like jumping from
heights or running out onto the road without looking out for
traffic.
• They act before they think.
• They are often easily upset.
• They get angry and ‘explode’ quite easily.
• They find it hard to make and keep friends, usually because of
their exuberance and bossiness rather than any nastiness.
These symptoms must have been present for at least the last six months, for a diagnosis of ADHD.

Children who are affected by ADHD

ADHD affects between three and five percent of school-aged children (one percent are affected quite severely). Some will have milder symptoms than others (about one in 20). ADHD is more common in boys than girls. Sometimes it is not diagnosed until the teenage years.
There is no cure for ADHD although there is a belief that many children seem to grow out of it before adolescence. Recently there has been an increasing awareness that ADHD can progress into adulthood. It is really important that children with ADHD get help early in life so that they can learn to manage their problems and develop the skills and confidence they will need to lead a successful adult life.

Myths

NOT TRUE Children with ADHD are deliberately naughty or bad children.
NOT TRUE ADHD is just youthful high spirits.
NOT TRUE Every child who displays some symptoms of ADHD has it. There may be other reasons for children having symptoms which mimic ADHD. For example, children who are anxious because they have been abused either sexually or physically, or whose parents have recently separated, maydisplay some of the above behaviour. That’s why it is extremely important for the assessment and diagnosis to be thorough and done by qualified professionals who, as much as possible, try to rule out any other causes for a child’s symptoms
NOT TRUE Children with ADHD are incapable of concentrating at all. Most children with ADHD are often able to concentrate for quite long periods of time on specific activities or hobbies – for example, watching videos they enjoy. In some, this ability to hyperfocus is extraordinary and has led some experts to comment that attention deficit might more accurately be called attention inconsistency.
NOT TRUE Everything that is wrong with the child is ADHD (e.g., all learning and behaviour problems are part of the ADHD).
NOT TRUE If you have ADHD you are not responsible for your behaviour and therefore can be excused for it (i.e., don’t have to face the consequences).

Causes of ADHD

Even though a lot of research into ADHD has gone on around the world, its exact cause is still unknown. It is likely that there are not one, but several causes, which, when they occur together, become ADHD.
Studies of computerised tomography or CT brain scans show that children with ADHD seem to have brain circuits which are wired a little differently from other people’s. This results in the brain having trouble processing the messages it receives – a little bit like a telephone exchange which gets overloaded with calls. This may happen to the infant’s brain in pregnancy, in babyhood, or it may just be an individual variation which has received more notice in the last 40 years. It does not seem to be caused just by a poor diet, yeast infections, allergies or food colourings as some people have thought, although these may be factors in the overall ADHD picture. It is also not caused by bad parenting although often a child’s behaviour will have earned plenty of negative attention in and outside of the family or whanau by the time ADHD is recognised.

Risks factors for developing ADHD

There is thought to be a genetic element to most ADHD, that is, it runs in families. Studies have shown that brothers or sisters of children with ADHD have two to three times the risk of having it as well.
ADHD often occurs with other child mental health problems. These may exist alongside or develop as a result of ADHD. For example, some children with ADHD will have Oppositional Defiant Disorder, Conduct Disorder or experience anxiety or depression. Learning difficulties which are unrecognised also present a risk for serious mental health problems, as they affect progress at school and self-esteem.
ADHD and its associated problems are serious if untreated because they can put young people at risk for accidents, drug or alcohol abuse problems, or suicide. Smoking during pregnancy and prematurity are all risk factors for ADHD.

Living with Attention Deficit / Hyperactivity Disorder

The most important thing to remember about having a child with ADHD is that, like all children, they need love, affection, nurturing and clear rules. Sometimes this is hard to remember when whole days of nagging seem to be the rule rather than the exception at home and everywhere else.
A child with ADHD may have chalked up quite a lot of frustrations and failures before his/her problem is recognised. Some parents worry about the label ADHD and wonder if they have caused it to happen, or failed their child in some way. They may feel anger that this has happened to their family or whanau, or upset that other family or whanau members have dismissed the child’s behaviour as being normal. Others will be relieved that the problem they’ve lived with over a number of years finally has a name.
For the child, knowing he/she has ADHD can be a relief. Often though, children feel there is something really wrong with them. ADHD needs to be carefully explained to them in a way that they can understand and learn to handle. Brothers, sisters and friends, too, may need an explanation that can help them to stop teasing or provoking the child with ADHD.
Some children who have to take medicine to help their symptoms say it is like admitting that something scary is wrong with them and worry that they are retarded or crazy – labels they’ve probably heard before.
In two-parent homes it is important for parents to support each other with managing their child’s behaviour. Consistency is essential. Often one parent will say that the child is “perfectly all right when he is with me.” This can be infuriating for the other parent. For single parents, having a child with ADHD is even more difficult. Have at least one supportive friend outside the family or whanau that you can confide in.
Treatment of Attention Deficit / Hyperactivity Disorder
Summary of treatment options
There is no magic pill to make ADHD disappear, and medication should not be used as a substitute for other appropriate interventions, including educational and psychosocial. It is a complicated condition generally best managed by a mixed treatment programme which may include the following components.

Medication

The main kind of medication are used in the treatment of ADHD are stimulants; antidepressants are only very occasionally prescribed. The same medications are used for both children and adults. It is important that the progress of a child on medication for ADHD is checked and the treatment reviewed regularly with regular weight and height checks if stimulants are taken. You are entitled to know the names of any medicines prescribed; what symptoms they are supposed to treat; how long it will be before they take effect; how long they will have to be taken for and what their side effects (short and long-term) are.

Psychosocial treatments

Psychosocial treatments are non-medical treatments which look at the child or young person’s thinking, behaviour, relationships and environment, including their culture. The main psychosocial treatments for ADHD include behaviour management and social skills training to ensure encouragement and support for the child at home and at school. Other psychosocial treatments may include individual psychological therapy or family therapy to help young people and their families and whanau understand the condition and to make positive changes in their lives and relationships.
All types of therapy/counselling should be provided to children, adolescents and their families and whanau in a manner which is respectful of them, and with which they feel comfortable and free to ask questions. It should be consistent with and incorporate their cultural beliefs and practices.

Complementary therapies

Complementary therapies that enhance the young person’s life may be used in addition to psychosocial treatments and prescription medicines.

Tips for paying attention

Having acknowledged that many children struggle with inattention (for many different reasons) there are a range of ways in which parents and teachers can help inattentive children stay on task long enough to learn better and accomplish the tasks they need to. Remember that it’s the boring, mundane activities that cause problems with inattention – fun, new, interesting activities don’t usually pose such a problem. The everyday routines like getting ready for school or other outings, after-school activities, homework and the usual evening activities are where problems tend to occur. Bear in mind that school is a tiring business and that inattention is likely to be worse in the late afternoon and early evening.

In this article we will match the common difficulties with strategies to assist with them. These strategies can usefully be employed with all children – not just those who struggle with inattention.

First, inattentive children have trouble holding onto a lot of information or instructions at one time. Thus, they forget a series of instructions, possibly only remembering one; they lose track of the sequence of tasks, and may skip out important parts of a routine; and they can’t hold information in mind long enough to think about it and work it out. Therefore, these strategies are helpful: Give one instruction at a time – wait until the child has completed the task before giving the next one; when there is a routine to be followed, for example, going to bed, make a “comic strip” of pictures depicting the steps in the routine – this way the child can return to the strip to check out what needs to be done, and in what order; tell the child what to do – not what NOT to do – because it may be too hard to think about an undesirable behavior and turn it into a desirable behavior, it will be easier for the child to think directly about what you want them to do.

Second, concepts of time are especially hard for children with attentional problems, and they find it difficult to judge or allow for the time available within which to complete a task. Therefore, it’s very helpful to make time “visible” for them – use timers wherever you can to keep them aware of the passing of time. Inexpensive “wind-up” timers work well because you can hear and see them winding down, and they give a buzz when the time is up. For younger children or those with more severe difficulties, you can break time into smaller chunks when a complex task is demanded. So, you may give a set amount of time for each subtask, for example, brushing teeth gets three minutes, then getting into pyjamas gets three minutes and so on. Re-set the timer after each subtask is completed. Timers are also great for Timeout – when a child is sent to timeout for a fixed period, the timer keeps them (and you) aware of the passing of time.

Third, rewards for success do not seem to be successful with children who struggle with inattention. The fact is that rewards and consequences do work with these children, but have to be implemented differently. The structures of the brain that are sensitive to positive and negative consequences do not operate as efficiently as they do in children without attentional problems. Consequently, it is harder for them to learn to associate particular behaviors with rewards or negative consequences. Children with attentional problems need rewards and consequences often, close in time to the behaviors they are intended for, and of strong significance for the child. Rewards need to be obvious and quickly available – for example, verbal praise or soft touches. Parents need to be on the lookout for positive behaviors so that they can use praise often and quickly. Praise can also be connected to a reward system that has a payoff in some material reward in the future. This helps children learn to wait for rewards by providing quick, frequent smaller rewards along the way to the bigger one.

Fourth, these children have trouble paying attention to speeches or explanations. Therefore, keep explanations to a minimum and, as has been advocated by the experts in the area – “act, don’t yak”! The more you talk, try to explain why a behavior is desirable, or “yak”, the further away the rewards or consequences will be from the target behavior. It’s not that the child doesn’t understand you, it’s that the child finds it difficult to comply because her attention wanders so easily.

Fifth, inattention also means that a child finds it difficult to remember what will happen from one experience to the next. It can be hard to generalise knowledge from one situation to another. So, for example, a child may have been difficult to control at a friends’ party with the consequence that he was removed from the party and had the party treats confiscated as a consequence. Unfortunately, there is no guarantee that this lesson will be remembered when visiting the grandparents’ house, or attending the next party. This can be particularly frustrating because it feels as though you have to go through the drama all over again when the same thing happened recently. Parents come to know what settings or places are going to be problematic, so can anticipate problems and prepare accordingly. Here is a five-step plan that helps. One, shortly before the event, review one or two rules that apply to the situation with the child (be concise!) and have the child repeat them back to you. For example, one rule for visiting other people may be that the child is not to touch the party food before permission is given by the hosts, and another may be that the child greet others appropriately. Two, set up a small immediate reward for being successful and a small immediate consequence for failure. For example, polite greetings earn public praise, and waiting for treat foods earn an extra treat. Three, as you enter the situation, begin giving praise for success before any difficulties arise. For example, comment repeatedly on the fact that the child has not taken any party food. Four, deliver rewards and consequences immediately after the target behaviors. For example, lack of greetings result in the child having to stay beside the parent (when he would rather be off playing with other children) for five minutes. Five, remember not to engage in conversations about what is happening – the child knows what the deal is, and conversations simply drag out the situation and dilute the strength of the rewards or consequences.

Sixth, keep stimulation levels down when you can as the child’s nervous system has trouble trying to screen out extra sensory information that is interfering with paying attention. Keep your voice down when giving instructions, and don’t try to compete with the TV or other noise. When you’re speaking, make sure you have the child’s full attention, with a minimum of interfering noise, light, or movement around her. Shouting can be overwhelming for these children and they won’t even get the first part of what you say if you yell. You’re far better off to whisper – this will make her lean in towards you and concentrate harder.

So, with these pointers, your child will be better able to grasp what is being asked of him, and better able to keep his attention going long enough to get things done.