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.

A growing body of research supports the powerful positive relationships between humans and their pets. There is now compelling evidence to suggest that pets help children and adults feel secure and unconditionally loved. It also seems that pets contribute to a child’s learning, and contribute to an elderly person’s ability to carry out daily activities.

The research is really interesting – for example, one study showed that the mere presence of a dog during a medical examination decreases a child’s stress level. It has also been shown that children exposed to a school-based animal humane education program showed increased empathy for each other. So it seems that positive interaction with animals, even if it is just one’s physical presence with them or an empathetic feeling toward them, seems to benefit children in many ways.

I recently read a research paper written by Professor Froma Walsh at the University of Chicago . She has found that more than 85% of pet owners regard their pets as family members, some according them full family status. One survey of families who had recently acquired a pet found that 70% reported an increase in family happiness and time spent together after the arrival of their pet. More than half of people who had a family pet said that, if they were stranded on a desert island with only one companion, they would choose to take their family pet. People report all sorts of reasons for having pets: they provide unconditional love and non-threatening physical contact. Some people become so attached to their pets that, after a stressful workday or schoolday, their enthusiastic greeting, affection, and nonjudgmental support lead many, on arriving home, to prefer the company of their pets to that of their partner or parent!

There is an increasing number of young adults who choose to raise pets before they become parents (or instead of parenting). Pets afford them the opportunity to provide nurturance, affection, limit-setting, and concern for another living being. So, pets can provide something of a “practice-run for parenthood”, or can provide the pleasure of caring and raising another being without the more burdensome aspects of parenting. It is also common to find that parents whose children have left home acquire a new pet (or pets!) to fill the emotional and activity void left by departing children.

Pets are particularly valuable for well-being in later life. There is lots of evidence to show that elderly people may remain more vital, active and happy when they care for a pet than when they do not. In one family, a daughter reported, ‘‘Mom has always been devoted to our pets, but since my dad’s death, they have become her family and her deepest attachments. She calls them her ‘tribe’ and her ‘fur folks.’’’ For elderly people with dementia, sitting and stroking a pet can be calming and soothing. This helps them to be part of family interactions and other social occasions without becoming anxious or confused.

Most families report that they value their pets most at times of crisis. Pets provide emotional support that makes it easier to cope and recover from stressful events. In the middle of a crisis, one’s usual supports may be preoccupied or distressed themselves. The bonds that people have with their pets offer comfort, affection, and a sense of security at these times. I have heard from many of the people I have seen since the earthquake that the children, particularly, have turned to their pets for comfort, with the usual rules about where the pet sleeps being relaxed somewhat!

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?

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

9-year old James says homework’s too hard. However, his teachers say that he’s very intelligent, so how can it be too hard? James picks through his food and takes longer than others. He seems “hyped up”, unable to settle down, and it’s late before he finishes his evening routines and goes to sleep. His parents worry that “he’s not achieving his potential”, “he doesn’t have many friends, or can’t maintain his friendships”, “he just doesn’t listen”, and there are arguments and temper outbursts.

James has always been a bit sensitive – hates loud noises, complains about the labels in his clothes, and is a “picky” eater. He has always found it difficult to settle to a task (unless it’s something on the computer, Playstation, or TV), been a bit distractible, and found it hard to wait for things. While he loves to play soccer and tennis, his handwriting is messy and he was a bit slow learning how to manage shoelaces. While he has very strong language skills, he finds maths hard, or battles to organise his thoughts to write stories.

This profile of strengths and difficulties is associated with a brain that is “wired” a bit differently from the usual. Children with this kind of profile may have social problems and they worry about a range of things, or worry about one particular thing. Those with strong language skills ask questions about their worries, or “talk themselves through” their activities. They have difficulties with the give and take of relationships. They can be “in your face” at times, or seem unaware of other peoples’ feelings. One of the really confusing aspects of their behavior is that it can vary from day to day – one day they can do everything they’re asked to do and the next day they can’t. Their strong oral language can lead parents and teachers to have expectations that are unrealistic. Just because a child has a highly developed vocabulary, doesn’t mean that he can write a well-structured story within a particular time-frame.

Sensory sensitivities may be most problematic during early childhood when feeding, washing hair or cutting nails becomes a battleground; inattention and distractibility may become more noticeable when a child is put into a structured teaching environment; specific learning difficulties may become more obvious in middle to late childhood as academic demands increase; motor planning and sequencing problems become more evident as children are expected to become more independent in their self-care. Anxiety may be a longstanding feature, with worry about upcoming events or changes in familiar routines. Social difficulties may appear at preschool with some boisterous or aggressive behavior, or withdrawn or solitary play.

A first step is to find out how the child’s brain works. An assessment of the child’s intellectual functioning can tease out the ways that his brain processes information, and an assessment by an occupational therapist can clarify how the child’s brain makes sense of sensory information from the eyes, ears, and skin. The psychologist helps to make sense of these assessments and gives practical recommendations making life easier for the child and his family. Parents might need to stop making assumptions about why the child is not completing homework; doing chores; having a tantrum when asked to put away their toys, or being whiney. While being oppositional may explain some of the behaviors, it’s also possible that tiredness or difficulties with remembering and carrying out directions is involved.

Unusual children can have above average intelligence, and may even be described as “gifted”. However, that does not mean to say that all of their abilities are at the same level. Difficulties with visual tracking (following a line of text across a page); problems with attention or organisation; and struggles with planning and sequencing information or activities can have a significant effect on children’s all-round behavior. Differences in abilities can result in frustration for everyone – particularly the child. Self confidence and the feeling that they are capable individuals can suffer as a result of these differences, and sometimes children become reluctant to try things out for fear of failure. Undetected, these difficulties may contribute to negative outcomes in adolescence, such as school failure, mood and anxiety problems, and poor peer relationships. If parents are puzzled by their child’s inconsistent abilities or contradictory behavior, observing what makes it harder or easier will provide clues as to how the child works in the world.

When human beings think they’re in danger, they react with either ‘fight’ or ‘flight’. These reactions are hard-wired in us, but we all respond differently. A child’s behavior when he is anxious or worried may be in the ‘fight’ mode, with disruptive, oppositional, explosive, angry, or a melt-down – trying to overcome the source of the fear by force. Another child’s behavior may be in the ‘flight’ mode, with inattentive, clingy, withdrawn, reassurance-seeking, or shyness – trying to escape the source of the fear. Unfortunately, behaviors in the ‘fight’ category can be mistaken for anger as they look similar to angry behaviors. Anxiety is often experienced as a fast heartbeat, shallow quick breathing, and discomfort in the tummy, but these sensations are also associated with being angry. It’s important to know the difference, because the way we react to a child’s anxiety is different from the way we react to a child’s anger.

While the principles of changing any behavior are fundamentally the same, parents respond quite differently to their child’s anxiety and anger. When parents perceive that their child is anxious, they become anxious themselves – there are few things that distress a parent more than thinking that their child is afraid. In this state, parents may relax their rules in an attempt to make sure they don’t make the child more afraid. This may have the undesired effect of making the child more anxious – as the parent withdraws control, the child feels less secure. In contrast, when parents perceive that their child is angry, they may be prompted to fight back – taking the child’s antisocial behavior as a personal attack or feeling intimidated. In this state, parents may retaliate with anger, trying to halt the aggression with force. But, if the child’s ‘fight’ behaviors are driven by anxiety, the parent’s forceful response is likely to increase the child’s anxiety.

How do you tell the difference between an angry outburst and an anxious outburst? Given that anger is a normal human reaction to perceived injustice or being thwarted, and anxiety is a normal human reaction to perceived threat or danger, you may get an insight into the child’s behavior by checking out the event that set off the outburst. Take the example of an 8-year old girl whose 10-year old brother won’t let her have a turn on the computer. She complains, “George won’t let me on the computer!”, and it turns out that she has hit George. She may be angry because she wants to play a game and she thinks it’s unfair or feels blocked in her desire to play, or she may be anxious because she cannot finish her homework project on the computer and worries about the consequences of not finishing. In both cases, a parent will ensure that the child has fair access to the computer, but the quality of the parent’s response is likely to be different in each case. In the case of the game-time on the computer, the parent may insist that the children themselves work out a time-sharing system, and in the case of the unfinished project, the parent may intervene to insist that the computer be preferentially available for homework. However, in both cases, there may be some consequence for hitting George, as a zero-tolerance attitude to aggression is important.